Development Flashcards
what is the diagnostic criteria for Tourette disorder?
A. Multiple motor and one or more vocal tics have been present at some time during the illness (not necessarily concurrently)
B. The tics may wax and wane but have persisted for >1 year since first tic onset
C. Onset before 18 years of age
D. not due to a substance (cocaine) or another medical condition
what is the difference between persistent motor or vocal tic disorder, provisional tic disorder and Tourette disorder
Persistent motor or vocal tic disorder- motor OR vocal tic for >1 year
Provisional tic disorder- motor OR vocal tic <1 year
Tourette disorder- motor AND vocal tic for >1 year
what are the treatment options for mild tics, tics that are distressing or functionally impairing or severe impairment in quality of life?
mild tics- psychoeducation
distressing or functionally impairing- habit reversal therapy or comprehensive behavioural intervention for tics
severe impairment- haloperidol, pimozide, aripiprazole
what does Gotta Find Strong Coffee Soon stand for?
Gross motor fine motor speech/language cognitive/ problem solving social/emotional
what investigation should you do if there is gross motor delay?
Do a CK
What does an average 18 month old do?
Running Scribbling with fisted crayon 10-25 words Word explosion Word combinations Single step commands Lots of gestures pointing Know body parts Symbolic and parallel play
When is separation anxiety normal?
18-24 months
What is the most common teratogen causing ID?
ETOH
Key speech and language milestones
2-4M: Visual attention 6-9M: Babbling 12M: Langauge emergence 2Y: 2 word combo: 1/2 intelligible 3Y: 3 word combo: 3/4 intelligible 4Y: Phrased speech 4/4 intelligible
Key Motor Milestones 3 mo 6 mo 9 mo 12 mo
3 M: Head control 6 M: Arms 9M: Trunk 12M: Legs
Key social and emotional milestones 5-6 mo 9-15 mo 3-5 y 8-10 y 4-6 y
Anxiety: Stranger 5-6M Separation 9-15M Monsters: 3-5Y Death 8-10Y Best friend 4-6Y
Key Play Milestones
Functional play
2-3Y imaginative play
3-5 years reciprocal play
6 years knock knock jokes
at what age do children cruise?
9 months
at what age to roll supine to prone?
6 months
what age to bring hands to midline?
2 months
what age to point to express interest?
15 months
when does babinski reflex disappear?
9-10 months
when does parachute reflex appear?
7-9 months and persists
when does rooting, sucking, moro, ATNR reflex disappear?
rooting- 3-4 months
sucking- 3 months
moro 3-6 months
ATNR- 3-4 months
when does withdrawal reflex disappear?
stays for life
what is the order for drawing shapes?
lines, circle, cross, square, triangle horizontal line- age 2 circle- age 3 square- age 4 triangle- age 5
when do you refer a child to SLP
Receptive:
15 months- does not look/point at 5-10 objects
18 months- does not follow simple commands
24 months- does not point to pictures or body parts when named
30 months- does not verbally respond or nod/shake head to questions
Expressive:
15 months- not using 3 words
18 months- not using mama, dada or other names
24 months- not using 25 words
30 months- not using unique 2 word phrases
what is the triad for serotonin syndrome
mental status changes- agitation, hallucinations, delirium, coma
autonomic instability- tachycardia, hypertension (bp lability), hyperthemia, diaphoresis, flushing, dizziness)
neuromuscular symptoms- tremor, hyperreflexia, myoclonus, rigidity
18 month old. Mother asks about toilet training. List 3 questions you’d ask in determining readiness.
- Is he able to tell you when he has to pee?
- Is he able to follow simple commands?
- Is he able to walk to the potty and sit on it?
- Can he stay dry for several hours?
- Does he want to do things independently?
- Does he like to do what you ask?
what is an uncommon but late serious side effect of stimulants?
