Language development

Question 1

The deficit or delay of speech and/or language may be due to:

Answer 1

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.

Question 2

Speech and language disorders include disorders of:

Answer 2

• language comprehension
• language expression
• intelligibility and speech production such as stammering (dysfluency), dysarthria or verbal dyspraxia.
• pragmatics
• social/communication skills (autistic spectrum disorder).

Question 3

Which test can be used for language development?

Answer 3

The Symbolic Toy test, which assesses very early
language development.

The Reynell test for receptive and expressive
language, used for preschool children.

Question 4

Prevalance of autism disorder ?

Answer 4

3-6 per 1000 live births.
7.6 per 1000 persons worldwide.
More common in boys

Question 5

Whats the triad of autistic difficulties?

Answer 5

Impaired social interaction

Speech and language disorder

Imposition of routines with ritualistic and repetitive behaviour

Question 6

Comorbidities associated with Autism?

Answer 6

general learning and attention difficulties, seizures, affective disroders (anxiety, sleep disturbances), mental health disorders (ADHD)

Question 7

Whats Asperger syndrome?

Answer 7

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.

Question 8

How is autism disorders and Asperger syndrome diagnosed?

Answer 8

standardized tests (Autism diagnostic interview, autism diagnostic observation schedule, and diagnostic interview for social communication disorders).
DSM5

Question 9

How to manage autism?

Answer 9

A behaviour modification approach that helps to reduce
ritualistic behaviour, develop language, social skills and
play, and to generalize use of all these skills.

Question 10

Whats the problem with behaviour modification approach?

Answer 10

it requires 25-30 hours of individual therapy each week, so is costly and time consuming.

Question 11

Describe developmental dyspraxia (coordination disorder):

Answer 11

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.

Question 12

What are the features?

Answer 12

problems with handwriting, dressing, cutting food, poorly established laterality, copying and drawing and messy eating difficulty in coordinating biting, chewing, and swallowing (oromotor dyspraxia).

Question 13

What is dyslexia?

Answer 13

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.

Question 14

What is the prevalence of ADHD?

Answer 14

10-50 per 1000 children, with boys exceeding girls three-fold.

Question 15

What is the underlying problem?

Answer 15

Dysfunction of brain neuron circuits that rely on dopamine as a neurotransmitter and which control self-monitoring and self-regulation.

Question 16

What characterizes a child with ADHD?

Answer 16

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.

Question 17

Whats the first line management?

Answer 17

active promotion of behavioral and educational progress.

Question 18

If the child with ADHD does not respond to 1st line treatment, what to you do?

Answer 18

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.

Question 19

Whats the two different types of hearing loss?

Answer 19

• 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.

Question 20

What kind of hearing aids do we give children with microtia (congenital underdeveloped external ear) and meatal atresia?

Answer 20

Bone conduction hearing aids.

Question 21

Which of the types of hearing losses is most common?

Answer 21

conductive hearing loss

Question 22

Children can get self-limiting hearing loss associated with what?

Answer 22

Upper respiratory tract infections. (Otitis media can cause effusion and hearing loss can be up to months or years).

Question 23

Which congenital diseases can give conductive hearing loss?

Answer 23

Down syndrome, cleft palate and atopy.

Question 24

What test can determine if the middle ear is functioning normally? And how does it work?

Answer 24

Impedance audiometry tests, which measures the air pressure within the middle ear and compliance of the tympanic membrane.

Question 25

What do you give if conductive hearing loss does not improve spontaneously?

Answer 25

Medical treatment (decongestant or a long course of antibiotics or treatment of nasal allergy)

Question 26

What do you do if medical treatment does not work?

Answer 26

surgery with insertion of tympanostomy tubes (grommets) with or without the removal of adenoids.

Question 27

What do you do if hearing loss recur after surgery?

Answer 27

Hearing aids are used in cases where porblems recur after surgery

Question 28

What is nystagmus? and what is it caused by?

Answer 28

repetitive, involuntary, rhythmical eye movement. Usually consequence of a problem.

Question 29

What is squint (strabismus)?

Answer 29

misalignment of the visual axis

Question 30

How long is it common to have squint for babies?

Answer 30

up to 3 months after birth

Question 31

If infants have squint, what should be tested?

Answer 31

red reflexes

Question 32

Whats the most common underlying cause of squint (strabismus)?

Answer 32

refractive error, but cataracts, retinoblastoma, and other intraocular causes must be excluded.

Question 33

Squints are commonly divided into?

Answer 33

• 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.

Question 34

what does corneal light reflex test detect? how is it done?

Answer 34

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.

Question 35

How is the cover test performed?

Answer 35

Child looks at a toy/light. if the fixing eye is covered, the squinting eye will move to take up fixation.

Question 36

What types of refractive errors is it in children? which is most common?

Answer 36

• Hypermetropia (long sight) (most common)
• Myopia (short sight)
• Astigmatism (abnormal corneal curvature)
• Amblyopia

Question 37

How can Hypermetropia and myopia be corrected?

Answer 37

hypermetropia with convex (plus) lenses which make eye look bigger.
Myopia with concave (minus) lenses which make the eye look smaller.

Question 38

Which refractive eye error is most common in preterms?

Answer 38

myopia

Question 39

What is amblyopia?

Answer 39

potentially permanent reduction of visual acuity in an eye that has not received a clear image.

Question 40

What is the most common cause of amblyopia?

Answer 40

squint, refrective errors and obstruction to the visual pathway (cataract)