LINGUISTIC AND LITERACY DEVELOPMENT OF CHILDREN AND ADOLESCENTS

NATURAL HISTORY OF LANGUAGE DEVELOPMENT

Speech and language are the tools humans use to communicate and share thoughts, ideas,
and emotions. For babies and children, they come to know these tools and develop at a varying
rate.
Language differs from speech in that language is the set of rules, shared by the individuals
who are communicating, that allows them to exchange those thoughts, ideas, or emotions.
Speech is talking, one way that a language can be expressed. Language may also be expressed
through writing or things like signing.
When we communicate successfully, we do so because we are able to do at least four
different things.
First, we need to be able to perceive and produce the sounds that make up a language
and convey meanings to other people.
How we produce meaningful sounds is the study of phonology.
Second, we need to know what the words of a language mean.
Semantics is the study of word meaning and how we acquire a vocabulary.
Third, we need to know how to put these words together in grammatically appropriate
ways such that others will understand us.
The study of grammar (or syntax) refers to how we learn the rules of a language.
Fourth, we need to know how to effectively use our language to communicate with
others.
Pragmatics is the study of how we use language to achieve communicative goals.
The earliest theory about language development assumed that children acquire language
through imitation. While research has shown that children who imitate the actions of those
around them during their first year of life are generally those who also learn to talk more quickly,
there is also evidence that imitation alone cannot explain how children become talkers.
Theories of Language Development
1. Behavioral Theory/ Learning Perspective
Behaviorists believe language is something that can be observed and measured. The need to
use language is stimulated and language is uttered in response to stimuli. To the behaviorist,
competence in the rules of language is not as important as the ability to speak it; speaking is
what makes language real. Knowledge is a mental state and the structure of a language doesnt
make it a language; it is the function of speaking words that makes a language a language.
B.F. Skinner is perhaps the best known behaviorist who posited that children are conditioned
by their environment to respond to certain stimuli with language. Children imitate what they
see and hear, and children learn from punishment and reinforcement. When children speak the
language of their parents they are rewarded and become more skillful. They grow in their ability
to respond in a manner that responds to the environmental stimuli given by his parents. This
shapes a childs language more than knowledge of rules. (Gleason and Ratner 2009). Skinner
argued that adults shape the speech of children by reinforcing the babbling of infants that sound
most like words.
While most would agree that a language-rich environment helps children achieve success in
communication, experts havent been able to prove this with experiments outside the lab. The
behaviorists approach has been criticized for not taking into account the many and varied
influences on a childs language learning.
2. Nativist Linguistic Theory
The manner in which a child acquires language is a matter long debated by linguists and child
psychologists alike. The father of most nativist theories of language acquisition is Noam
Chomsky, who brought greater attention to the innate capacity of children for learning
language, which had widely been considered a purely cultural phenomenon based on imitation.
The nativist perspective argues that humans are biologically programmed to gain knowledge.

 Nativist linguistic theories hold that children learn through their natural ability to organize the
laws of language, but cannot fully utilize this talent without the presence of other humans. This
does not mean, however, that the child requires formal tutelage of any sort. Chomsky claims that
children are born with a hard-wired Language Acquisition Device (LAD) in their brains. They are
born with the major principles of language in place, but with many parameters to set (such as
whether sentences in the language(s) they are to acquire must have explicit subjects). According
to nativist theory, when the young child is exposed to a language, their LAD makes it possible for
them to set the parameters and deduce the grammatical principles, because the principles are
innate. (Bigge and Shermis, 1998).
This is still a very controversial view, and many linguists and psychologists do not believe
language is as innate as Chomsky argues. There are important arguments both for and against
Chomsky's view of development. One idea central to the Chomskian view is the idea of Universal
Grammar, which posits that all languages have the same basic underlying structure, and that
specific languages have rules that transform these underlying structures into the specific
patterns found in given languages. Another argument is that without a propensity for language,
human infants would be unable to learn such complete speech patterns in a natural human
environment where complete sentences are the exception
More recently, researchers have shown that parents react differently to childrens
grammatically correct and incorrect utterances. This shapes the childs behavior and therefore
challenges the belief that language is innate.
3. Social Interactionist Theory
This theory is an approach to language acquisition that stresses the environment and the
context in which the language is being learned. It focuses on the pragmatics of language rather
than grammar, which should come later. In this approach, the beginning speaker and the
experienced speaker--be they child and adult or second-language learner and fluent speaker-exist in a negotiated arrangement where feedback is always possible. The basic appeal of this
approach is the importance it places on the home and the cultural environment in earlychildhood language acquisition. Interactionist theories are concerned with the interplay between
environmental & biological factors in the process of acquiring language.
Interactionist theories are concerned with the interplay between environmental & biological
factors in the process of acquiring language. Interactionists tend to view children as having a
strong biological predisposition to acquire a language.
However, in contrast to nativists, interactionists stress the importance of both the social
support that parents provide the young language learner, as well as the social contexts in which
language-learning child is instructed.
Jerome Bruner (1983) argues parents provide their children a language acquisition
support system or LASS.
The LASS is a collection of strategies that parents employ to facilitate their childrens
acquisition of language.
One of these strategies is scaffolding, the deliberate use of language at a level that is
slightly beyond what children can comprehend.
With parental support, scaffolding leads the child to acquire complex language more
quickly then they might on their own.
Another strategy is called infant-directed speech or motherese (aka baby talk).
When using infant-directed speech, parents speak in a higher pitch, stress important
words, and talk more slowly to their infants.
Very young infants show a clear preference for infant-directed speech. Gets an infants
attention & increases the chances of their understanding the message.
Another a pair of techniques that adults employ is expansion & recast.

 Expansion occurs when an adult takes a childs utterance and expands on its complexity.
For example, when a child might utter something like Felix eated, the parent might expand
on the complexity, adding Yes, thats right, Felix ate his dinner.
Notice here that the parent has also corrected the childs grammar, changing eated to its
appropriate past tense form, ate.
When parents expand, as in this example, they often recast the childs utterance as well,
correcting the grammatical form of the utterance.
Language is a social concept that is developed through social interactions. According to Lev
Vygotsky, language acquisition involves not only a childs exposure to words but also an
interdependent process of growth between thought and language. Vygotskys influential theory
of the "zone of proximal development" asserts that teachers should consider a childs
prospective learning power before trying to expand the childs grasp of language.
Vygotskys theory of language is based on constructivist learning theory, which contends
that children acquire knowledge as a result of engaging in social experiences. It focuses
on collaborative learning. Collaborative learning is the idea that conversations with
older people can help children both cognitively and linguistically. "Through social and
language interactions, older and more experienced members of a community teach
younger and less experienced members the skills, values, and knowledge needed to be
productive members of that community."
According to Vygotsky, words are signals. Rather than engage children in a primary
signal system, in which objects are referred to merely as themselves, adults engage
children in a secondary signal system, in which words represent objects and ideas.
A childs intellectual development is crucial to his language development. By interacting
with his environment, a child develops the ability to develop private, inner speech.
"Inner speech is thinking in pure meanings; it is the link between the second signal
system of the social world and the thought of the individual."
Through the development of inner speech, children straddle the divide between thought
and language, eventually being able to express their thoughts coherently to others.
The language learning process occurs as a result of give and take. Parents and teachers
usher a child through a process of guided discovery, addressing her learning potential.
Eventually, children internalize language skills. As young learners experience language
development, they "can reflect better on their own thinking and behavior and reach
greater levels of control and mastery over their own behavior."
Vygotskys constructivist language theory exists in opposition to Jean Piagets theory of
language acquisition. According to Piaget, children construct knowledge about language
through a complex process of assimilation, stressing the inherent capability of a childs
brain to adapt to stimulation. By contrast, Vygotsky stresses the social nature of
language learning, emphasizing the environment within which a child is raised.
4. Cognitive Theory of language development
This theory was proposed by Jean Piaget. He theorized that language is made up of symbols
and structures, but exhibits itself as a childs mental abilities mature. In addition, language is
only one of many human mental or cognitive activities.
Piagets view of how children's minds work and develop has been enormously influential,
particularly in educational theory. His particular insight was the role of maturation (simply
growing up) in children's increasing capacity to understand their world: they cannot undertake
certain tasks until they are psychologically mature enough to do so. His research has spawned a
great deal more, much of which has undermined the detail of his own, but like many other
original investigators, his importance comes from his overall vision. (Wood, 1998).
Piaget proposed that children's thinking does not develop entirely smoothly: instead, there are
certain points at which it "takes off" and moves into completely new areas and capabilities. He
saw these transitions as taking place at about 18 months, 7 years and 11 or 12 years. This has
been taken to mean that before these ages children are not capable (no matter how bright) of

understanding things in certain ways, and has been used as the basis for scheduling the school
curriculum. (Satterly, 1987).

PRE-SPEECH FORMS OF COMMUNICATION

During the first year and a half to two years of post natal life, until they have learned
enough words to use as a form of communication, babies use four pre-speech forms of
communication: crying, explosive sounds which soon develop into babbling; gestures; and
emotional expressions. Of these four, the second-babbling-is the most important in speech
development because it becomes the basis for real speech.
1. Crying: In the early days of postnatal life, most vocalization consists of crying. Crying is one
of the first ways in which the infant is able to communicate with the world at large. Through
cries, babies make known their need for someone to relieve their hunger, pain, fatigue, and other
unpleasant bodily states and to satisfy their desire for attention.
To make this communication easier for others to understand, nature provides for differentiation in
the tonal quality of the cries as early as the third or fourth week of life. Pain, for example, is
expressed by loud, shrill cries interrupted by groaning and whimpering while hunger cries are
loud and interrupted by sucking movements.
Comprehension of the meaning fl cries is aided by the intensity of the cries and by bodily
movements that accompany crying. The louder and the more persistent baby, for example, will
have a louder and more persistent cry than a baby who is less hungry. Social reactions to crying
influence the amount of crying babies do.
2. Cooing and Babbling: The second pre-speech form of communication is called cooing or
babbling. In addition to cries, babies may make simple sounds during the early months of life,
such as grunts of pain or disgust, squeals of delight, yawns, sneezes, sighs, belching, coughing,
guttural barking sounds, growls, and cries, that sound like the whine of a young pig or the bleat
of a goat. These are known as cooing. As the babys neuromuscular mechanisms develop,
explosive sounds change into babbling.
3. Gestures: The third preliminary form of communication consists of gesturesmovements of
the limbs or the body which serve as substitutes for, or supplements to, speech. As a substitute
for speech, gestures take the place of words; an idea is conveyed to others by meaningful
movements of the limbs or some part of the body. As a supplement to speech, gestures
emphasize on the meaning of spoken words. Gestures have the serious purpose of
communication. Most gestures made by babies are easy to understand. The need for gestures
as a substitute for speech does not end when babies say their first words, until children have
time to build up a large enough vocabulary to express their wants, needs, thoughts, and feelings
in words, they will continue to use gestures to make their incomplete sentences meaningful.
4. Emotional Expressions: The fourth pre-speech form of communication is the expression of
emotions through facial and bodily changes. The pleasant emotions are accompanied by
pleasant vocalizations in the form of cooing, chuckling sounds, and laughs, while the unpleasant
emotions are accompanied by whimpering and crying. When children grow older, they learn to
control emotional expressions and this decreases their communicative value. Expressions of the

emotions are a useful pre-speech form of communication for a second reason they are easy for
babies to interpret when they are used by others. Babies quickly notice a changed expression on
the parents (ace and a change in the tone of parental voice. Like gestures, emotional
expressions continue to be a useful form of communication even after children have learned to
speak.

