TYPICAL CHILD

                                             TYPICAL CHILD

NORMAL DEVELOPMENT

MOTOR SKILLS:

In Prone position

	Mean	Range
Lifts head momentarily	1 month	0.5-2months
Lifts head about 45degrees	2 months	1-3 months
Head and upper chest up on forearms	3 months	2-5 months
Head and chest upon extended arms	6months	4-8 months
Gets into crawling position	8 months	6-12 months

                                     

  In Upright posture

	Mean	Range
Bears some weight on feet	7 months	6-9  months
Takes full weight	8 months	6-12 months
Stands holding on	9 months	7-14 months
Pulls on stand	10 months	9-10 months
Stands alone	11 months	9-16 months

                                             


 Gross movement

	Mean	Range
Rolls (or squirms) forwards or backwards	8.5 months	6-11 months
Crawls	9.5months	7-13 months
Walks with support	10 months	8-12 months
Walks alone	13 months	11-18 months
Squats to pick up object	14.5 months	12-19 months
Runs	16 months	15-20 months
Jumps	18 months
Walks on tiptoe	20 months
Runs on tiptoe	20 months
Hops on one foot	3 years

                                                     

   Stairs

	Mean	Range
Walks upstairs with hands held	16 months	12-24 months
Walks upstairs with two feet on each step	25months	19-30 months
Walks upstairs, one foot per step and downstairs 2 feet per step	3years
Walks upstairs and downstairs one foot per step	4years

                                       


Manipulative skills

Number of bricks	Mean	Range
2	15 months	11-19 months
4	18 months	15-24 months
8	24 months	21-28 months
Bridge	3years	27-39 months
3steps	4years

                                       
  Drawing skills

	Mean
Scribbles	15 months
Imitates vertical line	2years
Imitates horizontal line	2.5years
Imitates circle	3years
Imitate cross	4years

                                           


Language skills

Speech sounds	Mean	Range
Grunts	4 weeks	1-6 weeks
Vocalizes (coo)	6 weeks	4-9 weeks
Laughs	3.5 months	2-5 months
Babbles (monosyllabic)	6.5 months	4-8 months
Imitates sounds	10 months	8-12 months
Jargon	12 months	10-15 months
One word	15 months	12-18 months
1-6 words	18 months	15-21 months
7-20 months	21 months	18-24 months
50 words	2 years	18-27 months
Joins 2 words	2 years	18-30 months
200 words	2.5 years	24-36  months
Joins 3-4words	2.5 years	2.3-3 years
Questions (why , what, where, who)	3 years	2.5-3.5 years
Pronouns (I, you, he, she)	3.5years	3-4 years
Conjunctions (and , but)	4 years	3-4.5 years
Sentences of 5+ words	4 years	3-4.5 years
Complex explanations and sequences	4.5 years	4-5.5 years

                                           
Comprehension

	Mean	Range
Understands ‘no’ / bye-bye	7 months	6-9 months
Recognizes own name	8 months	6-10 months
Recognizes familiar names	12 months	10-15 months
Selects 3out of four objects	15 months	12-18 months
Points to body parts on person	15 months	12-18 months
Points to body parts on doll	18 months	15-21 months
Follows a two steps command	2 years	18-27  months
Understands prepositions (in, on, under)	2.5 years	2-3 years
Understands simple negatives	3 years	2.5- 3.5 years
Follows a command with 2instructions	3.5 years	3-4 years
Understands complex negatives (neither/nor)	4 years	3.5-5 years
Follows a command with 3 instructions	4.5 years	4-5.5 years

                                           


  Play

	Range
Shakes rattle	3-6  months
Transfer objects from hand to hand	6-9 months
Plays ‘pat-a-cake’ and ‘peep-bo’	9-11  months
casts	12 – 15 months
Imitates domestic activities	18months-2 years
Isolated pretend play	2-3 years
Cooperate play with other children	3-4 years
Takes turns to play	4-5 years
Play games to rules	4.5 – 6 years

