Cognitive Development

Intellectual development depends on learning that involves three elements: the attention, information processing and memory (which includes both the encoding and retrieval of information). Intellectual development is reflected in the promotion of capacity to understand, reason and make judgments. The standardized intelligence tests measure general intelligence two forms of school-age children: verbal and performance (or non-verbal). These standardized tests are not available to measure intelligence infant. How then, can we recognize the attributes of intelligence verbal and non-verbal in infants? Over the past two decades, the discovery of visual habituation techniques for assessing the infants' attention was seen as a breakthrough in the study of infant cognition. It is illustrated by a study that describes 4-day-old infants to listen in a long series of "see-bee-lee" sounds. When a novel is "yes" sound is heard, the children responded with a change in heart rate and faster, stronger sucking on a pacifier, indicating that very young infants can perceive differences in vowel sounds.

More complex studies using simultaneous visual and auditory stimuli also indicate that infants are able to organise perceptions across sensory modalities (cross-modal matching), without the language skills to describe them. For example, 11 months, infants were presented in a sequence of continuous pure tones and interrupted. Two photos were in the infant view throughout the experiment: one contains a continuous line, the other a dotted line. Infants always correspond good visual stimulus to the hearing, inferring cross-modal matching and some rudimentary understanding of the concept of interruptedness. The use of these techniques, it has been shown that infants less than 1 year can form a wide range of categorical representations quite complex, including the faces, colors, geometric shapes, and the orientation of lines.

Attempts to measure the responses of infants, such as those described above, rely on sophisticated technologies, including infrared photography to monitor eye gaze and child pupillary dilation, video facial reactions, and electrophysiological monitoring in heart rate and evoked potentials. The primary pediatrician can best estimate infant intelligence by assessing problem-solving and language milestones. Language is the best indicator of intellectual potential, problem solving is the best measure. Their gross motor development less correlated with the cognitive potential, most children who are diagnosed with mental retardation later walk at the time.

RED FLAGS IN MOTOR DEVELOPMENT

It is important to start the engine to the assessment by observing the infant. Pay special attention to the hand; fisting persistent at the age of 3 months is often the earliest indication of the neuro-motor dysfunction. Spontaneous postures (eg, froglegs and scissoring) to provide visual cues to hypotonia / weakness and spasticity hypertonus, respectively. Delays in thea ppearance of postural responses announce the future delays in motor development voluntary. A baby is unable to sit or walk independently, without intact mechanisms for the protection and balance. Models of movement may indicate abnormal pathology. For example, in early turnover (1 to 2 months), firing directly into a booth at 4 months (instead of a sit), W-sitting, bunny hopping, and persistent toe walking may indicate spasticity. Hand domination before the age of 18 months should encourage clinicians to consider the contralateral upper extremity for weakness associated with hemiparesis.

Analysis of the information collected in these areas, it is relatively easy for the clinician to reassure himself (and parents) about a child's motor and identifying those motor skills at an early age. When a discrepancy engine has been identified, further evaluation of its exact nature and the cause is essential. This ensures almost always return to a team subspecialist or subspecialty. Based on the clinical examination and history, the usually astute clinician may decide which category falls the engine trouble: 1) static central nervous system disorders, 2) progressive diseases, 3) and spinal nerves Peripheral injuries, or 4) the structural defects.

FINE MOTOR DEVELOPMENT

In the first year of life, development of fine motor skills is highlighted by the evolution of a clamp seized. During the second year of life, the child learns how to use objects as tools for functional play. There are many steps in the realization of these two powers, some of them are illustrated in Exhibit 2GB. Earlier this month, the upper extremities help balance and mobility. As the balance in a sitting position and improves the infant assumes bipedal mobility, hands become available for handling objects of their ultimate function. Primitive reflexes are integrated, and the upper extremities under the cortical control. Reaching becomes more precise, and objects are placed in the mouth for oral exploration. That development is progressing distal to proximal, reaching and manipulative skills are further strengthened, and precise manual exploration replaces oral exploration. During the second year, fine motor is evaluated by observing how the hands use objects as tools (eg for building blocks and crayons for drawing). The close association between gross and fine motor skills in the first year of life evolves in a similar relationship between problem solving and fine motor skills during the second year. One skill allows or encourages the development of the other. If progress in the manual dexterity is slow, which may hinder cognitive development through the manipulation of objects.

