RIDDC Early Childhood4C6B6

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Miracles and Challenges: Early Childhood Development Birth To 5 Years Kathleen C. Schlenz, MS, OTR/L, BCP

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Goals of this presentation 1. Outline major developmental milestones for children birth to five in 4 areas: Gross Motor Fine Motor Cognitive Social / Emotional Skills. 2. Review “red flags” for developmental challenges 3. Discuss good parenting skills that support a child development.

First 6 Months of Life: Key Developmental Tasks : 

First 6 Months of Life: Key Developmental Tasks To learn to trust and begin establishing secure attachments to people, especially mother. To learn how to get most important needs met. To establish eye coordination, gain control of large muscles and distinguish sounds.

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Rolls over front to back and back to front Sits with support, then independently Reaches with one hand Transfers object from hand to hand Uses raking grasp 6 Months GrossMotor / Fine Motor

6 Months Cognitive: 

6 Months Cognitive Finds partially hidden object Explores with hands and mouth Struggles to get objects that are out of reach Explores and experiments with objects by looking, swatting, mouthing Begins to imitate actions and movements

6 Months Social/Emotional: 

6 Months Social/Emotional Enjoys social play Interested in mirror images Responds to expressions of emotion by others Smiles and laughs

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6 Months Good Parenting Skills Responsive, nurturing care is key to helping the child establish “basic trust.” State/arousal regulation is assisted by adequate parental responsiveness. Most parents benefit from good publications on development and the internet can be a source as well. Predictable parenting, including stimulation, is essential: talking to the child (“motherese”; mirroring), engaging in reciprocal play, providing opportunity for practice of emerging developmental skills. Safety is key: attend to all recommendations.

If by around age six months a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : 

If by around age six months a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delays: Does not respond to sound (startle or turn head in response to loud sound) or light (reflexive widening or blinking) Does not calm when held, spoken to, soothed Not rolling over or readying to sit (sitting when propped) Not making cooing noises or playing with sounds Warning Signs

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Indicators of possible developmental delays (six months): Does not recognize or prefer familiar individuals (caregivers) over strangers Not exploring hands, feet, objects, especially with mouth Not reaching for or swatting at hanging objects Not beginning to grasp objects placed in or near hand Feeding / weight gain difficulties Seems very tight in trunk, arms, or legs (straight or stiff) or has a rag doll-like appearance (floppy) Warning Signs (continued)

1 Year-old: Key Developmental Tasks : 

1 Year-old: Key Developmental Tasks To continue learning to trust parents and other caregivers. To feel secure in the world. To move the body independently. To learn ways other than crying to get adults to meet needs. To adjust to short periods away from caregiver. To develop eye/hand coordination.

1 Year Gross Motor Skills: 

Crawls forward on belly Assumes seated position unaided Gets up on all fours Creeps on hands and knees Transitions into several positions: sitting, all-fours, prone (on stomach) Pulls self to stand Walks holding on to furniture (cruises) Stands momentarily without support May walk two or three steps without support 1 Year Gross Motor Skills

1 Year Fine Motor Skills: 

Bangs two cubes together Puts objects into container Takes objects out of container Lets objects go voluntarily Pokes with index finger Tries to imitate scribbling Uses pincer grasp 1 Year Fine Motor Skills

1 Year Cognitive: 

Experiments with objects in more complicated ways (shaking, banging, throwing, dropping) Finds hidden objects easily Looks for object or person when mentioned or named Imitates gestures (wave bye) Uses objects by function (puts cup to mouth, brushes hair, puts phone to ear) 1 Year Cognitive

1 Year Social/Emotional: 

Shy or anxious with strangers Cries when parent leaves Enjoys imitating people in play Shows preference for certain people and toys Tests parental responses to behavior Fearful of novelty, loud noises Prefers parent and/or regular caregiver over others Repeats sounds or gestures for attention Extends arm or leg to help when being dressed Finger-feeds self 1 Year Social/Emotional

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1 Year Good Parenting Attend to safety, especially in the early months of crawling, walking and climbing. Model language and provide loads of stimulation. Use affect (emotion) words to label the child’s state/arousal. Use/teach distraction to cope with being upset. Provide clear behavioral limits with concise explanations. Promote good sleep habits. Establish good nutrition early; now is a good time to introduce balance, moderation and pacing. Allow and encourage practice of new skills (e.g., motor and language) and reward them.

