Lin Li

• Growth and development

are
characteristics of childhood
• Growth----Physical grow
• How our body to grow from a baby to a child to an
adult
• Development ----Psychological develop

• How our central nervous system to mature how we can see,

hear, sit,stand, walk and so on
Growth
Development
 Neuropsychological Development

• 1.Basis of neuropsychological development

——brain and myelin

• 2.Neuropsychological development
3.Neuropsychological development assessment
Basis of neuropsychological development

(1)Development of brain——structure and function

(2)Development of myelin

(3)Nervous reflex

(4)Development of sleep
 Nervous system

The nervous system consists of three main regions:

• The central nervous system (CNS) consists of the brain and spinal cord and
is protected by the cranium and vertebral column.
• The peripheral nervous system (PNS) includes the neurons outside the CNS
as well as the cranial nerves and spinal nerves (and their associated ganglia),
which connect the brain and spinal cord with peripheral structures.
• The autonomic nervous system (ANS) has parts in the CNS and PNS and
consists of the neurons that innervate smooth muscle, cardiac muscle, glandular
epithelium, and combinations of these tissues.
A , Dorsal view of an embryo of approximately 23 days shows fusion of the neural
folds, which forms the neural tube.
B , Lateral view of an embryo of approximately 24 days shows the forebrain
prominence and closing of the rostral neuropore.
C , Diagrammatic sagittal section of the embryo at 23 days shows the transitory
communication of the neural canal with the amniotic cavity (arrows) .
D , In the lateral view of an embryo of approximately 27 days, notice that the
neuropores shown in B are closed.
 1.Development of brain structure

Gyral development in the human brain from 25 days to 9 months. Note the prominent increase in volume and gyral
complexity in the last 3 months of gestation.
From Cowan WM. The development of the brain. Sci Am . 1997;241:113-133.
Sketches of lateral views of the left cerebral hemisphere, diencephalon, and brainstem show
successive stages in the development of the sulci and gyri in the cerebral cortex. Notice the gradual
narrowing of the lateral sulcus and burying of the insula, an area of cerebral cortex that is concealed
from surface view. The surface of the cerebral hemispheres grows rapidly during the fetal period,
forming many gyri (convolutions), which are separated by many sulci (grooves).

A , At 14 weeks. B , At 26 weeks. C , At 30 weeks. D , At 38 weeks. E , Magnetic resonance image of a

pregnant woman shows a mature fetus.
• Neuropsychological development bases
on central nervous system maturation

• Newborn 390g, 8% of weight

• 9m 660g
• 2yr 900-1000g
• 7yr 1350-1400g
• Adult 1400g, 4% of weight
 2.Development of brain function

Functional areas of the human cerebral cortex as determined by electrical

stimulation of the cortex during neurosurgical operations and by neurological
Map of specific functional areas in the cerebral cortex, showing especially
Wernicke’s and Broca’s areas for language comprehension and speech production,
which in 95% of all people are located in the left hemisphere.
Left and right brain
Diagrams show the position of the caudal end of the spinal cord in
relation to the vertebral column and meninges at various stages of
development. The increasing inclination of the root of the first sacral
nerve is also illustrated.
A , At 8 weeks. B , At 24 weeks. C , Neonate. D , Adult.
 （2）Myelin

Neuron and 0—14yrs

nerve conduction Synaptic connections and pruning
of the anterior and posterior
nervous system
Diagrammatic sketches illustrate myelination of nerve fibers.
A to E , Successive stages in the myelination of an axon of a peripheral nerve fiber by the
neurilemma (sheath of Schwann). The axon first indents the cell, and the cell then rotates
around the axon as the mesaxon (site of invagination) elongates. The cytoplasm between the
layers of the cell membrane gradually condenses. Cytoplasm remains on the inside of the
sheath between the myelin and the axon.
F to H , Successive stages in the myelination of a nerve fiber in the central nervous system
by an oligodendrocyte. A process of the neuroglial cell wraps itself around an axon, and the
intervening layers of cytoplasm move to the body of the cell.
 （3）nervous reflex

What is the characteristics of nervous reflex in infants ?

