Language development Flashcards
The deficit or delay of speech and/or language may be due to:
Hearing loss, global developmental delay, difficulty in speech production from an anatomical deficit, e.g. cleft palate, or oromotor incoordination (CP), environmental deprivation/lack of opportunity for social interaction, and normal variant/familial pattern.
Speech and language disorders include disorders of:
- language comprehension
- language expression
- intelligibility and speech production such as stammering (dysfluency), dysarthria or verbal dyspraxia.
- pragmatics
- social/communication skills (autistic spectrum disorder).
Which test can be used for language development?
The Symbolic Toy test, which assesses very early
language development.
The Reynell test for receptive and expressive
language, used for preschool children.
Prevalance of autism disorder ?
3-6 per 1000 live births.
7.6 per 1000 persons worldwide.
More common in boys
Whats the triad of autistic difficulties?
Impaired social interaction
Speech and language disorder
Imposition of routines with ritualistic and repetitive behaviour
Comorbidities associated with Autism?
general learning and attention difficulties, seizures, affective disroders (anxiety, sleep disturbances), mental health disorders (ADHD)
Whats Asperger syndrome?
Asperger syndrome refers to a child with the social
impairments of an autism spectrum disorder but at
the milder end, and near-normal speech development.
How is autism disorders and Asperger syndrome diagnosed?
standardized tests (Autism diagnostic interview, autism diagnostic observation schedule, and diagnostic interview for social communication disorders). DSM5
How to manage autism?
A behaviour modification approach that helps to reduce
ritualistic behaviour, develop language, social skills and
play, and to generalize use of all these skills.
Whats the problem with behaviour modification approach?
it requires 25-30 hours of individual therapy each week, so is costly and time consuming.
Describe developmental dyspraxia (coordination disorder):
A disorder of motor planning and/or
execution with no significant findings on standard
neurological examinations. It is a disorder of the
higher cortical processes and there may be associated
problems of perception (how the child interprets what
he/she sees and hears), use of language and putting
thoughts together.
What are the features?
problems with handwriting, dressing, cutting food, poorly established laterality, copying and drawing and messy eating difficulty in coordinating biting, chewing, and swallowing (oromotor dyspraxia).
What is dyslexia?
Dyslexia is a disorder of reading skills disproportionate to the child’s IQ. The term is often used when the
child’s reading age is more than 2 years behind his/her
chronological age.
What is the prevalence of ADHD?
10-50 per 1000 children, with boys exceeding girls three-fold.
What is the underlying problem?
Dysfunction of brain neuron circuits that rely on dopamine as a neurotransmitter and which control self-monitoring and self-regulation.
What characterizes a child with ADHD?
bad attention, cannot control impulses, short temper and form poor relationships, poorly regulated and excessive activity; have difficulty with taking turns or sharing, socially disinhibited, and butt into other peoples conversations and play.
They do poorly in school and lose self-esteem.
Whats the first line management?
active promotion of behavioral and educational progress.
If the child with ADHD does not respond to 1st line treatment, what to you do?
Give methylphenidate or dexamphetamine, and non-stimulants, such as atomoxetine, reduce excessive motor activity and improve attention on task and focused behaviour.
Reserved to children over 6 if the behavioral progress does not show improvement.
Whats the two different types of hearing loss?
- Sensorineural hearing loss: caused by a lesion in the cochlea or auditory nerve and is usually present at birth. Irreversible
- Conductive hearing loss: from abnormalities of the ear canal or middle ear, most often from otitis media with effusion.
What kind of hearing aids do we give children with microtia (congenital underdeveloped external ear) and meatal atresia?
Bone conduction hearing aids.
Which of the types of hearing losses is most common?
conductive hearing loss
Children can get self-limiting hearing loss associated with what?
Upper respiratory tract infections. (Otitis media can cause effusion and hearing loss can be up to months or years).
Which congenital diseases can give conductive hearing loss?
Down syndrome, cleft palate and atopy.
What test can determine if the middle ear is functioning normally? And how does it work?
Impedance audiometry tests, which measures the air pressure within the middle ear and compliance of the tympanic membrane.
What do you give if conductive hearing loss does not improve spontaneously?
Medical treatment (decongestant or a long course of antibiotics or treatment of nasal allergy)
What do you do if medical treatment does not work?
surgery with insertion of tympanostomy tubes (grommets) with or without the removal of adenoids.
What do you do if hearing loss recur after surgery?
Hearing aids are used in cases where porblems recur after surgery
What is nystagmus? and what is it caused by?
repetitive, involuntary, rhythmical eye movement. Usually consequence of a problem.
What is squint (strabismus)?
misalignment of the visual axis
How long is it common to have squint for babies?
up to 3 months after birth
If infants have squint, what should be tested?
red reflexes
Whats the most common underlying cause of squint (strabismus)?
refractive error, but cataracts, retinoblastoma, and other intraocular causes must be excluded.
Squints are commonly divided into?
- Concomitant (non-paralytic, common)- usually due to refractive error in one or both eyes.
- Paralytic (rare)- varies with gaze direction due to paralysis of the motor nerves. Check for space-occupying lesion such as brain tumor.
what does corneal light reflex test detect? how is it done?
squints. a pen torch is held at a distance to produce reflections on both corneas simultaneously. If the light reflection does not appear in the same position in the two pupils, a squint is present.
How is the cover test performed?
Child looks at a toy/light. if the fixing eye is covered, the squinting eye will move to take up fixation.
What types of refractive errors is it in children? which is most common?
- Hypermetropia (long sight) (most common)
- Myopia (short sight)
- Astigmatism (abnormal corneal curvature)
- Amblyopia
How can Hypermetropia and myopia be corrected?
hypermetropia with convex (plus) lenses which make eye look bigger.
Myopia with concave (minus) lenses which make the eye look smaller.
Which refractive eye error is most common in preterms?
myopia
What is amblyopia?
potentially permanent reduction of visual acuity in an eye that has not received a clear image.
What is the most common cause of amblyopia?
squint, refrective errors and obstruction to the visual pathway (cataract)
