Development SAQ

Question 1

1. Four features of dyslexia (reading impairment).

Answer 1

1. Difficulty reading due to poor word recognition
2. Poor spelling and decoding abilities
3. Normal cognition and comprehension when read to aloud
4. Strong FHx

Question 2

2 Child with ODD (they give you this).

a) What management would you suggest (2 marks)
b) What 3 comorbidities are associated (3 marks)

Answer 2

A)

1. Parent training classes
2. CBT + social emotional skill training for child
3. Medications to treat comorbidities

B)

1. ADHD
2. Anxiety
3. Conduct disorder

Question 3

3. 6 or 7 m.o. Boy that her mother is concerned about his development. He rolls both sides, is unable to sit without support, he babbles and her mother thinks he is right handed because he crosses midline to grab with his right hand when objects are on the left.
   a) Of those findings what one thing is the MOST worrisome on history?
   b) Explain why?

Answer 3

a) Early handedness
b) Handedness before 18mo is a red flag and is suggestive of CP

Spastic hemiplegia

• decreased spontaneous movment on affected side, arms > legs
• early hand preference

Question 4

4. Name 5 characteristics of Rett syndrome (5).

Answer 4

1. Females. MEC2P mutations
2. Normal development until ~1yo then regression of motor + language. Plateaus after
3. Acquired microcephaly
4. Repetitive handwringing. Loss of spontaneous movement of the hands
5. Autistic behaviour
6. Gait abnormalities
7. Sighing respirations with intermittent apenas +/ cyanosis
8. GTC Sz
9. Arrhythmias

Question 5

5) A 7 year old boy fights when going to bed and takes an hour to fall asleep. What are five pieces of advice you would give the parents for improving sleep hygiene?

30 ) Teenage boy with trouble sleeping. List 5 things to improve his sleep hygiene.

Answer 5

1. Set bedtime and routine
2. Sleep and wake hours should be same on school and non-school nights (<1H difference)
3. Shared quiet time 1H before bed without screens
4. Light snack before bed
5. Avoid caffeinated products for several hours before bed
6. Keep bedroom at appropriate temperature
7. Keep bedroom dark and quiet. Can use night light
8. Don’t use bedroom for punishment
9. No TV in bedroom
10. Ensure adequate exercise. Go outside (for sun)

For teenagers

1. Don’t use weekends to catch up on sleep
2. Limit naps to <1H in afternoons
3. Use bed only for sleep
4. No smoking or alcohol
5. No sleep meds unless prescribed

Question 6

6) A 9 year old girl has a short temper, is argumentative, and disrespects her parents. What are 5 key features of a parenting plan for this child?

Answer 6

Parent management training

1. Develop warm, supportive relationship with child
2. Encourage child-directed interaction + play
3. Provide predictable, structured household environment
4. Set clear + simple househodl rules
5. Consistently praise + reward positive behaviour
6. Consistently ignore annoying behaviour (then praise when it ceases)
7. Consistently give consequences for dangerous or destructive behaviour (time out or loss of privileges)

Question 7

7) A 6 year old boy is referred to you for school difficulties. He is previously healthy and was born at term. What information on history would help confirm your suspicion of reading disability (dyslexia)? (They had 5 lines but did not specify how many points they wanted.)

Answer 7

1. Difficulty with reading due to difficulties with fluency or accuracy of word recognition
2. Poor spelling and decoding abilities
3. Normal language comprehension when read to aloud
4. Normal cognitive ability
5. Family history

Question 8

8) Name 5 safe sleeping advice

Answer 8

1. Back to sleep
2. No extra bedding
3. Crib in same room as parents
4. No cosleeping
5. No bottle propping

Question 9

9) You noticed that the community has a high rate of dental caries, what 5 things can you do at the community level to decrease dental caries

Answer 9

1. Advocate for fluoride supplementation in water
2. Dental assessment for infants wtihin 6mo fo their first tooth. No later than 1yo for all children
3. Develop ongoing surveillence system to monitor state of pediatric oral health
4. Create leadership positions to represent specific interests of children + youth on oral health issues in the community
5. Child health care providers should get appropraite training + continuing education in oral health. Provide anticipatory guidance for parents so that disease can be prevented.

Question 10

10) A 28 week prem is now 10 months old. He is able to sit alone for 5 min, is commando crawling, can transfer objects from hand to hand and can stand if supported. He does not have a pincer grasp.
a. What is his developmental level?
b. How should you advise parents?