GROSS MOTOR DEVELOPMENT

Motor Development gross proceeds from a sequence of steps outlined (starting with the head and ending with rotation), at the meeting, then through a standing / ambulating sequence . Landmark motor do not take into account the quality of removal of a child. These sequences should be considered in the context of the part of the engine of the neurological examination, including observations of the station and approach, where the qualitative elements can be assessed. However, the neurological assessment of tone, strength, deep tendon reflexes, and coordination is difficult, in very young children because of the subjective nature of the evaluation and the infant's limited ability to cooperate. Clinical experience is essential for obtaining accurate and useful information.

Solicitation reflexes requires patience and repeated, yet gentle, trial and error. Tonus muscle (passive resistance) and strength (resistance) is a challenge to distinguish in the opposite infant. The best clues can be obtained from observation, not handling. Spontaneous or generated motor activity (for example, weight-bearing in sitting or standing) require sufficient strength. Thus, the weakness can be better appreciated by the observation of the quality of posture and transition stationary movements. The sign Gower (arising from sitting on the floor to standing with their hands through "back" his legs) is a classic and the pelvic bones and indicative quadriceps muscle weakness. Not before 2 or 3 years, does neurological examination become easier and more effective cooperation improves.

Station returns to the posture assumed in sitting or standing and should be considered in earlier, lateral and posterior perspectives, looking for the alignment of the body. Gait refers to the march and is discussed in progress. Initially, toddlers, walks with a broad base, slightly crouched, weapons removed and slightly elevated. Forward staccato progression is more than good. Movements gradually become more fluid, the base shrinks, and the swing arm is changing, leading to an adult walk model of 3 years.

The engine neuromaturational markers are primitive reflexes that develop during pregnancy and usually between the third and sixth month after birth, and postural responses, which are not present at birth, but develop sequentially between 3 and 10 months old. The Moro, labyrinthine tonic, asymmetric tonic neck, and positive support reflexes are most useful in clinical. As with all true reflexes, each requires a specific sensory stimuli to generate the stereotypical motor response. Normal infants demonstrate such postures inconsistently and transiently; those who have neurological central (ie brain) injury show stronger and more sustained primitive reflex posture. Primitive reflexes are a little difficult to assess, even in expert hands. The emergence of postural responses at the beginning of the movie, after 2 to 3 months of age is easier to get in the clinic and can provide a great idea of neuro-motor integrity of young infants. Reactions postural are sought in each of the three main categories: rehabilitation, protection and balance. These movements are much less stereotyped as primitive reflexes, and they require a complex interaction between the cerebral and cerebellar cortical adjustments to a barrage of sensory inputs (proprioceptive, visual, vestibular). They are easy to obtain in the normal infant, but apparently are much slower in the newborn who damage the central nervous system.

Motor Development

To make an important statement about a child's motor skills, the pediatrician must organize the data collected from history, physical examination, neuro-development and review as follows: 1) the engine of development milestones , 2) the classic neurological examination, and 3) Neuromoteur brain maturation markers (primitive reflexes and postural responses). Motor milestones are extracted from the history of the development as well as comments during the neurological examination.
Evaluation results in all areas is best summed up as indicating an age of child development. This approach helps to treat the child in terms of its level of operation compared to chronological age. For example, the development quotient (DQ) is the development of age divided by chronological age 100 times (see example below). This provides a simple expression of the deviation from the norm. A quotient higher than 85 in any area is considered within normal limits, a quotient of less than 70 is considered abnormal. A quotient between 70 and 85 is a grey area that warrants close monitoring. The values in the upper limit of normal is not specifically indicate Gong capabilities. Whether it is truly gifted athletes can be recognized early on by the use of this method sobering, but speculative.

RED FLAGS IN PHYSICAL GROWTH

Occipitofrontal Circumference of large and small size of the head two red flags are related to development problems. Microcephaly is associated with an increased incidence of mental retardation, but there is no simple relationship between the size of the head of small and depressed intelligence. As a reflection of the normal variation, microcephaly is not associated with structural pathology of the nervous system or low intelligence. In addition, microcephaly can be considered above average cognitive abilities. Micro-cephaly associated with genetic disorders or acquired reflects brain pathology and has almost always cognitive implications.

