Cognitive Development DTW

1. Learning and Normative Cognitive Development
   1. Key Points of Learning and Normative Cognitive Development
2. Musical Intelligence
   1. Key Points of Musical Intelligence
3. Logical Intelligence
   1. Key Points of Logical-Mathematical Intelligence
4. Nature Intelligence
   1. Key Points of Nature Intelligence
5. Learning Disorders
   1. Key Points of Learning Disorders
   2. Definitions of Learning Disorders
   3. Clinical Guides for Learning Disorders
   4. Differential Diagnosis of Learning Disorders
   5. Management of Learning Disorders
   6. Co-Morbid Conditions of Learning Disorders
6. Mental Retardation
   1. Key Points of Mental Retardation
   2. Definitions of Mental Retardation
   3. Clinical Guide for Mental Retardation
   4. Differential Diagnosis of Mental Retardation
   5. Co-Morbid Conditions of Mental Retardation
   6. Management of Mental Retardation
7. Resources for Parents
8. Gessell Figures
9. Citations

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• Overview of Piaget's Theories on Infant Cognitive Development: Much of how we understand, observe, and evaluate children is based on Jean Piaget's findings and the research that followed. 1) Piaget based his theories of cognitive development on the notion that learning is a process of adaptation. He believed that infants are active initiators in the learning process, that the infant is aware of his environment and begins to modify his behavior in response to environmental demands. An infant can take in-assimilate-information and apply it to existing mental structures that have evolved from primitive reflexive responses and were created in response to interactions with the environment. These structures (or schema) can be understood as a large filing system in the brain. The infant can create new "files" or change existing "files" to accommodate new information that does not conform to existing schema. The child's growing store of knowledge is made up of these schema, which are used to understand and organize the events, objects, and behaviors experienced in daily interactions. 2) Piaget also postulated that children develop their ability to learn, think, and reason as they progress through a series of developmental stages, each marked by an increased ability to think and reason more logically and abstractly. He identified practice and imitation as the primary tools for learning. 3) Piaget described the first 2 years of life as the sensorimotor period of development. He believed that infants and young toddlers are multisensory and active in the learning process. Through touch, taste, sight, sounds, and manipulation, young children learn about their bodies and the objects in their worlds. Piaget believed that through sensorimotor exploration, the young child develops increasingly more sophisticated schema for understanding and interacting with objects. An infant mouthing a book is learning about the nature of that object. A young child throwing blocks off a high chair and watching her father repeatedly retrieve them is learning about objects that bounce-and also about eliciting parent interaction. 4) As more complex schema develop, older infants begin to make connections between actions and consequences. An infant makes the connection between banging blocks and making a sound. Buttons, levers, VCRs, and appliances take on greater significance as the child learns that her action (pressing a button) causes exciting consequences (the TV goes on).
  Much of how we understand, observe, and evaluate children is based on Jean Piaget's findings and the research that followed. 1) Piaget based his theories of cognitive development on the notion that learning is a process of adaptation. He believed that infants are active initiators in the learning process, that the infant is aware of his environment and begins to modify his behavior in response to environmental demands. An infant can take in-assimilate-information and apply it to existing mental structures that have evolved from primitive reflexive responses and were created in response to interactions with the environment. These structures (or schema) can be understood as a large filing system in the brain. The infant can create new "files" or change existing "files" to accommodate new information that does not conform to existing schema. The child's growing store of knowledge is made up of these schema, which are used to understand and organize the events, objects, and behaviors experienced in daily interactions. 2) Piaget also postulated that children develop their ability to learn, think, and reason as they progress through a series of developmental stages, each marked by an increased ability to think and reason more logically and abstractly. He identified practice and imitation as the primary tools for learning. 3) Piaget described the first 2 years of life as the sensorimotor period of development. He believed that infants and young toddlers are multisensory and active in the learning process. Through touch, taste, sight, sounds, and manipulation, young children learn about their bodies and the objects in their worlds. Piaget believed that through sensorimotor exploration, the young child develops increasingly more sophisticated schema for understanding and interacting with objects. An infant mouthing a book is learning about the nature of that object. A young child throwing blocks off a high chair and watching her father repeatedly retrieve them is learning about objects that bounce-and also about eliciting parent interaction. 4) As more complex schema develop, older infants begin to make connections between actions and consequences. An infant makes the connection between banging blocks and making a sound. Buttons, levers, VCRs, and appliances take on greater significance as the child learns that her action (pressing a button) causes exciting consequences (the TV goes on).
• Birth-1 month: Characterized by reflexes: minor refinements of inborn behavior patterns. Behaviors include eye movements, sucking, grasping, crying, looking, and larger movements of the arms and legs
  Characterized by reflexes: minor refinements of inborn behavior patterns. Behaviors include eye movements, sucking, grasping, crying, looking, and larger movements of the arms and legs
• 1-4 months: Characterized by primary circular reactions: development of simple, repeated actions centered on the infant's own body Behaviors include regarding hands, putting hand to mouth
  Characterized by primary circular reactions: development of simple, repeated actions centered on the infant's own body Behaviors include regarding hands, putting hand to mouth
• 4-8 months: Characterized by secondary circular reactions: development of repeated actions involving external objects Behaviors include development of schema to explore objects (banging, shaking, mouthing, dropping, and throwing); connecting motor acts to consequences on objects; setting goals by chance; searching for objects if partially covered
  Characterized by secondary circular reactions: development of repeated actions involving external objects Behaviors include development of schema to explore objects (banging, shaking, mouthing, dropping, and throwing); connecting motor acts to consequences on objects; setting goals by chance; searching for objects if partially covered
• 8-12 months: Characterized by coordination of schemes: Coordination of separate actions into goal directed sequences of behavior, marking the beginning of intentional thought. Behaviors include: putting actions together in goal-directed, means-ends chains of behavior (e.g., manipulates features of busy boxes or pulls a string to get the attached object); beginning to anticipate actions (e.g. to cry when a person in a white coat appears); searching for hidden objects (beginning of true object permanence) but will only search in the original hiding place; searching for hidden object wherever it last disappeared (this is also the beginning of separation anxiety prompted by the child's ability to remember things that are out of sight)
  Characterized by coordination of schemes: Coordination of separate actions into goal directed sequences of behavior, marking the beginning of intentional thought. Behaviors include: putting actions together in goal-directed, means-ends chains of behavior (e.g., manipulates features of busy boxes or pulls a string to get the attached object); beginning to anticipate actions (e.g. to cry when a person in a white coat appears); searching for hidden objects (beginning of true object permanence) but will only search in the original hiding place; searching for hidden object wherever it last disappeared (this is also the beginning of separation anxiety prompted by the child's ability to remember things that are out of sight)
• Piaget and the Toddler Years: Beginning at about the age of two, children move from the sensorimotor stage of cognitive development to the preoperational stage. This stage ushers in a new era in children's thinking and reasoning skills, marked by the onset of symbolic function-children's use of mental symbols. Thinking and reasoning shift from an action-oriented, concrete approach to a slightly more abstract process that relies on representation. With emerging cognitive skills, toddlers show achievement in four significant areas: 1) Knowledge of object permanence and person permanence. During the toddler years, children become more aware of their own physical separateness. Separation anxiety typically begins between 9 and 12 months, when children become increasingly concerned with the whereabouts of their caregivers and actively search for them when they are not immediately present. Parents serve as a home base form which toddlers can gain confidence to explore their world. They become increasingly able to move away form their parents, but "check in" to "refuel." As toddlers' awareness of their separateness grows, and the memory centers in the brain mature and develop more complex schema in regard to objects, children develop an increasing need to share new skills with parents. By 15 months, toddlers are constantly bringing objects to parents. 2) Increased symbolic thought. Increased symbolic thought involves the ability to hold images in one's mind and to substitute one object for another. A child now understands that a toy car stands for a real car, for example, or that a baby doll stands for the real thing. As children mature, they will be able to use symbols even further: a block can stand for a truck, or play dough will turn into a worm. Later still, children will use symbolic play to resolve their anger and ambivalence. 3) Increased understanding of temporal sequencing. Toddlers can now understand that if mom puts her coat on, it means she is leaving, and that if mom says it is time for a bath, bedtime is likely to follow. Since toddlers can now understand the meaning of certain activities and can anticipate the sequence of events, they will protest earlier. 4) Egocentric thought. Toddlers have little ability to understand other people's perspectives. While they are tremendously empathic toward other toddlers, they also have a single-mindedness of possession. ("It's all mine and I want whatever you have.")
