Children with special needs

Question 1

What is median age and limit age in term of normal development?

Answer 1

Median age-average age in which will acquire a skill

Limit age-youngest and oldest limits in which acquiring skill is normal

Question 2

How is development assessed?

Answer 2

In terms of developmental domains

Question 3

What is developmental delay?

Answer 3

‘Developmental delay is present when functional aspects of the child’s development in one or more domains (motor, language, cognitive, social, emotional) are significantly delayed compared to the expected level for age’

Question 4

Global developmental delay & learning disability can be used interchangeably: what do they both mean?

Answer 4

‘Global developmental delay’ (GDD)=Performance below 2SD below mean of age-appropriate, norm-referenced testing

A learning disability is a significant impairment in intellectual functioning and affects the person’s ability to learn and problem-solve in their daily life. It has nearly always been present since childhood.

Question 5

What primary care assessment tools are available for assessing development?

Answer 5

ASQ (ages and stages questionnaire)

PEDS (Parents evaluation of developmental status)

M-CHAT (Checklist for autism in toddlers)

SOGS-2 (Schedule of Growing Skills)-0-5years, 9 key areas, separate cog score can be derived

Question 6

How are developmental abilities quantified?

Answer 6

All areas of development are age appropriate

Delay: Global or isolated

Disorder: Abnormal progression and presentation eg Autism

Regression: loss of milestones

Question 7

What secondary care assessment tools can be used to assess development?

Answer 7

Griffiths mental development scales

Bayley scales of infant development

Wechsler preschool and primary scales of intelligence

Question 8

What is the most commonly used assessment tool?

Answer 8

SOGS-2 (Schedule of Growing Skills)-0-5years, 9 key areas, separate cog score can be derived

Question 9

What should be included in a comprehensive Hx?

Answer 9

Family h/o neurodevelopmental/ genetic disorder
H/O miscarriages
Prenatal, perinatal, neonatal course
Drugs and alcohol use in pregnancy
Developmental, behavioural, social and educational history
Record of medications

Question 10

If Hx taking presents any findings what should be done and looked at?

Answer 10

Results of previous metabolic/ thyroid testing

Neuroimaging

Lead and iron screening

Growth records

Vision and hearing surveillance

High index of suspicion for abuse and neglect

Question 11

What should be included in examination?

Answer 11

Head circumference (measure of brain growth)
Dysmorphic features
Skin abnormalities (neurocutaneous markers)
Movement quality
Ability to sit and stand from supine
Eye movements and eye examination
General examination: CVS, respiratory
Abdominal examination
Observation of behaviour

Question 12

What are some common syndromes?

Answer 12

Down Syndrome

Fragile X Syndrome (small pointed nose, prominent ears, large testicles)

William’s Syndrome
- high Ca levels in the blood & urine
- elfin facies, supravalvular AS, MR. The dysmorphic facial features consist of a broad forehead, medial eyebrow flare, strabismus, flat nasal bridge, malar flattening, a short nose with a long filtrum, full lips, and a wide mouth

Question 13

What are positive RED FLAG signs?

Answer 13

Loss of developmental skills
Concerns re vision
Concerns re hearing
Floppiness
No speech by 18-24 months
Asymmetry of movement
Persistent toe walking
Head circumference >99.6th C or < 0.4th C

Question 14

What are negative red flag signs?

Answer 14

Sit unsupported by 12 months

Walk by 18months (boys) or 2 years (girls): Check creatinine kinase.Walk other than on tiptoes

Run by 2.5 years

Hold objects in hand by 5 months

Reach for objects by 6 months

Points to objects to share interest by 2 years

Question 15

What investigations are done when delayed development is signified?

Answer 15

Based on clinical abnormalities
Diagnostic yield of specific tests
Timing

Genetic testing: chromosomal analysis, Fragile X, FISH, array CGH
Creatine kinase
Thyroid screening
Metabolic testing: amino and organic acids,Ammonia,Lactate.

Ophthalmological examination
Audiology assessment
Consider congenital infection
Neuroimaging

Question 16

What are common problems in each of these categories: Motor, sensory, language/cognitive & social/communication?

Answer 16

Motor:
Delayed maturation
Cerebral palsy
Developmental coordination disorder

Language/Cognitive:
Specific Language Impairment
Learning Disability

Sensory:
Deafness
Visual impairment
Multisensory impairment

Social/Communication:
Autism
Asperger syndrome
Elective mutism

Question 17

What should be discussed in a case of spastic diplegia characteristic of CP?

Answer 17

Motor development
Posture
Tone
Primitive reflexes
Diagnosis
Prognostic factors

Question 18

What are additional support needs?

Answer 18

A child or young person is said to have ‘additional support needs’ if they need additional support with their education.

Additional support can mean any kind of educational provision that is more than, or very different from, the education that is normally provided in mainstream schools

Question 19

What is personal learning planning (PLP)?

Answer 19

Way of thinking about, talking about and planning what and how a child learns. It’s also a way of assessing their progress and acting on the results of that assessment

Question 20

What is an IEP (Individualised educational plan)?

Answer 20

IEP is a detailed plan for a child’s learning. It contains some specific, short-term learning targets for the child and will set out how those targets will be reached.

Targets are:
Specific ● Measurable ● Achievable ● Relevant
● Timed.
In some areas these plans are called additional support plans or individual support plans.

Not a legal document.

Question 21

What is a coordinated support plan (CSP)?

Answer 21

A CSP is a detailed plan of how child’s support will be provided.

It is a LEGAL document and aims to ensure all the professionals who are helping the child, work together. It also helps ensure that everyone, including parents and the child, is fully involved in that support.

For children in local authority school education and needing significant additional support.

Complex or multiple needs

Needs likely to continue > 1 year

Support required by > 1 agency.

Question 22

What is the GIRFEC approach and what is included in Childs plan?

Answer 22

In line with the ‘Getting it right for every child’ (GIRFEC) approach, many children will now have a Child’s Plan. This is part of the Children and Young People Act that applies from Autumn 2016.

Child’s Plans are created if a child or young person needs some extra support to meet their wellbeing needs such as access to mental health services or respite care, or help from a range of different agencies.

The Child’s Plan will contain information about:
● why a child or 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 a CSP

Question 23

What does long term outlook depend on?

Answer 23

Depends on nature of the problem

Acquisition of skills

Social and emotional needs

Personal attributes, family, social surroundings and level of care received