Approach to the child with developmental delay(s) Flashcards
Define what is meant by developmental delay ?
Failure to attain appropriate developmental milestones for child’s corrected chronological age.
What are the different patterns of abnormal development ?
Can be:
- Delay - can be specific or global
- Deviation eg Autism Spectrum Disorder
- Regression (loss of skills) - eg Rett’s Syndrome, Metabolic Disorders
Disorders for development are common - T/F?
True
What is retts syndrome ?
A rare genetic disorder that affects brain development, resulting in severe mental and physical disability.
Described in 4 main stages:
- Stage 1 - a rare genetic disorder that affects brain development, resulting in severe mental and physical disability. Development then slows down or stops altogether.
- Stage 2 - Child starts to lose some of their abilities. Child will gradually or suddenly start to develop severe problems with communication and language, memory, hand use, mobility, co-ordination and other brain functions.
- Stage 3 - plateau During stage three, some of the problems that occurred at stage two may get better – for example, there may be improvements in behaviour, with less irritability and crying.
- Stage 4 - deterioration in movement e.g. development of spinal curve, muscle weakness and spascicity, losing the ability to walk
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 re vision or hearing
- Loss of skills
What is meant by global developmental delay ?
Significant delay in 2+ of:
- Gross/fine motor, speech/language,
- Cognition, social/personal, ADL (activities of daily life e.g. dressing themselves)
What are some of the medical screening tests that should be carried out in downs syndrome kids ?
- Cardiac
- Vision
- Hearing
- Thyroid function
- Sleep related breathing disorders
- Growth- charts
- Development
What are the ranges for classification of severity of learning disabilities ?
- Normal range is broadly IQ 70 and above
- Mild learning disability: IQ 50-70
- Severe learning disability: IQ 20-50
- Profound learning disability: IQ < 20
Appreciate some of the causes of different developmental delays
Motor Delays:
- eg Duchenne Muscular Dystrophy, Cerebral Palsy, Co-ordination disorders
Language Delays:
- eg Specific Language Impairment
Sensory Deficits and Associated Delay:
- eg Oculocutaneous Albinism, Treacher-Collins
Developmental Deviations:
- eg Autism Spectrum disorders
Name the manoeuvre the kid is doing and the condition it is associated with
Gowers manoeuvre - associated with duchennes muscular dystrophy
Appreciate the different severities and characteristic appearances of cerebral palsy
What are some of the conditions (signs) of cerebral palsy?
- Mobility problems, spasticity and orthopaedic problems
- Learning difficulties
- Epilepsy
- Visual/Hearing impairment
- Communication difficulties
- Feeding difficulties
- Sleep problems
- Behaviour problems
Appreciate this point about visual impairment
Sometimes the potential for VI is not so obvious however, and we need to remember that at least 50% of VI is Cerebral Visual Impairment, seen in children with more complex disabilities, who are unable to clearly tell us what they are seeing.
Conditions such as hydrocephalus and cerebral palsy are often associated with CVI, as the visual tracts are often affected, along with the motor tracts. We therefore need to have a high level of suspicion in children with complex disability, along with innovative ways of assessing their functional vision.
What is the autism triad of impairments ?
- Communication impairment
- Social interaction impairment
- Flexibility of thought/ Imagination impairment
What are some of the signs of autisim seen in pre-school children ?
Spoken language:
- delayed speech development (for example, speaking less than 50 different words by the age of two), or not speaking at all
- frequent repetition of set words and phrases
- speech that sounds very monotonous or flat
- preferring to communicate using single words, despite being able to speak in sentences
- Responding to others
- not responding to their name being called, despite having normal hearing
- rejecting cuddles initiated by a parent or carer (although they may initiate cuddles themselves)
- reacting unusually negatively when asked to do something by someone else
Interacting with others:
- not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal space
- little interest in interacting with other people, including children of a similar age
- not enjoying situations that most children of their age like, such as birthday parties
- preferring to play alone, rather than asking others to play with them
- rarely using gestures or facial expressions when communicating
- avoiding eye contact
Behaviour:
- having repetitive movements, such as flapping their hands, rocking back and forth, or flicking their fingers
- playing with toys in a repetitive and unimaginative way, such as lining blocks up in order of size or colour, rather than using them to build something
- preferring to have a familiar routine and getting very upset if there are changes to this routine
- having a strong like or dislike of certain foods based on the texture or colour of the food as much as the taste
- unusual sensory interests – for example, children with ASD may sniff toys, objects or people inappropriately
