Behavioral Sciences: Medical School Crash Course

TABLE OF CONTENTS Introduction .................................................................................................................................... 1 Chapter 1: The Beginning of Pregnancy through Preschool ........................................................... 2 The Prenatal Period ..................................................................................................................... 2 Infant Development .................................................................................................................... 4 Toddler Development ................................................................................................................. 7 Preschool Development .............................................................................................................. 9 Key Takeaways .......................................................................................................................... 11 Quiz............................................................................................................................................ 11 Quiz Answers ......................................................................................................................... 13 Chapter 2: School Age and Adolescence...................................................................................... 15 School Age Development .......................................................................................................... 15 Adolescent Development .......................................................................................................... 16 Key Takeaways .......................................................................................................................... 18 Quiz............................................................................................................................................ 18 Quiz Answers ......................................................................................................................... 21 Chapter 3: The Challenges of Early and Middle Adulthood......................................................... 22 Early Adulthood ......................................................................................................................... 22 Middle Age Development ......................................................................................................... 24 Key Takeaways .......................................................................................................................... 26 Quiz............................................................................................................................................ 26 Chapter 4: Aging, Death, and Bereavement ................................................................................. 30 Aging .......................................................................................................................................... 30 Death ......................................................................................................................................... 31

Bereavement ............................................................................................................................. 31 Key Takeaways .......................................................................................................................... 33 Quiz............................................................................................................................................ 34 Quiz Answers ......................................................................................................................... 36 Chapter 5: Genetics, Anatomy, and the Biochemistry of Behavior .............................................. 37 Genetics of Human Behavior .................................................................................................... 37 Anatomy of Human Behavior .................................................................................................... 41 Biochemistry of Behavior .......................................................................................................... 43 Key Takeaways .......................................................................................................................... 46 Quiz............................................................................................................................................ 46 Quiz Answers ......................................................................................................................... 49 Chapter 6: Biological Assessment of Patients with Psychiatric Symptoms .................................. 50 Psychometric Testing ................................................................................................................ 50 Personality Testing .................................................................................................................... 51 Cognitive Testing ....................................................................................................................... 53 Key Takeaways .......................................................................................................................... 56 Quiz............................................................................................................................................ 57 Quiz Answers ......................................................................................................................... 59 Chapter 7: Sleep ............................................................................................................................ 60 Sleep .......................................................................................................................................... 60 Sleep Disorders.......................................................................................................................... 62 Key Takeaways .......................................................................................................................... 65 Quiz............................................................................................................................................ 66 Quiz Answers ......................................................................................................................... 68

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Chapter 8: Psychodynamic Factors in Behavior............................................................................ 70 Key Takeaways .......................................................................................................................... 72 Quiz............................................................................................................................................ 72 Quiz Answers ......................................................................................................................... 74 Chapter 9: Learning Theory .......................................................................................................... 76 Key Takeaways .......................................................................................................................... 81 Quiz............................................................................................................................................ 81 Quiz Answers ......................................................................................................................... 83 Chapter 10: Psychological Assessment of Patients with Behavioral Symptoms .......................... 85 Key Takeaways .......................................................................................................................... 91 Quiz............................................................................................................................................ 91 Quiz Answers: ........................................................................................................................ 93 Chapter 11: Psychological Therapies ............................................................................................ 95 Cognitive and Behavioral Therapy ............................................................................................ 96 Psychoanalytic and Psychodynamic Therapy............................................................................ 96 Humanistic Therapies ................................................................................................................ 98 Art Therapy.............................................................................................................................. 102 Key Takeaways ........................................................................................................................ 103 Quiz.......................................................................................................................................... 104 Quiz Answers: ...................................................................................................................... 106 Chapter 12: Schizophrenia and other Disorders......................................................................... 107

Psychoses ................................................................................................................................ 107 Schizophrenia .......................................................................................................................... 107 Acute Psychosis ....................................................................................................................... 110 Postpartum Psychosis ............................................................................................................. 112 Acute Delirium......................................................................................................................... 113 Key Takeaways ........................................................................................................................ 116 Quiz.......................................................................................................................................... 116 Chapter 13: Mood Disorders....................................................................................................... 120 Dysthymia................................................................................................................................ 120 Major Depressive Disorder...................................................................................................... 122 Bipolar Disorder ...................................................................................................................... 126 Postpartum Depression........................................................................................................... 129 Seasonal Affective Disorder .................................................................................................... 131 Premenstrual Dysphoric Disorder ........................................................................................... 133 Key Takeaways ........................................................................................................................ 136 Quiz.......................................................................................................................................... 136 Quiz Answers ....................................................................................................................... 139 Chapter 14: Suicide ..................................................................................................................... 140 Key Takeaways ........................................................................................................................ 147 Quiz.......................................................................................................................................... 147 Quiz Answers: ...................................................................................................................... 149 Chapter 15: Anxiety Disorders and Related Disorders ............................................................... 151 Panic Disorder ......................................................................................................................... 153 Generalized Anxiety Disorder ................................................................................................. 155

