Development Flashcards
- Mother of a 3 yo girl is concerned about her speech. She said her first words at 11 months. There are no concerns with development. She has had difficult speaking: will repeat the same word (mommy, mommy, mommy) and repeat sounds at the start of words (m-m-m-mommy), pause during speaking in the middle of sentences. This is associated with facial twitches and blinking. What do you recommend?
a. Audiology
b. Developmental assessment
c. Reassure
d. Refer to SLP
d. Refer to SLP - has pauses, facial twitches and blinking, more in keeping with stuttering, thus needs therapy
In a 15 month old infant, which of the following is the most indicative of an autism spectrum disorder?
a. Not babbling frequently
b. Not pointing to indicate interest
not pointing
What is the first line intervention for sleep onset association type sleep disorder?
a. Melatonin
b. Stable bedtime routine
c. Clonidine
stable bedtime
Management of night wakings should include establishment of a set sleep schedule and bedtime routine, and implementation of a behavioral program
A 3yo girl has signs of autism. Which of the following studies would have the highest yield in finding a cause of her symptoms?
a. Fragile X testing
b. Karyotype
c. Microarray
d. Serum amino acids
microarray
Parents are concerned about a child’s performance at school. He has normal intellect. He is very clumsy and teachers mention that he has poor handwriting. He has difficulty hopping on one foot and seems to tire easily. He has normal strength on exam but low tone. Diagnosis is most likely:
a. Duchenne muscular dystrophy -
b. Cerebral palsy - increased tone
c. Developmental coordination disorder
DEVELOPMENTAL coordination d/o
cant write, directly motor
Duchenne muscular dystrophy - weakness
b. Cerebral palsy - increased tone
c. Developmental coordination disorder
Developmental Coordination Disorder, (DCD, “Clumsy child syndrome”) - characterized by problems with motor coordination that interfere with academic performance and social integration in otherwise healthy children. can have LOW tone, DELAY to gross motor
Childhood DCD is strongly related to a history of preterm birth and low birth weight
Associated with other conditions: ADHD, autism spectrum disorder, learning disabilities, emotional problems (eg, anxiety and depression), conduct disorder, and oppositional defiant disorder
What size does a child need to be to switch from a booster seat to a normal seat belt?
a. 18 kg, 120 cm
b. 36 kg, 120 cm
c. 36kg, 145 cm
d. 45 kg, 150 cm
36kg 145cm
A 4 year old girl is referred to you for dysfluency. She grimaces when she stutters. What do you do?
a. Refer to SLP
b. Reassure
c. MRI head
SLP
A child is referred to you for assessment of a learning disability. What do you do?
a. Refer for psychoeducational testing
a. Refer for psychoeducational testing
A teenage boy with addiction issues is diagnosed with ADHD. His mother is concerned about the potential for abuse with some ADHD medications. Which stimulant do you start him on?
a. Concerta XR
b. Ritalin
c. Vyvanse
vyvanse its a prodrug
concerta XR next
In a 5 month old boy, which would be the most concerning?
a) Doesn’t turn to the sound of his own name
b) Doesn’t sit upright without support
c) Fisting of one of his hands
d) Doesn’t smile all the time at his caregiver
fisting,
stop fisting at 3 months
6 month turns to sound
The mother of a 2.5 yo girl is concerned about her speech. She said her first words at the age of 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy, mommy), repeat sounds at the start of words (m-m-m-mommy), pause during speech, and insert “uh” in the middle of a sentence. What do you recommend?
a. audiology
b. full developmental assessment
c. reassure
d. refer to speech language pathologist
reassure
Picture of Car seats- Choose best one for 7 yo with no head rest
a) booster no back
b) booster with back
c) 5 point restraint forward facing
booster with back
18 month old wont’ go to sleep, used to be breast fed at 12 months. What does he have?
a) Sleep onset association disorder
b) Nightmare
c) Night terror
d) Delayed sleep phas
sleep onset association disrder
Child with expressive language delay and otherwise makes 12 piece puzzle, sociable. most likely to be associated with
a) Reading difficulty
b) Autism
reading difficulty
Early language difficulty is strongly related to later reading disorder. Approximately 50% of children with early language difficulty develop reading disorder, and 55% of children with reading disorder have a history of impaired early oral language development.
