28: 18-month-old male with developmental delay

Question 1

Many developmental disorders affect some domains of development and not others. For example:

Answer 1

• Autism spectrum disorders primarily interfere with social interactions.
• Cerebral palsy is characterized by motor dysfunction, with variable impact on other domains.
• Genetic and metabolic disorders may cause global delay.

Question 2

ASD Screening

Answer 2

The AAP recommends routine screening for autism spectrum disorder in all children at the 18 and 24-month visits.

Screening Tool
The Modified Checklist for Autism in Toddlers (M-CHAT) is a parent-completed questionnaire that is validated as a screening tool to identify children between 16 and 30 months of age who are risk for autism spectrum disorders.

Question 3

Risk Factors for Developmental Delay

Answer 3

• Bronchopulmonary dysplasia (BPD)
• Retinopathy of prematurity (ROP)
• Hyperbilirubinemia
• Periventricular leukomalacia (PVL)

Question 4

diagnosis of cerebral palsy (CP)

Answer 4

• heterogeneous group of non-progressive disorders, characterized by motor and postural dysfunction.
• These conditions, which range in severity, are due to abnormalities of the developing brain resulting from a variety of causes.

Question 5

To calculate corrected age:

Answer 5

• Subtract gestational weeks of a premature infant from the average gestational period of 40 weeks.
• Subtract the result from the chronological age to obtain the “corrected age.”

Question 6

screening for CP

Answer 6

Screening for developmental delays, ophthalmologic abnormalities, hearing impairment, speech and language disorders, and disorders of oral-motor function are warranted as part of the initial assessment because these problems are commonly associated with CP.

Question 7

“Does your child play games?”

Answer 7

Lack of interest in sharing toys or engaging in activities with others at this age may be a sign of an underlying developmental disorder.

Question 8

“How does your child do with people s/he doesn’t know?”

Answer 8

A child’s level of willingness to interact with strangers-and the appropriateness of the interaction, from too familiar to too resistant-may be an indicator of a behavioral disorder.

Question 9

“Does your child seem to use one hand more

Answer 9

The expected answer to this question will change during toddler development. The presence of handedness should not occur before 18-24 months of age and therefore may indicate weakness of one side.

Question 10

“Does your child have a favorite toy?”

Answer 10

Demonstration of an intense interest in one “toy” or object to the exclusion of others is atypical at this age and may be symptom of an underlying developmental disorder.

Question 11

“You mentioned that he always seems to be standing. Tell me more about that.”

Answer 11

Toddlers who appear to prefer to stand than sit may do so because of abnormally tight muscles, possibly due to a neuromuscular disorder.

Question 12

When you are at your preceptor’s office, you are told to see Amy, a 20-month-old female diagnosed with cerebral palsy (CP) at the last visit. Your preceptor knows that you just had your lecture on CP and tries to have you figure out which type of CP Amy has. She tells you that Amy was born at full term but had severe jaundice and required extensive treatment for hyperbilirubinemia, including an exchange transfusion. She now has slow and uncontrolled movements throughout her body. Her brain MRI shows some atrophy of the basal ganglia. What type of CP does Amy have?

Answer 12

This choice is correct because dyskinetic CP is associated with kernicterus, due to hyperbilirubinemia, as well as findings of basal ganglia pathology on imaging. Patients typically have motor abnormalities throughout the body. Dyskinetic CP is also associated with perinatal asphyxia and can involve the thalamus and cerebellum on imaging.

Question 13

spastic diplegia

Answer 13

classically associated with premature birth and specific MRI findings of periventricular white matter abnormalities. Patients present with motor involvement that is more prominent in the legs than the arms.

a form of cerebral palsy, a non-progressive static encephalopathy characterized by delays in motor development. It may be associated with periventricular white matter abnormalities that are thought to be due to ischemia. These changes can be visualized on MRI. In spastic diplegia, the motor abnormalities are often greater in the legs than in the arms.

Question 14

spastic quadiplegia

Answer 14

spasticity, clonus, and exaggerated tendon jerks throughout their bodies. Imaging would show global brain abnormalities.

Question 15

spastic hemiplegia

Answer 15

associated with a stroke damaging a unilateral upper motor neuron tract-should present with spasticity of the contralateral arm and leg, not the entire body

Question 16

ataxic cerebral palsy

Answer 16

should show cerebellar abnormalities on imaging, while Amy’s MRI shows only basal ganglia involvement.

Question 17

Athetoid cerebral palsy

Answer 17

involves motor deficits of the entire body, not just the legs. It is often caused by perinatal asphyxia and kernicterus, both of which damage the basal ganglia, cerebellum, and/or thalamus.

Question 18

Children with cerebral palsy

Answer 18

often present with defects in motor development and are often found to have abnormal neuromuscular exams, including increased tone and reflexes. Other areas of development are less consistently impacted. The cerebral palsy most likely was the result of an hypoxic injury during the perinatal period