developmental disorders Flashcards
what are the 3 patterns of delay
slow and steady
plateau
regressing
causes of abnormal motor development
central motor deficit (CP)
spinal cord problem
congenital myopathy
global delay
How does cerebral palsy present
abnormal motor development characterised by NON-PROGRESSION
only visible after a couple of years of life
accompanied by visual/sensory/auditory/behavioural problems
What is the diagnostic difference between CP and acquired brain injury
motor development delay becomes attributed to acquired brain injury if it happens after 2 years
causes of CP
80% antenatal (from cerebral haemorrhage, failure of cortical migration etc.)
10% at birth from HIE
10% postnatal (meningitis, sepsis, hypoglycaemia)
how does CP present
a lot dx antenatally don't meet motor milestones abnormal posture abnormal gait primitive reflexes persist/become obligatory
what are the 4 classes of CP
spastic (80%)
dyskinetic
ataxic
other
Hallmarks of spastic CP
UMN/ corticospinal tract damage
spasticity which is velocity dependent (more you stretch muscle stiffer it is - dynamic catch)
brisk tendon reflexes
3 types of spastic CP
unilateral:
arm>leg
presents at 4-12 months with fisted hand and asymmetrical reach
associated with tip toe walking
bilateral quadriplegia:
affects all limbs equally and may present in trunk with opsithotonos
associated with HIE
bilateral diplegia:
legs>arms
get abnormal gait
associated with preterm birth (periventricular white matter damage)
features of dyskinetic CP
dyskinesias are abnormal stereotyped movements
primitive movements predominate:
choreas
athetosis - slow writhing movements (fanning of fingers)
dystonia - simultaneous contration of agonist and antagonist
present with floppiness and strange movements in infancy
linked with HIE
features of ataxic CP
also known as hypotonic
presents with limb floppiness and poor balance
RF for CP
antenatal: chorioamnionitis, maternal resp or GU infection
perinatal: preterm birth, LBW, neonatal sepsis + encephalopathy
post natal: meningitis, head trauma before age of 3
Mx CP
Physio
SALT assessment
speech and communication therapy
medical:
baclofen for stiffness
mx saliva - anticholinergics
lone bone mineral density cause non-ambulant - check vit d
mx sleep disturbances w/ sleep hygiene (can use melatonin)
referral for visual + hearing impairment
what medical conditions are associated with CP
gastro-oesophageal reflux
constipation (3/5)
epilepsy (1/3)
what two tests can you do for language development
toy test
Reynell test for expressive and receptive aphasia
causes of speech + language delay
hearing loss, anatomical defects meaning you can’t make sound, lack of social interaction
causes of speech + language disorder
problems with language comprehension and expression, stammer, dysarthria (where muscles used to make sound don’t work)
what is the ASD triad
problems with social interaction (avoids direct gazes)
speech and language disorder (takes stuff literally, doesn’t use hand gestures)
imposition of routines
what conditions are associated with ASD
learning + attention deficits, seizures (in adolescence), affective disorders (anxiety), ADHD
Mx ASD
psychocial help for social situations and communication SALT for speech problems medications if necessary special school help to carer
what is dyslexia
disorder of reading
child is 2 years behind when compared to IQ
what are disorders of executive function
Problems with planning or organisation
children: poor concentration, overeat, forgetful, volatile
mx of specific learning disorder
OT
physio
SALT
Educational psychologist
hallmarks of ADHD
child is legitimately overactive socially disinhibited can't take turns distracted fidgety (can't regulate activity given certain situation) tend to do poorly at school
Mx ADHD
refer to CAMHS
if adversely impacting education or development:
10 week watch and wait period
1. ADHD group parent training session (can liaise with school etc.)
2. 6-week trial of meds (methylphenidate)
3. CBT
S/E of ADHD meds
loss of appetite, tics, mood changes palpitations (meds are cardiotoxic so need to do ECG)
RF for conductive hearing loss
down’s syndrome, cleft palate, atopy (otitis media)
Ix for conductive hearing loss
impedance audiometry to assess if middle ear is working
what is a squint
misalignement of visual axes
common up to 3 months
after 3 months most likely due to refractive error eg. cataracts and retinoblastoma
what are the two types of squint
concomitant non-paralytic - refractive error, easily corrected with glasses
paralytic - depends on gaze direction as it’s a motor nerve problem
4 types of refractive errors
hypermetropia - long sighted
myopic - short sighted
astigmatism - abnormal curvature of cornea
amblyopia - eye fails to achieve acuity even with corrective lenses. causes include: squint or obstructions to visual pathway (cataracts)
causes of visual impairment
congenital: cataracts albinism retinoblastoma retinal dystrophy
Ante and post natal:
HIE
infections
optic nerve hypoplasia
paediatric
trauma
infection
jaundice
