Development/Behavior Flashcards

1
Q

Gold standard for autism diagnosis

A

ADOS and ADI-R scales

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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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5
Q

3 main features of autism

A
  • Limited range of interests
  • Deficits in reciprocal interactions
  • Deficits in verbal/nonverbal skills
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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
- Hands in midline | - Grasps objects and brings to mouth
4 months
26
- Transfers objects hand-hand | - Reaches unilaterally, raking grasp
6 months
27
- Early pincer grasp | - Eats with fingers
9 months
28
- Mature pincer grasp | - Releases object voluntarily
12 months
29
- Coos
2 months
30
- Orients to voice | - "Ah-goo"
4 months
31
- Babbles
6 months
32
- Mama, dada non-specifically | - Responds to name, no
9 months
33
- Mama, dada specifically - Immature jargoning (no real words) - One or more words with meaning - Understands commands with gestures
12 months
34
- Social smile | - Regards face
2 months
35
- Laughs
4 months
36
- Start of object permanence | - Prefers mother, stranger anxiety
6 months
37
- Object permanence: looks over edge - Plays peek-a-boo, pat-a-cake - Wave bye-bye - Uncovers hidden object (10mo)
9 months
38
- Plays simple games | - Takes pride in accomplishments
12 months
39
- Walks well | - Walks backwards
15 months
40
- Walks backwards - Runs clumsily, falls often - Walks pushing or pulling toys
18 months
41
- Runs well, wide-based gait
24 months
42
- Walks on tiptoes | - Tandem walks forward
4 years
43
- Tandem walks backwards | - Skips, alternating feet
5 years
44
- Crawls up stairs
15mo
45
- Walks up stairs with hand held | - Two feet per step
18mo
46
- Climbs up and down stairs alone | - Two feet per step
24mo
47
- Climbs up stairs alternating feet
3 years
48
- Climbs down stairs alternating feet
4 years
49
- Sits self in chair
18mo
50
- Kicks ball forwards - Jumps in place, jumps off step - Stands on one foot momentarily
24mo
51
- Stands on 1 foot 1-2seconds - Hops 2-3 times - Broad jump
3 years
52
- Stands on 1 foot 3-5 seconds | - Hops 5 times
4 years
53
- 2 cube tower
15mo
54
- 3-4 cube tower
18mo
55
- 6-7 cube towers
24mo (2+4 = 6 cubes)
56
- 8 cube tower | - Imitates train with chimney
30mo
57
- 9-10 cube tower | - Imitates bridge with 3 cubes
3 years
58
- Imitates gate
4 years
59
- Imitates steps
5-6 years
60
- Scribbles spontaneously | - Imitates a stroke
18mo
61
- Imitates vertical and circular strokes
24mo
62
- Imitates horizontal strokes
30mo
63
- Copies circle
3 years
64
- Copies cross
4 years
65
- Copies square
4.5 years
66
- Copies triangle | - Prints a few letters
5 years
67
- Copies diamond
6 years
68
- Takes off gloves, socks, shoe
18mo
69
- Can put on some clothes
24mo
70
- Dresses with supervision | - Unbutton
3years
71
- Dresses without supervision | - Buttons
4 years
72
- Can tie shoelaces
5 years
73
- Uses covered cup with little spilling
15mo
74
- Handles spoon well for solids
18mo
75
- Uses spoon well for semi-solids
24mo
76
- Eats neatly with spoon and fork
3 years
77
- Spreads with a knife
5-6 years
78
- Starting to cut food with the knife
7 years
79
- 2-3 words | - Immature jargoning
12-13mo (1+2=3)
80
- 4-6 words
15mo (1+5=6)
81
- 7-20 words | - Mature jargoning
16-17mo (1+7=8)
82
- 50+ words | - 2 word sentences
21-24mo
83
- Pronouns (appropriately used) | - Telegraphic speech
30mo
84
- 250+ words - 3-4 word sentences - Plurals - Present tense
3 years
85
- 4-6 word sentences | - Past tense
4 years
86
- Follows 1 step command without gestures | - Finds one body part
15mo
87
- Knows 5+ body parts | - Names pictures or common objects
18mo
88
- Follows 2 step command
24mo
89
- Knows sex, first and last name | - Understands 2 prepositions
30-36mo
90
- Names 3-4 colors - Counts 5-10 - Understands 4 prepositions - Understands opposites
4 years
91
50% Intelligibility
2 years (2/4 = 50%)
92
75% intelligibility
3 years (3/4 = 75%)
93
100% intelligibility
4 years (4/4 = 100%)
94
What milestones are most predictive of developmental problems?
Language milestones
95
Parental concerns about development identify __ % of children who fail screening tests.
80%
96
Physician's judgement alone identifies < __ % of children with significant developmental delays.
50%
97
AAP recommends developmental screening at these well visits
9mo, 18mo, 30mo (or 24mo)
98
What is developmental quotient
Developmenatal age/chronological age X 100 **Does not coorelate with IQ**
99
Language Delay differential diagnosis
- 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
- 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
Warning signs for language delay
101
- 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
Warning signs for language delay
102
Percentage of SNHL that has a genetic etiology
50% - most common mutation in Connexin 26 gene on chromosome 13 - 80% AR, 18% AD, 2% X-linked - 2/3 without other abnormalities
103
Most common cause of conductive hearing loss
OME
104
26-40dB
mild hearing loss | - difficulty with whispers, misses up to 50% speech
105
41-55dB
moderate hearing loss - misses 50-100% of speech - often poor voice and speech quality - hearing device required
106
56-70dB
moderate-severe hearing loss - loud shout heard as whisper - needs hearing aids, educational interventions
107
71-90dB
severe hearing loss | - may have difficulty with hearing aids
108
>90dB
profound hearing loss - feels vibrations only, does not hear - relies on vision for communication
109
IQ 55-69 (2SD < mean; mean 100, SD 15)
mild MR
110
IQ 40-54 (3SD < mean)
moderate MR
111
IQ 25-39 (4SD < mean)
severe MR
112
IQ < 25 (5SD < mean)
profound MR
113
- 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
Landau-Kleffner Syndrome
114
In this syndrome verbal skills < cognitive function
Down's Syndrome
115
These syndromes may present first with language delays
Klinefelter's, Fragile X
116
This syndrome may have language delay noted early, but eventually verbal skills > cognitive function
William's Syndrome
117
- 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
REM sleep
118
- 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
Non-REM Sleep
119
Phase of sleep where parasomnias occur
Non-REM (deep) sleep
120
Most of this phase of sleep happens in first 1/3 of night
NREM
121
Most of this phase of sleep happens in last 1/2 of night
REM
122
Percentage of infants that sleep through the night by 9 months
70%
123
Learned sleep associations
Sleep Onset Association Disorder
124
Treatment of sleep onset association disorder
- 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
- 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
Night terrors
126
- First 1/3 of night - Age 4-12yrs - Stage IV sleep - Confused, agitated - Not consolable - No recall
Night terrors
127
- Second 1/2 of night - Peak 3y-6y (all ages) - REM sleep - Upset but awake - Consolable - May recall
Nightmares