paeds - learning disorders Flashcards
theories of development
◦ Arnold Gesell - a “sequential” theory to development where each stage of development was a prerequisite for the next stage.
◦ Erikson -psychological view of development; eight stages
◦ Edgar A. Doll/Alfred Binet- adaptive skill development.
◦ Jean Piaget - four stages of development-
- Sensorimotor(0to2yearsoflife)
- Preoperational (age 2 to 7 years)
- Concrete operations (age 7 to 11 years)
- Formal operations (adolescence)
developmental disorder = impairments in
CLAMBS
o Cognitive
o Language
o Motor
o Behavioural
o Social
o Academic
developmental disorder main domains
oGross and fine motor
o Language
oAdaptive /social
developmental disorder - screening
- To identify all those requiring assessment
- Administered to large numbers of children
- Recommended that screening occur at all health visits
- inexpensive, brief, standardized
- high sensitivity
- Some require training
developmental disorder - assessment
- Screening test positive- assessment recommended
- May be general for global developmental delay or specific for each domain
- Developmental assessment tests - specialist training
- Comprehensive evaluation:
o History and 3 generation pedigree
o Physical examination
o Intellectual capacity & adaptive functioning
o +/- neuroimaging, metabolic work –up, chromosomes & genetic tests if needed
types of developmental assessments
A GAP SAC
General developmental assessments
o Griffiths mental developmental scales
o Bayley’s Scales
Cognitive or intellectual assessments
Autism assessments
o Child Autism Rating Scale(CARS), ADOS, ADI-R
Speech and language assessments
Occupational therapy assessments
Physiotherapy assessments
Attention assessments
o Connnors / Copelands
Academic assessments of literacy and mathematics
intellect disability if 2 or more in adaptive functioning:
Like CCHHefSSS
o communication
o self-care
o home living
o social skills
o community use
o self-direction
o health and safety
o functional academics
o leisure and work.
intellect disability IQ
- Mild (50-70)- IQ of 60= mental age of 9-10year old
- Moderate (35-50)- IQ of 40= 6 year old level
- Severe (20-35) IQ of 20=3 year old
- Profound <20
- Severe ID may be non-verbal, not toilet trained, self-injurious behavior, no awareness of danger
- Mild ID often do not have physical problems
intellect disability - associated deficits
FACCt BEVerage
- cerebral palsy (20% of severe ID)
- feeding difficulties
- visual and hearing impairments
- epilepsy (20%)
- communication deficits
- autistic features
- behavioural problems and psychiatric disorders (in 50%)
intellect disability - prevalence
1-3% of the population
* 85% of all ID is mild
* 5% is severe or profound- has not changed in past 50 years
intellect disability - cause
EEPic HAts
- hereditary 5%
- early alterations of embryonic development 32%
- Other Pregnancy Problems and Perinatal Morbidity 11%
- Environmental known causes 18%
- Acquired Childhood Diseases 4%
- unknown 30%
Hereditory (5%)
o Inborn Errors of Metabolism
o Other single gene abnormalities
o Chromosomal abnormalities
o Polygenic familial syndromes
Early Alterations of Embryonic Development
(32%)
o Embryodysgenesis; sporadic events
o Chromosomal changes
o Prenatal influence syndromes
Other Pregnancy Problems and Perinatal Morbidity (11%)
(2nd half of pregnancy or newborn period)
o Fetal malnutrition, antepartum
haemorrhage
o Perinatal difficulties
(prematurity, asphyxia, trauma)
Acquired Childhood Diseases (4%)
o Infection (meningitis, HIV, severe GE)
o Cranial trauma
o Other (near drowning, intoxications etc)
Environmental known causes (18%)-
o psychosocial deprivation, malnutrition, parental psychiatric illness, child abuse
Unknown causes (30%)–presumed genetic, presumed environmental
intellect disability prevention
Near total elimination
o congenital rubella
o Phenylketonuria
o Galactosaemia
o congenital hypothyroidism (newborn screening)
o kernicterus
Major Reduction
o measles encephalitis
o haem influenza meningitis
o tay-sachs
o morbidity from prematurity and perinatal asphyxia
Significant reduction
o neural tube defects
o Down’s Syndrome
o lead intoxication
o FAS
autism def
- a lifelong developmental condition that affects, among other things, the way an individual relates to his or her environment and their interaction with other people.
