1: Neurology: Assessment Development and Developmental Delay Flashcards
What is a developmental disorder
Group of conditions resulting in impairment of one or more functional areas
What are primitive reflexes
Reflexes that arise from the brainstem
What happens with age
Frontal lobe can suppress brainstem reflexes
What are 5 primitive reflexes
- Stepping
- Moro
- Grasp
- Rooting
- Asymmetric neck reflex
What is the stepping reflex
When placed on a surface infant will step
When does stepping reflex disappear
2-months
What is the moro reflex
When head is extended infant will abduct then adduct arms
When does the moro reflex dissapear
4 months
What is the grasp reflex
Object placed in palm, infant will grasp
When does the grasp reflex disappear
4-5 months
What is the rooting reflex
Object placed near infants mouth - will cause suckling
When does rooting reflex occur
4 months
What is asymmetric neck reflex
If lying supine, if head turned arm will extend giving a ‘fencing’ posture
What are the 4 developmental domains
- Gross Motor
- Fine Motor
- Speech (Language and Hearing)
- Social (Emotional and Behavioural)
What can an infant do gross-motor domain at 6W
Raised head 45’
What can infant do gross-motor at 6 months
Pulls to sit
Roll back to front
Lie on abdomen and extend arms
What can infant do gross-motor at 7-8 months
Sits without support
When can an infant sit without support
7-8 months
When should you refer an infant who can’t sit without support
12 months
What can an infant do at 9-months
Crawls
When an an infant crawl
9-months
What can an infant do at 12 months
Cruises
What can an infant do at 13-15 months
Walks unsupported
When can an infant walk unsupported
13- 15 months
When should you refer an infant if they cannot walk unsupported
18 - months
When can a child run
2- years
When can a child walk up and downstairs whilst holding on to hand rail
2-years
When can a child ride a tricycle
3-years
When can a child walk up and down stairs without holding hand rail
3-years
When does an infant have good head control
3-months
What can an infant do in fine-motor at 6W
Track objects
What can an infant do in fine-motor at 3 months
Reaches
What can an infant do at 6 months
Palmar grasp
Point to objects
When does an infant acquire a palmar grasp
6-months
When does early pincer grip occur
9-months
What can an infant do at 9-months
- Early pincer grip
- Points to objects
When does an infant have a neat pincer grip
12-months
What is abnormal before 12-months in fine-motor and what can it indicate
Hand preference. Can indicate cerebral palsy
What can infant do at 13-15m in fine-motor
Tower 2-bricks
What can infant do at 18m in fine-motor
Tower 3-bricks
Scribble
What can infant do at 2-years in fine-motor
Tower 6-bricks
Copy line
What can infant do at 3-years in fine-motor
Tower 9-bricks
Copy circle
What can infant do at 4-years in fine-motor
Copy cross
What can infant do at 5-years in fine-motor
Copy square and triangle
What age can an infant turn to sound
3-months
What can an infant do at 3-months in language
- Turn to sound
- Quieten to parents voice
- Squeals
When does an infant use double syllables
- 6-months
When does an infant say ‘mumma’ and ‘dadda’
9-months
What can an infant do at 9-months
Say mumma and dadda
Understand NO
When does an infant known and respond to its own name
12-months
What can an infant do at 13-15 months in language domain
Vocabulary 2-6 words
If an infant does not know 2-6 words by what age should you refer
18-months
When can an infant combine two words
2-years
How many words would you expect a 2.5-year old to know
200-words
What age may a child be able to talk in short sentences
3-years
What can a child of 3-years do in language domain
- Short sentences
- Asks questions
- Counts to 10
- Identifies colours
what age does a child smile
6W
if a child has not smiled by what time frame should they be referred
10W
when does a baby laugh by
3-months
when is a baby not shy
6-months
what can an infant do at 9-months in social domain
- Shy
- Takes objects by mouth
- Peek-a-boo
what can infant do at 12-months in social domain
Waves bye-bye
Patty cake
what can infant do at 13-15 months in social domain
- Drinks from cup
- Uses spoon
- Help getting dressed and undressed
what can infant do at 18-months in social domain
- Takes shoes off
- Plays alone
what can infant do at 2-years in social domain
- Plays near others, not with them
what can child do at 3-years in social domain
- Uses spoon and fork
what can child do at 4-years in social domain
- Dresses independently
- Plays with others
what is bottom-shuffling
normal variant: child may bottom shuffle, opposed to crawl, prior to walking
when should individual be referred if not smiling
10-weeks
when should children be referred if poor head control
6-months
when should children be referred if not sitting without support
12-months
when should children be referred if not walking
18-months
when should children be referred for not known 2-6Words
18-months
what is considered a red-flag for development
Regression in previously learnt skill
what are other red flags for development
- Parental concern
- Abnormal tone: difference between R and L
- Poort interaction
When is the new baby review
1-2W
Who performs the new baby review
Health visitor
When is a developmental review performed
9 months - 1-year
What is completed at the developmental review
ASQ3 questionnaire by the parents
When is the second health-development review
2-2.5 years
Who completes second health-review
ASQ3 questionnaire - done by parents
Visit by health visitor
What is developmental screening
Brief assessment where a screening tool is used to identify children who need further assessment and investigations
How is developmental screening performed
Using developmental screening tool
What Developmental screening test is used in the UK
Ages and Stages Questionnaire (ASQ)
What age-range is the ages and stages questionnaire suitable
1 month - 5.5 years
Define developmental delay
Slow acquisition of skills across all developmental domains or in one-specific developmental domain
What are the two types of developmental delay
Global DD = delay in two or more domains
Specific DD = delay in one domain
When is developmental delay often detected
When development for that skill is expected at that greatest
What are the 3 patterns of developmental delay
- Slow but steady
- Plateau
- Regression
What is slow-but-steady
Individuals are below where expected for they gestation but gradually improving
What is plateau effect
Individuals initially improved and now are not
What is regression
Individuals improved and then regressed
When should individuals be referred due to abnormal motor development
18m if unable to walk
What are 5 causes abnormal motor development
- Cerebral palsy
- Duchenne muscular dystrophy
- Global developmental delay
- Idiopathic
- Spina bifida
What does hand preference before 12-months indicate
CP
Explain late-walking in normal variants
Bottom-shufflers and commando crawlers are late variants associated with later-onset of walking
What can hypertonia indicate
CP
What is a sign of DMD
Gower’s sign = using arms to push up legs to stand-up
What do NICE recommend if child is at risk of cerebral palsy
General movement assessment at 0-3 months
If only motor developmental delay what may be ordered
creatinine phosphate kinase - to exclude DMD
what is language delay
delay in understanding or expressing speech
what are causes of language delay in children
- Familial
- Hearing: chronic otitis media
- Physical: tongue-tie, cleft palate
- Neuropsych: neglect, autism
how can language delay be divided
Receptive = understanding Expressive = communicating
when should child turn head to sound
3-months
when should infant be referred if not turning head to sound
9-months
when should infant babble
6-months
when should infant be referred if not babbling
12-months
when should child be referred if it has no clear words
18-months
when should child have 2-6 words
12-months
why may a child be referred at 2.5-years
if vocabulary is less than 50-words
how many words should a child have at 2.5 years
200 words
if child has language delay who should they be referred to
SALT
Audiology assessment
what is global developmental delay
delay in two or more domains
when does global developmental delay tend to appear
2-years
in which domains is global developmental delay more common
fine motor
social
speech
(less apparent in gross motor)