Nervous Reflex in Infants

• 1.Unconditional reflex
• 2.Tendon reflex
• 3.Superficial reflex
• 4.Pathologic reflex
 1.unconditional reflex: existing at birth and
disappearing before 6m after birth
• Rooting reflex(sucking reflex)
• Moro reflex
• Grasp reflex
• Walking reflex
• Neck tonic reflex
Ⅰ. Rooting reflex (Sucking reflex)

A reflex seen in newborn babies, who

automatically turn their face toward
the stimulus and make sucking
(rooting) motions with the mouth
when the cheek or lip is touched. The
rooting reflex helps to ensure
breastfeeding.
 Ⅱ. Moro reflex

◆ Moro reflex is one of the infantile reflexes.

This reflex is a response to unexpected
loud noise or when the infant feels like it
is falling.
◆ It is believed to be the only unlearned
fear in human newborns.
◆ It is normally present in all
infants/newborns up to 4 or 5 months of
age.
 Ⅱ. Moro reflex

• Its absence indicates a profound disorder of

the motor system.
• An absent or inadequate of moro response
on one side is found in infants with
hemiplegia, brachial plexus palsy, or a
fractured clavicle.
• Persistence of the Moro response beyond 4
or 5 months of age is noted only in infants
with severe neurological defects.
 Ⅲ. Grasp reflex

• When you touch the palm of your baby's

hand, the fingers will curl around and cling
to your finger or an object.
• This is a good reflex to allow the baby to
"hold" their hand.
• This reflex also makes it difficult to obtain
handprints until it disappears at about 6
months
 Ⅳ. Step reflex
• The walking or step reflex is present at birth;
though infants this young can not support
their own weight, when the soles of their feet
touch a flat surface they will attempt to 'walk'
by placing one foot in front of the other.

• This reflex disappears as an automatic

response and reappears as a voluntary
behavior at around 8 months to 1 year old.
 V NECK TONIC REFLEX

• In the supine position, the examiner turns

the baby's head to one side, extending the
upper and lower limbs on the same side as
the baby's face, and flexing the upper and
lower limbs on the opposite side.

• 3-4 mon disappear

紧张性颈反射
 2.Tendon reflex

• Knee-reflex: 1yr. negative or accentuation

• Achilles tendon reflex:1yr. negative or
accentuation
 Knee-reflex
• The reflex tested by tapping
just below the knee causing
the lower leg to suddenly
jerk forward .

• The Knee-reflex may be

negative or accentuation at
children before 1 year of age
 Achilles tendon reflex
• Elicitation: Tap the tendo-Achilles after
partially flexing the knee ＆externally
rotating the leg
• Response: Plantar flexion of the ankle ＆
visible contraction of the gastrocnemius
muscle
• Achilles tendon reflex may be negative or
accentuation at children before 1 year of
age
 3. Superficial reflex:

• Abdominal refelex
• Elicitation: Stroke the skin of the abdomen
from the lateral end towards the midline Abdominal
• Response: Contraction of the abdominal reflex
muscles of the same side towards the site of
Cremaster reflex
stimulation

• ＜1yr. negative
,
 3. Superficial reflex:

• Cremaster reflex
• Elicitation: Stroke the skin of the medial side
of the thigh from above downwards
Abdominal
• Response: Contraction of cremasteric muscle reflex
＆ elevation of the testicle on the stimulated
side cremaster reflex

• ＜1yr. negative
 4.Pathologic reflex

• 1. Babinski sign : positive

around 1yr (also called
sole reflex)
 Babinski sign

• Babinski sign is also present at birth and fades around the first year.
• The Babinski reflex appears when the side of the foot is stroked, causing
the toes to fan out and the hallux to extend.
• The reflex is caused by a lack of myelination in the corticospinal tract in
young children.
• The Babinski reflex is a sign of neurological abnormality, e.g. upper motor
neurone lesion in adults.
 4.Pathologic reflex

• 2.Kernig sign :

• In the supine position, with the hips ＆knees

in flexed position, extend the knees.
Normally this is possible upto 140°.

• It is restricted in meningitis.

