DEVELOPMENTAL

PEDIATRICS
MODERATOR:
Dr. MALIJAN
PRESENTOR:
Analyn P. Dizon M.D.
 GENERAL DATA

First time to seek

consult at our
L.C. Mandaluyong City institution via
Telemedicine (Oct.
5/M 2021)
CHIEF COMPLAINT

• Unable to Communicate
with Care takers
• Speech Delay
 BIRTH AND MATERNAL
HISTORY
•Live, baby boy born full-term to a 15-year-old G2P1 (1011) mother
via primary LTCS for CPD at Mandaluyong City Medical Center

• 2 PNCU started at 7 months AOG

•(+) Multivitamins, Calcium

•(+) Abortifacient drugs (Misoprostol & unrecalled tea) for 1 week at 1

month AOG
 BIRTH AND MATERNAL
HISTORY
•(+) Smoker (+) Alcohol beverage drinker

•CBC, OGTT, HIV, Hepatitis B, UA, Ultrasound

•(+) UTI at 8 months AOG

•No other maternal illnesses

•No feto-maternal complications

 PAST MEDICAL HISTORY
•Newborn screening: Normal
•Hearing Test: Normal

•(-) Bronchial asthma

•(-) Allergy to food/ medications

•(+) Previous Hospitalization at Tagaytay Medical

Center for a Skin Infection

•(-) Surgery/ blood transfusion

IMMUNIZATION
 NUTRITIONAL HISTORY
•Exclusive breastfeeding until 1 month

•Mixed feeding started at 2 months

•Complimentary feeding started at 7 months

•Fond of eating candies and bread, does not

eat rice.
 SOCIAL HISTORY
•Father is a 20 years old unemplyoed, high school
graduate

•Mother is a 20 years old, college undergraduate

•Parents are separated for 5 years

•Patient is currently living with his grandparents

 FAMILY MEDICAL HISTORY
•(+) Hypertension – maternal
•(-) Pulmonary tuberculosis
•(+) Behavioral disorder - maternal
•(-) Diabetes Mellitus
•(-) Malignancy
•(-) Bronchial asthma
•(-) Liver or Kidney Disease
 DEVELOPMENTAL MILES
TONES Age Seen Red Flag
Smiled socially 4 months 4 months
Able to hold head up from prone 4 months 5 months
Rolled over 5 months 6 months
Babbled 9 months 6 months
Sat without support 7 months 10 months
Walked alone 15 months 18 months
Pointed with index finger to get attention at Not yet 12 months
Able to wave bye, shook head no, “close-open” Not yet 12 months
Able to say “mama” 24 months 12 months
Combined 2 words to form phrases Not Yet 24 months
Toilet trained Not yet 24 months
 INFANCY
2 MONTHS
Begins to smile
Can briefly calm herself (bring hands to mouth and suck on hand)

Coos, makes gurgling sounds

 INFANCY
4 MONTHS
Begins to babble
Cries in different ways to show hunger,
pain, or being tired
 INFANCY
6 MONTHS
Responds to sounds by making sounds
Looks around at things nearby
Rolls over in both directions
Begins to sit without support
crawling backward
 ONE YEAR
Cries when grandmother leaves
Explores things in different ways, like shaking, banging,
throwing
Bangs two things together
Gets to a sitting position without help
Pulls up to stand, walks holding on to furniture
 TWO YEARS
Repeats words overheard in conversation
Stands on tiptoe
Begins to run
Climbs onto and down from furniture without help
Throws ball overhand
 THREE YEARS
Climbs well
Runs easily
Walks up and down stairs, one foot on
each step
 FOUR YEARS
Would rather play alone
Hops and stands on 2 feet
can eat alone without utensils
can hold crayons/pencil with palms
can undress oneself but cannot dress alone
FIVE YEARS
DIFFERENTIAL
DIAGNOSIS
1. Language Disorder
2. Autism Spectrum Disorder
 Salient Feature Differential
Diagnosis