  Beginning at about the age of two, children move from the sensorimotor stage of cognitive development to the preoperational stage. This stage ushers in a new era in children's thinking and reasoning skills, marked by the onset of symbolic function-children's use of mental symbols. Thinking and reasoning shift from an action-oriented, concrete approach to a slightly more abstract process that relies on representation. With emerging cognitive skills, toddlers show achievement in four significant areas: 1) Knowledge of object permanence and person permanence. During the toddler years, children become more aware of their own physical separateness. Separation anxiety typically begins between 9 and 12 months, when children become increasingly concerned with the whereabouts of their caregivers and actively search for them when they are not immediately present. Parents serve as a home base form which toddlers can gain confidence to explore their world. They become increasingly able to move away form their parents, but "check in" to "refuel." As toddlers' awareness of their separateness grows, and the memory centers in the brain mature and develop more complex schema in regard to objects, children develop an increasing need to share new skills with parents. By 15 months, toddlers are constantly bringing objects to parents. 2) Increased symbolic thought. Increased symbolic thought involves the ability to hold images in one's mind and to substitute one object for another. A child now understands that a toy car stands for a real car, for example, or that a baby doll stands for the real thing. As children mature, they will be able to use symbols even further: a block can stand for a truck, or play dough will turn into a worm. Later still, children will use symbolic play to resolve their anger and ambivalence. 3) Increased understanding of temporal sequencing. Toddlers can now understand that if mom puts her coat on, it means she is leaving, and that if mom says it is time for a bath, bedtime is likely to follow. Since toddlers can now understand the meaning of certain activities and can anticipate the sequence of events, they will protest earlier. 4) Egocentric thought. Toddlers have little ability to understand other people's perspectives. While they are tremendously empathic toward other toddlers, they also have a single-mindedness of possession. ("It's all mine and I want whatever you have.")
• Increased memory and language skills, problem solving, and creative thinking: Continuation of preoperational stage (beginning of symbolic functioning): 1) Plays pretend, e.g. dress-up 2) Uses the pronouns "I," "me," and "you" 3) Evaluates events as good or bad 4) Begins to use words to express emotions
  Continuation of preoperational stage (beginning of symbolic functioning): 1) Plays pretend, e.g. dress-up 2) Uses the pronouns "I," "me," and "you" 3) Evaluates events as good or bad 4) Begins to use words to express emotions
• Trigger Questions: 1)How are you? What are your questions and concerns today? 2) What new things have you noticed your child does now? 3) Are there things you think your child should do that he/she isn't doing? 4) How do you like to play with your child? 5) What is their favorite activity/toy? 6) Are you reading to your child? How often? Favorite book? 7) How often does your child watch TV?
  1)How are you? What are your questions and concerns today? 2) What new things have you noticed your child does now? 3) Are there things you think your child should do that he/she isn't doing? 4) How do you like to play with your child? 5) What is their favorite activity/toy? 6) Are you reading to your child? How often? Favorite book? 7) How often does your child watch TV?
• Age Newborn: Model face-to-face interaction with the infant. Note different infant responses and comment on the infant's growing capacity to provide clear cues and on the parents' increasing ability to 'read' the infant's cues. Demonstrate behaviors such as speaking to, touching, and holding the baby closely until he/she calms.
  Model face-to-face interaction with the infant. Note different infant responses and comment on the infant's growing capacity to provide clear cues and on the parents' increasing ability to 'read' the infant's cues. Demonstrate behaviors such as speaking to, touching, and holding the baby closely until he/she calms.
• Age 1-2 weeks: Point out unstable respirations, color and jerky movements brought out by exam. Reassure parents about this normal physiological instability.
  Point out unstable respirations, color and jerky movements brought out by exam. Reassure parents about this normal physiological instability.
• Age 1-2 months: 1) Comment on the infant's growing capacity to provide clear cues and on the parents' increasing ability to 'read' the infant's cues 2) Model face-to-face interaction with the infant. Elicit infant responses by using different tones of voice, facial expressions, and head movements. 3) Demonstrate and discuss consoling. Teach the 5 S's- swaddling tightly, side or stomach lie on lap, shushing or white noise, swinging or jiggling gently, sucking on finger or pacifier. 4) Begin a discussion about the baby's temperament and self-regulatory abilities. Help parents try new approaches to consoling or arousing. Demonstrate alerting. Demonstrate behaviors such as speaking to, touching, and jiggling alert. Show parents how raising the baby to a vertical position on the shoulder brings the baby to an alert state where he or she is ready for interaction. Parents may feel disappointed or rejected by a nonresponsive baby. By showing that the task is difficult for you as well, you help the parents understand that the baby's behavior is not their fault. 5) Discuss the benefits of hand versus pacifier sucking (the hand allows for self-regulation at any time, whereas the pacifier requires that the infant cry out for the assistance of another). 6) Demonstrate tracking with eyes. Also use the rattle to demonstrate reflex grasping, explaining that this reflex will gradually fade to allow for the emergence of coordinated reaching and grasping. Talk with parents about things the baby likes to look at and encourage them to expose the baby to new visual stimulation while gently describing it to the baby. Demonstrate tracking with eyes. Also use the rattle to demonstrate reflex grasping, explaining that this reflex will gradually fade to allow for the emergence of coordinated reaching and grasping. Emphasize the relevance of this 'looking schemata' to later cognitive skills. Talk with parents about things the baby likes to look at and encourage them to expose the baby to new visual stimulation while gently describing it to the baby.