- spectrum of clinical conditions
- of neurobiological origin
- impairments in social interaction and communication and characterized by restricted, repetitive and stereotyped patterns of behavior.
autism diagnostic criteria
Deficits in social communication and social interaction:
o Deficits in socio-emotional reciprocity
o Deficits in non-verbal communication behaviours
o Deficits in developing and maintaining or understanding relationships
Repetitive, restrictive patterns of behaviour, interests or activities:
o Stereotyped or repetitive movements, speech or use of objects o Insistence on sameness
o Restricted, fixated interests
o Hypo or hyperreactivity to sensory input
autism changes from DSM 4 to 5 symptoms
dyad symptoms
oSocial Communication Deficits
oRestrictive and repetitive behaviours
autism spectrum disorder (ASD) includes conditions:
PAAC No
Autism Disorder,
Asperger’s Syndrome,
Pervasive Developmental Disorder NOS and Childhood Disintegrative Disorder now all classified as Autism Spectrum Disorder
- Stereotyped and repetitive use of language now classified under RRB
- Hypo and hyper sensory difficulties included under RRB
autism causes:
- Known genetic conditions- 10-15%- Fragile X, Down’s syndrome, Retts syndrome, tuberous sclerosis
- Swedish study –ASD heritability - 83%; twins - 87%
- Many associated genes identified- heterogeneity and variable
penetrance are characteristics of autism genetics - Genetic recurrence risk- siblings 2%–18%;
- Environmental
o no link to vaccines
o increased paretal age
o LBW
o prenatal exposure to valproate and alcohol o air pollution
ASD associated findings
BASSS i
- 44% with ASD has average to above average intellectual ability.
- Splinter “savant” skills; uneven profile
- Sensory problems- auditory, visual, touch, taste and smell; increased pain threshold
- Seizures- 25-30%, peaks in adolescence
- Behavioural problems- tantrums, aggression, self-injurious behavior, sleep problems
- Anxiety and depression
ASD differential diagnosis
HISSSSTORy LL
- Social pragmatic disorder (no repetitive behaviours and restricted interests)
- Intellectual disability
- Language disorders
- Sensory impairments
- Rett’s syndrome
- Obsessive compulsive disorder
- Hearing impairment
- Selective mutism
- Landau-Kleffner disorder
- Tourette’s syndrome
- Schizophrenia
learning disability def
- Achievement in standardized tests of reading, writing, mathematics is below that expected for age, schooling and IQ
- Discrepancy between IQ and academic performance
- Diagnosis is mostly based on a psychoeducational assessment
learning disability cause
- Genetic- positive family history
- Environmental-prematurity, VLBW, prenatal nicotine exposure, perinatal
learning disability associated problems
CALM LIDDD
- Low self-esteem, social skills deficits
- Increased school drop out-40%
- Difficulties with employment and social adjustment
- ADHD, ODD
- Conduct disorder
- Major depressive disorder and dysthymia
- Language delay
- Developmental co-ordination disorder
- Deficits in specific areas- memory, visual-perceptual ability or language
learning disability assessment
- History (developmental, family, educational, medical)
- School reports
- Psycho-educational
ADHD risks to :
- drop out of school (32 - 40%)
- to have few or no friends (50 - 70%)
- to underperform at work (70 - 80%)
- to engage in antisocial activities (40 - 50%)
- to use tobacco and illegal drugs
- more likely to experience teen pregnancy (40%)
- to speed excessively and have multiple car accidents,
- to experience depression (20 - 30%) and personality disorders (18 - 25%) as adults.
