Kaplan + Sadock's Synopsis of Psychiatry, 11e

Table 31.1-2 Landmarks of Normal Behavioral Development

Age

Motor and Sensory Behavior

Adaptive Behavior

Personal and Social Behavior

Birth to

Hand-to-mouth reflex, grasping reflex Rooting reflex (puckering lips in response to perioral stimulation), Moro reflex (digital extension when startled), sucking reflex, Babinski reflex (toes spread when sole of foot is touched) Differentiates sounds (orients to human voice) and sweet and sour tastes Visual tracking Fixed focal distance of 8 inches Makes alternating crawling movements Moves head laterally when placed in prone position Tonic neck reflex positions predominate Hands fisted Head sags but can hold head erect for a few seconds Visual fixation, stereoscopic vision (12 weeks) Symmetrical postures predominate Holds head balanced Head lifted 90 ° when prone on forearm Visual accommodation Sits steadily, leaning forward on hands Bounces actively when placed in standing position Sits alone with good coordination Creeps Pulls self to standing position Points with index finger

Anticipatory feeding-approach behavior at 4 days Responds to sound of rattle and bell Regards moving objects momentarily

Responsiveness to mother’s face, eyes, and voice within first few hours of life Endogenous smile Independent play (until 2 years) Quiets when picked up Impassive face

4 wks

4 wks

Follows moving objects to the midline Shows no interest and drops object immediately

Regards face and diminishes activity Responds to speech Smiles preferentially to mother

16 wks

Follows a slowly moving object well Arms activate on sight of dangling object

Spontaneous social smile (exogenous) Aware of strange situations

28 wks

One-hand approach and grasp of toy Bangs and shakes rattle Transfers toys Matches two objects at midline Attempts to imitate scribble

Takes feet to mouth Pats mirror image Starts to imitate mother’s sounds and actions Separation anxiety manifest when taken away from mother Responds to social play, such as pat-a-cake and peek-a-boo Feeds self cracker and holds own bottle

40 wks

52 wks

Walks with one hand held Stands alone briefly

Seeks novelty

Cooperates in dressing

15 mos

Toddles Creeps up stairs

Points or vocalizes wants Throws objects in play or refusal

18 mos

Coordinated walking, seldom falls Hurls ball Walks up stairs with one hand held

Builds a tower of three or four cubes Scribbles spontaneously and imitates a writing stroke Builds a tower of six or seven cubes Aligns cubes, imitating train Imitates vertical and circular strokes Develops original behaviors Builds tower of 9 or 10 cubes Imitates a three-cube bridge Copies a circle and a cross Copies a cross Repeats four digits Counts three objects with correct pointing Copies a square Draws a recognizable person with a head, a body, and limbs Counts 10 objects accurately

Feeds self in part, spills Pulls toy on string

Carries or hugs a special toy, such as a doll Imitates some behavioral patterns with slight delay

2 yrs

Runs well, no falling Kicks large ball Goes up and down stairs alone Fine motor skills increase

Pulls on simple garment Domestic mimicry

Refers to self by name Says “no” to mother Separation anxiety begins to diminish

Organized demonstrations of love and protest Parallel play (plays side by side but does not interact with other children)

3 yrs

Rides tricycle Jumps from bottom steps Alternates feet going up stairs

Puts on shoes Unbuttons buttons Feeds self well Understands taking turns

4 yrs

Walks down stairs one step to a tread Stands on one foot for 5 to 8 seconds

Washes and dries own face Brushes teeth Associative or joint play (plays cooperatively with other children)

5 yrs

Skips, using feet alternately Usually has complete sphincter control Fine coordination improves

Dresses and undresses self Prints a few letters Plays competitive exercise games

6 yrs

Rides two-wheel bicycle

Prints name Copies triangle

Ties shoelaces

(Adapted from Arnold Gessell, M.D., and Stella Chess, M.D.)