Development Flashcards
DDx/mimics for ADHD
- Organic: Neuro (CN injury/infection, mass lesion, epilepsy, FASD), genetic, sensory (hearing, vision), med conditions (iron def, thyroid disease, DM, sleep d/o, malnutrition)
- Meds/toxins: lead, AEDs, steroids, substances
- Dev/behaviour: autism, learning disorder, ODD
- MH: Stress, personality d/o, mood/anxiety
- Enviro/psychosocial: poverty, family dysfunction
2 month milestones
- GM: neck control, head up to 45 deg when prone
- FM: hands open 1/2 the time, bats at objects
- Language: turns to voice, coo-ing
- Social: prefers usual caregiver, social smile
4 month milestones
- GM: sits with support, head up to 90 deg when prone, roll from front to back
- FM: palmar grasp, bring objects to midline
- Language: laughs, razz, “ga”, squeal
- Social: explores environment/faces
9 month milestones
- GM: pulls to stand, starting to cruise
- FM: pincher grasp
- Language: specific mama/dada, says “bye”
- Social: separation anxiety, object permanence
15 month milestones
- GM: walks well
- FM: using spoon, stacks 2 blocks
- Language: 1 step command, 5 words, 1 body part
- Social: experiment with toys, shared attention
18 month milestones
- GM: running
- FM: undress, carries toys when walking, fisted pencil grasp
- Lang: 25 words, follow 1-2 step commands, point to object, name x3 body parts
- Social: parallel play, symbolic play
4 year old milestones
- GM: alternating down stairs, one foot jump
- FM: buttons, draw square
- Lang: sentences, 100% intelligible, tells story, past tense
- Social: fantasy play, preferred friend
Handedness - when does it normally develop + when is it a concern?
- 18-24 months
- Red flag if before 1 year
x2 risk factors for DCD?
- Preterm
- Male
x5 co-morbidities associated with DCD?
- ASD
- ADHD
- Language impairments
- Specific learning disabilities
- Mental health
Diagnostic criteria for DCD
A: Acquisition + execution of coordinated motor skills are substantially below expectations for child’s age + opportunities for motor skill learning.
B: Motor skills deficit significantly/persistently interferes with activities of daily living + impacts school/activities.
C: Onset of symptoms in the early developmental period.
D: Deficit is not better explained by another disorder.
Examples of “soft” neuro findings on exam associated with DCD?
- Overflow movements
- Mirror movements
- Finger agnosia
- Coordination difficulties
- Behaviour -avoidance/excuses
- Hyper-mobility
- Low normal tone
When should you no longer have fists and raises concern for CP?
Past 4 months
Up to what point do you expect normal development in Rett Syndrome?
Until 6-9 months
For the pincer grasp, when do you develop (a) inferior grasp (with straight fingers) vs (b) true grasp?
(a) 9 months
(b) 12 months
Shapes that children can draw from 2-7 yeras
2 = straight line 3 = circle 4 = cross 5 = square 6 = triangle 7 = diamond
x5 genetic syndromes associated with Autism Spectrum Disorder
- TSC
- NF
- T21
- Rett Syndrome
- Angelman
- Fragile X
Diagnostic criteria for Autism Spectrum Disorder
A = impairments in social communication (3/3)
1) Socio-emotional reciprocity
2) Deficits in developing/understanding/maintaining friendships
3) Deficits in non-verbal communication
B = Behaviours (2/4)
1) Stereotyped/repetitive behaviours
2) Strict adherence/rigidity to routine
3) Intense, fixated, restricted interests
4) Atypical sensory reactivity
*Must occur in the early developmental period
Investigations for new dx of Autism
- Audiology
- Vision
- Microarray
- MECP2
- Fragile X
Risk factors for Autism
- Genetic: Male, genetic syndromes, family history
- Prenatal: older maternal age (>35), maternal obesity/DM/HTN, in-utero exposure to VPA/pesticide/air pollution, maternal infection, close spacing of pregnancies
- Post-natal: low BM, extreme prematurity
x3 components of a psychoeducational assessment
- Cognitive
- Academic achievement
- Adaptive/behavioural
What is a normal score for a psychoeducational test/IQ? And what would equate to 2 SD’s?
100 +/-15
2SD = +/- 30
Criteria for specific learning disorder
- Neurodevelopmental disorder with learning difficulty + problems acquiring academic skills
- Selective impairment with average intelligence
- Ongoing for 6 months
- Not attributed by another disorder or intellectual disability
Investigations to do/consider in GDD?
- Microarray, fragile X, MECP2
- Thyroid
- Lead
- Ferritin + iron studies
- Audiology + vision
- Metabolic screen
- Neuroimaging
- EEG
Definition/criteria for GDD
- Significant delay (by at least x2 SD below the mean) in 2 or more developmental areas
- For children <5 years old who cannot undergo assessment yet
x3 criteria for intellectual disability
- Cognitive deficits (low IQ)
- Adaptive dysfunction
- Onset before 18 years old (dx at >5 years old)
When must childhood-onset fluency disorder + stuttering resolve before you get worried?
7 years old
What types of dysfluency are okay?
- Interjection (“um”)
- Multi-syllabic repetitions (“I want to I want to”)
- Revised/abandoned utterances (“I want / hey look at that”)
When to refer a dysfluency case?
- Parental or child concern
- Impacts functioning
- Worsening in frequency/severity
- Has remained for 12 months or more or >7 years of age
- Presence of secondary behaviours (blinking, jaw jerks)
Criteria for ADHD
- Must have 6 symptoms from 1 or both categories for 6 months
- Functional impairment
- Symptoms present in at least 2 settings
- Inattention:
- Careless mistakes
- Trouble holding attention
- Does not listen
- Does not follow through
- Trouble being organized
- Avoids mental effort
- Loses things
- Easily distracted
- Forgetful - Hyperactivity + impulsivity:
- Fidgets + squirms
- Leaves seat
- Runs about
- Cannot be quiet
- Always on the go
- Talks excessively
- Blurts out answers
- Cannot wait for turn
- Interrupts
x5 early warning signs for CP
- Hand preference development <12 months of age
- Fisting beyond 4 months of age
- Delays or asymmetry in development of movement/posture
- Tightness of legs before 12 months of age
- Delay in sitting by 9 months of age
When will breath holding spells typically disappear by?
5 years old
What are the two types of breath holding spells and what is the mechanism for both?
- Cyanotic = hyperventilation + apnea = typically when angry
- Pallid = vagal mediated bradycardia = typically following mild injury
Mimics of seizures
- Breath holding spells
- Tics
- Sandifer syndrome
- Self gratification
- Benign sleep myoclonus of infancy
- Benign myoclonus of infancy
- PNES
- Syncope
- Migraine
- Dystonia
When do children develop a secure gender identity?
4 years old
What are the different characteristic reactions to parental divorce in (a) <3 years old, (b) 4-5 year olds, (c) school-aged, and (d) adolescent?
(a) development regression, irritable, separation anxiety, appetite/sleep disturbance
(b) blame themselves, externalizing behaviours
(c) take sides
(d) try to please everyone
At what age are you able to self-soothe yourself to bed?
8-10 months
