Development Flashcards
1) Baby can transfer a rattle hand-to-hand, sit with a rounded back using hands for support. What is his age: 1. 3 months 2. 4 months 3. 6 months 4. 9 months 5. 12 months
- 6 months
- most primitive reflexes gone, sits in tripod, shakes rattle, holds cube with 2 hands, vocalizes to give answers, bangs cubes together
2) 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.
a) 3 months
b) 6 months
c) 8 months
d) 9 months
e) 12 months
b) 6 months
3) What is true of a normal 9 month old child?
1. just acquired palmar grasp
2. says mama/dada and one other word
3. has object permanence
4. has names for objects
- has object permanence
Major milestone achieved by 9 months
4) A 10 month old child bites you. 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
c) Baby is developmentally normal and he is excited
Everything goes into the mouth at 6 months; lots of kids bite during play
5) Which is the most characteristic of a 9-12 month old?
a. object permanence
b. imitates scribbling
c. transfers objects from hand to hand
d. uses mama and dada specifically
ANSWER: d. uses mama and dada specifically
a. object permanence - have by 9 months
b. imitates scribbling - 18 months
c. transfers objects from hand to hand - starts at 6 months
6) All of the following are true about development EXCEPT:
a) walk 3 steps at 15 months
b) copy horizontal line at 15 months
c) stack 3 blocks at 18 months
d) speak 10 words at 18 months
e) climb stairs holding rail at 18 months
ANSWER: b) copy horizontal line at 15 months - “makes line with a crayon” at 15 months, but
“imitates vertical stroke at 18 months and horizontal stroke at 24 months”
a) walk 3 steps at 15 months - yes, should walk alone by 15 months
c) stack 3 blocks at 18 months - yes, should do this at 15 months
d) speak 10 words at 18 months
e) climb stairs holding rail at 18 months - yes, climbs stairs with one hand held
7) A picture of child showing the parachute reflex is shown. What is true?
a) This is a primitive reflex that disappears by 4 months
b) This is a voluntary reflex which disappears when child starts walking
c) This is an involuntary reflex that appears at 7-9 months and does not disappear
c) This is an involuntary reflex that appears at 7-9 months and does not disappear
Need parachute reflex to start walking so if you fall you don’t smash your face; it doesn’t go away (so you keep not face smashing)
8) Which is the indication for urgent evaluation?
a. Baby does not turn to sound at 4 month
b. Baby no babble at 6 mo
c. 15 mo does not follow simple command without gesture
d. 24 m without 2 word phrases
ANSWER: a. Baby does not turn to sound at 4 month
b. Baby no babble at 6 mo - should babble at 6 months, but not red flag if not
c. 15 mo does not follow simple command without gesture - 12 months should follow 1 step
command with gesture, 14 months should follow 1 step command without gesture
d. 24 m without 2 word phrases - should have 2 word phrases at 2 years
70) A child is seen with her mother. The child reportedly wakes to loud noises. She stops crying when comforted by her mother. She makes some cooing and gurgling noises and is feeding well. When prone she is able to lift her head off the surface. When she is held up against her mother’s shoulder she lifts her head off the shoulder. She is not yet putting weight on her forearms when in prone. She is not yet holding her head steady when in a sitting position. The developmental age of the child is:
a) 2 weeks
b) 4 weeks
c) 6 weeks
d) 8 weeks
e) 10 weeks
f) 12 week= Nelson’s 3 mon= life head with arm extended, waves at toys, head lag partially
compensated, moro gone, sustained eye contact and says “aah, ngah”
ANSWER: d) 8 weeks= Nelsons= raises head sustained on ventral suspension, head lag when pull to sitting, follow objects, smile with contact, listen to voice + coo
f) 12 week= 3 mon= lift head with arm extended, waves at toys, head lag partially compensated, moro gone, sustained eye contact and says “aah, ngah”
69) A little boy is brought in by his father. He responds to having his name called, smiles and babbles when you speak with him. He squeals with delight when bounced on his father’s knee. He grabs at a toy and puts the toy to his mouth When in prone he is able to push up on his hands and hold his head steady. He then rolls onto his back. In a sitting position he leans forward and puts some weight on
his hands. He not yet sitting unsupported. He is not picking up small items with thumb and first finger. The developmental stage is:
a) 2 months
b) 4 months
c) 6 months
d) 8 months
e) 9 months
c) 6 months
73) A child visits your office with her mother. She brings a doll and her purse with her. She asks her mother “where is my cookie?”. She tells you “I went to Allison’s birthday party. I wore my pink Sleeping Beauty dress, we had a fashion show and we made a wand craft. I am having a Dora birthday and all my friends are coming.” Her party is in 2 days. She easily imitates drawing a circle and cross, but has trouble with a square. She is happy to pretend to examine her doll with your stethoscope while you talk to her mother. How hold will this child be at her birthday party?