8 yr old boy is brought to you because of “difficulties learning”. he has difficulties finding words and with some pronunciation. he does not comprehend what he reads. however, he understands when his parents read to him.what is the most likely diagnosis? aspergers specific language impairment verbal apraxia dyslexia
dyslexia
Kid with Hx substance abuse. Needs medication for ADHD. Whis is BEST option? Vyvance Methylphenidate IR Guanfacine Ritalin SR
vyvanse
A mom brings in her son for concerns around his school performance, but feels he is cognitively normal. He has trouble with reading, and has trouble understanding when he reads to himself. His teacher has been spending more resource time with him, and when she reads aloud to him, he understands well. What is the most likely diagnosis? a. Myopia b. Dyslexia c. General learning disorder D. Speech apraxia
dyslexia
What is the best way for a 7 year old to ride in the back of a car, in the middle seat with no head rest? (pictures shown,taken from CPS statement)
a. Forward facing car seat
b. Booster seat with no back
c. Booster seat with a full back
d. Seat belt
booster with full back
An 18 month old boy presents with bilateral toe walking. Which findings on history and physical exam would support a diagnosis of spastic diplegic cerebral palsy?
A. Preterm delivery, delayed gross motor development, increased lower limb reflexes
B. Term delivery with asphyxia, delayed gross motor development, increased lower limb reflexes
C. Preterm delivery, global developmental delay, decreased lower limb reflexes
D. Term delivery with asphyxia, global developmental delay, decreased lower limb reflexes
Preterm delivery, delayed gross motor development, increased lower limb reflexes
vulnerable period of immature oligodendroglia between 20-34 wk of gestation. However, approximately 15% of cases of spastic diplegia result from in utero lesions in infants who go on to delivery at term.
You suspect a 3 year old female of having autism spectrum disorder. What diagnostic test would MOST likely reveal an abnormality?
a. karyotype
b. very long chain fatty acids
c. fragile x testing
d. chromosomal microarray
chromosomal microarray
36 mo baby what is the best predictor of cognition? Gross motor Fine motor Social language
language
“Normal Language Development and Communication Disorders”
Normal language ability is a complex function that is widely distributed across the brain through interconnected neural networks that are synchronized for specific activities. Language development usually follows a fairly predictable pattern and parallels general intellectual development.
remember there is expressive and receptive language DELAY – this can lead to a reading disability, but not always
The Mother of a 3.5 yo girl is concerned about her speech. She said her first words at 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy, mommy) and repeat sounds at the start of words (m-m-m-mommy), pause during speak and insert “uh” in the middle of a sentences. She has associated facial twitches and blinking. What do you recommend? Audiology Developmental assessment Reassure Refer to SLP
SLP
A 10 month old baby wakes up every 2 hours and needs to be rocked back to sleep by his mom. What is the most likely cause?
Benign rolandic epilepsy
Sleep onset association disorder
Night terrors
sleep onset assoc d/o
15 month old is seen in your office. What would make you the most concerned?
Not pointing to show interest
No words and part of a bilingual family
Cannot scribble with crayon
Not pointing to show interest
In a bilingual family, children can exhibit a mild delay. Should have caught up by 3 years of age.
(Repeat question): a 3 year old boy is in your office. He is very energetic, aggressive and destructive. His height is on the 50th percentile and his weight on the 95th percentile. He is described as having a voracious appetite. He comes to see you and hugs you. He speaks in 1 word sentences. What is the diagnosis? Emotional deprivation Diencephalic syndrome Prader Willi syndrome ADHD
Emotional deprivation
3 year old female, picky eater. Since 8 months of age, weight 15th percentile. Physical exam normal. Difficulties at mealtime specifically. Best option?
a. Allow kid to choose food.