Obsessive Compulsive Disorder .............................................................................................. 157 Social Phobia ........................................................................................................................... 159 Posttraumatic Stress Disorder................................................................................................. 161 Key Takeaways ........................................................................................................................ 165 Quiz.......................................................................................................................................... 165 Quiz Answers: ...................................................................................................................... 168 Chapter 16: Somatoform Disorders, Factitious Disorders, and Malingering ............................. 169 Somatoform Disorders ............................................................................................................ 169 Factitious Disorder .................................................................................................................. 171 Malingering ............................................................................................................................. 174 Key Takeaways ........................................................................................................................ 176 Quiz.......................................................................................................................................... 177 Quiz Answers ....................................................................................................................... 179 Chapter 17: Obesity and Dissociative Disorders ......................................................................... 180 Obesity .................................................................................................................................... 180 Dissociative Disorders ............................................................................................................. 184 Key Takeaways ........................................................................................................................ 189 Quiz.......................................................................................................................................... 189 Quiz Answers ....................................................................................................................... 192 Chapter 18: Eating Disorders ...................................................................................................... 193 Bulimia..................................................................................................................................... 194 Anorexia Nervosa .................................................................................................................... 195 Binge Eating Disorder .............................................................................................................. 196 Key Takeaways ........................................................................................................................ 197

Quiz.......................................................................................................................................... 198 Quiz Answers ....................................................................................................................... 200 Chapter 19: Doctor-Patient Communication .............................................................................. 201 Key Takeaways ........................................................................................................................ 209 Quiz.......................................................................................................................................... 209 Quiz Answers ....................................................................................................................... 211 Chapter 20: Psychosomatic Medicine......................................................................................... 213 Key Takeaways ........................................................................................................................ 217 Quiz.......................................................................................................................................... 217 Quiz Answers: ...................................................................................................................... 220 Chapter 21: Ethical and Legal Issues in Medicine ....................................................................... 221 Legal Actions against Doctors ................................................................................................. 222 The Litigation Process.............................................................................................................. 223 Common Ethical Issues in Medicine........................................................................................ 224 Key Takeaways ........................................................................................................................ 226 Quiz.......................................................................................................................................... 226 Quiz Answers ....................................................................................................................... 229 Chapter 22: Systems of Healthcare Delivery .............................................................................. 230 Payment Models ..................................................................................................................... 233 Healthcare Delivery ................................................................................................................. 234 Health Policy............................................................................................................................ 234 Key Takeaways ........................................................................................................................ 235 Quiz.......................................................................................................................................... 236 Quiz Answers ....................................................................................................................... 238

Chapter 23: Medical Epidemiology and Biostatistics.................................................................. 239 Epidemiology ........................................................................................................................... 239 Types of Epidemiological Studies ............................................................................................ 240 Biostatistics.............................................................................................................................. 242 Key Takeaways ........................................................................................................................ 243 Quiz.......................................................................................................................................... 244 Quiz Answers ....................................................................................................................... 246 Conclusion ................................................................................................................................... 247 Test Questions ............................................................................................................................ 248

INTRODUCTION Behavioral science is a vast area of health and medicine that involves human development from conception, to childhood, to adolescence, early adulthood, middle adulthood, old age, senescence, and death. Each of these key parts of a person‟s life is studied and evaluated when learning about behavioral science.

In the first few chapters, the process of growth and development will be discussed. This includes the development of the fetus, infant development, toddler and preschool development, school-age and adolescent development, young adulthood development, middle age development, and the aging process. The genetics of behaviors is also discussed in this course.

Aging and suicide are also studied in behavioral science. Chapters on aging and suicide are included in this course. Aging begins at the time of birth and continues throughout a person‟s life. Aging happens to organs and at a cellular level. Cells are programmed to die through mechanisms that are not completely known. When cells die, eventually the organs fail. When organs fail, individuals cannot sustain life and they die. Suicide involves intentionally taking one‟s life through several different methods. Suicide can happen at any age but is most common in the elderly.

