B4 School Check Waikato Hospital 2019 222 Pembroke Street Private - PowerPoint PPT Presentation

Child Development Child Development Centre B4 School Check Waikato Hospital 2019 222 Pembroke Street Private Bag 3200 Hamilton 3240 07 839 8726 www.waikatodhb.govt.nz/cdc

What is child development? • Predictable, pre-programmed pattern of sequential skill acquisition in a cephalocaudal (top to bottom) progression. • Reflects the growth and development of the brain and central nervous system. • Brain development starts in 4 th week of gestation and continues into the third decade of life. • A milestone is the acquisition of a key performance skill.

What is normal development? • A predictable pattern of milestones acquired one after the other. • Commonly divided into 4 domains: • Gross motor • Fine motor (and vision) • Language (and hearing) • Social, emotional and behavioural

What is normal development? • The normal age at which milestones are achieved can vary widely. • The median age is when 50% of children have acquired the skill. • The limit age is when 98% of children have acquired the skill (2 standard deviations).

What is normal development? – As milestones become more complex, multiple domains may be involved (eg. feeding self – fine motor, gross motor, behavioural) – There are a few normal variations of development • Bottom-shuffling to walking without crawling (often familial) • Initial language delay in bilingual children

What is abnormal development? – Developmental delay • Milestones achieved slower than the standard population (eg. intellectual disability). – Disordered development • Abnormal pattern of milestone acquisition (eg. Autism) – Developmental regression • Loss of developmental milestones (eg. Rett syndrome)

• Development can be affected by genetic and environmental factors. • Positive social experiences in early childhood support brain development, particularly language and social skills.

Abnormal development How common are developmental problems? – Global developmental delay affects 1-3% of children (up to 33,000 NZ children) • Autism 1% (>11,000 NZ children) • Mild learning disability 1-2% (up to 22,000 NZ children) • Severe learning disability 0.3-0.5% (up to 3,300 NZ children) • Specific learning disability in a single domain 5-10% (up to 112,000 NZ children)

Normal Development in 4 year olds • Gross motor – Can stand on one foot. – Can walk up and down stairs without holding a rail. – Can throw and kick a ball.

Normal Development in 4 year olds • Fine motor (and vision) – Can draw a circle. – Can build a tower of 10 blocks. – Can use scissors.

Normal Development in 4 year olds • Language (and hearing) – Can be understood by an unfamiliar adult. – Uses 5-6 word sentences. – Can describe something that has happened to them.

Normal Development in 4 year olds • Social, emotional and behavioural – Can dress and undress themselves with simple clothes (not buttons or zips). – Can say their first and last name. – Know if they are a boy or girl. – Can name some colours. – Can cooperate with other children in a simple game.

PEDS • Parents Evaluation of Developmental Status – 10 questions that draw out parent concerns. – Screening tool used to identify and address behavioural problems in 0-8 year olds. • Screening tools are not diagnostic. They screen populations to determine which individuals require further investigation. – The language is important. Please don’t deviate from the language on the form unless using a translator.

• Advice to support child development

• Advice to support child development • Ways to PLAY? – Use your senses: touch, listen and look at objects (e.g. sand, leaves and toys) – Move about: help your child move, push and pull objects – Out and about: go to libraries, talk about books; visit parks – climb, throw and kick balls, ride a bike – Talk and problem solve, e.g. with puzzles – Use imagination: play out simple ideas and gradually introduce different scenarios or roles; play with dolls/teddies/figurines; creatively use boxes or containers as play objects (e.g. as a car) – Explore: use a variety of things for your child to explore and play with e.g. bubbles, pots and pans, play doh. Your cupboards are full of exciting things!

What to do next? • Why refer? – Early identification and intervention improve the outcomes for children with developmental disability. • Preschool interventions are highly cost-effective. – Provides parents and caregivers with reliable information. – Early diagnosis of a genetic diagnosis may impact on family planning.

• When to refer – Any concerns about loss of skills (regression) – Unusual pattern of skill acquisition (disordered development) – Concerns flagged on screening tool (PEDS)

• When to refer – Red Flags for 4 year olds: • Unwilling or unable to play cooperatively with other children. • Speech difficult to understand. • Not able to follow two-step directions. • Not able to draw a circle or line. • Not toilet-trained by day – Affected by current cultural norm of child-led toilet training and nappies that keep children very dry. At school teachers can help with toileting, but this is resource intensive. If parents have not started toilet training at 4 years old, please encourage them to do so for school readiness. • Not able to run, jump or use stairs confidently • Not able to catch or kick a ball.

Child Development Centre (CDC) is: • Child centred and family focused CDC Team includes: disability service for children and • Paediatricians young people 0-15 years. • Psychologists • Provides services for child and youth • Occupational Therapists population of Waikato DHB • Physiotherapists • Works in outpatient clinics, home • Speech Language Therapists and community settings • Administration staff • Provides a variety of multidisciplinary • Social Workers • assessment services and Visiting Neurodevelopmental Therapists (OTs / PTs) • interventions ASD Co-ordinator • Provides ongoing service initiatives to meet needs of the population

• What happens when you refer – Referral is triaged – Initial assessment in preschool pathway with a child psychologist and an occupational therapist, speech language therapist or social worker. – May then be discharged if no concerns, or referred on for Autism Diagnostic Observation Scheduele (ADOS – diagnostic assessment for autism), Intellectual Disability Assessment or Individualised Developmental Assessment. – These assessments may include kindergarten observation visits.

Questions? With thanks to: • Dr Sadani • Waikato DHB • HealthLink British Colombia, • Queensland Health Child and Youth Community Health Service • NZ Ministry of Health