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Pediatric Board Review > Development/Behavior > Flashcards

Development/Behavior Flashcards

0
Q

Gold standard for autism diagnosis

A

ADOS and ADI-R scales

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1
Q

3 main features of autism

A
  • Limited range of interests
  • Deficits in reciprocal interactions
  • Deficits in verbal/nonverbal skills
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2
Q

Good prognostic signs in autism

A

Performance IQ >70
Speech by age 5
Highly structured environment

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3
Q

What is Rhett’s?

A

A subtype of autism:

  • Significant developmental regression
  • Deceleration of head growth
  • Loss of social engagement
  • Deficiency of language/social skills
  • MR
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4
Q
  • Normal for first several years of life
  • Regression in 2+ areas before 10 years
  • Looks like autism
A

Sensory Disintegration Disorder

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6
Q

Hallmark of Asperger’s

A

Social skills not appropriate, academically better

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7
Q

A child can perform all of the following:

  • stack 2 blocks
  • name one body part
  • walk
  • follow a simple command without gestures

How old are they?

A

24 months

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8
Q

“Most children”

A

75-90%

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9
Q

“Age is closest to”

A

75-90%

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10
Q

“All children”

A

Answer one age group older

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11
Q

“Some children”

A

Answer one age group younger

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12
Q

Typical HC growth

A
  • Birth = ~35cm
  • 0-3 months = 2cm/month
  • 3-6 months = 1cm/month
  • 6-12 months = 0.5cm/month
  • 1 inch between 2 and 12 years
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13
Q

Typical weight gain

A
  • Birth 3-3.5kg
  • Regain by 2 weeks
  • Double by 4 months
  • Triple by 1 year
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14
Q

How gross motor proceeds

A

Hed to toe

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15
Q

How fine motor development proceeds

A

Proximal to distal

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16
Q

When do primative reflexes disappear

A

3-9 months of age

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17
Q

When do postural reactions develop

A

Between 3-10 months of age, coinciding with motor skills

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18
Q
  • Head hangs down in ventral suspension
  • Head lag when pulled to sit
  • Turn head to side
  • Moro, stepping, grasp reflexes
A

Newborn

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19
Q
  • Head in line with body in ventral suspension
  • Lifts head 45 degrees when prone, arms extended
  • Follows object past midline
A

2 months

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20
Q
  • Lifts head to 90 degrees when prone
  • Chest up, supported on arms when prone
  • No head lag when pulled to sit
  • Rolls prone to supine
A

4 months

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21
Q
  • Chest up, supported on hands, when prone
  • Rolls supine to prone
  • Sits with support (no support by 7 months)
A

6 months

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22
Q
  • Gets into sitting position
  • Crawls
  • Pulls to stand
  • May cruise (10-11mo)
A

9 months

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23
Q
  • Takes a few steps with hand held

- May stand without help or walk independently

A

12 months

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24
Q
  • Swipes at objects

- Hands open

A

3 months

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25
Q
  • Hands in midline

- Grasps objects and brings to mouth

A

4 months

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26
Q
  • Transfers objects hand-hand

- Reaches unilaterally, raking grasp

A

6 months

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27
Q
  • Early pincer grasp

- Eats with fingers

A

9 months

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28
Q
  • Mature pincer grasp

- Releases object voluntarily

A

12 months

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29
Q
  • Coos
A

2 months

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30
Q
  • Orients to voice

- “Ah-goo”

A

4 months

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31
Q
  • Babbles
A

6 months

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32
Q
  • Mama, dada non-specifically

- Responds to name, no

A

9 months

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33
Q
  • Mama, dada specifically
  • Immature jargoning (no real words)
  • One or more words with meaning
  • Understands commands with gestures
A

12 months

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34
Q
  • Social smile

- Regards face

A

2 months

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35
Q
  • Laughs
A

4 months

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36
Q
  • Start of object permanence

- Prefers mother, stranger anxiety

A

6 months

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37
Q
  • Object permanence: looks over edge
  • Plays peek-a-boo, pat-a-cake
  • Wave bye-bye
  • Uncovers hidden object (10mo)
A

9 months

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38
Q
  • Plays simple games

- Takes pride in accomplishments

A

12 months

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39
Q
  • Walks well

- Walks backwards

A

15 months

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40
Q
  • Walks backwards
  • Runs clumsily, falls often
  • Walks pushing or pulling toys
A

18 months

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41
Q
  • Runs well, wide-based gait
A

24 months

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42
Q
  • Walks on tiptoes

- Tandem walks forward

A

4 years

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43
Q
  • Tandem walks backwards