a) 3 years
b) 4 years
c) 5 years
d) 6 years
b) 4 years = at least 3 given circle, cross but not quite 4 y.o. milestones so next birthday party is
72) The average 2 year old has the following developmental milestones?
a) Vocabulary of 100 words
b) Speaks in 2 word sentences
c) Follow 2 step commands
d) Clear articulation
e) 1 and 2
e) 1 and 2
a) Vocabulary of 100 words= YES should have by 18-24 month
b) Speaks in 2 word sentences = YES should have by 18-24 month
c) Follow 2 step commands= attained usually between 24-36 month
d) Clear articulation -> 90% in 4 y.o. and 100% in 5 y.o.
e) 1 and 2
68) A girl comes to your office, she walks into the room independently and squats to pick up a ball and follows the direction “throw me the ball” when you ask. She says dada and mama for dad and mom and baba for bottle and says “all gone” or “uh oh” in the exam room. When asked “where is your nose, eyes and head” she points appropriately. She points to a ball and says “ba”. She says “mo” to request more cheerios. She makes good eye contact. She stack 3 small blocks. When she leaves
the exam room she waves bye-bye. What is her developmental age?
a) 10 months
b) 12 months
c) 15 months
d) 18 months
e) 20 months
d) 18 months
-Gross Motor: walk (12 mon), squats (< 2y.o.)
-Fine Motor: throws (min. 12 months), 3 tower (min. 12 month since agex3= # cubes in tower)
-Speech: specific mama and dada (12 month minimum), points (15 month), follow simple command
(15 months). Not quite 2-3 word phrases = 2 y.o.
-Social: knows body parts (18 month),
71) Which milestone do most children achieve first?
a) Overhand throw of a ball
b) Kicking a ball
c) Hopping
d) Riding a tricycle
e) Skipping
b) Kicking a ball (18 month)
a) Overhand throw of a ball (2 y.o.)
b) Kicking a ball (18 month)
c) Hopping (4 y.o. hops on one foot)
d) Riding a tricycle (5 y.o.)
e) Skipping ( 5 y.o.)
93) 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%
b. no words by 18 months, in a bilingual household
refer to SLP if: not using 3 words at 15 months
102) Delayed 4 y/o. Can go up and down stairs one foot at a time. Three word sentences. Vertical lines, no circle. 50 words. What is his developmental age.
a. 18
b. 24
c. 30
d. 36
c. 30
Vertical line at 18 months, circle at 3 years, 3 word sentence at 2-3 years, alternating feet on stairs at 3 years
Name 1 milestone in each of the following criteria for a 36 month old: 1 line each
a) gross motor
b) fine motor
c) language
d) social
a) gross motor – tricycle, stairs alternating feet, stands on one foot briefly
b) fine motor – 9 block tower, circle, uses utensils, undresses
c) language – 3 word sentences, 250 words, 75% intelligible
d) social- group play, shares, knows name and age
Write “normal” or “abnormal” for an 18-month old child that you are assessing in your office?
Has 2 words
Walked at 14 months and is unable to go up and down stairs
Doesnʼt point to things
Displayed a hand preference at 10 months of age
Has 2 words – abnormal (should have 7-20)
Walked at 14 months and is unable to go up and down stairs - normal
Doesnʼt point to things - abnormal
Displayed a hand preference at 10 months of age – abnormal
Kid is 10 months old, ex 28 weeker. What is developmental age. Sitting independently for 10 min, could roll over, not yet cruising, no pincher grasp. Babbled. Not pulling to stand. Look for dropped objects briefly.
