Development/Behavior Flashcards
Gold standard for autism diagnosis
ADOS and ADI-R scales
Good prognostic signs in autism
Performance IQ >70
Speech by age 5
Highly structured environment
What is Rhett’s?
A subtype of autism:
- Significant developmental regression
- Deceleration of head growth
- Loss of social engagement
- Deficiency of language/social skills
- MR
- Normal for first several years of life
- Regression in 2+ areas before 10 years
- Looks like autism
Sensory Disintegration Disorder
3 main features of autism
- Limited range of interests
- Deficits in reciprocal interactions
- Deficits in verbal/nonverbal skills
Hallmark of Asperger’s
Social skills not appropriate, academically better
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?
24 months
“Most children”
75-90%
“Age is closest to”
75-90%
“All children”
Answer one age group older
“Some children”
Answer one age group younger
Typical HC growth
- 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
Typical weight gain
- Birth 3-3.5kg
- Regain by 2 weeks
- Double by 4 months
- Triple by 1 year
How gross motor proceeds
Hed to toe
How fine motor development proceeds
Proximal to distal
When do primative reflexes disappear
3-9 months of age
When do postural reactions develop
Between 3-10 months of age, coinciding with motor skills
- Head hangs down in ventral suspension
- Head lag when pulled to sit
- Turn head to side
- Moro, stepping, grasp reflexes
Newborn
- Head in line with body in ventral suspension
- Lifts head 45 degrees when prone, arms extended
- Follows object past midline
2 months
- 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
4 months
- Chest up, supported on hands, when prone
- Rolls supine to prone
- Sits with support (no support by 7 months)
6 months
- Gets into sitting position
- Crawls
- Pulls to stand
- May cruise (10-11mo)
9 months
- Takes a few steps with hand held
- May stand without help or walk independently
12 months
- Swipes at objects
- Hands open
3 months
- Hands in midline
- Grasps objects and brings to mouth
4 months
- Transfers objects hand-hand
- Reaches unilaterally, raking grasp
6 months
- Early pincer grasp
- Eats with fingers
9 months
- Mature pincer grasp
- Releases object voluntarily
12 months
- Coos
2 months
- Orients to voice
- “Ah-goo”
4 months
- Babbles
6 months
- Mama, dada non-specifically
- Responds to name, no
9 months
- Mama, dada specifically
- Immature jargoning (no real words)
- One or more words with meaning
- Understands commands with gestures
12 months
- Social smile
- Regards face
2 months
- Laughs
4 months
- Start of object permanence
- Prefers mother, stranger anxiety
6 months
- Object permanence: looks over edge
- Plays peek-a-boo, pat-a-cake
- Wave bye-bye
- Uncovers hidden object (10mo)
9 months
- Plays simple games
- Takes pride in accomplishments
12 months
- Walks well
- Walks backwards
15 months
- Walks backwards
- Runs clumsily, falls often
- Walks pushing or pulling toys
18 months
- Runs well, wide-based gait
24 months
- Walks on tiptoes
- Tandem walks forward
4 years
- Tandem walks backwards
- Skips, alternating feet
5 years
- Crawls up stairs
15mo
- Walks up stairs with hand held
- Two feet per step
18mo
- Climbs up and down stairs alone
- Two feet per step
24mo
- Climbs up stairs alternating feet
3 years
- Climbs down stairs alternating feet
4 years
- Sits self in chair
18mo
- Kicks ball forwards
- Jumps in place, jumps off step
- Stands on one foot momentarily
24mo
- Stands on 1 foot 1-2seconds
- Hops 2-3 times
- Broad jump
3 years
- Stands on 1 foot 3-5 seconds
- Hops 5 times
4 years
- 2 cube tower
15mo
- 3-4 cube tower
18mo
- 6-7 cube towers
24mo (2+4 = 6 cubes)
- 8 cube tower
- Imitates train with chimney
30mo
- 9-10 cube tower
- Imitates bridge with 3 cubes
3 years
- Imitates gate
4 years
- Imitates steps
5-6 years
- Scribbles spontaneously
- Imitates a stroke
18mo
