Child and Adolescent Reviewer - Stages between childhood and adulthood 4.

- Stages between childhood and adulthood 4. S-Shaped Growth – which starts and ends with rapid
- Includes mental, emotional and social maturity and growth periods separated by a long period of very little
Human Development – changes that occur between birth and at physical maturity. gain. This is the “general” type of growth.
the end of adolescence.
According to Piaget – “Psychologically, adolescence is the age As the major parts of the body, its organs and its systems develop,
 Biological when the individual becomes integrated into the society of adults, greater and greater precision of function within any one system
 Psychosocial the age when the child no longer feels that he is below the levels of becomes possible.
 Emotional his elders but equal, at least in rights”
This gradual “narrowing down” of behavior from a massive, all
Stages of Growth and Development Adolescence Characteristics inclusive pattern to several precise, limited, and relatively
independent ones has been observed all levels of analysis
 Early Childhood  A period of change
 Late Childhood  A problem age Some Common Skills in the Early Childhood Stage
 Adolescence  A time to search for identity
- Generally, babies possess common skills classified as
 A time for unrealism
Childhood – is the developmental stage of person. hand skills and play skills as discussed by Hurlock
Differences among Learners – differences between sexes are hard (1982). She also gave a detailed description of skills
 Early Childhood to identify. which the different body parts can perform among the
 Late Childhood early childhood.
- According to the studies by Fels Research Institute for
Early Childhood – refers to that stage between 2-6 years old. the study of human development, USA have helped Hand Skills
define these differences.
- Critical period Self-feeding – 8 months – babies can hold their bottles after the
- According to them, boys have a shorter span than girls.
- Rapid growth nipples have been placed in their mouths.
- Undergoes changes in pattern of intellectual Parents – tend to believe that they raise their children according to
development 9 months – they can put bottle nipples in their mouth and take
social pattern – independent boys, dependent girls.
- Emotions are easily stimulated them without any help.
- For social development, the child already develop self- Nature of Growth and Development
12 months – they can drink from a cup when they hold it with both
concept and sex role identification.
- Organic growth consists of 3 elements hands, and several months they can drink from the cup using one
Early Childhood Characteristics 1. Increase in size hand.
2. Differentiation of structure
 Problem/Troublesome age 13 months – babies began to feed themselves with a spoon, a
3. Alteration of form
month or two they can spear food with fork and carry it to their
 Toy age (psychologist)
Physical and Motor Development of the Child mouths with much spilling.
 Pre-gang stage – also called as exploratory stage
 Pre-school age (educators) Second Birthday/2 years old – most babies can use spoon and fork
- The “developmental pattern” of growth is seen in the
direction and growth rates of the individual. without too much spilling.
Late Childhood – comes at the age of 6-12 years old.
- Changes come about through different growth rates for
Self-dressing – most babies can pull their socks, shoes, caps and
- Concide with elementary schooling age from grade 1 to the different parts of the body.
mittens.
6.
- Requires major changes in pattern of intellectual Growth of Body Organs
Self-grooming – limited mainly to running a cloth or sponge over
development. the face and body. Before they are 2, most babies try to brush their
1. Positive Acceleration – a slow growth during
- Experience the age of equilibrium. hair and teeth.
childhood and then extremely rapid acceleration at
Late Childhood Characteristics puberty.
Play Skills – babies can learn to jump from an elevated position
Example: Genital Organs usually by movements resembling walking.
 Troublesome age
 Quarrelsome age 2. Negative Acceleration – rapid growth during the first Patterns of Motor Control
 Elementary school age six years of life and then a sharp slowing down such as
 Critical and gang stage Head Region
the brains and its parts.
 Age of Conformity 3. Reversal Growth – such as the lymphoid group which Eye Control – optic nystagmus or the response of the eyes to a
increases very rapidly at first, then actually decreases in succession moving objects, begins about 12 hours after birth.
Adolescence – comes from the latin word “Adolescere” which size. The lymphoid group consists of the thymus, lymph
means “to grow” nodes and intestinal lymphoid masses 3-4 weeks – ocular pursuit movements
2-3 months – horizontal eye movements
3-4 months – vertical eye movements
Several months later – circular eye movements
Smiling – reflex smiling, or smiling in response to a tactual
stimulus, appears during the first week of life; social smiling, or
smiling in response to the smile of other person, begins between
the 3-4 months.
Head Holding – babies can hold their heads erect at 1 month,
when lying on their backs, at 5 months; and when held in a sitting
position, between 4-6 months.
Trunk Region
Rolling – 2 months – babies can roll from side, 4 months from
back and 6 months, they can roll over completely.
String – 4 months sitting position, 5 months sit with support, 7
months sit without support momentarily, and 9 months sit without
support for 10 or more minutes.
Arm and Hand Region
Hands – Thumb opposition 3-4 months fingers appears to be
grasping and 8-10 months picking up objects.
Arms – 6-7 months babies can reach an object and 1 year old pick
up a small object with random movements.
Leg Region – 2nd week shifting of body by kicking, 6 months
hitching or moving in a sitting position, 8-10 months crawling and
creeping, 11 months babies can walk on “all fours”, 10 months
standing position, 11 months walk with support, 1 year stand
without support, 14 months walk without support.