b. Introduce child’s choice plus what family eats at mealtimes
c. cyproheptadine not recommended for isolated food refusal
d. Offer several small snacks throughout the day plus mealtimes
b. Introduce child’s choice plus what family eats at mealtimes
c. cyproheptadine —not recommended for isolated food refusal
d. Offer several small snacks throughout the day plus mealtimes
In a 5 month old boy, which would be the most concerning?
a) Doesn’t turn to the sound of his own name
b) Doesn’t sit upright without support
c) Fisting of one of his hands
d) Doesn’t smile all the time at his caregiver
UNFISTING by 2-3mo
a) Doesn’t turn to the sound of his own name starts developing between 5-6 months
b) Doesn’t sit upright without support by 6 months
c) Fisting of one of his hands unfist by 2-3m; may suggest corticospinal tract involvement
d) Doesn’t smile all the time at his caregiver “all the time” unnecessary
The mother of a 2.5 yo girl is concerned about her speech. She said her first words at the age of 11 months and is speaking in 3 word sentences. There are no concerns with her development. She has begun to have difficulty with speaking. She will repeat the same word (mommy, mommy, mommy), repeat sounds at the start of words (m-m-m-mommy), pause during speech, and insert “uh” in the middle of a sentence. What do you recommend?
a. audiology
b. full developmental assessment
c. reassure
d. refer to speech language pathologist
reassure
3 year old Girl with developmental regression and small head
a) Rett
Rett - MECP2
Females, autism, convulsion
normal development till age 1, wringing and loss movement, acquired SMALL head
at risk of cardiac arrythmia
Boy with enuresis, what is a good non pharm way to treat it
a) Positive reinforcement
b) Bed Alarm
c) Ddavp
d) Bladder training
bed alarm
18 month old won’t go to sleep, used to be breastfed at 12 months. What does he have?
a) Sleep onset association disorder
b) Nightmare
c) Night terror
d) Delayed sleep phase
a) Sleep onset association disorder
Child with expressive language delay and otherwise makes 12 piece puzzle, sociable. most likely to be associated with
a) Reading difficulty
b) Autism
a) Reading difficulty
2 ½ year-old girl who stutters. What would make you most concerned?
a. Repeats whole word
b. Repeats part of word
c. Facial grimacing
d. Pauses between words
Facial grimacing
12 year old boy with school difficulties. Teacher thinks he has a learning disability. Your history and physical exam are negative. What would you do?
a. CBC, lead levels, TSH
b. Start Stimulant
c. Send to psychology
d. Assess short term memory and fine motor skills
c. Send to psychology
Most correlated w future cognitive ability in a 30mo old?
a. Gross motor
b. Fine motor
c. Language
d. Social
language
9 mo w an asymmetric tonic neck reflex. Cause?
a. CP s
b. Normal
CP - should disappear by 3-4 months
Boy w hx of TAPVR, now has ADHD. You think he would benefit from stimulant medication. What is your next step? [cps]
a. Hx & physical then referral to cardiology
b. Refer immediately to cardiology
Hx & physical then referral to cardiology
Which one to refer?
a. 18 mo with no words in a bilingual household
a. 18 mo with no words in a bilingual household
4y girl w night terrors every night at midnight. What do you advise the parents?
a. Reassure the parents
b. Wake up kid 15 min before for half hour
b. Wake up kid 15 min before for half hour
8 year old boy with enuresis (did not tell you if it is primary or secondary or if it bothers him etc). What is the first step in management? [cps]
a. Bed alarm
b. Imipramine
c. DDAVP
Bed alarm
6 year old, teacher is concerned about his writing. He has always been clumsy and has some difficulty playing with his friends. Otherwise his development is normal. What is his most likely diagnosis
a. Developmental coordination disorder
b. ADHD
c. Autism
a. Developmental coordination disorder
A mother brings her 6 yr old son to your office with concerns that he has always been ‘awkward’. His teacher has commented on poor writing. On exam, he has normal power, low muscle tone and is unable to hop. Most likely diagnosis:
a. Developmental coordination disorder
b. Cerebral palsy
c. Muscular dystrophy
d. Tourette syndrome
a. Developmental coordination disorder
Which would be most concerning in a 15mo boy?