Mental health issues are a part of behavioral science and topics on mental health are included in this course. There are many mental health issues involved in the study of behavior, including depressive disorders, anxiety disorders, somatoform disorders, psychotic disorders, and eating disorders. People with mental health disorders require treatment, which is also a part of this course.

The screening of individuals for mental health illnesses, vocational screening, and the testing of individuals as to their personality, mood, and other aspects of behavior are discussed in some of the chapters of this course.

Doctor-patient communication is also an important part of behavioral science. This topic and issues on healthcare systems are a part of this course. In addition, medical ethics regarding patient care and payment for patient care will be discussed. Epidemiology in medicine is part of behavioral science as is biostatistics, which involves the application of epidemiology to human systems. These will be discussed as part of this course in the last chapter of the course.

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CHAPTER 1: THE BEGINNING OF PREGNANCY THROUGH PRESCHOOL This section is about the prenatal period, the development of the infant, toddler development, and preschool development. It is marked as starting from the time of fertilization of the egg to the birth of the infant. The fetus starts as a fertilized egg and goes on to become a fully functioning baby after nine weeks of gestation. After birth, the infant continues to develop and is walking by the time of the first birthday. After one year of age, the infant becomes a toddler and continues social and physical development. After the toddler years comes the preschool years, during which the child becomes ready to go to school.

THE PRENATAL PERIOD The beginning of the human lifestyle is fertilization. This happens when the sperm of a male unites with the egg of a female to form a fertilized egg. It takes nine months after this to have a baby that can live outside of the womb. Babies can be born prematurely, at the expected time, or longer than the expected time. The fetus goes through multiple developmental stages before being born.

The first month of life involves the joining of the sperm and egg in the fertilization process. It can occur within a couple of minutes after intercourse but may take up to three days after intercourse. The egg divides quickly to become a zygote that is smaller than a grain of sand.

Cell division continues until the zygote becomes a blastocyst. The zygote contains all the genetic information and cellular structures to form a human infant.

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Figure 1 shows what the fertilization process looks like:

Figure 1

Implantation occurs five to nine days following fertilization. This is when the zygote burrows into the wall of the uterus and forms a placenta that helps feed the growing embryo.

Hormones will be released that stop the menstrual cycle and will help maintain the pregnancy.

Between three and four weeks after fertilization, the infant has a heart that can beat detectably.

The facial features begin to form.

In the second month, the fetus is about an inch long and the placental lining begins to develop. By week twelve, the placenta takes over the hormone production for the remainder of the pregnancy. Blood circulation develops and the beginnings of the stomach, lungs, pancreas, and liver form. There are genitals but they look the same in males and females. It takes until about the eighteenth week of gestation before an ultrasound can detect the gender of the fetus.

The baby is called a fetus after two months‟ gestation. It has all its body organs and many of them are functioning. While they are functioning, they still need time to develop fully. There are eyes, fingernails, and internal organs by the end of the second month. The fetus has taste buds and can hiccup. The heartbeat can be heard by a Doppler device at ten weeks‟ gestation.

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At the third month of gestation, the baby can smile. They breathe in amniotic fluid and the teeth develop. The fetus weighs about one ounce and the pancreas begins to secrete hormones. This is when many of the organs begin to develop. Movement cannot be detected by the mother but it is happening during this month. The fetus can urinate and the urine makes up a part of the amniotic fluid. The fetus can hear at 15 weeks‟ gestation.

During the fourth month of gestation, the fetus is about eight inches tall. The baby‟s movements can be felt by the mother and thumb-sucking can occur. There is complete formation of the fingernails and they are long enough to need to be clipped at the time of birth. The umbilical cord attaches the fetus to the placenta and provides nutrients to the fetus.

In the fifth month of gestation, the fetus weighs fifteen ounces. It has full hearing capabilities and is extremely active. The fetus has a head heavier than the body so it goes into a head down position for the birth process. There are eyebrows and there is lanugo hair that covers the entire body. Vernix is a creamy substance that coats the lanugo hair and can be seen on the baby at the time of birth.

In the sixth month, the fetus has gained a pound. They have improved coordination and can open their eyes. Fat deposits begin to develop and the fetus can tell the difference between darkness and lightness. By month seven, the fetus develops wrinkled skin from being inside the amniotic fluid. Eyelashes develop and more fat is deposited. The testes descend into the scrotum by the seventh month in male fetuses. The baby can regulate its own body temperature. The baby now weighs about two to four pounds.

