Developmental delay

Question 1

what are the 2 types of delay

Answer 1

global - 2 or more areas of development effected

specific - 1 area of development effected

Question 2

what is developmental delay

Answer 2

failure to attain appropriate developmental milestones for child’s chronological age

Question 3

what are 3 abnormal development patterns

Answer 3

Delay
Deviation
Regression

Question 4

example of deviation

Answer 4

autism spectrum - not just a delay but they may not acquire a skill, or do things differently

Question 5

example of regression

Answer 5

Loss of skills that were previously acquired

examples: Rett’s syndrome (genetic condition when they acquire milestones up to 18 months then start to loose them again)

Question 6

what is the IQ of someone with a severe learning disability

Answer 6

Norm - 100

severe learning disability - 50

Question 7

what are some red flags for development

Answer 7

• Asymmetry of movement
• Not reaching out for objects by 6 months (could be vision or motor skill or lack of interest)
• Unable to sit unsupported by 12 months
• Unable to walk by 18 months (check CK for muscular dystrophy)
• No speech by 18 months
• Concerns re vision/hearing
• Loss of skills (regression)

Question 8

what is screened for in Down’s syndrome patients (common complications)

Answer 8

• cardiac problems
• vision
• hearing
• thyroid function
• sleep related breathing disorders
• growth charts (smaller, put on more weight)
• development

Question 9

what happens do children with a developmental delay, do they eventually catch up?

Answer 9

no, for example if a 2 year old is 6 months delayed then thats 1/4. They will most likely always been 1/4 delayed for their age eg. a 12 year old will act more like a 9 year old

Question 10

what is Duchenne muscular dystrophy

Answer 10

presents with a motor delay, hearing/speech problems- weakness in pelvic girdle which is seen by a compensatory back lordosis.

GOWERS manoeuvre is associated due to weakness in legs (pushing body up with arms on thighs instead of legs)

Question 11

what is hemiplegic cerebral palsy

Answer 11

when 1 side is effected

Question 12

what is biologic cerebral palsy

Answer 12

when 2 limbs are effected - most commonly related to an insult to pregnant women interrupting blood flow to foetus

Question 13

what is quadriplegic cerebral palsy

Answer 13

when all 4 limbs are involved

Question 14

most common cause of cerebral palsy

Answer 14

antenatal issues

Question 15

conditions associated with cerebral palsy

Answer 15

• mobility problems, spasticity and orthopaedic problems
• learning difficulties
• epilepsy
• visual/hearing impairment
• communication difficulties
• feeding difficulties
• sleep problems
• behaviour problems
• co-ordination disorders

Question 16

what are some causes of sensory defects and associated delay

Answer 16

Oculocutaneous albinism

• effects pigmentation of hair skin and eyes
• problems with eye movements, light sensitivity

‘Glue ear’ - ears blocked temporarily causing it to sound like you’re underwater - 3 months to clear

Question 17

what is the triad of autism impairments

Answer 17

communication
social interaction
flexibility of though/imagination

Question 18

what is the difference between receptive and expressive language in autism

Answer 18

receptive language is often less than expressive language meaning they use words and say things they don’t understand

Question 19

some signs of autism in expressive language

Answer 19

Echoes- repeating back what they’ve heard without understanding it

off intonation/pitch - either v monotone or sometimes high

Chunks of video speak- learn chunks of dialogue from tv ect and repeats it

Question 20

what non-verbal communication difficulties are seen in autism

Answer 20

facial expressions and gestures can be hard to read

eye contact can be difficult

struggle to recognise the intentions of others

Question 21

what difficulties with the use of language are seen in autism

Answer 21

initiating and sustaining conversation

restricted interests eg. child being obsessed with trains

lack of awareness of reciprocal nature of conversation - don’t stop talking at you

Question 22

Difficulties seen during social interaction in people with autism

Answer 22

joint attention and referencing - can’t get them interested in something you’re also interested in

taking turns - cant predict what will happen if they let someone else play with their toy

unable to share pleasure

dont follow social rules

lack empathy

relationships

other points of view/feelings

Question 23

difficulties in thought/imagination seen in autism

Answer 23

-theory of mind
-concrete and literal - don’t understand figures of speech
-no concept of time
dont like changes in

environment - can memorise entire environments an know of any changes to them
-ritualistic behaviour

Question 24

sensory issues associated with autism

Answer 24

fussy eater/medications 
textures of clothes 
sleep - prefer heavy blankets and heavy touch 
toilet training 
hair washing/cutting 
nail cutting 
noise

Question 25

what to ask about in the history for developmental delay

Answer 25

Presenting complaint 
PMH
Perinatal and birth 
Family and Social 
Developmental 
Play and Behaviour 
School/nursery

Question 26

examination for developmental delay

Answer 26

Observation 
Dysmorphism (abnormal body structure) 
Head circumference 
Systems 
CNS 
Vision 
Hearing

Question 27

Investigations for developmental delay

Answer 27

Chromosomes 
FRAX - not that common (fragile x) 
Oligoarray 
CGH 
Neonatal PKU, thyroid studies, CK 

If indicated: 
MRI
EEG
Metabolic studies 
Genetic consultation 
Others