DEVELOPMENTAL

DISABILITIES
Sam Lazuardi

Developmental Disabilities (DD)- 1

National Institute of Child Health and Human Development (NIH)

Are birth defects that cause lifelong

problems with how a body part or system
works, incl :
1.Nervous syst (NS) D affecting how the
brain, sp cord & NS function. They cause
mental re-tardation (Down Sy & Fragile X
sy) & also cause learning & behavioral
disorders (autism).
2.Sensory-related D, which cause vision,
hearing & sight problems

Developmental Disabilities (DD)- 2

National Institute of Child Health and Human Development (NIH)

3.Metabolic disorders (PKU), which

affect how the body processes the
material it needs to function
4.Degenerative disorders (Rett sy),
which might only become apparent
when children are older & can cause
physical & mental problems

Developmental Disabilities (DD)- 3

National Institute of Child Health and Human Development (NIH)

Most DD have no cure, but you can

often treat the symptoms
Physical, speech and occupational
therapy might help
Special education classes and
psychological counseling can also
help

DEVELOPMENTAL MILESTONES (DM)

Skills such as taking a first step,
smiling for the first time, waving
bye bye are called DM
Children reach M in how they play,
learn, speak, behave & move
(crawling, walking) & develop at their
own pace
If your child is not meeting the M for
his age, there could be a problem
with his develop-ment -> D

DEVELOPMENTAL
SCREENING (DS)
The doctor might ask some questions
or talk and play with the child to see
how he plays, learns, speaks,
behaves and moves
A delay in any of these areas could
be a sign of a problem
The American Academy of Pediatrics
recom-mends children to be
screened during regular visits at : 9,
18, 24 or 30 months

THE IMPORTANCE OF DS
In the US, about 13 % of children 3
17 yrs of age have DD such as autism,
mental retarda-tion and attention
deficit /hyperactive disor-der
Fewer than half of children with DD are
iden-tified before starting school, by
which time significant delays already
might have occurred and opportunities
for treatment might have been missed

EARLY INTERVENTION (EI) 1

Early intervention services help children
from birth through 3 yrs of age learn
important skills
Services incl. therapy to help the child talk,
walk and interact with others
Early Intervention is a system of services
that help babies and toddlers with DD
learn the basic and brand new skills that
develop during the first 3 years of life ,
such as :

EARLY INTERVENTION (EI) 2

Physical (reaching, rolling, crawling and
walking)
Cognitive (thinking, learning, solving
problems)
Communication (talking, listening,
understan-ding)
Social/emotional (playing, feeling
secure, and happy)
Self-help (eating & dressing)

CAUSES AND RISK FACTORS

-1
DD begin before a baby is born, but
some hap-pen after birth because of
injury, infection or other factors
A complex of mixed factors incl.
genetics, pa-rental health and
behavior (smoking, drinking) during
pregnancy, complications during
birth, infections during pregnancy or
very early in life, exposure to high
toxins (Pb).

CAUSES AND RISK FACTORS

-2
25 % of hearing loss due to CMV
infections during pregnancy,
complications after birth and head trauma
Intellectual disability cause due to alcohol
sy, genetic & chromosomal condition
(Downs sy & fragile X sy) and infections
during pregnancy (toxoplasmosis)
Autism spectrum disorder (ASD) due to
ASD in the family

CAUSES AND RISK FACTORS

-3
Low birth weight, premature birth,
multiple birth & infections during
pregnancy associated with many DD
Untreated newborn jaundice can
cause kern-icterus -> cerebral palsy,
hearing & vision & teeth problems ->
early detection & treatment
Obese pregnancy -> lower language
score

THINGS YOU NEED TO KNOW ABOUT

BIRTH DEFECTS (BD) - 1
BD affect 1 in 33 babies every year and
cause 1 in 5 infant death. For many babies
born with BD, there is no family history of
the condition
All women who can become pregnant
should take a vitamin with folic acid (FA)
every day. FA helps a babys brain and
spine develop very early in the first mo of
pregnancy when a women might no know
she is pregnant