Answer 10

A. 6mo (CGA 7mo)

• 6mo: sit momentarily propped on hands, 7mo: sits without support steadily, 8 mo: commando crawls
• 6mo: transfers hand to hand
• 6mo: palmar grasp, 9mo: inferior pincer grasp, 12mo: mature pincer grasp

B.

1. Reassure that he is developing appropriately for CGA
2. Anticipatory guidance: safety for furniture in preparation for walking, work on pincer grasp + utensils, work on drinking from cup, should have babbling + imitating sounds, shake head for no, read to baby
3. Counsel families about using correct GA for development + growth parameters until 2yo

Question 11

11) Name 4 biological factors that influence a child’s development.

Answer 11

1. Intrauterine exposures (teratogens, drugs, alcohols) + TORCH infections
2. Prematurity + low BW
3. Underlying genetic/metabolic condition
4. Postnatal illness, disease, injury
5. FHx of developmental delay

Question 12

13) Teacher concerned about 4 yr old child who can’t use scissors, can’t copy a square… she wonders about developmental coordination disorder. List 2 diagnostic criteria for developmental coordination disorder.

Answer 12

1. Acquisition and execution of coordinated motor skills below expected level for age and opportunity to learn
2. Interferes wtih ADLS/play/school
3. Began in early developmental period
4. Impairment in motor skills not better explained by another condition

Question 13

15) School refusal: what three recommendations would you make?

Answer 13

1. Early return to school - longer child stays out of school, more difficult it is to return
2. Address comorbid psychiatric problems, family dysfunction + other contributing problems
3. Positive reinforcements for going to school. No positive reinforcements for staying at home (TV)

Question 14

16) Table of 5 different developmental milestones for an 18 month old. Mark as normal or abnormal:
a. Walked at 14 months, not yet doing stairs
b. Speaks a 2 word vocabulary
c. Follows one step commands
d. Cries for wants but does not point to needs
e. Points to face but doesn’t know any other body parts

Answer 14

a. Walked at 14 months, not yet doing stairs: ?normal
* 15mo: creep up stairs, 18mo: creep down, 2yo: up/down stairs 2 feet/step + rail
b. Speaks a 2 word vocabulary - not normal
* 18mo: should have 10-25 words
c. Follows one step commands - normal

• 12mo: 1 step with gesture
• 15mo: 1 step without gesture

d. Cries for wants but does not point to needs - not normal

• 12mo: protoimperative pointing
• 15mo: protodeclarative pointing

e. Points to face but doesn’t know any other body parts - not normal
* 18mo: 3 body parts

Question 15

17) Mom brings in her 6 month old child. Noted to not be using the left hand, and left arm and leg appear stiff. Babbling, smiling, but unable to sit even with support. Otherwise looks well. What is your first management step?

Answer 15

CK + MRI brain

Question 16

18) List 3 criteria for autism that you would be able to identify in your office.

Answer 16

1. Deficits in social communication + social interaction
   
   • social emotional reciprocity
   • non-verbal communication behaviour for social interaction
   • developing, maintaining, understanding relationships
2. Restricted and repetitive interests
   
   • Stereotyped or repetitive movements, speech, use of objects
   • Insistence on sameness
   • Highly restricted, fixated interests that are abN in intensity or focus
   • Hyper/hyporeactivity to sensory input
3. Symptoms present in early developmental period

Question 17

19) A kid brought into your office. Teachers feel he is inattentive at school, and has poor school performance. List 4 DDx:

Answer 17

1. ADHD
2. Sleep disorder
3. Learning disability
4. Vision disorder
5. Hearing disroder
6. Anxiety
7. Depression
8. Substance use

Question 18

20) A mother is concerned that her 7-month-old baby is not sitting independently. She thinks that the baby is right handed and is able to transfer objects across the midline using her right hand. Do you have any concerns about this child’s development?

Answer 18

Yes, early handedness before 18mo is suspicious for CP (spastic hemiplegia)

• 6mo sit in tripod, so no worreis about not sitting independently
• 4mo: bring hands to midline
• 6mo: transfers objects

Question 19

21) The parents of a three year old girl want advice about toilet training. What are four signs of toilet readiness?

Answer 19

1. Eager to please parents due to positive relationship
2. Desire for independence + control of bowel + bladder functions
3. Able to walk to potty on own
4. Stable while sitting on potty
5. Can stay dry for a few hours
6. Expressive: can use words or reproducible gestures to indicate need to use potty
7. Receptive: can understand 1-2 step simple commands

Question 20

22) What are four features of infantile colic?

