Abnormal development

Question 1

What does delay refer to?

Answer 1

Slow acquisition of cells

Question 2

What does disorder refer to?

Answer 2

Maldevelopment of a skill

Question 3

If one domain is affected what is it called? And if 2 or more are?

Answer 3

One- domain specific

>2 domains- global

Question 4

What is consonant delay?

Answer 4

All domains are affected to the same extent

Question 5

What is dissonant delay?

Answer 5

Domains affected to different extent

Question 6

What are the patterns of delay?

Answer 6

Slow but steady, plateau and regress

Question 7

What do limit ages denote?

Answer 7

The age beyond which it is abnormal development

Question 8

How do children present with development problems?

Answer 8

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

Question 9

Why is it important to identify developmental problems in children?

Answer 9

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

Question 10

What is the structured clinical approach when identifying child developmental disease?

Answer 10

History- risk factors and reported milestones
Physical examination
Developmental assessment
Differential diagnosis and identification of co-morbidities
Targeted tests

Question 11

What is included in the clinical approach history?

Answer 11

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

Question 12

What is included in the clinical approach physical examination?

Answer 12

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

Question 13

What is the structure of child development services?

Answer 13

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

Question 14

What is cerebral palsy?

Answer 14

Prototype of abnormal motor development- disorder of movement and posture due to non-progressive lesion of motor pathways in developing brain

Question 15

What is the most common cause of motor impairment in children?

Answer 15

Cerebral palsy

Question 16

What are the causes of CP?

Answer 16

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

Question 17

How does cerebral palsy present clinically?

Answer 17

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

Question 18

What are the different types of cerebral palsy?

Answer 18

Spastic 70%
Ataxic hypotonic 10%
Dyskinetic 10%
Mixed pattern 10%

Question 19

What other problems are there with cerebral palsy?

Answer 19

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

Question 20

What is autism and what is it characterised by?

Answer 20

Neurobiological disorder characterised by:
Qualitative impairment of social interaction
Qualitative impairments in communication
Restricted, repetitive and or stereotyped patterns of behaviour, interest and activities

Question 21

What is the prevalence of autism?

Answer 21

3-6 per 1000 live births

Question 22

How does autism differ between genders?

Answer 22

More common in boys

Question 23

When does autism generally present?

Answer 23

2-4 years

Question 24

In what ways is social interaction impaired in autism?

Answer 24

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

Question 25

How is speech and language impaired in autism?

Answer 25

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

Question 26

How are people with autism affected by routines?

Answer 26

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

Question 27

What co-morbidities are there with autism?

Answer 27

General learning and attention difficulties (about two thirds)
Seizures (About one quarter, often not until adolescence)

Question 28

How are learning disabilities classified?

Answer 28

From mild, moderate, severe and profound

Question 29

How might learning disorder present?

Answer 29

Part of recognisable syndrome
Failure to meet milestones
Dysmorphic features with associated problems

Question 30

What are the causes of learning disorders?

Answer 30

Chromosome disorders 30%
Other identifiable syndromes 20%
Cerebral palsy, infantile spasms, post-meningitis 20%
Metabolic or degenerative diseases <1%
Idiopathic 25%

Question 31

How are learning disorders managed?

Answer 31

Identify a possible cause
MDT
School- statementing required
Associated problems- visions, hearing, epilepsy
Specific diagnosis

Question 32

How is education affected by learning disorders?

Answer 32

Early indentification and intervention maximises progress and potential

Question 33

What is attention deficit hyperactivity disorder?

Answer 33

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

Question 34

How is ADHD assessed?

Answer 34

Questionnaires- strengths and difficulties, Connors
Exclude medical causes- hyperthyroidism, iron deficiency anaemia
Hearing deficits
Identify risk factors and co-morbidities

Question 35

How is ADHD managed?

Answer 35

Psychotherapy
Family therapy
Medication - methylphenidate, other
Co-morbidities- medical management
?Diet modification
CAMHS