Approach to a child with developmental delays: Flashcards
(65 cards)
1
Q
what is developmental delay?
A
i. Failure to attain appropriate developmental milestones for child’s corrected chronological age.
ii. Can correct up to 2 years for a child grown pre-mature
2
Q
what are the patterns of abnormal development?
A
i. Delay (global – Down’s syndrome and specific – Duchenne’s muscular dystrophy)
ii. Deviation (autism spectrum disorder)
iii. Regression
3
Q
at what age are deviant patterns of development looked at specifically?
A
27 months
4
Q
what is delayed abnormal development?
A
achieves it but later on only
5
Q
what is deviation?
A
not just a simple delay, they may just do things slightly differently
6
Q
what is regression?
A
i. It is a loss of previously acquired skills
ii. Very worrying
iii. Looks like they are developing normally but if they get a disease and they get over it might stop doing things the right way
7
Q
what condition is an example of regression?
A
Retts syndrome - more predominant in girls, girls lose their ability to walk, in born biochemical problems
8
Q
what percentage of UK children have autism spectrum disorder?
A
1%
9
Q
what percentage of UK children have a mild learning disability?
A
1-2%
10
Q
what percentage of UK children have severe learning disability?
A
0.3-0.5%
11
Q
what percentage of UK children have a specific learning disability?
A
5-10%
12
Q
what is the range for mild learning difficulty?
A
50-70 IQ
13
Q
what is the range of IQ for moderate learning difficulty?
A
35-49 IQ
14
Q
what are the red flags for development?
A
asymmetry of movement not reaching for objects by 6 months unable to sit unsupported by 12 months unable to walk by 18 months no speech by 18 months concerns regarding vision or hearing loss of skills
15
Q
what is asymmetry of movement?
A
- Usually we are right handed more than left handed, but in this case they are ignoring the use of one hand completely
- Haven’t grown over the parachute reflex in one hand
16
Q
not reaching for objects by 6 months?
A
- Is there a problem with their vision?
- Is there a problem with their motor skills?
- Is there less interest in interaction?
17
Q
unable to walk by 18 months?
A
- CK a small number of children may have a form of muscular dystrophy
- Most will go on to walk but that is the time when we want to pick up diseases asap
18
Q
what range of children are affected by global developmental delay?
A
significant under 5’s
19
Q
how many skills should be affected in global developmental delay
A
Significant delay in 2+ of:
i. gross/ fine motor, speech/ language
ii. cognition. Social/personal, ADL
20
Q
do children usually catch up with the delay in global developmental delay?
A
i. They say that children usually catch up, but it later on it increases the gap btw them and a child with a normal IQ
ii. 6 months delay/ 2 years roughly 6 year level at 8 y/o, and 12 year level at 16 y/o
iii. The gap widens and many a times the kids won’t be able to live independently
21
Q
what are the two types of delay?
A
global and specific
22
Q
what is an example of global delay?
A
Down’s syndrome
23
Q
what is an example of specific delay?
A
Duchenne’s muscular dystrophy
24
Q
how common are genetic causes in global developmental delay?
A
common 5-25%
25
what are the 21 features of trisomy 21 (Down's syndrome)
Mental impairment Abnormal teeth
Stunted growth
Slanted eyes
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Umbilical hernia
Shortened hands
Increased skin on back of neck
Short neck
Low muscle tone
Obstructive sleep apnea
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Narrow roof of mouth
Bent fifth finger tip
Flat head
Brushfield spots in the iris
Flexible ligaments
Single transverse palmar crease
Proportionally large tongue
Protruding tongue
Abnormal outer ears
Congenital heart disease
Flattened nose Strabismus
Separation of first and second toes
Undescended testicles
26
what are the medical screenings that should be done for Down's syndrome?
i. Cardiac
ii. Vision hard to accommodate vision
iii. Hearing (Brachycephaly increased middle ear effusions)
iv. Thyroid function common under active thyroid
v. Sleep related breathing disorders sleep apnoea
vi. Growth- charts different growth patterns, height tends to be shorter and they tend to put on more weight
vii. Development
27
what is a motor delay in children?
Duchenne Muscular Dystrophy, Cerebral Palsy, Co-ordination disorders
28
what is a language delay in children?
specific language impairment
29
what is a sensory deficit and associated delay in children?
Oculocutaneous Albinism, Treacher-Collins
30
what is a developmental deviation in children?
autism spectrum disorders
31
what are the features of Duchenne muscular dystrophy?
i. X-linked disorder
ii. Mother is usually a carrier (50/50 chance of affecting the boy child)
iii. Carriers usually have a little bit delay in walking but nothing much
iv. Highly accentuated lordosis
v. Pseudohypertrophy of the calves (muscle replaced by fibrous tissue so they are still weak)
vi. Weakness of pelvic muscles **presents with Gower’s manoeuvre
vii. Speech and language delay
viii. Can develop associated respiratory and cardiac problems
32
what maneuver do children with DMD present with?
Gower's manoeuvre.
| also present in any disease that causes pelvic weakness
33
what are the conditions associated with cerebral palsy?
