L17 Psychological Medicine Infancy - First 1000 days

Content:

Module Objectives

• Understand that development occurs within systems, reflects contemporary and historical influences
• understand that development occurs across multiple connected domatins
• identify normal patterns of development and be able to spot any red flags in development across all domains
• consider what questions to ask, or things to observe if you do identify a developmental delay

Objectives:

• understanding normal development is key to identifying abnormal development
• so that you can identify common mental and developmental childhood disorders
• understand developmental level so as to communicate with child/adolescent and caregiver appropriately
• understand psychosocial needs of children and adolescents
• spot when these needs are not being met and consider what is needed

Take home/Things to note:
serve and return system

Key messages

Development occurs within systems

• the prescence of absence of opportunities and resources can faciliate or undermine healthy development
  Rapid development in the first 2 years of life lays the foundation for subsequent learning, relationships, behaviour, health, mental health
  Parents and caregivers are critical resources for young children
• Patterns of interactions shape behaviour and development

Reminder

The developmental checklist are in the context of being achieved within the first 1000 days unless specificed

Resources:

Zubler, J.M., Wiggins, L.D., Macias,
M.M., et al. (2022). Evidence-
Informed Milestones for
Developmental Surveillance Tools.
Pediatrics. 149(3):e2021052138

Objectives, refined

• Understand typical development
• understand developmental level as to communicate with child and caregiver appropriately
• understand the psychosocial needs of children

be able to identify common mental/developmental childhood disorders and when psychosocial needs arent met

Typical development

Ingredients for healthy development
basic needs met
emotional regulation - kdey skill to devleop
cognitive stimulation - need to be stimulated for good development
stable positive relationshio - needs to have a strong foundation for loving and growth

• serve and return- if a child makes any attempt at communication it should be returned and reciprocated

Developmental systems (Development occurs within systems)

• consider the context the child is in
• what systems is the child within and what interactions occur in these systems
  • what are the resources available to the child
    Consider the holistic models of health to understand potential challanges to development
    Potential questions to understand developmental systems
• who is in the family
• what is ithe dynamics like
• resources
• beliefs
• support networks
• peers
• neighbours
• school
• culture

Case for example

Therese (2 yrs)
Cognitions

• T feels unlovable abandoned
• P feels anxiety about Ts future and failure as parents
  Developmental expectations
• Emotional regulation skills
• language
• sharing
• independance
  Problems
• noncompliant
• aggressive
• tantrums
  Behavioural processes
• modeling from parents
• R- avoids tasks
• R+ parental attention
  Context (systems factors)
• new baby
• mother PND
• pather extra shifts
• parental upbringing
• culture
• parental disagreement

Case
therese presents with:
noncompliant behaviour
aggressive
tantrums
culture: children are to be seen not heard
parental disagreement with how therese should be raised
parental disagreement on development expectations
parental d

T wants to become more independent which is interpreted as noncompliance
T feels unloved with new child and parent being distant and parents stressing out bc of her behavioural change

Maybe T is seeing when you dont get your way you fight.
if T doesnt do what she wants mum comes and is annoyed at her which mean parental attention

Overall might not be a developmental problem just home difficulties but you need to consider the systems to tell

Developmental tasks

Rapid development occurs in the first 2 years that lays the foundation for successful long term development

Implication: assess broadly across multiple domains of development but understand domains are not independant
Ask yourself: what would i expect to see in place across different domains of development and what would i expect to see emerging, to check for next time. If there is incongruency what may account for that.

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Developmental task:
A developmental task is a taak which arises at or about a certain period in the life of the individual, successful achievement of which leads to his happiness and to success with later tasks. while failure lead to unhappiness in the individual, disapproval by the society, and difficulty with later tasks.