  1) Comment on the infant's growing capacity to provide clear cues and on the parents' increasing ability to 'read' the infant's cues 2) Model face-to-face interaction with the infant. Elicit infant responses by using different tones of voice, facial expressions, and head movements. 3) Demonstrate and discuss consoling. Teach the 5 S's- swaddling tightly, side or stomach lie on lap, shushing or white noise, swinging or jiggling gently, sucking on finger or pacifier. 4) Begin a discussion about the baby's temperament and self-regulatory abilities. Help parents try new approaches to consoling or arousing. Demonstrate alerting. Demonstrate behaviors such as speaking to, touching, and jiggling alert. Show parents how raising the baby to a vertical position on the shoulder brings the baby to an alert state where he or she is ready for interaction. Parents may feel disappointed or rejected by a nonresponsive baby. By showing that the task is difficult for you as well, you help the parents understand that the baby's behavior is not their fault. 5) Discuss the benefits of hand versus pacifier sucking (the hand allows for self-regulation at any time, whereas the pacifier requires that the infant cry out for the assistance of another). 6) Demonstrate tracking with eyes. Also use the rattle to demonstrate reflex grasping, explaining that this reflex will gradually fade to allow for the emergence of coordinated reaching and grasping. Talk with parents about things the baby likes to look at and encourage them to expose the baby to new visual stimulation while gently describing it to the baby. Demonstrate tracking with eyes. Also use the rattle to demonstrate reflex grasping, explaining that this reflex will gradually fade to allow for the emergence of coordinated reaching and grasping. Emphasize the relevance of this 'looking schemata' to later cognitive skills. Talk with parents about things the baby likes to look at and encourage them to expose the baby to new visual stimulation while gently describing it to the baby.
• Age 4 months: Discuss language stimulation. Encourage parents to mirror the infant's vocalizations and gestures. When the parent makes a sound that is followed by the infant doing the same and they continue to take turns, this reinforces the notion of turn-taking-an early sign of cognitive development in infants.
  Discuss language stimulation. Encourage parents to mirror the infant's vocalizations and gestures. When the parent makes a sound that is followed by the infant doing the same and they continue to take turns, this reinforces the notion of turn-taking-an early sign of cognitive development in infants.
• Age 6 months: Give baby a mirror and discuss self image. At this age, babies will smile at their image in the mirror, but a recognition of self typically does not emerge until the second year. Comment on beginning of stranger anxiety. When you approach an infant between 6 and 8 months of age, the infant will visually check with the parent to see if it is okay for the stranger to approach. If the parent smiles and appears comfortable, the child will allow the stranger to approach. If the parent is frightened or shows concern, the child will reflect that concern, turn away from you, or clutch the parent tighter.
  Give baby a mirror and discuss self image. At this age, babies will smile at their image in the mirror, but a recognition of self typically does not emerge until the second year. Comment on beginning of stranger anxiety. When you approach an infant between 6 and 8 months of age, the infant will visually check with the parent to see if it is okay for the stranger to approach. If the parent smiles and appears comfortable, the child will allow the stranger to approach. If the parent is frightened or shows concern, the child will reflect that concern, turn away from you, or clutch the parent tighter.
• Age 9 months: 1) Play peek-a-boo and discuss cognition. Note the affective components of the game-the range of emotions expressed (surprise, expectation, fear, delight), the turn-taking as you switch roles and the baby hides his/her eyes, and the expectation the baby has that your face will reappear. When you stop the game, comment on the strategies the baby uses to get you to continue (fussing, smiling, laughing, putting up his/her hands, touching your hands, etc.) 2) Drop paper towel ball and comment on search. This represents object permanence. Alternatively, hide an object under a cloth while the baby is watching. When the infant takes the cloth away, note that this demonstrates early understanding of object permanence, or the baby's understanding that the world has some consistency and dependability. 3) Compare this ability to understand object permanence with person permanence. Discuss how separation anxiety and protest when the parent leaves the room demonstrate that the baby now has a mental symbol of the mother; the discrepancy between that symbol and her not being there evokes crying and protest in an attempt to get the mother to return.
  1) Play peek-a-boo and discuss cognition. Note the affective components of the game-the range of emotions expressed (surprise, expectation, fear, delight), the turn-taking as you switch roles and the baby hides his/her eyes, and the expectation the baby has that your face will reappear. When you stop the game, comment on the strategies the baby uses to get you to continue (fussing, smiling, laughing, putting up his/her hands, touching your hands, etc.) 2) Drop paper towel ball and comment on search. This represents object permanence. Alternatively, hide an object under a cloth while the baby is watching. When the infant takes the cloth away, note that this demonstrates early understanding of object permanence, or the baby's understanding that the world has some consistency and dependability. 3) Compare this ability to understand object permanence with person permanence. Discuss how separation anxiety and protest when the parent leaves the room demonstrate that the baby now has a mental symbol of the mother; the discrepancy between that symbol and her not being there evokes crying and protest in an attempt to get the mother to return.
• Age 12 months: Discuss strategies the child uses to figure out how to get a toy to perform. Babies who use a variety of actions like banging, shaking, and poking are better able to extract meaning from the world around them than children who use fewer strategies.
  Discuss strategies the child uses to figure out how to get a toy to perform. Babies who use a variety of actions like banging, shaking, and poking are better able to extract meaning from the world around them than children who use fewer strategies.
• Age 15 months: Give the child a toy telephone and see if he/she can demonstrate fuctional use or ask if he can. Functional play expected at this age includes putting the phone to his ear. Ask the child to let a doll talk on the phone. This requires representational play. This stage of cognitive development signals the beginning of symbolic representation, when the child can use one object to represent another object that is not present. Children at this age can demonstrate the functional use of cars, dolls, and caregiving activities like feeding. They can also imitate housework like vacuuming and washing dishes.
  Give the child a toy telephone and see if he/she can demonstrate fuctional use or ask if he can. Functional play expected at this age includes putting the phone to his ear. Ask the child to let a doll talk on the phone. This requires representational play. This stage of cognitive development signals the beginning of symbolic representation, when the child can use one object to represent another object that is not present. Children at this age can demonstrate the functional use of cars, dolls, and caregiving activities like feeding. They can also imitate housework like vacuuming and washing dishes.
• Age 18 months: Talk about cognitive progress if you see any dumping and filling when you give the child a container and blocks. Note the seemingly endless delight toddlers have in dumping and filling. There is a sense of satisfaction and fulfillment to the activity. The actions also have a cognitive component. Toddlers are learning about the properties of objects in space, about completing a task, and about a parent's reactions to the toddler's goal of filling and dumping. This also gives you the opportunity to talk about throwing objects and offer more suggestions for how to handle limit-setting for young toddlers.