ADHD def & symptoms
Persistent pattern of inattention and/or
hyperactivity-impulsivity characterized by: Inattention – 6 or more of the following
o Fails to pay attention to detail
o Difficulty sustaining attention in tasks
o Often does not seem to listen when addressed directly
o Does not follow through on instructions
o Difficulty organizing tasks and activities
o Avoids tasks that require sustained mental effort o Loses things necessary to complete tasks
o Easilydistracted
o Often forgetful in daily activities
o Often fidgets or taps or squirms
o Often leaves seat in situation where being seated is expected
o Often runs or climbs
o Unable to play or engage in leisure activities quietly
o Is often on the go’ or ‘driven by a motor’
o Talks excessively
o Blurts out answers before question complete
o Interrupts or intrudes on others
- Symptoms present in two or more settings e.g. home & school
- Symptoms present for > 6 months
- symptoms present before 12 y/o
ADHD prevalence
- 8% of population (5-10%)
- Males: females 3:1 but more inattentive girls
- Genetic factors play a role in 80%
ADHD pathophysiology
BaG NALS hippo Locus Pocus
o Specific areas in the brain — the frontal lobe, its connection to the basal ganglia, the nucleus accumbens, limbic system, hippocampus, locus coeruleus and parietal lobes
o Less activity , may also be relatively smaller
o Neurotransmitters- dopamine and noradrenaline
ADHD associated comorbidities
CCOLT
o Oppositional defiant disorder.
o Conduct disorders.
o Communication disorders.
o Tourette’s syndrome.
o Learning disorders (70%)
ADHD causes
- The home environment, parental management abilities, stressful life events or deviant relationships are important, but do not cause ADHD,
- Nor does sensitivity to sugar, colourants and preservatives.
- ADHD is also not a direct result of allergies, intolerance or deficiencies in the diet, although these factors may adversely affect some patients
- ADHD is not a benign disorder
sensory disorders - visual impairment (prevalence, symptoms)
- 50% have associated disabilities:
- 20-25% have intellectual disability, cerebral
palsy, autistic behavior - Visually impaired may have repetitive head, body or hand movements, called “blindisms”
- VI has major effects on development as it underpins concepts of space and form, is important in early attachment, underlines fine and gross motor exploration.
sensory disorders - hearing impairment
- Threat to language, social, emotional and academic functioning
- Early diagnosis of this hidden deficit, is vital to optimal outcome
- Hearing testing essential in those at risk or with speech delay or recurrent otitis media
sensory processing disorders categories
classified into three categories:
o Sensory modulation disorder
o Sensory-based motor disorder
o Sensory discrimination disorder
- Not recognized as a mental disorder in ICD-10 or the DSM-5.
communication disorder - Developmental Language Disorder
- vocabulary, grammar, sentence structure
- Problems receptive (understanding language)
and expressive
communication disorder -Speech Sound Disorder
- previously phonological disorder
- problems with pronunciation and articulation of their home language
communication disorder - Childhood Onset Fluency Disorder
- standard fluency and rhythm of speech is interrupted, often causing the repetition of whole words and syllables.
communication disorder - Social Pragmatic Disorder
- difficulties in the social uses of verbal and nonverbal communication
- affects the development of social relationships and discourse comprehension
- the difference between this diagnosis and autism spectrum disorder is that in the latter there is also a restricted or repetitive pattern of behavior.
communication disorder - Unspecified Communication Disorder
- symptoms of a communication disorder but who do not meet all criteria, and whose symptoms cause distress or impairment.
Developmental Co-ordination Disorder - def
- clumsy child syndrome / developmental dyspraxia
- failure of acquisition of motor skills
- clumsiness, slowness and inaccuracy of motor skills (sports, handwriting)
- significantly and persistently interferes with activities of daily living
- impacts academic/school productivity, prevocational and vocational activities, leisure, and play
- onset of symptoms in the early developmental period.
- not better explained by intellectual disability or visual impairment or neurological condition affecting movement (e.g., cerebral palsy, muscular dystrophy, degenerative disorder)
Developmental Co-ordination Disorder - cause
increased risk with:
* Prenatal alcohol exposure
* Prematurity
Developmental Co-ordination Disorder - prevalence
- 5%-6% of 5-11 year olds
- More common in males
Developmental Co-ordination Disorder - associated features
ADHD, autism, specific learning disorders