BILINGUAL LANGUAGE DEVELOPMENT

Bilingualism is the ability to speak or write fluently in two languages. It refers to those children
who speak/have been spoken to in two languages in the home since birth and who are spoken to
in only or both of those two languages at daycare or school
Some Myths about Bilingualism
1. Bilingualism causes language delay. While a bilingual childs vocabulary in each individual
language may be smaller than average, his total vocabulary (from both languages) will be at
least the same size as a monolingual child. Bilingual children may say their first words slightly
later than monolingual children, but still within the normal age range (between 8-15 months).
And when bilingual children start to produce short sentences, they develop grammar along the
same patterns and timelines as children learning one language. Bilingualism itself does not cause
language delay. A bilingual child who is demonstrating significant delays in language milestones
could have a language disorder and should be seen by a speech language pathologist.
2.When children mix their languages it means that they are confused and having trouble
becoming bilingual. When children use both languages within the same sentence or
conversation, it is known as code mixing or code switching. Examples of English-Tagalog
code-mixing: big dede. Parents sometimes worry that this mixing is a sign of language delay or
confusion. However, code mixing is a natural part of bilingualism. Proficient adult bilinguals code
mix when they converse with other bilinguals, and it should be expected that bilingual children
will code-mix when speaking with other bilinguals. Many researchers see code mixing as a sign of
bilingual proficiency. For example, bilingual children adjust the amount of code-mixing they use
to match that of a new conversational partner (someone theyve never met before who also code
mixes). It has also been suggested that children code-mix when they know a word in one
language but not the other. Furthermore, sometimes code-mixing is used to emphasize
something, express emotion, or to highlight what someone else said in the other language. For
example, I want DEDE. Therefore, code-mixing is natural and should be expected in bilingual
children.

3. A person is not truly bilingual unless he is equally proficient in both languages. It is rare to find
an individual who is equally proficient in both languages. Most bilinguals have a dominant
language, a language of greater proficiency. The dominant language is often influenced by the
majority language of the society in which the individual lives. An individuals dominant language
can change with age, circumstance, education, social network, employment, and many other
factors.
4. An individual must learn a second language as a young child in order to become
bilingual. There is a Critical Period theory that suggests that there is a window of time (early
childhood) during which a second language is most easily learned. This theory has led many
people to believe that it is better to learn a second language as a young child. Young children
have been found to achieve better native-like pronunciation than older children or adult second
language learners. And they seem to achieve better long-term grammatical skills than older
learners. But other findings have called the idea of a critical period into question. For example:
older children (in middle elementary school) have been shown to have advantages when
learning academic English. Academic language refers to the specialized vocabulary,
grammar, and conversational ability needed to understand and learn in school. This is
likely easier for older children because they learn their second language with more
advanced cognitive skills than younger children, and with more experience with schooling
and literacy.
older children and adults seem to be advantaged when initially learning vocabulary and
grammar.
Therefore, while younger children seem to become more native-like in the long-term, older
children may pick up vocabulary, grammar, and academic language more easily in the initial
stages of language learning.
5. Parents should adopt the one parent-one language approach when exposing their child to
two languages. Some parents may choose to adopt the one parent-one language approach,
where each parent speaks a different language to the child. While this is one option for raising a
bilingual child, there is no evidence to suggest that it is the only or best way to raise a child
bilingually, or that it reduces code mixing. Parents should not worry if they both speak their
native language to the child or if they mix languages with their child, as it has been recognized
that children will mix their languages regardless of the parents approach. Many approaches can
lead to bilingualism. Parents should speak to their child in a way that is comfortable and natural
to them.
6. If you want your child to speak the majority language, you should stop speaking your home
language with your child. Some parents attempt to speak the majority language to their child
because they want their child to learn that language, even if they themselves are not fluent in
the majority language. This can mean that conversations and interactions do not feel natural or
comfortable between parent and child. There is no evidence that frequent use of the second
language in the home is essential for a child to learn a second language. Furthermore, without
knowledge of a familys home language, a child can become isolated from family members who
only speak the home language. Research shows that children who have a strong foundation in
their home language more easily learn a second language. Children are also at great risk of
losing their home language if it is not supported continually at home.
Benefits of Bilingualism

Bilingual children are better able to focus their attention on relevant information and
ignore distractions
Bilingual individuals have been shown to be more creative and better at planning and
solving complex problems than monolinguals.
The effects of aging on the brain are diminished among bilingual adults.
In one study, the onset of dementia was delayed by 4 years in bilinguals compared to
monolinguals with dementia.
Bilingual individuals have greater access to people and resources.
Aside from the obvious advantage of being able to speak more than one language,it
impacts the child positively in the sense of self esteem, future job opportunities and ability
to live and travel abroad.
The cognitive advantages of bilingualism (e.g. with attention, problem solving, etc.) seem
to
be
related
to an individuals proficiency in his languages. This means that a person will benefit more

from
bilingualism (cognitively) if he is more proficient in his languages.

his

How Children Learn More Than One Language

Bilingual acquisition can take place in one of two ways:

1. Simultaneous Acquisition occurs when a child is raised bilingually from birth, or when
the second language is introduced before the age of three. Children learning two
languages simultaneously go through the same developmental stages as children learning
one language. While bilingual children may start talking slightly later than monolingual
children, they still begin talking within the normal range. From the very beginning of
language learning, simultaneous bilinguals seem to acquire two separate languages. Early
on, they are able to differentiate their two languages and have been shown to switch
languages according to their conversation partner (e.g. speak French to a French-speaking
parent, then switch to English with an English-speaking parent)
2. Sequential Acquisition occurs when a second language is introduced after the first
language is well-established (generally after the age of three). Children may experience
sequential acquisition if they immigrate to a country where a different language is spoken.
Sequential learning may also occur if the child exclusively speaks his heritage language at
home until he begins school, where instruction is offered in a different language.
Ages of Bilingual Acquisiton
One way of categorizing types of bilingual acquisition is by the age at which the two languages
are acquired- infants, child, adoloscent, and adult.
Infant or early bilingual acquisiton involves the child learning two languages virtually
simultaneosly from the outset. Sometimes this results from having parents who have different
native languages, but also speak the other parents language. Early age of bilingual exposure
has a significant impact on multiple aspects of a childs development: linguistic, cognitive and
reading.Children who experince early and extensive exposure to both of their languages quickly
grasp the fundamentals of both of their languages and in a manner similar to that of monolingual
language learners
Child bilingual acquisiton may start quite early in life, but involves the successive
acquisition of two languages, as do adolescent and adult bilingualism. This may be occasioned
by the family moving to another country, the arrival of a caregiver who speaks a different
language, or the child starting a nursery class or school is taught in a different language from the
one used at home.
Adolescent bilingual acquisition refers to the acquisiton of a second language after
puberty, while adult bilingual acquisition refers to acquisition after the teen years.

EMERGENT AND EARLY LITERACY DEVELOPMENT

Literacy is communication in all forms: listening, speaking, reading,and writing. Literacy is
continually evolving, beginning at birth, through interactions with others and the environment in
which a child lives. While the sequence of literacy development follows the same general
pattern, individual rates of growth may vary.

 Childrens success in school and later in life is to a great extent dependent upon their ability to
read and write. One of the best predictors of whether a child will function competently in school
and go on to contribute actively in an increasingly literate society is the level to which the child
progresses in reading and writing.
A child's ability to read and write begins to develop long before entering Kindergarten. Infancy
through age eight is the most important time in a child's early literacy development as they learn
and develop the skills needed to be successful in school and later in life.
According to the joint position statement of the International Reading Association (IRA) and the
National Association for the Education of Young Children (NAEYC), most children learn to read at
around age six or seven, some children learn to read at age five, and a few at age four. In order
for children to develop healthy dispositions toward reading and literacy, experiences in the early
years must engage children actively in the process of learning.
Early Literacy is what children know about reading and writing before they actually read and
write. Research shows that children arriving at kindergarten with the following early literacy skills
are more likely to be successful in learning to read and write:

Vocabulary Development -- Knowing the names of things

Narrative Skills -- Being able to describe things, events, and tell stories
Letter Knowledge -- Understanding that each letter is unique and has a name and sound
Print Awareness -- Experience with different forms of print; knowledge of how to handle
books and how to follow words across a page
Print Motivation -- Interest in and enjoyment from books
Phonological Awareness -- Ability to hear and play with the small sounds that make up
words

Early Literacy Behaviors

1. Book Handling Behaviors - behaviors related to a child's physical manipulation or handling
of books, such as page turning and chewing.
2. Looking and Recognizing Behaviors - related to how children pay attention to and interact
with pictures in books, such as gazing at pictures or laughing at a favorite picture.
Behaviors that show recognition of and a beginning understanding of pictures in books,
such as pointing to pictures of familiar objects.
3. Picture and Story Comprehension Behaviors - show a child's understanding of pictures and
events in a book, such as imitating an action seen in a picture or talking about the events
in a story.
4. Story-Reading Behaviors - behaviors that include children's verbal interactions with books
and their increasing understanding of print in books, such as babbling in imitation of
reading or running fingers along printed words.
Promoting Literacy Development among Children
1.
2.
3.
4.
5.
6.
7.