If by around age one year a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : 

If by around age one year a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delays: Not smiling, laughing Does not imitate sounds/words Not using jargon (baby talk: tone of voice like adult speech but may have few real words) Not gesturing (e.g, pointing) with intent to communicate Not establishing eye gaze with loved ones Warning Signs

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Indicators of possible developmental delay (one year): Not responding to simple questions/commands (no! up?) Not sitting alone, creeping, readying to walk (walking may take place anywhere from 9-14 months) Does not respond to name being called Seems detached or apathetic, very difficult to console Does not protest when trusted caregiver leaves and/or not bothered by presence of strangers Little interest in new toys, unfamiliar or unusual objects Not finger feeding or difficulty with table foods Despite praise, does not repeat actions that please caregivers e.g., clap hands Warning Signs (continued)

Key Developmental Tasks for Toddlers: 

Key Developmental Tasks for Toddlers To become a distinct person with a positive emerging self image. To explore an ever-widening world by improving the ability to talk, walk, use fine motor skills and coordination. To demonstrate increased memory for objects and events. To develop the beginnings of self control.

Two Years Gross Motor Skills: 

Walks smoothly, turning corners Begins to run Stands on tiptoes Kicks a ball Pulls toys while walking Carries large toy or several toys while walking Climbs onto and down from furniture unassisted Walks up and down stairs with support (hand rail) Two Years Gross Motor Skills

Two Years Fine Motor Skills: 

Turns over containers to pour out contents Builds tower of four blocks or more Might use one hand more frequently than the other Scribbles spontaneously Two Years Fine Motor Skills

Two YearsCognitive: 

Finds hidden objects Begins to sort by shape, color Begins multi-step make-believe play (cooking, feeding baby) Groups objects by function Varies imitation from model Begins to think before acting Completes simple inset puzzles Two Years Cognitive

Two Years Social/Emotional: 

Imitates behavior, especially of adults and older children Increasingly aware of self as separate from others Enthused by company of other children Demonstrates increasing independence Begins to show defiant behavior (no!) Episodes of separation anxiety wax and wane, overall diminishing Two Years Social/Emotional

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Two Years Good Parenting Play! Remember (learn) how to pretend and encourage it. Gentle, firm, predictable limits are essential, particularly around safety. Promote affective regulation by soothing, using language of affect. Model and teach appropriate behaviors. Expect testing of limits -- use “if-then” reasoning and apply this to your response. Establish/maintain household routines (bathing, bedtime, meals). Talk about them. Extend learning with books, stimulating toys, community encounters (park, library, walks, water/sand play). Expect irregularities of mood and appetite; respond accordingly.

If by around age two years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : 

If by around age two years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delay: Not putting 2-3 words together in meaningful, spontaneous sentences (not just repeating others) Not pointing to objects or persons named Frustrated when others cannot understand the child’s attempts to communicate Not making eye contact with others; seems uninterested in others Doesn’t respond when name is called Warning Signs

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Indicators of possible developmental delay (age two): Not engaging socially, i.e., shifting gaze back and forth between an adult and a toy while talking about the top Not sorting objects or using them by function Seems withdrawn, uninterested, “in his own world” Difficulty manipulating objects such as large puzzle pieces, tower of blocks Not walking smoothly and rounding corners with ease Seems aggressive, difficult, often frustrated, angry, rageful, fearful Sleep disturbances or night terrors (should sleep through the night) Warning Signs (continued)

Key Developmental Tasks in the preschool years: 

Key Developmental Tasks in the preschool years Preschoolers Are learning, learning, learning… to control bodily functions, feelings, and behavior...to speak more clearly... about safety...about where to go for comfort...and about how to play with others. Have established a sense of self as an individual with skills, likes and dislikes. Can separate thinking from feeling by making conscious choices, accepting limits and finding solutions to simple problems. Can usually distinguish fantasy from reality. Are comfortable with body parts and gender identity.