By the eight month, the irises in the eyes can dilate or contract depending on the light and the fetus weighs about four to six pounds. They have a distinct pattern of sleeping and waking.

They are active and can cry. Surfactant is being created that helps mature the fetus‟s lungs at the time of birth. Babies can be born now and have a good chance of survival.

In the ninth month of gestation, the infant gains about a pound every week and has fully functioning organ systems. The placenta sends antibodies to the fetus to provide passive immunity to several childhood diseases. The fetus weights about five to seven pounds and is ready to be born. The head is down in most cases, which is the preferred method of delivery. By the time of birth, the baby weighs approximately seven and a half pounds.

INFANT DEVELOPMENT The development of the infant is divided into four separate categories. The first is social development. This involves the interaction of the baby to other humans. They learn to interact with the human voice and the face of loved ones. They can coo and smile. Some infants suffer from social delays because of hearing or visual defects, or defects in intellectual or emotional development.

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Receptive language development involves the understanding of speech. It is a way to gauge the development of the fetus that is better than their expressive language development, which is the production of speech. If language is delayed, the infant should have a thorough evaluation of their vision and hearing skills.

Infants develop their large motor skills in infancy. They learn to hold their head upright and sit up by themselves. They learn to roll over, pull up, crawl, and walk. If an infant seems delayed in these areas, they need an evaluation of their physical health to make sure there isn‟t a health problem causing a developmental delay.

Small motor development occurs in infancy. The infant develops eye hand coordination as an infant and learns to reach and grab for things. They can manipulate small objects but do not can draw or write. This is developed in the toddler and preschool years.

In the first month of life, the infant can briefly lift their head and can turn their head from side to side. They have clenched hands but have a strong grasp reflex. They can follow objects and see best in black and white. They become quiet when they hear their parents‟ voices. They can cry when they are unhappy and can intently look at their parents faces.

In the second month of life, the infant can lift their head to forty-five degrees. The grasp reflex decreases and the infant can focus on objects. They can visually search for the origin of sounds and make sounds that are not just crying. They have distinctive sounds depending on their mood. They vocalize when exposed to familiar voices. They have a social smile reserved for loved ones.

In the third month of life, the infant can bear some weight when held up to stand. They can hold their head up and can raise both their head and shoulders when lying on their stomach.

They can bear weight on their forearms and no longer have a grasp reflex. They can pull at their clothing and can follow visually in a one-hundred-and-eighty-degree direction. They can locate sounds by the turn of the head and have many different vocalizations. They can babble when spoken to and are able to recognize objects, voices, and faces. They smile when in contact with people they know and can play. They become fearful in strange situations.

In the fourth month of life, the infant begins to drool. The head is well supported and the infant can sit with some support. They can raise their head and chest when placed in a stomach down position. They have some small motor control with their hands and can reach for objects.

They can grab objects with both hands and work on hand eye coordination. They vocalize often and have the ability to laugh. They enjoy things like swinging, bouncing, and being rocked.

In the fifth month of life, the infant begins to teethe. They can hold their head up when in a seated position and can roll from their stomach to their back. They can put their feet in their mouth when lying on their back. They can hold onto objects and can play with their toes. They 5|Page

often put objects in their mouth. They look for objects that have been dropped and smile at themselves in the mirror. They show displeasure when objects are taken away from them and can tell the difference between a familiar person and a stranger. They spend time discovering their body parts.

In the sixth month of life, the infant can bite and chew. They can lift their head, chest, and stomach off the floor when in a stomach down position. They can roll from their back to their stomach and can support their head when seated. They can handle small objects and can hold their own bottle. They can put their feet into their mouth and focus on complex visual stimuli. They can say single syllable sounds and recognize their parents.

In the seventh month, they can sit without being supported and can bear their entire weight when placed in an upright position. They can sit without any type of support and will bounce when standing. They can transfer objects from one hand to another and can focus on small objects they are playing with. They respond to their name and have an awareness of space and depth. They prefer some tastes over others and babble when others are speaking.

In the eighth month of life, the infant can sit well without being supported and can bear weight on their legs. They can turn to reach for an object and use their fingers and thumbs to hold onto objects. They can release objects and can pull on a string to obtain an object. They can reach for objects that are out of their reach and can selectively listen to words that are familiar to them. They can say “mama” and “dada” but do not know the meaning of these words. They understand the meaning of the word “no” but do not always follow this.