- Imitates vertical and circular strokes
24mo
- Imitates horizontal strokes
30mo
- Copies circle
3 years
- Copies cross
4 years
- Copies square
4.5 years
- Copies triangle
- Prints a few letters
5 years
- Copies diamond
6 years
- Takes off gloves, socks, shoe
18mo
- Can put on some clothes
24mo
- Dresses with supervision
- Unbutton
3years
- Dresses without supervision
- Buttons
4 years
- Can tie shoelaces
5 years
- Uses covered cup with little spilling
15mo
- Handles spoon well for solids
18mo
- Uses spoon well for semi-solids
24mo
- Eats neatly with spoon and fork
3 years
- Spreads with a knife
5-6 years
- Starting to cut food with the knife
7 years
- 2-3 words
- Immature jargoning
12-13mo (1+2=3)
- 4-6 words
15mo (1+5=6)
- 7-20 words
- Mature jargoning
16-17mo (1+7=8)
- 50+ words
- 2 word sentences
21-24mo
- Pronouns (appropriately used)
- Telegraphic speech
30mo
- 250+ words
- 3-4 word sentences
- Plurals
- Present tense
3 years
- 4-6 word sentences
- Past tense
4 years
- Follows 1 step command without gestures
- Finds one body part
15mo
- Knows 5+ body parts
- Names pictures or common objects
18mo
- Follows 2 step command
24mo
- Knows sex, first and last name
- Understands 2 prepositions
30-36mo
- Names 3-4 colors
- Counts 5-10
- Understands 4 prepositions
- Understands opposites
4 years
50% Intelligibility
2 years (2/4 = 50%)
75% intelligibility
3 years (3/4 = 75%)
100% intelligibility
4 years (4/4 = 100%)
What milestones are most predictive of developmental problems?
Language milestones
Parental concerns about development identify __ % of children who fail screening tests.
80%
Physician’s judgement alone identifies < __ % of children with significant developmental delays.
50%
AAP recommends developmental screening at these well visits
9mo, 18mo, 30mo (or 24mo)
What is developmental quotient
Developmenatal age/chronological age X 100
Does not coorelate with IQ
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)
- 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
- 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
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
Most common cause of conductive hearing loss
OME
26-40dB
mild hearing loss
- difficulty with whispers, misses up to 50% speech
41-55dB
moderate hearing loss
- misses 50-100% of speech
- often poor voice and speech quality
- hearing device required
56-70dB
moderate-severe hearing loss
- loud shout heard as whisper
- needs hearing aids, educational interventions
71-90dB
severe hearing loss
- may have difficulty with hearing aids
> 90dB
profound hearing loss
- feels vibrations only, does not hear
- relies on vision for communication
IQ 55-69 (2SD < mean; mean 100, SD 15)
mild MR
IQ 40-54 (3SD < mean)
moderate MR
IQ 25-39 (4SD < mean)
severe MR
IQ < 25 (5SD < mean)
profound MR
- 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
In this syndrome verbal skills < cognitive function
Down’s Syndrome
These syndromes may present first with language delays
Klinefelter’s, Fragile X
This syndrome may have language delay noted early, but eventually verbal skills > cognitive function
William’s Syndrome
- 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
- 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
Phase of sleep where parasomnias occur
Non-REM (deep) sleep
Most of this phase of sleep happens in first 1/3 of night
NREM
Most of this phase of sleep happens in last 1/2 of night
REM
Percentage of infants that sleep through the night by 9 months
70%
Learned sleep associations
Sleep Onset Association Disorder
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
- 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
- First 1/3 of night
- Age 4-12yrs
- Stage IV sleep
- Confused, agitated
- Not consolable
- No recall
Night terrors
- Second 1/2 of night
- Peak 3y-6y (all ages)
- REM sleep
- Upset but awake
- Consolable
- May recall
Nightmares
