Community - developmental Flashcards

1
Q

Diagnostic criteria for Autism spectrum disorder

A

Persistent deficits in social communication and social interaction:

  • deficit in social-emotional reciprocity (normal back-and forth conversation; no sharing of interests, emotions)
  • deficits in non-verbal communication (eye contact, understanding gestures, lack of facial expressions)
  • deficits in developing, understanding and maintaining relationships (making friends; no imaginative play :(

Restricted, reptetitive patterns of behavior, interests, activities, manifested by 2 of the following:

  • Stereotyped or repetitive motor movements, use of objects, or speech
  • Inflexible adherence to routines, wanting sameness (taking same route everyday etc)
  • highly restricted, fixated interests
  • hyper or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (eg. sounds, lights, movements)

Symptoms must be present in early development. May not fully manifest until later

Symptoms cause clinically significant impairment in social, occupational, or other important areas

Intellectual disability or global developmental delay is not a better explanation of symptoms (although often co-exists)

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2
Q

3 main aspects of autism spectrum disorder + co-morbidities

A
Impaired Social Interaction:
Does not seek comfort or share pleasure
No interest in others
Gaze avoidance
No appreciatetion of feelings
Speech and Language Disorder

Delayed development:
Limited use of gestures/facial expression
Monotone voice
Echoes Qs & repeats instructions

Imposition of routings/Ritualistic Behaviour:
Violent tantrums if disrupted
Unusual movements (e.g hand flapping, tiptoe gait)
Concrete play
No imagination

Co-Morbidities:
General learning difficulties (2/3)
Seizures (1/4)

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3
Q

Gross motor developmental milestones 0-6 months

A

Rolls over front to back and back to front

Sits with support and then independently

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4
Q

Gross motor developmental milestones 6-12 months

A

crawls forward on belly
Sit without support (6months)

9 months:
Straight back sitting
Stands holding on

12months:
stands independently
walks alone (worry at 18 months)

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5
Q

Gross motor developmental milestones 18 months

A

Sits, crawls, walks
Jumps

Still has wide gait but walking/running less clumsy

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6
Q

Gross motor developmental milestones 2 years

A

Running

Picks up toys

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7
Q

Gross motor developmental milestones 3 years

A

Hops on one foot
Walks up and down stairs alternating feet
Jumps in place with feet together

TIP-TOE walking

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8
Q

Gross motor developmental milestones 4 years

A

Stand on 1 foot (5 sec)
Kick ball
Hop on one foot

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9
Q

Gross motor developmental milestones 5 years

A

Walk heel to toe (3 steps)

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10
Q

brief neurological examination in an infant for motor skills

A

Observe posture and movement of limbs
Note tone when picking infant up (eg. floppy or stiff)

If there is a neurological problem, do a detailed examination

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11
Q

Observing patterns of movement in a child (motor neuro)

A

Walking and running

Toe-heel pattern:
Toe walkers may suggest pyramidal tract dysfunction, although often idiopathic

Foot drop (superficial peroneal nerve lesion)
Tight tendon Achilles (neuromuscular disease or myopathy (weakness))

Broad-based gait may be immature (in toddler) or cerebellar disorder

Proximal muscle weakness around hip girdle can cause waddling gait
Rotation of hips in DMD while walking (proximal weakness.. also Gower’s sign)

Observe standing from lying down supine: up to 3 years, it is normal to turn prone. Later it indicated neuromuscular weakness (DMD) or low tone
Climbing up the leg is Gower’s sign

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12
Q

Pattern or movement in extrapyramidal lesions

A

Fluctuating tone.. Difficulty initiating or involuntary movemetns

Look for asymmetry

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13
Q

Assess coordination in a child

A

Finger-nose testing (use teddy if necessary)
Touching tip of each finger with thumb
Asking child to walk heel-toe, hump and hop

Ask child to hold out arm and then close eyes: observe for drift or tremor (looks for asymmetry, position sense, neglect of one side)

Fogg’s test: ask to walk on heels, then outside, then inside of sole - watch for pattern of abnormal movement in upper limb

Observe running

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14
Q

Inspect the limbs of a child (neuromuscular)

A

Muscle bulk: (wasting secondary to CP, meningomyocele, muscle disorder)
Increased bulk of calf muscle may indicate DMD

Muscle tone:
Take the whole weight and then bend and extend around single joint. Ankle and knee is easiest

Spasticity (increased tone) in adductors and internal rotators of the hip, clonus at ankles is PYRAMIDAL dysfunction (characteristic postures). Velocity dependent.

