child development and special needs Flashcards
what is developmental delay
present when functional aspects of the child’s development in one or more domains are significantly delayed compared to the expected level for age
what is global developmental delay
performance below 2SD below mean of age appropriate, norm referenced testing
what is a learning disability
significant impairment in intellectual functioning and affects the person’s ability to learn and problem solve in their daily life
has nearly always been present since childhood
how common is GDD
1-3% of children
? potentially up to 16%
1% have an autism spectrum disorder
when is GDD identified
only 1/3 identified before school entrance
careful evaluation and investigation can reveal a cause in 50-70% of cases
presentation of GDD - when is it picked up
routine health surveillance
children w/ identified risk factors
parental concern
professional contact - nursery/daycare
opportunistic health contact
UK healthy child programme
assessment of development in children
- hx and examination
- prenatal, perinatal and postnatal events
- developmental milestones
- red book
- environmental, SHx, FHx
- video recordings of child
- observation
1y care assessment tools for development
ASQ - ages and stages questionnaire
PEDS - parents evaluation of developmental status
M-CHAT - checklist for autism in toddlers
SOGS-2 - schedule of growing skills
quantification of developmental abilities
areas of development are age appropriate?
- delay: global (2 or more domains) vs isolated
- disorder: abnormal progression and presentation e.g. autism
- regression: loss of milestones
schedule of growing skills
information of child’s development across a range of areas
0-5yrs
9 key areas
separate cognitive score can be derived
2y care assessment tools
Griffiths mental development scales
Bayley scales of infant development
Wechsler preschool and 1y scale of intelligence
things to remeber to include in hx
comprehensive
- FHx neurodevelopmental/genetic disorder
- hx miscarriages
- prenatal, perinatal, neonatal
- drug and alcohol use in pregnancy
- developmental, behavioural, social, educational hx
- medications
hx - further investigatinos
- results of prev metabolic/thyroid testing
- neuroimaging
- lead and iron screening
- growth records
- vision and hearing surveillance
- high index of suspicion for abuse and neglect
examination - what do we include
head circumference
dysmorphic features
skin abnormalities - neuro-cutaneous markers
movement quality
ability to sit and stand from supine
eye movements and eye examination
general examination: CVS, resp, abdo
observation of behaviour
sensory screening - how common are disorders
vision - 13-50%
hearing impairment - 18%
red flag signs - positive
loss of developmental skills
concerns re vision/hearing
floppiness
no speech by 18-24mths
asymmetry of movement
persistent toe walking
head circumference >99.6th C or <0.4th C
red flag signs - negative
sit unsupported by 12mths
walk by 18mths (M) or 24mths (F) - check CK
walk other than on tiptoes
run by 2.5yrs
hold objects in hand by 5mths
reach for objects by 6mths
points to objects to share interest by 2yrs
investigations - 3 important things to remember
based on clinical abnormalities
diagnostic yield of specific tests
timing
types of investigations
- genetic testing - chromosomal analysis, fragile X, FISH, array CGH
- CK
- thyroid screening
- metabolic testing: aa and organic acids, ammonia, lactate
- ophthalmological examination
- audiology assessment
- consider congenital infection e.g. toxoplasmosis, CMV
- neuroimaging
1st line investigations for GDD
following thorough hx and exam:
- chromosomes
- fragile X
- U+E
- CK
- lead
- TFT
- urate
- FBC
- ferritin
- biotinidase
2nd line investigations for GDD and when are they considered
metabolic: bloods (lactate, aa, ammonia, VLCFA, carnitine, homocysteine, disialotransferrin)
- FHx
- consanguinity
- regression
- organomegaly
- coarse features
neuroimaging: MRI, CT (bones, calcification)
- abnormal head size
- seizures
- focal neurology
EEG:
- speech regression, seizures, neurodegenerative disorder
genetics:
- dysmorphism
- abnormal growth
- sensory impairment
- odd behaviour
- FHx
common motor problems
delayed maturation
cerebral palsy
developmental coordination disorder
common sensory problems
deafness
visual impairment
multisensory impairment
common language/cognitive disorders
specific language impairment
learning disability
common social/communication problems
autism
asperger syndrome
elective mutism
why is it important to investigate
- family understanding of condition and prognosis
- lessens parental blame and address concerns re causes
- prevents co-morbidity by identify preventable factors
- genetic counselling
- support
- potential treatment
MDT approach
developmental paediatrician
SLT
OT/PT
psychologist
social worker
geneticist
what are additional support needs
when a child needs additional support with their education
can mean any kind of educational provision that is more than/very different from the education that is normally provided in mainstream schools
why might a child required additional support
may be multiple different reasons:
- difficulties w/ mainstream approaches to learning
- disabiility/health needs e.g. motor/sensory impairment, learning difficulties, ASD
- family circumstances e.g. young people who are parents/carers
what is personal learning planning
a way of thinking about, talking about and planning what and how a child learns
also a way of assessing their progress and acting on the results of that assessment
what is an individualised educational plan (IEP)
- detailed plan for the child’s learning
- specific, short-term learning targets for the child and will set out how the targets will be reached
- targets are: specific, measurable, achievable, relevant, timed
- aka additional support plans, individual support plans
- not a legal document
what is a co-ordinated support plan (CSP)
- detailed plan of how child’s support will be provided
- legal document - aims to ensure all professionals helping the child work together
- helps ensure everyone (incl parents and child) if fully involved in the support
when is a CSP put in place
- for children in local authority school education and needing significant additional support
- complex/multiple needs, needs likely to continue >1yr
- support required by >1 agency
what is GIRFEC
getting it right for every child
- many children will now have a child’s plan
when is a child’s plan created
if a child/young person needs some extra support to meet their wellbeing needs
e.g. access to mental health services, respite care, help from a range of different agencies
what does the child’s plan contain information about
- why a child/young person needs support
- the type of support they will need
- how long they will need support and who should provide it
- all professionals working with the child would use the plan, which may include an IEP or CSP
what does the long term outlook of a developmental condition depend on
nature of the problem
acquisition of skills
social and emotional needs
personal attributes, family, social surroundings and level of care recieved
