Child “development” - what do we mean?

When helping a young kid learn to use a pencil, it’s worth looking at their feet. Why?

We use our hands best when our whole body is stable. Often, when a kid sits on a chair at a table, their legs don’t reach the ground. This means their trunk isn't stable, so it’s harder for them to learn to use a pencil. They’ll develop pencil skills quicker with their feet flat on the floor.

Some kids (e.g. those with cerebral palsy) need help to get into a stable sitting position, no matter what size chair they’re in. So, a kid’s mastery of pencil skills sometimes needs a good physio’s help, as much as a good OT’s.

This is a developmental framework - thinking about a child’s progress in terms of the abilities they’ve mastered, they’re currently mastering, or are yet to start on.

A deeper understanding of these abilities, in clinical practice, is the understanding of how these various abilities ‘interact’ with each other. One ability might be important or essential, for the subsequent development of other abilities. This can be obvious, e.g. an infant has to practice babbling, creating lots of different word sounds, before they’ll say their first word. But sometimes the connection isn’t as obvious, as in the feet/pencil example above.

The connections between abilities can be more complex. The development of one ability might need several separate, more basic abilities lined up first, e.g. for a kid to write a word with a pencil, they need fine motor ability with their hands, and early cognitive symbolic understanding of letters and words.

***

A little while ago I was reminded of the power of a developmental framework of understanding. I came across a description of an ability which we all take for granted - understanding the communicative intention of others:
“…Communicative intentions are a special type of intention in which an individual intends something not just toward an inert object but toward the intention states of someone else. Consequently, when an adult addresses an utterance to an infant too young to comprehend intentions, from the infant's point of view the adult is just making noise (for whatever reason). Infants this young may on occasion learn to associate one of these noises with a perceptual event in much the same way a household pet may understand that the sound ‘dinner’ heralds the arrival of food. But this is not language. Sounds become language for young children when and only when they understand that the adult is making that sound with the intention that they attend to something.”

Sometimes I see a very young kid, aged say 1 to 3yo, whose parents are worried because the kid “doesn’t listen”, “won’t follow instructions”, “doesn’t ask for things” or “doesn’t tell us anything”. Even though it seems that the kid is learning some words, and what each word means. In the consultation room, the same kid might wander around the room inspecting things and trying to manipulate them, largely oblivious to myself, and even their parents. The child might glance at me to check me out, and might even smile if I pull a silly face. But they don’t say anything to me, or listen to anything I try to tell them.

Reading about this concept, “understanding the communicative intentions of others”, helped clarify for me what might really be going on. And in a way which can be conveyed to others, especially the child's parents, desperate for meaningful explanations. It can be hard for a parent to understand how a child who knows the word “milk”, who can recognise a glass of milk in a picture book and say "milk" in that situation, doesn't just come out and say “milk” when they want a glass of milk. Instead of taking the parent to the fridge by the hand, or having a meltdown when their unspoken desire isn’t understood.

***

There are other actions and behaviours which come up a lot in clinical practice, but which aren’t really developmental abilities. One example is ‘making eye contact’ (which usually means ‘making eye contact in the culturally accepted, socially appropriate way’). Most young kids will make eye contact with adults they meet, especially when it’s clear that their parents like and trust this new grownup. But some kids don’t, especially not with unfamiliar adults. And their failure to is noticed. The child might be admonished by their parents, that they shouldn’t be so rude to Auntie Beryl. Or the child might end up in a paediatrician’s consulting room.

This detail about the child, that they rarely or never make eye contact, is one of myriad important details which a clinician must try to make sense of, if they’re going to help the kid and family.

But it’s not helpful to think of making eye contact as a developmental ability. It doesn’t fit into that framework well - there's nothing wrong with the kid's visual acuity, or extraocular muscle control. A different framework(s) will make better sense of what’s really going on for the kid.

The quote is from Tomasello M, "Constructing a Language" (2003) Harvard University Press.