Neurodevelopmental and behavioral problems in children and school dysfunction

What is developmental delay?

failure to meet milestones

explain the difference between isolated delay and global delay

isolated delay is in one domain (like motor, speech/language, social, etc.) while global delay is in 2+ domains

explain the difference between delay and disorder

there is a difference in function and degree of impairment

____ is always a red flag with children

loss of milestones

what are some important components for the management of developmental delay?

early intervention

refer to services/subspecialties as needed (speech, physical, or occupational therapy for example)

support and educate parents

be a medical home <3

____ is an early marker of cognitive development

language development

exposure to speech matters

persistent difficulties in comprehension and/or production of language

functional limitations, reduced vocab/convos/sentences

deficits in spoken and/or written communication

language disorder

persistent difficulty with speech and sound production that interferes with speech intelligibility or prevents verbal communication

50% of speech should be understood at 2yrs, 75% at 3yrs, and 100% at 4yrs

speech sound disorder

stuttering

clinically significant impairment in speech fluency and timing

child-onset fluency disorder

impairment in the use of language for social exchanges, ability to adapt communication style to context of interaction, ability to follow conventional and cultural norms for conversation, and ability to understand ambiguous language

social pragmatic communication disorder (must be differentiated from autism)

What are the key differences between autism and speech disorders?

the social aspect (autism has lack of social interactions/interest)

the imaginative/imitative play (autism has very limited imitation and no symbolic play)

deficits in social communication and social interaction accompanied by restrictive/repetitive behaviors

autism spectrum disorder

describe the two categories of risks for autism spectrum disorder with some examples

genetics: chromosomal disorders and heredity

biological: older parents, prenatal exposures, prematurity/ low birth weight

lack of social interaction: lack of response to their name, lack of eye contact, lack of social smile

delay in language development

lack of gestures (like pointing) to communicate

echolalia

limited imaginative play/ odd play patterns

early symptoms of autism spectrum disorder

most patients with _____ show normal cognitive development and have intellectual abilities in the normal range

autism spectrum disorder

What is the screening tool used by PCP to aid in diagnosing ASD?

M-CHAT-R

done 18-30 months

it is important to do ____ when you suspect ASD

refer for eval by developmental pediatrician

BUT

do not delay management steps while you are awaiting the evaluations and formal diagnosis

you have a combination of impairment of cognitive and adaptive development

cognitive: reduced IQ

adaptive: deficits in conceptual, social, or practical skills

intellectual disability (used to be called mental retardation)

explain causes of intellectual disability

often no causes is identified but if there is one:

prenatal and genetic are most common (fragile X, trisomy 21, fetal alcohol, infection)

An important part of the workup for a child that is non-specific to a certain disease is

hearing and vision test

reduced coordinated motor skills: clumsiness, slowness, and inaccuracy

developmental coordination disorder

repetitive purposeless motor behaviors that may or may not be self-injurious

stereotypical movement disorder

multitple motor and 1+ vocal tics

present for at least one year

Tourette syndrome

motor or vocal tics (not both)

present for at least one year

persistent/chronic tic disorder

when there is a discrepancy between intellectual ability and academic performance we suspect

a learning disorder

difficulty learning and using academic skills (not intellectual disability)

things like reading, writing, or mathematics

learning disorder

“school is boring”, class clown behavior, spending a much longer time completing homework than classmates

frequent failing grades, absences, social disengagement, suspension

school failure: retention, expulsion, dropping out

learning disorder

goal is to detect and intervene early in order to prevent school failure

trouble with authority

breaks school rules

always seems angry

argumentative

easily annoyed

noncompliant

oppositional defiant disorder (ODD)

significant aggression toward others

animal cruelty

theft/ setting fires

law breaking

substance abuse

poor school performance

conduct disorder (CD)