Pediatrics

Developmental Disorders Dra. Annah Rebecca Valmores-Doroja

12/7/2018

DEVELOPMENT LANGUAGE
• A process of unfolding, expanding, Expressive Receptive
becoming fuller, more complex, and more Coo Smiles 1.5
complete Ah-goo Orients to voice 4.0
• The refinement and specialization of a Babbles Orients to bell 7.0
child’s function Dada/mama (non- 8
• Acquisition of increasingly complex abilities specific)
in various functional domains Dada/mama Follows command w/ 11
(specific) gesture
Mechanisms that make development possible Mature jargon Recog 5 body parts 17
• Well-formed and functioning nervous 2-word combination Points to 2 pictures 24
system
• Unique set of genes Rule of Thumb
• An environment which provides appropriate • At age 1,a child uses single words and is
and adequate nutrition at all ages intelligible about 25% of stranger
• Opportunities to learn and act • At age 2, two-wrrds. 50%
• Challenges and rewards • 3, 3-word, 75%
• Age 4, 4-word, all strangers
Domains of Development
COGNITIVE
• Gross motor
Milestone Age
• Fine motor/eye-hand coordination
• Language
• Personal/social
• Cognitive
Developmental Red Flags
Milestones of Development • The red flag age is the age at which one
would expect almost every child to have
• Functional skills acquired at a certain age already mastered a particular skill
• Serve as a criteria in assessing • Red flag
development expectations
• Acquired in stages
Gross motor
“By understanding what to expect during each • Persistent primitive reflexes beyond 9
stage of development, parents can easily capture months
the teachable moments in everyday life to enhance • Unable to sit alone by 9 months
their child’s language development, intellectual • Unable to walk alone by 18 months
growth… • Asymmetric movement
• Hyper/hypotonia
TABLE NAME • Hyper/hyporeflexia
Milestone Mean age Range
Hold head 3 1-4 Fine Motor
Rolls over 5 2-10 • Fisting beyond 4 months
Sitting 7 5-9 • Handedness before 1 year
Crawling 8 6-11 • Mouthing as primary means of exploration
Standing 10 8-14 after 14 months
Walking 12 8-16 • Inconsistent visual attention
Running 14.8 18-24
Language
Parachute reflex – baby is about to walk • Does not turn to sound by 6 months –
immediately refer for hearing test
TABLE NAME • Lack of a protodeclarative point by 20
months
Hands open 3 2-4 • “rote” non-related phrases after 24 months
Hands midline 4 2-5 • Parents do not understand…
Transfers 5 4-6
objects Social Language
Unilateral 6 5-7 • Inconsistent auditory attention
reach • Lack of shared of reference by 20 months
Inferior 9 8-10 • Lack of joint attention span
pincher • Echolalia after 30 months
Vol. release 11 9-12
Scribbling 15 12-18 Absolute indications in the immediate assessment of
Draws circle 36 30-40 language delay
• No babbling, gesturing, or pointing at 12
months
• No single words by 16 months
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 • No 2-word spontaneous phrases by 24 A. Persistent deficits in social…
months B. Restricted, repetitive patterns of behavior,
• Any regression in language or social skills interests, or activities, as manifested by at
at any age least two of the following

Psychosocial Delay Specify if

• No social smile by 3 months • With or without accompanying intellectual
impairment
• Not laughing in playful situation by 6 months
• With or without accompanying language
• Hard to console, stiffens when approached
impairment
by 1 year
• Associated with a known medical or genetic
• In constant motion, resists discipline
condition or environmental factor
• Does not play with other children at 3 years
• Associated with another
• Frequent temper tantrums after 4 years old
neurodevelopmental…
IDENTIFY PATTERNS OF DEVELOPMENTAL Levels of severity in ASD
DELAY Level 3: Requiring very substantial support
• General/Global Developmental Delay Social Communication
• Developmental Deviancy • Severe deficits in verbal and nonverbal
• Developmental Dissociation social communication skills; social
impairments
NEURODEVELOPMENTAL DISORDERS
Behavioral Disorders Management
• Autism • Multidisciplinary comprehensive evaluation
• ADHD • Identification of areas and strengths and
weaknesses
Autism Spectrum Disorder • Occupational and speech therapy/structured
Impairments in behavioral programs
• Special education
• Social communication and interaction • Pharmacotherapy for specific problems
• Restricted play repertoire (seizure, irritability, SIBs, etc.)
Red flags
Attention Deficit Hyperactivity Disorder
Communication concerns • “A persistent pattern of inattention and/or
• Does not respond to name hyperactivity-impulsivity that interferes with
• Appears deaf at times functioning or development has symptoms
• Doesn’t follow directions presenting in two or more settings (e.g.
• Seems to hear sometimes home, school, work) and negatively impacts
• Doesn’t point or wave goodbye directly on social, academic or occupational
• Has language delay functioning” – DSM 5
• Cannot tell what he wants • Most common neurodevelopmental disorder
• Used to say a few words, but now he of childhood
doesn’t • Prevalence rate of 3-5% of school age-
Social concerns children
• Doesn’t smile socially • Boys affected more than girls (3-4:1)
• Seems to prefer to play alone
• Gets things for himself Etiology
• Is very independent • Genetic
• Does things “early” o Twin studies
• Has poor eye contact ▪ parents w/ adhd 50% in
• Is in his own world children
• Tunes people out ▪ children with adhd 25% in
• Is not interested in other children parents
o Molecular genetic studies
Behavioral concerns • biologic
• Throws intense or violent tantrums o biologic influences
• Hyperactive/uncooperative/oppositional ▪ brain injury
• Doesn’t know how to play with toys ▪ brain dysfunction
• Gets stuck with things over and over again • environmental
• Spend time lining up toys or puttings in o family dysfunction
order o poor child management
• Oversensitive to certain textures or sounds o parental psychopathology
• Odd movements patterns
• Unusual attachments to toys, objects, electronic screen syndrome
schedules screen dependent syndrome
video chatting: 15 minutes only (3 years old)
Symptom clusters
• Persistent deficits in social communication
and social interaction

