Children with Special Needs Flashcards
What is child development?
The process by which each child evolves from infancy to adulthood
Includes development of: Gross motor skills Fine motor skills Speech and Language Social, Personal, Activities of Daily living Performance and Cognition
By what age does the majority of brain development occur?
5
What are the features of normal development?
A constant pattern Sequential acquisition of skills Median age vs limit age Genetic factors Environmental influences
Median age - the age at which half the population…
What constitutes a significant developmental delay?
Greater than 2 SD from population means
What constitutes global developmental delay?
When 2 or more domains are affected
What is a 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
How may a childhood disability present?
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 child development be assessed?
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 the primary 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)
What is SOGS-2?
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 must you ask parents about in developmental history?
Comprehensive
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
What past evidence may be useful in history?
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
What do you examine for when assessing development?
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 some common syndromes that may cause developmental abnormalities?
Down syndrome
Fragile X syndrome
William’s syndrome
What percentage of vision and hearing issues are picked up in sensory screening?
Vision disorders: 13-50%
Hearing impairment: 18%
What are red flag signs?
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 are positive signs?
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
What investigations can be carried out when concerned about developmental delay?
Based on clinical abnormalities Diagnostic yield of specific tests Timing Genetic testing: chromosomal analysis, Fragile X, FISH, array CGH Creatine kinase (dystrophy) Thyroid screening Metabolic testing: amino and organic acids, Ammonia, Lactat Ophthalmological examination Audiology assessment Consider congenital infection Neuroimaging
What are the first line investigations if history and examination do not provide diagnosis?
Chromosomes Fragile X U and E Creatine kinase Lead Thyroid function Urate Full blood count Ferritin Biotinidase
What are some common motor problems?
Delayed maturation
Cerebral palsy
Developmental coordination disorder
What are some common sensory problems?
Deafness
Visual impairment
Multisensory impairment
What are some common language/cognitive problems?
Specific Language Impairment
Learning Disability
What are some common social/communication problems?
Autism
Asperger syndrome
Elective mutism
How can you 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
What are additional support needs?
If they need additional support with their education
What is PLP?
Personal learning planning 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
What is IEP?
Individualised Educational Plane 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
What is a CSP?
A Co-ordinated Support Plan 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
What is the GIRFEC approach?
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