  Talk about cognitive progress if you see any dumping and filling when you give the child a container and blocks. Note the seemingly endless delight toddlers have in dumping and filling. There is a sense of satisfaction and fulfillment to the activity. The actions also have a cognitive component. Toddlers are learning about the properties of objects in space, about completing a task, and about a parent's reactions to the toddler's goal of filling and dumping. This also gives you the opportunity to talk about throwing objects and offer more suggestions for how to handle limit-setting for young toddlers.
• Age 24 months: Comment on attempts at problem-solving during a simple 2- or 3-piece puzzle task. Does she or he try to bang pieces into place, or examine each one first? Encourage parents to offer the child strategies that will help the child learn how to problem solve on their own.
  Comment on attempts at problem-solving during a simple 2- or 3-piece puzzle task. Does she or he try to bang pieces into place, or examine each one first? Encourage parents to offer the child strategies that will help the child learn how to problem solve on their own.
• Age 30 months: Preoperational thought (tendency to think literally, literally believe what is seen: 1) Understands more than 200 words and can say 30-50 words 2) Begins to understand categories such as "big" and "little" and can sort objects accordingly 3) If something looks different it is, e.g., when a ball of clay is rolled into a snake, the child will think there is now more clay 4) Can scribble with a crayon 5) Says "no" when breaking the rules but usually continues the behavior 6) Depends on consistency and rituals, and gets upset at changes
  Preoperational thought (tendency to think literally, literally believe what is seen: 1) Understands more than 200 words and can say 30-50 words 2) Begins to understand categories such as "big" and "little" and can sort objects accordingly 3) If something looks different it is, e.g., when a ball of clay is rolled into a snake, the child will think there is now more clay 4) Can scribble with a crayon 5) Says "no" when breaking the rules but usually continues the behavior 6) Depends on consistency and rituals, and gets upset at changes
• Age 36 months: 1) Assess language and cognition by asking the child's name and age. 2) Assess language skills by three-step commands using a doll. Using a doll, bottle, and tissue, for example, ask the child to feed the baby, or using a car and little people, ask the child to get the little people ready to go to the store. 3) Many children who are within the normal range for expressive and receptive language may show a different ability for each skill. However, wide gap between expressive and receptive language abilities may indicate language delay.
  1) Assess language and cognition by asking the child's name and age. 2) Assess language skills by three-step commands using a doll. Using a doll, bottle, and tissue, for example, ask the child to feed the baby, or using a car and little people, ask the child to get the little people ready to go to the store. 3) Many children who are within the normal range for expressive and receptive language may show a different ability for each skill. However, wide gap between expressive and receptive language abilities may indicate language delay.
• Encouraging Cognitive Growth Through Appropriate Stimulation: This section adapted from Jellinek M, Bright Futures in Practice, Mental Health, 2002.
  This section adapted from Jellinek M, Bright Futures in Practice, Mental Health, 2002.
• Experience shapes early brain development: Research on brain development suggests that early experiences in infancy shape brain architecture and function. Early experiences have a dramatic impact on the development of the brain, increasing or decreasing the final number of synapses or connections. The early experiences which best support complex brain development are activities which are repetitive, responsive to the infant's interests and abilities and occur within the context of a positive emotional relationship with caregivers.
  Research on brain development suggests that early experiences in infancy shape brain architecture and function. Early experiences have a dramatic impact on the development of the brain, increasing or decreasing the final number of synapses or connections. The early experiences which best support complex brain development are activities which are repetitive, responsive to the infant's interests and abilities and occur within the context of a positive emotional relationship with caregivers.
• Repetition fosters mastery: The drive towards mastery that is so evident in toddlers has its roots in early experiences as infants repeat actions over and over again to see the effect of their actions on their own bodies, on objects and on caregivers. It is this sense of self as actor and doer that fuels a child's emotional development as well as cognitive growth. When infants act on objects, they gradually develop a critical understanding of such cognitive processes as causality, object permanence, and imitation.
  The drive towards mastery that is so evident in toddlers has its roots in early experiences as infants repeat actions over and over again to see the effect of their actions on their own bodies, on objects and on caregivers. It is this sense of self as actor and doer that fuels a child's emotional development as well as cognitive growth. When infants act on objects, they gradually develop a critical understanding of such cognitive processes as causality, object permanence, and imitation.
• Play is natural way to interact and stimulate infant: Play presents a natural window through which caregivers can provide repetitive, responsive experiences within the context of a positive emotional relationship to support brain development. Assure a stimulating environment. Infants are constantly processing input from their environment. Every setting a child spends time in has an impact on their development. Environments that are stimulating for infants are filled with objects to explore, allow for freedom of movement, and provide a variety of sensory input (e.g., different colors, textures, sounds.) Spaces for infants should also provide for quiet areas where they can soothe themselves.
  Play presents a natural window through which caregivers can provide repetitive, responsive experiences within the context of a positive emotional relationship to support brain development. Assure a stimulating environment. Infants are constantly processing input from their environment. Every setting a child spends time in has an impact on their development. Environments that are stimulating for infants are filled with objects to explore, allow for freedom of movement, and provide a variety of sensory input (e.g., different colors, textures, sounds.) Spaces for infants should also provide for quiet areas where they can soothe themselves.
• Trigger Questions: 1) What are his favorite ways to play? 2) Do you find time to play with him every day? 3) How do you feel about his childcare? What do they do with him there?
  1) What are his favorite ways to play? 2) Do you find time to play with him every day? 3) How do you feel about his childcare? What do they do with him there?
• Encourage developmentally appropriate play.: Activities and toys need to be geared to a developmentally appropriate level. After infants master dumping everything out of a coffee can, they then revel in the thrill of putting everything back in the can and starting the whole game over again.
  Activities and toys need to be geared to a developmentally appropriate level. After infants master dumping everything out of a coffee can, they then revel in the thrill of putting everything back in the can and starting the whole game over again.
