Foundations Of Pediatric OT

Question 1

Pediatrics is an overarching term that encompasses birth through adolescence or age of majority.

What is age of majority?

Answer 1

Age of majority is typically 21 years but can be 18 or 26 in some states.

Some third-party payers cease pediatric support at age 18.

Question 2

Who are typically considered early intervention clients?

Answer 2

infants (0–12 months)
toddlers (12–36 months)

Question 3

In the United States, education is divided into preschool (age ________ years), elementary school (________ years), middle school (________ years), and high school (________ years).

Answer 3

In the United States, education is divided into preschool (age 3–6 years), elementary school (6–12 years), middle school (12–15 years), and high school (16–18 years).

Some students in special education continue in public school through age 21. Emphasis of schooling is on transition planning, including vocational, ADL, and IADL skills.

Question 4

Developmental milestones serve as general guidelines for client factors and performance skills; attainment of milestones helps determine whether there are areas of concern (i.e., atypical development) that may create a delay in occupational performance.

Name at least 2 of the general principles of development.

Answer 4

Dominance of flexion to increased extension

Security in prone to supine

Movement of the center of gravity from the upper body to the pelvis (frees the upper body for functional tasks)

Increased dissociation (able to separate between two sides of the body and upper and lower body) during movement

Proximal stability for distal control

Lateral movements to midline

Ability to move against gravity

Increased stability and freedom of movement for functional tasks.

Question 5

What occurs during Piaget’s Sensorimotor stage, from 0-2 years?

Answer 5

Substage 1: Simple reflex, 0–1 month: Reflexes are the center of the infant’s cognitive interaction with the world

Substage 2: First habits and primary circular reactions, 1–4 months: Coordinates separate actions into single integrated activities

Substage 3: Secondary circular reactions, 4–8 months: Shifts cognitive horizons beyond the individual and begins to act on the outside world

Substage 4: Coordination of secondary circular reactions, 8–12 months: Uses more calculated approaches to produce a single act; object permanence emerges

Substage 5: Tertiary circular reactions 12–18 months: Begins to use deliberate variations of actions that bring desirable consequences

Substage 6: Beginnings of thought, 18–24 months: The capacity for mental representation or symbolic thoughts is achieved

Question 6

What occurs during Piaget’s Preoperational stage, 2–7 years?

Answer 6

Use of symbolic thinking grows
mental reasoning emerges
use of concept increases

Question 7

What occurs during Piaget’s Concrete operational stage, 7–12 years?

Answer 7

Applies logical operations to concrete problems

Question 8

What occurs during Piaget’s Formal operational stage, 13 years–adult?

Answer 8

Develops the ability to think abstractly

Question 9

What occurs during Erikson’s Trust vs Mistrust development period, 0-18 months?

Answer 9

A sense of trust develops when needs are met by caregiver.

Question 10

What occurs during Erikson’s Autonomy vs. shame and doubt period, 18 months-3 years?

Answer 10

Self-sufficiency is achieved if exploration is encouraged, or doubts about self, lack of independence result.

Question 11

What occurs during Erikson’s Initiative vs. guilt period, 3–6 years?

Answer 11

One feels a conflict between independence of action and the sometimes negative results of that action or feeling guilty for actions and thoughts results.

Question 12

What occurs during Erikson’s Industry vs. inferiority period, 6–12 years?

Answer 12

Focus on efforts to attain competence in meeting the challenges presented by parents, peers, school, and the other complexities of the modern world, or sense of inferiority, no sense of mastery results.

Question 13

What occurs during Erikson’s Identity vs. Confusion period, 13 years–adult?

Answer 13

Adolescent awareness of uniqueness of self, knowledge of roles to be followed, or inability to identify appropriate roles in life results.

Question 14

From birth to age 3, OT services can be in hospitals, outpatient clinics, or home and community settings; this includes neonatal intensive care unit (NICU), typically a specialized practice area.

How is it funded?

How is it documented?