Research Studies on Motor Control
- Studies have shown evidence that the development of
sitting, standing and walking is determined by growth
changes and maturational development of the neural
and muscular systems rather than practice.
Late Childhood
Physical Development
Height – the annual increase in height is 2-3 inches
Weight – increases is more variable than height
Body Proportion – although the head is still proportionately too
large for the rest of the body, some of the facial disproportions
disappear as the mouth and jaw become larger, the forehead
broadens and flattens, the lips fill out, the nose becomes larger and
acquires more shape.
Homeliness – the body disproportions, so pronounced during late
childhood, are primarily responsible for the increase in homeliness
at this time.
Muscle-Fat Radio – fat tissues develop more rapidly than muscle
tissues which have a marked growth spurt beginning at puberty.
Teeth – by the onset of puberty, a child normally has 28 of the 32
permanent teeth. The last 4, the wisdom teeth, erupt during
adolescence.
Late Childhood Skills – Hurlock (1982) classified these skills
into: self-help skills, social-help skills, school skills, and play
skills.
Self-help skills – older children should be able to eat, dress, bathe
and groom themselves with almost as much speed and adeptness as
an adult.
Social-help skills – skills In this category relate to helping others.
This includes making beds, dusting, etc.
School Skills – the child develops the skills needed in writing,
drawing, painting, clay modeling, dancing, crayoning, sewing,
cooking and woodworking.
Handedness – most children are so pre-dominantly right-or-left
handed that changing handedness is far from easy. Doing so must
be with caution and only under conditions.
The Adolescent
Physical Development – at puberty, alteration in growth rate
occurs. Some of these changes are common to both sexes, but most
are sex specification.
- Girls generally reach puberty ahead of boys.
- They embark on the adolescent growth spurt at an
average of 10% as against 12 ½ for boys.
- Although the intensity and duration of this spurt vary
widely from one youngster to another, it usually lasts
for 2 to 2 ½ years in both sexes.
- Though the growth spurt begins earlier in girls, it is
during this period that boys outstrip them in
development.
Height and Development - in childhood, boys and girls of the
same age practically the same height.
- Boy grows approximately 8 inches taller and adds 45
pounds to his weight, at its peak, about 14 years of age,
he is growing at the rate of 4 inches a year.
- Girls gain about 6 and a quarter inch in height and 35
pounds in weight during this spurt. This peak comes
sooner, at about 12, when their rate of growth averages
3 and a quarter inches a year.
Muscular and Skeletal Dimension – practically all skeletal and
muscular dimensions take part within the spurt in puberty though
not to an equal degree. Every muscular and skeletal dimension of
the body seems to take part in the adolescent spurt.
Facial Contour – the whole profile becomes more angular, the
forehead more prominent, the chin more pointed, the nose longer.
Strength – in both sexes, strength increases, although increase is
proportionately much greater tin boys than girls.
- Before puberty, most girls can hold their own tussles
with boys of the same age. But this is no longer so after
the growth spurt.
Difference in Growth Rate - growth may continue although
slowly, for many years after adolescence though imperceptibly.
- On the average, boys reach 98% of their final height by
the time they are 17%, girls by the time they are 16%.
- These statistical and descriptive summaries of the
adolescent spurt, oversimplify what is in fact a rather
complicated process.
Disadvantages of Late Growth – differences in individual rates of
growth can create social and psychological difficulties.
Abnormal Development – in some human beings, the most
important growth-controlling gland, the pituitary, functions
abnormally. The results are startling and most often tragic. The 2
extremes human stature are giantism and dwarfism, and while
other factors are sometimes involved, the usual cause of these
abnormalities is the production by the pituitary of too much or too
little of its growth hormone.
- 2 methods are usual to its treatment: surgical removal
of the pituitary, and the use of radiation to slow its
activity.
Brain Development
The Brain – the brain is the portion of the central nervous system
within the skull composed of a three- pound mass of pinkish-gray
tissue of about 10 million nerve cells.
- Control center for movement, sleep, hunger, thirst, and
virtually every other vital activity necessary to survival.
- All human emotions, including love, hate, fear, anger,
elation and sadness are controlled by the brain.
The Brain Before and at Birth – brain development in the fetus is
far enough by the 4-month-old that 3 major regions of the brain.
The medulla, cerebellum and cerebrum are clearly separate.
- By the middle of 6 month, a dent like fissure appears on
the surface of the cerebrum which will mark the border
 between the centers of sensation and voluntary muscle
control.
- At birth, a baby’s brain contains 100 billion neurons,
roughly as many nerve cells as there are stars in the
Milky Way.
- During the first years of life, the brain undergoes a
series of extraordinary changes.
Anatomy and Composition of the Brain
The Brain Stem – usually refers to all structures lying between the
cerebrum and the spinal cord, that is, the diencephalon, midbrain,
pons, and medulla.
The Cerebrum – is the largest part of the human brain.
- Its large surface area, the cortex, and the intricate
development account for the superior intelligence of
human compared with other animals.
The Cerebellum – cerebellum lies in the posterior, or hind part of
the cranium, underneath the cerebral hemisphere.
- Essential to control of movement of the human body.
Thalamus – it is the crucial relay station for incoming sensory
signals and outgoing motor signals passing to and from the
cerebral cortex.