- Skips, alternating feet

A

5 years

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44
Q
  • Crawls up stairs
A

15mo

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45
Q
  • Walks up stairs with hand held

- Two feet per step

A

18mo

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46
Q
  • Climbs up and down stairs alone

- Two feet per step

A

24mo

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47
Q
  • Climbs up stairs alternating feet
A

3 years

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48
Q
  • Climbs down stairs alternating feet
A

4 years

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49
Q
  • Sits self in chair
A

18mo

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50
Q
  • Kicks ball forwards
  • Jumps in place, jumps off step
  • Stands on one foot momentarily
A

24mo

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51
Q
  • Stands on 1 foot 1-2seconds
  • Hops 2-3 times
  • Broad jump
A

3 years

52
Q
  • Stands on 1 foot 3-5 seconds

- Hops 5 times

A

4 years

53
Q
  • 2 cube tower
A

15mo

54
Q
  • 3-4 cube tower
A

18mo

55
Q
  • 6-7 cube towers
A

24mo (2+4 = 6 cubes)

56
Q
  • 8 cube tower

- Imitates train with chimney

A

30mo

57
Q
  • 9-10 cube tower

- Imitates bridge with 3 cubes

A

3 years

58
Q
  • Imitates gate
A

4 years

59
Q
  • Imitates steps
A

5-6 years

60
Q
  • Scribbles spontaneously

- Imitates a stroke

A

18mo

61
Q
  • Imitates vertical and circular strokes
A

24mo

62
Q
  • Imitates horizontal strokes
A

30mo

63
Q
  • Copies circle
A

3 years

64
Q
  • Copies cross
A

4 years

65
Q
  • Copies square
A

4.5 years

66
Q
  • Copies triangle

- Prints a few letters

A

5 years

67
Q
  • Copies diamond
A

6 years

68
Q
  • Takes off gloves, socks, shoe
A

18mo

69
Q
  • Can put on some clothes
A

24mo

70
Q
  • Dresses with supervision

- Unbutton

A

3years

71
Q
  • Dresses without supervision

- Buttons

A

4 years

72
Q
  • Can tie shoelaces
A

5 years

73
Q
  • Uses covered cup with little spilling
A

15mo

74
Q
  • Handles spoon well for solids
A

18mo

75
Q
  • Uses spoon well for semi-solids
A

24mo

76
Q
  • Eats neatly with spoon and fork
A

3 years

77
Q
  • Spreads with a knife
A

5-6 years

78
Q
  • Starting to cut food with the knife
A

7 years

79
Q
  • 2-3 words

- Immature jargoning

A

12-13mo (1+2=3)

80
Q
  • 4-6 words
A

15mo (1+5=6)

81
Q
  • 7-20 words

- Mature jargoning

A

16-17mo (1+7=8)

82
Q
  • 50+ words

- 2 word sentences

A

21-24mo

83
Q
  • Pronouns (appropriately used)

- Telegraphic speech

A

30mo

84
Q
  • 250+ words
  • 3-4 word sentences
  • Plurals
  • Present tense
A

3 years

85
Q
  • 4-6 word sentences

- Past tense

A

4 years

86
Q
  • Follows 1 step command without gestures

- Finds one body part

A

15mo

87
Q
  • Knows 5+ body parts

- Names pictures or common objects

A

18mo

88
Q
  • Follows 2 step command
A

24mo

89
Q
  • Knows sex, first and last name

- Understands 2 prepositions

A

30-36mo

90
Q
  • Names 3-4 colors
  • Counts 5-10
  • Understands 4 prepositions
  • Understands opposites
A

4 years

91
Q

50% Intelligibility

A

2 years (2/4 = 50%)

92
Q

75% intelligibility

A

3 years (3/4 = 75%)

93
Q

100% intelligibility

A

4 years (4/4 = 100%)

94
Q

What milestones are most predictive of developmental problems?

A

Language milestones

95
Q

Parental concerns about development identify __ % of children who fail screening tests.

A

80%

96
Q

Physician’s judgement alone identifies < __ % of children with significant developmental delays.

