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
Which type of cerebral palsy affects 22-33 weeks of pregnancy, big placental abruption, interruption of blood shed to the water shed areas of the brain at crucial areas?
Diplegic
What is affected in Oculocutaneous albinism?
i. Blonde skin
ii. Blonde hair
iii. Can see right back to the retina (as the iris isn’t coloured)
iv. Involuntary to movement
v. Photophobia
vi. May have nystagmus
vii. Hearing impairment
What are the causes of hearing impairments?
i. bilateral middle ear effusions, blocked, sticky ears, sounds like you are under water and miss out a lot of high frequency sounds
ii. sensory neuro
What is the autistic trio?
i. Communication
ii. Social interaction
iii. Flexibility of thought/ Imagination
iv. Restricted, repetitive behaviours
v. Sensory difficulties
What are the differences in the language variations in ASD communication?
i.Receptive Language • Delayed • Expressive>Receptive • Abstract language difficult • Visually more able
ii.Expressive Language
• Can appear Delayed
• Echoes -repeating what they have just heard, or actually delayed, so it might look like they are coming up with something new but tbh they are just repeating it
• Odd intonation/pitch - not spontaneous
• Chunks of video speak
• Non-verbal signs are affected
iii.Non-verbal language
• Facial expressions, gesture
• Eye contact
• Recognising intention of others
iv.Use of language
• Initiating and sustaining conversation
• Restricted interests
• Lack of awareness of reciprocal nature of conversation they usually just keep going and don’t stop talking
• They don’t know that they have to ask to get something
How is the use of language different btw boys and girls in ASD?
- Difference in girls vs boys?
i. Girls - neurotypical, its something that their peers are talking about and they a lot about it but don’t know what else to talk about,
can learn a lot of things about filmstars, idols etc.. but onbly about it and are fixated with the topic
ii. Boys - stuck with Thomas engine
How does ASD affect social interaction?
i.Joint Attention and Referencing
• Trying to turn their attention to what you want
ii.Turn taking
• Very hard to get them to wait for others
• Keep control as much as they can
iii.Unable to share pleasure
iv.Not motivated by need for social approval
v.Social rules - don’t always follow it
vi.Empathy – can’t empathise with their own emotions, so extremely difficult to relate to others
vii.Relationships
viii.Others point of view/feelings
What are the various flexibility/ thoughts/ imaginations in ASD?
i. Theory of mind – have a box with smarties cover in it but they only have pencil, and they think that everyone should know it
ii. Concrete and lateral – eg: told that they should cut out crisps from him diet but he thought they were literally going to cut him open
iii. Concept of time
iv. Routines
v. Changes in environment
•Some may notice very tiny changes in the environment
•Line up cars and objects according to size and shape and they want to put it back
vi. Ritualistic behaviour
•Carry around certain objects
What are the sensory issues associated with ASD?
i. Fussy eater/ medications
ii. Textures of clothes
iii. Sleep
iv. Toilet training – big issues
v. Hair washing / cutting – they will scream but will have a problem when they are not in control
vi. Nail cutting
vii. Noise
• May be over/ under sensitive – a big bag may calm them and stuffing themselves in small places
What is the approach to Developmental Delay?
i. History
ii. Exam
iii. Investigations
iv. Assessments
What is the main approach in history taking?
Concerns – presenting complaint Past Medical History Perinatal and Birth Family & Social Developmental Play and Behaviour School/Nursery
Who are play assistants?
3 years of experience od working in a healthcare setting
combine fun opportunities in ward areas
gives parents a break, batha dn play with kids in Kids ward
What is the role of Play specialists?
try to get the kids to get along during procedures
in the paeds surgical ward
distract the kids and make them comfortable before surgery
to get a cannula put in before nuclear medicine scan
Paeds assessment unit
where the kids are assessed before getting admitted or befroe getting discharged
What is the appraoch to a clinical examination in kids?
Observation Dysmorphism Head Circumference Systems CNS inc neurocutaneous Vision Hearing
What other factors should be looked for: neonatal infants pregnancy term of the mother environment skin and CNS Ear
Neonatal – odd behaviour, won’t eat, won’t respond to sound
Infant - are they achieving their milestones, are they developing their language
Pregnancy - did mom smoke/ alcohol, did she have any infections,
Environment – post-natal depression/ environmental problem, meningitis, post- injury
Skin and CNS - both come from the same embryological origin -> ectodermal
How is impared hearing manifest?
big dip at the higher frequencies, not the same conduction through air compared to bones
- What are the investigation for developmental delay?
i. Chromosomes, FRAX (fragile x) & Oligoarray CGH
ii. Neonatal PKU, thyroid studies, CK
iii. If indicated:
- MRI brain only in indicated
- EEG (only is seizures)
- Metabolic studies (intercurrent illness)
- Genetic consultation (conasngruant parents)
- Others (hypertonic or not)
What are the various developmental assessments done?
Multidisciplinary Team Appropriate Assessment Tool – Eg Griffiths (0-8yrs) – Bayleys (0-3yrs) – Schedule of Growing Skills (0-5yrs) – ADOS (ASD)
When should intervention be started for children?
Always start with immediate early intervention without waiting for the results to come back o Therapy o Physio o SLT o OT o Family Support o Educational Placement o Referral to Other Agencies