THINGS YOU NEED TO KNOW ABOUT

BIRTH DEFECTS (BD) - 2
Many BD are not found immediately at birth.
Some are easy to see (cleft lip), but heart
defects are not
Tests (USG & amniocentesis) can detect BD
before the baby is born (Spina bifida, heart
defects, Down Sy) -> prenatal care & screening
Most cause of BD unkown.
Smoking, alcohol & other drugs, medicines,
chemicals, infectious diseases during
pregnancy linked to BD

THINGS YOU NEED TO KNOW ABOUT

BIRTH DEFECTS (BD) - 3
BD prevention : take FA, regular medical
check ups, control diabetes & obesity,
have tests for infectious diseases and get
vaccinations, do not smoke & drink or
other drugs
Prevent infections during pregnancy :
wash hands often, especially after using
bathroom, touching raw meat, uncooked
eggs, unwashed veggies, handling pets,
gardening or caring small children

WHO IS AFFECTED
DD occur among all racial, ethnic &
socioeco-nomic groups
US : one in six (15 %) of children age
3 17 have 1 or more DD, such as :
ADHD, Autism Spectrum disorders,
cerebral palsy, hearing loss,
intellectual disability, learning
disability, vision impairment and
other Developmental Delays

DD IS INCREASING IN US
About 1 in 6 children had DD in 2006 2008
showed that prevalence of DD has increased
17.1 % from 1997 - 2008
Males had twice the prevalence of any DD
than females and more specifically had
higher prevalence of ADHD, autism, learning
disabi-lities, stuttering / stammering and
other DDs
Children from families with income below the
federal poverty level had a higher prevalence

REGULAR EXERCISE BENEFIT FOR

DD
Physical Activity Guidelines provides
guidance to help people with DD age
6 and older to improve their health
through appropriate physical activity
each day, since they have a
tendency to live less active lifestyles

NUTRITION FOR PERSONS WITH DD

People with DD often have a higher
tendency of being obese than people
in the general population
General recommendations include :
Eat a diet low in saturated fat
Watch portion control
Read labels to choose foods that
comprise a healthful diet

BRAIN DEVELOPMENTNational Center for infant, toddlers and families

The human brain begins forming very

early in prenatal life, 3 weeks after
conception
Brain development is a lifelong
project
The brain in a child is more plastic,
more open to learning and enriching
influences, but also more vulnerable
to developmental problems
(impoverished and un-nurturing)

NATURE VERSUS NURTURE

-1
Genes (G) and Environment (E) interact
at every step of brain development
G are responsible for basic wiring plan,
for-ming all of the neurons & general
connections between different brain
regions, while E is res-ponsible for finetuning those connections, helping the
child adapt to the particular E (cultural, family, school, peer group).

NATURE VERSUS NURTURE

-2
Our brains are programmed to recognize
human speech, to put words and meaning
together and to pick up the grammatical
rules of ordering words in sentences.
However, the particular language each child
masters, the size of his vocab and the exact
dialect accent he speaks are determine by
his social E in which he is raised.
Genetic potential is necessary, but DNA
alone cannot teach a child to talk

DOES EXPERIENCE CHANGE THE

ACTUAL STRUCTURE OF THE BRAIN ?
Brain development is active-dependent
Every experience, excites certain neural
circuits & leaves others inactive. Those that
are consistent-ly turned on over time will
be strengthened, while those that are
rarely excited may be dropped away ->
cells that fire together, wire together
Elimination of unused neural circuits
referred to as pruning, making the
remaining work more quickly & efficiently

CRITICAL PERIOD IN BRAIN

DEVELOPMENT
Pruning is more common in early childhood
Babies require normal visual input or they
may suffer permanent impairment
Crossed eyes will fail to develop full acuity if
it is not promptly corrected
Critical period for language learning begins
around 5 yrs of age and ends around puberty
Individuals who learn a new language after
puberty almost always speak it with a
foreign accent