Answer 14

Funding/payment: IDEA Part C, third-party payer, or private pay

Documentation: IDEA Part C services are documented on the individualized family service plan (IFSP).
Specific requirements for transition to preschool are included in IDEA Part C.
Part C services can be provided in the home, school, community, or outpatient clinic.

Question 15

Occupational therapy practitioners can be part of the team that provides multitiered systems of support (MTSS).

There are three tiers of intervention (describe them).

Answer 15

Tier 1: high-quality classroom instruction with support for all students

Tier 2: targeted support for identified students in smaller groups or as part of the whole classroom

Tier 3: intensive 1:1 or small-group support for short periods for identified students who need assistance that would unduly impact classroom activities.

Question 16

________________ are a deficit in the quantity of chromosomes (too few or too many).

Answer 16

Chromosomal disorders

Typically, a human has 46 chromosomes arranged in 23 pairs in each cell.
Chromosomal disorders affect 1:200 live births; some are inherited, but most are spontaneous.

Question 17

________________ involve a fault in one of the 22 autosomes; examples are cystic fibrosis, Tay Sachs, and sickle cell disease.

Answer 17

Autosomal disorders

There are 22 numbered pairs of chromosomes, also known as autosomes, and one pair of sex chromosomes (X and Y).

Sex chromosome abnormalities involve a fault in one of the sex chromosomes (e.g., Fragile X).

Question 18

True or false: Brain activity in children with ADHD is significantly diminished in the frontal lobes, which are responsible for inhibition and attention control.

Answer 18

FALSE

Brain activity in children with ADHD is significantly diminished in the parietal lobes, which are responsible for inhibition and attention control.

Medication alone is ineffective in addressing all the needs of children with ADHD; psychotherapy, behavioral therapy, and other therapies may also be used.

Question 19

There is a growing movement among people with ASD to embrace an autistic identity. As such, how should you address a person with ASD?

Answer 19

Ascertain their preference regarding identity-first language

Question 20

Children with ASD typically have difficulty with__________, or using variation in pitch, emphasis, or rhythm of speech.

Answer 20

prosody

Question 21

Children with ASD typically have difficulty with _____________, or the use of language in social situations

Answer 21

pragmatics

Question 22

Many children with ASD have dyspraxia or poor motor planning abilities. Dyspraxia can be seen with fine and gross motor activities.

What is often addressed to enhance function?

Answer 22

underlying sensory integrative functions

Question 23

_____________ describes trauma that has happened in early life or during critical developmental periods. It can have an impact on brain development.

Answer 23

Developmental trauma

Trauma, including developmental trauma, can interrupt development and occupational performance.

Trauma and developmental trauma cause a wide range of both psychological and physical symptoms.

Question 24

Trauma, including developmental trauma, be passed down through the generations and cultures and is often referred to as ___________________.

Answer 24

intergenerational trauma

Trauma, including developmental trauma, can interrupt development and occupational performance.

Trauma and developmental trauma cause a wide range of both psychological and physical symptoms.

Question 25

True or false: Chemotherapy can cause hearing loss in children.

Answer 25

True

Question 26

Visual impairment is the loss of vision or visual deficits as a result of pathology or difficulties in processing visual information.

Name 2 difficulties with visual skills caused by the central nervous system.

Answer 26

Tracking, pursuits
Saccade
Accommodation
Convergence
Binocular vision
Stereopsis (binocular depth perception)

Question 27

What are 2 common postural and motor presentations in children with visual impairment?

Answer 27

Hypotonia
Shoulder and pelvic instability
Pronounced head tilt to one side
Hyperextended neck
Wide base of support
Tendency to move in straight planes
High guard posture when walking

Question 28

Red flags related to visual problems can be physical, behavioral, performance-related, and social.

Name at least 2 per category.

Answer 28

Physical red flags
- Eye shake
- Excessively large or small pupils
- Eyes not in alignment
- Pupils not black or that appear to have an opaque film over them.

Behavioral red flags
- Moves closer to objects or surfaces that need visual attention
- Squinting, straining, frequently rubbing eyes, closing one eye, excessive head movements
- Headaches
- Avoidance of work tasks with a strong visual component, seemingly short attention span, or both.

