Development Flashcards
Describe an average 18 month old
Running Scribble with fisted crayon 15-25 words “Word explosion” Embedded jargon-communicative babbling Joint attention Single step commands Lots of gestures, pointing Know body parts Symbolic and parallel play
Describe the speech of an average 2 year old
200 words
Too many to count!
2-3 word phrases
Pronoun use
2 step unfamiliar commands
When should a patient with speech delay be referred?
-When the parent is concerned
By 9 months:
–Vocalizing to initiate social interaction
By 12 months:
–Not babbling, not pointing
By 18 months:
-Less than 15 words
Social communication concerns
Differential diagnosis of speech and language delay
•CNS processing
–Autism spectrum disorder, global developmental delay, specific language impairment
•Hearing loss
•Environmental
–Social, abuse, deprivation
•Anatomic
–Cleft palate, craniofacial
•Production problems
–Stuttering, Apraxia of speech
List 3 management steps for a patient with speech and language delay
Hearing test
Referral to local preschool speech and language initiative
Tips for parents about language facilitation
Describe 5 ways parents can facilitate language development
- Read to him at night
- Make him stop his activity and look at you when you talk
- Do not complete his sentences
- Get down to the child’s level and play with what he/she is interested in
- Talk to your child throughout the day about things you are doing and seeing together in all everyday activities.
- Let them touch and hold books while you point to and name the pictures.
- Take the time to listen/respond to your child’s communications, whether they are eye gazes, gestures, sounds, or words.
- Imitate the sounds and words that your child makes.
- Sing songs and include your child in the actions.
- Take your child to play groups, so they can first watch other children, and then begin interacting with them.
- Encourage parents to use whichever language they are more comfortable with
.It takes 2 to talk-Hanen program book
In what age group is stuttering/dysfluencing most common?
Common between 3-8 years
Does most stuttering persist through to adulthood?
NO
Resolves in 80% of children by adulthood
Name 5 characteristics of developmental dysfluency?
- Occasional (once every 10 sentences)
- Brief (0.5 seconds or less)
- Repetition of sounds, syllables or words (no prolongations, at start of word)
- Worse when tired, excited, complex language, questions, anxious
Name 5 indications for referring a patient with developmental dysfluency to SLP?
- Parental and/or child concern
- Presence of secondary behaviours (e.g. eye blinking, jaw jerks, head or other involuntary movements)
- Repetitions are parts of words or single sounds (e.g. li-li-li-like; a-a-a-apple)
- Speech seems to get blocked (trying to make sound but no sound coming out)
- Persists for more than 8 weeks
Under what age can one use the term Global Developmental Delay?
<5 years of age
After becomes intellectual disability (disturbance in adaptive functioning)
List 3 investigations in the workup of GDD
For all patients: 1. Chromosomal Microarray (10-15%) 2. Fragile X (2.5% of males, 1.5% of females)
- Hearing and vision
Consider:
4. MECP2 (1.5% of females mod-severe ID)
5. Thyroid (4% or nearly 0% with normal newborn screen)
6. Lead and Ferritin (only if mouthing/PICA)
7. Metabolic testing (1-5%)
•Blood: amino acids, homocysteine, acylcarnitine profile
•Urine: organic acids, GAA/creatinine metabolites, purines/pyrimidines, MPS screen, oligosaccharide screen
8. Neuroimaging (MRI 10-55%)-focal neuro signs, micro/macrocephaly
9. EEG (only if seizures suspected) (<1%)
What percentage of ASD is syndromic?
10%
Name 4 syndromic causes of ASD
Fragile X
Tuberous sclerosis
Rett’s syndrome, Angelman’s syndrome
NF
What are the DSM V Criteria for ASD?