A

50%

97
Q

AAP recommends developmental screening at these well visits

A

9mo, 18mo, 30mo (or 24mo)

98
Q

What is developmental quotient

A

Developmenatal age/chronological age X 100

Does not coorelate with IQ

99
Q

Language Delay differential diagnosis

A
  • Hearing loss
  • Mental retardation
  • Developmental language delay
  • Autistic-spectrum disorders
  • Dysarthria (due to CP etc)
  • Psychosocial deprivation
  • Stuttering
  • Selective mutism (situational, due to anxiety)
100
Q
  • 9mo, no response to name
  • 10-12mo, not babbling
  • 15mo, does not respond to “no” or “bye bye”
  • 18mo, no words other than mama, dada; does not point to wants
  • 24mo, no 2 word phrases or 2 syllable words; does not understand simple commands
A

Warning signs for language delay

101
Q
  • 36mo; speech not fully intelligible to family; not using pronouns and verbs; no simple sentences; echolalia still present
  • 4 years; speech not fully intelligible to strangers
  • 5 years; persistent stuttering, frequent letter substitution
  • 6 years; speech errors other than s, ch, sh, z, j, v, th, zh
  • 8 years; any speech errors
A

Warning signs for language delay

102
Q

Percentage of SNHL that has a genetic etiology

A

50% - most common mutation in Connexin 26 gene on chromosome 13

  • 80% AR, 18% AD, 2% X-linked
  • 2/3 without other abnormalities
103
Q

Most common cause of conductive hearing loss

A

OME

104
Q

26-40dB

A

mild hearing loss

- difficulty with whispers, misses up to 50% speech

105
Q

41-55dB

A

moderate hearing loss

  • misses 50-100% of speech
  • often poor voice and speech quality
  • hearing device required
106
Q

56-70dB

A

moderate-severe hearing loss

  • loud shout heard as whisper
  • needs hearing aids, educational interventions
107
Q

71-90dB

A

severe hearing loss

- may have difficulty with hearing aids

108
Q

> 90dB

A

profound hearing loss

  • feels vibrations only, does not hear
  • relies on vision for communication
109
Q

IQ 55-69 (2SD < mean; mean 100, SD 15)

A

mild MR

110
Q

IQ 40-54 (3SD < mean)

A

moderate MR

111
Q

IQ 25-39 (4SD < mean)

A

severe MR

112
Q

IQ < 25 (5SD < mean)

A

profound MR

113
Q
  • Sudden deterioration in language (receptive, then expressive) at 3-7 years old
  • EEG abnormalities (temporal lobe spikes, sharp waves)
  • 80% with clinical seizures
  • Rx: high-dose steroids, IVIG, anticonvulsants, surgery
A

Landau-Kleffner Syndrome

114
Q

In this syndrome verbal skills < cognitive function

A

Down’s Syndrome

115
Q

These syndromes may present first with language delays

A

Klinefelter’s, Fragile X

116
Q

This syndrome may have language delay noted early, but eventually verbal skills > cognitive function

A

William’s Syndrome

117
Q
  • Physiologically active (increased HR and HR)
  • Generalized loss of activity in large muscles
  • EEG: low voltage, fast, dysynchronous
  • Low threshold to stimuli
  • Dreams occur here
A

REM sleep

118
Q
  • This sleep had 4 stages
    1. drowsiness, head nodding
    2. sleep spindles, K complexes, HR, RR, eye movements slowed, easily awakened
    3. 20-50% delta waves (high voltage, slow waves)
    4. >50% delta waves, difficult to awaken
A

Non-REM Sleep

119
Q

Phase of sleep where parasomnias occur

A

Non-REM (deep) sleep

120
Q

Most of this phase of sleep happens in first 1/3 of night

A

NREM

121
Q

Most of this phase of sleep happens in last 1/2 of night

A

REM

122
Q

Percentage of infants that sleep through the night by 9 months

A

70%

123
Q

Learned sleep associations

A

Sleep Onset Association Disorder

124
Q

Treatment of sleep onset association disorder

A
  • Putting infant to bed “drowsy but awake”
  • Ignoring (“cold turkey”)
  • Graduated extinction
  • Scheduled awakenings
  • Use of transitional objects
  • Wean nighttime feedings (“learned hunger”)

**Often gets worse before it gets better

125
Q
  • Occur within 1-2 hours after sleep onset (partial awakenings from deep sleep)
  • Present in 3% of 4-12 year olds
  • Varies in severity from confusion (infant) to terror (older child)
  • Precipitated by stress, illness, sleep deprivation
A

Night terrors

126
Q
  • First 1/3 of night
  • Age 4-12yrs
  • Stage IV sleep
  • Confused, agitated
  • Not consolable
  • No recall
A

Night terrors

127
Q
  • Second 1/2 of night
  • Peak 3y-6y (all ages)
  • REM sleep
  • Upset but awake
  • Consolable
  • May recall
A

Nightmares

Pediatric Board Review (17 decks)

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