• positive before 4m
 4.Pathologic reflex

• 3. Chvostek sign:

• Strike the cheek between the

zygomatic arch and the mouth with
the fingertips or a percussion hammer

• Chvostek sign may be positive in

newborn without any hypocalcemia

• positive in newborns
 Development of sleep
• Sleep is a reversible state of reduced sensitivity to external
environment and stimuli.
• Normal sleep time and rhythm are important indexes to evaluate
children's neuropsychological behavior development
• During sleep, the body's sensitivity to external stimuli is reduced, muscle
tension is reduced, nerve reflex is weakened, body temperature drops,
heart rate slows down, metabolism slows down, and high nerve activity
is temporarily suspended

1. Sleep phase

2. sleep cycle

3. Sleep development
 1. SLEEP PHASE

•Rapid eye movement sleep, REM (快速眼动睡眠）

•Periodic agitation, increased heart rate and respiratory rate, increased blood pressure, increased
cerebral blood flow, decreased cervical muscle tone, suppressed spinal cord reflex, and frequent
rapid eye movement
•Electroencephalogram: low voltage fast wave
Most people dream during REM sleep and are easily aroused

•Nonrapid eye movement sleep, NREM （非快速眼动睡眠）

•Resting state ，4 phases（I light sleep浅睡眠，II true sleep进入睡眠，IIIdeep sleep深
睡眠，IV deepest sleep最深睡眠）
•Decreased heart rate, blood pressure and metabolic rate, shallow and regular
breathing, decreased muscle tone, closed eyes, no rapid eye movement
 2.SLEEP CYCLE

Infants Children Adolescents

light sleep

REM true sleep

true sleep deep sleep

deep sleep deepest sleep

 2.Sleep cycle
ADULT INFANCY
20MIN
10MIN
30-40MIN

REM-NREM alternate 4-6 times Average 60min/cycle

Average 90min/cycle
Deep sleep for 6 hrs，most
from nightfall to midnight
Rem for 2hrs，most in
second half of the night
After 1yr turn to adult mode
Longest REM in infancy
REM is about ¼ in elder children
NREM deep sleep has the
highest percentage in adolescents.
 SLEEP OF INFANCY

• For newborn, REM is ½ of sleep. For premature, REM is

85% of sleep，whole sleep time is about 16-20hrs

• Sleep cycle of newborn is about 50mins，3-4hrs of sleep

and then1-2hrs of wake stage

• For newborns, day and night sleep time is basically equal

 Sleep of infancy

• Changes in external light intensity from the age of 1-2 months adjust
sleep phase

• 2-3 months is a critical period for infants to establish circadian sleep

phases

• Onset of deep sleep (stage III and IV) at 3-6 months of age

• At 9 months of age, sleep lasts about 6-8 hours

 Night walking

• Normal phenomenon ， a protective mechanism

• Active sleep, or rem sleep, protects against temperature, breathing, and
hunger

Night walking ≠Night terror

Night terror is a sudden sitting up at night,

screaming, Shouting or crying, may have
tachycardia, shortness of breath, sweating, skin
flushing and other autonomic nervous system
excited symptoms, generally lasting 1 ~ 10
minutes.
3.Sleep development
• Toddler sleep: 12-14 hours
30% of children have different degrees
of sleep problems
• Pre-school sleep: 11-12 hours
Mode close to adult, 90 minutes/cycle
• School-age sleep: 9-11 hours
The structure tends to be stable, and
there is basically no short period of
sleep during daytime
• Adolescent sleep: 8-10 hours
Both deep sleep and REM sleep are
shortened
 2.Neuropsychological Development

• Sense and perception development

• Motor development
• Language development
• psychological development
 1. Sense and perception development

• Vision seeing---eye
• Audition hearing---ear
• Olfaction smelling---nose
• Taste tasting---tongue
• Tactility touching---skin
 • We’ll emphasize:

• When do these sense and perception emerge?

• How do they develop？（key age)
 1.Vision

• When do we begin to see?