a. Not pointing
b. No words yet
no pointing
A 3.5 year old girl was referred to you for assessment. She speaks 50 words and 50% of her words are intelligible others. She points to things she wants. She can run well, can kick a ball, she can walk up and down stairs. She cannot throw a ball overhand. She can use a spoon. What is the MOST likely explanation of her symptoms?
a. Hearing deficit
b. Developmental delay
c. Language delay
c. Language delay
At what weight and age can a child start to use a front facing car seat?
a. 9 kg, 9 mo
b. 10kg, 12mo
c. 18kg, 20mo
10kg, 12mo by 1 year & double digit weight they are allowed to look at you
A 13y.o. boy with ADHD is taking 36mg of Concerta. His symptoms and school performance have improved and his mother is happy with his improvements. For the past 2 weeks, however, he has been sad, often crying unpredictably. He also is having difficulty falling asleep at night. What is the next best step in his management?
a. Decrease the dose of Concerta to 27mg
b. Change from Concerta to Adderall
c. Add fluoxetine
d. Add melatonin
a. Decrease the dose of Concerta to 27mg
Mood lability – If mood lability occurs at the time of peak concentration, try reducing the dose or switching to a longer acting preparation;
concerta- is longest acting one
4 year old with various developmental descriptions (stacks 7 cubes, 1 step at a time, 3 word sentences). What is their developmental age?
a. 24 months
b. 30 months
c. 33 months
d. 36 month
24 mo
1 year - 1 word phrase; 2 years - few word phrase
9 y girl’s parents separate/divorce. What do you expect from her? (CPS statement)
a. She takes sides school-aged
b. She wants them to get back together
c. She is blames herself
a. She takes sides –school-aged
b. She wants them to get back together
c. She is blames herself 4-5yo
Kid talking well at home but refuses to talk at school. Normal development. What is your diagnosis?
a. selective mutism
b. language delay
c. learning disability
a. selective mutism
Child with concerns LD what to test
a. psychoeducational
b. CBC
c. lead levels
psychoed
A mom comes to see you about her 2 year old, previously well child. The child is having daily episodes where her trunk is writhing, and she becomes flushed and diaphoretic. She also grunts, and breathes rapidly during these episodes. Mom is sure she does not lose consciousness and if she talks to her daughter, she can shorten the duration of the episode. They happen when the child is in her car seat or watching tv. What is your next step?
a. Refer to neurology for an EEG
b. Upper GI to rule out reflux
c. Reassure mom
d. Refer to a psychologist
c. Reassure mom
A mom comes to see you about her 2 year old, previously well child. The child is having daily episodes where her truck is writhing, and she becomes flushed and diaphoretic. She also grunts, and breathes rapidly during these. Mom is sure she does not lose consciousness and if she talks to her daughter, she can shorten the duration of the episode. They happen when the child is in her car seat or watching tv. What is your next step?
a. refer to neurology for an EEG
b. GI imaging to rule out reflux
c. reassure mom
d. refer to a psychologist
c. reassure mom
Signs of toilet readiness?
a. able to dress and undress himself - just needs to be able to be stable sitting on potty
b. desire to please based on positive relationship parents
c. can stay dry overnight
d. can communicated need for toilet using full sentences - only needs 2 word phrases
b. desire to please based on positive relationship parents
just needs to be able to stay dry for several hours
Mom comes in wondering if her 2 year old is ready for toilet training. Of the following, which is most likely to show readiness?
a. child motivated to please parents
b. child able to follow two-step commands
c. child has at least a 100 word vocabulary
a. child motivated to please parents
can follow one-two step commands but not always the case
Teenage girl with severe ADHD. Started on Concerta 36 mg. Medicine is working great for her ADHD, but on follow-up noted to have lost 10 pounds. What would you do?
a. switch to strattera - did not pick this because it is third line
b- decrease concerta to 5 days/week from 7 days/week
STIMULANT
Amphetamine - aderrall and vyvanse
Methylphendiate - biphentin and concerta
Nonstimulant - slective NE reuptake inhibitor - STRATTERA_ third line
A 5 year old boy is having increasing difficulties with bad behaviour at school, including stealing objects. His parents have recently divorced and are having difficulties in their relationship. His mother would like advice on how to help with his behaviour. Best advice?