• Newborn: 1) Appropriate Toy: Mobile 2) Appropriate Game: Kissing/blowing on fingers and toes when changing 3) Appropriate Song: Lullabies 4) Goal: Focusing attention and facilitating regulation
  1) Appropriate Toy: Mobile 2) Appropriate Game: Kissing/blowing on fingers and toes when changing 3) Appropriate Song: Lullabies 4) Goal: Focusing attention and facilitating regulation
• 4 months: 1) Appropriate Toy: Crib gym 2) Appropriate Game: Peek-a-boo (adult initiated) 3) Appropriate Song: "Clap, Clap, Clap Your Hands" 4) Goal: Increasing awareness of actions of arms and legs
  1) Appropriate Toy: Crib gym 2) Appropriate Game: Peek-a-boo (adult initiated) 3) Appropriate Song: "Clap, Clap, Clap Your Hands" 4) Goal: Increasing awareness of actions of arms and legs
• 7 months: 1) Appropriate Toy: Dumping, filling and stacking toys 2) Appropriate Game: Peek-a-boo (reciprocal) and patty cake 3) Appropriate Song: "Trot, trot to Boston" 4) Goal: Beginning to understand object permanence
  1) Appropriate Toy: Dumping, filling and stacking toys 2) Appropriate Game: Peek-a-boo (reciprocal) and patty cake 3) Appropriate Song: "Trot, trot to Boston" 4) Goal: Beginning to understand object permanence
• 9 months: 1) Appropriate Toy: Balls, push/pull, and rolling toys, toys that make music 2) Appropriate Game: Rolling objects across floors and to caregivers 3) Appropriate Song: "Where is Thumpkin?" 4) Goal: Beginning to understand cause and effect (causality)
  1) Appropriate Toy: Balls, push/pull, and rolling toys, toys that make music 2) Appropriate Game: Rolling objects across floors and to caregivers 3) Appropriate Song: "Where is Thumpkin?" 4) Goal: Beginning to understand cause and effect (causality)
• 12 months: 1) Appropriate Toy: Board books 2) Appropriate Game: Practicing emerging locomotion's skills, i.e. cruising, walking 3) Appropriate Song: "Wheels on the Bus" 4) Goal: Developing motor skills and receptive language
  1) Appropriate Toy: Board books 2) Appropriate Game: Practicing emerging locomotion's skills, i.e. cruising, walking 3) Appropriate Song: "Wheels on the Bus" 4) Goal: Developing motor skills and receptive language
• Encourage parents to support the infant's exploration.: Help parents understand how their child gradually starts to actively seek out stimulation, first through the use of his own body as seen with the acquisition of hand regard at 2-3 months, and then through the exploration of objects. It is this desire to actively seek out and explore new worlds that guides infants in the second half of the first year of life. Encourage parents to support the infant's drive toward exploration. Through their senses, infants interact with objects to determine what they can do, e.g., what can be rolled, chewed, or shaken.
  Help parents understand how their child gradually starts to actively seek out stimulation, first through the use of his own body as seen with the acquisition of hand regard at 2-3 months, and then through the exploration of objects. It is this desire to actively seek out and explore new worlds that guides infants in the second half of the first year of life. Encourage parents to support the infant's drive toward exploration. Through their senses, infants interact with objects to determine what they can do, e.g., what can be rolled, chewed, or shaken.
• Encourage parents to make their play responsive to the child's needs and interests.: Infants attend to those experiences which are meaningful to them, like being bounced on a caregiver's knee while they giggle and shriek for more. Encourage parents to have play be initiated and led by the child.
  Infants attend to those experiences which are meaningful to them, like being bounced on a caregiver's knee while they giggle and shriek for more. Encourage parents to have play be initiated and led by the child.
• Help parents understand repetition.: In order to master new situations, infants like to have some things feel repetitive, stable, and dependable. They want to hear the same lullaby, play the same finger and toe games when being changed, and see the same mobile over their crib. They need those experiences to be interspersed with novel elements in order to thrive. For example, infants love the "wheels on the bus" song because the refrain remains the same while the verses change slightly with each new element of the bus ride; similarly, infants enjoy discovering new toys such as balls that are slightly different in color, size, or texture than their own familiar ball.
  In order to master new situations, infants like to have some things feel repetitive, stable, and dependable. They want to hear the same lullaby, play the same finger and toe games when being changed, and see the same mobile over their crib. They need those experiences to be interspersed with novel elements in order to thrive. For example, infants love the "wheels on the bus" song because the refrain remains the same while the verses change slightly with each new element of the bus ride; similarly, infants enjoy discovering new toys such as balls that are slightly different in color, size, or texture than their own familiar ball.
• Classification: Help parents understand how children develop the concept of classification of objects ("These balls are for throwing; these crackers are for eating."), spatial and temporal qualities of objects ("When I throw balls off my tray they bounce; when I throw food off my tray it splats."), and consider the emotional component of learning (infants quickly learn that throwing balls is OK but throwing food makes caregivers angry). It is through the interaction with objects and caregivers that an infant comes to understand the world.
  Help parents understand how children develop the concept of classification of objects ("These balls are for throwing; these crackers are for eating."), spatial and temporal qualities of objects ("When I throw balls off my tray they bounce; when I throw food off my tray it splats."), and consider the emotional component of learning (infants quickly learn that throwing balls is OK but throwing food makes caregivers angry). It is through the interaction with objects and caregivers that an infant comes to understand the world.
• Causality: Help parents understand how children develop the concept of causality: through repetition, infants learn that one action causes another. When the caregiver coos back in response to the infant's coos, when the mobile makes noise every time it is batted by the baby's hand, when the parent responds to the infant's cry for food, the child develops the concept of causality. Gradually, the infant's actions become more purposeful and goal-directed ("I reach in order to grasp"), and more differentiated, separating means from ends ("I hit the button to make the balls spin around in the top"). Infants begin to see themselves as agents of change and as purposeful learners who experiment to make interesting things happen. Examples of the developing concept of causality include the following: 1) Newborn: Random acts cause events to happen 2) 4 months: Focused attention on and attempts to reactivate events that do something, e.g. shaking a rattle, banging a spoon 3) 7 months: Repeats actions to make events happen after first discovering the action by chance, e.g. batting a crib gym to activate a spin toy 4) 9 months: Understands that something causes the action and tries to do it, e.g. manipulates mechanism on wind-up toy unsuccessfully and hands to parent to activate 5) 1 year: Uses a string to pull a toy
  Help parents understand how children develop the concept of causality: through repetition, infants learn that one action causes another. When the caregiver coos back in response to the infant's coos, when the mobile makes noise every time it is batted by the baby's hand, when the parent responds to the infant's cry for food, the child develops the concept of causality. Gradually, the infant's actions become more purposeful and goal-directed ("I reach in order to grasp"), and more differentiated, separating means from ends ("I hit the button to make the balls spin around in the top"). Infants begin to see themselves as agents of change and as purposeful learners who experiment to make interesting things happen. Examples of the developing concept of causality include the following: 1) Newborn: Random acts cause events to happen 2) 4 months: Focused attention on and attempts to reactivate events that do something, e.g. shaking a rattle, banging a spoon 3) 7 months: Repeats actions to make events happen after first discovering the action by chance, e.g. batting a crib gym to activate a spin toy 4) 9 months: Understands that something causes the action and tries to do it, e.g. manipulates mechanism on wind-up toy unsuccessfully and hands to parent to activate 5) 1 year: Uses a string to pull a toy
• Object Permanence: Help parents understand how children develop the concept of object permanence. As infants explore the properties of objects and the relationships between themselves and objects, they also learn about the permanence of objects, that objects and people continue to exist even when they are out of sight. This has emotional implications. As infants develop the capacity to hold a symbolic image of a parent in their minds, they exhibit increased separation anxiety, crawling frantically after the parent who momentarily leaves the room. Examples of the developing concept of object permanence include the following: 1) Newborn: "out of sight, out of mind" 2) 4 months: stops feeding to look around and locate source of noises ("nosy nurser") 3) 7 months: eyes follow object dropped from sight, e.g. watches food dropped from high chair 4) 9 months: searches for object partially hidden under a blanket 5) 1 year: searches for object seen being hidden completely under a blanket
