Approach to the child with developmental delay(s) Flashcards Preview

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1

Define what is meant by developmental delay ?

Failure to attain appropriate developmental milestones for child's corrected chronological age.

2

What are the different patterns of abnormal development ?

Can be:

  • Delay - can be specific or global 
  • Deviation  eg Autism Spectrum Disorder
  • Regression (loss of skills) - eg Rett's Syndrome, Metabolic Disorders

3

Disorders for development are common - T/F?

True 

4

What is retts syndrome ?

A rare genetic disorder that affects brain development, resulting in severe mental and physical disability. 

Described in 4 main stages:

  • Stage 1 - a rare genetic disorder that affects brain development, resulting in severe mental and physical disability. Development then slows down or stops altogether. 
  • Stage 2 - Child starts to lose some of their abilities. Child will gradually or suddenly start to develop severe problems with communication and language, memory, hand use, mobility, co-ordination and other brain functions. 
  • Stage 3 - plateau During stage three, some of the problems that occurred at stage two may get better – for example, there may be improvements in behaviour, with less irritability and crying.
  • Stage 4 - deterioration in movement e.g. development of spinal curve, muscle weakness and spascicity, losing the ability to walk 

5

What are the red flags for development ?

  • Asymmetry of movement
  • Not reaching for objects by 6 months
  • Unable to sit unsupported by 12 months
  • Unable to walk by 18 months → check CK
  • No speech by 18 months
  • Concerns re vision or hearing
  • Loss of skills

6

What is meant by global developmental delay ?

Significant delay in 2+ of:

  • Gross/fine motor, speech/language,
  • Cognition, social/personal, ADL (activities of daily life e.g. dressing themselves)

7

What are some of the medical screening tests that should be carried out in downs syndrome kids ?

  • Cardiac
  • Vision
  • Hearing
  • Thyroid function
  • Sleep related breathing disorders
  • Growth- charts
  • Development

8

What are the ranges for classification of severity of learning disabilities ?

  • Normal range is broadly IQ 70 and above 
  • Mild learning disability: IQ 50-70
  • Severe learning disability: IQ 20-50
  • Profound learning disability: IQ < 20

9

Appreciate some of the causes of different developmental delays 

Motor Delays:

  • eg Duchenne Muscular Dystrophy, Cerebral Palsy, Co-ordination disorders

Language Delays:

  • eg Specific Language Impairment

Sensory Deficits and Associated Delay:

  • eg Oculocutaneous Albinism, Treacher-Collins

Developmental Deviations:

  • eg Autism Spectrum disorders

10

Name the manoeuvre the kid is doing and the condition it is associated with 

Gowers manoeuvre - associated with duchennes muscular dystrophy 

11

Appreciate the different severities and characteristic appearances of cerebral palsy 

12

What are some of the conditions (signs) of cerebral palsy?

  • Mobility problems, spasticity and orthopaedic problems
  • Learning difficulties
  • Epilepsy
  • Visual/Hearing impairment
  • Communication difficulties
  • Feeding difficulties
  • Sleep problems
  • Behaviour problems

13

Appreciate this point about visual impairment 

Sometimes the potential for VI is not so obvious however, and we need to remember that at least 50% of VI is Cerebral Visual Impairment, seen in children with more complex disabilities, who are unable to clearly tell us what they are seeing. 

Conditions such as hydrocephalus and cerebral palsy are often associated with CVI, as the visual tracts are often affected, along with the motor tracts.  We therefore need to have a high level of suspicion in children with complex disability, along with innovative ways of assessing their functional vision.

14

What is the autism triad of impairments ?

  • Communication impairment 
  • Social interaction impairment 
  • Flexibility of thought/ Imagination impairment 

15

What are some of the signs of autisim seen in pre-school children ?

Spoken language:

  • delayed speech development (for example, speaking less than 50 different words by the age of two), or not speaking at all
  • frequent repetition of set words and phrases
  • speech that sounds very monotonous or flat
  • preferring to communicate using single words, despite being able to speak in sentences
  • Responding to others
  • not responding to their name being called, despite having normal hearing
  • rejecting cuddles initiated by a parent or carer (although they may initiate cuddles themselves)
  • reacting unusually negatively when asked to do something by someone else

Interacting with others:

  • not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal space
  • little interest in interacting with other people, including children of a similar age
  • not enjoying situations that most children of their age like, such as birthday parties
  • preferring to play alone, rather than asking others to play with them
  • rarely using gestures or facial expressions when communicating
  • avoiding eye contact

Behaviour:

  • having repetitive movements, such as flapping their hands, rocking back and forth, or flicking their fingers
  • playing with toys in a repetitive and unimaginative way, such as lining blocks up in order of size or colour, rather than using them to build something
  • preferring to have a familiar routine and getting very upset if there are changes to this routine
  • having a strong like or dislike of certain foods based on the texture or colour of the food as much as the taste
  • unusual sensory interests – for example, children with ASD may sniff toys, objects or people inappropriately 

16

What are some of the signs of autism seen in school aged children ?

Spoken language:

  • preferring to avoid using spoken language
  • speech that sounds very monotonous or flat
  • speaking in pre-learned phrases, rather than putting together individual words to form new sentences
  • seeming to talk "at" people, rather than sharing a two-way conversation
  • Responding to others
  • taking people’s speech literally and being unable to understand sarcasm, metaphors or figures of speech
  • reacting unusually negatively when asked to do something by someone else

Interacting with others:

  • not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal space
  • little interest in interacting with other people, including children of a similar age, or having few close friends, despite attempts to form friendships
  • not understanding how people normally interact socially, such as greeting people or wishing them farewell
  • being unable to adapt the tone and content of their speech to different social situations – for example, speaking very formally at a party and then speaking to total strangers in a familiar way
  • not enjoying situations and activities that most children of their age enjoy
  • rarely using gestures or facial expressions when communicating
  • avoiding eye contact

Behaviour:

  • repetitive movements, such as flapping their hands, rocking back and forth, or flicking their fingers
  • playing in a repetitive and unimaginative way, often preferring to play with objects rather than people
  • developing a highly specific interest in a particular subject or activity
  • preferring to have a familiar routine and getting very upset if there are changes to their normal routine
  • having a strong like or dislike of certain foods based on the texture or colour of the food as much as the taste
  • unusual sensory interests – for example, children with ASD may sniff toys, objects or people inappropriately

17

What should you focus on in an examination when suspecting developmental problems ?

  • Observation
  • Dysmorphism
  • Head Circumference
  • Systems
  • CNS inc neurocutaneous
  • Vision
  • Hearing

18

What are some of the investigations you should do to investigate developmental delay ?

Chromosomes, FRAX & Oligoarray CGH

Neonatal PKU, thyroid studies, CK

If indicated:

  • MRI brain
  • EEG
  • Metabolic studies
  • Genetic consultation
  • Others

19

What are some of the early interventions for developmental delay?

Therapy:

  • Physio
  • SLT
  • OT

Family Support

Educational Placement

Referral to Other Agencies

20

Appreciate some of the different assessment to test for developmental delay 

Multidisciplinary Team

Appropriate Assessment Tool:

  • Eg  Griffiths (0-8yrs)
  • Bayleys (0-3yrs)
  • Schedule of Growing Skills (0-5yrs)
  • ADOS (ASD)