a. take parenting classes and learn way to manage his behaviour
b. you need to meet with both parents together to better assess the situation
c. She needs to start disciplining her child ASAP
you need to meet with both parents together to better assess the situation
3 strong predictors for good outcome
Effective parenting
Parent-child relationship
Intensity/duration of hostile conflict
ie) EPI is GOOD
- 5 year old child who is not combining 2-words, has about a 50-word vocabulary and other people understand about 25%. Otherwise, climbs stairs, runs around, throws underhand. Interested in other people. What is this most consistent with?
a. isolated language delay
b. global developmental delay
c. autism
a. isolated language delay
57 lb child. What car seat should you use? (57 lbs = 25.9 kg)
a. lap and shoulder belt with seat
b. seat with built in restraint
c. lap and shoulder belt, no airbag - rear facing seats should never be placed near airbag, no comment on lap and shoulder belt without airbag.
d. lap and shoulder with airbag
b. seat with built in restraint
A 18kg child is being transported in a car. Which of the following is the best restraint?
a. Car’s lap and shoulder belt
b. Car seat with its own restraining device (
c. Car seat with the car’s restraining device
c. Car seat with the car’s restraining device
Rear facing seat < 10 kg (and 1 year of age and ability to walk)
Forward facing seat: 10-18 kg
Booster seat: 18-36 kg
Finally graduate to seat belt when >36 kg (80lbs) and 145 cm height
Cannot sit in front seat until 13 years of age.
What is considered a developmental delay?
a. no turning to name at 4 months (red flag: lack of turning to voice - 6 mo, lack of response to name 12 months)
b. no babbling at 6 months (red flag: no babbling at 9 mo)
c. can’t follow single command without gesture at 15 months
d. no 2 words together at 2 years
can’t follow single command without gesture at 15 months (JELD)
IF THIS CHILD CANNOT DO its red flag–
Sit unsupported by 12 mo
Walk by 18 mo (boys) or 2 yr (girls) (check creatine kinase urgently)
Walk other than on tiptoes
Run by 2.5 yr
Hold object placed in hand by 5 mo (corrected for gestation)
Reach for objects by 6 mo (corrected for gestation)
Point at objects to share interest with others by 2 yr
Child who doesn’t talk at school or make good eye contact with people. Including recess. Doesn’t have friends. At home speaks normally. Diagnosis
a. Selective mutism
b. Language delay
c. Autism spectrum disorder
mutism
anxiety d/o
- A 10 month old child has just started to bite his parents. Which statement is true?
a. This is an early sign of possible autism spectrum disorder
b. There may be an abusive situation in the family
c. Baby is developmentally normal and he is excited
d. The baby may be emotionally disturbed
c. Baby is developmentally normal and he is excited
Mother has questions about her 5 year old sons’ performance at school. She is concerned that he will have reading problems because his father had significant problems with reading. Of the following which predicts a future difficulty with reading:
a. Delayed walking
b. Delayed language milestones
Delayed language milestones
Which of the following has the lowest relapse rate when used for primary enuresis in a 7 year old boy?
a. Imipramine
b. DDAVP
c. alarm system
d. nighttime fluid restriction
alarm
Desmopressin: greatest value may be for short-term treatment, in settings such as camp or sleepovers, rather than as an attempt at a cure [17] (strength of recommendation – A, level of evidence – I).
Imipramine: TCA, high risk of overdose. Use with caution. Can be used for short-term treatment of nocturnal enuresis in distressed older children if other treatments unsuccessful.
Behaviour therapy: Insufficient evidence
Avoid caffeine-containing foods and excessive fluids before bedtime.