Sitting independently for 10 min (6-8m) , could roll over ( 6-8mo) , not yet cruising ( 9-11m) , no
pincher grasp (9-11m). Babbled (6-8mo). Not pulling to stand (9-11). Look for dropped objects
briefly. (9-11m)
- cGA 7 months, developmental age 6-8m
Child who is 2 years old. Speaks 8 words. Points and gestures. Socially appropriate. What is the most likely diagnosis:
- Global developmental delay
- Developmental language disorder
- PDD
- Developmental language disorder
A 3 year old child is seen in your office. He just started making 2 word sentences and has about a 50 word vocabulary. His receptive language is better than his expressive language. He can build a tower of 12 blocks and make a very nice house out of Legos. What do you counsel the mother that he is at risk for in the future:
a. Autistic spectrum disorder
b. Developmental disorder
c. Reading disorder
d. ADHD
c. Reading disorder (yes! strong association (50%) between language disorder and later reading disorder)
A mother is concerned that her 3-year-old child was able to speak 3-4 words sentences at 22 months of age but now she seems to be stammering/having dysfluency of speech a lot. What next:
a) reassure
b) audiology testing
c) refer to speech pathologist
d) complete neurodevelopmental assessment
e) emotional disturbance can be the cause of stammering
a) reassure - developmental disfluency - common between 2-3 years, lasts weeks to months and resolves by age 4 without treatment; child is not frustrated or distressed versus stuttering they are
If they specifically were talking about stuttering, usually onsets between 4-5 years, multiple repetititions common (more severe than dysfluency), and needs referral to SLP (of note, can be caused/worsened by emotional disturbance)
7 yo boy with past history of speech delay. His reading is now below a grade 1 level. Teacher thinks that he has ADD. What would be the most appropriate next step:
a) investigate for learning disability
b) psychotherapy
c) behavior therapy
d) Ritalin 5mg bid
e) Ritalin 20 mg bid
a) investigate for learning disability
Early language disorder is strongly associated with reading disorder
In a child with expressive speech delay, the parents should be encouraged to all of the following except:
a) read to him at night
b) make him repeat incorrectly pronounced words over and over
c) make him stop his activity and look at you when you talk
d) don’t complete his sentences
b) make him repeat incorrectly pronounced words over and over
A 2 year old boy has only 3 single words, he has poor receptive language, does not point to indicate his wants, does not orient to his own name and does not engage in pretend play. He loves to play with his blocks. Which of the following is important in your investigation of his problem:
a. Psychological assessment
b. MRI head
c. Speech/language assessment
d. Audiology testing
d. Audiology testing
Sounds like autism, but always need to rule out hearing impairment
You are seeing a 3 year old girl for language delay. While her mother is talking she wanders around your exam room. She says ‘go out’ to her mother. She puts her mothers hand on a toy to get her to fix it. She does not respond when you call her name. Of the following history items, which would assist you to make your diagnosis?
a) Recent family stressors
b) Family history of delayed language
c) Description of her social interactions with family and children at daycare
d) Resuscitation history after birth
c) Description of her social interactions with family and children at daycare
She be autistic
2½-year-old child is referred with language delay and inferior ectopia lentis. You should
a) molecular studies for Marfan syndrome
b) echocardiogram to rule out aortic root abnormalities
c) fibroblasts/skin biopsy for enzyme assays
d) quantitative serum amino acids
e) platelet count and coagulation studies for hypercoagulability
d) quantitative serum amino acids
homocystinuria: mitral valve prolapse, tall stature, long bone overgrowth, developmental delay
diagnosis: elevated methionine or homocystine in body fluids (including blood
and urine) are diagnostic, cystine is low or absent in plasma
- can do liver biopsy to look for the enzyme
All of the following are true of vision in newborn infants EXCEPT:
a) should be able to fix on a large object from birth
b) by 2 months of age the infant can follow through 180 degrees
c) retinal hemorrhages are rare in newborns and cause permanent deficits
d) a newborn’s sclera is thin which causes a blue hue
c) retinal hemorrhages are rare in newborns and cause permanent deficits
- superficial retinal hemorrhages may be observed in many newborn infants
- the majority resolve within 2 weeks
- complete resolution of all birth related hemorrhages expected between 4-6 weeks
Which is true regarding children in foster care:
- In older kids, occasional visits with parents is warranted if child previously had developed a strong attachment to parents
- Disruption of continuity of care may be potentially detrimental to all children
- If they are in a loving foster home for their first year of life, they will do well long term
- Child should be placed with grandparents for best long-term outcome
- Disruption of continuity of care may be potentially detrimental to all children
unpredictable contact with parents, and placement changes negatively impact child’s health
1-year-old child with psychosocial deprivation. Which is the most likely finding:
a) poor appetite
b) parental history of inadequate caloric intake
c) microcephaly
d) normal development
e) absence of cuddling response
a) poor appetite - per Alli
A mother of a 9 yo boy visits you in your office. She would like to know what the effects of her separation and impending divorce will have on her son. The statement that you are most likely to include in your discussion with her would be:
a) If the mother and son undergo psychological counselling the effects of the separation and
divorce will likely be short-lived.