  Help parents understand how children develop the concept of object permanence. As infants explore the properties of objects and the relationships between themselves and objects, they also learn about the permanence of objects, that objects and people continue to exist even when they are out of sight. This has emotional implications. As infants develop the capacity to hold a symbolic image of a parent in their minds, they exhibit increased separation anxiety, crawling frantically after the parent who momentarily leaves the room. Examples of the developing concept of object permanence include the following: 1) Newborn: "out of sight, out of mind" 2) 4 months: stops feeding to look around and locate source of noises ("nosy nurser") 3) 7 months: eyes follow object dropped from sight, e.g. watches food dropped from high chair 4) 9 months: searches for object partially hidden under a blanket 5) 1 year: searches for object seen being hidden completely under a blanket
• Imitation: Help parents understand the concept of imitation. Imitation happens very early in the "dance" between parent and young infant as the baby adjusts her movements to mirror the subtle movements of the parent, tilting her head as the mother adjusts her head during a face to face encounter. Piaget described imitation as pure accommodation, changing one's own behavior and mental structures to copy behavior of another. Imitation of the actions of others provides new ideas on how to explore the environment and to act on objects (e.g., a child learns to roll a ball back to her father by imitating her father's rolling of a ball to her). Initially imitation must immediately follow the action to be copied, but as older infants develop the ability to hold action sequences in their minds, they display delayed imitation, storing and copying such interesting spectacles as tantrums observed earlier on the playground, for trying out later in the day. Imitation of the actions of others leads older infants towards greater autonomy and independence, such as self-feeding. Early imitation of language sounds and patterns of shared communication leads to the imitation of important early words like "no" and "bye-bye" and to a pragmatic understanding of how to have a conversation. Examples of the developing concept of imitation include the following: 1) Newborn: tongue thrust in response to caregiver sticking out tongue 2) 4 months: imitates caregiver's sounds 3) 7 months: imitates symbolic gestures (e.g. waves bye-bye) 4) 9 months: imitates others' actions on objects, e.g. pushes button on busy box, dumps toys from box 5) 1 year: Imitates social actions, e.g. "talks" on a phone
  Help parents understand the concept of imitation. Imitation happens very early in the "dance" between parent and young infant as the baby adjusts her movements to mirror the subtle movements of the parent, tilting her head as the mother adjusts her head during a face to face encounter. Piaget described imitation as pure accommodation, changing one's own behavior and mental structures to copy behavior of another. Imitation of the actions of others provides new ideas on how to explore the environment and to act on objects (e.g., a child learns to roll a ball back to her father by imitating her father's rolling of a ball to her). Initially imitation must immediately follow the action to be copied, but as older infants develop the ability to hold action sequences in their minds, they display delayed imitation, storing and copying such interesting spectacles as tantrums observed earlier on the playground, for trying out later in the day. Imitation of the actions of others leads older infants towards greater autonomy and independence, such as self-feeding. Early imitation of language sounds and patterns of shared communication leads to the imitation of important early words like "no" and "bye-bye" and to a pragmatic understanding of how to have a conversation. Examples of the developing concept of imitation include the following: 1) Newborn: tongue thrust in response to caregiver sticking out tongue 2) 4 months: imitates caregiver's sounds 3) 7 months: imitates symbolic gestures (e.g. waves bye-bye) 4) 9 months: imitates others' actions on objects, e.g. pushes button on busy box, dumps toys from box 5) 1 year: Imitates social actions, e.g. "talks" on a phone
• Monitor the stimulation in all the child's environments: 1) Ask parents about their home environment and about other places their infant spends time. 2) Discuss with parents the importance of providing safe and varied sensory experiences for their baby.
  1) Ask parents about their home environment and about other places their infant spends time. 2) Discuss with parents the importance of providing safe and varied sensory experiences for their baby.
• Monitor for problematic parent-child interactions and watch for family barriers to stimulation: 1) Lack of stimulation can be associated with a number of factors including extreme poverty, lack of knowledge about the learning abilities of infants, child-rearing and cultural beliefs, parental mental health difficulties, or infants' biological or neurological impairments. While each of these can be a complicated issue, the message we give to parents should be clear and uncomplicated: Infants are born with an intrinsic motivation to learn, to figure out how their world works. It is the parents' job to help infants master their environment by taking the time to talk to them, play with them, love them, hold them and keep them safe. 2) Parental mental health concerns, particularly maternal depression, or environmental risk factors such as substance abuse or domestic violence make it extremely difficult for caregivers to focus on an infant's need for stimulation and emotional support. The research on early brain development suggests that infants who are being raised by depressed mothers, for example, make fewer synaptic connections during early brain development. 3) For those infants whose apparent lack of interest in the world appears to be related to the child's biological or neurological development, it is critical to provide timely assessment and treatment through early intervention and community-based child development programs. Family support programs, home visiting, quality childcare and community-based programs such as early Head Start can be important referral sources for pediatric practice 4) Refer to early intervention programs or quality childcare if the family cannot provide adequate stimulation. See resources.
  1) Lack of stimulation can be associated with a number of factors including extreme poverty, lack of knowledge about the learning abilities of infants, child-rearing and cultural beliefs, parental mental health difficulties, or infants' biological or neurological impairments. While each of these can be a complicated issue, the message we give to parents should be clear and uncomplicated: Infants are born with an intrinsic motivation to learn, to figure out how their world works. It is the parents' job to help infants master their environment by taking the time to talk to them, play with them, love them, hold them and keep them safe. 2) Parental mental health concerns, particularly maternal depression, or environmental risk factors such as substance abuse or domestic violence make it extremely difficult for caregivers to focus on an infant's need for stimulation and emotional support. The research on early brain development suggests that infants who are being raised by depressed mothers, for example, make fewer synaptic connections during early brain development. 3) For those infants whose apparent lack of interest in the world appears to be related to the child's biological or neurological development, it is critical to provide timely assessment and treatment through early intervention and community-based child development programs. Family support programs, home visiting, quality childcare and community-based programs such as early Head Start can be important referral sources for pediatric practice 4) Refer to early intervention programs or quality childcare if the family cannot provide adequate stimulation. See resources.
• Adjustment of milestones for prematurity: It is customary to adjust chronological age for the weeks of prematurity until age 2 years so that children will not be overly regarded as delayed.
  It is customary to adjust chronological age for the weeks of prematurity until age 2 years so that children will not be overly regarded as delayed.
• True prevalence is higher, possibly closer to 15%: 2.3 million children with learning disabilities; 120,000 students per year are diagnosed as having a "learning disablilty"
  2.3 million children with learning disabilities; 120,000 students per year are diagnosed as having a "learning disablilty"
• Chronic illnesses that have direct effects on the CNS: HIV
  HIV
• Neurobiological Conditions: neurofibromatosis
  neurofibromatosis
• Chromosomal Disorder: Turner syndrome, Fragile X, Kleinfelter
  Turner syndrome, Fragile X, Kleinfelter
• CNS Syndrome: Riley-Day syndrome
  Riley-Day syndrome
• Hereditary: 35-40% of first degree relatives of reading-disabled children also have reading disabilities.
