INFLUENCING

FACTORS
& MILESTONES
OF CHILD DEVELOPMENT
Objectives

👶🏼Factors influencing for child development

👶🏼Concept and theory of brain development
👶🏼Child development milestones from newborn
until 2 years old
 Child Development
Processes that underlie the changes in the child’s cognitive, emotional, motor, and social
capacities and behaviors from the beginning of life through adolescence

Biopsychosocial Model
Societal and community systems are simultaneously considered
along with more proximal systems that make up the person and
the person's environment

Psychological
Social Factors
Influences

Biological Unifying
Influences Concepts

Parke RD, Gauvain M. Child psychology: A contemporary viewpoint. 7th ed. New York: McGraw-Hill Inc;2009.
Feigelman S. Developmental and behavioral theories. In: Kliegman RM, St. Geme JW, Blum NJ, et al., editors. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2019.
 1. Biological Influences

01
Genetics
Heredity accounts 40% of the
variance in IQ and other
personality traits
02 03
In utero exposure to Long-term negative effects of
teratogens low birthweight
Include mercury, alcohol, Chronic illness affectgrowth
meningitis, traumatic brain injury and development

04 05 06
Maturation Exposure to Postnatal
Generate behavioral challenges at hazardous substances illnesses
predictable times. Maturation brings
about physical changes in size,
body proportions, strength,
Feigelman S. Developmental and behavioral theories. In: Kliegman RM, St. Geme JW, Blum
hormonal changes NJ, et al., editors. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2019.
 2 . Psychological Influences

Attachment Contingency
Biologically determined tendency of a young child to Contingent responses to nonverbal gestures create the
seek proximity to the parent during times of stress groundwork for the shared attention and reciprocity

● Secure attachment → Reestablish a sense of well-

● Critical for later language and social development
being after a stressfulexperience
● Children learn best when new challenges are just
● Insecure attachment → Predictive of later learning slightly more difficult than what they have already
and behavioral problems mastered,

Feigelman S. Developmental and behavioral theories. In: Kliegman RM, St. Geme JW, Blum NJ, et al., editors. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2019.
 3. Social Influences
Family Ecologic
Systems Model

Individuals within systems The family system, functions

adopt implicit roles. within the larger systems of
extended family, subculture,
● Birth order does not have
long-term effects on culture, society.
personality development
● Changes in one person's
behavior affects everyother
member of the system →
roles shift until a new
equilibrium is found

Parke RD, Gauvain M. Child psychology: A contemporary viewpoint. 7th ed. New York: McGraw-Hill Inc; 2009.
Feigelman S. Developmental and behavioral theories. In: Kliegman RM, St. Geme JW, Blum NJ, et al., editors.
Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2019.
 4. Unifying Concepts
Child's status at any point in time isa
function of the interaction between
biologic and social influences.

Feigelman S. Developmental and behavioral theories. In: Kliegman RM, St. Geme JW, Blum NJ, et al., editors. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2019.
 Ecobiodevelopmental Framework Stress responses
The ecology of childhood (social and physical
environments) interacts with biologic processes to
determine outcomes and life trajectories Alterations in brain structure and function

Disruption of later coping mechanism

Long lasting effects onthe

health &well-being

Passed on to future generations

Feigelman S. Developmental and behavioral theories. In: Kliegman RM, St. Geme JW, Blum NJ, et al., editors. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2019.
https://gooddayswithkids.com/2014/09/26/brain-development-poster/
Postnatal brain and head growth
• The human brain and head size increase
rapidly during the first and second
postnatal years, followed by a more
gradual increase into early adulthood
• The increase in brain and head size largely
results from elaboration of connectivity.
• Axon and dendrite growth and
arborization continue after birth into early
postnatal years.
• Synaptogenesis continues after birth,
peaking at various points during childhood
(depending on brain region).
• Synapses mature and remodel to form
appropriate connections, and then
undergo gradual pruning into early
adulthood.
• Gliogenesis continues after birth, and glial
cell differentiation and myelination
continue into early adulthood.

van Dyck LI, Morrow EM. Genetic control of postnatal human brain growth. Curr Opin Neurol. 2017;30:114-124.
Knuesel, Irene et al. “Maternal immune activation and abnormal brain development
across CNS disorders.” Nature Reviews Neurology 10 (2014): 643-660.
• In the process of proliferation and
pruning, simple neural connections
are formed first, followed by more
complex circuits.
• The timing of this brain
development is genetic, but
experiences during early life
determine how strong or weak the
neural circuits between brain parts
are.

