Abnormal Development Flashcards
What is developmental delay?
Failure to attain developmental milestones for the child’s corrected chronological age
What are the patterns of abnormal development?
Delay = global or specific
Deviation (e.g autism spectrum disorder)
Regression (e.g Rett’s syndrome or metabolic disorders)
Is developmental delay common?
Yes
What are the red flags for development?
Asymmetry of movement Not reaching for objects by 6 months Unable to sit unsupported by 12 months Unable to walk by 18 months (check CK) No speech by 18 months Concerns about vision or hearing Loss of skills
What are some features of global developmental delay?
Affects 1-3% of under 5s
Genetic causes account for 5-25%
Termed learning disability in school age children
What is global developmental delay?
Significant delay in 2 or more of gross/fine motor, speech and language, cognition, social/personal skills or ADL
What is assessed in the medical screening for Down’s syndrome?
Cardiac function, vision and hearing, thyroid function, sleep related breathing problems, growth charts and development
What are the specific developmental delay categories?
Motor delays
Language delays = specific language impairment
Sensory deficits and associated delay
Developmental deviations = autism spectrum disorder
What are some causes of specific motor delays?
Duchenne muscular dystrophy, cerebral palsy, co-ordination disorders
What are some causes of sensory deficits and their associated delay in development?
Oculocutaneous albinism, Treacher-Collins
What is Gower’s sign?
Patient uses hands and arms to walk up their body from squatting position = indicates proximal muscle weakness
What are some conditions associated with cerebral palsy?
Mobility problems, spasticity and orthopaedic problems
Learning and communication difficulties
Epilepsy and sleeping problems
Feeding difficulties and behaviour problems
Visual and hearing impairment
What three areas make up the autistic triad?
Communication, social interaction, and flexibility of thought/imagination
How does autism spectrum disorder tend to manifest generally?
Restricted, repetitive behaviours and sensory difficulties
What areas of communication are affected by autism?
Repetitive language, expressive language, non–verbal language and use of language
How is repetitive language impacted in autism?
Delayed, expressive>receptive, abstract language difficult, visually more able
How is expressive language impacted in autism?
Delayed, echoes, odd intonation or pitch, chunks of video speak
What types of non-verbal language are impacted by autism?
Facial expressions, gestures, eye contact, recognising intentions of others
How may use of language be impacted in a person with autism?
Difficulty initiating and sustaining conversation, restricted interests, lack of awareness of reciprocal nature of conversation
How may social interaction be affected by autism spectrum disorder?
Joint attention and referencing
Turn-taking, social rules, other points of view/feelings
Empathy and unable to share pleasure
Not motivated by need for social approval
Relationships
What areas of flexibility of thought/imagination are impacted by autism?
Theory of mind, concrete and literal, concept of time, routines, changes in environment, ritualistic behaviour
What are some triggers of the sensory issues of a person with autism?
Fussy eater/medications, textures of clothing, sleep, toilet training, hair washing/cutting, nail cutting, noise
What should be included in the history of a child with a suspected developmental delay?
Presenting complaint, past medical history, perinatal and birth details, family and social history, development, play and behaviour, school/nursery performance
How should children with suspected developmental delay be examined?
Observation, look for dysmorphism, measure head circumference, systemic examination, CNS (including neurocutaneous), vison and hearing
What investigations can be done for developmental delay?
Chromosomes, FRAX, oligoarray CGH, neonatal PKU, thyroid studies, CK
If indicated = MRI brain, ECG, metabolic studies etc
How should developmental assessment be approached?
Using the multidisciplinary team
What are some diagnostic tools that can be use to assess development?
Griffiths = 0-8 years
Bayleys = 0-3 years
Schedule of growing skills = 0-5 years
ADOS = for autism spectrum disorder
What interventions can be done for developmental delays?
Intervention should be early
Therapy = physio, SLT, OT
Family support and educational placement
Referral to other agencies