• Newborn

• How dose vision develop？

• (key age : newborn, 3m, 6m, 9m,12m, 18m,
2yrs, 3yrs, 6yrs)
 Newborn:

• To gaze (blink reflex)

• To recognize facial expressions
(smiles) as similar, even when
they appear on different faces.
• 3m: voluntary muscle movements generate predictable visual sensations ,
moving head to follow object with eyes.

• 6m: voluntary muscle movements generate predictable tactile and visual

sensations, finding object and catching it .

• 9m: visual depth perception developing—locates object accurately.

• 12m: to differentiate simple figures.

• 18m: to differentiate complicated figures

• 2yr: eyes coordinate well. To differentiate
Vertical and transverse lines

• 3yr: to imitate circle

• 4yr: square ,5yr:triangle,6yr:diamond

• 6yr: to differentiate 6 from 9 、b from d

 Audition

When a baby can hear ?

• Newborn but not at once, at 3-7days after birth.

• amniotic fluid

• How dose audition develop？

• (key age: newborn, 3-4m, 5-6m, 9m, 1yr, 2yr.)
• Newborn: Sound at 50~70 dB causing
different breathe rate , blink, to frown at
3-7days after birth.
3~4m: voluntary muscle movements
generate predictable audible sensations ,
moving head to follow voice .
• 5~6m: to show favoritism to mother’s
voice .
• 9m: to located the sound source and know
different meaning of words.
• 1yr: a special respond to the name of himself.
• 2yr: understanding some orders.
 Olfaction and Taste

• Newborn: smelling milk smell to look for

mammary papilla or nursing bottle.

• 3m: differentiating good smell or not.

• 7~8m: delighting to fragrance.

.
• A Newborn has different facial expressions
when give them something with sweet
taste and sour taste .

• 4~5m: to taste food sensitively

 Tactility (skin sensation)

• Tactile sensation: sensitiveness in newborn

• Temperature sensation: sensitiveness in newborn
(crying not escaping)
• Pain perception: dull or slow in newborn
 Perception development
• Perception is the comprehensive reflection of the body to various
material properties.
• Such as: recognition of color, size, weight, thickness, soft and hard,
up and down, left and right , morning and evening, season and
time.

Space:
3 years old, distinguish up from down
4 years old, front and behind
5 years old , distinguish right and the left
Age 7-9, distinguish right and left
• Time:
• The age of four, depends on specific times, such as
getting up in the morning and going to bed at night
• 4-5 years old, have a certain time sequence, know a
day time, morning, afternoon and evening
• 5-6 years old can master a week, know the season
 2.Neuropsychological Development

• Sense and perception development

• Motor development
• Language development
• Psychological development
 2.Motor development
• A motor skill is a learned series of movements that
combine to produce a smooth, efficient action.

• Gross Motor

• Fine Motor
 Gross motor skills

• Include lifting one's head, rolling over,

sitting up, crawling, and walking.
 Gross motor skills

Gross motor development usually follows a pattern.

• Generally large muscles develop before smaller ones,
thus, gross motor development is the foundation for
developing skills in other areas (such as fine motor skills).
• Development also generally moves from top to bottom.
The first thing a baby usually learns to control is his eyes.
 Law of development of Gross Motor

• 1. Up to down(korulla law) (head, chest, waist, legs)

• 2. Near to far

• 3. Forward to backward

• 4. From generalization to concentration

• 5. From discordance to concordance

 Gross Motor

• 1.Lift head :3m

• 2.Roll over : 6m

• 3.Sit: 7m

• 4.Creep:8m
 Gross Motor

• 5.Stand:9-11m

• 6.Deliberate step:10m-12m

• 7.Walk alone :15m

• 8.Run：18-24m

• 9.Jump：24-30m

• 10.Go upstairs：3y
 Standing with assistance

Walking with assistance

Standing alone
Walking alone

Sitting without support

Hands and knee crawling
 Gross Motor
Average Age of
Milestone Attainment (mo) Developmental Implications
Head steady in sitting 2.0 Allows more visual interaction

Pull to sit, no head lag 3.0 Muscle tone

Hands together in midline 3.0 Self-discovery

Sits without support 6.0 Increasing exploration

Rolls back to stomach 6.5 Truncal flexion, risk of falls

creeps 8.5 Exploration, control of proximity to

parents

Walks alone 12.0 Exploration, control of proximity to

parents

Runs 16.0 Supervision more difficult

 Fine motor skills
• Include the ability to manipulate small objects, transfer
objects from hand to hand, and various hand-eye
coordination tasks.
• Fine motor skills may involve the use of very precise
motor movement in order to achieve an especially
delicate task.
 Fine motor skills

• Some examples of fine motor skills are using the pincer grasp
(thumb and forefinger) to pick up small objects, cutting,
coloring, writing, or threading beads.