Performance red flags
- Appearing clumsy
- Difficulty locating needed items
- Trouble learning the alphabet and recognizing spatial concepts
- Difficulty with drawing, writing, or reading
- Difficulty copying
- Social difficulty
- Lack of interest

Question 29

Describe the levels of intellectual disability, including IQ and presentation.

Answer 29

Mild: IQ between 55 and 70; able to learn academic skills at the third- to seventh-grade level; able to work with minimal support.

Moderate: IQ between 40 and 55; able to learn academic skills to at least the second-grade level; able to perform unskilled as well as some skilled work tasks.

Severe: IQ between 25 and 40; able to communicate and perform some basic ADLs and health habits; often requires support to complete routines.

Profound: IQ below 25; requires caregiver assistance for basic tasks; also generally has neuromuscular, orthopedic, or behavioral deficits.

Question 30

Name at least 2 early indicators of intellectual disability.

Answer 30

• Delays in meeting motor and speech milestones
• Unresponsiveness to handling and physical contact
• Reduced alertness
• Limited reactions to play
• Feeding difficulties
• Neurological soft signs
• Poor balance
• Motor asymmetry
• Decreased perceptual–motor skills
• Decreased fine motor skills

Common causes of intellectual disability
1. Acquired in childhood through trauma, toxins, or infections
2. Problems of fetal development and birth
3. Chromosomal disorders
4. CNS malformations
5. Congenital anomalies
6. Metabolic, neurocutaneous, and endocrine disorders.

Question 31

_______________ are a group of problems that affect a child’s ability to perform and master academic skills, process information, and communicate effectively.

Answer 31

Learning disabilities

Question 32

______________: difficulty with reading
______________: difficulty with writing
______________: difficulty with math

Answer 32

Dyslexia: difficulty with reading

Dysgraphia: difficulty with writing

Dyscalculia: difficulty with math

Not associated with any underlying neurological insult

Question 33

Between ___% and ____% of school-age children have a mental health disorder. Mood and depressive disorders are not commonly diagnosed in young children, and researchers and clinicians believe these are one of the most underdiagnosed health problems.

Answer 33

5 to 11%

Question 34

What are 2 ways anxiety can impact a child’s performance skills and function.

Answer 34

• Energy
• Time management (i.e., feeling overwhelmed when facing deadlines, to-do lists, etc., while being unable to plan or even begin these tasks)
• Organizing space and objects
• Adapting performance
• Social interaction skills
• Digestive system functions
• Mental functions

Question 35

What are 2 ways depression can impact a child’s performance skills and function.

Answer 35

• School and social dysfunction
• Inability to participate in leisure, ADL, and IADL activities
• Cognitive impact: loss of concentration, diminished problem-solving ability, poor coping
• Slowed or increased psychomotor activity.

Question 36

What are 2 ways bipolar disorder can impact a child’s performance skills and function.

Answer 36

• Suicidal thinking or behaviors that affect social relationships
• Intense emotional states that affect performance in school
• Episodes of drastic changes in mood and behaviors that affect relationships with others.

Three types
Bipolar disorder I: intermittent manic and major depressive episodes
Bipolar disorder II: intermittent hypomanic and major depressive episodes with no occurrence of manic episodes
Cyclothymia: marked mood swings between depression and elation.

Question 37

What are 2 ways eating disorders can impact a child’s performance skills and function.

Answer 37

• Strength
• Energy
• Time management
• Adapting performance
• Mental functions
• Cardiovascular functions
• Respiratory functions
• Neuromusculoskeletal functions
• Digestive functions

Question 38

_________________ is a nonprogressive condition that encompasses neurological, motor, and postural deficits.

Answer 38

Cerebral palsy (CP)

Congenital CP is the result of an injury or a disease that occurs at or before birth.

Acquired CP may result from trauma, intracranial hemorrhage, CNS infections, near drowning, hypoxia, and metabolic disorders.

