Transcript 1. dia
Normal and abnormal psychomotor development Katalin Hollody Developmental milestones Gross motor milestones mean age (months) Head up in prone position 1 Chest up in prone position 2 Up on elbows in prone position 3 Head control 3 Up on hands or wrists in prone position 4 Roll over prone to supine 4 Roll over supine to prone 5 Sit supported (tripod) 5 Creep 7 Get to sit 7 Crawl 8 Gross motor milestones mean age (months) Pull to standing 8 Cruise 10 Walk 12 Walk backward 14 Run 15 FINE MOTOR MILESTONES age (months) Fisted birth Unfisted 3 Reach and grab 4 Transfer 5 Rake from the surface 6 Immature pincer 9 Mature pincer 10 Voluntary release 12 INDICATIONS FOR REFERRAL FOR DELAYS AND DISORDERS OF LANGUAGE AND SPEECH Age Finding Birth and at any age Lack of response to sound Lack of interest in interaction with people 4 months Lack of any drive to communicate 6 to 9 months Loss of the early ability to coo or babble Poor sound localization or lack of responsiveness No verbal routines Failure to use ma-ma or da-da Loss of previous language or social milestones 12 months INDICATIONS FOR REFERRAL FOR DELAYS AND DISORDERS OF LANGUAGE AND SPEECH Age 15-18 mo 24 mo 36 mo Finding No single words Poor understanding of language Vocabulary less than 50 words No two-word phrases Less than 50% of speech intelligible to strangers Rote memorization of words or phrases Frequent immediate or delayed repetition of others’ speech Flat or stilted intonation More than 75% of speech unintelligible to strangers INDICATIONS FOR AUDIOLOGIC EVALUATION Family history of deafness Prematurity Perinatal complications Ototoxic drugs Congenital anomalies Intrauterine infection CNS infection Delayed speech or language development Parental concern about hearing loss EYE EVALUATION SCREENING congenital intrauterine infection cerebral palsy strabismus nystagmus cornea problems cataracta prematurity RISK FACTORS FOR COGNITIVE DEVELOPMENTAL DELAY 2-3 mo not alert to mother, with special interest 6-7 mo not searching for dropped object 8-9 mo not interest in peek-a-boo 12 mo does not search for hidden object 15-18 mo not interest in cause-and-effect games 2y does not categorize similarities 3y does not know own full name 4y can not pick shorter or longer of two lines 4,5 y can not count sequentially 5y does not know colors or any letters 5,5 y does not know own birthday or address RISK FACTORS FOR PSYCOSOCIAL DEVELOPMENTAL DELAY 3 mo not smiling socially 6-8 mo not laughing in playful situation 1 yr hard to console, stiffens when approached 2 yr kicks, bites, screams easily and without provocation rocks back and forth in crib no eye contact or engagement with other children and adults 3-5 yr in constant motion resists discipline does not play with other children SLEEP REQUIREMENTS IN CHILDREN PREVALENCE OF DEVELOPMENTAL DISABILITIES EVALUATION OF THE PATIENT History detailed family history search for other affected family members consanguinity prior gestational history (early postnatal death ?) pregnancy with the affected child timing, mode of delivery birth weight, head circumference, Apgar score duration of postnatal hospital stay timing of developmental milestones scholastic history coexisting medical problems (sz, feeding, sleeping, behavior) PHYSICAL EXAMINATION Careful observation Dysmorphology Cutaneous markers Hepatosplenomegaly Height, weight Head circumference, shape, fontanels, sutures Focal neurological findings Vision, hearing EXAMINATIONS Cytogenetic/molecular genetic examinations Metabolic work-up Imaging (UH, CT, MRI, SPECT, PET) Histology Evoked potentials EEG Tests (Bayley, Brunet-Lezine, Budapest-Binet) IDENTIFICATION RATES OF DEVELOPMENTAL DISABILITIES Prevalence MD is first Mean age at cases/1000 to make dg identification (mo) Ment. retardation 25 76 39 Learning disab. 75 12 69 ADHD 150 44 59 CP 2-3 99 10 0,3-0,6 87 55 0,8-2 64 39 Visual disab. Hearing disab. CO-MORBIDITIES Behavior challenges Psychiatric disorders Seizures Sensory impairments Motor impairments Sleep disorders Recurrent vomiting Autism EVALUATION OF THE CHILD WITH GLOBAL DEVELOPMENTAL DELAY 1. 2. 3. 4. 5. Obtain a detailed history and examination Refer for auditory and ophthalmologic screening Consider metabolic studies Obtain EEG, if history of seizures Consider screening for autism or a language disorder Is there a close family member with GDD? yes Obtain specific tests for that disorder (cytogenetic screen, subtelomeric rearrangements) no Are there features suggesting a specific dg? -genetic diagnosis (e.g. dysmorphic features)? specific test -CNS injury or malformation (aphyxia, seizures, CP)? MRI -environmental problems (lead exposure)? lead screen -loss or regression of dev. milestones? comprehensive evaluation: MRI, metabolic testing, EEG, cytogenetic screen Consultation ! Multidisciplinary, comprehensive evaluation ! Second visit ! Early intervention ! Follow-up !