In the ninth month of life, the infant begins crawling. They can pull themselves into a standing position and can sit for a long period. They develop a hand preference and use their thumb and index finger to pick objects up. They understand verbal commands and understand the meaning of the word “no”. They are interested in pleasing loved ones and do not like having their face washed or their clothing changed.

In the tenth month of life, the infant goes from a stomach to a seated position. They can balance themselves when sitting and will lift a foot to step when standing. They can say “byebye” and understand the words used to express their mother‟s and father‟s names. They can say more words and can wave to others. They develop object permanence and can repeat behaviors that attract the attention of others. They play interactive games with others and like being read to.

In the eleventh month, the infant can walk while holding on to furniture and can put objects into containers. They explore objects and can manipulate objects. They can roll a ball on command and become excited when they master a task. They do not like to become restricted in their movements and will shake their head from side to side to indicate the word “no”.

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In the twelfth month of life, the infant can walk holding on to another‟s hand. They can sit down after standing and can build a tower of two blocks. They can turn pages in a book and can follow moving objects, even when they are moving quickly. They can say three or more words besides “dada” and “mama”. They comprehend many different words and often repeat the same words over and over again. They can imitate animal sounds and can recognize the names of objects. They follow simple commands and are affectionate with others. They develop a sense of independence and will stay close to parents when in a strange situation. They search for objects that have been lost.

Figure 2 describes infant motor skill development:

Figure 2

TODDLER DEVELOPMENT This section is on the physical development of the toddler. The child becomes a toddler by the age of twelve months. Now, they are interested in balls and can throw and kick balls by the age of twenty-four months. They can roll balls back and forth with another person and can kick a ball. They can catch balls but often miss.

Between twelve and eighteen months, the child can walk well and like to push or drag toys. They can walk forward while looking backwards. They need toys that can be pushed or 7|Page

pulled. At twelve to eighteen months, they can also squat on the ground to pick objects off the ground. They learn to climb during this period and take physical risks. They need to have objects to climb on so they can develop climbing abilities.

Between eighteen and twenty-four months, toddlers learn to run. They learn how to play tag and like chasing others or being chased by others. Between twenty-four and thirty-six months, they can be potty trained and no longer need to wear diapers during the day. They are usually big enough to get on an off the toilet but may use a toilet training chair instead.

At twenty-four to thirty-six months, the toddler learns how to jump off objects and learns to jump from a standing position. They can play games that involve jumping.

Figure 3 shows what toddler development in large motor skills looks like:

Figure 3

Toddlers develop emotional and psychological milestones as well as physical milestones.

Toddlers between the ages of twelve to thirty-six months like to be read to. They like pictures and books with sounds. They learn early reading skills, such as how books work, reading from left to right, storytelling, and the fact that stories have a beginning, middle, and end. They like to play with books and pretend to read.

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By eighteen to thirty-six months, the toddler develops a sense of independence and separation from their parents. They are particularly attached to their mothers. They become insistent on doing things by themselves and need help enhancing their independence.

The eighteen to twenty-four- month toddler will begin to use simple sentences. They have a larger vocabulary and can begin to put together words. They can engage in conversation to a limited degree and are rapidly learning new words all the time. They model speech after others but do not exhibit correct grammar skills.

At twenty-four months, they begin to connect their own feelings and behaviors as they relate to others. They learn empathy toward others and feel bad when others are sad. Some toddlers will develop normally for a while but will regress during times of increased anxiety or stress.

PRESCHOOL DEVELOPMENT This section is about the development of preschoolers. Three-year-old preschoolers often question everything and are fixated on questions starting with the word “why”. They will pay attention to the answers given when they ask a question and begin to understand social rules.

They understand that some behaviors are done because they are good for them but do not understand detailed explanations of what behaviors are appropriate.

Three-year-old preschoolers develop reasoning skills but cannot see things from different angles and cannot solve complex problems. They develop logic skills but cannot think logically about complex things.

They develop a better sense of time around three years of age. They develop daily routines but do not understand that others may have different routines. They understand that there are special days, such as holidays and birthdays but don‟t have a sense of when these events occur nor do they understand the length of a year.

By the age of four years, the child can understand many basic but abstract concepts. They understand that the day is divided into morning, afternoon, and night. They understand the concept of the different seasons. By the age of five, they can count on a limited basis and understand the days of the week. They understand that days can be measured in hours and minutes and understand some of the letters of the alphabet. They understand geometric shapes.

