developmental disorders

Question 1

what are the 3 patterns of delay

Answer 1

slow and steady
plateau
regressing

Question 2

causes of abnormal motor development

Answer 2

central motor deficit (CP)
spinal cord problem
congenital myopathy
global delay

Question 3

How does cerebral palsy present

Answer 3

abnormal motor development characterised by NON-PROGRESSION
only visible after a couple of years of life
accompanied by visual/sensory/auditory/behavioural problems

Question 4

What is the diagnostic difference between CP and acquired brain injury

Answer 4

motor development delay becomes attributed to acquired brain injury if it happens after 2 years

Question 5

causes of CP

Answer 5

80% antenatal (from cerebral haemorrhage, failure of cortical migration etc.)
10% at birth from HIE
10% postnatal (meningitis, sepsis, hypoglycaemia)

Question 6

how does CP present

Answer 6

a lot dx antenatally
don't meet motor milestones
abnormal posture
abnormal gait
primitive reflexes persist/become obligatory

Question 7

what are the 4 classes of CP

Answer 7

spastic (80%)
dyskinetic
ataxic
other

Question 8

Hallmarks of spastic CP

Answer 8

UMN/ corticospinal tract damage
spasticity which is velocity dependent (more you stretch muscle stiffer it is - dynamic catch)
brisk tendon reflexes

Question 9

3 types of spastic CP

Answer 9

unilateral:
arm>leg
presents at 4-12 months with fisted hand and asymmetrical reach
associated with tip toe walking

bilateral quadriplegia:
affects all limbs equally and may present in trunk with opsithotonos
associated with HIE

bilateral diplegia:
legs>arms
get abnormal gait
associated with preterm birth (periventricular white matter damage)

Question 10

features of dyskinetic CP

Answer 10

dyskinesias are abnormal stereotyped movements
primitive movements predominate:
choreas
athetosis - slow writhing movements (fanning of fingers)
dystonia - simultaneous contration of agonist and antagonist

present with floppiness and strange movements in infancy
linked with HIE

Question 11

features of ataxic CP

Answer 11

also known as hypotonic

presents with limb floppiness and poor balance

Question 12

RF for CP

Answer 12

antenatal: chorioamnionitis, maternal resp or GU infection
perinatal: preterm birth, LBW, neonatal sepsis + encephalopathy
post natal: meningitis, head trauma before age of 3

Question 13

Mx CP

Answer 13

Physio
SALT assessment
speech and communication therapy

medical:
baclofen for stiffness
mx saliva - anticholinergics
lone bone mineral density cause non-ambulant - check vit d
mx sleep disturbances w/ sleep hygiene (can use melatonin)
referral for visual + hearing impairment

Question 14

what medical conditions are associated with CP

Answer 14

gastro-oesophageal reflux
constipation (3/5)
epilepsy (1/3)

Question 15

what two tests can you do for language development

Answer 15

toy test

Reynell test for expressive and receptive aphasia

Question 16

causes of speech + language delay

Answer 16

hearing loss, anatomical defects meaning you can’t make sound, lack of social interaction

Question 17

causes of speech + language disorder

Answer 17

problems with language comprehension and expression, stammer, dysarthria (where muscles used to make sound don’t work)

Question 18

what is the ASD triad

Answer 18

problems with social interaction (avoids direct gazes)
speech and language disorder (takes stuff literally, doesn’t use hand gestures)
imposition of routines

Question 19

what conditions are associated with ASD

Answer 19

learning + attention deficits, seizures (in adolescence), affective disorders (anxiety), ADHD

Question 20

Mx ASD

Answer 20

psychocial help for social situations and communication
SALT for speech problems
medications if necessary 
special school
help to carer

Question 21

what is dyslexia

Answer 21

disorder of reading

child is 2 years behind when compared to IQ

Question 22

what are disorders of executive function

Answer 22

Problems with planning or organisation

children: poor concentration, overeat, forgetful, volatile

Question 23

mx of specific learning disorder

Answer 23

OT
physio
SALT
Educational psychologist

Question 24

hallmarks of ADHD

Answer 24

child is legitimately overactive
socially disinhibited
can't take turns
distracted
fidgety (can't regulate activity given certain situation)
tend to do poorly at school

Question 25

Mx ADHD

Answer 25

refer to CAMHS
if adversely impacting education or development:
10 week watch and wait period
1. ADHD group parent training session (can liaise with school etc.)
2. 6-week trial of meds (methylphenidate)
3. CBT

Question 26

S/E of ADHD meds

Answer 26

loss of appetite, tics, mood changes palpitations (meds are cardiotoxic so need to do ECG)

Question 27

RF for conductive hearing loss

Answer 27

down’s syndrome, cleft palate, atopy (otitis media)

Question 28

Ix for conductive hearing loss

Answer 28

impedance audiometry to assess if middle ear is working

Question 29

what is a squint

Answer 29

misalignement of visual axes
common up to 3 months
after 3 months most likely due to refractive error eg. cataracts and retinoblastoma

Question 30

what are the two types of squint

Answer 30

concomitant non-paralytic - refractive error, easily corrected with glasses
paralytic - depends on gaze direction as it’s a motor nerve problem

Question 31

4 types of refractive errors

Answer 31

hypermetropia - long sighted
myopic - short sighted
astigmatism - abnormal curvature of cornea
amblyopia - eye fails to achieve acuity even with corrective lenses. causes include: squint or obstructions to visual pathway (cataracts)

Question 32

causes of visual impairment

Answer 32

congenital:
cataracts
albinism 
retinoblastoma
retinal dystrophy

Ante and post natal:
HIE
infections
optic nerve hypoplasia

paediatric
trauma
infection
jaundice