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Approach to Developmental Delay PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "APPROACH TO DEVELOPMENTAL DELAY" by PROF RASHMI KUMAR.
This medical PowerPoint presentation talks about approaches to developmental or behavioral disorders in children.
There are a variety of approaches to developmental or behavioral disorders in children, and the best approach will depend on the specific needs and circumstances of the child and their family. Some common approaches include Early Intervention, Medication, Behavioral Therapy, Parent Training and Support, and Educational Support.
Its important to note that every child is different, and what works for one child may not work for another. A multi-disciplinary approach, involving healthcare providers, educators, and therapists, can help ensure that each child receives the support and care they need to reach their full potential.

Tags : developmental disorders in children, behavioral disorders in children, Child Neurology PowerPoint presentation, Neurology PowerPoint presentation

Published on : Mar 21, 2023 | Views : 3663 | Downloads : 0

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Slide 1-

APPROACH TO DEVELOPMENTAL DELAY PROF RASHMI KUMAR DEPARTMENT OF PEDIATRICS KGMU
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Normal Development Developmental Testing Screening Formal Testing Differential Diagnosis of delay Mental Retardation Prevalence Classification Etiology Evaluation -Confirm diagnosis -Cause -Associated problems -Investigation -Management Special types
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What is development? Maturation of function, acquisition of skills Cephalocaudal Mass responses  specific Predictable sequence, stepwise Achievement of different functions  Milestones Tested in 4 areas : Gross motor Fine motor Language Social
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DDX of Delay: Late starter (outlier) MR - global delay Deprivation - social/emotional Motor defects - muscular / Cerebral palsy Hearing & vision defects Speech & language disorders Autism Specific learning disorders Attention deficit hyperactivity disorder
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Evaluation: Detailed history of events at birth, past illnesses Pattern of delay H/o Onset/regression Examine for motor problems Screening Formal developmental / IQ assessment
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3 step process Clinical evaluation Screening Formal assessment
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WHY SCREEN 12-22% of children in US have developmental or behavioral disorders Services available to children with developmental delays from birth on Better outcomes for participants: higher graduation rates, delayed pregnancy, employment, decreased criminality $30,000 to >$100,000 benefit to society
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Types of Screening Tools Two major categories Developmental Behavioral Two mechanisms of administration Parental Provider
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Developmental Screening Tools Provider Denver CAT/CLAMS (Clinical Adaptive Test/ Clinical Linguistic and Auditory Milestone Scale ) Bayley Screener Brigance DIAL-R (Developmental Indicators for Assessment of Learning) Parent Ages and Stages Questionnaire (ASQ) Parent’s Evaluations of Developmental Status (PEDS)
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Developmental Screening Tools: India Baroda Development Screening Test Trivandrum Development Screening Test Lucknow Development Screen Indian norms used
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Lucknow Development Screen
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Denver Developmental Screening Test - 2 Very commonly used screening tool Birth to 6 years old Poor sensitivity and specificity (40-60%) 10-20 minutes to administer Normed on diverse population sample Multiple languages Domains: fine and gross motor, language, and social skills
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DDST (continued) Identifies children at 25,75, and 90% completion of task Scored as concern if child completing task in shaded area (75-90%) Scored as failure if not completed by time 90% complete Referrals warranted for one failure or two concerns Correct for prematurity till 2 years old chronological age
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Developmental Scales/IQ tests Bayley Scales of Infant Development (BSID): Baroda norms (DASII): 0-42 m Stanford Binet (Binet Kamat) 3-15 y Weschler’s Preschool Weschler’s Intelligence scales (WISC) Malin’s adaptation: Draw a man Form Boards Coloured progressive matrices Raven’s Matrices VSMS/ VABS (Malin’s Adaptation) : Give Social Quotient Non verbal
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MENTAL RETARDATION: Since 2002, replaced by the term Intellectual Disability Most common cause of delayed development Global impairment of milestones & cognitive function Symptom of many disorders Known & unknown etiology Poses mainly an educational, sometimes social and rarely a medical problem Diagnosis should be conveyed with caution (stigma, trauma) Definition: Subaverage intellectual functioning (IQ <=70) Concurrent deficits in adaptive function Onset < 18 years Classification: Borderline IQ 70-90  90% Educable Mild 51-70 Moderate 36-50 Trainable Severe 20-35  5% Custodial Profound <20 Prevalence: 2-3% children have IQ <70 Only 0.4% have profound MR <5 yrs, IQ not possible DQ used  GDD
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MR – ETIOLOGY: Subcultural MR Larger group Borderline/ mild MR Lower end of SE spectrum No organic defect ? polygenic inheritance +/- adverse sociocultural influences eg: maternal smoking, undernutrition, prematurity/SFD, poor antenatal care Organic MR - No social class preference
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Organic MR: Etiology Prenatal: Inherited metabolic defects eg: Aminoacidurias, CHO disorders, lipidoses, MPS, leukodystrophies, inherited degenerative disorders, hormonal (cretinism, hypoparathyroid) Nonbiochemical genetic defects eg. Hydrocephalus, Soto’s, Lissencephaly, Pradervilli, Laurence Moon Beidl, Cockayne’s etc. Neurodermatoses – Tuberous sclerosis, Sturge Weber etc, neurofibromatosis. Chromosomal – Down’s, Fragile X, subtelomeric defects Maternal – TORCH infections, placental dysfunction, radiation, alcohol, teratogens, Iodine
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Organic MR: Etiology Perinatal Prematurity SFD Asphyxia, trauma, infection Bilirubin toxicity Postnatal CNS infections Trauma Anoxia Metabolic – hypoglycemia, hyponatremia etc
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Etiology: Diagnosis of etiology often not possible Important questions: ? organic ? progressive ? treatable
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MR – Treatable causes Cretinism Some inborn errors: Galactosemia, PKU etc Toxoplasma/syphilis: if detected early Hydrocephalus
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MR – Evaluation Suspect if delayed milestones in all 4 areas ‘too good’, ‘sleeps a lot’, feeding difficulties, delayed language, school failures, delinquency Screening Tests Confirm diagnosis: by IQ/DQ & SQ Etiology Associated problems
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DQ = developmental age/chronological age X 100 Larger motor component Preschool, toddlers & infants IQ = mental age/chronological age X 100 Measures memory, visuospatial function, etc, takes average School children If IQ/DQ is > 2 SD below mean on standard psychometric scale (~ 70)MR
Slide 24-