Question 39

Classification of CP is made based on limb involvement and distribution of tone.

What is the difference between diplegia, hemiplegia, and paraplegia regarding limb involvement?

Answer 39

Diplegia/diparesis usually indicates the legs are affected more than the arms; primarily affects the lower body.

Hemiplegia/hemiparesis indicates the arm and leg on one side of the body is affected.

Paraplegia/paraparesis means the lower half of the body, including both legs, are affected.

Question 40

Classification of CP is made based on limb involvement and distribution of tone.

What is the difference between Spasticity, Athetosis, Choreoathetosis, Flaccidity, and Ataxia regarding tone?

Answer 40

Spasticity: increased muscle tone, stiffness, and involuntary contractions

Athetosis: muscle tone fluctuations between hypertonia (unusually high muscle tone) and hypotonia (unusually low muscle tone).

Choreoathetosis: Either hemiplegia or diplegia may be present, and the involuntary movements affect only the paretic limbs; muscle tone fluctuations between hypertonia (unusually high muscle tone) and hypotonia (unusually low muscle tone).

Flaccidity: decreased muscle tone

Ataxia: low muscle tone, or hypotonia causing poor coordination and gait disturbance

Question 41

Muscular dystrophies result in progressive degeneration and weakness of a variety of muscle groups and could lead to death. Degeneration is a result of biochemical and structural changes of the surface and internal membranes of the muscle cells.

________________ affects the proximal muscles of the pelvis and shoulder girdle.

________________ affects the face, upper arms, and scapular region.

Answer 41

Limb girdle muscular dystrophy affects the proximal muscles of the pelvis and shoulder girdle. Onset occurs within the first 30 years of life. Progression is typically slow.

Facioscapulohumeral muscular dystrophy affects the face, upper arms, and scapular region. Onset usually occurs in adolescence. This type of dystrophy is characterized by sloped shoulders and limited ability to raise the arms above the head. Decreased mobility in the facial muscles results in a “masklike” appearance.

Question 42

This is the most common form of muscular dystrophy, affecting only boys. Caused by a deficiency in the production of dystrophin; muscles degenerate without dystrophin.

Answer 42

Duchenne’s muscular dystrophy (DMD)

Enlarged muscles and a positive Gower’s sign are present (when asked to get up from sitting on the floor, the child will move the hands on the legs as though crawling up to the thighs and then assume a standing position

The condition progresses quickly, and children often need to use a wheelchair by age 9.

ADLs become increasingly difficult.

People with DMD typically die in or near their 20s as a result of respiratory problems or cardiovascular complications.

Question 43

Congenital muscular dystrophy (CMD) is a heterogeneous group of disorders with onset in utero or during the first year of life.

Brain involvement is apparent, along with neuromuscular dysfunction. Characterized by hypotonia, generalized muscle weakness, and contractures. Common comorbidities include clubfoot, torticollis, diaphragmatic involvement, and congenital heart and spinal defects.

What are the four categories of CMD?

Answer 43

CMD I: does not include severe intellectual functioning difficulties.

CMD II: involves muscle and brain abnormalities.

CMD III and CMD IV: involve muscle, brain, and eye abnormalities.

Question 44

____________ are Malformations that occur early in fetal development.

Answer 44

Neural tube defects

Question 45

A/an ________________ is a protrusion in the occipital region of the brain. Typically associated with severe deficits, such as cognitive impairments, hydrocephalus, motor impairments, and seizures.

Answer 45

Encephalocele

Question 46

A/an ___________________ is a neural development above the level of the brain stem is lacking. Children with anencephaly do not survive infancy.

Answer 46

Anencephaly

Question 47

A/an ___________________ is the most common type of neural tube defect. A congenital defect of the vertebral arches and spinal column.

Answer 47

Spina bifida

The mild form of spina bifida is called spina bifida occulta, and it consists of only one or two affected vertebrae, with no involvement of the spinal cord. No symptoms may be present.

Meningocele spina bifida involves an extensive spinal opening with an exposed pouch of cerebrospinal fluid and meninges.