Hypothalamus – regulates or is involved directly in the control of
many of the body’s vital activities and drives that are necessary for
survival: eating, drinking, temperature regulation, sleep, emotional
behavior, and sexual activity.
Pons – located between medulla and midbrain, the pons is directly
in front of the cerebellum.
Medulla Oblongata - situated between the spinal cord and pons,
the medulla actually is a pyramid-shaped enlargement of the spinal
cord.
Limbic System – collectively, portions of the thalamus,
hypothalamus, hippocampal formation, amygdala, caudate nucleus,
septum, and mesencephalon make up functional unit of the brain
called the limbic system.
Cerebral Cortex – brain’s outer layer of gray matter about 3-4
millimeters thick.
- Just behind the central fissure is the somatosensory
area, sensations such touch and taste are processed here.
- The area of the cortex concerned with hearing, the
auditory area, is in the upper or superior convolution of
the temporal lobe; the area of seeing.
- The visual cortex, is in the hind portion, or occipital
lobe; and the area of smell, the olfactory are, is located
in the front, internal portion of the temporal lobe.
- A large part of the human cortex, the frontal area, is
used for awareness, intelligence, and memory.
Neuroscientists are actively studying the cellular mechanisms
by which nerve cells store memories. These are their theories
(Nash, 1988):
1. A change occurs in the ribonucleic acid (RNA) in the
cells of the cortex to code the memory trace in the brain
protein material.
2. Peptides (hormonlike substances) in the brain are
activated as an event is being stored as a memory.
3. Neurotransmitters (chemicals that relay nerve impulses
between two or more neurons) are altered as impulses
are stored.
Brain Development is the most sensitive part of fetal growth.
The Endocrine Glands
The Pituitary Gland – the pituitary is predominant. Its interior
lobe serves as a compact field headquarters for all gland action
aimed at growth.
- Most of the anterior-lobe secretions are “tropic”
meaning nourishing hormones.
Thyroid – is a butterfly-shaped mass of tissue near the base of the
neck. It secretes at least two major hormones, very similar
structure and effects to one another.
- Testosterone released in bloodstream causes sudden
increase in height and weight.
- In girls, pituitary hormones stimulate the production of
the progesterone and estrogen by the ovaries.
Adrenal Glands and the Gonads – the 2 adrenal glands cap the
kidneys while the gonads are the base of the torso.
- At puberty, when the final stage of growth begins, the
adrenals and gonads become active with dramatic
suddenness.
Adolescent Feeling - all these dramatic physical occurrences are
bound to affect the adolescent feelings about himself or others.
Researches Related to the Brain
- Scientists have found that the brain during the first year
of life is so malleable that very young children who
suffer strokes of injuries that wipe out an entire
hemisphere can still mature into highly functional
adults. Moreover, it is becoming increasingly clear that
well-designed preschool pro- grams can help many
children overcome glaring deficits in their home
environment.
Factors Affecting Development
Maternal Nutrition - Maternal weight gain during pregnancy
results from a variety of factors, including maternal dietary intake,
pre-pregnancy weight and height, length of gestation, and size of
fetus. The mother’s pre-pregnancy weight and height are in turn, a
consequence of her genetic make-up, past nutritional status, and
environmental factors.
- During pregnancy, the need for calories and nutrients
such as protein, iron, folate, and other B vitamins is
increased to meet the demands of the fetus as well as
the expansion of maternal tissues that supports the
fetus. The nutritional needs of the fetus are second only
to the needs of the mother’s brain. Thus, it is important
for a pregnant woman to have a well-balanced
nutritious diet to meet the changing needs of her body
and her fetus.
Avoiding Drugs and Other Environmental Hazards
- In addition to the food the mother eats, the drugs she
takes and the chemicals she is exposed to affect the
fetus. Everything the mother ingests may eventually
reach the fetus in some proportion.
Alcohol - Alcohol is a potent teratogen. A high level of alcohol
consumption during pregnancy is associated with miscarriages,
still births, and in live babies, fetal alcohol syndrome (FAS).
Tobacco -Smoking during pregnancy increases the rise of
miscarriage, low birth weight and infant death. If nicotine levels in
a mother's bloodstream are high, fetal breathing rate and
movement become more rapid, the fetus may also metabolize
cancer-causing by products of tobacco.
Caffeine - It puts both mother and fetus under stress by raising the
level of the hormone epinephrine. Caffeine also reduces the blood
supply to the uterus. Coffee, colas, strong black tea, and chocolate
are high in caffeine. A pregnant woman should limit her caffeine
intake to no more than the equivalent of two cups of coffee per
day.
Child Nutrition
Lactation - The production of milk begins about 3 days after
childbirth. Prior to that time (sometimes as early as the second
trimester) colostrum is secreted by the nipples. Colostrum contains
antibodies and helps protect the newborn from infectious diseases
and is also high in protein.
Breastfeeding - is also beneficial to the mother. First, it stimulates
contractions that help the uterus to return to normal more rapidly.
Second, it contributes to post pregnancy weight loss. Third, it may
reduce the risk of ovarian cancer, early breast cancer, and
postmenopausal hip fracture. Fourth, nursing also provides a sense
of close- ness and emotional well-being for mother and child.