C.A. Nelson (2000)

 Child Development:
Theoretical Perspective
PSYCHOANALYTIC THEORIES

1. Freud’s Psychodynamic Theory

● Basic biological drives direct thebehavior

● The emotional health of the child and the adult depends on adequate resolution (whether

the child’s drives were deprived or satisfied at each earlier stage)

2. Erikson’s Psychosocial Theory

● Social and cultural factors influence child’sdevelopment

● Fundamental personal and social tasks must be accomplished at each stage

● The child's sense of basic trust develops through the successful negotiation of infantile needs.

Parke RD, Gauvain M. Child psychology: A contemporary viewpoint. 7th ed. New York: McGraw-Hill Inc;2009.
Feigelman S. Developmental and behavioral theories. In: Kliegman RM, St. Geme JW, Blum NJ, et al., editors. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2019.
 Child Development:
Theoretical Perspective
COGNITIVE THEORIES

1. Piagetian Theory

● Development results from complex reorganizations of understanding as the child moves to

more advanced levels of cognitive functioning.

● Children construct knowledge through assimilation (taking in new experiences according to

existing schemata) and accommodation (creating new patterns of understanding to adapt to
new information)

2. Kohlberg’s Theory
● Children are guided by the basic precepts of moral behavior and they take into account local

standards

Parke RD, Gauvain M. Child psychology: A contemporary viewpoint. 7th ed. New York: McGraw-Hill Inc;2009.
Feigelman S. Developmental and behavioral theories. In: Kliegman RM, St. Geme JW, Blum NJ, et al., editors. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2019.
 BRAIN DEVELOPMENT
A protracted process that begins about 2 weeks afterconception
and continues into young adulthood 20 years later.

Pediatric brain development is a complex process:

Include both linear and non-linearstructural and functional processes

GROWTH & DEVELOPMENT OF THE HUMAN BRAIN

A. ANATOMICAL DEVELOPMENT
● Cortex development (dynamic changes in gray and white matter)
Cortical volume
Cortical thickness
Cortical surface area

● Subcortical brain development

B. FUNCTIONAL DEVELOPMENT

Tierney AL, Nelson CA. Brain development and the role of experience in the early years. Zero Three. 2009; 30: 9–13.
Houston SM, Herting MM, Sowell ER. The neurobiology of childhood structural brain development: Conception through adulthood. Curr Top Behav Neurosci. 2014; 16: 3–17.
Taki Y, Kawashima R. Brain development in childhood. Open Neuroimag J. 2012; 6: 103–110.
 BRAIN DEVELOPMENT
ANATOMICAL DEVELOPMENT
Essential to the maturation & development of thebrain

Neurulation Proliferation Cell Migration Differentiation

Myelination Synapse Pruning Synaptogenesis

Tierney AL, Nelson CA. Brain development and the role of experience in the early years. Zero Three. 2009; 30: 9–13.
 BRAIN DEVELOPMENT
DEVELOPMENT OF THE CORTEX Gestational Week 8

A. PRENATAL DEVELOPMENT ● Differentiation of epiblast cells → producing all the

The cellular chain of in utero events that lay the cells necessary for development ofthe brain

foundation for the development of the cortex ● Neural patterning establishes the primary
organization of the central nervoussystem.
1. Embryonic (conception-GW 8)
2. Early fetal (GW 9-GW 20) Gestational Week 9-20
3. Fetal periods (GW 9-birth) ● Orderly and sequential formation of the gyri and
sulci of the brain
Influenced by both positive and negative
genetic and environmental influences Gestational Week 20-adulthood
● Myelination: Enhanced efficiency in the transmission
of information between newly developed brain
regions

Houston SM, Herting MM, Sowell ER. The neurobiology of childhood structural brain development: Conception through adulthood. Curr Top Behav Neurosci. 2014; 16: 3–17.
 BRAIN DEVELOPMENT
FUNCTIONAL DEVELOPMENT
Brain is a system of tiered networks of highly organized neurons
● Spatiotemporal biochemical and bioelectrical activity gives specialized functionality to
structural anatomic components

Brain Brain The functional dynamics of the network can change physical

structure function characteristics of brain structure, vice versa(bidirectional)

Properties of the network change from the infancy into adulthood

❏ Strong correlations between brain activity in closelylocated anatomical regions tend
to weaken
❏ Initially weak correlations between more distant regions tend to increase
→ Result in mental and behavioral functional repertoire of an adult to be substituted for that of
a newborn.

