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3F: Peds Final > Learning Disabilities And Special Needs Populations > Flashcards

Learning Disabilities And Special Needs Populations Flashcards

1
Q

Parks 3 step purpose

A

Isolate the single muscle responsible for a vertical deviation

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2
Q

Parks 3 step and multiple muscles

A

Not helpful if there are multiple muscles involved

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3
Q

Parks 3 step questions

A
  1. Which eye is highest in primary position
  2. Is the hyper worse when looking to the L or R
  3. Is the hyper worse with left or right head tilt (Bielchoswkys head tilt test)
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4
Q

Assessment of ocular alignemtn

A

Hirschberg/Krimsky, amblyoscope, bruckner, 4 BO test

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5
Q

EF assessment

A

Visuoscopy, haidinger brushs, maxwell spot

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6
Q

ARC assessment

A

After image test, bagolini lenses

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7
Q

Sensory status assessment

A

W4D, stereopsis

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8
Q

Allows for gross determination of ocular alignemtn

A

Hirschberg

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9
Q

Administration of hirschberg

A

Hold light 50cm-observes corneal reflex of each eye compared to pupillary axis

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10
Q

Nasal displacement in hirschberg

A

Exotropia; temporal displacement-esotropia

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11
Q

Upward displacement on hirschberg

A

Hypotropia; downward displacement-hypertropia

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12
Q

Angle lambda

A

Angle between the pupillary axis (center of pupil) and line of sight (through fovea)

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13
Q

What os the abiltiy to recall visually presented materials and to manipulate these images

A

Visualization

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14
Q

In what order should you treat visual analysis dysfunction

A 
Visual discrimination
FG
Visual closure 
Visual memory 
Visualization
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15
Q

How would you explain to the parent that the child exhibits difficulty with executive function

A

Tested with CCT

Difficulty planning out, sequencing, and executing actions

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16
Q

Learning disabilities and objectives of OD treatment

A
  • role of the optometrist is to treat the underlying vision problem-not to treat th reading or learning problems
  • remediation these vision problems allows the kid to benefit more fully from educational intervention
  • goal: reduce or elimate the signs and symptoms of particular visual deficits
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17
Q

A heterogenous groups of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities

A

learning disability

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18
Q

learning disability and other problems

A

Even though a LD may occur concomitant with other handicapping conditions, it is not the direct result of those conditions or influencers

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19
Q

Prevalence of learning disability

A
  • definition is ambiguous
  • about 5% of school aged kids in the US are diagnosed with the learning disability
  • varies based on definition, age, and population
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20
Q

Learning disability and etiology

A 
Genetics
Nutrition 
Low birth weight 
Psychological status 
Maturation of the nervous system
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21
Q

Adaptive behaviors for LD chidlren

A

Withdrawal reaction
Clowning reaction
Regression reaction

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22
Q

Withdrawal reaction

A

The child leans to avoid situations that are stressful

Refuses the participate in classroom or life experience that could lead to failure or frustration

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23
Q

Clowning reaction

A

The child is clowning around in school-child can rationalize that he is not learning because he has chosen not to learn

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24
Q

Regression reaction

A

The child tries to avoid the potential embarrassment of not being able to perform at an acceptable level by regressing to a less mature level or social and emotional development

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25
Q

Reading dysfunction

A

Defined as a failure to read

Most common and specific learning disability

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26
Q

Most common and specific learning disability

A

Reading dysfunction

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27
Q

OD intervention and reading dysfunction

A

optometric intervention has a maximum impact when the reading problem is related to speed, comprehension, fatigue, and loss of place when reading

With appropriate intervention, these cases have an excellent prognosis

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28
Q

Reading dysfunction info

A
  • average or above average intelligence
  • adequate educational opportunities
  • normal sensory development (auditory and visual)
  • normal acculturation
  • no frank brain damage
  • no emotional disturbances
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29
Q

Dyslexia

A
  • specific type of reading dysfunction in which there is deficit in the individuals abiltiy to interpret the symbols of written language
  • important to differate from other nonspecific or generalizes form of reading dysfunction (less severe)
  • poorer prognosis-exhibit aberrations in the brain functions
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30
Q