Micronutrient Deficiencies
Iron. Evidence on the effects of iron deficiency on preschoolers
and older children is clear. Children with iron deficiency scored
lower on cognitive tests and per- formed less well on school tests.
Iron supplementation led to significantly improved performance on
measures of overall intelligence and on tests of specific cognitive
processes among iron-deficient children
Iodine. Maternal iodine deficiency in early pregnancy and
associated with thyroxine deficiency impair the development of the
fetal central nervous system and can result in cretinism in the child.
Zinc. In stunted school-age children, no differences were found
between groups varying in zinc status, or within groups in response
to some supplements, in scores on standardized tests of attention.
Vitamin A. This vitamin, essential before protein can be
synthesized, is required by every cell in the body, including each
cell in the brain. Vitamin A prevents infections by keeping cell
walls so strong that viruses and bacteria cannot penetrate the
tissues and by enabling the cells to secrete a mucus which contains
virus and bacteria destroying enzyme, lysozyme.
Vitamin A. deficiency can cause the skull to stay underdeveloped
that room for the brain is limited. Vitamin A deficiency can result
to night blindness, respiratory infection, diarrhea, cessation of bone
growth and paralysis resulting from brain and nerve damage.
Vitamin B. All the vitamins in the B group are essential, as part of
the enzyme system and to every cell in the body. They help in
producing energy; in utilizing fats, carbohydrates, and proteins;
and in preventing cholesterol from clogging the baby's arteries.
Vitamin C. The advantages of using vitamin C generously are
almost endless: it protects the child from anemia, allergies, and
infections; decrease the need for B vitamins by stimulating growth
of intestinal bacteria; reduces the harm done by drugs, food addi-
tion nitrates, and other foreign substances reaching the blood; and
speeds up recovery from almost any type of illness.
Vitamin D. When Vitamin D is adequate, protein produced in the
intestine car- ries calcium into the blood, thus allowing the normal
development of bones and of well- spaced decay-resistant teeth.
Vitamin D also increases the absorption, retention, and utilization
of magnesium as well as calcium and throughout it decreases the
loss of both minerals in urine and feces. Without vitamin D rickets,
a bone disease, is produced by the time a baby is 3-6 months old.
Vitamin E. Blood analyses show that all newborn infants are
extremely low in vitamin E. As a result, the essential fatty acids in
the walls of the red blood cells which are exposed to larger
amounts of oxygen and cells elsewhere in the body break down to
such an extent that an anemia known as hemolytic anemia is often
produced in the first days of life.
Vitamin K. Deficiency of vitamin K which prevents blood from
clotting and causes hemorrhage are common in new born infants.
One cause of cerebral palsy, for example, bleeding of the brain or
spinal cord is deficiency in Vitamin K.
Researches Related to Child Nutrition
In summary, there is convincing evidence that general
undernutrition and iodine and iron deficiency can impair
behavioral and cognitive development. Iodine deficiency has its
maximal effect in the utero, while that of iron deficiency and
general undernutrition is greatest in the early postnatal period.
These effects, however, are no longer believed to be limited to the
phase of maximal brain growth or to be mediated exclusively
through neuro-anatomical structural changes.
EARLY SENSORY STIMULATION
Much of the baby's activity in his first weeks of life is reflexive.
For instance, when you put your finger in his mouth, he doesn't
think about what to do, but sucks by reflex. When confronted by a
bright light, he will tightly shut his eyes, because that's what his
reflexes make him do. He is born with many of these automatic
responses, some of which remain with him for months, while
others vanish in weeks.
Sucking is another survival reflex present even before birth. If an
ultrasound test was done during pregnancy, the baby could be seen
sucking his thumb. After birth, when a nipple (either breast or
bottle) is placed in the baby's mouth and touches the roof of his
mouth, he automatically begins to suck.
Moro reflex Another more dramatic reflex present during these
first few weeks.
Neck reflex You may notice that when the baby's head turns to one
side, his arm on that side will straighten, with the opposite arm
bent, as if he's fencing.
Stepping He can not support his own weight, of course, but if you
hold him under the arms (being careful to support his head as well)
and let his soles touch a flat surface, he will place one foot in front
of the other and "walk". This reflex will disappear after two
months, then recur as the learned voluntary behavior of walking
toward the end of the first year.
Physical Stimuli and the Senses
We usually are familiar with the world we perceive and its
dimensions such as: space, time, structure, object, movement,
change, expression, and power qualities. These basic features are
found in the perception of all people because we have similar
nervous system; because we are exposed to physical environments
with many main features in common; and because we must all
meet basically similar problems.
Physical energy that can excite a receptor and thus produce an
effect on the organism is called a stimulus. If the energy fails to
produce an effect, it is not properly called a stimulus. Persons react
to certain stimuli - visual, auditory, cutaneous, and olfactory.
Visual Perception
The Human Eye. The human eye consists of an eyeball enveloped
by a tough skin called the sclera. It is white and opaque (the white
of the eye), except in one area, the cornea, where it is clear and
transparent.
Auditory Perception. The stimulus for hearing is, of course, the
sound waves. When a sound wave enters the outer ear, a series of
events is set off which eventually lead to an auditory perception.
The ear consists of three parts: the outer ear, the middle ear, and
the inner ear.
a) The outer ear includes the auricle and the ear canal.