b) Males adjust better than females in the immediate period after divorce.
c) Joint custody is better for the child regardless of whether there is continued conflict between the parents.
d) Parental depression and conflict issues will more likely determine the adjustment of the child than custody issues.
e) The most important issue to address at this time is custody.
d) Parental depression and conflict issues will more likely determine the adjustment of the child than custody issues.
3 most significant factors impacting child’s well being during a divorce:
- quality of parenting
- quality of parent-child interaction
- degree, frequency, intensity and duration of hostile conflict
Of the following behavioral phenotypes, which describes Williams Syndrome (7q11.23 deletion)?
a) Strengths in verbal short term memory, extreme weakness in visual-spacial skills, excessive
talking, hyperacusis, inattention, phobias and sleep problems
b) Depression, shyness, social anxiety, executive function deficits, cognitive decline and dysinhibition
c) Delays in motor and language skills, mild cognitive impairments or learning disabilities, and obsessive compulsive characteristics
d) Severe cognitive impairments, minimal verbal communication, movement or balance disorder,
easily excitable
a) Strengths in verbal short term memory, extreme weakness in visual-spacial skills, excessive
talking, hyperacusis, inattention, phobias and sleep problems
NOTE: c) Delays in motor and language skills, mild cognitive impairments or learning disabilities, and obsessive compulsive characteristics (Usually more ADHD, GAD)
You are seeing an 18 month old boy with Fragile X syndrome. Which of the following developmental issues would not be seen in boys with a full FMR mutation?
a) Delays in fine and gross motor skills
b) Relatively strong expressive communication
c) Cognitive impairments
d) Hyperactivity and distractibility
e) Social avoidance and anxiety
b) Relatively strong expressive communication (usually delayed speech by 2y.o.)
You are seeing a 3 year old boy with his foster parents. There is a confirmed history of prenatal alcohol consumption. Which of the following physical findings would support a diagnosis of FAS?
a) Weight at 50 th percentile
b) Height at 50 th percentile
c) Philtrum length at <3 rd percentile
d) Palpebral fissure length <3 rd percentile
e) Head circumference at 25 th percentile
d) Palpebral fissure length <3 rd percentile
Of the following syndromes with tall stature, which does not have MR as part of the presentation?
a) Fragile X
b) Sotos Syndrome
c) Karyotype XYY
d) Marfan’s Syndrome
e) Homocysteinuria
d) Marfan’s Syndrome
Karyotype XYY: (Jacob’s tall and possible LD and behavioural/aggression; and extra note:
XXY- tall stature called Klinefelter also at risk for LD)
What syndromes are on the differential diagnosis for a child with tall stature and developmental of behavioural abnormalities?
Klinefelter, fragile X, homocysteinuria, Loeys-Dietz, Sotos, Weaver syndrome
What’s the syndrome? ● Tall stature, Gynecostmastia, delayed puberty, infertility, small firm testes, high pitched voice, LD
Klinefelter (XXY)
What’s the syndrome? Tall stature, ● large head, long thin face with receding hairline
● feeding difficulty since birth with facial flushing and hypotonia.