There is no critical periods in the

development of every brain function-1
In visual development : 2 visual
abilities :
Acuity (the perception of fine detail)
and bin-ocularity (the coordinated
use of both eyes), which is important
for depth perception, do depend on
normal visual experience as a child,
whereas 2 other visual abilities (color
and pe-ripheral vision) are not
impaired by visual problems in early

There is no critical periods in the

development of every brain function-2
In language development, the ability to perceive
and produce individual speech sounds (incl.
grammar and phonology) are more sensitive
than vocabulary size to a childs experience
with language in the first few yrs of life
A childs social-emotional development depends
on a positive, nurturing attachment to a primary
caregiver, based on the higher frequency of serious behavioral problem among children who
were severely neglected during the first year or
more of life

Why does the developing brain

undergo these critical periods ?
Between infancy and early grade school
yrs, some 50 % more over-produce
connections will be preserved in adulthood
Through pruning, the brain becomes better
tuned to meet the challenges of his
particular environment
Kittens that are deprived of all vision in the
first months of life show a delayed critical
period for visual experience, beginning
from the time their deprivation ends

When is the brain fully developed-1

Our brain are continually re-shaping
them-selves to meet the demands of
everyday life
In spite of the great number or
neurons pre-sent at birth, brain size
itself increases more gradually, a
newborns brain is about one quarter
the adults size
It grows to about 80 % of adult size
by 3 yrs of age & 90 % by age 5

When is the brain fully developed-2

* Brain growth is largely due to
changes in the neurons, each brain cell
begins as a tiny sam-pling and
gradually sprouts its hundreds of long,
branching dendrites, which serve as
the recei-ving point for synaptic input
from other neurons
* A newborns brain works
considerably more slowly than an
adults, transmitting information some

When is the brain fully developed-3

The speed of neural processing increases
dra-matically during infancy childhood,
reaching its maximum at about 15 yrs
The increase is due to gradual
myelination of the long wires connecting
one neuron to another neurons dendrites
Myelination begins around birth and is
most rapid in the first yrs but continues
as late as 30 yrs of age

Developing brain nutrition 1

Brain development is most sensitive to a
babys nutrition between mid-gestation
and 2 yrs of age
Malnourished (deprived of adequate
calories & protein) throughout this period,
causes smaller brains, because of reduced
dendritic growth, reduced myelination and
have fewer glia (supporting cells which
continue to form after birth and are myelin
producers

Developing brain nutrition 2

They will suffer from behavioral and cognitive
deficits, incl. slower language & fine motor
development, lower IQ & poorer school performance
Babys birth weight & brain size do depend on
the quality of mothers nutrition during pregnancy
Pregnant women should gain 20 % of their
ideal pre-pregnancy weight & requires an extra
300 cal per day incl. 10 -12 grams of protein

Developing brain nutrition 3

After birth, brain growth depends on
the qua-lity of the childs nutrition
Breast milk : best nutrition for brain
growth, provided they receive some
from of Fe suppl starting from 6 mo
of age, Fe def linked to cognitive
deficits, as Fe is critical for maintaining adequate # of O2 carrying
rbc neces-sary to fuel brain growth

Developing brain nutrition 4

They also need a high level of fat (50
% of the calories) until 2 yrs of age
for the rapid pace of myelination in
early life
Whole cows milk -> after the 1st
birthday & after age 2 ->
transitioning to a heart-healthy level
or fat ( no more than 30 % of total
cal), incl. lo-fat cows milk (1 2 %)

PRENATAL DEVELOPMENT
Brain development begins with the
formation & closure of the neural
tube (NT)
The NT forms from the neural plate,
16 days after conception
The plate lengthens, start folding up,
forming a groove around 22 days
post-conception.
By 27 days the tube is fully closed &
begin its transformation into the