Letter recognition

A

Gibson postulates that perceptual learning occurs in two stages

  1. Learns to look for the individual parts of the letters-enable to identify and name
  2. Requires attention to directional orientation
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31
Q

Dyseidesia

A

Poor sight word recognition

Genetic form

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32
Q

Dysphonesia

A

Impaired phonetic abiltiy (auditory)

  • relies on sight word vocabulary
  • poor spelling
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33
Q

Dysnemkinesia

A

Abnormally high frequency of letters reversals

-problems with writing or printing

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34
Q

Dyslexia screening

A

Rapid screening tool for the three types of dyslexia

Requires about 5 minutes

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35
Q

Dyslexia and eye movements

A

Increased number of fixations and regressions

Longer duration of fixation

Inefficient eye movements as a result of dyslexia

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36
Q

Legislation of children with LD

A

Federal and state laws mandate that each exceptional child has the right to a free and appropriate education to meet the child’s unique learning needs from birth to 21 yo

Provisions included:
Assessment
Specially designed classroom instruction
Related services necessary for the classroom program

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37
Q

Attention deficit disorder

A

ADD: attention deficit disorder

ADHD: attention deficit hyperactivity disorder

Prevalence: 5% of the school aged chidlren

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38
Q

Common characteristics of ADD and ADHA

A

Inattention
Impulsivity
Hyperactivity

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39
Q

Inattention

A

Includes disorganization, problems staying on task, constant daydreaming, and not paying attention when spoken to directly

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40
Q

Impulsivity

A

Includes spur of the moment decisions without thinking about the chance of harm or long term effects. The child acts quickly to get an immediate reward and may regularly interrupt teachers, friends, and family

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41
Q

Hyperactivity

A

Involves squirming, fidgeting, tapping, talking, and constant movement, especially in situations where its not appropriate

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42
Q

ADD and other problems

A

64% of them have other mental, emotional or behavior problems

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43
Q

Complaints of ADD and ADHD

A
  • trouble paying attention
  • doesnt like or avoids long mental tasks
  • trouble staying on task during school, at home, or even at play
  • doesnt pay close attention to details
  • doesnt appear to listen when spoken to
  • disorganized and seems forgetful
  • careless mistakes
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44
Q

Diagnosis of ADHD

A

16 years or younger

  • 6 or more hyperactivity/impulse symptoms fro at least 6 months
  • chidlren with this form of ADHD have tons of energy and are constantly moving in a way that causes problems
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45
Q

ADD diagnosis

A

16 years or younger
-6 or more symptoms of inattention for at least 6 months but not signs of hyperactivity/umpulsitivity

ADD is type of ADHD that doesn’t involve constant movement and fidgeting

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46
Q

treatmetns for ADD and ADHD

A

Stimulants

  • most common type
  • dopamine and NE
  • side effects: increased BP, HR, anxiety, HA, stomach aches

Non stimulants

  • take longer to start but can alos improve focus, attention ,and impulsivity in a person with ADHD
  • used when a person has bothersome side effects from stimulants, when a stimulant was not effective, or in combination with a stimulant to increase effectiveness
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47
Q

Drugs used for ADD/ADHD

A 
Methylphenidate (Ritalin)
Amphetamine (aderall)
Dextroamphetamine (Dexedrine)
-MOA: increase release of dopamine 
-ADHD, narcolepsy, and depression 
-act as adrenegeric agonists thus causing the following ocular side effects: mydriasis, dry eyes, acute angle closure (for this with narrow angles)
48
Q

Neurodevelopemtnal disorders

A

Socializing
Language and communications
Problems solving
Physical

Problems with all of these

49
Q

Autism spectrum disorder

A

-previously defined as separate subcategories on the autism spectrum (or persuasive developmental disorders-PPD): as-regression, PDD-NOA, childhood distegrative disorder, and automatic disroder

Now defines as “autism spectrum disorder” by the DSM-V

  • improved clarity
  • defines by a common set of behaviors and should be characterized by a single name according to severity
50
Q

Prevalence of autism spectrum disorder

A
  • Estimated that 1:59 chidlren have ASD
  • 4-5x more likely in boys than girls
  • increasing prevalence may be due to: changes in the case definition, increased awareness
51
Q