Macrocephaly may be due to hydrocephalus, which is associated with an increased incidence of cognitive deficits, particularly learning disabilities. Macrocephaly without hydrocephalus, far from being a predictor of advanced intelligence, is also associated with a higher prevalence of cognitive deficits. It may be due to metabolic abnormalities or anatomical. In about 50% of cases, family is macrocephaly, and the implications are harmless in terms of intellect. When assessing the infants whose macrocephaly is isolated, the finding of a large size of the head in one or both parents may be reassuring.

The weight and size Although the majority of people who are below-or above-average size are otherwise normal, there is an increased prevalence of developmental disabilities in these two sub-populations. Many genetic syndromes are associated with a small, high stature syndromes are less frequent. Again, when considering the standard deviation of the specific child, family characteristics should be reviewed. The notion of parental authority mid-height is useful for determining whether a child is appropriate for the size of his family pattern of growth.

Dysmorphism Although most of the unaccompanied minors dysmorphic are significant, the presence of three or more may indicate the presence of a malfunction of development. Approximately 75% of these minors dysmorphisms surface can be found by looking at his face, skin and hands. The presence of minor and major abnormalities may indicate a more serious genetic syndrome. In many cases, dysmorphic lead to the diagnosis of a clinical syndrome during the neonatal period and prior to the recognition of any neurological deficit.

Physical Growth

Growth stages are more predictable, even if they must be considered in the context of each child's specific genetic and ethnic influences. It is important to trace the growth of the child sex and age appropriate graphs. Charts now available for certain ethnic groups, as well as a small number of genetic syndromes (eg, low and syndromes Turner). Fetal weight gain is the strongest in the third trimester of pregnancy. During the first few months of life, this rapid growth continues, after which the growth rate slows. Bithweight decrease was found by 2 weeks of age and twice as 5 months. Height is not up to double between 3 and 4 years. Head of the growth during the first 5 or 6 months is due to the continuation of the division of neuronal cells. Later, the increased size of the head is due to the growth of nerve cells and supporting tissue proliferation.

The First Two Years of Life

Before dissecting the development of children in different stages of development within each field, it is useful to consult the infant at shorter intervals. These 6 months "snapshots" are displayed in the graph 1. Gestalt This approach may help the clinician make sense of the interdependence of specific changes within each area of development.

These four photographs illustrate several generalizations about the neuro-development, maturation over time:

The responses to stimuli move from the widespread reflexes involving the whole body, as seen in the newborn (and the fetus), discrete voluntary measures that are under cortical direction. This specialization allows the child to move reactions symmetrical mandatory when attending a stimulus (ie, vocalizations, waving his arms and kicking) to volunteers, asymmetric, and the precision of movements to a stimulus (ie, typing with one hand and inspection with others).

Product development of cephalic and caudal proximal to distal. Thus, the movement of the arm falls under management and cortical visual guidance movement of the front leg. With this, the child is progressing hand-foot-mouth-to-mouth play. The upper extremities are becoming more accurate to reach, grasp, manipulate and transfer. Distal development is seen when the infant can isolate and use the index poke and explore object parties. When this happens in concert with the thumb opposition, the fine is increased clamp controlled. Clarifies Liberation tiny following objects so that the core competencies of manipulation reaches adult levels by the end of infancy.

Developmental progression of dependence to independence. The newborn depends totally progressing at a toddler who has mobility and handling skills which enable him to discover more of the environment. Toddlers can get around the house, opening doors, staircases maneuver, and that the recovery of items desired. They feed and undress and even toilets can be trained. The new self becomes the basis for the challenge "two".

Evalution of Developmental Theory

Developmental theory has been shaped by the continuing debate as to whether the nature (intrinsic forces) or nurture (extrinsic forces) is the predominant influence. At the turn of the century, the theories of development promoted nature as the main influence. Gesell (early 1900) was one of the first to systematically study the child's development and to set standards for development. The development was seen as a function of neurological maturation and growth. Because age and genetic inheritance are the main mechanisms for change, it was believed that babies develop at a rate predetermined biological parents need a little more todo provide a good nurturing environment.

By mid-century, the theories that have highlighted the importance of food began to prevail. Pavlov (1930), Watson (1950) and Skinner (1960) has developed the opposite view that the development was a function of learning. Operant conditioning (positive and negative reinforcements through social interactions or changes in the environment) in the form of learning and promoting the development of the child. This line of thinking philosophy has formed the basis for the "Head Start" of the 1960's. Freud (1920) and Erikson (1950) has encouraged the development of progress in terms of conflict resolution. The quality of relations between the child and the key people were found to be essential to future development.