Answer 20

1. <4mo
2. Paroxysms of irritability, fussiness or crying that starts or stops without obvious cause
3. Episodes last for >3H/d and >3d/wk for at least 1wk
4. No FTT

Question 21

23) Description of a child with autism. His physical exam is normal and he has no history of developmental regression. What are three tests you would order?

Answer 21

1. Microarray
2. Fragile X
3. Vision + hearing test

Question 22

24) Mom would like to toilet train her child – list 3 questions you would ask to assess readiness for toilet training.

Answer 22

1. Desire to please parents b/c of positive relationship
2. Desire for independence + control of bowel + bladder function
3. Can walk to potty on own
4. Stable while sitting on potty
5. Remains dry for several hours
6. Expressive: able to communicate need for potty with words or reproducible gestures
7. Receptive: can follow 1-2 step simple commands

Question 23

25) List 4 diagnostic features of Autism

Answer 23

1. Persistent deficits in social communication and social interaction, across multiple domains
2. Restricted and repetitive interests, behaviours, or activities
3. Appears early in early developmental period
4. Sx cause significant impairment in social, occupationa, or other important areas of functioning

Question 24

26) A mom has brought her 2 y.o. son in for a regular visit. She has the following concern and asks for your advice: when she says “no” for whatever reason, he screams and hits her. There are otherwise no concerns in behaviour or development. What are 3 recommendations you can give her?

Answer 24

1. Consistent limit setting, clear communication of rules
2. Redirect to another activity with brief explanation
3. Discipline should be immedate, specfiic to the behaviour + time limited (1 min per year of age)
4. Positive reinforcement for good behaviours

Question 25

27) Parents of a 6 year-old boy. Teaches are concerned because he doesn’t seem to be paying attention in school. Development is normal, and parents have no concerns about his behaviour. List 3 possible diagnoses.

Answer 25

1. ADHD 2. Sleep disorder (OSA) 3. Hearing/vision problem 4. Depression 5. Anxiety

Question 26

28) A Mom wonders if her autistic 2-year-old daughter could have Rett’s. Name 3 characteristics of Rett’s (besides autism).

Answer 26

1. Female, MEC2P 2. Normal development until ~1yo, then regression of language + motor 3. Repetitive hand wringing or lack of purposeful movement of hands 4. Acquired microcephaly 5. Unusual sighing respirations with intermittent cyanosis + apneas 6. GTC sz 7. Cardiac arrhythymias

Question 27

29) Night terrors (name from situation described).

Answer 27

* 4-12yo, most stop by adolescence * Arouse from first 1/3 of night (slow wave sleep) * Confused on awaking * Amnesia * Autonomic Sx (tachycardia, dilated pupils)

Question 28

31) Developmentally delayed child. Brother in special class. Maternal cousin has autism. Diagnosis and test.

Answer 28

? Autism ? Fragile X * FMR1 gene sequencing for CGG repeats

Question 29

32) Guidance counselor calls you about 12 y.o. from Inuit population. Thinks he may have ADHD. Give four other things on your differential diagnosis.

Answer 29

1. Sleep disorder 2. Vision/hearing issue 3. Anxiety 4. Depression 5. Learning disability 6. FASD 7. Substance use

Question 30

33) Picture of child (large ears, macrocephaly) He is hyperactive. 50th percentile for ht and wt. 95th percentile for head circumference. Identify diagnosis

Answer 30

Fragile X

Question 31

34) Description of a child with florid autism. A) Name 3 tests you should order. B) Which 2 consultants or services would you involve to help you with your diagnosis?

Answer 31

1. Vision/hearing 2. Microarray 3. Fragile X B. 1. Developmental pediatrics 2. Genetics/metabolics 3. Neuro if abN

Question 32

35) Child comes to the office because his teacher wants him investigated for disruptive behaviour and is concerned about ADHD. Parents may have some concerns about his attention but none about his behaviour. A) What do you think is the diagnosis? B) What are 4 things to request to investigate for this diagnosis?

Answer 32

A. Sleep disorder B. 1. Vision 2. Hearing 3. PSG 4. Psychoeducational assessment

Question 33

36) Description of night terrors. List two things to do for management.

Answer 33

1. Sleep hygiene 2. Scheduled awakenings. 15-30min before onset of expected event