Etiology of autumn

A

Not completely understood

  • genetics
  • environmental factors
52
Q

Genetics and autism

A

May alter brain development
Multiple genes are responsible for ASD with genetic and environmental factors that contribute to variable expression
MRIEs indicate that ASD individuals use diffuse patterns of connectivity, cognitive strategy, and brain areas to process information

53
Q

Environmental factors and ASD

A

There is little evidence to conclude that this is a cause

54
Q

ASD comorbidities

A 
Intellectual disability 
Seizures 
Fragile X syndrome 
Tuberous sclerosis 
Down syndrome 
CP
NF

20% will also be diagnosed with some type of psychiatric disorder

55
Q

ASD: deficits in social communication and social interaction

A
  • social reciprocity-how actions of one affect others
  • joint attention: abiltiy to share an interest
  • nonverbal communication: using or interpreting
  • social relationships: developing and maintains friends
56
Q

ASD: restricted repetitive patterns of behavior, interests, and activities

A
  • lining of toys, flapping hands
  • fixed on routine
  • restrictive thinking
57
Q

Early indicators for ASD

A
  • no babbling or pointing by age 1
  • no single words by 16 months or 2 words phrases by 2
  • no response to name
  • loss of language or social skills
  • poor eye contact
  • excessive lining up of toys or objects
  • no smiling or social responsiveness
58
Q

ASD: later indicators

A
  • impaired ability to make friends
  • impaired ability to initiate or sustained a conversation with others
  • absence or impairment of imaginative and social play
  • restricted patterns of interest that are abnormal in intensity of focus
  • preoccupation with certain objects or subjects
  • inflexible adherence to epscific routines or rituals
59
Q

ASD characteristics

A

Sensory
Social relatedness
Repetitive and restrictive interests
Communication

60
Q

Sensory issues with ASD

A
  • over and under reaction to common environmental stimuli
  • stimuli may relate to sense such as auditory, tactile, visual, etc
  • stereotyped body movements (flaps hands, rocks, bounces repetitively)
  • unusual behaviors (looks form angles, sniff/licks objects, toe walks, etc)
61
Q

Social difficulties for ASD

A
  • difficulty relating to or expressing emotions
  • limited eye contact
  • limited use or understanding of non verbal gestures
  • flat or limited facial expressions
  • minimal initiation or response to joint attention
  • lack or social/emotional repirciocity (difficulty taking perspective of another person)
  • difficulty making friends
  • trouble understanding abstract words or concepts (analogies, sarcasm, love)
  • inappropriate behaviors may occur due to anxiety and discomfort
62
Q

Repetitive interests and activities in ASD

A
  • limited range of interests
  • finds comfort in predictability of structure and repetition
  • often rigid and excessive interest in usual objects/activities
  • exhibits atypical play behaviors
  • these actions may cause the individual to appear distracted/inattentive and viewed as inflexible and disobedient
63
Q

Communication and ASD

A
  • very limited verbal communication
  • communications primarily to have needs met and not for social reasons
  • language often develops late
  • prior to language development: poor understanding of language, gestural deficits (Lack of understanding), jargon/unusual nosies
64
Q

ASD diagnosis

A
  • observe behaviors
  • listening to caretakers observations
  • given a severity score
65
Q

Level 1 autism

A

High functioning autism

  • needs support
  • patients social and communication skills and repetitive behaviors are only noticeable without support
66
Q

Autism level 2

A

Needs substantial support
Patients social and commutation skills and repetitive behaviors are still obvious to the causal observer, even with support in place

67
Q

Severe autism level 3

A

Needs very substantial support

Patients social and communication skills and repetitive behavior severely impair daily life

68
Q

ASD treatment

A

There is no cure

Educational problems and behavioral therapy may be recommended

69
Q

Examine kids with ASD

A

A successful visual often begins before you ever see the patients

  • it may be beneficial to have the caregiver complete the forms prior to the exam
  • staff training for awareness of ASD and appropriate interactions during office visit
70
Q

Pre-examination questions for ASD

A
  • pateitns mode of communication
  • sensory needs or triggers
  • motivations
  • proactive behavioral strategies used before
  • negative behaviors
  • is the patient echolalic
  • follow directions
  • able to answer questions
71
Q

