Community - Developmental Disorders

Question 1

What is Asperger’s syndrome?

Answer 1

child has social impairments of an autism spectrum disorder but at the milder end and near normal speech development

Question 2

What are the main clinical features of autism? (long)

Answer 2

Impaired social interaction e.g. prefers own company, does not appreciate that others have thoughts or feelings, gaze avoidance
Speech and language disorder e.g. delayed development, limited use of gestures
Imposition of routines with ritualistic and repetitive behaviour e.g. violent tantrums if interrupted, concrete play, peculiar interests and repetitive adherence
Comorbidities e.g. general learning and attention difficulties, seizures, affective disorders, mental health disorders

Question 3

How is Autism managed?

Answer 3

usually by behaviour modification such as applied behavioural analysis

Question 4

What should the gross motor development of a newborn be?

Answer 4

limbs flexed, symmetrical posture marked head lag on pulling up

Question 5

What should the gross motor developments at 6-8 months?

Answer 5

6 months - with round back

8 months - with straight back

Question 6

What should the gross motor developments at 8-9 months be?

Answer 6

crawling

Question 7

What should the gross motor developments at 10 months be?

Answer 7

standing independently

Question 8

What should the gross motor developments at 12 months be?

Answer 8

walks unsteadily broad gait hands apart

Question 9

What should the gross motor developments at 15 months be?

Answer 9

walking steadily

Question 10

What should the vision and fine motor developments be at 6 weeks?

Answer 10

follows moving object or face by turning

Question 11

What should the vision and fine motor developments be at 4-6 months?

Answer 11

reaching out for toyspalmar grasp

Question 12

What should the vision and fine motor developments be at 7-10 months?

Answer 12

7 - transferring toys from one hand to the other 10 - pincer grip

Question 13

What should the vision and fine motor developments be at 16-18 months?

Answer 13

makes marks with a crayon

Question 14

What drawings should children be able to do between 2-5 years?

Answer 14

2 - line 3 - circle 3.5 - cross 4 - square 5 - triangle

Question 15

What are the speech and language stages in infants?

Answer 15

3-4 months - vocalises alone,
laughs 7-10 months - dada, mama uses them indiscriminately at 7 months and discriminately at 10 months
18 months - 6-10 words, shows two body parts
2.5-3 years - talks constantly in 3-4 word sentences

Question 16

How should the social behaviour develop in infants?

Answer 16

8 weeks - smiles 
10 months - fear of strangers 
18 months - feeds self/spoon
2-2.5 years - symbolic play 
3-3.5 years - interactive play

Question 17

What neurological examination for assessing motor skills delay and give differentials?

Answer 17

pGALS is used to assess motor skills in children
Starts by asking three screening questions
paediatric gait arms legs and spine

Question 18

How is a pGALS assessment carried out?

Answer 18

3 screening questions:
Do you have any pain in your joints?
Do you have any pain or trouble walking?
Do you have any pain or problems dressing yourself?
Assess GAIT - walk on heels and their toes for this
ARMS LEGS SPINE

Question 19

How are the arms assessed in pGALS?

Answer 19

look for any wasting/deformaties in arms and hands
assess pronation and supination
get them to squeeze their fists touch each finger and thumb
Get them to put their hands together and elbows straight out.
Do the same but with the back of the hands now touching.
Get the child to stretch their hands into the air and then put their head back.
Get the child to put their hands behind their head with elbows pointing out.
Get the child to put their head to either shoulder.

Question 20

How are the legs assessed in pGALS?

Answer 20

Get the child to lay down before assessing legs.
Get the child to bring each ankle, in turn, up to their bottom.
Then pick up each leg and check it form mobility.
Check the knee for oedema and excess fluid using two techniques (1 – push down from above the knee to move fluid into the knee, 2 – push around the knee in a circle to check for fluid).

Question 21

How is the spine assessed in pGALS?

Answer 21

Get the child to stand and then reach for their toes.

Question 22

What are the limit ages for speech development?

