Development Flashcards
What are the primitive reflexes?
Moro, grasp, rooting, stepping, asymmetrical tonic neck reflex
What are the postural reflexes?
Labyrinthine righting, postural support, lateral propping, parachute
What are the three types of cerebral palsy in order of how common they are?
Spastic, dyskinetic, ataxic
What causes a concomitant squint?
Refractive error
What causes a divergent squint?
Paralysis of the motor nerves
Lifetime prevalence of anorexia nervosa
1% females, <0.5% males
Lifetime prevalence of bulimia nervosa
2% females, 0.5% males
Lifetime prevalence of binge eating disorder
3.5% females, 2% males
Risk factors for eating disorders
Exposure to ideally thin body image Rapid weight loss due to dieting FH of eating disorder, mental health issues Obsessional, perfectionist personality Comorbid mental health issue Certain sports e.g. ballet
What is superior mesenteric artery syndrome?
Seen in referring, due to compression of the SMA as it is no longer protected by a fat pad. Presents with abdominal pain, feeling of fullness, vomiting
What is the global prevalence of ADHD?
5% of children, 2.5% adults
Risk factors for ADHD?
Parental ADHD
Maternal cigarette and alcohol use during pregnancy
Low birthweight
What are the diagnostic criteria for ADHD?
Inattention Hyperactivity and impulsivity Present before 12y Impairs functioning Present in at least 2 settings Not explained by another disorder
What are the 2 main medications used in ADHD?
Dexamphetamine or methylphenidate
What is the mechanisms of action of dexamphetamine and methylphenidate?
Increase extracellular synaptic dopamine
Side effects of stimulant use in ADHD?
Anorexia, weight loss, insomnia, social and emotional withdrawal, priapism, emotional lability, occasional psychosis
What can be used instead of stimulants in ADHD if the parents want a non-stimulant medication?
Atomoxetine
What is the mechanism of action of atomoxetine?
Highly selective inhibitor of the presynaptic noradrenaline transporter - increases extracellular noradrenaline and dopamine levels in the prefrontal cortex
When is clonidine useful in ADHD?
Where there is comorbid tic disorder
What is the mechanism of action of clonidine?
Alpha-2 noradrenergic agonist
What are the side effects of clonidine?
Drowsiness, cardiotoxicity, depression, confusion, dry mouth
Where is melatonin produced?
The pineal gland
What is the heritability of autism spectrum disorder?
50%
What is the recurrence rate in subsequent siblings of a child with autism spectrum disorder?
10-20%
What are the diagnostic criteria for autism spectrum disorder?
Impaired social communication Restricted, repetitive behaviours Onset in early childhood Impairs functioning Not explained by another disorder
Which conditions are associated with autism spectrum disorder?
Rett, fragile X, tuberous sclerosis, Angelman, Down
Which medications might be useful in autism spectrum disorder?
Stimulants
SSRIs - for compulsive/ritualistic behaviours
Melatonin
Atypical antipsychotics e.g. risperidone for aggression
How is Rett syndrome inherited?
X-linked dominant but sporadic in 99% of cases
What is the mutation in Rett syndrome?
Almost always MECP2
What are the features of Rett syndrome?
Developmental regression Dyspraxic gait Stereotypical hand movements Seizures Breathing problems Abnormal tone Screaming or laughing spells Scoliosis Autonomic dysfunction GI problems
What is Rolando variant Rett syndrome?
Congenital where development is impaired earlier
What is Zapella variant Rett syndrome?
Preserved speech - speech is regained after the regression
What medications might be needed in Rett syndrome?
Lamotrigine for early seizures Sodium valproate or carbamazepine for later seizures Anti dystonic e.g. baclofen SSRIs for agitation Melatonin for sleep
How many children with developmental delay have an underlying issue?
