Developmental delay Flashcards
What are the developmental domains
Gross motor skills (locomotor)
Fine motor skills (manipulative)
Visual skills
Hearing & language skills (receptive language)
Speech & language skills (expressive language)
Interactive social skills
Self care social skills
Define median age and limit age
Median age = age at which half a population of children acquire a skill
Limit age = the age at which a skill should have been achieved and is two standard deviations from the mean.
How should you adjust milestone expectations for prematurity
<2 years old: should have the anticipated skills of the average infant who is their age-number of weeks premature e.g. 9 month old baby born 3 months premature → should have the skills of a 6 month old
What are the primitive reflexes
Reflexes that the infant should be born with, then will lose after time
Sucking and rooting: turns face to the side of a stimulus places near the mouth
Palmar grasp
Stepping: stepping when held upright
Asymmetric tonic neck reflex (ATNR): when head is turned to one side, the same arm extends while the other flexes
Moro: sudden change in position causes sudden abduction of arms and adduction of legs
Babinski: toes fan outwards and big toe extends up
What are the protective/postural responses
These must develop before the child can attain gross motor development
Head righting (4-6 months): tilting the baby to one side causes baby to hold its neck perpendicularly/vertically
Parachute (7-8 months): when holding the baby upside down the hands should shoot forward to catch themselves
Postural support: baby may push up/bounce when held upright
Lateral propping: arm extends to the side they are falling on when sitting
How does cognition change throughout childhood
- Pre-operational thought
- Centre of the world
- Inanimate objects are alive
- Events have a magical element
- everything has a purpose - Operational thought
- Practical and orderly - Abstract thought
- Formal operational
- Abstract reasoning, resting hypotheses
Define developmental delay and what are the types
Slow acquisition of all skills or one particular field or area of skill
Slow but steady
Plateau (good progression which then stops)
Regression (loss of skills previously acquired)
Define global delay and significant delay
Global delay = a significant delay in two or more of the four main developmental domains
Significant delay = 2 or more SD below the mean on age appropriate norm-referenced testing
Define disorder, impairment, disability, and disadvantage
Disorder = maldevelopment of a skill
Impairment = loss or abnormality of physiological function or anatomical structure
Disability = any restriction or lack of ability due to the impairment
Disadvantage = results from the disability, and limits or prevents fulfilment of a normal role. It is situationally specific e.g. a child with a learning disability may be a good skier or swimmer
What are the causes of a global developmental delay
Prenatal:
Chromosomal abnormalities (Down’s syndrome, Fragile X)
Microcephaly, hydrocephaly, haemorrhage, vascular occlusion
Metabolic (hypothyroidism), PKU
Use of alcohol or drugs
Congenital infections
Tuberous sclerosis, neurofibromatosis
Perinatal
Acquired brain injury (Hypoxia, meningitis, IVH, HIE)
Postnatal
Seizure disorders (West syndrome)
Meningitis, encephalitis
Anoxia (suffocation, near drowning)
Environmental-social issues
Chronic illnesses e.g. inborn errors of metabolism
What are the causes of Gross motor and posture delay
Cerebral palsy (most common cause of motor impairment)
Global delay e.g. Down’s syndrome
Congenital dislocation hip
Social deprivation
Muscular dystrophy -Duchenne’s
Neural tube defects: spina bifida
Hydrocephalus
Joint hypermobility
What are the causes of language and hearing delay
Hearing loss or deficit
Learning disability
Autistic spectrum disorder, Rett;s syndrome
Lack of stimulation, Environmental deprivation
Impaired comprehension of language
Stammering
Anatomical deficit e.g. cleft palate, cerebral palsy
What are the causes of a social, emotional and behavioural delay
Autism spectrum disorder
What should be looked for on exam for development delay
Developmental assessment
Neuro exam: abnormal posture, wasting, patterns of mobility, dexterity, hand dominance, communication and cognition
General: ?dysmorphic features
Focused physical assessment: look, growth, hearing, vision, skin and genitalia
Growth parameters + head circumference
What tools can be used for developmental screening
Denver developmental screening test
Schedule of Growing Skills (II)
Griffiths developmental scale
Bailey developmental scale
the ages and stages questionnaire (ASQ)
the parents ’ evaluation of developmental status (PEDS)
modified checklist for autism in toddlers (M-CHAT)
