Children with Special Needs Flashcards
What is child development?
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
what are the Features of normal development?
A constant pattern
Sequential acquisition of skills
Median age vs limit age
Genetic factors
Environmental influences
what is developmental delay?
‘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’
Global developmental delay when 2 or more domains are affected
what is classed as a Global developmental delay (GDD)?
Performance below 2SD below mean of age-appropriate, norm-referenced testing
what is alerning 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 do they 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 is a Assessment of development done?
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 Primary care assessment tools?
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 Quantification of Developmental abilities?
All areas of development are age appropriate
Delay: Global (across 2 or more domains) or isolated
Disorder: Abnormal progression and presentation eg Autism
Regression: loss of milestones
what is Schedule of growing skills (SOGS)?
Information of child’s development across a range of areas
0-5 years
9 key areas
Separate cognitive score can be derived
what information should be gathered in a 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
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 (can cause developmental delay)
what do you want to do on 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 some common syndromes?
William: 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
what are some Red flag signs: Positive
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 some Red flag signs: Negative
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
how is investigaiton done?
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
what are Common problems affecting motor, sensory, lamguage/cognition and social/communication
why investigate?
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
The multidisciplinary approach - who should be involved?
Developmental paediatrician
Speech and Language therapist
OT/ PT: functional impairments and strengths
Psychologist
Social worker
Geneticist
what are some possible effects on a family?
Emotional
Social isolation
Financial implications
Implication for siblings
Wider family
what are the possible signs of cerebal palsy in a child
delays in reaching development milestones – for example, not sitting by 8 months or not walking by 18 months
seeming too stiff or too floppy (hypotonia)
weak arms or legs
fidgety, jerky or clumsy movements
random, uncontrolled movements
muscle spasms
shaking hands (tremors)
walking on tiptoes
The severity of symptoms varies significantly from child to child.
The parts of the body affected can also vary. Sometimes only one side of the body is affected, sometimes the whole body is affected, and sometimes mainly the legs are affected.
what is the Evaluation of 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 Local services for developmental problems is there?
Community paediatric clinics
Child development teams
Multidisciplinary assessment
Therapy services
what is Additional Support Needs?
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
Why ASL? Additional Support for Learning
“To ensure the development of the personality, talents and mental and physical abilities of that child or young person to their fullest potential.”
A child or young person may need additional support for a number of different reasons, for example what?
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
what is Personal learning planning (PLP)?
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 a Individualised Educational Plan (IEP)
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
what is a Co-ordinated Support Plan (CSP)?
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
GIRFEC appraoch, Childs Plan - what is it?
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
What does the Long term outlook depend on?
Depends on nature of the problem
Acquisition of skills
Social and emotional needs
Personal attributes, family, social surroundings and level of care received