•Impairments in Social Communication (3/3)
–Deficits in socio-emotional reciprocity
–Deficits in nonverbal communication used for social interaction (eye contact, gestures, facial expressions)
–Deficits in developing, maintaining and understanding relationships (peer relations, sharing imaginative play)
• Restricted, repetitive patterns of behaviour, interests, activities (2/4)
–Stereotyped/repetitive motor movements
–Insistence on sameness, routine
–Highly restricted, fixated interests
–Hyper or hypo-reactivity to sensory stimuli
•Symptoms in early developmental period
•Impact on current functioning
List 8 red flags for autism in a 12-18 month old child
Reduced or atypical:
- eye gaze and shared joint attention
- sharing of emotion
- social or reciprocal smiling
- social interest and shared enjoyment
- orienting when his or her name is called
- coordination of different modes of communication
- babbling
- language comprehension and production
- unusual tone of voice
- development of gestures (pointing, waving)
- imitation of actions
- functional and imaginative play
- excessive or unusual manipulation or visual exploration of toys and other objects
- repetitive actions with toys and other objections
- atypical visual tracking, visual fiation
- under or over reaciton sounds
- repetitive motor behaviours
Name 5 conditions in the differential for social communication deficit
- Language disorder
- Developmental disability
- Sensory impairments
- Attention deficit hyperactivity disorder
- Oppositional defiant disorder
- Anxiety (rigid, like routines, tantrums)
- Non verbal learning disability (difficulty with perceptual reasoning, social realm-can’t read cues)
Name 5 steps in the management of ASD
- Audiology testing
- Referral to SLP for initiation of therapy
- ASD specific screening instrument
-Referral to Developmental Pediatrician/Centre for
multidisciplinary team assessment
-Behavioural intervention:
•Intensive Behavioural Intervention (IBI)
•Applied Behavioural Analysis (ABA)
- Treat medical co-morbidities – sleep, feeding, seizures, GI
- Specialized school programming
- FAMILY SUPPORT – Autism Speaks, Autism Ontario, Geneva Centre for Autism
What is the definition of a learning disability?
- Average or higher cognitive abilities
- Specific processing weakness
- Unexpectedly behind in academics
What are the DSM V criteria for ADHD?
1) Inattentive symptoms (6/9) •Inattentive •Does not listen •Needs repeated instructions •Careless errors •Disorganized •Avoids/dislikes homework •Loses things •Distractible •Forgetful
2) Hyperactive/Impulsive symptoms (6/9)
•Often fidgets or squirms in seat
•Leaves seat when remaining seated is expected
•Inappropriately runs about/climbs
•Difficulty with quiet leisure activities
•“On the go”, “Driven by motor”
•Talks excessively
•Blurts out answers before questions completed
•Difficulty waiting turn
•Interrupts or intrudes on others
Symptoms for at least 6 months
Symptoms present before 12 years
Functional impairment
Several symptoms are present in two or more setting
Symptoms are not better explained by another mental disorder
Name 5 conditions that can mimic ADHD
- Hearing/vision problems
- Learning disability
- Gifted children
- ASD
- Metabolic disorders (eg, adrenoleukodystrophy, mucopolysaccharidosis type III)
- Neurodevelopmental syndromes (eg, fragile X, fetal alcohol syndrome, Klinefelter syndrome)
- Mood/behavioural disorder (anxiety, ODD)
- Substance use disorder
- Lead poisoning
- Thyroid abnormalities
- Absence seizures
- Sleep disorders
What is recommended management of ADHD?
- Preschool (age 4-5)-behavioural therapy, meds if necessary
- Everyone else, meds +behavioural therapy
What is a late onset side effect of stimulants?
Depression
What ADHD medications should be started in children >6 years old?
Long acting stimulant (e.g. concerta)
What ADHD medication should be used if there is a risk of substance abuse/diversion?
Vyvanse
Strattera (atomoxetine)
Approach to patient with ADHD who fails treatment
- Assess for compliance
- Rule out possibility of medication diversion
- Revisit whether the expectations are realistic
- Assess for comorbid psychiatric diagnosis
- Rule out rebound
- Increase dose (to maximum recommended dose)
- Switch to another stimulant medication
- If above fails, try non stimulant
List 10 side effects of stimulants
Decreased appetite Poor growth Mood lability Insomnia Tics Priapism (methyphenidate and atomoxetine)
Name 4 clinical features of FASD
- Typical facial features
- Cognitive and learning disorders
- ADHD (severe and refractory)
- Poor judgement, poor sense of cause and effect
What is sleep onset association disorder?
- Inability to fall asleep on own
- Falls asleep easily when parent present
- Frequent night wakenings