Grigorenko EL. Brain development: The effect of interventions on children and adolescents. In: Bundy DAP, Silva Nd, Horton S, et al., editors. Washington (DC): The
International Bank for Reconstruction and Development / The World Bank; 2017.
 BRAIN DEVELOPMENT
FUNCTIONAL DEVELOPMENT
Brain is a system of tiered networks of highly organized neurons
● Spatiotemporal biochemical and bioelectrical activity gives specialized functionality to
structural anatomic components

Developmental increases in functional connectivity due to spontaneous or

orchestrated co-occurrences of activity
❏ Co-activation of different brain structures in the context of implicit or explicit
learning, based on which functional connections within the brain might be
established as new skills are acquired.
❏ Characteristics of functional networks have been associated in adulthood with
indicators of intellectual performance andexecutive control.

Grigorenko EL. Brain development: The effect of interventions on children and adolescents. In: Bundy DAP, Silva Nd, Horton S, et al., editors. Washington (DC): The
International Bank for Reconstruction and Development / The World Bank; 2017.
Growth and Development
THE CHILD’S BRAIN

NEURO ANATOMY
NEUROANATOMY (De Graff, 2006)

CORTEX

Frontal

Occipital

NEUROCHEMISTRY
The Developing Brain
Circuits-Specific Assessment
Ideally:
Specific deficiencies → a
recognizable and characteristic
spectrum of:
• neuroanatomical
• neurochemical
• neurophysiological
dysfunction in perinatal
humans.
Each deficiency have a
“signature”developmental
effect.
Unfortunately:
• Infants have limited behavioral
expression of the higher-
function cortical activities that
are the basis for behaviors later
assessed as intelligence.
• Latercatch-up brain growth and
the capacity for repair make
predictive assessments difficult.
The Developing Brain
Circuits-Specific Assessment

NEURO ANATOMY
NEUROANATOMY (De Graff, 2006)

• CAT
• MRI
• DTI
• etc
NEUROBEHAVIOUR
NEUROPHYSIOLOGY DEVELOPMENTAL
SIGNATURE
• EEG
• ERG • Reflexes
• ABR • Milestone
• ERPs • Spontaneous
• EMG, etc movements
NEUROCHEMISTRY • Denver II
• BSID-MDI-PDI
• HPA axis respons • DQ-IQ
• ANS respons • Mullen Scale
• MR Proton-spectroscopy • etc
• etc
Characterize :
• Human brain connectivity & map patterns of structural and
functional connectivity to important behavioral skills
• Infancy to early childhood
• Biological & environmental measures

?
 • Longitudinal group & cross-sectional groups
• Parent report and direct assessment of cognitive and
Imaging: behavioral development
Structural • More comprehensive picture of how emerging patterns of
Diffusion brain connectivity shape behavioral development
Functional
(resting state) Behavioral / Cognitive Assessments:
Vineland Adaptive Behavior Scales (VAS-II)
Social Responsiveness Scale (SRS)
Children’s Social Understanding Scale (CSUS)
MacArthur-Bates Commun. Dev. Inventory (MCDI)
Infant Behavior Questionnaire-Revised (IBQ-R)
Preschool Child Behavioral Checklist (P-CBCL)
Early Childhood Behavioral Questionnaire (ECBQ)
Infant-Toddler Social and Emotional Assessment (ITSEA)
Preschool-Aged Strengths and Differences (SDQ)
Family interview for Genetic Studies (FIGS)
Major Life Events Inventory (MLEI)
State-Trait Anxiety Inventory for Adults (STAI)
Repetitive Behavior Scales (RBS)
Minnesota Executive Functional Scale (MEFS)
Dimensional Joint Attention Assessment (DJAA)
Mullen Scales of Early Learning (MSEL)
Imaging:
Structural
Diffusion
Functional
(resting state) Behavioral / Cognitive Assessments:
█ Vineland Adaptive Behavior Scales (VAS-II)
Social Responsiveness Scale (SRS)
Children’s Social Understanding Scale (CSUS)
█ MacArthur-Bates Commun. Dev. Inventory (MCDI)
Infant Behavior Questionnaire-Revised (IBQ-R)
█ Preschool Child Behavioral Checklist (P-CBCL)
Early Childhood Behavioral Questionnaire (ECBQ)
Infant-Toddler Social and Emotional Assessment (ITSEA)
█ Preschool-Aged Strengths and Differences (SDQ)
Family interview for Genetic Studies (FIGS)
Major Life Events Inventory (MLEI)
State-Trait Anxiety Inventory for Adults (STAI)
Repetitive Behavior Scales (RBS)
█ Minnesota Executive Functional Scale (MEFS)
Dimensional Joint Attention Assessment (DJAA)
█ Mullen Scales of Early Learning (MSEL)
Imaging:
Structural
Diffusion
Functional
(resting state)
█ Vineland Adaptive Behavior Scales
(VAS-II)
1.Communication: Receptive,
Expressive, Written
2.Daily Living Skills: Perso-
nal, Domestic, Community
3.Socialization: Interpersonal
relationship, Play and leisure
time, Coping skills
4.Motor Skills: Gross motor,
Fine motor
5.Maladaptive Behaviour
 DEVELOPMENTAL MILESTONES
Specific skill attainments occurring in a predictable sequence over time, reflecting the
interaction of the child’s developingneurological system with the environment

