- 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

- 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

- 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

- GM: pulls to stand, starting to cruise - FM: pincher grasp - Language: specific mama/dada, says "bye" - Social: separation anxiety, object permanence

- GM: walks well - FM: using spoon, stacks 2 blocks - Language: 1 step command, 5 words, 1 body part - Social: experiment with toys, shared attention

- 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

Development Flashcards by Alexa Geddes

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

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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

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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

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9 month milestones

GM: pulls to stand, starting to cruise
FM: pincher grasp
Language: specific mama/dada, says “bye”
Social: separation anxiety, object permanence

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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

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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

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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

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Handedness - when does it normally develop + when is it a concern?

18-24 months

- Red flag if before 1 year

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x2 risk factors for DCD?

Preterm

- Male

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x5 co-morbidities associated with DCD?

ASD
ADHD
Language impairments
Specific learning disabilities
Mental health

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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.

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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

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When should you no longer have fists and raises concern for CP?

Past 4 months

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Up to what point do you expect normal development in Rett Syndrome?

Until 6-9 months

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For the pincer grasp, when do you develop (a) inferior grasp (with straight fingers) vs (b) true grasp?

(a) 9 months

(b) 12 months

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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 1. Inattention: - Careless mistakes - Trouble holding attention - Does not listen - Does not follow through - Trouble being organized - Avoids mental effort - Loses things - Easily distracted - Forgetful 2. 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?

1. Cyanotic = hyperventilation + apnea = typically when angry 2. 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