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diplegia
hemiplagia
quadriplegia
epilepsy
visual/hearing impairment
communication difficulties
feeding difficulties
sleep problems
behavior problems
hearing loss
visual loss
increased tightness of muscle groups
```
34
what determines what conditions a child with cerebral palsy will have?
depends on which side of the brain are affected - children born pre-mature usually always have problems with visual tracts such a lower visual tract defects
35
what is needed when there is increased tightness of muscle groups as those with CP grow older?
physiotherapy
36
what may be different in delivering babies that are affected by CP?
may be difficult to deliver these babies (as there has been damage done antenatally and are born that way)
37
diplegia
22-33 weeks of pregnancy, big placental abruption, interruption of blood shed to the water shed areas of the brain at crucial areas, walk on tiptoes so increased risk of falling
38
between hemiplegia and quadriplegia which one is less common?
hemiplegia
| quadriplegia - highest effect, worst prognosis
39
CP
is not a progressive condition
40
which type of cerebral palsy affects 22-33 weeks of pregnancy, big placental abruption, interruption of blood shed to the watershed areas of the brain at crucial areas?
diplegia
41
what is spastic diplegia?
protected from learning problems
42
what are sleep problems that people with CP have?
* Normal circulating levels of melatonin not in the right amount in these children
* Silent reflux due to co-ordination difficulties
* Bad dental decay
43
what are behavior problems that people with CP have?
Abused
| Poor communication skills
44
what are hearing loss problems do people with CP get?
bilateral middle ear effusions, blocked, sticky ears, sounds like you are under water and miss out a lot of high frequency sounds
Sensory neuro
45
what is affected in oculocutaneous albinism?
i. Blonde skin
ii. Blonde hair
iii. Can see right back to the retina (as the iris isn’t coloured)
iv. Involuntary to movement
v. Photophobia
vi. May have nystagmus
vii. Hearing ipairment
46
what are the causes of hearing impairments in those with oculocutaneous albinism
i. bilateral middle ear effusions, blocked, sticky ears, sounds like you are under water and miss out a lot of high frequency sounds
ii. sensory neuro
47
what is the autistic trio?
i. Communication
ii. Social interaction
iii. Flexibility of thought/ Imagination
iv. Restricted, repetitive behaviours
v. Sensory difficulties
48
what are the differences in the language variations in ASD communication?
receptive language
expressive language
non-verbal language
use of language
49
receptive language
* Delayed
* Expressive>Receptive
* Abstract language difficult
* Visually more able
50
expressive language
* Can appear Delayed
* Echoes repeating what they have just heard, or actually delayed so it might look like they are coming up with something new but tbh they are just repeating it
* Odd intonation/pitch not spontaneous
* Chunks of video speak
* Non-verbal signs are affected
51
non-verbal language
* Facial expressions, gesture
* Eye contact
* Recognising intention of others
52
use of language
* Initiating and sustaining conversation
* Restricted interests
* Lack of awareness of reciprocal nature of conversation they usually just keep going and don’t stop talking
* They don’t know that they have to ask to get something
53
difference in girls vs boys?
i. Girls neurotypical, its something that their peers are talking about and they a lot about it but don’t know what else to talk about
ii. Boys stuck with Thomas engine
54
how does ASD affect social interaction?
i. Joint Attention and Referencing
• Trying to turn their attention to what you want
ii. Turn taking
• Very hard to get them to wait for others
• Keep control as much as they can
iii. Unable to share pleasure
iv. Not motivated by need for social approval
v. Social rules - don’t always follow it
vi. Empathy – can’t empathise with their own emotions, so extremely difficult to relate to others
vii. Relationships
viii. Others point of view/feelings
55
what are the flexibility/thoughts/imagination in ASD?
i. Theory of mind – have a box with smarties cover in it but they only have pencil, and they think that everyone should know it
ii. Concrete and lateral – eg: told that they should cut out crisps from him diet but he thought they were literally going to cut him open
iii. Concept of time
iv. Routines
v. Changes in environment
• Some may notice very tiny changes in the environment
• Line up cars and objects according to size and shape and they want to put it back
vi. Ritualistic behaviour
• Carry around certain objects
56
what are sensory issues associated with ASD?
i. Fussy eater/ medications
ii. Textures of clothes
iii. Sleep
iv. Toilet training – big issues
v. Hair washing / cutting – they will scream but will have a problem when they are not in control
vi. Nail cutting
vii. Noise
• May be over/ under sensitive – a big bag may calm them and stuffing themselves in small places
57
what is the approach to developmental delay?
i. History
ii. Exam
iii. Investigations
iv. Assessments
58
how to identify developmental delay in neonatal?
odd behavior, won't eat, won't respond to sound
59
how to identify developmental delay in infants?
are they achieving their milestones, are they developing their language
60
pregnancy and developmental delay
did mom smoke/alcohol infections?
61
environmental and developmental delay
post natal depression/environmental problem, meningitis, post injury
62
what are the investigations of developmental delay?
i. Chromosomes, FRAX (fragile x) & Oligoarray CGH
ii. Neonatal PKU, thyroid studies, CK
iii. If indicated:
- MRI brain 9only in indicated
- EEG (only is eizures)
- Metabolic studies (intervurrent illness)
- Genetic consultation (conasngruant parents)
- Others (hypertonic or not)
63
what are the various developmental assessments done?
MDT
appropriate assessment tool
always start with immediate early intervention without waiting for the results to come back
other things to help make the environmental conditions better - realistic approach
64
immediate early interventions:
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o Therapy
o Physio
o SLT
o OT
o Family Support
o Educational Placement
o Referral to Other Agencies
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65
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appropriate assessment tools: for the ages:
0-3
0-5
0-8
ASD
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Bayleys
schedule of growing skills
Griffiths
ADOS