Things to make exam better for ASD

A 
Limit wait time
Offer quiet alternative if needed
Visual aids may assist in understanding 
Reinforce items throughout 
Consider shortened visual or taking a break
End on a positive note
72
Q

Effective commutation and exam for ASD

A
  • clear and concise
  • clear expectations
  • respectful, neutral tone
  • use visuals (gestures, pointing)
  • praise often
73
Q

Important keys for ASD

A
  • ASD should automatically limit your exam
  • remain positive
  • allow the caregiver/parent to respond
  • be flexible
  • some test may need to be modified if fixation is an issue
  • know when to throw in the towel but always end on a positive note
  • know when to refer to another doctor
74
Q

OD treatment for ASD

A
  • do not avoid giving glasses because you do not think the patient will respond
  • talk about adaptation to the frames and lenses
  • consider the type of fram-sensory isues, frame adjustment, period of adjustment to glasses
75
Q

Addressing ASD

A
  • dont say “for an autistic child..”
  • instead “everything is normal for your child”
  • do NOT identify the child by the condition
76
Q

Intellectual disability

A

Disability characterized by the following

  • limitations in intellectual functioning (learning, problem solving, judgement)
  • limitations in adaptive behavior (activities of daily life including social and practical skills)
  • onset prior to the age of 18
  • previously referred to as mental retardation
77
Q

Intellectual disability epidemiology

A
  • affects about 1% of the population. Of those, 85% have mild intellectual disability
  • Malle more likely than females to be diagnosed with intellectual disability
78
Q

Intellectual disability-intellectual functioning

A
  • IQ test is a major tool in the measuring of INTELLECTUAL FUNCTIONING (mental capacity for learning, reasoning, problem solving, etc)
  • a test score below for around 70 indicates a limitation in intellectual functioning
79
Q

Conceptual skills and intellectual disabilities

A

Language and literacy
Money, time, and number concepts
Self direction

80
Q

Social skills and intellectual disabilities

A 
Interpersonal skills
Social repsosnsibility
Self esteeem 
Social problem solving 
Ability to follow rules, obey laws, and avoid being victimized
81
Q

Practical skills and intellectual disability

A

Activities of daily living

Problems living by themselves

82
Q

Down syndrome

A
  • remains the most common chromosomal condition in the US

- 1:700 babies born with down

83
Q

Genetics of Down syndrome

A

Trisomy 21
Translocation Down syndrome
Mosaic Down syndrome

84
Q

Trisomy 21

A

95% with Down syndrome

3 copies of chromosome 21

85
Q

Translocation Down syndrome

A
  • 3% with Down syndrome
  • extra part or a whole chromosome 21 is present ,but it is attached or translocation to a different chromosome
  • 1/3 cases of Down syndrome resulting from translocation has a hereditary component
86
Q

Mosaic Down syndrome

A

2% of Down syndrome

-they have a mix of normal characteristics and down charactieriscs

87
Q

Downs sybdrome and mother age

A

Probability of having kids with Down syndrome increases droaamtically after the age 35 and up

88
Q

Screeenign test for Down syndrome

A
  • estimate the chance of the fetus having Down syndrome (provides probability)
  • involve bloodwork and ultrasound
89
Q

Diagnostic test for down sydnrome

A
  • chorionic villus sampling and amneocentesis

- 1% risk of miscarriage but nearly 100% accurate in diagnosisning Down syndrome

90
Q

Diagnosis at birth of down sybdrome

A

Presence of certain physical traits

  • low muscle tone
  • single deep crease across the palm of hand
  • slightly flattened facial profile
  • upward slant of the eyes

Karyotype is done to confirm the diagnosis

91
Q

Physical features of Down syndrome

A
  • hypotonia
  • small, broad head
  • large, protruding tongue
  • small nose with low, flat bridge
  • upward slanting tmperoal palpebral fissure
  • small, poorly defined ears
  • short, thick neck
  • study hands with a single palmar crease
  • short, stubby fret
92
Q

