From Birth to Five Years: Practical Developmental Examination

Ajay Sharma, Helen Cockerill

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781135049508
• Edition: 1
• Topic: Medicine
• Subtopic: Pediatric Medicine

From Birth to Five Years: Practical Developmental Examination is a step-by-step 'how to' guide to the developmental examination of pre-school children. This book has been developed alongside the original From Birth to Five Years as a companion volume that expands on the normative developmental stages outlined in Mary Sheridan's pioneering work in the field, by offering practical guidance for health, education and social care professionals, or anyone concerned with putting the theory behind children's developmental progress into practice in a real-life setting.

This book is based on up-to-date research into current child development philosophies and practices, and aims to support the wider group of professionals that are required to assess children's developmental progress as part of their day-to-day working practices. The book begins with a practical framework for developmental examination, then progresses through each of the key physical, cognitive and social developmental assessment areas, offering guidance on enquiry and observation, and how to chart typical and atypical patterns, with 'red flags' for recognising significant delay or abnormality. Advice is also given on how to make sense of the findings and how best to communicate this information to parents.

To consolidate and expand on the practical and theoretical information across this book and the original From Birth to Five Years, a new companion website is available at www.routledge.com/cw/sharma, which includes the following additional learning material:

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• An interactive timeline of the key developmental domains

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• Introductions to theory with links to further reading

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• Research summaries

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• Video clips demonstrating practical assessment skills

Conceptual framework

Section 1

A practical framework for developmental examination

Developmental examination is a part of the process of early identification of children’s developmental difficulties. It is most meaningful when it builds on the developmental surveillance for all children and leads to further focused assessment, investigations, facilitative guidance, support and intervention (Table 1). Developmental examination is undertaken in response to parental or other professionals’ concerns regarding a child’s function and/or behaviour and to proactively monitor progress in children with health or social risks.

Table 1 Process for identification of developmental needs

	Objectives	Methods
Surveillance: Universal: for all children	Promoting health and development; promotion of good care and parenting; identification of risk factors; early presumptive identification of developmental difficulties.	Ongoing process involving parents (through the use of a personal child health record) and practitioners working with children at the universal level, e.g. child development workers, health visitors and general practitioners.
Developmental examination	To verify concerns, to elicit and categorise developmental function and any likely risk or impairment, provide support and guidance and arrange further assessment and/or investigations as required.	Clinical evaluation based on the knowledge of developmental progression and factors influencing it, skills and tools for eliciting concerns, history and making developmental observations.
Developmental assessment: for established concerns	To provide a detailed description of the child’s developmental strengths and weaknesses for management planning and monitoring.	Standardised assessment methods used by paediatricians, psychologists and therapists, e.g. Griffith’s or Bayley’s scales.
Diagnostic or functional assessment	Diagnostic or functional assessment for management planning	Diagnostic tools, e.g. Autism Diagnostic Observations Schedule or functional assessment tools used by therapists.

The wide variation in ages at which typically developing children achieve developmental milestones may create difficulties in identifying children with vulnerabilities. Practitioners risk causing a delay in identification or falsely reassuring parents if they use subjective impressions to comment on the child’s developmental progress (Glascoe and Dworkin 1993). Standardised tests of development differentiate children, comparing their performance to the expected norms, for their level of abilities or function. These tests are considered as gold standard by some but may be impractical in terms of time, unsuitable for the child’s comprehension or motor abilities, and often too narrowly focused on measuring development (Greenspan and Meisels 1996).

Developmental examination may, on its own, lack the sensitivity and specificity of standardised assessments, but combined with the right knowledge, training and experience, and connected with the wider system of developmental surveillance, it has a useful place in promoting positive developmental outcomes. Developmental examination generally takes place when risks or concerns have been identified by parents or professionals. It enables professionals to identify any vulnerability, provide the required guidance and support, and access further detailed assessment and/or intervention services as required.

The structured developmental examination framework described here combines knowledge of the sequence of developmental progression* and an understanding of the processes influencing development (see Influences on development, p. 14 below), with the tools of systematic enquiry and observation. It provides a practical stepwise approach for eliciting concerns and normative and qualitative information about children’s development. It provides a basis for identifying children who would benefit from support, by creating a focus on carers’ concerns and the child’s development, and guides practitioners in making further appropriate assessments and investigations.

* From Birth to Five Years – Children’s Developmental Progress

The main components of this framework are:

A. Systematic enquiry of parents

i. eliciting concerns

ii. gathering information about the child’s current abilities and function

iii. identifying risks and protective factors

B. Observations

i. generic observations

ii. structured domain-specific observations/examination of developmental abilities, using age appropriate methods.

A. SYSTEMATIC ENQUIRY

Gathering information from parents and carers is undoubtedly the most important aspect of evaluating development (Dooley et al. 2003). There are three main components of a systematic enquiry:

i. Eliciting concerns

Parents, for various reasons, may not always bring up all their concerns (Box 1) (Glascoe and Marks 2011). A sensitive and supportive approach, starting first with open-ended questions and then following with more specific questions, is always helpful (see Communicating with parents/carers, p. 125). Well-elicited and carefully interpreted parental concerns guide practitioners in deciding the focus of further detailed enquiry, judging the need for parental assurance and advice and/or further examination or referrals. The sensitivity and specificity of systemically elicited concerns is as good (70–80 per cent) as standardised screening instruments for detecting developmental impairments (Glascoe 2003). Using a structured set of questions can elicit valid and useful responses (Table 2).

The significance of parental concerns changes with children’s age. For example, concerns regarding general development, expressive language and social abilities are predictive of impairments at any age, while concerns regarding receptive language and motor function become more predictive of impairments after the age of 3 years (Tervo 2005). The relationship between parental concerns and the domain of impairment is not always direct: some concerns, such as poor language or social abilities, may also indicate global developmental delay or learning disability (Tervo 2005; Glascoe 1994). The onset and course of concerns, including any regression, should always be noted.

BOX 1 Barriers to parents raising concerns or accessing services

■ Lack of awareness of children’s developmental progress and/or of local services and how they can help

■ Language barrier, social isolation

■ Emotional and behavioural problems may be seen by some parents as moral, rather than psychological, deviations because of cultural beliefs (Katz and Pinkerton 2003)

■ Parents living in poverty are more likely to be stressed and less likely to express concerns about their children (Elder et al. 1985)

■ Stigma of a label or being seen as a ‘failed parent’

■ Lack of trust or suspicion

Table 2 Questions for eliciting concerns

Do you have any concer...