Separating the ear canal from the middle ear is a thin
membrane, the eardrum.
b) The middle ear, the area between the eardrum and the
inner ear, contains three little bones, ossicles, forming a
chain from the eardrum to the window of the inner ear.
c)The inner ear consists of two parts, the vestibular apparatus and
the coiled, divided, fluid-filled tubes, the cochlea. One end of the
cochlea is closed off by the third ossicle at the oval window and
the other end by a thin membrane at the round window.
Perception of Taste and Smell
The senses of vision and hearing (the primary senses for the
perception of space) are probably the most important senses for
man, since he is a spatial animal.
Taste. The receptors for taste are mostly concentrated in certain
areas of the tongue. But they are also found in the mucous
membrane of throat, larynx, and soft palate.
Smell. There are two outstanding attributes of smell which merit
particular attention:
1) its sensitivity and,
2) its rate of adaptation. The sense of smell is exceedingly
sensitive. In terms of the concentration of molecules necessary to
stimulate the receptors it has been estimated that the sense of smell
is 10,000 times as sensitive as taste (Krech & Crutchfield, 1958).
The Skin Senses. The sensations of touch, temperature, pressure,
and pain are thought of as originating from receptors in the skin,
and are, therefore, called cutaneous (skin) sensations.
The skin is liberally supplied with sensory cells. The fibers from
the various skin receptors travel to the brain. Experiments and
clinical observations clearly show that when the fibers from the
skin receptors are cut (as in an accident or deliberately), sensa-
tions from areas of the skin served by those fibers disappear; we
can no longer feel touch, heat, pain, tickle, or wetness.
The Child's World of Perception
Though every adult has passed through the world of childhood, he
ordinarily finds it hard to remember how different the world
looked to him as a child. This is due, in part to the continuous
process of growth and development of the individual, involving
many slight, hardly noticed, step-ty-step changes in his world.
Body and Child's World. To start with the simplest fact, the much
smaller physical body of the child affects his perception of the
environment. We, adults, have con- structed our surroundings to
accommodate our own bodily needs, and since the child views
things from a much lower height, many physical objects around
him loom larger, more imposing, and less within reach.
Boundaries of a Child's World. The world in which the child lives
is narrower in scope than that of the adult. The boundaries of space
and time are much less extended. His world is here and now, rather
than there and then. When he sees it raining here, it is "raining
everywhere in the world".
Organization of a Child's World. With the child's more restricted
span of what can be taken in at one time, the simultaneous
perception of parts and wholes is limited. The child may lose much
of the richness of detailed structure by attending only to the main
features of the whole.
Physiognomic property in the Child's World. Expressive and power
qualities of objects and events seem to play a relatively greater role
in the child's perceptions than in the adult's. Such qualities are
often uppermost for the child. The triangular shape may look
"jagged, sharp, and hurtful" before it looks "triangular".
The child's perceptual world may seem to suffer by comparison
with the adult's but there are compensatory values. The very
absence of complete objectivity and "real- ism", and the sensitivity
to the influence of physiognomic qualities, are such as to pre- serve
a freshness and a spontaneity in the child's view of the world. It
has been noted that often the mark of a truly great and original
person, whether he is an artist, scientist, inventor, or entrepreneur
is that he has somehow retained as an adult much of the fresh- ness
and spontaneity of the "childlike" perception of the world.
EXCEPTIONAL DEVELOPMENT
Physical and Sensory Disabilities
It is natural for parents to compare their children with others.
When a neighbor's child can walk at 10 months, and a parent's
child could not even crawl at the same age, worry creeps in.
Usually, however, such differences are not significant. Each baby
has his own unique rate of development, so some learn skills faster
than others.
Types of Developmental Disabilities
Children with developmental disabilities show significant
difficulties in one or more of the following areas: cognition, speech
and language, motor skills, vision, hear- ing, emotions and
behavior, and self-help skills (American Humane Association,
1991). 67
Accurate diagnosis, careful assessment, and appropriate medical
management are important in helping parents, caretakers,
educators, and health personnel to work together effectively on
behalf of a child with a handicap.
Seven types of disability are described here: mental retardation,
visual impairment, hearing impairment, cerebral palsy, language
problems, learning disabilities, and attention deficit disorder.
1. Mental retardation is identified under the following
conditions: a person has intellectual functioning that is
more than two standard deviations below the norm; be-
cause retarded as a result of injury, disease, infection,
chromosomal abnormality, con- genital syndrome, or
other problems that existed before age 18, is impaired
in his ability to adapt to the environment. Attainment of
developmental stages is slowed and depen- dency is
prolonged.
a. Causes of some incidence of mental retardation are
sometimes unclear.
b. Intellectual impairment and capacity:
(1) Mild retardation - IQ scores 55 to 69, adult capacity 8-11 years
old;
(2) Moderate retardation - IQ scores 40-54; adult capacity 5-7
years old;
(3) Severe retardation - IQ scores 25-39; adult capacity 3-5 years
old;
(4) Profound retardation - IQ scores below 25, adult capacity, less
than 3 years old.
c. Degree of eventual independence and lifestyle in adulthood
vary widely:
(1) Mild retardation. Many individuals achieve economic and
social indepen- dence with equivalent of up to fourth grade
educational skills. Approximately 80 per- cent marry normal IQ
spouses and have children with normal to near normal intelligence.