NEURAL TUBE DEFECTS

(NTD) -1
If, during this 4th week after conception, the
tube fails to seal the head end, a anencephaly
(lack of cerebral cortex) results & is always
fatal
If the tube fails to seal its lower end, the defect
is spina bifida (SB), part of the sp cord may
develop outside the spine & is highly
vulnerable to damage
SB range from symptomless to highly disabling
(paralysis, sensory loss & loss of bladder
bowel function)

NEURAL TUBE DEFECTS

(NTD) -2
SB can be prevented -> 400
microgram folic acid 1 mo before
conception till the end of the first
trimester of pregnancy

IMPORTANT INFLUENCES ON BRAIN

DEVELOPMENT PRENATALLY
Good nutrition of the mother
Alcohol & smoking should be avoided, as
they impair the formation & wiring of brain
cells
Some chemical & radiation are harmful
Infections : rubella, varicella, CMV, toxoplasmosis, syphilis, GO, genital herpes
Prevent with strict hygiene (wash hands frequently, avoid sick friends, dont share food)

POSTNATAL DEVELOPMENT
By birth, only the lower portion of the
CNS (sp. cord & brain stem) are very
well developed :
1.kicking, grasping, crying, sleeping,
rooting, feeding
2. Primitive reflexes :dolls eye
maneuver, moro or startle response,
stepping reflex
3.Vital body functions: breathing,
heartbeat, circulation, sleeping,

PARENTS ROLE IN BABYS BRAIN

DEVELOPMENT
Infants prefer human stimuli : your
face, voice, touch and even smell
over everything else
Parents are programmed to love &
respond to our babies cues
Because brain development is
dependent on early experience ->
right kind of nurturing
Infants who are conversed with a lot
of verbal interaction -> more

IMPORTANT CHANGES IN THE BRAIN

AFTER BIRTH - 1
The cerebral cortex produces most of
its synaptic connections after birth in
a massive burst exuberant period
-> color vision, pincer grasp & strong
attachment to parents
By 2 yrs : synaptic exuberant begins
earlier in primary sensory regions
(visual & primary touch area) & later
in the temporal & frontal lobes
(higher cognitive & emotional

IMPORTANT CHANGES IN THE BRAIN

AFTER BIRTH - 2
In the middle elementary school yrs until
end of adolescence, the number of synapses
gra-dually declines down to adult levels
Childrens brain are working very hard
during the period of exuberant that
corresponds to various critical periods of
mental development
Myelination to process information
efficiently, begins in the primary motor &
sensory areas:

IMPORTANT CHANGES IN THE BRAIN

AFTER BIRTH - 3
Eyes, ears, nose, skin and mouth and
then progresses to higher order or
association regions that control the more
complex inte-gration of perception,
thoughts, memories and feelings
Myelination continue throughout
childhood into a persons 20 & appears
to be largely hard wired & is badly
influenced by severe malnutrition

DIFFERENCES IN THE DEVELOPMENT

OF BOYS AND GIRLS BRAINS -1
Mens brain tend to be more lateralized,
the 2 hemispheres operate more
independently during specific mental tasks
(speaking)
Females tend to use both hemisphere more
equally
Males tend to have slightly larger brains
Girls are more advanced in sensory &
cogni-tive development (vision, hearing,
memory, smell & touch)

DIFFERENCES IN THE DEVELOPMENT

OF BOYS AND GIRLS BRAINS -2
Girls tend to be more socially-attuned
responding more readily to human voices
or faces or crying in response to another
infants cry & lead boys in the emergence
of fine motor & language skills
Boys catch up by age 3, to out-perform in
one cognitive area : visual- spatial
integration (jig-saw puzzles & hand-eye
coordination) prefer activities like climbing
& pushing trucks

DIFFERENCES IN THE DEVELOPMENT

OF BOYS AND GIRLS BRAINS -3
Males tend to perform better on task
like mental rotation, while females
tend to per-form better at certain
verbal tasks & at identi-fying
emotional expression in another persons face
Parents compensate the different
tendencies:
Boy -> lots of conversation & word
play