20 month old with 3 words, points to pictures to book when asked to, mimics mother at works, stack two blocks. What is diagnosis?
a. global developmental delay
b. speech delay
c. hearing loss
d. pervasive development disorder
GDD
more then 2 or more domains
*GDD = preferred term to describe intellectual and adaptive impairment in children <5 years old who fail to meet expected developmental milestones in several areas of intellectual functioning. Not all children with GDD will meet criteria for ID as they grow older. The term ID usually is applied to children ≥5 years old, when the clinical severity of impairment is more reliably assessed.
Autism. Risk for recurrence in the child-
a. Slightly higher than general population
b. Equal to gen population
c. 50 % chance because AD
d. non if avoids MMR
slightly higher then gen popn
incidence 1/68 in general, 3-10% in sibs
3 year old boy brought for assessment of developmental delay; features of autism: 3 words, no response to name, not interested in play, no identification of body parts, not pointing, wants to play with blocks only. Initial test?
a. Hearing screen
b. MR of head
c. Psychometric testing
hearing screen
Recommended evaluations in children with ASD:
Careful physical exam to identify dysmorphic physical features, micro/macrocephaly, features of neurocutaneous syndrome (TS, NF1)
Formal audiologic testing
Chromosomal microarray
If negative or associated with intellectual impairments
DNA testing for Fragile X syndrome
MECP2 testing in females
FISH for PWS/Angelman
3 year old kid with very delayed language, no imaginative play, no reciprocal social interaction & some other developmental abnormalities. How to investigate first?
a. audiology
b. psych testing
c. ?karyotype
audiology
A couple wants to adopt a child from overseas, and brings a file for you to review. Which of the following would MOST likely be associated with other problems?
a. Microcephaly in context of normal growth and weight
b. Delayed speech with low weight
c. Microcephaly in proportion to low height
a. Microcephaly in context of normal growth and weight
A couple comes in to your office with asking for advice regarding the adoption of a child. Which scenario gives the worst prognosis?
a. significant height and weight restriction.
b. microcephaly propotionate to height reduction.
c. significant microcephaly with normal height and decreased weight
c. significant microcephaly with normal height and decreased weight
7 year old girl still thumb sucking. What do you tell mother?
a. Can lead to malocclusion and facial deformation
b. Topical aversion therapy works well
c. Reassure
Can lead to malocclusion and facial deformation
beyond 5yo get sequlae and perinichae
no dont put bitter - ignore it, praise for subtitute
child sent to you for assessment of failing academic stuff, teacher wanted to know if there is a LD. Hx and physical normal. What do you do now?
a. Psychology assessment
b. lead levels
c. Get tutor
d. TSH
a. Psychology assessment
Mother brings 4 year old child in to you worrying that they are delayed. Gross motor: stands on one foot momentarily, rides tricycle. Fine motor: draws circle, copies cross, Speech: counts to three, remembers 3 numbers, Social: washes hands, parallel plays
a. 24 m
b. 30 m
c. 36m
d. 48 m
c. 36m
Typical 4 year old:
GM: Hops on one foot, down stairs with alternating feet
FM:Draws square, X, cuts shape with scissors, does buttons
Language: Sentences, 100% intelligible, tells a story, past tense
Cognitive: Counts to 4, opposites, identifies 4 colours
Social/Play: has preferred friend, fantasy play
- Which child would you send for further speech and language evaluation?
a. 3 yr with dysfluency with repetitions of words and syllables
b. a 2 yr old with 75 words and understood 50% by strangers
c. a 6 year old with trouble with phonemes
d. 18m from bilingual household with no words
d-18 mo
Developmental dysfluency is normal up to around 8yo (Hamilton review lecture)
Normal 2yo has 50+ words, 50% understandable by strangers
Again, can have difficulty with some phonemes up to 8yo
RED FLAG = no single words by 15 months (bilingual household should not influence this!
