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Flashcards in RDA Deck (14):
1

List the 4 developmental domains

(1) gross motor and posture;
(2) fine motor and vision; (3) language and hearing;
and (4) social, emotional and behaviour.

2

What tools are used to assess childhood development

Developmental progress can be monitored or
identified either through developmental screening or
by the use of standardised developmental tools

3

What is the clinical approach to a child with developmental delay

History
• Antenatal - illnesses/infections; medications; drugs;
environmental exposures
• Birth –Prematurity, Prolonged/complicated labour
• Postnatal - illnesses/infections; Trauma
• Consanguinity – increases chances of chromosomal or
autosomal recessive conditions
• Developmental milestones from parent
Examination
• Growth parameters – height, weight and head
circumference
• Dysmorphic features
• Neurological examination and skin
• Systems examination to identify associations,
syndromes
• Standardised developmental assessment – SOGSII,
Griffiths

4

What factor can impact neural tube? What would this cause?

Biological factors may impact on development – e.g.
folate deficiency increases the risk of neural tube
defects which, in its most severe form, can result in
limb paralysis, neurogenic bladder and bowel; and
intellectual impairment.

5

When are developmental delays identified?

Children may present with developmental concerns either
through (i) identification of antenatal or postnatal risk factors;
(ii) developmental screening; or (iii) concerns raised by parents
or other healthcare professionals. Thus, these children may
present at any age.

6

brief: cerebral palsy

Cerebral palsy
• A disorder of movement and posture arising from a
non-progressive lesion of the brain acquired before the
age of 2 years.
• Incidence 1-2 per 1000 live births
• Most causes (~80%) are antenatal
• Presentation may evolve and vary with age
• Associated problems exist – learning difficulties,
epilepsy, visual impairment, hearing loss, feeding
difficulties, poor growth, and respiratory problems.

7

Autism

Boys>girls
• Usually presents between 2 – 4 years of age
• Features include (1) impaired social interaction; (2)
speech and language disorder; and (3) imposition of
routines with ritualistic and repetitive behaviour.

8

ADHD: diagnostic criteria

Diagnostic criteria – (1 )Inattention; (2) Hyperactivity;
(3) Impulsivity (4) Lasting > 6 months (5) commencing
< 7 years and inconsistent with the child’s
developmental level
• These features should be present in more than one
setting, and cause significant social or school
impairment.
• These children also have an increased risk of: conduct
disorder, anxiety disorder & aggression

9

Onset of Puberty
How does it happen?


Two theories:
1. Maturation of the CNS affecting GnRH neurones
(increased pulsatile release)
2. Altered set point to gonadal steroid negative feedback
What might trigger the maturation of the CNS?

10

Adolescence

Adolescence refers to the period of development that
occurs between ages 12-18 years.

11

Anorexia Nervosa
Cardinal features


• Body weight maintained 15% below expected wight,
or BMI < 17.5.
• Weight loss is self-induced
• Psychopathology – dread of fatness, and
preoccupation with this.
• Endocrine disturbance: amenorrhoea, or delayed
growth and puberty in younger sufferers.
Epidemiology
Approx 0.5-1% adolescent females. Approx 10% cases or less
male.

12

Anorexia causes

Causes
Genetic predisposition, perfectionist temperament, specific
subcultures, childhood abuse and adversities; perhaps higher
social class.
Outcome
Community sample: 50% recover after 5 years
Clinic samples: after 1 year 37% recover; 25% weight gain but
not menstruating; 37% underweight, symptoms.

13

Epidemiology of Depressive Disorder and interventions

Epidemiology of Depressive Disorder
2-5% adolescents
Causes
• Familial aggregation; genetic factors known
• Effects of family interaction e.g. criticism
• Life events, adversities
Prognosis
Major depression: Duration
In specialist CAMHS settings: 6-9 months
Primary care: 2-3 months
High risk recurrence
Prepubertal onset – better prognosis
Small number in adolescence – bipolar (mania, hypomania)
Interventions:
Cognitive behavioural therapy
Interpersonal psychotherapy
Family intervention for associated family problems
Antidepressants – selective serotonin reuptake inhibitors e.g.
fluoxetine for moderate - severe depression.

14

Features of conduct disorder

Conduct disorder
Persistent failure to control behaviour appropriately within
socially defined rules.
Clinical Features
Child
• looses temper and argues
• defies adult requests or rules
• bullies, fights or intimidates,
• stealing, breaking into cars or houses, destroys
property
• running away, truanting