Establish a positive climate that supports children as literacy learners.

Use childrens play to facilitate reading and writing.
Create a physical learning environment that promotes reading and writing.
Make reading and writing a part of the daily routine of the classroom.
Encourage children to read and write to one another.
Read aloud to children on a regular basis.
Engage parents in literacy activities.

FACTORS AFFECTNG LNGUSTC AND LTERACY DEVELOPMENT

A. BIOLOGICAL FACTORS

1. Childs Age
2. Cognitive Processing or Intelligence
3. Delayed general development (global developmental delay), physical
development (motor skills), cognitive development etc.
4. Neurological Disorders or medical problems
5. Family history of speech and language delays or difficulties
6. Reduced hearing e.g. ear infection, fluid in ear, impacted earwax etc.
B. PSYCHOSOCAL FACTORS
1. Early Stimulation
2. Family Structure or Literate Environment
3. Childs Attitude (i.e. not very interested in language, prefers other modalities like
physical activities.)
4. Economic Status
5. Changes in childs environment (e.g. moving.)
6. Short attention span.
7. Exposure to too many languages for the child.
8. Inadequate awareness of communication, lacks communication intent.
EXCEPTIONAL DEVELOPMENT: APHASIA AND DYSLEXIA
Language disorders or language impairments refer to any systematic deviation in the way
people speak, listen, read, write, or sign that interferes with their ability to communicate with
their peers. The disorders may involve the form of language (phonology, syntax, and
morphology), its content or meaning (semantics), or its use (pragmatics), in any combination.
The disorders themselves vary according to the degree of severity and the level of language they
affect.
I. Aphasia
Aphasia is a condition that affects the brain and leads to problems using language correctly.
It is communication disorder that results from damage to the parts of the brain that contain
language (typically in the left half of the brain).

People with aphasia make mistakes in the words they use, sometimes using the wrong sounds
in a word, choosing the wrong word, or putting words together incorrectly. Aphasia also affects
speaking and writing in the same way. Many people with the condition find it difficult to
understand words and sentences they hear or read.

Aphasia may causes difficulties in speaking, listening, reading, and writing, but does not affect
intelligence. Individuals with aphasia may also have other problems, such as dysarthria (a
condition in which problems effectively occur with the muscles that help produce speech, often
making it very difficult to pronounce words), apraxia (a motor disorder caused by damage to the
brain, in which someone has difficulty with the motor planning to produce speech), or swallowing
problems.
Signs and Symptoms of Aphasia
The specific symptoms and severity of aphasia vary depending on the location and extent of
brain damage. Individuals with damage to the front part of the brain may have "choppy" or nonfluent speech. However, they can typically understand what people say fairly well. Those with
damage to the posterior regions of the brain often have fluent speechthat is, the rate and
rhythm of speech may sound normal. However, their speech may contain the wrong words or
made-up words. They also typically have difficulty understanding what is spoken.

 Additionally, all individuals with aphasia may also have one or more of the following problems:
1. Difficulty producing language:
Experience difficulty coming up with the words they want to say
Substitute the intended word with another word that may be related in meaning to the
target (e.g., "chicken" for "fish") or unrelated (e.g., "radio" for "ball")
Switch sounds within words (e.g., "wish dasher" for "dishwasher")
Use made-up words (e.g., "frigilin" for "hamburger")
Have difficulty putting words together to form sentences
String together made-up words and real words fluently but without making sense
2. Difficulty understanding language:
Misunderstand what others say, especially when they speak fast (e.g., radio or
television news) or in long sentences
Find it hard to understand speech in background noise or in group situations
Misinterpret jokes and take the literal meaning of figurative speech (e.g., "it's raining
cats and dogs")
3. Difficulty reading and writing:
Difficulty reading forms, pamphlets, books, and other written material
Problems spelling and putting words together to write sentences
Difficulty understanding number concepts (e.g., telling time, counting money,
adding/subtracting)
Causes of Aphasia
Aphasia is caused by damage to parts of the brain responsible for understanding and using
language. Common causes include:
stroke, thought to be the most common cause, around one in three people experience
some degree of aphasia after having a stroke
severe head injury
brain tumour
progressive neurological conditions (conditions that over time cause progressive brain and
nervous system damage, such asAlzheimers disease)
Treatments of Aphasia
There are many types of treatment available for individuals with aphasia. The type of
treatment depends on the needs and goals of the person with aphasia. Treatment may be
provided in individual or group sessions.
If the brain damage is mild, a person may recover language skills without treatment. However,
most people undergo speech and language therapy to rehabilitate their language skills and
supplement their communication experiences. Researchers are currently investigating the use of
medications, alone or in combination with speech therapy, to help people with aphasia.
1. Speech and language rehabilitation
Recovery of language skills is usually a relatively slow process. Although most people make
significant progress, few people regain full pre-injury communication levels. In aphasia, speech
and language therapy:

Starts early. Therapy is most effective when it begins soon after the brain injury.

Builds on success. The speech-language pathologist uses exercises to improve and

practice communication skills. These may begin with simpler tasks such as naming objects
and evolve into more complex exercises of explaining the purpose of an object.

Shifts focus. The speech-language pathologist might teach the person ways to
compensate for the language impairment and to communicate more effectively with gestures
or drawings. Some people with aphasia may use a book or board with pictures and words to
help them recall commonly used words or help them when they're stuck.

Often works in groups. In a group setting, people with aphasia can try out their
communication skills in a safe environment. Participants can practice initiating conversations,
speaking in turn, clarifying misunderstandings and fixing conversations that have completely
broken down.

May include outings. Participating in real-life situations such as going to a restaurant

or a grocery store puts rehabilitation efforts into practice.

May include use of computers. Using computer-assisted therapy can be especially

helpful for relearning verbs and word sounds (phonemes).

2. Medications
Certain drugs are currently being studied for the treatment of aphasia. These include drugs
that may improve blood flow to the brain, enhance the brain's recovery ability or help replace
depleted chemicals in the brain (neurotransmitters). Several medications, such as memantine
(Namenda) and piracetam, have shown promise in small studies. But more research is needed
before these treatments can be recommended.

II. Dyslexia
Dyslexia is a language-based learning disability. Dyslexia refers to a cluster of symptoms,
which result in people having difficulties with specific language skills, particularly reading.

Students with dyslexia usually experience difficulties with other language skills such as
spelling, writing, and pronouncing words. Dyslexia affects individuals throughout their lives;
however, its impact can change at different stages in a persons life.

It is referred to as a learning disability because dyslexia can make it very difficult for a student
to succeed academically in the typical instructional environment, and in its more severe forms,
will qualify a student for special education, special accommodations, or extra support services.

The problem in dyslexia is a linguistic one, not a visual one. Dyslexia in no way stems from any
lack of intelligence. People with severe dyslexia can be brilliant.

Signs and Symptoms of Dyslexia

Dyslexia is a spectrum disorder, with symptoms ranging from mild to severe. People with
dyslexia have particular difficulty with:

phonological awareness
verbal memory
rapid serial naming
verbal processing speed

1. Phonological awareness - is thought to be a key skill in early reading and spelling

development. It is the ability to identify how words are made up of smaller units of sound,
known as phonemes. Changes in the sounds that make up words can lead to changes in
their meaning.
For example, a child with a good level of phonological awareness would understand that if you
change the letter "p" in the word "pat" to "s", the word becomes "sat".

2. Verbal memory - is the ability to remember a sequence of verbal information for a short
period of time.
For example, the ability to remember a short list such as "red, blue, green", or a set of simple
instructions, such as "Put on your gloves and your hat, find the lead for the dog and then go
to the park."

3. Rapid serial naming - this is the ability to name a series of colors, objects or numbers as
fast as possible.
4. Verbal processing speed - is the time it takes to process and recognize familiar verbal
information, such as letters and digits.
For example, someone with a good verbal processing speed has the ability to quickly write
down unfamiliar words when they are spelled out, or write down telephone numbers they are
told.

The Dyslexia Research Trust includes these as the most common signs and symptoms
associated with dyslexia:
a. Learning to read - the child, despite having normal intelligence and receiving proper
teaching and parental support, has difficulty learning to read.
b. Milestones reached later - the child learns to crawl, walk, talk, throw or catch things, ride
a bicycle later than the majority of other kids.
c. Slow in speech - apart from being slow to learn to speak, the child commonly
mispronounces words, finds rhyming extremely challenging, and does not appear to distinguish
between different word sounds.
d. Slow at learning sets of data - at school the child takes much longer than the other
children to learn the letters of the alphabet and how they are pronounced. There may also be
problems remembering the days of the week, months of the year, colors, and some arithmetic
tables.
e. Problems in Coordination - the child may seem clumsier than his or her peers. Catching a
ball may be difficult.
f. Difficulties determining Left and right - the child commonly gets "left" and "right" mixed
up.
g. Reversal - numbers and letters may be reversed without realizing.
h. Difficulties in Spelling - may not follow a pattern of progression seen in other children.
The child may learn how to spell a word today, and completely forget the next day. One word
may be spelt in a variety of ways on the same page.
i. Phonology problems - phonology refers to the speech sounds in a language. If a word has
more than two syllables, phonology processing becomes much more difficult. For example, with
the word "unfortunately" a person with dyslexia may be able to process the sounds "un" and
"ly", but not the ones in between.
j. Concentration span - children with dyslexia commonly find it hard to concentrate for long,
compared to other children. Many adults with dyslexia say this is because after a few minutes
of non-stop struggling, the child is mentally exhausted. A higher number of children with
dyslexia also have ADHD (attention-deficit hyperactivity disorder), compared to the rest of the
population.
k. Sequencing ideas - when a person with dyslexia expresses a sequence of ideas, they may
seem illogical for people without the condition.
l. Autoimmune conditions - people with dyslexia are more likely to develop immunological
problems, such as hay fever, asthma, eczema, and other allergies.
Causes of Dyslexia
Specialist doctors and researchers are not sure what causes a person to develop dyslexia. Some
evidence points to a possibility that the condition is inherited, as dyslexia often runs in families.
1. Genetic Causes

 Genetic defect linked to reading problems - a team at the Yale School of Medicine found
that defects in a gene, known as DCDC2, were associated with problems in reading performance.
They also reported that this defective gene appears to interact with KIAA0319, a second dyslexia
gene.

