Pediatric Developmental Theories – OT / NBCOT® Exam Study Guide

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Study Guide

  • Developmental theories help to explain a child’s occupational performance by their components.
  • Explain development and allows occupational therapists to use this as a basis to provide interventions.


  • Piaget was curious about the child’s response to their environmental experiences.
  • Focus was on the explanation of cognitive learning.
  • Adaptation – the child’s ability to adjust to change in his or her environment.
  • Children interact with, instead of to their environment.
  • Children develop a schema in their brain to represent the relationships of symbols of the world around them. The everyday interactions allowed children to develop new schemas or build on the ones that they have.
  • Assumptions: children are motivated to learn by nature without any need for rewards as motivation.

Piaget’s Stages

  • Sensorimotor, Preoperational, Concrete Operational, and Formal Operational.
  • “Let’s go 2 7-11”.


  • Birth to 2 years old
  • Goal is object permanence.
  • Learning is based on trial and error with the use of symbols.


  • 2 to 7 years
  • Goal is symbolic thought.
  • Language, memory, and imagination develop.


  • 7 to 11 years old
  • Child continues to build on their language.
  • Goal is operational thought.
  • Child develops logical and methodical manipulation of symbols.
  • Child is less egocentric and considered more aware of the outside world and its events.

Formal Operational

  • Adolescence to adulthood
  • Goal is abstract concepts.


  • Vygotsky was primarily interested in speech and language development.
  • Child development is dependent on social interactions.
  • Cognitive processing in children first requires the assistance of another person.
  • Zone of proximal development – difference between what the learner can do without help and what they can achieve with help from a skilled partner, socially.
  • “Proximal” refers to the skills learned and the child is close like proximity to mastering.
  • Similar to scaffolding.
  • Scaffolding is the process by which the therapist or adult guides the child to improve their learning.
    • Requires just the right amount of support to enable the child to perform at a higher level than they were at.
    • Goal is to decrease the amount of support provided so that the child can be more independent.


  • Hierarchy of needs – needs serve as a motivator to achieve a higher level of potential on the hierarchy.
  • Pyramid, starting from physiologic needs on the bottom.
  • Physiologic needs – the most basic of needs like food, water, rest, air, and warmth.
  • Safety needs – or physical and physiologic security. Include employment and health.
  • Love and belonging – friendship, intimacy, and connections.
  • Self-esteem – the ability to regard the self as competent and of value to society. Respect, status, recognition, strength.
  • Self-actualization – meeting our full potential in life. Different for every person, depending on personal goals.
  • Recognizing the child’s needs in the hierarchy helps occupational therapists to understand their behaviors and identify what may not be met in order to focus on identifying what to focus on for goals and interventions.

Behavioral Theory


  • Reinforcement by the environment or punishment.
  • Learning occurs through the use of reinforcement to modify behavior.
  • Behaviors are strengthened with positive reinforcement, such as praise.
  • Behavioral approach can help a child achieve learning through shaping.
  • Shaping – breaking down something complex into its components to reinforce on its own until the ultimate desired behavior is achieved.
  • Client practices the skill repeatedly until it is achieved before moving on.

Social Cognitive Theory


  • Children learn by observing the behavior of others.
  • Children determine their own learning by focusing on their goals.
  • Children do not learn random things in their environment.
  • Learning is self-directed and goal-oriented.
  • May learn through how their peers are rewarded or punished.
  • Learning can be indirect.
  • Children with delayed social skills can learn through the modeling of their peers.

Dynamic systems theory (Systems Theory)

  • Explains motor control.
  • Movement organization is derived from the study of chaotic systems.
  • Movement patterns that accomplish a goal come from a combination of multiple subsystems.
  • Nonhierarchical
  • Learning occurs not just in the brain, but also in the body and its environment.
  • Sub-systems spontaneously self-organize, or come together and interact in a specific way, to produce the most efficient movement solution for each specific task.
  • No one sub-system is more important.
  • Different goals may use the same synergy pattern.
  • Synergy pattern – through repeated practice, the child selects a functional pattern that meets their environmental demand to learn and do the same task the next time.
  • Learning occurs when a task is functional and has a goal or outcome.

Motor Learning

  • Focuses on having the child achieve a goal-directed action.
  • Development from the child with their interaction in the environment for a task.
  • Child uses a general movement pattern in their environment for a goal.
  • Through repetition of the task, the child refines their motor function to achieve the same goal more successfully.
  • Motor learning calls these movement synergies and is a child’s way of solving a task efficiently.

Motor Learning Concepts

  • Therapists should practice with experiences that promote fast learning and skill retention by using the entire task in the child’s natural environment.
  • Learning should be implicit and not made to bring attention to the task.
  • Repetition is essential such as through massed practice (drill) or random practice (no particular order).
  • Random practice is considered better for learning.
  • Practice should be allowed to be distributed or over with rest periods compared to massed practice.
  • The child should receive feedback from the therapist about performance.
  • Practice should be done in a variety of environments to allow the transfer of learning.


  • “Normal” – normal postural reactions for movement.
  • Movements and postural reactions are thought to be automatic.
  • Handling (therapeutic handling) – therapist guidance of the child in specific ways at specific locations in therapy.
  • Principles have shifted historically from this normal and automatic premise to a combination of motor learning and dynamic system theories.
  • Recognizes how the environment is important.
  • Efficacy? Remains to be widely used for conditions such as cerebral palsy.

Sensory Integration

Jean Ayres

  • Sought to explain learning difficulties that came from organizing sensory information.
  • SIPT – sensory integration and praxis test.
  • SIPT looks at several subtypes of sensory interactive problems that include visual and tactile perception, vestibular and proprioception, bilateral functions, attention and tactile or touch defensiveness, and visual and touch discrimination.
  • Helps to explain sensory processing disorders
    • Over or under-sensitivities to our environment.
    • Visual, auditory, tactile, vestibular, proprioceptive, taste, smell, and posture.

Sensory Integration Concepts

  • Provide opportunities to experience their senses.
  • Provide the just-right challenge.
  • Child is active in choosing the activity for the therapy session.
  • Environment should be modified to support engagement for the child’s optimal arousal level and comfort.
  • Intrinsically motivate the child.
  • Activity should be play-based.
  • Activity should be modified as necessary to promote success.
  • Physical safety is the most important including the use of protective equipment and staying in close proximity.