MR Evaluation:History h/o high risk events eg toxemia, placenta previa, abruptio, fetal Xray, TORCH infection, teratogen, consanguinity, multiple pregnancy FH/o MR Maternal age <16 or > 40 Maternal undernutrition Birth asphyxia, LBW, birth trauma, apgar, neonatal convulsions/hypoglycemia/severe jaundice Postnatally, intracranial infections, trauma, CVA, anoxia H/o early milestones H/o regression of milestones  degenerative brain disorder
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MR Evaluation: Examination Look for stigmata or dysmorphisms – seen in small % of normal, clue to organicity/ chromosomal/teratogen Development Neurological examn Hearing/vision/speech Genitalia Organomegaly
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MR: Evaluation of associated problems CP – motor deficit Visual/hearing defect Convulsions Strabismus Hyperactivity Feeding difficulties Clumsiness Disturbed sleep pattern Emotional instability Low frustration tolerance behavioral problems Poor self esteem Obesity/ PEM
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MR: Investigations Karyotype, FISH for subtelomeric region, MLPA, CGH CT scan head – 72% normal, 20% atrophy, 8% specific abnormality in severe MR T3, T4, TSH TORCH antibodies Xray skull CSF For biochemical defects (IEM): TMS/ GCMS
Slide 28-

MR - Management: Discuss with both parents after full work up Compassion, sympathy, truth Assist family to adapt, remove guilt, build self esteem Emphasize abilities, not just disability Same basic care – tender, loving High appreciation Short term goals & objectives No harsh criticism
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MR: Management Contd Infant stimulation programs – aim at optimum potential Structured learning Special classes Sheltered workshops Institutionalisation Management of associated problems – Physiotherapy Anticonvulsants Treat hyperactivity
Slide 30-

MR - Prevention: Genetic counseling Rubella vaccine Folic acid Good antenatal & perinatal care. High risk approach Early recognition & management of infections, metabolic derangements, hyperbilirubinemia Metabolic screening for PKU, cretin Prenatal diagnosis of Down’s
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Down’s syndrome Most common chromosomal disorder 1:800 -1:1000 newborns Trisomy 21 Extra chromosome may be maternal or paternal Advanced maternal age 15-29 yrs 1:1550 30-34 yrs 1:800 35-39 yrs 1:270 40-45 yrs 1:100 >45 yrs 1:50 Regular trisomy in 94%; 5% translocations; 1% mosaic
Slide 32-

Downs: Clinical features Mental & physical retardation Hypotonia Happy disposition Music lovers Facies: flat occiput oblique palpebral fissures Epicanthal folds Small nose with flat nasal bridge Small, furrowed, protruding tongue Ears small, dysplastic
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Downs: Clinical features Short, broad hands Clinodactyly Simian crease Wide gap between 1st and 2nd toes Brushfield spots in iris - in light skinned people Typical dermatoglyphics: distal triradius, ulnar loops
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Downs: Other problems Congenital heart disease: endocardial cushion defect, VSD, PDA Hypothyroidism in 13-54% of older patients Higher risk of chronic myeloid leukemia, anorectal malformations, duodenal atresia Frequent lower respiratory infection, chronic rhinitis
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Down’s: Risk of recurrence Risk is 1% with normal parents and one affected child 10% risk if mother is a translocation carrier 5% if father is translocation carrier Antenatal Dx: Chorionic villus sampling at 10-12 wks or amniocentesis at 16 wks offered to pregnancies > 35 yrs/ one affected child In others with less risk, Triple test - maternal sAFP, HCG and estriol levels : sens 70%, spec 95% Quadruple test: Add inhibin A – sens  to 81% USG : nuchal thickness, length of femur & humerus
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