Feeding

  

	Mean
Holds spoon but does not feed	12 months
Holds spoon, brings it to mouth but cannot prevent   it turning over	15 months
Holds spoon and gets food safely to mouth	18  months
Eats skillfully with spoon	2-2.5 years
Eats with fork and spoon	3 years
Eats skillfully with little help	3.5- 4 years
Copes with entire meal unaided	5 years

                                         


Toileting

	Mean
Reflex emptying of bladder	Up to 6 months
Empties bladder less frequently (CNS inhibition of reflex)	6-12  months
Indicates or vocalizes toilet needs or wetness	1-2 years
Bowel control	2.5-4 years
Dry during the day (occasional accidents)	3-4 years
Dry at night (occasional accident)	3.5 – 5 years
Able to control voiding, and micturate on command	4-5 years

Developmental progression of motor planning skills:

Age	Skills
8    months	Plays with rattles, blocks, string, etc rather than merely grasping them, picking them up or chewing on them
1    year	Manipulate things, takes them a parts puts one thing inside another, rearranges them, makes noise by banging them together instead of merely pulling and pushing them around
2    years	Feeds himself with a spoon Holds a cup and drinks from it Makes lines with a crayon
3   years	Takes off and puts on a coat, or dress Uses a fork Unwraps a stick of gum Dries hands with a towel
4   years	Buttons easy buttons Fills glass from pitcher of water Washes hands Cuts with scissors Climbs  under and over chairs and tables, into boxes Rides a bicycle Jumps up  with both feet together
5     years	Puts on almost all clothes (except for tying shoe laces) Draws a cross with a crayon Cleans himself at the toilet Cuts and pastes creative paper design Makes a tent or house out of furniture and blankets
6    years	Hops on one foot Prints his name Colours between the lines in a colouring book Uses a pencil eraser Plays catch with a ball
7    years	Bathes himself with assistance Uses hammer, screwdriver and pliers, although not well Spreads butter with a table knife Ties shoe laces
8    years	Writes his name Pins two things together with a safety pin Uses a straight pin, needle, paper clip, etc Jumps rope
9    years	Uses a table knife for cutting Baths himself without assistance Uses screwdriver, hammer etc efficiently Skips (Girls usually learn earlier)
10    years	Beats on egg with a spoon without spilling it Breaks an egg, separates yolk from the white Peals an apple with a knife Imitates adults as adults folds paper to make a mat

                                       ***************

                                           PLAY

If play is a child’s language, then toys can be thought of as the words. Through play therapy the child can work through their challenges and issues using the toys that they choose, revealing their inner dialogue. Through play the child is able to test out various situations and behaviors in a supportive environment. Unconditional positive regard and acceptance encourages the child to feel safe enough to be able to explore their inner selves without censorship. In this environment children are able to try out different roles, work through conflicting emotions and thoughts, and try to figure out what the world is like. The child is able to form a relationship with the provider, and through this relationship they are able to develop trust, improved self-esteem, and self efficacy.

        The classic study of how play develops in children was carried out by Mildred Parten in the late 1920s at the Institute of Child Development in Minnesota. She closely observed children between the ages of 2 and 5 years and categorised their play into six types.

Parten collected data by systematically sampling the children's behaviour. She observed them for pre-arranged 1 minute periods which were varied systematically (Parten, 1933).

The thing to notice is that the first four categories of play don't involve much interaction with others, while the last two do. While children shift between the types of play, what Parten noticed was that as they grew up, children participated less in the first four types and more in the last two - those which involved greater interaction.

1.     Unoccupied play: the child is relatively stationary and appears to be performing random movements with no apparent purpose. A relatively infrequent style of play.

2.     Solitary play: the child is are completely engrossed in playing and does not seem to notice other children. Most often seen in children between 2 and 3 years-old.

3.     Onlooker play: child takes an interest in other children's play but does not join in. May ask questions or just talk to other children, but the main activity is simply to watch.