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DSM V Criteria Goals in Management
INATTENTION
HYPERACTIVITY-IMPULSIVITY Specific Learning Disorder
• often fidgets with hands and feet or squirm • Refers to a heterogenous group of disorders
manifested by significant difficulties..
Unmanaged ADHD leads to COMPLICATIONS • A neurodevelopmental disorder of biological
origin manifested in learning difficulty and
3 Clinical Presentations problems in acquiring academic skills
markedly below age level and manifested in
Predominantly inattentive
the early school years, lasting for at least 6
• easily distracted months; not attributed to intellectual
• not excessively hyperactive or impulsive in disabilities, developmental disorders, or
behavior neurological or motor disorders
• SLD is understood to be a cross-cultural
Predominantly hyperactive-impulsive and chronic condition that typically persists
• extremely hyperactive and into adulthood, albeit with cultural
differences and developmental changes in
Treatment Options way the learning difficulties manifest
• educational accommodations
o classroom placement Diagnosis
o special education • To be diagnosed with specific learning
o tutoring disorder, a person must have difficulties in
o private schools at least one of the following areas. The
• behavior therapy symptoms must have continued for at least
o parent training 6 months despite targeted help
o social skills training o Difficulty reading (e.g. inaccurate,
slow and only with much effort)
Differential diagnosis in children with learning o Difficulty understanding the meaning
problems: of that is read
• Intellectual Disability (Mental Retardation) o Difficulty with spelling
o Difficulty with written expression
• Specific Learning Disorder
(e.g. problems with grammar,
punctuation or organization)
Intellectual Disability o Difficulty understanding number
Intellectual Developmental Disorder concepts, number facts or
Mental Retardation calculation
• Not a medical or mental disorder o Difficulty with mathematical
• “Fit” between the capabilities of an reasoning (e.g. applying math
individual and the structure and concepts or solving math concepts)
expectations of his environment
• Characterized by substantial limitations in Specify if:
both intelligence and adaptive ski;;s • With impairment in reading
• With impairment in written expression
The following three criteria must be met:
a. Deficits in… Severity
b. Deficits in adaptive functioning that result in
failure to meet developmental and Mild Some difficulties with learning in one or
sociocultural standards for personal two academic areas, but may be able
independence and social responsibility. to compensate
Without ongoing support Moderate Significant difficulties with learning,
requiring some specialized teaching
Specifiers and some accommodations or
• The various levels of severity are defined on supportive services
the basis of adaptive functioning and not IQ Severe Severe difficulties with learning,
scores because it is adaptive functioning the affecting several academic areas and
determines.. requiring ongoing intensive specialized
Level of IQ Educ. Adaptive Level of
ID score Equiv. behavior – support Dyslexia
ADL • Characterized by an unexpected difficulty in
Mild 55-70 Educable Employable Intermittent
in simple – prn basis
reading and other academic…
jobs
Moderate 40-55 Trainable Trainable Limited: Red Flags: Reading Skills
Employed more than • Slow in learning connection between letters
in sheltered prn and sounds
env.
Severe 25-40 Trainable Trainable in Extensive; • Confuses basic words
Depended some basic support at • Make consistent reading errors
ADL least 1/day o Letter reversals – b-d, p-q
Profound Below Custodial Dependent Pervasive o Letter inversion – m-w
25 (life sup) in all ADLs
• Transpositions – felt-left
o Number reversals – 14-41
o Repeats, omits,
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Epidemiology Management
• 5-15% of school aged children • Early identification is crucial
• Boys outnumber girls 3:2 • May benefit from individualized instruction
• 50-80% with positive family history programs addressing specific need
• May flourish…
Etiology
SUMMARY
• A
• All developmental disorders are diagnosed
Not because of: through its clinical presentation – there is no
specific laboratory or diagnostic test
• Intellectual disability
• All developmental disorders run a chronic
• Uncorrected visual or auditory problems
course – NO CURE!
• Other mental or neurological disorders
• Early diagnosis and early intervention are
• Psychosocial adversity
the key to management
• Lack of proficiency in language of
instruction
• Inadequate educational instruction
TECHNOLOGY USE GUIDELINES FOR CHILDREN AND YOUNG ADULT
Developmental How Non Handheld Non-violent Violent video Online, violent, video games
age much violent TV devides video games games or pornography
0-2yrs None Never
3-5yrs 1hr/d Check
6-12yrs 2hr/d Check Never
13-18yrs 2hr/d check Check Limit to 30 mins/d never

ECCD Corrected age

Every quarter in the newborn period For premature babies aged less than 2 years old
Every 1-6 months after 1 year old
Every year

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