Children with Special Needs Flashcards
What is child development?
The process by which each child evolves from infancy to adulthood
What are features of normal development?
- A constant pattern
- Sequential acquisition of skills
- Median age vs limit age
- limit age, skill should have been acquired and is 2 SD from the mean
- Genetic factors
- Environmental influences
What are some normal developmental milestones?
- Gross motor skills
- Fine motor skills
- Speech and Language
- Social, Personal, Activities of Daily living
- Performance and Cognition
What is 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.
What is criteria for developmental delay?
- ‘Global developmental delay’ (GDD)
- Performance below 2SD below mean of age-appropriate, norm-referenced testing
- GDD vs Learning disability
- 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.
What is the epidemiology of GDD?
- GDD: 1-3% of children (? Upto 16%…)
- 1% have an autistic spectrum disorder
- Only 1/3 identified before school entrance
- Careful evaluation and investigation can reveal a cause in 50-70% of cases.
How do we detect these children?
- Routine health surveillance
- Children with identified risk factors
- Parental concern
- Professional contact: nursery/ daycare
- Opportunistic health contact
- The UK Healthy Child programme (HCP)
How can we assess development?
- History and examination
- Prenatal, perinatal, postnatal events
- Developmental milestones
- The ‘Red Book’
- Environmental, social and family history
- Video recordings of child
- Observation in clinic / other settings
What are some of our primary care assessment tools for assessing 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)a
What is SOGS?
Schedule of growing skills
- Information of child’s development across a range of areas
- 0-5 years
- 9 key areas
- Separate cognitive score can be derived
What are some secondary care assessment tools?
- Griffiths mental development scales
- Bayley scales of infant development
- Wechsler preschool and primary scales of intelligence
What do we need to include in the history?
- Comprehensive
- FH
- H/O misscarriage
- Prenatal, perinatal, neonatal course
- Drugs/bevvies during pregnancy
- Developmental, behavioural, social and educational history
- Record of medications
- Results of previous thyroid testing
- Neuroimaging
- Lead/iron screening
- Growth records
- Vision/hearing surveillance
- High index suspicion for abuse/neglect
What is included in examination?
- Head circumference
- Dysmorphic features
- Skin abnormalities
- Movement quality
- Ability to sit and stand from supine
- Eye movements and eye examination
- General examination: CVS, Respiratory
- Abdominal examination
- Observation of behaviour
What are common syndromes?
- Down syndrome
- Fragile X syndrome
- William’s syndrome
What sensory screening do we use?
- Vision disorders: 13-50%
- Hearing impairment: 18%
What positive red flag signs do we use?
- 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
What negative red flags do we use?
- Sit unsupported by 12 months
- Walk by 18months (boys) or 2 years (girls): Check creatinine inase
- 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
Ix for developmental probs?
- 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,NH4,Lactate.
- Ophthalmological examination
- Audiology assessment
- Consider congenital infection
- Neuroimaging
Common motor problems?
- Delayed maturation
- Cerebral palsy
- Developmental coordination disorder
Common sensory problems?
- Deafness
- Visual impairment
- Multisensory impairment
Common language problems?
- Specific Language Impairment
- Learning Disabilitya
Common social/communication problems?
- Autism
- Asperger syndrome
- Elective mutism
How do we break the bad news?
Tact, Timing, Tenderness
Bad news broken well minimises the tragedy (Tact), badly broken compounds it.
Timing: both parents together ASAP ( as soon as diagnosis probable, not wait till confirmatory test).
We have a duty to do no harm, misplaced worry can do harm.
Tenderness: the way you tell parents. Show you care and empathise but be careful not to go overboard.
How do we evaluate developmental problems?
- Is there a problem?
- Global or single field?
- Delay, Disorder or Regression
- Aetiology
- Co-ordination of care and support
- Problem based approach
