Developmental Delay Flashcards
What is developmental delay?
i. Failure to attain appropriate developmental milestones for child’s corrected chronological age.
ii. Can correct up to 2 years for a child grown pre-mature
What are the patterns of abnormal development?
i. Delay (global – Down’s syndrome and specific – Duchenne’s muscular dystrophy)
ii. Deviation (autism spectrum disorder)
iii. Regression (Rett’s syndrome and metabolic disorders)
At which age are deviant patterns of development looked at specifically?
27 months
What is deviation?
i. Not just a simple delay,
ii. They may do things a slightly different way
What is regression?
i. It is a loss of previously acquired skills
ii. Very worrying
iii. Rett’s syndrome – think it’s more in girls?, lose their ability to walk, inborn biochemical problems
iv. Looks like they are developing normally but if they get a disease and they get over it might stop doing things the right way
How common is ASD in UK?
1% of the UK children have it
What is the percentage of children with mild learning difficulty?
1-2%
What is the percentage of children with severe learning difficulty?
0.3 - 0.5%
What is the percentage of children with a specific learning difficulty?
5-10%
What is the range of IQ for mild learning difficulty?
50- 70
What is the range of IQ for moderate learning difficult?
35- 49
What are the red flags for development?
i.Asymmetry of movement
• Usually we are right handed more than left handed, but in this case they are ignoring the use of one hand completely
• Haven’t grown over the parachute reflex in one hand
ii. Not reaching for objects by 6 months
• Is there a problem with their vision?
• Is there a problem with their motor skills?
• Is there less interest in interaction?
iii. Unable to sit unsupported by 12 months
iv. Unable to walk by 18 months → check CK
• CK a small number of children may have a form of muscular dystrophy
• Most will go on to walk but that is the time when we want to pick up diseases asap
v. No speech by 18 months
vi. Concerns re vision or hearing
vii. Loss of skills
What if the age range of children are affected by global developmental delay?
Significant under 5 years
How many skills should be affected in global developmental delay?
Significant delay in 2+ of:
i. gross/ fine motor, speech/ language
ii. cognition. Social/personal, ADL
Do children usually catch up with the delay in global developmental delay?
i. They say that children usually catch up, but it later on it increases the gap btw them and a child with a normal IQ
ii. 6 months delay/ 2 years roughly 6 year level at 8 y/o, and 12 year level at 16 y/o
iii. The gap widens and many a times the kids won’t be able to live independently
- How common are genetic causes in global developmental delay?
5 - 25%
- What are the 21 features of Trisomy of 21? (Down’s syndrome)
What is global developmental delay termed in school age?
Learning disability
What are the medical screenings that should be done for Down’s Syndrome?
i. Cardiac
ii. Vision hard to accommodate vision
iii. Hearing (Brachycephaly increased middle ear effusions)
iv. Thyroid function common under active thyroid
v. Sleep related breathing disorders sleep apnoea
vi. Growth- charts different growth patterns, height tends to be shorter and they tend to put on more weight
vii. Development
- What are the specific developmental delays In children?
i. Motor Delays
eg Duchenne Muscular Dystrophy, Cerebral Palsy, Co-ordination disorders
ii. Language Delays
eg Specific Language Impairment
iii. Sensory Deficits and Associated Delay
eg Oculocutaneous Albinism, Treacher-Collins
iv. Developmental Deviations
eg Autism Spectrum disorders
- What are the features of Duchenne muscular dystrophy?
i. X-linked disorder
ii. Mother is usually a carrier (50/50 chance of affecting the boy child)
iii. Carriers usually have a little bit delay in walking but nothing much
iv. Belly sticks out and their shoulders are pulled back to prevent falling
v. Pseudohypertrophy of the calves (muscle replaced by fibrous tissue so they are still weak)
vi. Weakness of pelvic muscles **presents with Gower’s manoeuvre
vii. Speech and language delay
viii. Can develop associated respiratory and cardiac problems
What is the manoeuvre that kids use in Duchenne?
i. Gower’s manoeuvre
ii. Also present in any disease that causes pelvic weakness
- What are the conditions associated with cerebral palsy?
• Group of permanent movement disorders that occur in early childhood
• Caused by the abnormal development or the damage of the areas of the brain that control movement, balance and posture
• Not a progressive condition
• Movement problems, spasticity and orthopaedic problems muscles affected
• Increasing tightness of the muscles over the years
• Various forms are present, most common include:
o Hemiplegics (arm and leg on one side)
o Diplegics (both legs with slight movement elsewhere)
o Paraplegic (both legs only)
o Quadriplegics (both arms and both legs)
• Learning difficulties
o Some people might have it
o Spastic diplegics usually spared
• Visual impairment
o Pre-mature babies usually have problems with visual tracts lower visual tract defects
• Communication difficulties
• Can have speech difficulty
• Feeding difficulties
o Silent reflux due to co-ordination difficulties
o Bad dental decay
• Hard to deliver these babies
• Sleep problems
o Normal circulating levels of melatonin not in the right amount in these children
• Behaviour problems
o Abused
o Poor communication skills
• Hearing loss – bilateral middle ear effusions, blocked, sticky ears, sounds like you are under water and miss out a lot of high frequency sounds
o Sensory neuro
Which type of cerebral palsy has the worst prognosis?
quadriplegic