-Difficulty in forming sentences 1. Language Disorder

- Difficulties in the acquisition and
use of language across modalities
(spoken and written)
-Limited sentence structure
-Language abilities below for age
-Onset is early in the development
-Not attributed to other cause
 Salient Feature Differential
Diagnosis
Abnormal Body Posturing
Avoidance of Eye Contact or Poor Eye Contact
Behavioral Disturbances
Deficits in Language Comprehension
-No Social Interaction Delay in Learning to Speak
Intense Focus on One Topic
Lack of Empathy
Lack of Understanding Social Cues
Learning Disability or Difficulty
Not Engaging in Play With Peers
Preoccupation With Specific Topics
Problems With Two-Way Conversation
Repeating Words or Phrases
Repetitive Movements
Sleep Disturbances
Social Withdrawal
Using Odd Words or Phrases
 PRESENT
WORKING
IMPRESSION:
AUTISIM
SPECTRUM
DISORDER
Autism spectrum disorder (ASD) is a neurobiologic
disorder with onset in early childhood. The key features
are impairment in social communication and social
interaction accompanied by restricted and repetitive
behaviors. The presentation of ASD can vary significantly
from one individual to another, as well as over the course
of development for a particular child. There is currently no
diagnostic biomarker for ASD. Accurate diagnosis
therefore requires careful review of the history and direct
observation of the child's behavior.
The prevalence of ASD is estimated at 1 in 59 persons by the
U.S. Centers for Disease Control and Prevention (CDC). The
prevalence increased significantly over the past 25 years,
primarily because of improved diagnosis and case finding
as well as inclusion of less severe presentations within the
autism spectrum. There is a 4:1 male predominance. The
prevalence is increased in siblings (up to 10% recurrence rate)
and particularly in identical twins. There are no racial or ethnic
differences in prevalence. Individuals from racial minorities and
lower socioeconomic status are at risk for later diagnosis.
 Etiology

The etiology of ASD is thought to result from

disrupted neural connectivity and is primarily
impacted by genetic variations affecting early brain
development.
 Developing, Maintaining, and Restrictive and
1 Understanding Relationships 2 Repetitive Behavior
 Severity Levels Defined in
DSM-5
LEVEL 1 LEVEL 2 LEVEL 3

• “Requiring • “Requiring • “Requiring

support” substantial very
support” substantial
support”
SEVERITY SOCIAL RESTRICTED,
COMMUNICATION REPETITIVE
BEHAVIORS
LEVEL 1 Without supports in place, deficits in Inflexibility of behavior causes
social communication cause noticeable significant interference with
impairments. Difficulty initiating social functioning in one or more contexts.
interactions, and clear examples of Difficulty switching between
atypical or unsuccessful responses to activities. Problems of organization
social overtures of others. May appear and planning hamper
to have decreased interest in social independence.
interactions. For example, a person
who is able to speak in full sentences
and engages in communication but
whose to-and-fro conversation with
others fails, and whose attempts to
make friends are odd and typically
unsuccessful
SEVERITY SOCIAL RESTRICTED,
COMMUNICATION REPETITIVE
BEHAVIORS
LEVEL 2 Marked deficits in verbal and Inflexibility of behavior, difficulty
nonverbal social communication coping with change, or other
skills; social impairments apparent restricted/repetitive behaviors
even with supports in place; limited appear frequently enough to be
initiation of social interactions; and obvious to the casual observer
reduced or abnormal responses to and interfere with functioning in a
social overtures from others. For variety of contexts. Distress
example, a person who speaks and/or difficulty changing focus
simple sentences, whose interaction or action.
is limited to narrow special interests,
and who has markedly odd
nonverbal communication
SEVERITY SOCIAL RESTRICTED,
COMMUNICATION REPETITIVE
BEHAVIORS
LEVEL 3 Severe deficits in verbal and Inflexibility of behavior, extreme
nonverbal social communication difficulty coping with change, or
skills cause severe impairments in other restricted/repetitive
functioning, very limited initiation of behaviors markedly interfere with
social interactions, and minimal functioning in all spheres. Great
response to social overtures from distress/difficulty changing focus
others. For example, a person with or action.
few words of intelligible speech who
rarely initiates interaction and, when
he or she does, makes unusual
approaches to meet needs only and
responds to only very direct social
approaches
Specifiers Defined in
DSM-5
Screening

The American Academy of Pediatrics recommends screening

for ASD for all children at age 18 mo and 24 mo. Screening
should also occur when there is increased risk for ASD, such as
a child with an older sibling who has ASD, or concern for
possible ASD. Screening can be done by parent checklist or
direct assessment. The most frequently used screening tool is
the Modified Checklist for Autism, Revised/Follow-Up Interview
(MCHAT-R/FU), a 20-item parent report measure, with
additional parent interview completed for intermediate scores.
The MCHAT-R/FU can be used from age 16-30 mo.
 Treatment and Management
• EDUCATIONAL
• PHARMACOLOGICAL
• COMPLEMENTARY AND
ALTERNATIVE MEDICINE
Outcome
Autism spectrum disorder is a lifelong condition. Although a minority of
individuals respond so well to therapy that they no longer meet criteria for
the diagnosis, most will make progress but continue to have some
impairment in social and behavioral function as adults. Adult outcome
studies are sobering, indicating that many adults with ASD are socially
isolated, lack gainful employment or independent living, and have higher
rates of depression and anxiety. It is not clear if these data can be
extrapolated to younger children currently receiving intensive educational
therapies. There is a growing network of adult self-advocates who promote
the unique strengths in individuals with ASD. Outcome as measured by
developmental progress and functional independence is better for
individuals who have higher cognitive and language skills and lower ASD
severity at initial diagnosis.
Thank you for
listening