Development problems in pre school and school going children.

1. Developmental problems in
Pre School and School going
children
Dr. Ujjwal Dev

2. The Child is the Father of the man. . .
William Wordsworth

3. Periods Of Growth
PRENATAL PERIOD
 Ovum - 0 to 14 days
 Embryo – 14 to 9 weeks
 Fetus – 9 Weeks to Birth
POSTNATAL PERIOD
 New Born - First 4 Weeks Of
life
 Infancy – First Year
 Toddler – 1 to 3 years
 Pre School – 3 to 6 years
 School Age- 6 to 12 years
 Adolescent – 10 to 19 years

4. Theories of Develpment
 Mainly Five theories
1.Development of Maturation – as the body grows
behavior grows. . .
2.Learning theory – rewards and punishment shape the
chapter and personality. .
3.Resolution of Conflict – primary mechanism of
change is the resolution of personal conflict. .
4.Cognitive Theory – Assimilation and Accomodation
5. Cultural Theory – variation of child’s mind from one
culture to another. .

5. Behavioral Development
In the Postnatal life the newborn infants
reclines in a helpless manner with disorganised
manner.
With age he/she acquires better coordination of
motor activity and reacts to his/her
environment into a fully integrated individual.

6. Denever Development Screening Test
Asses the child’s development in four separate
segments..
 1 – Gross Motor i.e control of child over his body
 2 – Fine Motor i.e coordination of eyes, hand –eye ,
hand – mouth coordination
 3 – Language i.e hearing, understanding sounds and
speech
 4- Personal Social i.e social smile, recognition of
mother

7. Personal Social Milestones
 2 months - Social Smile
 3 months – Recognizes mother
 6 months – Smiles at mirror images
 9 months – waves bye bye
 12 months – plays simple game
 36 months- recognises gender

8. Developmental Problems in young
child
 Head Banging – occurs in 5- 20 % of Children during infancy
and Toddler. Can cause abrasions and contusions at the site.
Mgmnt- ignore the behavior as attention in form of concern can
reinforce it. . .
 Thumb Sucking and Nail biting – can be associated with
number of sequalae if persist beyond 4 to 6 years.
- Dental Problems such as decrease alveolar bone growth,
mucosal trauma, altered facial bone growth
- digital deformity etc.
Mgmnt- indicated in children older than 4 years of age.
- Managing stress if any (praise and Reward)
- Application of aversive taste substance to thumbnails.
- Physical barriers like gloves. . .

9.  Temper Tantrum – starts at the age of 18 mnths to 3 years.
- showing frustration and defiance with physical aggression
such as biting,crying,throwing objects,hitting and head
banging.. .
Mg – Deviating attention from immediate cause and changing
the environment can reduce tantrum. . .
- Parents/Teachers should be calm,loving and consistent and
not allow the child to take advantage for gaining things. . .
- Ignoring is effective way to avoid reinforcing of tantrums. . .

10. Enrolling in a Preschool
- an opportunity for socialization and confidence
building ,not academic preparation. .
- Creative abilities should be fostered in contrast
to rote learning. . .
-

11. Pre school Age Problems
 Stuttering – defect in speech characterized by hesitation or
stumbling and spasmodic repetition of some syllables with
pauses. .
- usually begins between the ages of 2 and 5 years ,a period in
which there is non-fluency of speech.
- occurs in children who cannot cope with the environmental
and emotional stresses. . .
- Parents and playmates who remind the child of his stumbling
speech or ridicule him aggravates his emotional stress. .
Mgmnt- reassurance to the parents of child between 2 to 5 years
that stuttering during this phase would go off with time. .
- Older children should be given emotional support and
referred to speech therapist.

12. PICA
 Child develops habit of eating non-edible substances
such as wall plaster,clay,paint and earth etc.
 Tasting or mouthing of strange objects is normal up to
age of 2 years but persistence of this habit beyond 2
years may be due to parental neglect, poor
supervision or lack of affection. . .
 Children often prone to lead poisoning,abdominal
pain and pallor. .
Mgnmnt –No any specific treatment

13. Behavior in Middle Childhood
 Time of earnest searching, goal directed
exploration and problem solving and of
increasingly sophisticated decision making.
 Period of preparation and reharsal.
 Leads to critical moment called “readiness for
adolescense. ”

14. Developmental Achievements
Sustain self-esteem – influenced by feedbacks from peers, respected adults
or a record of success or mastery.
- when there are no areas of intact self-esteem, middle childhood becomes a
time of growing emotional vulnerability.
Social Acceptance – time for admission into one’s peer group.
Modeling and Indetifiaction – helpful one and its normal.
- extracting attributes from some movie personality or sport sensation. . .
Skill Acquisation – School is the principal arena for this effort, however,
children also learn from one another, from their parents and from a wide
range from exposures.