Most males are employed in unskilled labor occupations and most
females in domestic or service roles.
(2) Moderate retardation. The majority of individuals attain
independence in self-help skills and many are capable of living in
supervised group homes or apartments and doing routine tasks in a
sheltered work setting. Few marry.
(3) Severe and profound retardation. As a group, they require
life-long care or a high level of assistance, structure and
supervision. Some may achieve some level of independence in
basic self-help skills such as dressing, feeding and toileting.
Treatment of mental retardation is best provided as a
multidisciplinary effort to maximize the child's abilities and
potential.
(1) Mental retardation has no cure.
(2) Treatment planning should include educational, psychological,
physical, and behavioral aspects of the child's life; and impact of
other deficits associated with retardation, e.g. seizure disorders,
visual defects, speech disorders, etc.
(3) Physical as well as cognitive and adaptive status needs to be
considered when setting goals.
(4) Medication may be needed for a small portion of this group to
facilitate learning, control hyperactivity, decrease self-injurious
behavior, or suppress other behaviors.
Visual Impairment and Legal Impairment
(a) Incidence of blindness in children is 0.4/1000; with 46 percent
of this group born blind and 38 percent losing their sight prior to
age one (American Humane Associa tion, 1991).
(1) Approximately 25 percent are totally blind.

(2) Approximately 25 percent have some light perception.
(3) Approximately 50 percent have enough vision to read enlarged
type.
(b) Causes of blindness in children are numerous:
(1) Prenatal viral infection and eye malformations are
the most common congenital causes.
(2) Trauma, infection, tumors, and retinopathy or
prematurity are
(c) Developmental differences are seen in blind children even
when blindness is an isolated finding and intelligence is normal.
(1) Infants display abnormalities in eye movement-random, jerky
movements, neither focusing on nor following objects. Baby does
not blink or cry to a threatening gesture. Pupils do not constrict
when light is shone in the eyes.
(2) Muscle tone is floppy and gross motor skills are delayed. Most
blind children do not crawl. Sitting may not occur until after eighth
month. Walking may not occur until two years to two and one-
halfyears.
(3) Speech and language development is delayed, but usually
normal by school age.
(4) Unusual behaviors may be seen e.g. rocking, eye gouging, light
gazing and head banging. Behaviors can be controlled with
behavior modification techniques. Behaviors decrease by age four
in normal intelligence children, but often persist in deaf-blind and
mentally re- tarded-blind children.
(d) Outcome may be very positive depending on intellectual
functioning and absence of other disabilities. Technical or
vocational training is generally available in the public school
secondary curriculum. Students with at least average intelligence
should be encouraged to pursue college and a professional career.
(e) Early treatment involves extra stimulation through the infant's
primary means of exploring, e.g. touch and sound. Parents need to
do lots of explaining and describing, not become overly
discouraged by slow motor development, avoid overprotection and
provide lots of touching and physical affection.
(f) By school age the child may need to learn to read braille or use
large-type materials. Supplemental aids such as a volunteer reader,
talking computer adaptations, opticons, and computerized
operation of appliances may also be beneficial.
(g) Mobility training needs will vary with the type and degree of
visual impairments. Walking aids such as seeing eye dog, cane, or
sonar-guided obstacle device may be used to promote
independence. 70
Hearing Impairment
Hearing impairment occurs when some part of the hearing
apparatus malfunc tion with resulting hearing loss and possible
impairment or loss of the ability to speak.
(a) There are three types of hearing loss:
(1) Conductive-resulting from damage to external or middle ear
(2) Sensorineural-results from malfunctioning of the cochlea or
auditory nerve.
(3) Mixed-resulting from both sensorineural and conductive prob
lems.
(b) Hearing loss is also categorized by severity.
(1) Mild hearing impairment means a child can hear sounds that
are 15 to 45 decibels.
(2) Moderate hearing loss means a child can hear sounds if they are
at least 45 to 70 decibels.
(3) Severe hearing loss means that sounds must register at least 70
to 90 decibels to be heard.
(4) Profound hearing loss means that sounds must be at least 9
decibels to be heard.
(c) Hearing losses may be bilateral, involving both ears, or
unilateral, present in one ear. Less than 20 percent of hearing
losses are unilateral.
(d) Causes of hearing loss in children include middle ear
infections, other infections, cleft palate, Down's syndrome, genetic
or chromosomal abnormalities, and noise pollution. In
approximately half the cases, cause can not be determined.
(e) Communicative functioning varies as a factor of the degree of
hearing loss
(1) Mild hearing impairment: speech and conversational skills are
normal, difficulty hearing distant sounds.
(2) Moderate hearing loss: ability to speak clearly is affected
(articulation), ability to hear conversation is significantly limited.
(3) Severe hearing loss: child cannot participate in spoken
conversation, but may catch an occasional word. Hearing aids are
most often useful with this group. (4) Profound hearing loss: child
may react to very loud sounds, but hearing ability not useful for
communication. Hearing aid may help. Usually not able to
speak/articulate normally.
(f) Long-term outcome is determined by factors which include
severity of loss, and presence or absence of other disabilities.