Etiology of primary enuresis as opposed to secondary:
a. holding urine during the day
b. family history
c. abuse
family hxx
*As long as this is nocturnal enuresis; if diurnal enuresis then holding urine is probably the correct answer
Question on car seat indications. When can the child use regular seat belt?
a. When child weighs 41 lbs
b. If child is > 6 yrs old -
c. when child, while in booster seat, has level of ears over headrest of the seat
d. when child has a sitting height at or greater than 63 cm
when child, while in booster seat, has level of ears over headrest of the seat
When child weighs 41 lbs - no 80 lbs
b. If child is > 6 yrs old - no >8yo
c. when child, while in booster seat, has level of ears over headrest of the seat
d. when child has a sitting height at or greater than 63 cm - no, >145cm
Child slow at school because goes over every letter three times. What is the problem?
a. Learning disability
b. ADHD
c. OCD
ocd
8 month old baby is not sleeping through the night. She is waking up one hour after being put down in her crib. Which of the following is true:
a. this should improve if she learns to fall asleep in her crib vs. being rocked to sleep
b. she should be allowed to cry to sleep to solve this problem
c. giving the baby a pacifier is a proven technique
d. she should be given a bottle of warm milk to help her fall asleep in her crib
this should improve if she learns to fall asleep in her crib vs. being rocked to sleep
A 2 year old child cries when mother is leaving for work everyday. She is also attached to a “special” teddy bear. What should be done?
a. remove child’s teddy bear since this is abnormal attachment to an object
b. reassure parents that this is normal separation anxiety appropriate for child’s developmental level
reassure parents that this is normal separation anxiety appropriate for child’s developmental level
An infant can sit with a round back using his hands for support, can roll from prone to supine, stands with support, has a palmar grasp, laughs, and babbles. What is his most likely age?
a. 3 months
b. 6 months
c. 8 months
d. 12 months
6 months
A 12 month old child has psychosocial deprivation. What is the most likely finding?
a. poor appetite
b. microcephaly
c. normal development
d. absence of cuddling response
d. absence of cuddling response
usu incrased apetite
A 4 month old child is observed to have positional plegiocephaly. What do you recommend to the parents?
a. encourage tummy time
b. refer to neurosurgery to rule out craniosynostosis
encourage tummy time
18 month boy, wakes up 1-2 hours after going to bed, screaming, difficult to arouse, is confused and diaphoretic. Likely cause?
a. nightmares
b. night terrors
c. seizures
night terror
. 3 yo with isolated language delay. What do you tell mom he is at risk for?
a. Reading disability
b. ADHD
c. Articulation disorder.
reading disability
At what age should a child be able to self-soothe when he awakens at night?
a. 5-7 months
b. 8-10 months
c. 11-13 months
d. 14-17 months
5-7 month
5 yr old with 21 yr old single mom. Teacher says she is hyperactive, hoarding food and not remorseful for inappropriate behaviour. No eye contact with mom, but runs up and hugs you. Most likely diagnosis?
a. ADHD
b. Autism
c. Attachment disorder
attachment disorder
Reactive Attachment Disorder DSM-5 Diagnostic Criteria Code
“A. consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of
Question about kid with mild MR. Most likely etiology?
a. Mom didn’t finish high school
b. Cocaine
c. Infection
d. Htn
mom didnt finish high school
intellectual disability DSM5
1) deficit in intellectual functioning(reasoning, judgement etc)
2) deficit in adaptive functioning (comm, social skill, school or work)
3) occur during the devleopemtnal period
Boy is great at making lego designs, and building 12 piece puzzles. Only 50 words, and not putting two words together. Diagnosis?
a. isolated language impairment
isolated language impairment
-can be receptive and expressive delay/impairment
30 month old child has been introduced to potty training. She has been encouraged to sit on potty after meals whether she can void or not. She has been doing it for one week. Now she is having temper tantrums every time you get her near the toilet. What is your advice on management?
a. continue with current toilet training
b. stop for 1-3 months and try again later
c. punish her
d. give treat every time she can sit on toilet quietly
b. stop for 1-3 months and try again later
Suspected autism at 15 months. What feature most suspicious for autism at this age?
