Developmental Delay Flashcards
Definition of developmental delay
Failure to attain appropriate developmental milestones for child’s corrected chronological age
What are the 3 main patterns of abnormal development?
Delay (global or specific), deviation (autism) or regression (Rett’s or metabolic)
What are the red flags for development?
- Asymmetry of movement
- Not reaching for objects by 6 months
- Unable to sit unsupported by 12 months
- Unable to walk by 18 months → check CK
- No speech by 18 months
- Concerns re vision or hearing
- Loss of skills
Global development delay
Significant delay in 2+ of gross/fine motor, speech/language, cognition, social/personal, ADL (termed learning difficulty in school age)
What are examples of specific developmental delays?
- Motor Delays eg Duchenne Muscular Dystrophy, Cerebral Palsy, Co-ordination disorders
- Language Delays eg Specific Language Impairment
- Sensory Deficits and Associated Delay eg Oculocutaneous Albinism, Treacher-Collins
- Developmental Deviations eg Autism Spectrum disorders
What is the autistic triad?
- Communication
- Social interaction
- Flexibility of thought/ Imagination (lack of)
What are the characteristics of autism?
- Communication
- Receptive Language - Expressive>Receptive (they can recite a lot of language but not understand it)
- Abstract language difficult – can take things very literally
- Expressive Language- Odd intonation/pitch – no change in pitch
- Non-verbal language - find eye contact challenging
- Lack of awareness of reciprocal nature of conversation – unaware if you aren’t interested
- Social Interaction
- Joint Attention and Referencing - normal children will be pointing to something on a shelf and making sure mum is looking
- Social rules – personal space, offense
- Empathy – aren’t in tune with peoples emotions
- Flexibility of thought/imagination
- Concrete and literal
- Like Routines – because routine is predicatble
- Changes in environment – too much noise or over stimulating and they cant cope
- Sensory issues
- Fussy eater/ medications
- Textures of clothes
- Noise
What should be done in an examination of developmental delay?
- Observation – how are they behaving, moving, any asymmetry
- Dysmorphism
- Head Circumference
- Systems
- CNS inc neurocutaneous, look at skin and gait
- Vision and Hearing
What investigations should be done with developmental delay?
First line:
- Creatinine Kinase (looking for DMD)
- TFT’s, U+Es, LFTs, FBC
- Bone age
- Chromosomes
- FRAX (fragile X)
Second line:
- Oligoarray CGH
- Neonatal PKU
- Thyroid studies
- If indicated:
- MRI brain
- EEG (electroencephalogram)
- Metabolic studies
- Genetic consultation
What is involved in the therapy of developmental delay?
Early intervention!
- Therapy
- Physio
- SLT – speech and language therapy
- OT
- Family Support
- Educational Placement
- Referral to Other Agencies
What are some of the characteristics of Down’s Syndrome?
- Congenital heart defects
- Vision problems, particualrly with focus
- Hearing – skull is slightly flattened which affects the developement of ENT
- Underactive thyroid
- Sleep related breathing disorders – underlying anatomy, sleep apnoea
- Shorter stature
- Weight gain
Which gait is associated with Duchenne’s Muscular Dystrophy?
Lordotic gait (shoulder bending backwards due to weakness of the pelvic girdle)
What is Gower’s Manouvre and what is it associated with?
Associated with Duchenne’s Muscular Dystrophy, due to weakness in pelvic girdle, when getting up from the floor they push up with their hands and then up.
What gait is associated with cerebral palsy?
Spastic diplegic gait (dragging toes and knees together)
Occulocutaneous albinism
- Reduced pigment in the iris and retina.
- Pale eyes.
- Very photophobic and struggle to be out in bright light.
- Often have staggers (rapid involuntary eye movements).
What does conductive and sensorineural hearing loss audiograms look like?