(1) Children with conductive losses often grow up to attend
college, have professional careers, communicate verbally, and
understand speech with help of a hearing aid.
(2) Children with moderate-to-severe sensorineural losses rarely
speak unless the loss occurs after child has already attained speech,
e.g. after age three. Communication and language-based reasoning
are negatively affected. Deaf children may do well in mathematics
and science, but even children with above average intelligence,
reading skills rarely exceed sixth grade level by high school
graduation.
(g) Treatment approaches are designed to improve hearing and
speech language skills to the maximum extent possible for each
child.
(1) Hearing aids amplify sound to increase the range of sound a
child can hear from 10 to 80 decibels. Ear level aids are more
commonly used than more bulky body level aids.
(2) Preferential seating in the front row of the classroom facilitates
lip reading from the teacher.
(3) Oral and manual communication techniques are available and
decision as to which to emphasize is mostly made on the basis of
the child's potential to develop understandable speech. Decision is
often controversial.
(4) "Total communication" approach helps each child learn to use
whatever combination of techniques is most effective. Language
pro- gram may include combinations of the following: hearing
aids, sign language, finger spelling, lip reading, and automated
communication devices with or without oral speech.
Cerebral palsy refers to various disorders of movement and
posture that are d to damage/ abnormality of the immature brain.
This condition occurs before the child's brain has fully matured
(about 16 years) and it is not progressive. This disability does no
have a cure.
(a) Cerebral palsy may be classified into three groups.
(1) Pyramidal or spastic cerebral palsy involves increased muscle
tone which gives way abruptly. Abrupt changes in muscle tone
interfere with initiating normal movement.
(2) Extrapyramidal cerebral palsy is most commonly
choreoathetoid type and involves problems controlling movement
and maintaining posture because of abrupt involuntary movement
of the arms and legs.
(3) Mixed-type cerebral palsy involves elements of the two forms
de- scribed above. This type often involves extensive brain damage
and is thus usually associated with other developmental disabilities
such as mental retardation.
(b) There are many causes of cerebral palsy. In 60 percent of cases,
there is an identifiable cause, but in 40 percent of children no cause
is identified.
(c) Newborns in the following high-risk groups are more likely
than other infants to have cerebral palsy: premature babies, twins,
small for gestational age babies.
(d) Developmental and behavioral differences are often seen early.
(1) Infants with cerebral palsy may experience excessive sleep,
irritability, poor suck, weak cry, poor alertness to environment,
floppy resting position or arched, extended position in bed.
(2) During the first year, intellectual development may be normal,
but motor development is not.
(3) Primitive reflexes persist and interfere with normal movement
and posture, e.g. walking, sitting, etc.
(e) Many children with cerebral palsy also have other disabilities.
(1) Mental retardation is seen in approximately 60 percent of
individuals with cerebral palsy; most commonly with spastic
quadriplegia, extrapyra- midal and mixed-type.
(2) Normal intelligence is found in most children with hemiplegia
and some with spastic diplegia.
(3) Visual problems are commonly seen: retinopathy of
prematurity, in- ability to see out of one part of visual field, visual-
perceptual interferences to academic learning, strabismus, or
squint. Incidence is approximately 40 percent.
(4) Hearing, speech, and language occur in approximately 20
percent of these children: hearing loss, articulation problems,
language disorders, and difficulty with tongue and vocal cord
movement.
(5) Seizure disorders develop in approximately 30 percent of
affected children.
(6) Emotional and behavioral disorders are common. Hyperactivity
and self-injurious behaviors as well as psychosocial adjustment
problems for the child and family may develop. Adolescents with
normal intelligence have a particularly difficult time.
Language Problem
Language problems can be classified as language delays or
language disorders. Language or communication disorders are
diagnosed when a child's speech, verbal expression, and/or
understanding of language are significantly less well developed for
his age than his other abilities.
a Incidence of speech disorders is less than five percent of all
children. This includes articulation problems, stuttering, and voice
defects. Causes include prematurity. birth trauma, serious
infections, chromosomal abnormalities, and genetic disorders.
Speech disorders can occur in isolation in otherwise normal
children or be associated with cerebral palsy, cleft palate, mental
retardation, or traumatic brain injury.
(b) Diagnosis of speech-language problems is made by a
speech language pathologist.
(c) Treatment approaches are designed to meet the child's
individual needs.
(1) Speech-language therapy is provided by a speech language
pathologist, Parents and teachers may also help to carry out
specific practice exercises, model appropriate language, or offer
experiences to stimulate language development.
(2) Alternative communication methods are helpful for the child
with severe impairments. Computer assisted speech,
communication boards, and manual signing are examples.
(3) For school-age children, treatment is most effective when it is
integrated with the child's educational program.
(4) Language problems also show improvement; but children with
these problems often need special assistance in reading, written
language, and other language related school areas.
Learning Disabilities
Learning disability is broadly defined as a disorder in
which children with average or above average cognitive
ability demonstrate significantly lowered achievement
in reading, spelling, written language, mathematics,
and/or language skills. The discrepancy between actual
and expected achievement is not the result of lack of
educational opportunity, emotional disturbance,
physical disability, or health impairment.
(a) Incidence of learning disabilities is approximately 10-15
percent of school age children. Specific reading and written
language disorders (dyslexia) are more common than specific
mathematics disorder (dyscalculia) or hand writing disorder
(dysgraphia).