• Fine motor development refers to the development of skills

involving the smaller muscle groups.
 Fine Motor

• 1.Grasp object : 5m

• 2.Transfer object: 6~7m

• 3.Thumb-finger grasp:9-10m

• 4.scribbles:12-15m
6-7
 Fine Motor

Milstone Average age of Development Implication

attainment(mo)
Grasps rattle 3.5 Object use

Reaches for objects 4.0 Visuomotor coordination

Palmar grasp gone 4.0 Voluntary release

Transfers object hand to hand 5.5 Comparison of objects

Thumb-finger grasp 8.0 Able to explore small objects

Turns pages of book 12.0 Increasing autonomy during book

time
Scribbles 13.0 Visuomotor coordination

Builds tower of two cubes 15.0 Uses objects in combination

Builds tower of six cubes 22.0 Requires visual, gross, and fine
motor coordination
pick up small objects

threading beads

Visuomotor coordination Voluntarily Ulnar grasp

 3.Language development

• Language is unique for human being .

• Language development is a mark of well-

development for children .
 The precondition of Language development

• 1. Auditory perception normally

• 2. Phonatory organ functionally

• 3.The function of brain normally

• 4. Language acquisition depends critically on environmental

input.
 The process of Language development

• Pronunciation (voice)

• Understand (Verbal reception)

• Expression (talking)
• Receptive language, the understanding of others' speech,
appears to have a gradual course of development : 6 months.

• Expressive language, the production of words, moves rapidly

after its beginning :1.5yrs

"vocabulary explosion" of rapid word acquisition occurring in:

2.5yrs

( the middle of the second year.)

• Grammatical rules and word combinations appear :2yrs.

• Mastery of vocabulary and grammar continue gradually

through the preschool and school years.

• Adolescents still have smaller vocabularies than adults and

experience more difficulty with constructions like the passive
voice.
 Communication and Language
Milestone Aver-age of Developmental Implications
attainment(mo)

Smiles in response to face, voice 1.5 Child more active social participant

Monosyllabic babble 6.0 Experimentation with sound, tactile sense

Inhibits to "no" 7.0 Response to tone (nonverbal)

Follows one-step command with gesture 7.0 Nonverbal communication

Follows one-step command without 10.0 Verbal receptive language

Gesture (e.g.,"Give it to me")

Speaks first real word 12.0 Beginning of labeling

Speaks 4-6 words 15.0 Acquisition of object and personal names

Speaks 10-15 words 18.0 Acquisition of object and personal names

Speaks two-word sentences (e.g., "Mommy 19.0 Beginning grammaticization, corresponds

shoe") with 50+ word vocabulary
• The evaluation of neuropsychological
development

• ------- Psychometry
 Psychometry

• Using a quantificat experimental method to evaluate the

sense and perception , motor , language and psychological

development of children.
• Intelligent quotient, IQ

An important parameter of psychometry

 Some common IQ test
Test Age Fidelity Assess
normal , abnormal,doubtful,
DDST 0-6y screen
imposible to assess
Drawn-a-man 5-9.5y screen IQ
PPVT 4-9y screen IQ
Gesell 4w-3y diagno DQ
Bayley 2-30m diagno PDI, MDI
Standford-binet 2-18y diagno IQ
WPPSI 4-6.5y diagno IQ
WISC-R 6-16y diagno IQ
 Grading of IQ

IQ grading percentage
>130 excellent 2.3
115-129 above average 13.59
85-114 average 68.26
70-84 below average 13.59
<70 retardation 2.3