4.     Parallel play: the child mimics other children's play but doesn't actively engage with them. For example they may use the same toy.

5.     Associative play: now more interested in each other than the toys they are using. This is the first category that involves strong social interaction between the children while they play.

6.     Cooperative play: some organisation enters children's play, for example the playing has some goal and children often adopt roles and act as a group.

For occupational therapists who work with young children and their families, the topic of play often holds secondary importance in their intervention priorities. The therapist may focus primarily on the atypical physical signs that are present in the child. The therapist uses play, or more precisely toys, as motivators or modalities to encourage the child to move in a certain way or to calm or distract the child to apply a given type of intervention that the child might otherwise resist or protest. E.g. therapist who is interested in facilitating a quadraped position in an infant with hypotonia may reach for the nearest toy to engage the child’s visual attention while facilitating a desire position.

Dimensions of play:

·        As an opportunity for the child to grow and develop and to learn about physical, social, and emotional abilities and skills.

·        As a mechanism for exploring and defining one’s  own motivation and achievement

·        Nonserious, pressure-free opportunity to perform for the process or feeling rather than the product

·        As an imaginary world for mastery over unmanageable aspects of reality

·        To activate an individual’s exploration and sense of wonder

·        As a foundation and builder of interpersonal relationships

·        As a way of teaming and developing interests, skills in concentration and in problem solving, and judgment

·        As an arena for learning about adolescent and adult roles, as well as role behaviors

TAKATA’S Play Epochs:

Takata an occupational therapist first published “The play history” in 1969, further elaborated in 1974, and later in 1984.

In describing each epoch, Takata  designed a strategy for looking at elements of  play behavior across age spans. Together with consideration of the age-appropriate materials, actions, people, and places for the child, Takata described the emphasis of the epoch.

EPOCH	Emphasis
Sensorimotor ( birth – 2yrs)	Emergence of independent play Exploration of play based on the trial-and-error behavior
Symbolic and simple constructive (2-4 years)	Parallel play Emergence of sharing Simple pretense and simple constructive play
Dramatic and complex constructive and pregame (4-7yrs)	Emergence of cooperative play Purposeful use of materials for construction Dramatization of reality Skills and tool used
Games (7-12yrs)	Complex constructional  play Sports and play with rules Completion and cooperation in play
Recreation (12-16yrs)	Team play Special interest and hobby group

Children's perceptions of play experiences and play preferences:

Play is a child's primary and most important occupation and it has historically been regarded by occupational therapists as both an indicator of development and a means of intervention. As the discipline of occupational science has emerged, the concept of play as an occupation and the study of patterns of play participation have been further explored. Recent occupational science literature has suggested that therapists must understand play as providing value and quality to children's lives as they freely engage in it. Occupational scientists believe that play should be viewed, studied, and considered in its naturalistic form and that it need not be broken down into components. Therefore, how children make play choices and assign meaning to the experience of this occupation is an important area of study for occupational therapists. To better understand this occupation and the use of play within practice, an expanded understanding of the complexities and nuances of play and play behaviors and how these affect occupational therapy practice is needed. 

Play choice can be affected by many variables, and one of the most studied is gender research that has frequently found play preferences that differ by gender. For example, girls have been shown to have a preference for doll play and boys a preference for car and truck play. Girls prefer dyadic play and interaction, and boys prefer vigorous and outdoor play. Parental interaction with children using gender-stereotyped toys and labeling and familiarity of toys that are deemed gender specific may contribute to the gender differences.

          Another well-researched variable related to play choices is age. As children develop new motor and cognitive skills, they have the capacity to play in new and more complex ways, and those new abilities are reflected in their choices of more complex play over time. Infants use object play to explore and learn about the world around them. Relational play with multiple objects is then followed by symbolic and fantasy play. Outdoor play preferences and the preference for rough-and-tumble play have been shown to change with age, as have pretend play and social play.