Dutch scientists reported in the journal Dyslexia that dyslexia is a "highly heritable learning
disorder" that has a complex genetic architecture. Over the past ten years, they added, scientists
have identified several candidate genes that may contribute to dyslexia susceptibility.

2. Acquired Dyslexia

A small minority of people with dyslexia acquired the condition after they were born. The most
common causes of acquired dyslexia are brain injuries, stroke or some other type of trauma.

3. Phonological Processing

According to the National Health Service8, people with dyslexia find reading and writing
difficult because of "phonological processing impairment".

Humans have the ability to understand spoken language, it is something the brain acquires
easily and naturally from a very early age. That is why during very early childhood (3 years) we
can utter and understand relatively complicated sentences.

This natural ability to acquire language, which most linguists call the LAD (language
acquisition device), explains the reason why, when we listen to verbal communication, we do not
consciously register that words are made up of phonemes, we only hear the word itself.
Phonemes are the smallest units of sound that words are made of. For example, when we hear
the word "Kangaroo", we hear it as a whole, seamless utterance. We do not need to break it
down into the phonemes - "kan" "ga" "roo", then put them together again in order to make sense
of it.

This is the case only when we learn to utter and hear speech, not when we are learning to
read and write. When we learn reading/writing we need to be able to initially recognize the
letters that make up a word, and then use them to identify the phonemes, and put them together
to make sense of the word - this is called phonological processing. Experts say that people with
dyslexia have problems with phonological processing.

Types of Dyslexia
A. By Sensory System

1. Auditory Dyslexia - Auditory dyslexia involves difficulty processing sounds of letters or groups
of letters. Multiple sounds may be fused as a singular sound. For example the word 'back' will be
heard as a single sound rather than something made up of the sounds 'b' - 'aa' -'ck'. Single
Syllable words are especially prone to this problem.

2. Visual Dyslexia - Visual dyslexia is defined as reading difficulty resulting from vision related
problems. Though the term is a misnomer, visual problems can definitely lead to reading and
learning problems.

3. Attentional Dyslexia - A 2010 study from Tel Aviv University in Israel found a type of dyslexia
they call Attentional Dyslexia in which children identify letters correctly, but the letters jump
between words on the page. 'kind wing' would be read as 'wind king.' The substitutions are not
caused by an inability to identify letters or convert them to sounds, but instead result from the
migration of letters between wordsthe first letter of one word switches place with the first
letter of another word.

B. By Deficit

1. Phonological Dyslexia - Phonological dyslexia is extreme difficulty reading that is a result of

phonological impairment, meaning the ability to manipulate the basic sounds of language. The
individual sounds of language become 'sticky', unable to be broken apart and manipulated easily.

2. Surface Dyslexia - According to Nancy Mather and Barbara Wendling in their excellent 2012
book Essentials of Dyslexia Assessment and Intervention, surface dyslexia is: "A type of dyslexia
characterized by difficulty with whole word recognition and spelling, especially when the words
have irregular spelling-sound correspondences."

3. Deep Dyslexia - Deep dyslexia is an acquired form of dyslexia, meaning it does not typically
result from genetic, hereditary (developmental) causes. It represents a loss of existing capacity
to read, often because of head trauma or stroke that affects the left side of the brain. It is
distinguished by two things: semantic errors and difficulty reading non-words.

C. By Time of Onset

1. Developmental Dyslexia - Developmental dyslexia is not so much a type of dyslexia, it is

dyslexia.

In fact our definition of it would be the same as our definition of dyslexia generally: Extreme
difficulty reading caused by a hereditary, brain based, phonologic disability. So why do people
use the term instead of just saying dyslexia? The simple answer is they are trying to be more
specific, distinguishing 'regular' dyslexia from the other types of dyslexia. In particular,
distinguishing it from acquired forms of dyslexia that result from stroke or head trauma for
example, which often present very differently.

2. Acquired Dyslexia - This type results from trauma or injury to that part of the brain that
controls reading and writing. Late in life this can be the result of a tumor or stroke.

Other Dyslexia Types:

1. Directional Dyslexia - Directional dyslexia is distinguished by left-right confusion and a

tendency to become disoriented or lost. The term is also occasionally used to mean confusion
with letters such as p and b or d and b, where there is confusion over the 'direction' of the letter.
Generally, problems with directions are a symptom of dyslexia more than a sub-type. Not all
dyslexics have this problem.

2. Math Dyslexia (dyscalculia) - Math dyslexia or dyscalculia is not, in fact, a type of dyslexia, but
we included it here because the term is frequently used. According to the U.S. National Center for
Learning Disabilities, math dyslexia, or dyscalculia, refers to a wide range of lifelong learning
disabilities involving math, varies from person to person and affects people differently at
different stages of life.
As with reading, when basic math skills are not mastered early, more advanced math becomes
extremely difficult. Approximately half of people with dyslexia also have dyscalculia, though far
less research has been conducted regarding testing, assessment and remediation.

Treatment of Dyslexia
While dyslexia is a lifelong problem, there is a range of specialist educational interventions
that can help children with dyslexia with their reading and writing. The amount and type of
intervention necessary will depend on the severity of their condition. In some cases, a specific
action plan for your child can be drawn up and implemented by their school.

Most children with dyslexia will only need to miss a few hours of their regular classes each
week to receive specialist one-to-one teaching, or teaching in small groups. A small number of
children with dyslexia may need to be transferred to a specialist school. Many specialist schools
charge a fee, although financial support may be available from your Local Educational Authority
(LEA).

1. Early educational interventions

 Research has found that early educational interventions, ideally before a child reaches seven
or eight years old, are the most effective way of achieving long-term improvements in their
reading and writing. A wide range of educational interventions and programmes are available,
and it can be difficult for parents to find out which would most benefit their child.

However, there is a large body of good quality evidence that interventions focusing on
phonological skills (the ability to identify and process sounds) are the most effective way of
improving reading and writing. These types of educational interventions are often referred to as
phonics. This is a system widely used to teach all children to read and write, not just those with
dyslexia.

1.a PHONICS: CORE ELEMENTS - Phonics focuses on the six core elements described below.

1.a.1 Phonemic awareness - Phonemic awareness teaches children how to recognise and
identify sounds (phonemes) in spoken words. For example, it helps a child to recognise that even
very short words such as "hat" are actually made up of three phonemes: "h", "a" and "t". Another
important part of phonemic awareness involves understanding that you can manipulate
phonemes to change words, such as changing the "h" to a "c" to create the word "cat".
1.a.2. Phonics instruction - Phonics instruction teaches children how to sound out printed
words by recognising the written letters that correspond to spoken phonemes. Letters that
correspond to phonemes are known as graphemes. Phonics also teaches children how to decode
multisyllabic words, such as "crocodile" and apply previous learned rules so they have a better
understanding of new words.
1.a.3. Spelling and writing instruction
Spelling and writing instruction encourages children to combine letters and graphemes to create
words, and then, over time, to use the words to create more complex sentences.

1.a.4. Fluency instruction - Fluency instruction allows children to practice reading words
accurately. The goal is for a child to be able to read with a good level of accuracy and speed. This
is important because if a child spends a lot of time trying to focus on reading individual words, it
is easy to lose track of the text as a whole, and they may not properly understand what they are
reading.
1.a.5. Vocabulary instruction - Vocabulary instruction teaches children to recognise words
they are reading, while building and understanding new words.
1.a.6. Comprehension instruction - Comprehension instruction teaches children to monitor
their own understanding while they read. They are encouraged to ask questions if they notice
gaps in their understanding, while also linking what they are reading to information they have
previously learned.

1.b. PHONICS - IMPORTANT FEATURES - There is good evidence to indicate that the most effective
methods of teaching phonics to children with dyslexia contain the features described below.

1.b.1. Structure - Teaching should be highly structured, with development in small steps,
building logically on what has been previously learnt.
1.b.2. Multisensory - Children with dyslexia learn better when they use as many different
senses as possible. An example of multisensory teaching is where a child is taught to see the
letter "a", say its name and sound, and write it in the air (all at the same time).
1.b.3. Reinforcement - Skills should be reinforced through regular practice, because children
with dyslexia often have to "overlearn" skills already mastered. This helps to improve their
automatic recognition of correct phonemes, letters and rules in reading and writing.
1.b.4. Skill teaching - Early interventions in children with dyslexia should focus on
development of useful skills that can be transferred to other areas, rather than teaching children
to learn and retain big chunks of information that could place unnecessary strain on their
memory.
1.b.5. Metacognition - Metacognition means "thinking about the way you think". In practice,
metacognition involves encouraging children to recognise that there are different learning
methods and approaches available to them, and then thinking about which ones would be best
for them to use in different circumstances.
1.b.6 Breaking down emotional barriers - Another important feature of any educational
intervention is to recognise that many children with dyslexia can develop emotional barriers that
can make learning more difficult, such as anxiety, frustration and low confidence. Therefore, it is
important to break down these barriers through encouragement, empathy and fostering the
childs self-esteem.

COGNITIVE DEVELOPMENT OF CHILDREN AND ADOLESCENTS

COGNITION is the process of learning in the broadest sense that includes perception,
memory, judgment, and thinking. It is both a mental activity and behavior that provides an
understanding of the world from biological, experiential, motivational, and social influences.
THEORIES OF COGNITVE DEVELOPMENT
A. Jean Piagets Stages of Cognitive Development
According to Jean Piaget, children actively seek out information. Such information is in
turn adapted to the childrens acquired knowledge and conceptions about the world. It is from
their experiences that children construct their understanding of reality, a view held by the
constructivists.
Piagets theory of cognitive development focuses on mental processes such as perceiving,
remembering, believing, and reasoning. Reasoning is the essence of intelligence, and reasoning

is what Piaget studied in order to discover how we come to know (Singer & Revenson, 1997, p.
13). Piaget believed that cognitive development is cumulative; that is, understanding a new
experience grows out of a previous learning experience.
Main Elements of Piagets Cognitive Development Theory

There are three elements to Piagets theory:

1. Schema
2. The four processes that enable the transition from one stage to another
3. The four stages of cognitive development

I. Schema

Is an organized unit of knowledge. The child uses this to be able to understand a situation
or an experience and which will serve as basis for organizing actions to respond to the
environment.

