Approach to the Child with Developmental Delay Flashcards
4 areas of development?
- Gross motor
- Fine motor and vision
- Language and hearing
- Social behaviour and play
Define developmental delay?
Failure to attain appropriate developmental milestones for a child’s corrected chronological age
3 patterns of abnormal development?
- Delay - can be:
• Global (affecting all areas of development)
• Specific (affecting 1 of the 4 areas of development) - Deviation
- Regression (loss of skills that were previously developed)
Example of deviation?
Autism Spectrum Disorder (ASD)
Examples of regression?
Rett’s syndrome
Metabolic disorders, e.g: febrile illness - can result in loss of skills that were previously developed; these may/may not be regained
Define mild and severe learning disability?
Mild - IQ 50-70
Severe - IQ <50
Examples of a specific learning disability?
Dyslexia, dyscalculia
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 creatine kinase)
- No speech by 18 months
- Concerns from family/friends of vision (e.g: squinting) or hearing
- Loss of skills (regression)
Define global developmental delay?
Significant delay in 2+ of:
• Gross/fine motor, speech / language
• Cognition, social/personal, • ADL (activities of daily living)
In school-aged children, it is termed learning disability
Features of Down’s syndrome (AKA trisomy 21)?
Mental impairment and stunted growth
Umbilical hernia
Increased skin at the back of the neck, a short neck and a flat head
Low muscle tone and flexible ligaments
Narrow roof of mouth, proportionally large tongue that protrudes, abnormal teeth
Abnormal outer ears, flattened nose, slanted eyes and Brushfield spots in iris
Separation of 1st and 2nd toes, a bent 5th fingertip (clinodactyly) and a single transverse palmar crease
Congenital heart disease, obstructive sleep apnoea, strabismus (eyes do not properly align when looking)
Undescended testicles)
Medical screening in Down’s syndrome involves?
Cardiac screening (many have congenital heart defects, e.g: atrio-ventricular septal defect)
Vision
Hearing
Thyroid function (many develop hypothyroidism)
Sleep-related breathing disorders, e.g: sleep apnoea
Growth charts (are often short but tend to be overweight)
Development
Examples of specific developmental delays?
Motor delays:
• Duchenne Muscular Dystrophy (DMD)
• Cerebral palsy
• Coordination disorders
Language delays:
• Specific language impairment
Sensory deficits and assoc. delay:
• Oculocutaneous albinism, Treacher-Collins
Developmental deviation:
• Autism Spectrum Disorders
Features of DMD?
Development of a lordotic posture
+ve Gower’s manoeuvre indicates pelvic girdle weaakness; this is where the child has to push themselves up by moving hands all the way up their legs
Types of cerebral palsy?
Hemiplegic - arm and leg on one side
Paraplegic - both legs only
Diplegic - both legs with slight inv. elsewhere
Quadriplegic - both arms and both legs
Features of hemiplegia?
One side is completely/almost normal and the other has abnormalities:
• Arm bent with the hand spastic/floppy and often of little use
• Walking on tiptoe or outside of foot on the affected side
Features of paraplegia?
Upper body is usually normal or with very minor signs; may develop contractures of the ankles and feet
Features of quadriplegia?
When they walk, arms, head and even mouth twist strangely
Children with all 4 limbs affected often have such severe brain damage that they are never able to walk
Knees press together and legs and feet turn inwards
Conditions assoc. with cerebral palsy?
Mobility problems, spasticity and orthopaedic problems
Learning, communication, feeding difficulties
Behaviour and sleep problems
Epilepsy
Visual/hearing impairment
Cautions when considering visual impairment in those with complex disabilities?
Many have cerebral visual impairment so have a high a level of suspicion
Signs of visual impairment in cerebral palsy?
Photophobia
Rapid, involuntary eye movements
What is Treacher-Collins syndrome?
Autosomal dominant condition characterised by craniofacial deformities, inv. ears, eyes and cheekbones but their is normal intelligence
They have conductive hearing loss
What is the autistic triad?
Difficulties shared by all patients with autism:
• Communication
• Social interaction
• Flexibility of thought/imagination
Other problems that occur in the autistic triad?
Restricted, repetitive behaviours
Sensory difficulties
Describe receptive language in autistic patients
This is delayed (they tend to be better with expressive language)
They do not understand abstract language (idioms)
They are more visually able (pictures accompanying words)
Describe expressive language in autistic patients
This is also delayed and they tend to echo
They have an odd intonation/pitch
They can repeat chunks of video speak
Issues autistic patients have with non-verbal language?
Trouble with facial expressions and gestures
Trouble with eye contact
Trouble recognising the intentions of others
Issues autistic patients have with use of language?
INITIATING and SUSTAINING conversation
Restricted interests
Lack of awareness of reciprocal nature of conversation
Features in the social interaction of ASD patients?
Joint attention and referencing trouble (pointing and looking at the person to see if they know that they are pointing)
Turn-taking
Unable to share pleasure and they are not motivated by a need for social approval
Lack of empathy for point of view/feelings of others
Features in the flexibility of thought/imagination in ASD patients?
Have ritualistic behaviour and routines (repetition)
Trouble with changes in environment and the concept of time
Sensory issues in ASD?
Fussy with food and texture of clothing
Sleep, toilet-training, hair washing/cutting, nail cutting, noise abnormalities
Points of consider in a history of developmental delay?
- Presenting complaint
- PMH, peri-natal and birth
- FH and SH
- Developmental
- Play and behaviour
- School/nursery
Examination points in a child with developmental delay?
observations
Dysmorphism (difference of body structure, often with a very long face; this is more recognisable as the patient grows up)
Head circumference
Vision, hearing, CNS
Ix of developmental delay?
Karyotyping, FRAX (for Fragile X syndrome), oligoarray CGH
Neonatal PKU (phenylketonuria), TFTs and CK
If indicated, consider MRI brain, EEG, metabolic studies, genetic consultation, etc
How to assess development?
Use an appropriate assessment tool: • Griffiths (0-8yrs) • Bayleys (0-3yrs) • Schedule of Growing Skills (0-5yrs) • ADOS (ASD)
Principles of intervention with developmental delay?
Aim for early intervention (physio, speech and language therapy, etc)