Myelomeningocele is the most severe form of spina bifida. In addition to an extensive spinal opening with an exposed pouch of cerebrospinal fluid and meninges, the nerve roots are also exposed. Children with myelomeningocele spina bifida usually display sensorimotor problems at or below the level of the lesion. Lower extremity paralysis and loss of sensation is common.

Question 48

In Ayres Sensory Integration, proximal senses are emphasized; these senses are thought to dominate a child’s early life experiences. What are they?

Answer 48

Vestibular
Tactile
Proprioceptive

Question 49

______________ is the ability to take in information through our senses, organize and interpret the information, and then have an appropriate response.

Answer 49

Sensory processing

Children with challenges with sensory processing may have a clinical diagnosis of sensory processing disorder (SPD). They have extreme responses to sensory input; can be hypo (under) responsive or hyper (over) responsive.

Question 50

Ayres hypothesized that SI takes place in the __________ levels of the CNS, specifically at the brainstem and the thalamus.

Answer 50

Lower

Vestibular input is processed mostly in the brainstem.

Somatosensory input is processed mostly in the thalamus.

For sensory input to be effective, it must be matched to the child’s specific CNS requirements. The child must be able to organize and use sensory input to respond to the environment.

Question 51

Sensory modulation is regulation by the CNS of its own activity. Problems with modulation are characterized by children being unable to grade responses in relation to external stimuli.

Describe underactivity and overactivity.

Answer 51

Underreactivity, also known as hyporesponsivity: Children demonstrate a pattern that looks as though they fail to orient to stimuli.

Overreactivity, also known as hyperresponsivity: Children demonstrate a pattern that looks as though they over orient to stimuli.

Question 52

Sensory-seeking behavior is thought to be due to hyporesponsivity to a stimulus; children may seek intense input or large quantities of input.

How might a child who is proprioceptive seeking present?

Answer 52

Children seeking proprioceptive input may try to get their needs met by engaging in roughhousing and other activities that provide them with deep-pressure input or muscle resistance. Children who seek this type of input may be trying to regulate their experiences of touch or movement.

Children seeking vestibular input may appear to be reckless or risk takers.

Question 53

Overresponsiveness to stimuli may be the result of tactile defensiveness or gravitation insecurity. Describe each.

Answer 53

Tactile defensiveness is an extreme reaction or overreaction to tactile input; light touch may be particularly noxious. Children may be extra sensitive on their face, their abdomen, or the palmar surfaces of their hands.

Gravitational insecurity is overresponsivity to vestibular input; children with this type of dysfunction may be extremely afraid of movement and may move carefully. In addition, they may prefer to have their feet stay on the ground.

Overresponsivity may be present in any of the other senses as well.

Question 54

Difficulty with tactile discrimination and perception is one of the most common types of sensory integrative dysfunction. It is characterized by difficulty making sense of, or interpreting, tactile input.

How might this present in a child (examples)?

Answer 54

Fine motor manipulation skills may be delayed.

Being able to feel objects and use them efficiently is an important part of child development. When children have difficulty interpreting what they are feeling, they may experience delays.

May have difficulty with visual–motor tasks and motor planning in general.

Children with sensory discrimination or proprioceptive problems should be taught to compensate for motor skills by using visual guidance.

Question 55

Children who have visual perceptual sensory integration problems may have what types of difficulties?

Answer 55

May have difficulty with form and space perception, figure–ground perception, spatial orientation, depth perception, and visual closure.

Question 56

___________________ problems are characterized by poor bilateral coordination and difficulty sequencing actions.

Answer 56

Vestibular–proprioceptive

Projected action sequences, which involve being able to move the body in relation to changing environmental conditions (e.g., a child responding to a ball being kicked to them), are difficult.

Common presentations include decreased equilibrium reactions, poor posture, lower-than-average tone, and delayed gross motor skills.

Question 57

________________ involves difficulty with any of the three parts of praxis: ideation, planning, and execution.

Answer 57

Dyspraxia