A schema is the mental framework that is created as children interact with their physical
and social environments. A schema can be thought of as a unit of knowledge, relating to one
aspect of the world including objects, actions, and abstract (theoretical) concepts.

We use schemas to understand and to respond to situations. We store them and apply
them when needed. A child is considered to be in a state of equilibrium or in a state of cognitive
balance when she or he is capable of explaining what he or she is perceiving (schema) at the
time.

For example, my schema for Christmas includes: Christmas trees, presents, giving, money,
green, red, gold, winter, Santa Claus etc. Someone else may have an entirely different
schema, such as Jesus, birth, Church, holiday, Christianity etc. Of course, there are
schemata for all kinds of things yourself (self schemata), other people (people
schemata), events/situations (event schemata) and roles/occupations (role schemata).
With regards to Piagets theory, a child might have a pre-conceived schema for a dog. If
the household has a small West Highland White Terrier as a dog, the schema might be
small, furry, four legs, white. When the child interacts with a new dog perhaps
a Labrador, it will change to incorporate the new information, such as big, golden, smooth
etc.
At any age, children rely on their current cognitive structures to understand the world
around them. Moreover, younger and older children may often interpret and respond to the same
objects and events in very different ways because cognitive structures take different forms at
different ages.

Different schemata change as the children develop. Piaget opined that schemata are
modified by organization and adaptation.
Organization is the predisposition to combine simple physical or psychological structures
into more complex systems. Structures are viewed from larger dimensions and not on limited
parameters.

Adaptation is adjusting ones thinking according to environmental demands. Assimilation

and accommodation are the two parts of adaptation which is simply what it says adapting our
schemata to make an accurate (enough) model of the world we live in.

II. The Four Processes:

The four processes that enable the transition from one cognitive stage to another
are assimilation, accommodation, disequilibrium, and equilibration.

Assimilation is the process of taking in new information and fitting it into a preconceived
notion about objects or the world; it is making use of an existing schema to a new experience.
Accommodation is the process of adjusting to new experiences or objects by revising the
old plan to fit new information; it is modifying an existing schema to make it work in a new
experience.
Disequilibrium is a state of confusion, dissonance, or discomfort when new information
does not integrate within existing structures. This confusion motivates us to achieve the new
challenge and to restore balance between assimilation and accommodation, which when
achieved, is equilibrium.

Equilibration is the balance between the processes of assimilation and accommodation. It

is the force that drives the learning process to restore balance by mastering the new challenge
(information) presented.

Educators generally view these processes as an explanation of cognitive learning

processes, not just those that lead to major shifts in cognitive ability (Piaget, 1973, p. 36).

Together, assimilation and accommodation are processes of adjustment to changes in the

environment and are defined as adaptation, the continuous process of using the environment to
learn. And, according to Piaget, adaptation is the most important principle of human functioning.

In summary, children have schemata (cognitive structures that contain pre-existing ideas
of the world), which are constantly changing. Schemata constantly undergo adaptation, through
the processes of assimilation and accommodation. When seeing new objects there is a state
of tension, and a child will attempt to assimilate the information to see if it fits into prior
schemata. If this fails, the information must be accommodated by either adding new schemata or
modifying the existing ones to accommodate the information. By balancing the use of
assimilation and accommodation, an equilibrium is created, reducing cognitive tension
(equilibration).

III. The Four Stages of Cognitive Development:

 Piaget identified the following four stages in development of cognition:

Sensory-Motor (Ages Birth Through Two)

Preoperational (Ages Two Through Seven)
Concrete Operations (Ages Seven Through Eleven)
Formal Operations (Ages Eleven Through Sixteen)

1. Sensory-Motor Stage: Ages Birth to Approximately Two Years Old

During this stage, information is received through all the senses. The child tries to make
sense of the world during this stage, and as the name suggests, only senses and motor abilities
are used to do so. The child utilizes innate behaviors to enhance this learning process, such as
sucking, looking, grasping, crying and listening.

 To make this even more complex, there are 6 sub-stages of this one stage. To begin, the
child uses only reflexes and innate behaviour. Towards the end of this stage, the child uses a
range of complex sensorimotor skills. The sub-stages are as follows:
1.a. Reflexes (0-1 month): The child uses only innate reflexes. For example, if a nipple or
dummy is put into a babys mouth, they will reflexively suck on it. If an object is placed in
their palm, the hand will automatically grab it. These reflexes have the sole function of
keeping the child alive.
1. b Primary Circular Actions (1-4 months): The child now has a fixation with its own body
with regards to behavior (what Piaget refers to as primary behaviour); they will perform
actions repeatedly on themselves (like sucking their own hand). They also begin to refine
reflexes here to form more complex versions of them.
1. c Secondary Circular Reactions (4-8 months): At around 4 months, the child begins to take an
interest in their environment (their behavior is secondary). They notice that they can actually
influence events in their world, for example they can drop a teddy which bashes a ball on the
floor. Although this occurs, the infant will not make conscious connections between what they
do and the consequences, they merely observe that their actions have interesting effects.
1. d Co-ordination of Secondary Circular Reactions (8-12 months): At this point, the child
begins to engage in goal-directed behaviour; they begin to develop cause-effect relationships.
So rather than crawl over to a teddy in a cart to pick it up, they might instead pull the cart
over with the teddy in to acquire it. The child effectively knows that their behaviour will have
a certain consequence. At this stage, object permanence is acquired.
1. e Tertiary Circular Reactions (12-18 months): At this stage, children like to use creativity
and flexibility with their previous behaviours, and the result of their experimentation often
leads to different outcomes. So rather than grabbing a box, they might instead try to tilt or
manipulate it.
1. f Symbolic/Mental Representation (18-24 months): At this stage, the child
develops symbolic thought and the ability to mentally represent objects in their head.
Normally, the child would need to resort to trial-and-error to achieve a desired effect. Now,
however, the child can plan to some extent and mentally construct the consequences of an
action in their head. Of course, predictions are not always accurate, but it is a step up from
trial-and-error.
There are two key examples of mental
object permanence and deferred imitation.

representation

developed

in

children:

Object permanence is when objects exist even when out of sight. In the first three substages, children will not attempt to search for an object which is hidden from their view; in
their mind, the object simply ceases to exist as they cannot see it. At sub-stage four,
however, they show this characteristic of object permanence. If an object is hidden from
them, they will attempt to find it, but will repeatedly look in the same place even if the
object is moved (the so called A-not-B error). However, by sub-stage 6, the child is able to
mentally represent the object in their mind, leading to exploration for an object even if it is
moved. They will continue to look for an object until they find it, as they understand objects
exist regardless of where they are.
Deferred imitation is simply the imitation of behaviour a child has seen before. As a child
can mentally represent behaviour they have seen, they are able to enact it through playing
and in other situations. So a child might talk down a toy telephone or steer a toy car
around the room.
2. The Pre-operational Stage: 2-7 years of age.
Now that the child has mental representations and is able to pretend, it is a short step to
the use of symbols. A symbol is a thing that represents something else. A drawing, a written
word, or a spoken word comes to be understood as representing a real thing.
The use of language is, of course, the prime example, but another good example of symbol
use is creative play, wherein checkers are cookies, papers are dishes, a box is the table, and so

on. By manipulating symbols, we are essentially thinking, in a way the infant could not: in the
absence of the actual objects involved!
Along with symbolization, there is a clear understanding of past and future. For example, if
a child is crying for its mother, and you say Mommy will be home soon, it will now tend to stop
crying. Or if you ask him, Remember when you fell down? he will respond by making a sad
face.
On the other hand, the child is quite egocentric during this stage, that is, he sees things
pretty much from one point of view: his own! She may hold up a picture so only she can see it
and expect you to see it too. Or she may explain that grass grows so she wont get hurt when
she falls.
Piaget did a study to investigate this phenomenon: He would put children in front of a
simple plaster mountain range and seat himself to the side, then ask them to pick from four
pictures the view that he, Piaget, would see. Younger children would pick the picture of the view
they themselves saw; older kids picked correctly.

Similarly, younger children center on one aspect of any problem or communication at a

time. for example, they may not understand you when you tell them Your father is my
husband. Or they may say things like I dont live in the USA; I live in Pennsylvania! Or, if you
show them five black and three white marbles and ask them Are there more marbles or more
black marbles? they will respond More black ones!
Perhaps the most famous example of the preoperational childs centrism is what Piaget
refers to as their inability to conserve. Children struggle to understand the difference in
quantity and measurements in different situations. For example, suppose a child is shown a
short, fat beaker full of water. When that water is transferred entirely to a tall, thin beaker we
would know the level of water is identical only the beaker has changed. However, a child in this
stage will conclude there is more water in the tall beaker, just because the level of water looks
higher. Children in this stage also lack the required cognition to apply reversibility to
situations; they cannot imagine objects or numbers reversed to their previous form. This will be
explored in the next stage (where reversibility is present).

 When a child has the ability to decenter, they are said to progress to the next stage.
3. The Concrete Operational Stage: 7-11 years of age.
This stage sees another shift in childrens cognitive thinking. It is aptly named concrete
because children struggle to apply concepts to anything which cannot physically be manipulated
or seen. Nevertheless, the child continues to improve their conservation skills, and by the age of
11 they can conserve numbers, weight and volume (acquired in that order).
The word operations refers to logical operations or principles we use when solving
problems. In this stage, the child not only uses symbols representationally, but can manipulate
those symbols logically. Quite an accomplishment! But, at this point, they must still perform
these operations within the context of concrete situations.

The stage begins with progressive decentering. By six or seven, most children develop
the ability to conserve number, length, and liquid volume. Conservation refers to the idea
that a quantity remains the same despite changes in appearance. If you show a child four
marbles in a row, then spread them out, the preoperational child will focus on the spread, and
tend to believe that there are now more marbles than before.

Or if you have two five inch sticks laid parallel to each other, then move one of them a
little, she may believe that the moved stick is now longer than the other.

The concrete operations child, on the other hand, will know that there are still four
marbles, and that the stick doesnt change length even though it now extends beyond the other.
And he will know that you have to look at more than just the height of the milk in the glass: If
you pour the milk from the short, fat glass into the tall, skinny glass, he will tell you that there is
the same amount of milk as before, despite the dramatic increase in milk-level!

