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Paediatrics > Children with Special Needs > Flashcards

Children with Special Needs Flashcards

1
Q

What is child development?

A

The process by which each child evolves from infancy to adulthood

  • Gross motor skills
  • Fine motor skills
  • Speech and language
  • Social, personal, activities of daily living
  • Performance and cognition
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2
Q

What are the features of normal development?

A
  • A constant pattern

- Sequential acquisition of skills

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3
Q

What is normal development influenced by?

A
  • Genetic factors

- Environmental factors

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4
Q

What is median age?

A

The age by which half the population of children have acquired that skill.

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5
Q

What is limit age?

A

The skill should have been acquired by this and is 2SD from the mean

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6
Q

What do genetic factors determine?

A

The fundamental developmental potential

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7
Q

What is developmental delay?

A

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

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8
Q

What is global developmental delay?

A
  • Performance below 2SD below mean of age-appropriate, norm-referenced testing
  • A significant delay in 2 or more of the developmental domains
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9
Q

What is a learning disability?

A

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.

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10
Q

What is the scope of special needs?

A
  • GDD: 1-3% of children
  • 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
  • Early intervention has long term benefits
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11
Q

How does a child present with a learning difficulty or developmental delay?

A
  • Routine health surveillance
  • Children with identified risk factors
  • Parental concern
  • Professional contact: nursery/ daycare
  • Opportunistic health contact
  • The UK Healthy Child programme (HCP)
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12
Q

How is development assessed?

A
  • 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
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13
Q

What primary care tools are used in the assessment of children?

A
  • ASQ (ages and stages questionnaire)
  • PEDS (Parents evaluation of developmental status)
  • M-CHAT (Checklist for autism in toddlers)
  • SOGS-2 (Schedule of Growing Skills)
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14
Q

How can developmental abilities by quantified?

A
  • All areas of development are age appropriate
  • Delay: Global or isolated
  • Disorder: Abnormal progression and presentation eg Autism
  • Regression: loss of milestones
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15
Q

What is SOGS?

A

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
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16
Q

What secondary care assessment tools are used in the assessment of children?

A
  • Griffiths mental development scales
  • Bayley scales of infant development
  • Wechsler preschool and primary scales of intelligence
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17
Q

What history should be obtained?

A
  • 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
  • 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
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18
Q

What examination should be carried out?

A
  • 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
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19
Q

Give examples of some common syndromes.

A
  • Down syndrome
  • Fragile X syndrome
  • William’s syndrome
20
Q

What may sensory screening identify?

A
  • Vision problems

- Hearing impairment

21
Q

What positive red flags are there?

A
  • 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
22
Q

What negative red flags are there?

A
  • 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
23
Q

How should children be investigated?

A
  • 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
24
Q

What are some common motor problems?

A
  • Delayed maturation
  • Cerebral palsy
  • Developmental coordination disorder
25
Q

What are some common language/cognitive problems?

A
  • Specific language impairment

- Learning disability

26
Q

What are some common sensory problems?

A
  • Deafness
  • Visual impairment
  • Multisensory impairment
27
Q

What are some common social/communication problems?

A
  • Autism
  • Asperger syndrome
  • Elective mutism
28
Q

Why do we investigate developmental delay?

A
  • The family gains understanding of the condition, including prognostic information
  • Lessens parental blame
  • Ameliorates or prevents co-morbidity by identifying factors likely to cause secondary disability that are potentially preventable
  • Appropriate genetic counselling
  • Accessing more support
  • Address concerns about possible causes e.g. events during pregnancy or delivery
  • Potential treatment for a few conditions
29
Q

What are the 3 components to breaking bad news?

A
  • Tact: bad news broken well minimises the tragedy
  • Timing: both parents together ASAP
  • Tenderness: show you care and empathise
30
Q

What are the stages in the process of receiving bad news?

A
  • Shock
  • Anger
  • Disbelief
  • Acceptance
31
Q

Who is involved in the MDT approach?

A
  • Developmental paediatrician
  • Speech and Language therapist
  • OT/ PT: functional impairments and strengths
  • Psychologist
  • Social worker
  • Geneticist
32
Q

What are the effects on the family following a diagnosis?

A
  • Emotional
  • Social isolation
  • Financial implications
  • Implication for siblings
  • Implications on wider family
33
Q

How are developmental problems evaluated?

A
  • Is there a problem?
  • Global or single field?
  • Delay, Disorder or Regression
  • Aetiology
  • Co-ordination of care and support
  • Problem based approach
34
Q

What local services are there for developmental problems?

A
  • Community paediatric clinics
  • Child development teams
  • Multidisciplinary assessment
  • Therapy services
35
Q

What does additional support needs mean?

A

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

36
Q

Who is said to have additional support needs

A

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

37
Q

Why may a child/young person need additional support?

A
  • Difficulties with mainstream approaches to learning
  • Disability or health needs, such as motor or sensory impairment, learning difficulties or autistic spectrum disorder.
  • Family circumstances e.g. young people who are carers or parents.
38
Q

What is personal learning planning?

A

Personal learning planning(PLP) is a 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.

39
Q

What is an individualised education plan?

A
  • 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.
  • In some areas these plans are called additional support plans or individual support plans
  • Not legal documents
40
Q

Targets in IEP are…

A
  • Specific
  • Measurable
  • Achievable
  • Relevant
  • Time specific
41
Q

What is a co-ordinated support plan?

A

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.

42
Q

Who are CSPs for?

A

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.

43
Q

What is a child’s plan?

A

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.

44
Q

What will a child’s plan contain?

A

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
45
Q

What does long term outlook depend on?

A
  • Nature of the problem
  • Acquisition of skills
  • Social and emotional needs
  • Personal attributes, family, social surroundings and level of care

Paediatrics (38 decks)

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