Abnormal development Flashcards
What does delay refer to?
Slow acquisition of cells
What does disorder refer to?
Maldevelopment of a skill
If one domain is affected what is it called? And if 2 or more are?
One- domain specific
>2 domains- global
What is consonant delay?
All domains are affected to the same extent
What is dissonant delay?
Domains affected to different extent
What are the patterns of delay?
Slow but steady, plateau and regress
What do limit ages denote?
The age beyond which it is abnormal development
How do children present with development problems?
Routine child health surveillance
Identified risk factors (such as prematurity)
Parents may be worried
Professionals in a nursery or day care setting concerned
Concerns may be detected opportunistically at health contacts
Why is it important to identify developmental problems in children?
Identification of aetiological factors- avoid blame
Making diagnoses- impact, support and genetic counselling
Identification and management of secondary disabilities
Offering support and singposting to information and services
What is the structured clinical approach when identifying child developmental disease?
History- risk factors and reported milestones
Physical examination
Developmental assessment
Differential diagnosis and identification of co-morbidities
Targeted tests
What is included in the clinical approach history?
Antenatal: Illnesses/infections Medications Drugs Environmental exposures Birth: Prematurity Prolonged/complicated labour NNU stay and problems Postnatal: Illnesses/infections Trauma Consanguinity Family and social history Developmental milestones from parents
What is included in the clinical approach physical examination?
Growth parameters- height, weight and head circumference
Dysmorphic features- face, limb, body proportions
Skin- neurocutaneous stigmata and injuries
Central nervous examination- power, tone, reflexes and asymmetry
Systems examination e.g. cardiac- Associatewd with many syndromes/chromosomal abnormalities
Formal developmental assessment- SOGS II, Griffiths, Denver and specialised
What is the structure of child development services?
It is multidisciplinary with predominantly health professionals and a social worker
It is multi-agency- health, social services, education, volunteers, voluntary agencies and parent support groups
Emphasis on childrens needs within community
Nominated key worker for child
What is cerebral palsy?
Prototype of abnormal motor development- disorder of movement and posture due to non-progressive lesion of motor pathways in developing brain
What is the most common cause of motor impairment in children?
Cerebral palsy
What are the causes of CP?
80% of cases are antenatal- genetic syndromes and congenital infection
10% of cases are thought to be due to hypoxic-ischaemia injury at birth
10% are postnatal in origin
Preterm infants- meningitis/encephalitis and encephalopathy
Head trauma, symptomatic hypoglycaemia and hyperbilirubinaemia
How does cerebral palsy present clinically?
Abnormal limb tone and limb or trunk posture in infancy with delayed motor milestone- may be accompanied by slowing of head growth
Feeding difficulties with oromotor incoordination, slow feeding, gaggin and vomiting
Abnormal gait once walking is achieved
Asymmetric hand function before 12 months of age
Primitive reflexes may persist and become obligatory
What are the different types of cerebral palsy?
Spastic 70%
Ataxic hypotonic 10%
Dyskinetic 10%
Mixed pattern 10%
What other problems are there with cerebral palsy?
Learning difficulties epilepsy squints visual impairment and cortical damage Hearing impairment Speech and language disorders Behaviour disorders Feeding problems Joint contractures, hip subluxation and scoliosis
What is autism and what is it characterised by?
Neurobiological disorder characterised by:
Qualitative impairment of social interaction
Qualitative impairments in communication
Restricted, repetitive and or stereotyped patterns of behaviour, interest and activities
What is the prevalence of autism?
3-6 per 1000 live births
How does autism differ between genders?
More common in boys
When does autism generally present?
2-4 years
In what ways is social interaction impaired in autism?
Doesn’t seek comfort, share pleasure or form close friendships
Prefers own company, no interest or ability in interacting with peers
Gaze avoidance
Lack of joint attention
Socially and emotionally inappropriate behaviour
Doesn’t appreciate others have thoughts
Lack of appreciation of social cues
How is speech and language impaired in autism?
Delayed development
Limited use of gestures and facial expression
Formal pedantic language, monotonous voice
Impaired comprehension with over-literal interpretation of speech
Echoes questions, repeats instructions, refers to self as you
Can have superficially good expressive speech
How are people with autism affected by routines?
Routines are imposed with ritualistic and repetitive behaviour:
On self and others with violent temper tantrums if disrupted
Unusual stereotypical movements such ads hand flapping and tiptoe gait
Concrete play
Poverty of imagination in play and activities
Peculiar interests
Restriction in behaviour repertoire behaviour
What co-morbidities are there with autism?
General learning and attention difficulties (about two thirds)
Seizures (About one quarter, often not until adolescence)
How are learning disabilities classified?
From mild, moderate, severe and profound
How might learning disorder present?
Part of recognisable syndrome
Failure to meet milestones
Dysmorphic features with associated problems
What are the causes of learning disorders?
Chromosome disorders 30% Other identifiable syndromes 20% Cerebral palsy, infantile spasms, post-meningitis 20% Metabolic or degenerative diseases <1% Idiopathic 25%
How are learning disorders managed?
Identify a possible cause MDT School- statementing required Associated problems- visions, hearing, epilepsy Specific diagnosis
How is education affected by learning disorders?
Early indentification and intervention maximises progress and potential
What is attention deficit hyperactivity disorder?
A persistent pattern (>6 months) of inattention and or hyperactivity-impulsivity that interferes with functioning or development to a degree that is inconsistent with developmental level and that negatively impacts directly in social and academic/occupational activities:
- Not solely manifestation of oppositional behaviour, defiance, hostility or failure to understand tasks or instructions
- Were present prior to age 12 years
- Present in two or more settings
How is ADHD assessed?
Questionnaires- strengths and difficulties, Connors
Exclude medical causes- hyperthyroidism, iron deficiency anaemia
Hearing deficits
Identify risk factors and co-morbidities
How is ADHD managed?
Psychotherapy Family therapy Medication - methylphenidate, other Co-morbidities- medical management ?Diet modification CAMHS