● Milestones follow predictable courses, and later developmental skills build on

previous ones achieved
● Developmental milestones are commonly assessed to support pediatric
surveillance and as part of developmental screening
● Early identification of developmental delays allows for referral to therapeutic
services, and children referred for early intervention are more likely to make gains
in developmental milestones.

Sheldrick RC. Schlichting LE, Berger B, Clyne A, Ni P, Perrin EC, et al. Establishing new norms for developmental milestones. Pediatrics. 2019; 144: e20190374
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 DEVELOPMENTAL MILESTONES
● Ages of milestones should be evidence-based to the extent possible
and represent all developmental sectors
● Developmental milestones have been established in gross and fine
motor skills, self-help, problem-solving, social / emotional, and
receptive and expressive language domains

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health. 2012; 17: 561–568.
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 Developmental Milestones:
Newborn
● Baby uses actions to achieve a goal
● Behavioural cues (crying, gazing, imitation) elicit responsive care and sensory
stimulation → activate genes to promote brainplasticity
● Responsive care → calm, alert processing state (self-regulation) for engagement and
interaction → with repetition → creates memory and attachment

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health. 2012; 17: 561–568.
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 Developmental Milestones:
1-2 Months
● Caregiver responds supportively to feeding cues and is emotionally available for
interactions → baby learns to be treated with attention andrespect
● Most infants display evening irritability at 2-16 weeks → mediated by decreasing
central nervous system ability to modulate responses to environmental stimuli

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health. 2012; 17: 561–568.
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 Developmental Milestones:
3-4 Months
● Baby is delightful, engaging caregivers in playful interactions (verbal, tactile, motor) –
creating mastery of theseskills

● Positive emotional state and sense ofself-effectiveness.

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health. 2012; 17: 561–568.
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 Developmental Milestones:
6 Months
● While baby is sitting supported, freed-up hands can reach and grasp, enabling
sensorimotor exploration

● Baby learns through vision and mouthing, preferringnovelty

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health. 2012; 17: 561–568.
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 Developmental Milestones:
9 Months

● Object permanence (knowing objects exist when out ofsight)

● Stranger and separation anxiety and night-wakings emerge
● Object constancy (understanding objects will reappear and maintaining a memory
long enough to beable to retrieve it at any time) emerges

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health. 2012; 17: 561–568.
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 Developmental Milestones:
12 Months

● Joy is apparent when ambulate independently and choose what to explore

● First word appears between 8-14 months ofage
● Gesture number, variety and frequency predict later languagelevels

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health. 2012; 17: 561–568.
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 Developmental Milestones:
18 Months
● Toddler shows excitement about exploring but increased separation anxiety with
previously accepted situations

● Toddlers begin simple pretend play, first directed to self and then toward a doll
● Temper tantrums result from rapid acquisition of gross motor and receptive language
skills

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health. 2012; 17: 561–568.
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 Developmental Milestones:
2 Years
● Major growth in cognition and language represents the transition from infancy to
childhood
● Symbolic pretend play by assigning imaginary properties to objects and using figures as
agents of their own action.

● Tantrums, aggression and noncompliance peak

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health. 2012; 17: 561–568.
Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones. Pediatr Rev. 2016; 37: 25–38.
 DETEKSI DINI MASALAH PERKEMBANGAN ANAK
INSTRUMEN DI INDONESIA

SURVEILANS PRA SKRINING EVALUASI MANAJEME

DIAGNOSTIK N
TERAPI

Buku KIA Buku SDIDTK Denver II DSM V

Mengenal tanda Mempercepat Mengetahui Menegakkan

& gejala dini skrining dan tingkat risiko diagnosis pasti
Memperluas
cakupan
Diagnosis Intervensi
Deteksi Dini Dini Dini
Summary
The development of a child is closely related to the growth and
development of the function of the central nervous system

The environment must be optimized to obtain optimal growth

and development of central nervous system function

The first 2 years of life are important for optimizing growth and
function of the central nervous system

it is important to carry out monitoring and early detection of

growth and development problems on a regular basis
Thank you