Paediatrics: Developmental perspective

Developmental perspective

A cross-sectional understanding, effectively a snap-shot in time, is not usu-ally informative about the child’s pre-presentation strengths and vulner-abilities, and has been shown to have little predictive validity about future development. A developmental model acknowledges that the individual’s needs, demands, skills and contributions change over time. Infant, child, and adolescent stages of development are described, as being embed-ded within the, also changing, emotional and material resources of the primary caregivers, which in turn exist within evolving social and com-munity resources and cultural factors such as a given group’s typical way of expressing emotion, reaction to adversity, and morals about acceptable behaviour.

·Some factors, such as a genetic vulnerability, act continuously, but variably across time.

·Some care giving influences, such as coercive parenting styles, are often seen as developmental continuities, unless an active process of change is undertaken.

·Children can be described as being on a normal, or abnormal, trajectory, either globally or for a range of constructs such as regulation of mood, impulsivity, emotional reciprocity, etc.

The usefulness of this perspective lies in understanding whether a recent presentation is a continuation of a long-standing behavioural or emotional state or a recent discontinuity from a normal trajectory. The former usu-ally involves continuity of causative factors. Such presentations require more complex interventions, over longer periods and generally have a more guarded prognosis.

The heuristic bio-psychosocial is another framework that helps the clinician avoid reductionist and simple formulations for complex presentations.