 By seven or eight years old, children develop conservation of substance: If I take a ball of
clay and roll it into a long thin rod, or even split it into ten little pieces, the child knows that there
is still the same amount of clay. And he will know that, if you rolled it all back into a single ball, it
would look quite the same as it did - a feature known as reversibility.

By nine or ten, the last of the conservation tests is mastered: conservation of area. If you
take four one-inch square blocks ("houses"), and lay them on a six-by-six cloth together in the
center, the child who conserves will know that they take up just as much room as the same
blocks spread out in the corners, or, for that matter, anywhere at all.

If all this sounds too easy to be such a big deal, note that many adults do not conserve
area. Or test your friends on conservation of mass: Which is heavier: a million tons of stone, or
a million tons of feathers? Many will focus on the words "stone" and "feathers", and ignore the
fact that they both weigh a million tons.
In addition, a child learns classification and seriation during this stage. Classification
refers back to the question of whether there are more marbles or more black marbles. Now the
child begins to get the idea that one set can include another.
However, as this stage is concrete, Piaget suggests children will struggle to apply any prior
knowledge to abstract situations. For example, when asked seriation (putting things in order)
tasks such as John is taller than Pete. John is shorter than Simon. Who is tallest?, concrete
children often fail to provide a correct answer as the situation is too abstract. However, when
dolls are used to represent Pete, Simon and John, the children are able to answer as the
situation is bought back to a concrete one with physical representations.

4. The Formal Operational Stage: from age 11 onwards.

Children at this stage acquire the ability to think hypothetically and outside the box.
Logical conclusions can be inferred from verbal information, and concrete, physical objects are
no longer necessary. When presented with a problem, children at this stage can consider
solutions to the problem in a logical manner. The child becomes increasingly adult-like with
regards to their cognitive abilities. This involves using logical operations, and using them in the
abstract, rather than the concrete. We often call this hypothetical thinking.

 Scientific or abstract reasoning is apparent in this stage, and is indicated by Piaget and
Inhelders Pendulum Task (1958). When asked to determine the effect different weights and rope
length have on the speed of a swinging pendulum, formal operational children came to
consistent and logical conclusions.
It is the formal operations stage that allows one to investigate a problem in a careful and
systematic fashion. Ask a 16 year old to tell you the rules for making pendulums swing quickly
or slowly, and he may proceed like this:
A long string with a light weight - lets see how fast that swings. A long string with a heavy
weight - lets try that. Now, a short string with a light weight. And finally, a short string with a
heavy weight.
His experiment - and it is a true experiment - would tell him that a short string leads to a fast
swing, and a long string to a slow swing, and that the weight of the pendulum makes no
difference at all!
Educational Implications of Piagets Theory
Piagets theory had a major impact on the theory and practice of education (Case, 1998).
First, the theory focused attention on the idea of developmentally appropriate educationan
education with environments, curriculum, materials, and instruction that are suitable for students
in terms of their physical and cognitive abilities and their social and emotional needs (Elkind,
1989). In addition, several major approaches to curriculum and instruction are explicitly based on
Piagetian theory (Berrueta-Clement, Schweinhart, Barnett, Epstein, & Weikart, 1984), and this
theory has been influential in constructivist models of learning, which will be described in
Chapter 8. Berk (2001) summarizes the main teaching implications drawn from Piaget as follows:
1. A focus on the process of childrens thinking, not just its products. In addition to
checking the correctness of childrens answers, teachers must understand the processes
children use to get to the answer. Appropriate learning experiences build on childrens
current level of cognitive functioning, and only when teachers appreciate childrens
methods of arriving at particular conclusions are they in a position to provide such
experiences.
2. Recognition of the crucial role of childrens self-initiated, active involvement in
learning activities. In a Piagetian classroom the presentation of ready-made knowledge
is deemphasized, and children are encouraged to discover for themselves through
spontaneous interaction with the environment. Therefore, instead of teaching didactically,
teachers provide a rich variety of activities that permit children to act directly on the
physical world.
3. A deemphasis on practices aimed at making children adultlike in their thinking.
Piaget referred to the question How can we speed up development? as the American
question. Among the many countries he visited, psychologists and educators in the
United States seemed most interested in what techniques could be used to accelerate
childrens progress through the stages. Piagetian-based educational programs accept his
firm belief that premature teaching could be worse than no teaching at all, because it
leads to superficial acceptance of adult formulas rather than true cognitive understanding
(May & Kundert, 1997).
4. Acceptance of individual differences in developmental progress. Piagets theory
assumes that all children go through the same developmental sequence but that they do
so at different rates. Therefore, teachers must make a special effort to arrange classroom
activities for individuals and small groups of children rather than for the total class group.
In addition, because individual differences are expected, assessment of childrens
educational progress should be made in terms of each childs own previous course of
development, not in terms of normative standards provided by the performances of sameage peers.
B. Lev Vygotskys Socio-Cultural Theory of Cognitive Development
Vygotskys theory emphasizes the crucial influence that social interactions and
language, embedded within a cultural context, have on cognitive development. He asserts that
complex forms of thinking have their origins in social interactions rather than in childs private
explorations.

Social
Cognitive
Language
Interactions
Development
Cultural Context

Vygotsky emphasized that effective learning happens through participation in

social activities. He believed strongly that community plays a central role in the process of
"making meaning."

He also suggested that language is the most important tool for gaining this social
knowledge; the child can be taught this from other people via language. He defined intelligence
as the capacity to learn from instruction, which emphasises the fact there is a requirement for
a more knowledgable other person or teacher. He referred to them as just that: the More
Knowledgable
Other(MKO). MKOs can be parents, adults, teachers, coaches,
experts/professionals but also things you might not first expect, such as children, friends and
computers.
Parents, teachers and other adults in the learners environment all contribute to the
process. They explain, model, assist, give directions and provide feedback. Peers, on the other
hand, cooperate and collaborate and enrich the learning experience.

He described something known as the Zone of Proximal Development (ZPD), which is a

key feature of his theory. Zone of Proximal Development refers to the difference between what
the child accomplish alone and what he/she can accomplish with guidance of another. There are
two levels of attainment for the ZPD:

Level 1 the present level of development. This describes what the child is capable of
doing without any help from others.
Level 2 the potential level of development. This means what the child could potentially
be capable of with help from other people or teachers.

The gap between level 1 and 2 (the present and potential development) is what Vygotsky
described as this zone of proximal development. He believed that through help from other, more
knowledgeable people, the child can potentially gain knowledge already held by them. However,
the knowledge must be appropriate for the childs level of comprehension. Anything that is too
complicated for the child to learn that isnt in their ZPD cannot be learnt at all until there is a
shift in the ZPD. When a child does attain their potential, this shift occurs and the child can
continue learning more complex, higher level material.

Zone of Proximal Development:

The
The
What I can do with the
help
Known:
Unkno
of someone else.
What
I LEARNING SPACE
wn:
THE
can do
What
by
I
myself
canno
t do
at all
Another important feature of this theory is scaffolding. Scaffolding refers to the support or
assistance that lets the child accomplish a task he/she cannot accomplish independently. When
an adult provides support for a child, they will adjust the amount of help they give depending on
their progress. For example, a child learning to walk might at first have both their hands held and
pulled upwards. As they learn to support their own weight, the mother might hold both their
hands loosely. Then she might just hold one hand, then eventually nothing. This progression of
different levels of help is scaffolding. It draws parallels from real scaffolding for buildings; it is
used as a support for construction of new material (the skill/information to be learnt) and then
removed once the building is complete (the skill/information has been learnt).

According to Vygotsky, there are two central factors in cognitive development:

1. Social Interaction
Vygotsky emphasized that effective learning happens through participation in social
activities.
Parents, teachers and other adults in the learners environment all contribute to the
process. They explain, model, assist, give directions and provide feedback.
Peers, on the other hand, cooperate and collaborate and enrich the learning experience.
2. Language
Language can be viewed as a verbal expression of culture.
Every culture has the words it needs for its lifestyle.
It opens the door for learners to acquire knowledge that others already have.
It is use to know and understand the world and solve problems.
It serves a social function but it also has an important individual function. It helps the
learner to regulate and reflect on his own thinking.
Educational Implications of Vygotskys Theory

 Vygotskys concept of the zone of proximal development is based on the idea that
development is defined both by what a child can do independently and by what the child can do
when assisted by an adult or more competent peer (Daniels, 1995; Wertsch, 1991). Knowing both
levels of Vygotskys zone is useful for teachers, for these levels indicate where the child is at a
given moment as well as where the child is going. The zone of proximal development has several
implications for teaching in the classroom.
According to Vygotsky, for the curriculum to be developmentally appropriate, the teacher
must plan activities that encompass not only what children are capable of doing on their own but
what they can learn with the help of others (Karpov & Haywood, 1998).
Vygotskys theory does not mean that anything can be taught to any child. Only instruction
and activities that fall within the zone promote development. For example, if a child cannot
identify the sounds in a word even after many prompts, the child may not benefit immediately
from instruction in this skill. Practice of previously known skills and introduction of concepts that
are too difficult and complex have little positive impact. Teachers can use information about both
levels of Vygotskys zone of proximal development in organizing classroom activities in the
following ways:
1. Instruction can be planned to provide practice in the zone of proximal development for

individual children or for groups of children. For example, hints and prompts that helped
children during the assessment could form the basis of instructional activities.
2. Cooperative learning activities can be planned with groups of children at different levels
who can help each other learn.
3. Scaffolding (Wood, Bruner, & Ross, 1976) is a tactic for helping the child in his or her zone
of proximal development in which the adult provides hints and prompts at different levels.
In scaffolding, the adult does not simplify the task, but the role of the learner is simplified
through the graduated intervention of the teacher (Greenfield, 1984, p. 119).

C. Information-Processing Theories

The information-processing approach takes the human mind as a system that

processes information. This is similar to computer programming where the processes
involved are subject to limitations and observance of logical rules.

Several basic assumptions of information-processing approaches are:

1. Thinking is information processing. Mental activity or thinking is putting

into the mind whatever information there is to process in ways or means that
can render the information understandable, functional, and usable. There are
underlying questions about how the processes such as perceiving, encoding,
representing, and storing information, change as children get older and have
more experiences with the world.
2. Mechanisms of change are important to describe. Mechanisms like

encoding, strategy construction, automatization, and generalization all

together help in instituting change in the childrens cognitive skills.

