Developmental Delay

Question 1

By what age do you expect all primitive reflexes (fisting, morrow) to be extinguished?

Answer 1

6 months. If they persist beyond this, consider developmental delay.

Question 2

What is the technical definition of intellectual disability?

Answer 2

IQ < 2 SD from mean for age (usually IQ < 80.)

Question 3

True or False? Intellectual disability of all severities is linked to SES and is more common in boys.

Answer 3

FALSE: Although intellectual disability of all severities is more common in boys, mild disability is more common in low SES but severe disability is not associated with SES.

Question 4

A 5 year old who has not received much primary care presents with intellectual disability. IQ is 75. There is no family history of intellectual disability and overall, the child’s exam is normal except for skin. You decide to refer for chromosome testing. What skin finding triggered this decision?

Answer 4

Pigment abnormalities should prompt chromosome testing in intellectual disability.

Test if any of the following are present:

• Microcephaly
• Family history of intellectual disability
• Family history of fetal loss
• IQ < 50
• Skin pigment abnormalities
• Suspected genetic syndrome

Question 5

A mother is concerned her baby of 6 months age is not saying “mamma.” Is this normal?

Answer 5

YES

Cooing only is normal and babbling may not start until after age 6 months.

Question 6

A couple bring in their 18 month old child for a well-check and you note that the child only babbles. Is this a concern?

Answer 6

YES

By 18 months, there should be at least some words.

Question 7

A 24 month old can speak a few phrases but you can only understand about half of what the child is saying. Is this normal?

Answer 7

YES

• By age 2, strangers can understaind about 50% of what the child says.
• By age 3 this should be 75%.
• After age 4 this should be 100%.