Community - developmental Flashcards
Diagnostic criteria for Autism spectrum disorder
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)
3 main aspects of autism spectrum disorder + co-morbidities
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)
Gross motor developmental milestones 0-6 months
Rolls over front to back and back to front
Sits with support and then independently
Gross motor developmental milestones 6-12 months
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)
Gross motor developmental milestones 18 months
Sits, crawls, walks
Jumps
Still has wide gait but walking/running less clumsy
Gross motor developmental milestones 2 years
Running
Picks up toys
Gross motor developmental milestones 3 years
Hops on one foot
Walks up and down stairs alternating feet
Jumps in place with feet together
TIP-TOE walking
Gross motor developmental milestones 4 years
Stand on 1 foot (5 sec)
Kick ball
Hop on one foot
Gross motor developmental milestones 5 years
Walk heel to toe (3 steps)
brief neurological examination in an infant for motor skills
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
Observing patterns of movement in a child (motor neuro)
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
Pattern or movement in extrapyramidal lesions
Fluctuating tone.. Difficulty initiating or involuntary movemetns
Look for asymmetry
Assess coordination in a child
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
Inspect the limbs of a child (neuromuscular)
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)
test muscle power in a child
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
Test reflexes in a child
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
Test sensation in children (neuromuscular)
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)
Testing of cranial nerves in children
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
What is pGALS. Questions?
paediatric Gait Arms Legs and Spine
Pain in joints?
Pain or trouble walking?
Pain or problem dressing yourselves?
pGALS examination
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
Speech and language milestones
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
Limit ages for speech
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
Causes of speech and language delay
Hearing loss Global developmental delay Anatomical deficit (cleft palate) Environmental deprivation Normal variant
Causes of speech and language disorder
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
When does global developmentl delay usually become apparent?
Usually in first 2 years
Not likely to be associated with cognitive difficulties. May become apparent later though
Social milestones
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
Limit ages for social development
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