  35-40% of first degree relatives of reading-disabled children also have reading disabilities.
• General cognition:: How old are you? When is your birthday? What school do you go to? What grade are you in? Who is your teacher?
  How old are you? When is your birthday? What school do you go to? What grade are you in? Who is your teacher?
• Attitudes towards school:: Is she nice or mean? What does she do that is mean? Is she only mean to you? Would you rather go to school or stay home?
  Is she nice or mean? What does she do that is mean? Is she only mean to you? Would you rather go to school or stay home?
• Achievement:: What grades did you get on your report card (by subject)? What are you learning in math? What books do you like to read? What is your best subject? What is the hardest? What makes it hard for you? Tests vs. Homework vs. Assignments/projects vs. Classroom work
  What grades did you get on your report card (by subject)? What are you learning in math? What books do you like to read? What is your best subject? What is the hardest? What makes it hard for you? Tests vs. Homework vs. Assignments/projects vs. Classroom work
• Homework:: When do you do your homework? How long does it take? Who helps you if you need it? How is that for you? Do you always turn in your homework?
  When do you do your homework? How long does it take? Who helps you if you need it? How is that for you? Do you always turn in your homework?
• Peers:: Who is your best friend in school? What do you like to do together?
  Who is your best friend in school? What do you like to do together?
• Story of each grade of schooling: do they know the material? are they distracted easily?
  do they know the material? are they distracted easily?
• Pencil Grasp: the optimal pencil grasp is the "tripod grasp". This is when the pencil is supported by the thumb, index and middle finger. The ring and little finger are bent and rest comfortably on the table. There is no need to worry about a child's pencil grasp unless it is affecting their writing or your child is experiencing pain.
  the optimal pencil grasp is the "tripod grasp". This is when the pencil is supported by the thumb, index and middle finger. The ring and little finger are bent and rest comfortably on the table. There is no need to worry about a child's pencil grasp unless it is affecting their writing or your child is experiencing pain.
• : Alcohol, Marijuana, Cocaine
  Alcohol, Marijuana, Cocaine
• Medications: anticholinergic, benzodiazepine
  anticholinergic, benzodiazepine
• Communication disorder: Although early language and articulation disorders place a child at risk for reading disorders, if therapy is instituted before first grade and there is no further evidence of the language disorder, they may have normal development of reading. However, they may still show subtle dysfunctions which will manifest in ability to follow directions and in social skills.
  Although early language and articulation disorders place a child at risk for reading disorders, if therapy is instituted before first grade and there is no further evidence of the language disorder, they may have normal development of reading. However, they may still show subtle dysfunctions which will manifest in ability to follow directions and in social skills.
• : Children with mental retardation can also have specific learning disabilities relative to their degree of retardation.
  Children with mental retardation can also have specific learning disabilities relative to their degree of retardation.
• : 20-25% of reading-disabled children have ADHD. 10-50% of children with ADHD have a reading disability.
  20-25% of reading-disabled children have ADHD. 10-50% of children with ADHD have a reading disability.
• Depression: Children with learning disabilities are more likely to have a negative self-esteem, report higher rates of depression, and are more likely to internalize failures as reflecting on their overall worth.
  Children with learning disabilities are more likely to have a negative self-esteem, report higher rates of depression, and are more likely to internalize failures as reflecting on their overall worth.
• Separation Anxiety Disorder / School Phobia / General Anxiety: May be secondary to avoiding embarrassment in classes by not being able to express themselves, or not wanting to talk in class ; Children with LD are also more likely to complain of somatic symptoms, which would keep them home from school such as headaches and stomachaches.
  May be secondary to avoiding embarrassment in classes by not being able to express themselves, or not wanting to talk in class ; Children with LD are also more likely to complain of somatic symptoms, which would keep them home from school such as headaches and stomachaches.
• Goals for younger children: adaptation implies: achievement of useful coordinated psychomotor skills, then communication capacity, finally gains in 'activities of daily living' (ADL), self-help and independence in eating, dressing and toileting
  adaptation implies: achievement of useful coordinated psychomotor skills, then communication capacity, finally gains in 'activities of daily living' (ADL), self-help and independence in eating, dressing and toileting
• Goals for older children: look at: broad social skills, accommodation to the educational environment, achievement of prevocational and vocational competence, ability to manage outside living requirements
  look at: broad social skills, accommodation to the educational environment, achievement of prevocational and vocational competence, ability to manage outside living requirements
• Characteristics of differences for an individual with MR: Achievement and performance, Effects of constraints in intelligence are modulated by the child's environment, Child may require services, Connectedness to others may be impaired
  Achievement and performance, Effects of constraints in intelligence are modulated by the child's environment, Child may require services, Connectedness to others may be impaired
• Infants may be "at risk" for developmental disorder: 1) Established risk: presence of biomedical conditions known to affect personal progress (<1% of infants) 2) Biological risk: children with a history of events that have significant potential for brain impairment or whose early functioning gives concern about development Premature infants are major component- though only 15% developmentally threatened. (1% of all infants) 3) Environmental risk: young children reared with incomplete supports or compromised settings (10% of all infants) 4) Various states enroll 2-6% of all infants in early intervention programs
  1) Established risk: presence of biomedical conditions known to affect personal progress (<1% of infants) 2) Biological risk: children with a history of events that have significant potential for brain impairment or whose early functioning gives concern about development Premature infants are major component- though only 15% developmentally threatened. (1% of all infants) 3) Environmental risk: young children reared with incomplete supports or compromised settings (10% of all infants) 4) Various states enroll 2-6% of all infants in early intervention programs
• Children with MR are often in integrated classes: Special education plans: 10-20% of school children have special ed plans, most for LD, speech or language problems, 18% for MR 1990 study in 5 large school districts: of children with MR: 18% received OT or PT; 34% had counseling services; 57% had speech and language therapy
  Special education plans: 10-20% of school children have special ed plans, most for LD, speech or language problems, 18% for MR 1990 study in 5 large school districts: of children with MR: 18% received OT or PT; 34% had counseling services; 57% had speech and language therapy
• Parental roles in caring for child with MR: 1) Physical maintenance of child 2) Emotional and psychological support 3) Ensuring access to appropriate education 4) Social and recreational opportunities 5) Ensuring the transition to adulthood
  1) Physical maintenance of child 2) Emotional and psychological support 3) Ensuring access to appropriate education 4) Social and recreational opportunities 5) Ensuring the transition to adulthood
• Need of families caring for child with MR: Parent education of rights and entitlements, Financial counseling, Information on community resources, Recreational opportunities, Parent support groups, Parent training for child's health needs, Transportation, Respite care, Legal services
  Parent education of rights and entitlements, Financial counseling, Information on community resources, Recreational opportunities, Parent support groups, Parent training for child's health needs, Transportation, Respite care, Legal services
• Siblings of children with special needs: Must deal with alterations in the normalcy of family rhythm Competition for parental resources and attention, Possible misconceptions about the origins or outcome of the syndrome of the involved child, A requirement to act as a surrogate parent, An obligation to meet enhanced parental expectations, Bewilderment about parents' conflicts. May receive mixed messages about double standards on compliance and behavior and on the competency of the affected child Siblings should be: Provided with meaningful information in suitable form, Involved in decision making, Have counseling or group activity with like peers when appropriate. Majority of studies show a favorable long-range adaptive outcome for siblings. More children with MR or other DD are being adopted. MD assistance is needed both during preadoption time and in post-placement supportive services.