Clinical findgins with Down syndrome

A

Cognitive impairment
Developmental delays (static)
Impaired social skills

93
Q

Associations of down sybdrome

A
  • hearing loss
  • otitis media
  • obstructive sleep apnea
  • congenital heart defects
  • delayed dental eruption and hypodontia
94
Q

Down syndrome and vision problems

A

60% of kids with Down syndrome have vision problems

95
Q

Down sybdrome ocular findgins

A
  • significant refractive error
  • cataracts
  • strab
  • nystagmus
  • NLD
  • brushfiled spots
  • commonly see amblyopia and keratoconnus
96
Q

High refractive error and Down syndrome

A
  • most often high astigmatism and hyperopia
  • prescribe to prevent amblyopia
  • may notice more behavior challenges with attempting glasses wear
97
Q

Down syndrome and glasses

A

Often need frames to fit flat nasal bridge

  • regular most pads often font fit well
  • specs 4 us: frames have lower set bridge and nose pads
98
Q

Acccommodative insufficiency and Down syndrome

A

Could be an additional barrier to literacy and early learning

May benefit from bifocal or reading glasses

Reduced amplitudes and lags on MEM

99
Q

Brushfield spots

A
  • multiple round focal areas on anterior surface of the iris that appear beige or light brown/gray
  • areas of iris stromal hyperplasia surrounded by relative hypoplasia
  • more commonly seen in chidlren with down sybdrome and with lightly pigmented irises and of European decent
  • not pathognomonic
100
Q

Reduced VA and Down syndrome

A
  • studies have shown reduced contrast and vernier acuities
  • important: may no be abnormally for your patient to have 20/30 to 20/60 BCVA

Normal is 20/45

101
Q

Cataract ans and Down syndrome

A

Congential
Cerulean
-blue dot opacities in the anterior and posterior capsule
-typically bilateral
-often do not affect visual acuity
-often stable and do not progress over time

102
Q

Nystagmus and Down syndrome

A

Up to 1/3 mah have it
Horizontal
May see latent nystagmus

103
Q

Strab and down sydnrome

A
  • esotropia is the most common
  • congential or infantile ET
  • accommodative ET
  • do not confuse with spasm of over accomodation
104
Q

Amblyopia and Down syndrome

A

Isometropia and anisometropia
Strabismus

IMPORTANT: avoid atropine penalization due to common cardiac abnormalities

105
Q

Keratoconnus and Down syndrome

A 
Onset in early adulthood
Possibile etiolgoes
-increased eye rubbing
-steeper cornea with higher rates of astigmatism 
-genetic linke to chromosome 21
106
Q

Exam recommendations for Down syndrome

A
  • best technique depends on the cognitive/developmental leve, cooperation, and associated conditions
  • pediatric test may be ideal for some patients with Down syndrome regardless of age
107
Q

Cerebral palsy

A
  • disorder of movement, muscle tone, or posture that is caused by damage that occurs to the immature, developing brain (most often before birth)
  • every case of cerebral palsy is unique to the individual
108
Q

Etiology of cerebral palsy

A

Abnormalriy or disruption in brain development, usually before a child is born, factors that may lead to problems with brain develpepemtn include

  • mutations
  • maternal infections
  • fetal stroke
  • infant infections
  • traumatic head injury
  • lack of oxygen
109
Q

Signs of CP

A
  • impaired movement associated with abnormal reflexes
  • rigidity of limbs and trunk
  • abnormal posture
  • involuntary movements
  • unsteady walking
110
Q

Functional abilities and CP

A

Effect greatly varies

-physical and intellectual

111
Q

Associations with CP

A

Epilepsy, blindness, and deafness

Commonly have eye muscle imbalance

112
Q

Mild CP

A

A child can move without assistance, his or her daily activities are not limited

113
Q

Moderate CP

A

A child will need braces, medications, and adaptive technology to accomplish daily activities

114
Q

Severe CP

A

A child will rewuire a wheelchair and will have significant challenges in accomplishing daily activities

115
Q

CP location

A

How it affects the body, one arm, two arms, upper half, lower half, whole body

116
Q

Spastic CP

A

Increased muscle tone

117
Q

Non spatis CP

A

Exhibit decreased or fluctuating muscle tone

3F: Peds Final (11 decks)

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