Child Development Flashcards
Red Flag - can’t sit at___
9 mo
Red Flag - can’t walk by ____
18 mo
Red Flag - no pincer grasp by ____
12 mo
Red Flag - hand dominance at
<18mo
Red Flag - no response to name by ____
12 mo
Red flag - <15 words by ___
18 mo
Red Flag - no two word sentences at
2 years
Red Flag - no pretend play by
3 years
Red flag – does not point to desired object by ___
15 mo
Other general red flag
regression at any age
Developmental Hx
med hx, prenatal diet sleep hearing, vision seizures milestones famhx soc hx corroboration - teachers, etc
Developmental physical exam
growth (HC, wt, ht)
full exam
esp: neuro, dysmorphic features, neurocutaneous signs
developmental observation
Developmental Disorder - DDx / categories
- motor: CNS (e.g. CP), PNS (e.g. MD), developmetnal coordination disorder
- language: oromotor anatomy, hearing impairment, language disorder, ASD
- emotional/social: ASD, neglect, social communication disorder
- if 2+ areas: global developmental delay (language, social, cognitive, motor (fine, gross))
Developmental disorder w/u
- hearing, vision
- genetic syndromes potentially
- MRI head (if neuro findings, seizures, macro/microcephaly)
- metabolic testing
- EEG if ?seizures
- lead + iron studies possibly
- TSH
Autism Spectrum Disorder - diagnostic criteria
A criteria (persistent + multiple contexts):
- deficit in social-emotional reciprocity, affect, fail to initiate/respond
- deficit in non-verbal communication
- deficit in relationships
B restrictive behaviours
- repetitive motions / speech
- insistence on routine
- restricted + fixed interests
- hyper or hypo-reactivity to sensory input
Present early in development, cause impairment, not explained by ID or GDD
If co-occur with ID, ASD social communication is below expected for IQ
ASD risk factors
- genetic, epigenetic, environment
- males
- sibling /w autism
- advanced paternal age
- downs, NFT, tuberous sclerosis, fragile X, angelman, rett syndrome
- prematurity, low BW
ASD w/u and diagnosis
- screen: 18-24mo
- M-CHAT-R, ADOS-2
- DSM5 to dx
- speech, OT, maybe psych assessments
- chromosome microarray + fragile X testing
- hearing test if speech delay
- +/- genetic test, MRI, EEG, metabolic test, CBC, TSH, lead
- psychoeducational testing for school
ASD management
- early multi-D intervention
- applied behavioural analysis therapy
- SLP, OT, behaviour support
- meds if refractory aggression
- social skills + vocational training
Cerebral Palsy Description / types
non-progressive movement disorder from peri-natal brain injury. Hypertonia.
types:
- spastic (uni or bilat)
- ataxic
- dyskinetic (dystonic or choreoathetosis - kernicterus)
investigations for CP
MRI
**vision + hearing **
EEG if seizures
coagulopathy profile if hemiplegic
metabolic + genetic testing NOT routine
CP management
physio, OT, speech therapy
hypertonia: botox, diazepam, dantrolene, baclofen, tizanidine
intrathecal baclofen pump
surgery: contractures, neuro (dorsal rhizotomy)
CP possible associations
speech delay ID LD hearing + vision issues seizures feeding/swallowing constipation
Global developmental delay definition
delay in 2 domains (motor, speech/language, cognition, social, ADLs)
only for kids <5, may become ID when older
Global Dev Delay w/u
chromosome microarray + fragile X basic metabolic testing hearing + vision others based on physical: EEG, lead, iron, genetics consult MRI if neuro, seizures, abnormal HC
Intellectual Disability criteria
3 criteria (meets all)
- deficit in intellectual functioning (reasoning, problem solving, planning, etc) by clinically + testing
- deficit in adaptive functioning (independence, ADLs, social role)
- onset during developmental period
mild, mod, severe, profound levels (based on adaptive function)
diagnosed by psychologist
FASD criteria
Can be either
with sentinel features
- (all 3) smooth philtrum, thin lip, short palpebral fissures
- prenatal EtoH confirmed or unknown AND
- evidence of impairment in 2+ neurodev domains OR microcephaly if infant
without sentinel features
- impaired in 3+ neurodev domains AND
- confirmed prenatal EtOH
associated defects: CHD, cleft palate, hearing loss, renal, eye
high risk of mental illness, criminality, peer issues
Learning Disabilities - diagnostic criteria
4 criteria
- learning difficulty in 1+ area (word reading, comprehension, writing, numbers, math reasoning)
- academics below grade level
- begin in school years
- not explained by ID, hearing/vision, psychosocial, psych
Co-occurs: ADHD, ASD, anxiety, dev coordination
2 months
- raises chin briefly when prone
- coos / sounds
- social smile
- follows movement with eyes
3 months
- head control
- hand regard
4 months
- rolls to supine
- hold object briefly if put in hand
- reach for midline objects
- turn head to sound
- excited reaction to people
6 months
- sits tripod / briefly
- transfer objects hand to hand
- babbles
- stranger anxiety
9 months
- sits well
- crawl/shuffle
- pull to stand
- stand /w support
- pincer grasp
- points
- raises arms to be picked up
- object permanence
- social games (peek a boo)
- separation anxiety
- seeks joint attention
12 months
- stands with support
- walks while holding on
- holds cup to drink
- cubes into cup / release
- first word, up to 3 words
- follows simple command
- responds to name
15 months
- walks without support
- self feed finger foods
- imitates, scribbles
18 months
- runs stiffly
- stoop + recover
- eat /w spoon
- 10+ words
- three body parts
- eye contact, affection
2 years
- upstairs 1 at a time
- draws lines, circular stroke
- 50% intelligble
- 2 step directions
- says 50+ words
- temper tantrums
- parallel + pretend play
3 years
- tricycle
- copy circle
- 3-4 word sentence
- 75% intelligble
- recognizes colours
- toilet training
- make-believe / role play
4 years
- stairs alternating feet
- hop on 1 foot
- buttons / zippers
- dresses with help
- copies a cross
- sings nursery rhymes
- 100% intelligible
- toilet trained at day
5 years
- ride bike
- copies square / triangle
- full sentences
- counts to 10, tell story
- group play
- separate easily
