Conditions and Influences on Occupational Performance · 5 min read
Development Across the Lifespan and Aging
This chapter covers typical development from infancy through childhood, the play stages, primitive reflexes and the normal changes of aging. Exam questions use these milestones to decide whether a child's skill is age appropriate, which activity is the right next step, and which aging change explains an older adult's difficulty.
Gross Motor and Postural Milestones
Development generally proceeds from head to toe (cephalocaudal) and from the center of the body outward (proximal to distal). Proximal stability supports distal mobility, which is why a child with a weak trunk often has poor fine motor control.
| Skill | Typical Age |
|---|---|
| Head control | About 4 months |
| Rolling | About 4-6 months |
| Sitting independently | About 6-8 months |
| Crawling | About 7-10 months |
| Pulling to stand | About 9-10 months |
| Walking | About 12-15 months |
Fine Motor, Prewriting and Scissor Skills
Grasp moves from reflexive to voluntary and from the ulnar side of the hand to the radial side. An inferior pincer grasp appears around 9 months and a neat pincer between 10 and 12 months; voluntary release develops around 9-10 months. Crayon grasp progresses from palmar-supinate (about 1-1.5 years) to digital-pronate (about 2-3 years), static tripod (about 3.5-4 years) and dynamic tripod (about 4.5-6 years).
| Shape (copied) | Typical Age |
|---|---|
| Vertical line | About 2-3 years (imitates earlier) |
| Circle | About 3 years |
| Cross | About 4 years |
| Square | About 4-5 years |
| Triangle | About 5 years |
| Diamond | About 6-7 years |
Scissor skills follow a similar sequence: snipping around 2 years, cutting across paper at 2.5-3 years, cutting along a line at 3-3.5 years, cutting a circle at 4-5 years and a square at 5-6 years.
Self-Care Milestones
Children typically remove socks around 1 year, self-feed with a spoon at about 15-18 months, begin daytime toilet training at about 2-3 years, put on a pullover shirt around 4 years, manage large front buttons at about 3-4 years and tie shoes at about 5-6 years. Undressing develops before dressing, because taking clothes off requires less planning and precision.
Primitive Reflexes
Primitive reflexes are automatic responses present at birth that become integrated as the nervous system matures. Persisting reflexes can interfere with rolling, sitting, midline play and feeding.
| Reflex | What It Looks Like | Integrates By About |
|---|---|---|
| Rooting and suck | Turns toward cheek touch; sucks when lips touched | 3-4 months |
| ATNR | Head turn causes arm extension on face side, flexion on skull side | 4-6 months |
| Moro | Sudden head drop causes arm extension then flexion | 4-6 months |
| Palmar grasp | Fingers flex around object placed in palm | 4-6 months |
| STNR | Neck flexion flexes arms and extends legs; reverse with neck extension | 8-12 months |
| Plantar grasp | Toes curl with pressure on ball of foot | 9-12 months |
Play Development
Play is the primary occupation of childhood. Typical stages are solitary play (infancy), parallel play (playing next to peers with similar toys, about 2-3 years), associative play (sharing materials with loose interaction) and cooperative play (shared goals and rules, about 4-5 years). Piaget described cognitive stages that line up with play: sensorimotor (birth to about 2, learning through senses and movement; object permanence), preoperational (about 2-7, symbolic and pretend play, egocentric thinking), concrete operational (about 7-11, logical rules, games with rules) and formal operational (about 11 and older, abstract reasoning).
Adolescence and Adulthood
Adolescents work on identity, independence, peer belonging and transition to adult roles. Under IDEA, transition planning for work and community life becomes part of the IEP by age 16. Young and middle adults typically focus on work, relationships, parenting and caring for aging parents; illness in this stage often threatens income and family roles.
Normal Aging Changes
Aging is not a disease, but predictable changes affect occupation. The COTA should separate normal changes from signs of a condition that should be reported.
| System | Typical Change | Functional Impact |
|---|---|---|
| Vision | Presbyopia, reduced contrast sensitivity, slower adaptation to dark, more glare sensitivity | Trouble reading labels, night driving, stairs in low light |
| Hearing | High-frequency loss (presbycusis) | Missed conversation, social withdrawal |
| Musculoskeletal | Loss of muscle mass (sarcopenia), lower bone density, stiffer joints | Slower gait, fall and fracture risk |
| Cardiopulmonary | Lower maximum heart rate and reserve | Lower endurance for IADLs |
| Neurological | Slower processing and reaction time | More time needed for new learning; memory for well-learned skills largely preserved |
| Skin | Thinner, more fragile skin | Skin tears and pressure injury risk |
Key Takeaways
- Development is cephalocaudal and proximal to distal; trunk stability supports hand skill.
- Know the sequences: grasp patterns, shapes (line, circle, cross, square, triangle, diamond), scissors and self-care.
- Persisting primitive reflexes such as the ATNR interfere with midline play and feeding; positioning comes first.
- Play moves from solitary to parallel (2-3 years) to associative to cooperative (4-5 years).
- Normal aging brings slower processing, reduced contrast sensitivity and sarcopenia; real functional decline in familiar tasks is not normal and should be reported.
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