                 It is difficult to determine whether children with disabilities play differently from typically developing children because of differences in preference or an inability to access and participate in certain choices. However, research suggests that children with disabilities do play differently. Although it appears that children with disabilities do play differently from typically developing children, the issue of whether children with disabilities have different play preferences or not is unresolved.

                 The occupational therapy profession is undergoing a move toward client-centered practice. To be client centered with children, occupational therapists must give children a voice and must listen to that voice. Therefore, research is needed to explore children's perceptions of play choice, their feelings regarding play, and their assignation of meaning to their choices for play.

                 The purpose of this grounded theory study was to explore, understand, and describe children's perceptions of play, the meaning of play from their point of view, and the rationale for their choice of play experiences. Our findings will enable professionals working with children to better understand children's perceptions regarding their play preferences and how they experience and assign meaning to play activities. Such understanding may particularly enable occupational therapists to better conceptualize and use play as an occupation in pediatric intervention and improve the use of play in pediatric evaluation and intervention.

              The four main categories that related and contributed to an activity being identified by a child as fun were activity characteristics, relational characteristics, child characteristics, and contextual characteristics. The categories related to one another in a dynamic process that produced a choice of activity, a meaning or emotion associated with that activity choice, and the development of preference. Each category is described individually in the sections that follow.

Activity Characteristics:

                        Activity characteristics emerged as influential factors in children's play choice. One activity characteristic that children frequently mentioned as creating fun (and therefore choice) was the activity level or amount of movement it provided. Kathy stated that fun was "when you get to run around," and Lucy said one of her favorite games was special because "it's fast and it's really interesting." Kathy also enjoyed playing tag and chase with her dog specifically because "he's really fast, and I like to catch him." Kathy summed up many of the comments made in this category by saying that play was when "you get to move, run, and play on the swings." Work, on the other hand, was when "you have to sit down and write."

Although this activity characteristic was important to the children, the primary concept they spoke of with regard to activity characteristics was the level of challenge the activity provided. The children enjoyed challenges and sought them out. They preferred play that provided them with an appropriate challenge and that was not too easy or too difficult. The desire for challenge was noted whether the play was with others (team sports) or alone (computer games). Comments from the children included statements such as Sabrina's: "I always like challenges" and "I'd like it rather be easy, well, like not really easy but not really hard either. In the middle so that I'm being challenged but I'm still doing good." She continued, "It kinda needs to start out being easy enough so I can have fun with it, then it can get hard." Whether an activity was perceived as fun seemed to be based on a delicate balance in the challenge level. The activity could not be perceived as too hard or too easy for it to be preferred.

Relational Characteristics

        Friends, siblings, and even pets figured prominently in the descriptions of play and fun in this age group of children. The relational aspects of play involved whom to play with and who decided what to play. This group of children also frequently mentioned aspects of teamwork and bonding.

        Peers were a primary motivator in the children's play and in their description of fun. All the children preferred to play with others rather than alone and felt that play was more fun with their peers. Matt expressed the depth of the importance of peers to children at this age with the statement "If I'm not playing with my friends, I can't play." Children who had siblings or pets considered them playmates equal with peers and frequently chose them as preferred. Several responses from participants of both genders, however, suggested the competitive nature between siblings. Jack preferred to play with his younger brothers, for example, "because I always beat them." Participants also expressed the opposite, reporting feelings of interdependence and support associated with peer and sibling relationships during play. For example, Lucy stated that "everybody depends on me to catch the ball," and Jane responded that she liked to play on a team because "you have more people to help you out."

        Others, both peers and adults, were important in the children's choices of what to play. The children did not feel that it was extremely important that they themselves chose what to play, as long as they agreed it was fun. Peers could choose what to play, adults could choose what to play, and even siblings could choose what to play, as long as it was fun. Many children also spoke about shared decision making. Kathy discussed the cooperativeness of play decisions: "We both try to decide on something we both want to play." Sabrina's response regarding choice was "[my brother] has always had favorites ... sometimes even Dad picks the game, we take turns." Jane's choices seemed based on her brother: "[My brother] and I play videogames, and if he's home I play basketball with him."

