Children with Special Needs

Question 1

What is child development?

Answer 1

The process by which each child evolves from infancy to adulthood

Includes development of:
Gross motor skills
Fine motor skills
Speech and Language
Social, Personal, Activities of Daily living
Performance and Cognition

Question 2

By what age does the majority of brain development occur?

Answer 2

5

Question 3

What are the features of normal development?

Answer 3

A constant pattern
Sequential acquisition of skills
Median age vs limit age
Genetic factors 
Environmental influences

Median age - the age at which half the population…

Question 4

What constitutes a significant developmental delay?

Answer 4

Greater than 2 SD from population means

Question 5

What constitutes global developmental delay?

Answer 5

When 2 or more domains are affected

Question 6

What is a learning disability?

Answer 6

A learning disability is a significant impairment in intellectual functioning and affects the person’s ability to learn and problem-solve in their daily life
It has nearly always been present since childhood

Question 7

How may a childhood disability present?

Answer 7

Routine health surveillance
Children with identified risk factors
Parental concern
Professional contact: nursery/daycare
Opportunistic health contact
The UK Healthy Child programme (HCP)

Question 8

How can child development be assessed?

Answer 8

History and examination
Prenatal, perinatal, postnatal events
Developmental milestones
The ‘Red Book’
Environmental, social and family history
Video recordings of child
Observation in clinic/other settings

Question 9

What are the primary care assessment tools for development?

Answer 9

ASQ (ages and stages questionnaire)
PEDS (Parents evaluation of developmental status)
M-CHAT (Checklist for autism in toddlers)
SOGS-2 (Schedule of Growing Skills)

Question 10

What is SOGS-2?

Answer 10

Information of child’s development across a range of areas
0-5 years
9 key areas
Separate cognitive score can be derived

Question 11

What are some secondary care assessment tools?

Answer 11

Griffiths mental development scales
Bayley scales of infant development
Wechsler preschool and primary scales of intelligence

Question 12

What must you ask parents about in developmental history?

Answer 12

Comprehensive
Family h/o neurodevelopmental/genetic disorder
H/O miscarriages
Prenatal, perinatal, neonatal course
Drugs and alcohol use in pregnancy
Developmental, behavioural, social and educational history
Record of medications

Question 13

What past evidence may be useful in history?

Answer 13

Results of previous metabolic/thyroid testing
Neuroimaging
Lead and iron screening
Growth records
Vision and hearing surveillance
High index of suspicion for abuse and neglect

Question 14

What do you examine for when assessing development?

Answer 14

Head circumference
Dysmorphic features
Skin abnormalities
Movement quality
Ability to sit and stand from supine
Eye movements and eye examination
General examination: CVS, Respiratory
Abdominal examination
Observation of behaviour

Question 15

What are some common syndromes that may cause developmental abnormalities?

Answer 15

Down syndrome
Fragile X syndrome
William’s syndrome

Question 16

What percentage of vision and hearing issues are picked up in sensory screening?

Answer 16

Vision disorders: 13-50%

Hearing impairment: 18%

Question 17

What are red flag signs?

Answer 17

Loss of developmental skills
Concerns re vision
Concerns re hearing
Floppiness
No speech by 18-24 months
Asymmetry of movement
Persistent toe walking
Head circumference >99.6th C or < 0.4th C

Question 18

What are positive signs?

Answer 18

Sit unsupported by 12 months
Walk by 18months (boys) or 2 years (girls): Check creatinine kinase
Walk other than on tiptoes
Run by 2.5 years
Hold objects in hand by 5 months
Reach for objects by 6 months
Points to objects to share interest by 2 years

Question 19

What investigations can be carried out when concerned about developmental delay?

Answer 19

Based on clinical abnormalities
Diagnostic yield of specific tests
Timing
Genetic testing: chromosomal analysis, Fragile X, FISH, array CGH
Creatine kinase (dystrophy)
Thyroid screening
Metabolic testing: amino and organic acids, Ammonia, Lactat
Ophthalmological examination
Audiology assessment
Consider congenital infection
Neuroimaging

Question 20

What are the first line investigations if history and examination do not provide diagnosis?

Answer 20

Chromosomes
Fragile X
U and E
Creatine kinase
Lead
Thyroid function
Urate
Full blood count
Ferritin
Biotinidase

Question 21

What are some common motor problems?

Answer 21

Delayed maturation
Cerebral palsy
Developmental coordination disorder

Question 22

What are some common sensory problems?

Answer 22

Deafness
Visual impairment
Multisensory impairment

Question 23

What are some common language/cognitive problems?

Answer 23

Specific Language Impairment

Learning Disability

Question 24

What are some common social/communication problems?

Answer 24

Autism
Asperger syndrome
Elective mutism

Question 25

How can you evaluate developmental problems?

Answer 25

``` Is there a problem? Global or single field? Delay, Disorder or Regression Aetiology Co-ordination of care and support Problem based approach ```

Question 26

What are additional support needs?

Answer 26

If they need additional support with their education

Question 27

What is PLP?

Answer 27

Personal learning planning is a way of thinking about, talking about and planning what and how a child learns It’s also a way of assessing their progress and acting on the results of that assessment

Question 28

What is IEP?

Answer 28

Individualised Educational Plane is a detailed plan for a child’s learning. It contains some specific, short-term learning targets for the child and will set out how those targets will be reached. Targets are: - Specific - Measurable - Achievable - Relevant - Timed In some areas these plans are called additional support plans or individual support plans. NOT A LEGAL DOCUMENT

Question 29

What is a CSP?

Answer 29

A Co-ordinated Support Plan is a detailed plan of how child’s support will be provided It is a legal document and aims to ensure all the professionals who are helping the child, work together It also helps ensure that everyone, including parents and the child, is fully involved in that support For children in local authority school education and needing significant additional support Complex or multiple needs Needs likely to continue > 1 year Support required by > 1 agency

Question 30

What is the GIRFEC approach?

Answer 30

In line with the ‘Getting it right for every child’ (GIRFEC) approach, many children will now have a Child’s Plan This is part of the Children and Young People Act that applies from Autumn 2016 Child’s Plans are created if a child or young person needs some extra support to meet their wellbeing needs such as access to mental health services or respite care, or help from a range of different agencies The Child’s Plan will contain information about: - why a child or young person needs support - the type of support they will need - how long they will need support and who should provide it All professionals working with the child would use the plan, which may include an IEP or a CSP