Three Years Fine Motor Skills: 

Three Years Fine Motor Skills Makes vertical, horizontal, and circular strokes with pencil/crayon Turns book pages one at a time Builds a tower of more than six blocks Holds a pencil in writing position Screws and unscrews jar lids, nuts and bolts Turns rotating handles

Three Years Cognitive: 

Three Years Cognitive Makes mechanical toys work Matches an object in his hand or room to a picture in a book Plays make-believe with dolls, animals, and people Sorts objects by shape and color Matches like objects Completes puzzles with three or four pieces Understands concept “two”

Three Years Social/Emotional: 

Three Years Social/Emotional Imitates adults and playmates Spontaneously shows affection for familiar playmate Can take turns in games Understands concepts mine, yours and his/hers Expresses affection openly Expresses a wide range of emotions Separates easily from parents Objects to major changes in routine

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Three Years Good Parenting Step up expectations for behavior and accommodation to routine. Praise and value independence. Promote pro-social behavior by close monitoring of encounters with other children. Examine cultural-familial rules for affect, behavior. Understand your values and articulate them. Begin using “consequential” (if-then) discipline: withhold privilege for misbehavior. Keep intervention brief & concise. Extend learning by reading, watching TV together, puzzles, outdoor play, computer. Teach good coping skills by labeling frustration and encouraging perseverance.

If by around age three years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : 

If by around age three years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delay: Not speaking in full, fairly elaborate sentences Not pronouncing consonant sounds (b, t, d, g) or blending sounds well (tr, cl); deleting parts of words Stranger cannot understand child’s speech in context (the listener knows the topic) Does not understands and use pronouns (ours, yours, mine) articles (a, an, the), prepositions (over, under) readily Warning Signs

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Indicators of possible developmental delay (age three): Play does not include fantasy, roles, scripts Does not walk, climb, run, jump well Cannot pedal a bike or tricycle (with practice) Not matching/sorting by two attributes (size, color) Odd pencil/crayon grasp or cannot draw simple figures Not expressing or regulating emotion well (overly angry, sad, aggressive) Apathetic, disinterested, or destructive Overly preoccupied with certain topics, ideas, or age-inappropriate material Warning Signs

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Hops and stands on one foot up to 5 seconds Goes up and down stairs without support Kicks ball forward and throws it overhand Catches bounced ball Moves forward and backward with agility Four Years Gross Motor Skills

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Copies squares and other shapes Draws a person with two to four body parts Uses scissors Begins to copy capital letters Four Years Fine Motor Skills

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Correctly names colors Counts and may know numbers Says first and last name Approaches problems from a single point of view Develops a clearer sense of time Follows three-part commands Recalls parts of a story Understands same/different Engages in fantasy play with roles and scripts Four Years Cognitive

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Interested in new experiences Cooperates with other children Role plays (mom, dad, teacher) Increasingly inventive in fantasy and role play Dresses and undresses Negotiates solutions to conflicts More independent Imagines that unfamiliar images are monsters Views self as a whole person involving body, mind, and feelings Difficulty distinguishing fantasy and reality at times Four Years Social/Emotional

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Four Years Good Parenting Encourage the inquisitive mind of the three-year-old: read, travel, visit museums, etc. Teach preschool skills in a fun, appealing way. Have explicit behavioral expectations (In our family, we talk about mad feelings…) and enforce them reasonably. Set up clear responsibilities and consequences for meeting them. Keep behavioral expectations in line with development. Expect less when your child is upset, but push for more. Promote healthy sleep and eating habits. Teach empathy. Respond to fears with understanding, but don’t encourage avoidant behavior.