40% have chromosomal abnormality
5-10% have a developmental malformation
4% have metabolic disorders
Gross motor milestones at 6 weeks
Raises head to 45 degrees when on tummy
Stabilises head when raised to sitting
Head can be held in same plane as body on ventral suspension
Gross motor milestones at 3 months
Able to raise head and chest on forearms when prone
Head steady when pulled to sit
Gross motor milestones at 6 months
Can roll over
Sits without support with rounded back
Gross motor milestones at 9 months
Sits with straight back
Pivots to reach objects
Stands holding onto objects
Gross motor milestones at 12 months
Crawling
Pulls to stand
Cruising or walking
Gross motor milestones at 15 months
Walking well
Gross motor milestones at 18 months
Stoops and retrieves objects
Carries toys while walking
Running
Jumping
Gross motor milestones at 2-2.5 years
Climbs and descends stairs one step at a time
Throws a ball at shoulder level
Kicks a ball (2.5y)
Climbs furniture
Gross motor milestones at 3 years
Pedals tricycle
Jumps well
Hops on one foot for 3 steps
Walks upstairs one foot per step, downstairs two feet per step
Gross motor milestones at 4 years
Stands on one foot well
Gross motor milestones at 5 years
Was down stairs one foot per step
Bounces and catches ball
Fine motor and vision milestones at 6 weeks
Fixes and follows through 90 degrees horizontally
Fine motor and vision milestones at 3 months
Fixes and follows through 180 degrees horizontally
Hands beginning to be brought to the midline
Attempts to make contact with offered object
Fine motor and vision milestones at 6 months
Transfers
Reaches our for objects
Mouthing objects
Palmar grasp
Fine motor and vision milestones at 9 months
Looks for toy fallen from view
Pokes objects with index finger
Inferior pincer grip
Fine motor and vision milestones at 12 months
Neat pincer grip
Banging bricks together
Stacks 2 bricks
Fine motor and vision milestones at 15 months
Pincer grip refined, can pick up tiny objects
Casting should disappear by 18m
Fine motor and vision milestones at 18 months
Delicate pincer grip
Scribbles to and fro
Stacks 4 bricks
Fine motor and vision milestones at 2-2.5 years
Copies a vertical line
Tower of 8 bricks
Shape matching
Turns several pages of a book at once
Fine motor and vision milestones at 3 years
Copies a circle Matches 2 colours Builds a bridge or train Can make single cuts at 3 years, cuts pieces at 3.5 Griffiths beads Turns one page of a book at a time
Fine motor and vision milestones at 4 years
Copies a cross and a square
Draws a man with 3 parts
Cuts paper in half
Builds 12 blocks, or steps
Fine motor and vision milestones at 5 years
Copies triangle Draws a man with 6 parts Writes name Can do up buttons Can build big steps Can thread small beads
Language milestones at 6 weeks
Makes throaty noises
Stills, startles at loud noise
Language milestones at 3 months
Vowel sounds and noises uttered on social contact
Turns head to sound, level to the ear
Language milestones at 6 months
Unintelligible babble
Will turn when name is called
Understands ‘bye bye’ and ‘no’
Language milestones at 9 months
Shouts to gain attention
Two syllable babble
Imitates adult sounds
Responds to own name
Language milestones at 12 months
2 words with meaning Responds to 'give it to me' Understands nouns Points to own body parts Shows recognition of objects by using them e.g. brush
Language milestones at 15 months
Expression of several words
Understands words like cup, names of siblings
Jargon and jabbering
Echolalia
Language milestones at 18 months
Understands up to 50 words Knows common objects by name e.g. cat Follows one step commands 1-6 different words Points to doll's body parts
Language milestones at 2 years to 2.5 years
Uses plurals
Understands verbs a 2y, prepositions at 2.5y
Follows two step requests
Identifies objects from hearing their use
Selects toy from others e.g. ‘give me the sheep’
2 words together at 2 years 3-4 at 2.5
Language milestones at 3 years
Knows some colours Three to four word sentences Name, age and sex on request Pronouns and plurals Knows more about time, today and not today Starts to tell stories Understands negatives and adjectives Understands comparatives (3.5y)
Language milestones at 4 years
Counts to 10 Identifies several colours 100s of questions Understands numbers Past tense Increasing concentration
Language milestones at 5 years
Comprehension of ‘what do you do if you are hungry, cold, tired?’
Understands opposites
Social milestones at 6 weeks
Social smile
Social milestones at 3 months
May show displeasure on interruption of social contact
Social milestones at 6 months
Plays with feet Holds onto bottle when fed Puts object to mouth Shakes rattle Reaches for bottle/breast
Social milestones at 9 months
Finger feeds
Resists when objects removed
Stranger fear
Social milestones at 12 months
Waves bye bye Claps hands Empties cupboards Plays alone if familiar person nearby Drinks from beaker with lid
Social milestones at 15 months
Drinks from a cup
Indicates wants without crying i.e. pointing, pulling, asking
Social milestones at 18 months
Holds spoon and gets food to mouth
Takes shoes and socks off
Imitates everyday activities
Social milestones at 2 to 2.5 years
Plays alone
Eats with spoon
Social milestones at 3 years
Out of nappies during the day, bowel control Separates from mother easily Eats with spoon and fork Dresses with supervision Begins to share toys
Social milestones at 4 yeas
Concern/sympathy for others if hurt Has best friend Shares toys Out of nappies at night Brushes teeth Toilet alone Eats skilfully with little help Dressing and undressing
Social milestones at 5 years
Acts out role play, imaginative play
Handles knife