Depression is an uncommon but serious late onset side effect of stimulants
what treatment do you offer for head banging
most remit over time
redirect, take attention onto something else with time she will learn to communicate in different ways and this will stop
need to rule out that there are no other developmental disorders going on
rarely leads to serious injury
Name 3 conditions associated with Tourette’s
OCD ADHD behavioral issues Learning disability depression anxiety ASD
what is sleep onset association disorder?
special conditions are required for caregivers before child goes to/returns to sleep at night
tx: establish a bedtime routine
remove maladaptive sleep associations
teach children to fall asleep on their own (timed waiting or chair sitting strategy)
what is limit setting behavioural sleep insomnia?
Limit setting type - child refuses to go to bed and the parent demonstrates poor limit setting
what is Developmental coordination disorder
- The acquisition and performance of coordinated motor skills is substantially below that expected given the person’s chronological age and opportunity for skill learning and use
- The poor performance significantly and persistently interfere with activities of daily living appropriate to chronologic age and impact academic/school productivity, prevocational and vocational activities, leisure, and play
Name some underlying neurological disorders associated with autism (7)
Rett syndrome Fragile X Down syndrome Tuberous Sclerosis NF Angelman Seizures
Child who is 7 years old and very bad behavior, anger outburst, list 5 things to tell parents to help them have some tools to manage this behavior
Scheduled routine
Clear expectations of the child
Consequences for bad behaviour that are age-appropriate, immediate, and consistent (eg. Withdrawal or delay of privileges, and time-out) and realistic
Do not make empty threats, apply rules consistently
Give positive reinforcement for good behaviour
Parents need to model good behaviour
what is the most common cause of inherited ID
Fragile X
Physical features: Elongated face, large ears, high-arched palate, poor tone, flat feet, large testicles, joint laxity, mitral valve prolapse
what is psychosocial deprivation?
Absence of appropriate stimuli in physical or social environment which are necessary for emotional, social, intellectual development
what are some symptoms of psychosocial deprivation? (13)
- Unusual watchfulness
- Avoidance of eye contact
- Absent smiling or vocalization
- Lack of interest in environment
- Children over 5 months do not reach for interesting objects
- Negative response to cuddling ***
- Arches back, scissors legs OR lies limp
- Inability to be comforted
- Head banging
- Self stimulation (ano-genital manipulation)
- Immobility with infantile posturing
- Inappropriately seeking affection from strangers **
- Flat occiput
what is Rett syndrome
X-linked disease that occurs predominantly in females
developmental regression
acquired microcephaly
mutations in the MeCP2
ataxic gait or fine tremor of hand movements is an early neurologic finding
Most children develop peculiar sighing respirations with intermittent periods of apnea that may be associated with cyanosis.
The hallmark of Rett syndrome is repetitive hand-wringing movements and a loss of purposeful and spontaneous use of the hands; these features may not appear until 2-3 yr of age.
Autistic behavior is a typical finding in all patients.
Generalized tonic-clonic convulsions occur in the majority but may be well controlled by anticonvulsants.
what is recommended for good sleep hygiene?
Regular bedtime and wake up time
Age appropriate amount of hours asleep
Consistent routine before bed
Sleep environment: quiet, dark
Teach the child how to relax prior to sleep
Strict avoidance of television, computers, and video games prior to bedtime
Encourage reading prior to bedtime
Avoid hunger and eating prior to bedtime
Avoid caffeine alcohol and nicotine prior to bedtime
No TV in room
Do not use the bedroom for punishment
List 3 questions you’d ask in determining readiness for toilet training? (6)
- Is he able to tell you when he has to pee?
- Is he able to follow simple commands?
- Is he able to walk to the potty and sit on it?
- Can he stay dry for several hours?
- Does he want to do things independently?
- Does he like to do what you ask?
Name 3 DSM-V diagnostic criteria for ADHD - inattentive subtype.
close attention/mistakes sustaining attention does not listen when spoken to does not follow through on instructions poor organization avoids sustained mental effort lose things easily distracted forgetful in daily activities
6/9 required for the diagnosis**
functional impairment in more than one setting
criterion for age of onset= 12
Name 3 DSM-V diagnostic criteria for ADHD hyperactive/impulsive subtype
fidgets leaves seat runs/climbs no quiet play on the go/motor talks excessively blurts not wait turn interrupts/intrudes
6/9 required for the diagnosis**
functional impairment in more than one setting
criterion for age of onset= 12