3. The cognitive system is self-modifying. Child is able to modify his responses

to new situations or problems by using the acquired knowledge and strategies from
solving earlier problems. With a powerful knowledge base new and better ways of
responding to situations are developed. Thus children play an active role in their
own cognitive development.
4. Careful

task analysis is crucial. Childs cognitive performance is

dependent on the problem or situation and the ability to handle such
according to his level of development. A careful task analysis is needed to
appraise the childs actual performance and how the performance vary
according to age. Most likely, the analysis will reveal how children of different
ages understand, approach and solve a problem.

(see attached handout for additional INFORMATION)

D. BIO-CULTURAL THEORIES

One of the most current trends in developmental psychology is the established

link between physiological processes and development explained through universal
changes and individual differences.

D.1 Nativism views human as endowed with genetic traits seen in all members of
the species, regardless of differences in their environments. Developmentalists
who adhere to the nativist theory hold that peculiarities in behavior can be
identified early in life, developed in all individuals in every culture but do not exist
in other species. Example: a child learns to speak the language in the absence of
formal instructions from adults at home, he learns by imitating and by hearing.

D.2 Ethology points to genetically survival behaviors assumed to have evolved through
natural selection. Ethologists say that nature has equipped birds with nest-building genes
which is imperative for survival. Likewise, as claimed by exponents of ethology even
emotional relationships are important for infants survival. Emotional bonding is achieved
between the infant and the mother everytime she attends to the needs of the infant. As
ethologists say, even infants crying is genetically programmed to a babys crying needs.
The interaction between the infant and the adult increases the prospect of infants
survival. Major influences in the field of Ethology are Konrad Lorenz and John Bowlby,
who studied the adaptive nature of human behaviour.

D.3 Sociobiology focuses on the study of society using the methods and concepts of
biological science. Like the ethologists, sociobiology emphasizes genes that aid group
survival. Living in groups affords humans better chances of survival.

 BRONFENBRENNERS ECOLOGICAL THEORY

This theory views an individuals development within the context of the system of
relationships that form her environment.
Bronfenbrenners theory has been historically applied to child development. By defining
complex layers of environment, each having an effect on a childs development, this theory
emphasizes that a childs interaction between factors in the childs maturing biology, his
immediate family/community environment, and the societal landscape fuels and steers his
development.
Furthermore, changes or conflict in any one layer will ripple throughout other layers. To
study a childs development then, we must look not only at the child and her immediate
environment, but also at the interaction of the larger environment as well.
LEVELS:

1. Microsystem - this is the layer closest to the individual and contains the structures with
which the individual has direct contact. Structures in the microsystem include family, school,
neighborhood, or childcare environments. At this level, relationships have impact in two
directions - both away from the individual and toward the individual. For example, a childs
parents may affect his beliefs and behavior; however, the child also affects the behavior and
beliefs of the parent. Bronfenbrenner calls these bi-directional influences, and he shows how they
occur among all levels of environment.

2. Mesosystem - This layer provides the connection between the structures of the individuals
microsystem (Berk, 2000). Examples: the connection between the childs teacher and his
parents, between his church and his neighborhood, etc.
3. Exosystem - this layer defines the larger social system in which the individual does
not function directly. The structures in this layer impact the childs development by
interacting with some structure in her microsystem (Berk, 2000). Parent workplace
schedules or community-based family resources are examples. The child may not be directly
involved at this level, but he does feel the positive or negative force involved with the interaction
with his own system.
4. Macrosystem: This layer may be considered the outermost layer in the individuals
environment. While not being a specific framework, this layer is comprised of cultural
values, customs, and laws (Berk, 2000). The effects of larger principles defined by the
macrosystem have a cascading influence throughout the interactions of all other
layers. For example, if it is the belief of the culture that parents should be solely responsible for
raising their children, that culture is less likely to provide resources to help parents. This, in turn,
affects the structures in which the parents function.
5. Chronosystem: This system encompasses the dimension of time as it relates to an
individuals environments. Elements within this system can be either external, such
as the timing of a parents death, or internal, such as the physiological changes that
occur with the aging of a child. As children get older, they may react differently to
environmental changes and may be more able to determine more how that change will influence
them.

 INDIVIDUAL DIFFERENCES: THEORIES OF INTELLIGENCE

Intelligence is the capacity to think and understand. It includes the combination of

various separate abilities that includes verbal communication, abstract thinking, logical
reasoning and use of common sense.

A. Robert Sternbergs Triarchic Theory of Intelligence

Psychologist Robert Sternberg (1985) has constructed a threepronged, or triarchic theory

of intelligence. The Three types are:

1. Analytical Intelligenceis what we generally think of as academic ability. It enables us

to solve problems and to acquire new knowledge. Problemsolving skill includes encoding
information, combining and comparing pieces of information and generating a solution.
2. Creative Intelligenceis defined by the abilities to cope with novel situations and to
profit from experience. The ability to quickly relate novel situations to familiar situations (that
is, to perceive similarities and differences) fosters adaptation. Moreover, as a result of
experience, we also become able to solve problems more rapidly.
3. Practical Intelligenceor street smarts, enable people to adapt to the demands of
their environment. It involves the use of tacit knowledge or common sense. For example,
keeping a job by adapting ones behavior to the employers requirements is adaptive. But if
the employer is making unreasonable demands, reshaping the environment (by changing the

employers attitudes) or selecting an alternate environment (by finding a more suitable job) is
also adaptive.

B. Howard Gardners Theory of Multiple Intelligences

1. Verbal-linguistic intelligence - well-developed verbal skills and sensitivity to the

sounds, meanings and rhythms of words.

2. Logical-mathematical intelligence - ability to think conceptually and abstractly,

and capacity to discern logical and numerical patterns

3. Visual-Spatial intelligence - capacity to think in images and pictures, to visualize

accurately and abstractly

4. Bodily-kinesthetic intelligence - ability to control ones body movements and to

handle objects skillfully

5. Musical intelligences - ability to produce and appreciate rhythm, pitch and timber.
6. Interpersonal intelligence - capacity to detect and respond appropriately to the

moods, motivations and desires of others.

7. Intrapersonal - capacity to be self-aware and in tune with inner feelings, values,

beliefs and thinking processes.

8. Naturalist intelligence - ability to recognize and categorize plants, animals and

other objects in nature.

9. Existential intelligence - sensitivity and capacity to tackle deep questions about

human existence such as, What is the meaning of life? Why do we die? How did we
get here?

EXCEPTIONAL DEVELOPMENT

Every child is unique to himself, in personality traits, in cognitive abilities, in physical

stature, in emotional stability, and others. Among children, these differences are highly

noticeable. Even in the aspect of learning some children are fast learner, those gifted with
exceptional intellectual capabilities and some are slow, those who function at significantly lower
intellectual levels.
A. Intellectually Gifted
An IQ score above 130 signal intellectual giftedness. Even among the gifted children, there
can be difficulties in learning attributed to language impairments and reading disabilities.
General Behavior Characteristics
Gifted children's behavior differs from that of their age-mates in the following ways:
1. Many gifted children learn to read early, with better comprehension of the nuances
of language. As much as half the gifted and talented population has learned to read
before entering school.
2. Gifted children often read widely, quickly, and intensely and have large
vocabularies.
3. Gifted children commonly learn basic skills better, more quickly, and with less
practice.
4. They are better able to construct and handle abstractions.
5. They often pick up and interpret nonverbal cues and can draw inferences that other
children need to have spelled out for them.
6. They take less for granted, seeking the "hows" and "whys."
7. They can work independently at an earlier age and can concentrate for longer periods.
8. Their interests are both wildly eclectic and intensely focused.
9. They often have seemingly boundless energy, which sometimes leads to a
misdiagnosis of hyperactivity.
10. They usually respond and relate well to parents, teachers, and other adults. They may
prefer the company of older children and adults to that of their peers.
11. They like to learn new things, are willing to examine the unusual, and are highly
inquisitive.
12. They tackle tasks and problems in a well-organized, goal-directed, and efficient
manner.
13. They exhibit an intrinsic motivation to learn, find out, or explore and are often very
persistent. "I'd rather do it myself" is a common attitude.
Learning Characteristics
Gifted children are natural learners who often show many of these characteristics:
1. They may show keen powers of observation and a sense of the significant; they have
an eye for important details.
2. They may read a great deal on their own, preferring books and magazines written for
children older than they are.
3. They often take great pleasure in intellectual activity.
4. They have well-developed powers of abstraction, conceptualization, and synthesis.
5. They readily see cause-effect relationships.
6. They often display a questioning attitude and seek information for its own sake as
much as for its usefulness.
7. They are often skeptical, critical, and evaluative. They are quick to spot
inconsistencies.
8. They often have a large storehouse of information about a variety of topics, which they
can recall quickly.
9. They readily grasp underlying principles and can often make valid generalizations
about events, people, or objects.
10.They quickly perceive similarities, differences, and anomalies.
11.They often attack complicated material by separating it into components and analyzing
it systematically.

