Approach to the Child with Developmental Delay Flashcards
what is developmental delay?
failure to attain appropriate developmental milestone for child’s corrected chronological age
what are the 3 patterns of abnormal development?
delay (global - eg down’s syndrome/specific - e.g duchenne muscular dystrophy)
deviation (e.g autistic spectrum)
regression = loss of skills which were once present (e.g Rett’s syndrome, metabolic disorders)
what IQ range defines a mild learning disability?
50-70
what IQ range defines a severe learning difficulty or intellectual disability?
<50
what are the red flags for development?
asymmetry of movement (normal hand dominance is normal, only a problem if neglect of one side)
not reaching for objects by 6 months
unable to sit unsupported by 12 months
unable to walk by 18 months (check CK - looks for muscular dystrophy)
no speech by 18 months
concerns re vision or hearing
loss of skills
what is a global developmental delay?
significant delay in 2+ of
- gross/fine motor, speech/language
- cognition, social/personal, ADL
termed learning disability in school age
what causes a global developmental delay?
5-25% are genetic
in what areas are down’s syndrome children screened?
cardiac vision (often have trouble moving from distance to close up vision) hearing thyroid function sleep related breathing disorders growth-charts development
why is the term “developmental delay” somewhat inappropriate for down’s syndrome?
implies that they will catch up
this is not the case in down’s syndrome as the gap in development and IQ etc will actually widen between the child and their normally developing peers
what are the 4 groups of specific developmental delays?
motor delays (muscular dystrophy, cerebral palsy, coordination disorders- e.g dyspraxia) language delays sensory deficits and associated delays (treacher-collins, oculocutaneous albinism) developmental deviations (autistic spectrum)
how is duchenne muscular dystrophy inherited?
X linked
how is duchenne muscular dystrophy characterised?
increased arching of the back as child gets older to compensate for weak pelvic muscles
bulky calves = pseudohypertrophy - muscles replaced by fibrous tissue
gower’s manoeuvre (walking up legs)
what are the 3 types of cerebral palsy?
hemiplegic (one side effected)
diplegic (both legs affected - caused by prematurity/injury to foetus if mother has trauma, most common type)
quadriplegic (both arms and legs affected)
what causes most cases of cerebral palsy?
antenatal injury
what conditions are associated with cerebral palsy?
mobility problems - spasticity and orthopaedic problems learning difficulties epilepsy visual/hearing impairment communication difficulties feeding difficulties sleep problems behaviour problems
what can cause hearing impairment?
bilateral middle ear effusions (“glue ear”)
sensory neuro (damage to auditory nerve)
treacher collins
what is the autistic triad of impairment?
communication
social interaction
flexibility of though/imagination (struggle to put themselves in other people’s shoes)
what other 2 behaviours are common in autistic spectrum disorders?
restricted, repetitive behaviours
sensory difficulties
how is receptive language affected in ASD?
delayed expressive > receptive abstract language is difficult find it more difficult to talk about things they cant actually see, touch etc visually more able
how is expressive language affected in ASD?
delayed
echoes (copy speech of others)
odd intonation/pitch
chunks of video speak
how is non-verbal language affected in ASD?
facial expressions, gestures
expect others to just know what they want/need without having to tell them - can get frustrated
trouble with eye contact
trouble recognising intention of others
how is use of language affected in ASD?
initiating and sustaining conversation
restricted interests - only interesting to them and want to talk about it
lack of awareness of reciprocal nature of conversation (don’t understand that one person talks, then stops to let the other person talk)
how is social interaction affected in ASD?
joint attention and referencing cant understand turn taking unable to share pleasure not motivated by need for social approval (some are, but cant understand why socialising is going wrong) social rules empathy relationships others point of view/feelings
how is flexibility of though/imagination affected in ASD?
theory of mind (think that others should know what they know and think what they think)
concrete and literal (take all language very literally)
concept of time
routines
struggle with changes in environment (sensitive to sensory changes)
ritualistic behaviour
what sensory issues are present in ASD?
fussy eater/medications texture of clothes sleep - can need specific environment toilet training hair washing/cutting nail cutting noise (can be fine if they are making the noise as they are in control of it - only if others are making the noise) can be under or overly sensitive
what is the general approach to developmental delay?
history
exam
investigations
assessment
important aspects of history?
PMH perinatal and birth family and social developmental play and behaviour school/nursery
what are the 2 types of hearing impairment?
sensorineural
conductive
how is developmental delay investigated?
chromosomes, FRAX and oligoarray CGH neonatal PKU, thyroid studies, CK if indicated - MRI - EEG - metabolic studies - genetic consultation - others
what assessment tools can be used for developmental assessment?
Griffiths (0-8 yrs)
Bayleys (0-3)
schedule of growing skills (0-5)
ADOS (ASD)