Answer 22

Polysyllabic babble – 7 months 
Consonant babble – 10 months 
Saying 6 words with meaning – 18 months 
Joins words – 2 years 
3-word sentences – 2 ½ years

Question 23

What are the causes of speech and language delay?

Answer 23

hearing loss 
global developmental delay 
difficulty in speech 
production from an anatomical deficit (e.g. cleft palette) 
environmental deprivation
normal variant/familial pattern

Question 24

What are the causes of speech and language disorder?

Answer 24

language comprehension
language expression (inability to produce speech)
Phonation and speech production (stammering, dysarthria etc)
Pragmatics, constriction of sentences etc
Social/communication skills (ASD)

Question 25

What is a global developmental delay?

Answer 25

implies a delay in acquisition of all skill fields usually becomes apparent in the first two years of life

Question 26

What is the diagnostic criteria for ADHD?

Answer 26

- usually has its onset before the age of 6-7 and is - characterised by impaired attention or hyperactivity or impulsivity - important that symptoms are evident in more than one situation (home and school) - distinguish it from age appropriate behaviour

Question 27

How is ADHD managed?

Answer 27

Pharmacological: CNS stimulants such as methylphenidate (Ritalin) have been shown to be effective in some children. Antidepressants and antipsychotics are second line. Psychotherapy: behavioural modification and family education are important

Question 28

Who are the key professionals involved in the management of ADHD?

Answer 28

``` Psychiatrist Teachers Parents Doctors Nurses Pharmacists ```

Question 29

Describe enuresis

Answer 29

Can be daytime or nocturnal | Due to lack of bladder control in a child old enough to be continent

Question 30

What are the causes of enuresis?

Answer 30

lack of attention to bladder sensation with detrusor instability bladder neck weakness neuropathic bladder (ass with spina bifida) UTI constipation ectopic ureter (constant dribbling)

Question 31

What should an examination for enuresis involve?

Answer 31

check for neuropathic bladder (distension) abnormal perineal sensation, anal tone or abnormal leg reflexes and gait Sensory loss in S2,3,4 should be checked USS may be useful in showing incomplete emptying Urodynamic studies

Question 32

How should day time enuresis be managed?

Answer 32

daytime enuresis: when neuro cause excluded star charts, bladder training should be used treat constipation anticholinergic drugs can be used

Question 33

How should nocturnal enuresis be managed?

Answer 33

treatment rarely undertaken before 6 years stop punishing child star charts can be encouraging enuresis alarm can be used to wake the child and prompt them to empty their bladder

Question 34

Who are the key professionals involved in managing children with learning difficulties?

Answer 34

most healthcare professionals parents teachers

Question 35

What are the common causes of learning difficulties in isolation or as part of global delay?

Answer 35

organic causes of learning difficulties prenatal - genetic - downs, fragile X, microcephaly - vascular - occlusions, haemorrhage - metabolic - hypothyroidism, Phenylketonuria - teratogenic - alcohol and drug abuse - congenital infection - rubella, CMV, HIV- neurocutaneous syndromes - tuberous sclerosis, NF perinatal - extreme prematurity - brith asphyxia - metabolic - symptomatic hypoglycaemia postnatal - infection - meningitis, encephalitis - anoxia - suffocation, seizures - trauma - head injury - metabolic - hypoglycaemiavascular - stroke

Question 36

What is the diagnostic criteria for dyspraxia?also called developmental coordination disorder

Answer 36

assessment is usually carried out by an OT or S&L therapist disorder of higher cortical processes and there may be associated problems of perception, use of language and putting thoughts together features include problems with:- handwriting - dressing - cutting up food poorly establishes laterality - copying and drawing - messy eating

Question 37

What is a stammer?

Answer 37

speech disorder in which flow of speech is disrupted by involuntary repetitions and prolongations of the sounds, syllables etc factors affecting condition: genetics (runs in families), other S&L problems or developmental delays, differences in brain processing, interruption and competition with siblings

Question 38

What is a speech impediment?

Answer 38

a type of communication disorder where normal speech is disrupted can be a stutter, lisp, muteness, articulation disorders, articulation disorders, dysarthria