        When asked whether they preferred to play with children or adults, all children preferred other children. When asked about adult play, however, some children did not note differences between adult and child play, based on their understanding of play. Because their conception of play is merely that play is fun and because adults have fun, too, the children felt that both children and adults could play in the same way. For example, Lucy stated, "It is as much fun to play with adults as it is kids because when you play with kids they run around and laugh and stuff like that and the same thing happens when you play with adults." Others clearly expressed a preference for peers or siblings. Kathy answered that kids are "more fun" and that adults are "boring sometimes." Specifically, she responded that "kids like to play and run a lot and grownups don't." She also thought that adults were too serious to play with kids and that they should "act more like a kid" if they want to try to play with kids. The inconsistencies appeared to be related to characteristics of the adults who were available to play with the children. Some children had access to playful adults, who were fun, and others did not. Although some children did not specifically note differences in the way in which children and adults play, none of the children indicated that an adult would be a preferred playmate over another child.

Child Characteristics

         Characteristics inherent in the child also emerged as a factor influencing children's play choices and whether an activity was viewed as fun. The children made many comments about their age, ability level, gender, and the opposite gender in relation to play choices. They were able to perceive the changes in their play choices as they got older. Kathy noted that "when you grow up, your mind changes and you like different stuff." She also stated that "littler things are kinda boring when you get older." Throughout the interviews, the children made comments that indicated that their ability to participate in and have a level of success with the activity influenced play choices and likelihood of perceiving an activity as fun. When comparing play choices now to those when they were younger, many children cited ability level as a reason for change. For example, Joe said that when he was younger he played board games as opposed to a current favorite, football, "because it [was] really the only thing I could be able to play."

         The children were very aware that girls played differently from boys. Lucy specifically said, "They [boys] like to get dirty and roll on the ground.... They like to push each other around and roughhouse." She stated that girls "like to walk around, and they talk or they play tag or four square." Olivia said, "Boys don't like to play girls things mostly." Kathy stated "boys act weird" and that "they don't listen, they don't share, and they argue." Girls, on the other hand, according to Kathy, "don't argue as much and they share too."

        In addition to being aware of the differences in play by gender, most of the children reported that they preferred to play with their own gender. Jim's response when asked why he preferred to play with boys was "they like the same stuff that I do" and "girls for some reason like makeup and stuff and dolls; boys sort of think that's weird." Jack specifically said that he preferred playing with boys to girls "because I'm a boy" and "'cause they [girls] don't really know how to play." One girl in the sample, however, was reported by her mother to be a "tomboy" who preferred to play with boys, specifically older boys who were the peers of her older brother. This child was reported to excel at sports, and she preferred to play sports with her brother and his peers. This preference speaks to the importance of child characteristics in the choice of fun and the individuality of the conception of fun related to play.

Contextual Characteristics

The contextual issues that emerged included the effects of environment and location of activities in time and space. There was a definite preference for outdoor play over indoor play because outdoor play was considered to be more fun. Outdoor play also provided the opportunity to run and move. For example, Kathy stated that she preferred the outdoors because "there is more room to run and have fun." Preference for outdoor play was also explained by Lucy, who commented that outside

   “You can yell and you can scream ... and you can run    around and chase each other and you could, you could    play on like the playscape and ... inside you have to sit down and play a board game or something”.

          Jim also favored outdoors because of its "big open spaces" and the ability to just "run around." Last, Kathy stated that the opposite of fun and play was "sitting inside and doing nothing," equating inside with boredom. It follows, then, that the weather factored prominently in decisions about where to play and when. Given the preference for outdoor play and the belief that outdoor play was more fun, the choice of indoor play was specifically frequently related to the weather. Kathy commented that she plays inside only "when it's a rainy day."