Children at this age need to have a wide variety of learning opportunities. They need to go places that can help them learn new things and actively participate in the learning process.

They develop special talents and interests now and should be allowed to develop these interests as they become evident. They should be allowed to develop their interests by exploring activities that they find fascinating.

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By the time they reach three years of age, they become more focused on fantasy and have vivid imaginations. They are no longer as difficult to manage as they were when they were toddlers and are mature in many ways. Preschoolers can hop and stand on one foot, go up and down stairs, and can kick a ball forwards. They can throw a ball, catch a ball, and can run without difficulty.

Small motor skills develop as well. They can copy square shapes and draw simple figures representing the human body. They can use a scissors and can draw circles. They can begin to copy some of the letters of the alphabet. They understand the concepts of different and same, and have proper grammar when speaking. They can speak sentences as long as five to six words in length and can tell stories.

Preschoolers can correctly identify colors and may count to a limited degree. They have a better sense of time and can follow complex commands. They can recall stories sent to them and spend a lot of time in fantasy play. They are interested in new experiences and can cooperate with other children. They engage in play-acting that is based on fantasy. They can dress and undress themselves and are much more independent. They may be afraid of imaginary monsters and have difficulties telling the difference between fantasy and reality.

A four or five-year-old child has an increase in bossiness and energy. They may misbehave and engage in behavior that is not socially acceptable. They may have a vast imagination and develop more complex thought processes that will continue through the schoolage years.

Developmental milestones in this period include being able to stand on their foot for more than ten seconds, hopping, doing somersaults, swinging, climbing, and skipping. They can copy several different geometric shapes and can draw a person with some degree of accuracy.

They can print some letters and can dress without difficulty. They can use a fork, spoon, and knife. They do not need help with toileting.

Children of this age can recall stories and can speak in long sentences. They can learn the future tense and can say their whole name and address. They can count objects that are greater than ten and can name at least four colors. They understand time and understand the function of objects used in the home.

They advance socially as well and want to please their friends. They want to be liked and can agree to social rules. They like to act out things and can sing or dance. They are more independent and are aware of their sexuality. They can tell the difference between fantasy and reality. Socially, they can be demanding or cooperative, depending on their mood.

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KEY TAKEAWAYS 

Life begins at the time of fertilization of the egg.

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It takes nine months for a fetus to go from a fertilized egg to an infant that is ready to be born.



Fetuses can hear by the fifth month of gestation.

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Infants at one month of age have a strong grip strength.

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Infants at twelve months of age can begin to walk.

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Toddlers at twenty-four months to thirty-six months of age can be toilet trained.

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Preschoolers have concrete thought processes.

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Children three years of age develop daily routines.

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Children of five years of age are ready for kindergarten and can count objects greater than ten.

QUIZ 1. At what developmental age is a child able to lift their head and chest from a stomach down position? a. One month b. Two months c. Three months d. Four months 2. What is an unborn child referred to shortly after fertilization? a. Zygote b. Blastocyst c. Fetus d. Infant 3. When does fertilization occur in pregnancy?

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a. A few minutes or days after ovulation b. At the time of the missed menstrual period c. At the time of implantation d. When the egg is released 4. When does a child first begin to walk? a. At six months of age b. At twelve months of age c. At eighteen months of age d. At twenty-four months of age 5. When is a preschool child able to tell the difference between fantasy and reality? a.

At six months of age

b.

At two years of age

c.

At three years of age

d.

At four years of age

6. When is a preschool child able to draw a simple human figure? a. At two years of age b. At three years of age c. At four years of age d. At five years of age 7. When does a preschool child engage in fantasy play? a. At two years of age b. At eighteen months c. At three years of age

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d. At five years of age 8. When does a fetus develop the ability to hear? a. At the second month of gestation b. At the third month of gestation c. At the fourth month of gestation d. At the fifth month of gestation 9. When does a child learn to count objects greater than ten? a. At two years of age b. At three years of age c. At four years of age d. At five years of age 10. When does a child learn to roll a ball? a. At twelve months of age b. At eighteen months of age c. At twenty-four months of age d. At three years of age

QUIZ ANSWERS 1.

D.

2.

A.

3.

A.

4.

B.

5.

D.

6.

D.

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7.

C.

8.

D.

9.

D.

10.

A.

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