  Must deal with alterations in the normalcy of family rhythm Competition for parental resources and attention, Possible misconceptions about the origins or outcome of the syndrome of the involved child, A requirement to act as a surrogate parent, An obligation to meet enhanced parental expectations, Bewilderment about parents' conflicts. May receive mixed messages about double standards on compliance and behavior and on the competency of the affected child Siblings should be: Provided with meaningful information in suitable form, Involved in decision making, Have counseling or group activity with like peers when appropriate. Majority of studies show a favorable long-range adaptive outcome for siblings. More children with MR or other DD are being adopted. MD assistance is needed both during preadoption time and in post-placement supportive services.
• Transitions: Most difficult: Movement from early intervention services to public preschool at 3yr. Graduation from education services, and entitlements at 21 - into the potential for further vocational training and employment as an adult
  Most difficult: Movement from early intervention services to public preschool at 3yr. Graduation from education services, and entitlements at 21 - into the potential for further vocational training and employment as an adult
• Adolescents with mild and moderate MR: Thinking may be immature, concrete, passive-dependent, or compulsive - resulting in increased isolation and diminished self-image Emergence of sexual feelings is seldom realistically acknowledged by parents or service providers.
  Thinking may be immature, concrete, passive-dependent, or compulsive - resulting in increased isolation and diminished self-image Emergence of sexual feelings is seldom realistically acknowledged by parents or service providers.
• Youth with MR: In their search for suitable autonomy they need assisted preparations including: 1) Consent and choice (training for skills in problem solving and choice making 2) Personal life planning (exploring one's identity, aspirations and potential 3) Social support network (peer groups, peer counselors, neighbors, relative ad service providers 4) Self advocacy (learning to carry out self assistance and promotion)
  In their search for suitable autonomy they need assisted preparations including: 1) Consent and choice (training for skills in problem solving and choice making 2) Personal life planning (exploring one's identity, aspirations and potential 3) Social support network (peer groups, peer counselors, neighbors, relative ad service providers 4) Self advocacy (learning to carry out self assistance and promotion)
• Employment prognosis.: With the development of assisted employment and supported employment virtually all persons with MR can be established in gainful jobs - but this has only been achieved for a minority. A greater variety of options for community living has made transitional planning more comprehensive than in the past.
  With the development of assisted employment and supported employment virtually all persons with MR can be established in gainful jobs - but this has only been achieved for a minority. A greater variety of options for community living has made transitional planning more comprehensive than in the past.
• Severe and Profound Retardation: At most 5% of all persons with cognitive disabilities display: 1) Lack of self-care and even survival skills 2) Communication blockage 3) Deviant behavior - bizarre repetitive or stereotypic behavior, sometime self-stimulation, may have self injurious behavior 4) Serious organic pathology- usually combined disabilities and serious health issues 5) Greater system commitment for intervention 6) May have teacher confusion regarding potential.
  At most 5% of all persons with cognitive disabilities display: 1) Lack of self-care and even survival skills 2) Communication blockage 3) Deviant behavior - bizarre repetitive or stereotypic behavior, sometime self-stimulation, may have self injurious behavior 4) Serious organic pathology- usually combined disabilities and serious health issues 5) Greater system commitment for intervention 6) May have teacher confusion regarding potential.
• Prevention of MR: Provide protection and sustenance to the developing CNS- support pregnant women and young children. Include family life education in public school (in parenting skills). Provide early, high-quality and affordable prenatal care. Have regional newborn ICUs. Generously support early intervention programs. Provide a medical home with continuity of care. Provide effective services for children and families where there is disability. HOWEVER: many of the most important risk indicators are not changing appreciably (teenage fertility, racial disparity in infant mortality, preterm birth, child abuse. Successful efforts: early immunization, newborn screening with dietary management or replacement therapy, carrier screening and prenatal diagnosis, folic acid supplementation and alpha-fetoprotein screening, environmental improvement (lead), public education (Fetal Alcohol Syndrome), car seats (head injuries), genetic counseling
  Provide protection and sustenance to the developing CNS- support pregnant women and young children. Include family life education in public school (in parenting skills). Provide early, high-quality and affordable prenatal care. Have regional newborn ICUs. Generously support early intervention programs. Provide a medical home with continuity of care. Provide effective services for children and families where there is disability. HOWEVER: many of the most important risk indicators are not changing appreciably (teenage fertility, racial disparity in infant mortality, preterm birth, child abuse. Successful efforts: early immunization, newborn screening with dietary management or replacement therapy, carrier screening and prenatal diagnosis, folic acid supplementation and alpha-fetoprotein screening, environmental improvement (lead), public education (Fetal Alcohol Syndrome), car seats (head injuries), genetic counseling
• Higher rates of mental health disorders: Symptoms often confused with underlying disorder; difficult to interview; atypical presentation of symptoms eg depression; may fall into gap in services; respond differently to medication; may be unable to benefit from psychotherapy; degree of dysfunction strongly affects obtaining optimal school or vocational placement and outcome
  Symptoms often confused with underlying disorder; difficult to interview; atypical presentation of symptoms eg depression; may fall into gap in services; respond differently to medication; may be unable to benefit from psychotherapy; degree of dysfunction strongly affects obtaining optimal school or vocational placement and outcome
• Conveying the diagnosis: 1) Listen to what the parents say about the child 2) Ask parents what aspects of their child's problems bother them most 3) Review the results of the evaluation in a way that is easily understandable and unambiguous 4) Offer consistent and persistent reassurance that the condition was not their fault 5) Respect parents preference for an alternative term to MR e.g. special needs
  1) Listen to what the parents say about the child 2) Ask parents what aspects of their child's problems bother them most 3) Review the results of the evaluation in a way that is easily understandable and unambiguous 4) Offer consistent and persistent reassurance that the condition was not their fault 5) Respect parents preference for an alternative term to MR e.g. special needs
• Prognosis: Help the family prepare for the future- provide balance between not giving overly optimistic predictions and not underestimating long term potential.
  Help the family prepare for the future- provide balance between not giving overly optimistic predictions and not underestimating long term potential.