PREGNANCY AND SUBSTANCE

ABUSE
Smoking during pregnancy passes
nicotine & ca causing drugs to your
baby -> risk of still-birth and
premature birth
Alcohol -> life-long physical &
behavioral problems in children, incl
fetal alcohol sy
Illegal drugs can cause underweight
babies, birth defects or withdrawal
symptoms after birth

SECONDHAND SMOKE
Pregnant women : spontaneous
abortions, stillbirth, sudden infant
death sy after birth
Children : acute respiratory
infections, ear problems, severe
asthma, meningitis, premature death

ADHD
According to 2010 US survey : 1 in 10
Ameri-can children has ADHD a 22
% increase from 2003 twice as
many boys than girls
Five dietary factors to address if your
child has ADHD : to much sugar,
gluten sensitivity, too few beneficial
bacteria (probiotics the new
prozac), animal sourced omega-3
deficiency, food additives & GMO

How to optimize your childs gut

flora
Avoid processed, refined foods as they
promote the growth of pathogenic bacteria,
yeast, fungus processed foods are also
high in sugar , grains (gluten), artificial
additives
Eat traditionally fermented, unpasteurized
foods
Use a high quality probiotic supplement
Beware of the hidden hazards of
glyphosate (most widely used pesticide)

Additional strategies to relieve

ADHD
Clear house of dangerous pesticides
Avoid commercial washing
detergents & cleaning products
Spend more time in the nature
Investigate sensory therapy and
emotional wellness tools

PEROKOK INDONESIA
70 % PEROKOK ADALAH ORANG
MISKIN
PEROKOK KRN KECANDUAN ->
EGOIS, EMO-SIONAL, TERPENTING
ROKOK, MAKANAN DLL NO 2 ->
KELUARGA TERMASUK ANAK KURANG
GIZI, SAKITAN, PENDIDIKAN
TERLANTAR DAN MENDERITA AKIBAT
2ND HAND SMOKE
ANAK PEROKOK MISKIN MENDERITA

PEROKOK PASIF LEBIH CEPAT ALAMI

KERUSAKAN OTAK Science Daily, 11 Jan 2013
China adalah negara dg tingkat perokok terbesar di dunia, sekitar 350 juta orang
DR Ruoling Chen, survei pd 6000 orang
diatas 60 th di 5 provinsi di China
Dilakukan penelitian gabungan Kings
College London dan Universitas Kesehatan
Anhui
Perokok pasif berisiko demensi lebih cepat
WHO : hanya 11 % negara : ruang bebas
asap rokok di dunia

PP TEMBAKAU Perlindungan tak

total Kompas, 12 Jan 2013
PP no 109 2012 seharusnya disahkan
2010
Menkes : harus PP Khusus, krn tembakau
ter-masuk zat adiktif & hrs diatur spt UU
narkotika lain dan mgd 4000 zat racun,
dimana 60 di-antaranya penyebab kanker
-> melindungi penduduk usia produktif,
anak, remaja & ibu hamil
Diharapkan pengawasan utama dari
masyarakat sendiri

11.4 Balita Indo terpapar ROKOK

Metrotvnews, 17 Jan 2013
Nafsiah Mboi : PP no 109 2012 : bahan aditif
tembakau utk lindungi Indo dr bahaya rokok
200.000 or Indo meninggal / th akibat 61 jt
perokok aktif
92 jt terpapar asap rokok, 78 % (usia 13-15
th) di tempat umum, 69 % di rumah sendiri
Penerimaan bea cukai rokok Rp 55 triliun,
se-dang biaya pengobatan Rp 231 triliun
(2012) utk peny jantung, stroke, kanker &
25 peny lain

American Idolfavorite overcomes

Tourettes, Aspergers
James Durbin appeared on the 10th
season of American Idol
Durbin was bullied by his peers,
causing him to drop out of high
school
Singer says his wife and child
balance him , keep him motivated

Hillary Clinton receives a football helmet in a State Department meetin

From Deputy Secretary Tom Nides, 7 Jan 2013