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%%{init: {"flowchart": {"htmlLabels": false}} }%%
flowchart LR
	id1[Determinants: Physical, psychological, social, and cultural demands]
	id2[Successful mastering of developmental tasks]
	id3[Consequences: personal individuation and social integration]
	id1-->id2-->id3

Age period	Task
Infancy to preschool	Social: Secure relationship with caregivers Cognitive/social: Language Cognitive: Differentiation of self from enviroment (red dot on nose in front of mirror) Social/emotion: Self control and compliance

INFO

The multiple domains of development end up effecting one another.
These are: emotional, behavioural, cognitive, social, and physical

Physical

Theme: independent motor control and locomotion

Age	Birth	3 months	6 Months	9 Months	12 Months	18 months	24 months	36 months
Motor Skills	Survival reflexes/crawling motion when on back	head control, lifting head up, push	Sit briefly unaided, rolls from back to tummy, transfer block between 2 hands	Standing up. walk holding furniture/fingers. crawl, pick up button with thumb and forefinger	Walk unaided, make mark with crayon	Climb stairs, throw ball in box, build tower with three cubes	run, walk backwards, place square peg in square hole, build tower six blocks.	Dress seld, toilet training underway (day vs night), ride a balance bike

Cognitive

Theme: making sense of the world and the things in it

• Cause and effect
  if i push this cup over then it will fall and an adult will come put it back
• Active explorlation/discovery/environment
  exploring and curiosity
• Object permanence
  if i cant see it it can still exist
• Mental representations
  words and symbols have meaning associated with them. eg “what does the cow saw, “moo""
• Goals directed behaviour
  intentionally starting to manipulate items
• Use of tools
  see above
• Imitation
  imitate someone or something and see what happens
• Memory
  allows higher levels of learning and social connections

Social: Language Development

This is accelerated by language stimulation. the more you talk to your child the faster they develop

3 months	6 months	12 months	18 months	2 years	3 years	4 years	5 years
Cooing and gurgling	Babbling	First words	Knows 5 to 40 words	150-300 words, 2-3 word sentences	900-1000, asks short questions	2000 words, 5+ word sentences	Identifies letters, creates longer sentences

Social: relationshops and interactions

• attachment/relationship development
• social smiling
• crying
• laughing
• social referencing
• self awareness

Caregiver relationship attachment

• Bond between child and primary caregiver
• the relationship allows infant to:
  • seek proximity to the attachment figure
  • provides soothing when distressed
  • develop an interal working model of a secure base
• Caregiver becomes a safe haven from which child can explore the world
  Learning to converse: serve and return (example video in the lecture)

Social and emotional milestones

Theme: learning to understand, predict, and influence interaction with others

2 mths	4 mths	6 mths	9 mths	12 mths	18 mths	24 mths
Begins to smile, Can briefly calm self, directs gaze towards caregivers	smiles spontenously at people	knows those who are familiar, likes to interact in play with others, looks at self in the mirror	may be afraid of strangers, has favourite toys	nervous with strangers, cries when caregiver leaves, cooperate with dressing, brings a book to be read, repeats sounds	afraid of strangers, affection for familiar people, simple pretend play	copies others especially those who are familiar excited with other children, parallel play, increasing independance

Behavioural milestones

• activation of skill in other domains
• talking and gesturing
• initating and responding to social interactions
• exploring the environment
• pretend play
• grasping objects
• independant movement
• expressing emotion
• follow simple instructions

Take 1:

understanding normal development is key to identifying abnormal development

so that you can identify common mental and developmental childhood disorders

understand developmental level so as to communicate with child/adolescent and caregiver appropriately

understand psychosocial needs of children and adolescents

spot when these needs are not being met and consider what is needed

children need
basic needs met
emotion regulation
cognitive stimulation
stable positive relationships

• serve and return
  • all communication needs to be responded and reacted to
    development occurs within systems

features of systems children are developing within
family
support networks
peers
neighborhoods
school
culture

rapid development occurs in the first 2 years the lays the foundation for successful long-term development

implication
assess broadly across multiple domains of development
domains are not independant

asl yourself: what would i expect to see in place across different somains and what would i ecpact to see emergind to check next time

developmental task
a task which is representative of normal development and opens up new views tasks and development

developmental tasks
infancy to preschool
i affect the world around me

secure relationship with caregivers
language
differentiation of self from environment
self control and compliance

multiple domains of development
they all are separate and yet inteconnected
physical
emotional
behavioural
cognitive
social

cognitive development
cause and effect
active exploration discovery of objevts enviroment
object permenacne
mental representation
goal directed behaviour
use of tools
imitation
memory