In extra-pyramidal, there is lead-pipe rigidity (movement meets same resistance in both directions). No characteristic postures. Not-velocity dependent. Can be with Tremor (cogwheel)

Typical postures:
Scissoring of legs, pronated forearms, fisting, extended legs all suggest HYPERTONIA

Frog-like sitting posture suggests hypotonua

Truncal tone:
Extensor posturing in extra-pyramidal tract disorders (trunk and head arch backwards)
In muscle disease and central brain disorders, trunk may be hypotonic (feels floppy and cannot support trunk in sitting)

HEAD-LEG: best test
Pulling the child up by the arms from supine (see for delayed flexion at neck)

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15
Q

test muscle power in a child

A

difficult in babies
watch for antigravity movement

From 6 months onwards, watch pattern of mobility and gait. Watch standing up from lying and climbing stairs.

From 4 years, power can be tested formally against gravity and resistance. First proximal, then distal. Comparing sides

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16
Q

Test reflexes in a child

A

Test in a relaxed position and demonstrate on a parent or toy first

Brisk reflex = anxiety or pyramidal disorder

Absent = neuromuscular problem or lesion within spinal cord

Children can be asked for reinforcing methods

Plantar response is unreliable below 1 year of age. Provide evidence of pyramidal dysfunction

17
Q

Test sensation in children (neuromuscular)

A

Testing ability to withdraw from tickle is usually adequate

Loss of sensation with meningomyocele or spinallesion (eg. transverse myelitis)

Palpable bladder in spinal and cauda equina (+ absent perineal sensation)

18
Q

Testing of cranial nerves in children

A

I - not routine
II - acuity. Direct and consensual pupillary response to light + accommodation. Visual fields if old enough to cooperate

III, IV, VI - Full eye movement (+). Squint?Nystagmus? Avoid extreme lateral gaze

V - clench teeth

VII - close eyes, smile, show teeth

VIII - ask parents about hearing, if in doubt, formally assess in a suitable environment

IX - levator palati - say aagh. Look for deviation of uvula

X - listen for hoarseness

XI - trapezius and sternomastoid power

XII - put out tongue and look for any atrophy/deviation

19
Q

What is pGALS. Questions?

A

paediatric Gait Arms Legs and Spine

Pain in joints?
Pain or trouble walking?
Pain or problem dressing yourselves?

20
Q

pGALS examination

A

Inspect (only wearing shorts):
-front, side, back - wasting, deformity, other problems

GAIT - get to walk normally, on heels, on toes

ARMS - hold arms out: look at hands for wasting or other deformity. Assess pronation and supination. Fist. Touch each finger with thumb. Squeeze gently between 2nd and 5th finger for pain.

etc etc etc..

LOOK ONLINE

21
Q

Speech and language milestones

A

Newborn: starts to loud noise
4 months: coos and laughs
7 months: turns to soft sound out of sight
10 months: uses sounds discriminately
12 months: 2 or 3 words other than mama or dada
18 months: 6-10 words, shows 2 parts of body
24 months: uses 2 or more words to make simple phrases
3 years: talks constantly in 3-4 word sentences

22
Q

Limit ages for speech

A

Polysyllabic babble:
7 months
Consonant babbles:
10 months

Saying 6 words with meaning: 18 months
Joins words: 2 years
3 word sentences: 2 and a half years

23
Q

Causes of speech and language delay

A
Hearing loss
Global developmental delay
Anatomical deficit (cleft palate)
Environmental deprivation
Normal variant
24
Q

Causes of speech and language disorder

A

Language comprehension
Language expression
Phonation and speech production such as stammering, dysarthria (slurring) or verbal dyspraxia (incorrect muscle movement resulting in wrong sound)

Pragmatics - difference between sentence meaning and speakers meaning. eg. construction of sentences, grammar

Social/communication skills - autistic spectrum disorder

25
Q

When does global developmentl delay usually become apparent?

A

Usually in first 2 years

Not likely to be associated with cognitive difficulties. May become apparent later though

26
Q

Social milestones

A

6 weeks - smiles responsively
6-8 months -puts food in outh
10-12 months: waves bye bye, plays peek a boo
12 months: drinks from cup with 2 hands
18 months: Holds spoon and gets food to mouth
18-24: symbolic play
2 years: dry by day, pulls of some clothes
3 years: takes turn in play, interactive play

27
Q

Limit ages for social development

A
Smile - 8 weeks
Fear of strangers - 10 months
Feeds self/spoon - 18 months
Symbolic play - 2 1/2 years
Interactive play - 3 1/2 years