If by around age four years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : 

If by around age four years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delay: Does not say first and last name Speech is not understandable to strangers (should be mostly comprehensible even out of context) Not engaging in elaborate fantasy play with multiple characters and changing roles Not telling stories, either original or repeated (fairy tale, video tape) Not counting, learning alphabet, or identifying colors with exposure or instruction Warning Signs

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Indicators of possible developmental delay (age four): Not dressing self; Not potty trained for day time Play does not include fantasy, roles, scripts Not matching/sorting by two attributes (size, color) Odd pencil/crayon grasp or cannot draw simple figures Not drawing basic shapes or form recognizable as a human figure Not expressing or regulating emotion well (overly angry, sad, aggressive) Apathetic, disinterested, or destructive Overly preoccupied with certain topics, ideas, or age-inappropriate material Warning Signs (continued)

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Indicators of possible developmental delays (age four): Does not walk, climb, run, jump well Cannot pedal a bike or tricycle (with practice) Movement is awkward, extremely clumsy, many falls; cannot negotiate climbing toys Not yet kicking and throwing ball with practice Extremely upset by changes in routine Seems very fearful, angry, preoccupied Aggressive, rageful or vengeful Engages in repetitive or unusual behaviors Does not seek approval, affection, contact Warning Signs (continued)

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Stands on one foot for ten seconds or longer Hops, somersaults Swings, climbs Learning to skip Five Years Gross Motor Skills

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Copies triangles and other geometric shapes Draws person with body Prints some letters, name Dresses and undresses self Uses fork, spoon, and (sometimes) a table knife Toilets independently Five Years Fine Motor Skills

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Counts ten or more objects Correctly names most colors Better understands time Sequences well (understands cause and effect) Knows about things used in the home/community (money, food, vehicles, appliances) May have rigid, all-or-nothing view of things Five Years Cognitive

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Wants to please friends Wants to be like peers More likely to agree to rules Likes to sing, dance, and act Shows more independence; may visit a neighbor by self Aware of gender Able to distinguish reality from fantasy Sometimes demanding, sometimes eager Five Years Social/Emotional

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Five Years Good Parenting Expect the five-year-old to test limits and explore: provide guidelines for safety. Prepare for kindergarten. Involve the child in decisions that impact her; allow choices appropriate to capacity. Help the child understand complicated emotions (guilt, embarrassment, ambivalence). Help the child understand his reaction to upsetting situations. Distinguish thoughts, feelings, behaviors. Parental coaching about emotion is correlated with children’s social competence by age 5. Girls are particularly vulnerable to “guidance.”

If by around age five years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. : 

If by around age five years a child exhibits one or some of these signs, a developmental delay may or may not exist. These signs warrant further assessment by a professional. Indicators of possible developmental delay: Exposed to but not acquiring basic preschool skills (colors, counting, recognizing letters, writing letters) Not aware or able to maintain basic safety rules (danger of stove, traffic, etc.) Not making friends despite exposure to other children; disliked or feared by peers Having difficulty expressing self (stuttering, hard to understand, can’t find the right word) Warning Signs

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Indicators of possible developmental delay (age 5): Not telling stories with clear beginning, middle, end Not using full sentences, asking/answering all wh questions (who, what, when, where, how, why) Does not give full name, address, town when asked (assumes an adult has attempted to teach this) Not competently feeding self with utensils Unable to toilet independently and without reminders, both day and night Not able to hop, somersault, stand on one foot, run, climb, and jump ably Extreme moodiness, anger, sadness Destructive, preoccupied or obsessed with certain ideas or actions Warning Signs

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Miracles and Challenges: Supporting Early Childhood Development Thank you to Anne Farrell, PhD and the Westchester Institute for Human Development, New York for their contribution to this training.