a. hand flapping
b. no single word at 15 months
c. infrequent pointing for interest
c. infrequent pointing for interest
ASD
1-Persistent deficits in social communication and social interaction in multiple settings
2-Restricted, repetitive patterns of behavior, interests, or activities; demonstrated by ≥2 of the following (either currently or by history):
concerns include absent babbling or gestures by 12 mo, absent single words by 16 mo or loss of language,
Required w.u ; look for TS wood lamp, audiology, lead test, karyotype, fragile X moleuclar DNA test
IF have intellectual disability yo - check for prader/angelman, telomeric abn, mecp2, and DNa for fragile X
14 month old says specifically “dada” only. What other features make you worried about language delay?
a. not responding to own name
b. not babbling
respond to name by 12 mo otherwise red flag
Young boy is having trouble at school with reading. Cannot read out loud and has trouble understanding when he reads to himself. He seems to understand well when read to by the teacher.
a. learning disability
b. expressive language delay
c. dyslexia
dyslexia
The term “dyslexia” is used as a synonym for specific reading disability. Dyslexia is a specific learning disability that is neurological in origin. undesrtanding/listening is ROBUST
A child is ready to be transferred to a regular car seat. What is the minimum weight and height criteria for this to occur:
a. 40kg and 150cm
b. 40kg and 145cm
c. 36kg and 145cm
d. 36kg and 150cm
36kg, 145cm
Whom would you refer to speech and language therapy?
a. 18 month old with no single word
b. 6 y.o with phoneme problem
c. 3 year old with 3 word sentences
d. 4 yo with dysfluency
18 month old with no single word
Who to refer to SLP?
a. 6 year old with trouble with phonemes
b. no words by 18 months, in a bilingual household
c. 2 year old, people only understand 50%
no words by 18 months, in a bilingual household
Developmental dysfluency is normal and managed with resarruance and parents should not reprimand
Stuttering should be referred to SLP
Child with hyperphagia, disruptive in your waiting room, talking excessively, normal weight and hugs you repeatedly. Most likely diagnosis:
a. ADHD
b. Diencephalic syndrome
c. Autsim
d. Psychosocial deprivation
Psychosocial deprivation
. 3.5 year old, follows 2 step commands, interested in communication, developmentally appropriate girl with 50% intelligible speech and repeats syllables and whole words. Most likely diagnosis:
a. developmental dysfluency
b. normal development
c. delayed expressive language skills
d. delayed receptive language skills
delayed expressive language skills
Receptive language intact, not expressive though -echolalia, should also be mostly intelligible by 3 yo
Child wakes up about 1 hour after sleep, cries out for parents, upset. Never wakes up after midnight. Falls back asleep by herself. No recollection in AM. Diagnosis?
a. Nightmares
b. Sleep onset association disorder
c. Night terrors
d. Circadian Rhythm disorder
night terror
A child is having episodes of waking up about an hour after falling asleep, inconsolable screaming lasting 5 minutes, and then returning to bed. Does not remember in the morning. Parents are at their wits end and getting no sleep. You suggest?
a. wake child at 11:45 pm and keep awake
b. reassure parents
c. stop afternoon naps
d. start a reward chart system for nights he doesn’t wake up
a. wake child at 11:45 pm and keep awake for 10 minutes X 7nights in a row
Scheduled awakenings → parents wakes child 15-30 minutes before the time of night that the parasomnia episode is most likely to be successful in situations in which partial arousal episodes occur on a nightly basis.
BZ next first line- but may be indicated in cases of frequent or severe episodes, high risk of injury, violent behavior, or serious disruption to the family; the primary pharmacologic agents
Which is an indication for urgent evaluation?
a. baby does not turn to sound at 4 months - make sure not deaf
b. baby does not babble at 6 months
c. 15 mo old does not follow simple command without gesture
d. 2 ½ year old without 2 word phrases
. baby does not turn to sound at 4 months - make sure not deaf
15 month old who only says a couple words, stereotypical play, does not engage in social play. What in your office is the best indicator of ASD?
a. hyperactivity
b. hand flapping
c. does not point to objects to show interest
c. does not point to objects to show interest
What are three distinguishing and diagnostic factors for disruptive behaviour
Also three areas to asesss
1) atypical for child’s developmental age and persist for 6 months
2) across diff situations and impaired functioning
3) family and child distress
AREAS: non compliance , temper and aggression