15. Failure- School aged child is armed with very little tolerance
for failure
- giving up seems better than facing humiliation and having
tried and failed.
Fears – important mission during school years is to deal with
fears.
Typical targets are fear of death, concerns about ghosts and
monsters etc.
Children may do so by intelligence and knowledge. One
mechanism is through play, they sense that they become fear
free by acting fearless. . .

16.  Learning how to obtain satisfaction -important
mission for school aged children.
- Includes compromising with others when
there is conflict over desires, sharing, settling
for fulfillment in less than anticipating
dosages.

17. Impact of Television
 May represent mixed blessings for developing
children.
- Children watch much of their television alone
and 80% of their viewing is developmentally
inappropriate adult fare.
- Numerous studies have shown that there is
increase in aggression in children immediately
after viewing violent content.

18. Poor school achievers
 About 10% of children in early school years
perform poorly and have difficulty in learning
academic skills.
These children are not always mentally retarded
and may show a near normal intelligence and
potential for development.

19. Causes of poor school Achievers
 May be suffering from chronic illness and has to be absent
from school for prolonged period.
 Too frequent relocation of parents due to transfers in service.
 Children with undetected error of refractions or mild deafness.
 Lack adequate environment stimulation in the family for
school work.
 Incompetent and harsh teachers make learning a boring and
unpleasant experience.
 Developmental dysfunction due to learning disabilities and
attention deficits.

20. Learning disabilities
 Suspected when there is unexpected
underachievement in adequate educational
settings.
 It is defined as a disorder in one or more of the
basic psychological processes involved in
understanding or in using language, spoken or
written, which may manifest itself in an
imperfect ability to listen, speak, read, write,
spell or do mathematical calculations.

21.  Causes –
 Increase risk include first degree relatives,
PEM (Protein Energy Malnutrition) , Lead
exposure etc.

22. Dyslexia
a variable often familial learning disability
involving difficulties in acquiring and
processing language that is typically
manifested by a lack of proficiency in reading,
spelling, and writing.
- About 23 – 65 % of children with dyslexia
have a parent reported to have the above
disorder.

23. Signs & Symptoms
 Delayed language, trouble rhyming words,
mispronunciations, hesitations and word finding
difficulties.
 Phonologic awareness is poor
 Difficulty learning the letters of alphabet and the
names of numbers as well as association of sounds
with letters.
 Reading is slow, inaccurate and labored.
 Spellings are also poor with presence of letter
reversal.

24. Management
 Special reading programs need to be designed
including use of computers.
 Often useful are provision of computers with
spelling checkers, tape recorders and recorded
books.
 Orally administered exams compared to
written.

25. Attention Deficit Hyperactivity
Disorder
 One of the most common psychiatric problem
in school age population see in 3 to 10% of
school children.
 Characterized by an age inappropriate
hyperactivity, impulsiveness and inattention.
 Aetiology – Many factors such as minimal
brain damage, genetics and early
developmental psychodynamic factors have
been incriminated.

26. Diagnosis
 Based on clinical symptoms.
 DSM 4 edition of American Psychiatric
Association consists of at least 6 symptoms of
either inattention or hyperactivity and
impulsivity and onset before 7 years of age,
behavior present for at least 6 months, causing
significant disturbances in learning and
adaptibility and impairment in academic and
behavior pattern.

27. Inattention
1. Often fails to give close attention to details or makes
careless mistakes in schoolwork or other activities.
2. Often has difficulty in sustaining attention in tasks or play
activities.
3. Often doesn’t seem to listen when spoken directly.
4. Often doesn’t follow through on instructions and fails to
finish shool work, duties etc.
5. Often has difficulty in organising tasks and activities.
6. Often avoids or dislikes tasks that require mental effort.

28. 7. Often loses things necessary for tasks or
activities.
8. Is often easily distracted by extraneous
stimuli.
9. Is often forgetful in daily activities.

29. Hyperactivity and Impulsivity
1. Often fidgets with hands or squirms in seat.
2. Often leaves seat in classroom or in other situations
in which remaining seated is expected.
3. Often runs or climbs excessively in situations in
which it is inapproriate.
4. Often has difficulty in playing or engaging in
leisure activities.
5. Is often “on the go” mode.
6. Often talks excessively.
7. Impulsivity

30. 8. Often blurts out answers before questions have
been completed.
9. Often has difficulties awaiting turns.
10.Often interrupts or intrudes others.

31. Treatment
 1. Behavior Therapy
- Head on confrontation should be avoided by
parents/Teachers and should remain calm as
much as they can.
- Simple instructions should be given with only
one thing to do at a time.
- Rewarding for following routines.
- Study periods should be brief with constant
feedback.

32. 2. Drug Therapy
- Stimulant Medication such as Dexaphetamine,
Methylphenidate.
- Tricyclic AntiDepressants such as Fluoxentine
etc.

33. Thank You…