● High palate and pointy chin
Sotos syndrome (5q35 deletion)
What’s the syndrome? ● marfan-like habitus, developmental delay, inferior subluxation of lens , cataracts, crowding of teeth
Homocysteinuria
You are asked to consult on a newborn with congenital anomalies. The child has a coloboma of
the iris, TOF, choanal atresia, dysplastic low set ears. The pregnancy and family history are
unremarkable. The karyotype is normal and FISH for microdeletion of 22q11 is negative. What is the
most likely diagnosis?
a) Cornelia de Lange
b) Williams Syndrome
c) Noonan Syndrome
d) Vater association
e) CHARGE syndrome
e) CHARGE syndrome - AD genetic disorder, usually no fhx
● Coloboma (hole in structure of eye: iris, retina, choroid disc etc.)
● Heart Defects (including conotruncal like TOF), AV canal defect, aortic arch abnormalities
● Atresia Choanae (unilateral or bilateral)
● Retardation of growth/development (DD, short stature)
● Genital/urinary abnormalities (micropenis, cryptorchidism, hypoplastic labia, delayed puberty)
● Ear abnormalities and deafness (asymmetric, reduced height, cup shaped etc.)
Note major criteria are different than acronym - coloboma, choanal atresia, cranial nerve anomalies, ear anomalies
How is CHARGE syndrome diagnosed?
Clinical criteria (all 4 major or 3 major and 3 minor); genetic testing - molecular testing
A 3 mo baby with wt. 6.3kg, length normal, hc 47cm. What initial investigation would you do?
Head U/S
4 biologic determinants of child development
- genetics
- in utero exposure to teratogens (mercury, alcohol)
- low birth weight
- postnatal illness/ insults (meningitis, TBI, chronic illness)
Which of the following interventions would be provided by an Early Childhood Resource
Specialist?
a) Design home or school based activities to practice speech and language skills
b) Provide consultation to parents regarding behavioral concerns and parenting strategies for children with special needs
c) Develop augmentative communications tools
d) Focus on sensory environment to achieve functional daily tasks
e) Provide information on positioning and handling
b) Provide consultation to parents regarding behavioral concerns and parenting strategies for children with special needs
You are working in an international adoption clinic. A family brings you a file on a potential adoptee. Which of the following is most likely to correlate with a poor outcome:
a. Microcephaly proportional to height and weight delay
b. Developmental delay proportional to height delay
c. Microcephaly with normal height and weight parameters
a. Microcephaly proportional to height and weight delay - to me more suggestive of malnutrition, which could be reversible
b. Developmental delay proportional to height delay
c. Microcephaly with normal height and weight parameters - more suggestive to me of underlying syndrome/early exposure that will not be reversible - peds in
review 2004 - preparing families for international adoption (red flags: IUGR, microcephaly out of proportion to other growth parameters, FAS facies)
2.5 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
An 18 month old child in your office with the concern of developmental delay. He is babbling but does not yet say mama and dada or any other words. He is able to sit unsupported for a brief period of time. He does not yet have a pincer grasp
a. What is her developmental age?
b. He has a 13 year old brother in “special education” classes and a maternal cousin with autism. What one test would you want to do and why (2 lines)?
A) 6 months Babbling: 6-8 months Mama/dada: 9 months Other words: 12 months Sit unsupported briefly: 6 months Pincer grasp: 9 months
B) fragile X - male child with global delay, has a brother similarly affected and fragile X is X-linked and would come from mother - notable that there is another affected relative on mom’s side; fragile X can present like autism
A 3 y/o girl with regression of milestones is noted to have microcephaly. What is the most likely diagnosis:
- Childhood disintegrative disorder
- Autism
- Rett’s
- Fragile X
- TORCH infection
- Rett’s
- Childhood disintegrative disorder - removed from DSM 5, not associated with microcephaly; now part of autism spectrum disorder
- Fragile X - accounts for 3% of males with intellectual disability, females have less severe disease, no regression
You are seeing a 2 year old girl in whom you have told the family that you are suspicious of autism. The mother has been doing some research and asks you questions about Rett syndrome. Name 4 features of Rett Syndrome.
- normal prenatal/perinatal course
- normal development until at least 6 months
- regression of previously acquired milestones (especially language and social)
- acquired microcephaly
- repetitive hand wringing movements
Most predictive of mild MR?
a. Maternal alcohol during pregnancy
b. Cocaine during pregnancy
c. Mom did not finish high school
d. Neonatal hypoxia
c. Mom did not finish high school