Creative Characteristics

 Gifted children's creative abilities often set them apart from their age-mates. These
characteristics may take the following forms:
1. Gifted children are fluent thinkers, able to generate possibilities, consequences, or
related ideas.
2. They are flexible thinkers, able to use many different alternatives and approaches to
problem solving.
3. They are original thinkers, seeking new, unusual, or unconventional associations and
combinations among items of information.
4. They can also see relationships among seemingly unrelated objects, ideas, or facts.
5. They are elaborate thinkers, producing new steps, ideas, responses, or other
embellishments to a basic idea, situation, or problems.
6. They are willing to entertain complexity and seem to thrive on problem solving.
7. They are good guessers and can readily construct hypotheses or "what if" questions.
8. They often are aware of their own impulsiveness and irrationality, and they show
emotional sensitivity.
9. They are extremely curious about objects, ideas, situations, or events.
10.They often display intellectual playfulness and like to fantasize and imagine.
11.They can be less intellectually inhibited than their peers are in expressing opinions and
ideas, and they often disagree spiritedly with others' statements.
12.They are sensitive to beauty and are attracted to aesthetic values.
B. Intellectually Deficit
An IQ score below 70 in intelligence testing indicates mental retardation visibly
demonstrated by the childs inability to cope with appropriate activities of everyday life.
1. MENTAL RETARDATION
The conceptualization of mental retardation includes deficits in cognitive abilities as
well as in behaviors required for social and personal sufficiency, known as adaptive
functioning.
Measures of adaptive function assess competency in performance of everyday tasks,
whereas measures of intellectual function focus on cognitive abilities.
According to the DSM-IV-TR, mental retardation is defined as significantly subaverage
general intellectual functioning resulting in, or associated with, concurrent impairment in
adaptive behavior and manifested during the developmental period, before the age of 18.
Term significantly subaverage is defined as an IQ of approximately 70.
The diagnosis is made regardless of whether the person has a coexisting physical
disorder or other mental disorder.
Degrees of Mental Retardation
1)
Mild mental retardation - (IQ range, 50 to 70) represents approximately 85 percent of
persons with mental retardation. Many adults with mild mental retardation can live
independently with appropriate support and raise their own families.
2)
Moderate mental retardation - (IQ range, 35-50) represents about 10 percent of
persons with mental retardation. They are challenged academically and often are not able to
achieve academically above a second to third grade level. As adults, persons with moderate
mental retardation may be able to perform semiskilled work under appropriate supervision.
3)
Severe mental retardation - (IQ range, 20-35) comprises about 4 percent of individuals
with mental retardation. In adulthood, persons with severe mental retardation may adapt well to
supervised living situations, such as group homes, and may be able to perform work-related
tasks under supervision.
4)
Profound mental retardation - (IQ range below 20) constitutes approximately 1 to 2
percent of persons with mental retardation. Most individuals with profound mental retardation
have identifiable causes for their condition. Children with profound mental retardation may be
taught some self-care skills and learn to communicate their needs given the appropriate training.

Degrees of Severity of Mental Retardation

Borderline intellectual functioning, according to DSM-IV-TR, is not within the diagnostic

boundary of mental retardation and refers to a full-scale IQ in the 71 to 84 range that is a
focus of psychiatric attention.

The DSM-IV-TR lists mental retardation, severity unspecified, as a type reserved for
persons who are strongly suspected of having mental retardation, but who cannot be
tested by standard intelligence tests or are too impaired or uncooperative to be tested.
This type may be applicable to infants whose significantly subaverage intellectual
functioning is clinically judged but for whom the available tests (e.g., Bayley Scales of
Infant Development and Cattell Infant Scale) do not yield numerical IQ values.
This type should not be used when the intellectual level is presumed to be above 70.

Prevalence- 1% to 3%.
Highest incidence- school-age children with the peak at the ages 10 to 14 years.
1.5 times more common among men than among women.

COMORBIDITY
Prevalence

DOWN SYNDROME
is a genetic condition that causes delays in physical and intellectual development. It
occurs in approximately one in every 800 live births. Individuals with Down syndrome have 47
chromosomes instead of the usual 46. It is the most frequently occurring chromosomal disorder.
Down syndrome is not related to race, nationality, religion or socioeconomic status. The most
important fact to know about individuals with Down syndrome is that they are more like others
than they are different.
Diagnosis
Down syndrome is usually identified at birth or shortly thereafter. Initially the diagnosis
is based on physical characteristics that are commonly seen in babies with Down syndrome.
These include low muscle tone, a single crease across the palm of the hand, a slightly flattened
facial profile and an upward slant to the eyes. The diagnosis must be confirmed by a
chromosome study (karyotype). A karyotype provides a visual display of the chromosomes
grouped by their size, number and shape. Chromosomes may be studied by examining blood or
tissue cells.
Cause
Down syndrome is usually caused by an error in cell division called nondisjunction. It is
caused by a deviation in the set of chromosomes labeled number 21. It is not known why this
occurs. However, it is known that the error occurs at conception and is not related to anything
the mother did during pregnancy. It has been known for some time that the incidence of Down
syndrome increases with advancing maternal age. However, 80% of children with Down
syndrome are born to women under 35 years of age.
Health Issues
Many children with Down syndrome have health complications beyond the usual
childhood illnesses. Approximately 40% of the children have congenital heart defects. It is very
important that an echocardiogram be performed on all newborns with Down syndrome in order to
identify any serious cardiac problems that might be present. Some of the heart conditions require
surgery while others only require careful monitoring. Children with Down syndrome have a higher
incidence of infection, respiratory, vision and hearing problems as well as thyroid and other
medical conditions. However, with appropriate medical care most children and adults with Down
syndrome can lead healthy lives. The average life expectancy of individuals with Down syndrome
is 55 years, with many living into their sixties and seventies.
Learning & Development
It is important to remember that while children and adults with Down syndrome
experience developmental delays, they also have many talents and gifts and should be given the
opportunity and encouragement to develop them. Most children with Down syndrome have mild
to moderate impairments but it is important to note that they are more like other children than
they are different. Early Intervention services should be provided shortly after birth. These
services should include physical, speech and developmental therapies. Most children attend their
neighborhood schools, some in regular classes and others in special education classes. Some
children have more significant needs and require a more specialized program. Some high school

graduates with Down syndrome participate in post-secondary education. Many adults with Down
syndrome are capable of working in the community, but some require a more structured
environment.
Types of Down Syndrome
There are 3 chromosomal patterns that result in Down syndrome:
1. Trisomy 21 (nondisjunction) is caused by a faulty cell division that results in the
baby having three #21 chromosomes instead of two. Prior to or at conception, a pair of #21
chromosomes in either the egg or the sperm fails to separate properly. The extra chromosome
is replicated in every cell of the body. Ninety five percent of all people with Down syndrome
have Trisomy 21.
2. Translocation accounts for only 3% to 4% of all cases. In translocation a part of
chromosome #21 breaks off during cell division and attaches to another chromosome. The
presence of an extra piece of the 21st chromosome causes the characteristics of Down
syndrome. Unlike Trisomy 21, which is the result of random error in the early cell division,
translocation may indicate that one of the parents is carrying chromosomal material that is
arranged in an unusual manner. Genetic counseling can be sought to ascertain more
information when these circumstances occur.
3. Mosaicism occurs when nondisjunction of chromosome #21 takes place in one of the
initial cell divisions after fertilization. When this happens, there is a mixture of two types of
cells, some containing 46 chromosomes and some with 47. The cells with 47 chromosomes
contain an extra 21st chromosome. Because of the mosaic pattern of the cells, the term
mosaicism is used. This type of Down syndrome occurs in only one to two percent of all cases
of Down syndrome. Regardless of the type of Down syndrome a person may have, a critical
portion of the 21st chromosome is present in all or some of their cells. This additional genetic
material alters the course of development and causes the characteristics associated with the
syndrome.
Treatments
There is no single, standard treatment for Down syndrome. Treatments are based on
each individual's physical and intellectual needs as well as his or her personal strengths and
limitations.1 People with Down syndrome can receive proper care while living at home and in the
community. Treatment includes:
a. Early Intervention and Educational Therapy
b. Treatment Therapies
c. Drugs and Supplements
d. Assistive Devices
2. TURNER SYNDROME
is a chromosome abnormality found in females in which secondary sex characteristics
are developed only with the administration of female hormones.
The most common feature of Turner syndrome is short stature, which becomes evident
by about age 5. An early loss of ovarian function (ovarian hypofunction or premature ovarian
failure) is also very common. The ovaries develop normally at first, but egg cells (oocytes)
usually die prematurely and most ovarian tissue degenerates before birth. Many affected girls do
not undergo puberty unless they receive hormone therapy, and most are unable to conceive
(infertile). A small percentage of females with Turner syndrome retain normal ovarian function
through young adulthood.

About 30 percent of females with Turner syndrome have extra folds of skin on the neck
(webbed neck), a low hairline at the back of the neck, puffiness or swelling (lymphedema) of the
hands and feet, skeletal abnormalities, or kidney problems. One third to one half of individuals
with Turner syndrome are born with a heart defect, such as a narrowing of the large artery
leaving the heart (coarctation of the aorta) or abnormalities of the valve that connects the aorta
with the heart (the aortic valve). Complications associated with these heart defects can be lifethreatening.

Most girls and women with Turner syndrome have normal intelligence. Developmental
delays, nonverbal learning disabilities, and behavioral problems are possible, although these
characteristics vary among affected individuals.

 Turner syndrome is related to the X chromosome, which is one of the two sex
chromosomes. People typically have two sex chromosomes in each cell: females have two X
chromosomes, while males have one X chromosome and one Y chromosome. Turner syndrome
results when one normal X chromosome is present in a female's cells and the other sex
chromosome is missing or structurally altered. The missing genetic material affects development
before and after birth.

About half of individuals with Turner syndrome have monosomy X, which means each
cell in the individual's body has only one copy of the X chromosome instead of the usual two sex
chromosomes. Turner syndrome can also occur if one of the sex chromosomes is partially missing
or rearranged rather than completely absent. Some women with Turner syndrome have a
chromosomal change in only some of their cells, which is known as mosaicism. Women with
Turner syndrome caused by X chromosome mosaicism are said to have mosaic Turner syndrome.
Most cases of Turner syndrome are not inherited. When this condition results from
monosomy X, the chromosomal abnormality occurs as a random event during the formation of
reproductive cells (eggs and sperm) in the affected person's parent. An error in cell division
called nondisjunction can result in reproductive cells with an abnormal number of chromosomes.
For example, an egg or sperm cell may lose a sex chromosome as a result of nondisjunction. If
one of these atypical reproductive cells contributes to the genetic makeup of a child, the child
will have a single X chromosome in each cell and will be missing the other sex chromosome.
Mosaic Turner syndrome is also not inherited. In an affected individual, it occurs as a
random event during cell division in early fetal development. As a result, some of an affected
person's cells have the usual two sex chromosomes, and other cells have only one copy of the X
chromosome. Other sex chromosome abnormalities are also possible in females with X
chromosome mosaicism. Rarely, Turner syndrome caused by a partial deletion of the X
chromosome can be passed from one generation to the next.

3. PERVASIVE DEVELOPMENTAL DISORDERS

is a collection of disorders characterized by gross deficits

4. AUTISTIC DISORDER
is a pervasivedevelopmental disorder otherwise known as early infantile autism or
childhood autism. The first to have identified this disorder is psychiatrist Leo Kanner (another
name for the disorder is Kanners autism) who noted its many puzzling and disturbing
characteristics.

5. ASPERGERS SYNDROME