The concepts of interaction and resilience: The development of any child is determined not by genetic or environmental factors in isolation but by the interaction between them. The child's temperament and abilities affect the parents' responses to the child — in other words, the child contributes to the creation of his/her own environment.
Parental responses and interactions are also influenced by the extent to which the child matches their own preconceived ideas about the kind of child they hoped to have. This has been called the 'goodness of fit' between parental expectations and the child's actual temperament and personality.
All children are exposed to some degree of stress and adversity, but they vary in their resilience or vulnerability in response to life experiences. The differences are partly dependent on genetic factors such as temperament but are also affected by protective factors in the environment.
Assessment
Too many people 'assessment' has come to mean administration of a developmental or psychological test, but this is only a small part of the assessment process, and in many cases it may even be irrelevant to the presenting complaint. Assessment has been defined as 'the systematic collection, organization and interpretation of information about a person and their situation'. It should be conducted for a purpose rather than as a ritual. A very different approach is needed in each of these situations and it is vital to identify and deal with the real problem — for example, a conflict over management.
A complete assessment might include the following components: definition of the main problem(s); evaluation of the genetic, biological, environmental and pathological factors which contribute to the problem; an estimate of the child's present development status — this may vary from a rough approximation to a detailed set of measurements using a psychometric test battery; tests of hearing and vision; evaluation by speech therapist, physiotherapist or occupational therapist; the organization of an intervention programme; and a review of the response to intervention.
Methods of assessment
For the paediatrician, the usual approach would be an interview with the parents, followed by involvement of the child in simple play and/or observation of their spontaneous activities. The information obtained in this way is interpreted using a developmental scale, together with one's general knowledge of child development. A developmental scale is simply a means of arranging information about the mean ages at which children achieve various milestones. The way in which information is elicited about the items in the scale is left to the discretion of the clinician, and the extent of normal variation is indicated only in the most general terms.. Items are classified into convenient, though arbitrary, categories, for example: (i) posture and large movements; (ii) vision and fine movement; (iii) hearing and speech; and (iv) social behaviour and play.
There are many clinical situations in which it might be sufficient for the paediatrician to state, for example, that a child aged 3 years is functioning at the level of an 18 month old. Parents find it easy to understand this concept and can state whether or not they agree with the doctor's estimate. This information can also be expressed as a developmental quotient:
Developmental age
------------------------- x 100
Chronological age
However, this practice has some disadvantages; it has an aura of accuracy which is not justified by the precision of the test procedures used, it conceals variations between different aspects of development, and it is mistaken by parents and sometimes other professionals for an IQ. and is interpreted accordingly.