During the second half of the century, the name of Piaget has become almost synonymous with child development. Piaget was the first to describe the infant as having intelligence. For centuries it was assumed that the infant's mind was an "empty shelf waiting to be written." Because children could not tell us what they were experiencing, it was believed they had seen and heard little thought and even less so with the awareness that adults do not know exist. Piaget showed that the children were, in fact, able to think, to analyze, and assimilation. He considered the development as a step-like cognitive changes. Child actively explore objects in an effort to understand its environment. Depending on the stage of development, a child organizes information into new theories about how the world works.

It was not until the latter part of this century that the emotional and social development began receiving the same level of attention as that given to the automobile and cognitively. Research has revolved around theories about infantile expression of emotion (Mandler, 1970), attachment (Bowlby, 1960; Mahler, 1970, and Ainsworth, 1980), and the temperament (Thomas and Chess, 1970). Once it was recognized that newborns could demonstrate distress (pain and hunger), interest and disgust, those facial expressions were used to investigate the handling of information in childhood before the age where thoughts can be verbalized. As the 20th century ends, remarkable progress in the genetics of behavior, as well as recent findings on the child's innate abilities, the pendulum has swung in favour of nature as the main influence on the development process.

Infant Growth and Development

"Infant" is derived from the Latin word "infans" which means "unable to speak." Thus, many define childhood as the period from birth to about 2 years, when the language begins to develop. This is an exciting period of "firsts"-first smile, first hit enter, first evidence of the anxiety of separation, the first word, first step, first sentence. The infant is a dynamic, ever-changing current undergoing an ordered sequence and predictable physical growth and neurological. This sequence is constantly influenced by the intrinsic and extrinsic forces that produce individual variation and to make each child unique path of development. Influences intrinsic children include physical characteristics, the state of wellness or illness, temperament, genetically determined, and other attributes. Extrinsèque during childhood influences come mainly from the family's personality and style of caregiving by parents and siblings, family, the economic status of its impact on the resources of time and money , and the cultural milieu in which the child was born. Neurodéveloppementaux sequences can be viewed broadly in terms of traditional stages of development. Developmental milestones provide a systematic approach for tracking the evolution of the baby over time. Causing a specific power based on the achievement of previous skills, competencies are rarely ignored. When this happens, advanced skills can be a "dissident" skills, it is a deviant development model. For example, five sentences in a word 2 years the child who does not follow simple commands can be echolalia typical of autism. The penalties are not significant and have no intention communicative. The developmental delays in one area can affect the development in another area. For example, because of the immobility of neuromuscular disorders precludes exploration of the environment and, in turn, impedes cognitive development caused by the manipulation of objects. Finally, a deficit in one area may affect the assessment of the levels of skills in another area, even though development in the second area is normal. For example, it is difficult to assess the abilities to solve problems in a child who has cerebral palsy, for the child can understand the concept of matching geometric shapes, and yet not be able to insert them into a formboard physically. Developmental milestones serve as a basis for most standardized assessment and screening tools. While these screening tools provide the clinician with a structured approach to monitor the child's progress and help define developmental delay, many lack sensitivity. Parental concern over the normal resulting in the development of screening should not be overlooked. Focusing only on the discrete steps may not be atypical organizational processes that are involved in the progress of child development. Thus, it is important to analyze all stages in the context of the history of the child, growth, and physical examination as part of a monitoring program underway. Only then is it possible to formulate an overall impression of the child's true development, the status and the need for intervention. Although the steps at the base of the discussion, the main intent of this article is to provide an insight into the broader infant development processes and assist the clinician to recognize warning behaviors ( "red flags") indicative Development deficits. The milestone ages are not included in the text to allow for greater fluidity in the discussion of development issues within each area. The milestones were held in areas to assist the clinician in recognition of their independence as well as their interactions. The tables showing all areas, at all ages can be found at Vaughan (Reading). Problem-solving and language milestones facilitate early identification of cognitive deficits. Adaptive skills (ie, skills related to the independence, food, clothing, hygiene), traditionally, have been included in the field of fine motor skills. However, because these steps are influenced by the social environment, we have included in a "psycho-social". Lists of emotion and socialization milestones are also included in this area. Contrary to step motor and cognitive, psychosocial behaviour is more influenced by extraneous factors, which makes them less well defined.