(b) Learning disabilities are thought to be caused by differences in
neurological processing. These differences are often also seen in a
member of the child's extended family. Learning disabilities may
also occur in children with specific chromosomal disorders
(Fragile X, Turner's syndrome), following traumatic brain injury,
or a history of recurrent ear infections.
(c) Children with learning disabilities often experience lowered
self-esteem, anxiety, depression, and behavior problems because of
their disappointing school performance.
(d) Diagnosis of learning disabilities is done in a school or clinical
setting.
(1) Information about the child's developmental status,
educational history. cognitive abilities, language skills,
perceptual abilities, and academic achievement are
gathered by a team which may include a psychologist,
educational diagnostician or learning disabilities
specialist, speech-language pathologist, classroom
teacher, social worker, and other health professionals as
appropriate.
(e) Treatment approaches for learning disabilities are designed to
meet the individual learning needs of each child. In the school
setting these are specified in an Individual Education Plan.
(1) Learning disabilities are not "cured". Children can
be taught more effectively with particular methods, and
some difficulties are more or less disabling as the child
matures, but the underlying deficits persist throughout
the child's school years and into adulthood.
Attention Deficit Disorder (ADD) and Attention Deficit
Hyperactivity Disorder (ADHD)
Attention Deficit Disorder (ADD) and Attention Deficit
Hyperactivity Disorder (ADHD) are thought to be neurochemical
disorders that interfere with attention. Children with either of these
have a difficult time paying attention to the task at hand and are
easily distracted by any stimuli around them. Most children
identified as ADD are also hyperactive and restless (ADHD), have
poor impulse control, and are prone to outbursts of anger and
aggression. Often they are emotionally labile and immature, and
are resistant to discipline.
(a) ADD and ADHD affect five to 10 percent of school-
age children. ADHD is significantly more prevalent
than ADD, although the higher incidence of ADHD
may be due in part to the fact that parents and teachers
recognize it more frequently than ADD alone. Boys
with ADD are much more likely also to be hyperactive
than girls with ADD are. For many children,
 hyperactivity symptoms diminish in adolescence but
the attentional deficits persist into adulthood causing
disappointing school performance and poor vocational
adjustment if untreated.
(d) ADHD and ADD are not synonymous with learning
disability although some children experience both
ADHD and ADD children who are not learning
disabled may achieve academically, at or close to grade
level, but perform poorly in the classroom and not
complete homework. Among learning disabilities,
reading disorders and poor communication skills are
highly associated with ADD.
Behavior Management of ADD/ADHD
Management and treatment of ADD and ADHD children may be
both environmental and pharmacological.
(1) Environmental management occurs both in school and at home.
Structured, low stimulus environments and predictable routines are
critical Individualized attention with unequivocal directions and
immediate concrete rewards and consequences are helpful. Since
many ADD and ADHD children do have learning disabilities, they
also benefit from individualized educational planning
(3) Individual group psychotherapy may also be helpful for
developing self-awareness, relationship skills, and improving the
self-esteem of children who have experienced chronic school
and/or peer group failure.
(4) Metacognitive strategies for monitoring attention, persistence
and on task behaviors can also be taught in individual therapy
sessions or by specially trained school personnel.
De Harlan Gephart, former medical director of the Center for
Attentional Deficit Disorders in Redmont, Washington said that
children with AD/HD may exhibit any or many of the following
symptoms:
(1) restlessness as evidenced by fidgeting with hands or
feet
(2) leaving his seat when remaining seated is expected
(3) running about or climbing when remaining seated
(4) being "on the go" or often acting as if "driven by a
motor
(5) blurting out answers before questions are completed
(6) difficulty waiting for his turn
(7) interrupting or intruding on others' conversations
and/or activities
(8) not paying attention to details or making careless
mistakes
(9) difficulty paying attention to what needs to be done
(10) seeming not to listen when spoken to directly
(11) not following through when given directions, and
failing to finish activities
De Gephart cited studies indicating that AD/HD remains a lifelong
condition and that if left untreated, adults with AD/HD are at
higher risk for substance abuse. Among untreated students with
AD/HD, 35 percent drop out of school and 46 percent are ex \
pelled from school. However. Dr. Gephart stressed that AD/HD)
can be managed: "The key, "he said. "is early intervention."
Sandy Malone Long, counselor and psychologist in the Bellevue
Washington School District, talked about working with schools
and emphasized the importance of parent advocacy (cited in PDI,
2005). She said that once a child is diagnosed with AD HD, the
parents would plan for a multiple meeting with the physician, the
teachers and the guidance counselor The teachers are informed of
the diagnosis and possible interventions and accommodations are
discussed. Acceptable interventions include seating the child in the
least distracting area of the classroom, setting up a reward system
for desired behavior and the administration of medication while in
school Malone-Long stressed that parents should establish strong
working partnerships with teachers ensuring continuing
communication and that goals are being achieved.
Award-winning educator, author and lecturer, Sandra Rief, MA
(cited in PDI. 2005) described and demonstrated teaching
strategies for helping AD/HD children. She
explained that children succeed in school by modifying
curriculum, teaching method resources, and learning activities. She
also advised parents to explain to their children their condition.