Approach to the child with developmental delay

Question 1

What is the definition of developmental delay?

Answer 1

Failure to attain appropriate developmental milestones for a child’s corrected chronological age

Question 2

Why may a chronological age be corrected?

Answer 2

If a baby is premature then the growth to normal must be accounted for

Question 3

What are the three patterns of abnormal development?

Answer 3

Delay
Deviation
Regression

Question 4

What are the 2 branches of delayed development?

Answer 4

Global

Specific

Question 5

What is an example of a global delay?

Answer 5

Down syndrome

Question 6

What is an example of specific delay?

Answer 6

Duchenne’s muscular dystrophy

Question 7

What is an example of a deviation development problem?

Answer 7

Autism spectrum disorder (ASD)

Question 8

What are 2 examples of regression development?

Answer 8

Loss of skills
Rett’s syndrome
Metabolic disorders

Question 9

What % of the UK child population have ASD?

Answer 9

1%

Question 10

What is a mild learning disability and what % of children have one?

Answer 10

IQ 50-70

1-2%

Question 11

What is a severe learning difficulty and what % have one?

Answer 11

IQ<50

Question 12

What are 3 examples of a specific learning difficulty and what % of children have one?

Answer 12

Dyslexia
Dyscalcuria
Dyspraxia

Question 13

What are 7 red flags for development?

Answer 13

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 re vision or hearing
Loss of skills

Question 14

What may be a concern when a child isn’t walking by 18 months and what should be checked?

Answer 14

Muscular Dystrophy
Check CK
(10x in DMD)

Question 15

How is a global development delay characterised?

Answer 15

Significant delay in 2+ of:

• Gross/fine motor
• Speech/language
• Cognition
• Social/personal
• Activities of daily living

Question 16

What accounts for 5-25% of global development delays?

Answer 16

Genetic causes

Question 17

What % of under 5s have a global developmental delay?

Answer 17

1-3%

Question 18

What 7 things are screened for in down syndrome?

Answer 18

Cardiac
Vision
Hearing
Thyroid function
Sleep related breathing disorders
Growth-charts
Development

Question 19

What are 3 examples of motor delays?

Answer 19

Duchenne MD
Cerebral palsy
Co-ordination disorders

Question 20

What are 2 examples of sensory deficits and associated delay?

Answer 20

Oculocutaneous albinism

Treacher-collins

Question 21

What are three variants of cerebral palsy?

Answer 21

Hemiplegic
Diplegic
Quadriplegic

Question 22

What does hemiplegic mean and what does this present with?

Answer 22

Only one side affected
Arm bent, hand spastic or floppy
Walks on tiptoe of foot

Question 23

What does diplegic mean and what does this present with?

Answer 23

Both legs affected only
Normal upper body
May develop contractures of the ankles or feet

Question 24

What does quadriplegic mean and what does this present with?

Answer 24

Both arms and legs
Arms head and mouth may twist strangely
Severe brain damage
Knees press together
legs and feet turned inwards

Question 25

What are 10 conditions associated with cerebral palsy?

Answer 25

``` Mobility problems Spasticity Orthopaedic problems Learning difficulties Epilepsy Visual/Hearing impairment Communication difficulties Feeding difficulties Sleep probelms Behaviour problems ```

Question 26

What is the autism triad?

Answer 26

Communication Social interaction Flexibility of thought/imagination

Question 27

How is receptive language affected in ASD?

Answer 27

Delayed Expressive>Receptive Abstract language difficult Visually more able

Question 28

How is expressive language affected in ASD?

Answer 28

Delayed Echoes Odd/intonation/pitch Chunks of video speak

Question 29

How is non-verbal language affected in ASD?

Answer 29

Facial expressions Gestures Eye contact Recognising intention of others

Question 30

How is use of language affected in ASD?

Answer 30

Initiating and sustaining conversation Restricted interests Lack of awareness of reciprocal nature of conversation

Question 31

How is social interaction affected in ASD?

Answer 31

``` Joint attention and referencing Turn taking Unable to share pleasure Not motivated by need for social approval Social rules Empathy Relationships Others point of view/feelings ```

Question 32

How is flexibility of thought/imagination affected in ASD?

Answer 32

``` Theory of mind Concrete and literal Concept of time Routines Changes in environment Ritualistic behaviour ```

Question 33

What are some sensory difficulties of ASD?

Answer 33

``` Fussy eater/medication texture of clothes Sleep Toilet training Hair washing/cutting Nail cutting Noise ```

Question 34

What are the 5 main points in the approach to developmental delay?

Answer 34

``` History Examination Investigations Assessments Intervention ```

Question 35

What are important aspects of the history?

Answer 35

``` Concerns PMH Perinatal and birth Family and social Developmental Play and behaviour School/nursey ```

Question 36

What are important aspects of the examination?

Answer 36

``` Observation Dysmorphism Head circumference Systems CNS (including neurocutaneous) Vision Hearing ```

Question 37

What are important investigations in developmental delay?

Answer 37

``` Chromosomes Fragile X Oligoarray CGH Neonatal PKU Thyroid studies CK ```

Question 38

What investigations can be done if indicated?

Answer 38

MRI brain EEG Metabolic studies Genetic consultation

Question 39

What are 4 assessment tools for assessing development?

Answer 39

griffiths (0-8yrs) Bayleys (0-3 yrs) Schedule of growing skills (0-5yrs) ADOS (ASD)

Question 40

What interventions can help a child with a developmental delay?

Answer 40

``` Early intervention Therapy -Physio -SLT -OT Family supprt Educational placemtn Referral to agencies ```