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Development Continued

Development Continued. Presentation 2 of 2. Early Reflexes. Asymmetrical Tonic Neck Reflex - appears at 2-4 wks; disappears by 6 months. Moro – disappears by 4 months. Head Control. Trunk Control. Come on baby do the locomotion!. Question 4.

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Development Continued

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  1. Development Continued • Presentation 2 of 2

  2. Early Reflexes Asymmetrical Tonic Neck Reflex - appears at 2-4 wks; disappears by 6 months Moro – disappears by 4 months

  3. Head Control

  4. Trunk Control

  5. Come on baby do the locomotion!

  6. Question 4 A mother reports that her 10 month old boy is right handed because he reaches for most objects with that hand. She asks you if this is normal for his age. What should your answer be? A. It is normal. B. It's a little early but probably normal and don't worry about it. C. It's a little early but probably normal. It's something that needs to be watched over time. D. It's abnormal for a baby to have a hand preference at this age.

  7. Fine Motor

  8. Fine Motor

  9. Fine Motor

  10. Cognitive Development • Newborns • 20/200 to 20/400 • Fixates 9-12 inches • May orient to sound • 4-8 months • Changes in position and appearance • Mouthing, shaking and banging

  11. Cognitive Development • 9-12 months • Object permanence • 12 months • Purpose

  12. Cognitive Development • 18 months • Can deduce the location even if hidden from view • 2 years • Pretending and symbolic thinking

  13. Cognitive Development • Preschool • Objects are alive • Appearance influences logic • School-age • Cognitive reasoning • Adolescents • Hypothetical and abstract

  14. Sense of Self • 6-9 months • Mirror images • 7-8 months • May try to grab cups and utensils • 1 -2 years • Independence • Tantrums • 2-3 years • Body sensations

  15. Red Flags Gross Motor Be concerned if there is no head control by 4 months Be concern if persistent head lag at 6 months Be concerned if a child does not sit without support by 7 months Be concerned if a child is not walking by 15 mo or running by 24 mo Be concerned if a child does not have open grasp & midline activity by 4 mo or reaching by 6 mo

  16. Red Flags • Fine Motor • Be concerned if a child shows hand preference in the first year of life • Cognitive • When mouthing of toys persists as predominant mode of exploration after 12-18 mo, assessment of cognitive function is warranted

  17. Question 5 Which of the following is a cause of speech or language delay? A. Uncomplicated twin birth B. Bilingual home C. Reported “tongue-tie” by mother D. Parent or sibling speaking for the child E. None of the above

  18. Red Flags Language Failure to orient to sound or absent babbling may indicate a hearing deficit Get a hearing test on any child who does not have a single word by 15 mo or several single words by 18 mo Lack of protodeclarative pointing or pointing for naming may indicate a pervasive devt d/o Refer any child who is not combining words and at least 50% intelligible by 2 y/o for a hearing and speech assessment

  19. Question 6 A grandmother brings her 32 month old grandchild to your office because she is concerned about his speech. The child began to use single words at 10 months and combine 2 words at 17 months. At 30 months he began repeating the first words in sentences. For example, he would ask “when-when-when Mommy coming home?” The repetitions occur about once or twice in a conversation. Grandmother has noticed that he is more likely to repeat words when she asks him a question. He is also more likely to repeat words when he is tired, upset, excited or rushed to speak. This child MOST likely has: A. Severe stuttering B. Moderate hearing loss C. Dysarthria D. Normal disfluency E. Tongue-tie

  20. Red Flags Intelligibility Lack of intelligible speech by age 3 Frequent omission of initial consonants after age 4 Continued substitution of very easy sounds for harder ones after age 5 Persistent articulation errors after age 7 Stuttering/rapid speech beyond age 4 If any of these delays persists for 6 months or more, a referral should be initiated

  21. Red Flags Social Be concerned if a child does not focus on Mom’s face at 1st visit or have a social smile by 8 w/o Be concerned if a child does not show pride in accomplishments by 12 m/o or social relatedness by 15-18 m/o Be concerned if a child has excessive temper tantrums, hyperactivity, or persistent poor transitions at 24 m/o

  22. Abnormal Development

  23. Question 7 • This 3 week old infant has: • Normal tone and average risk for developing cerebral palsy • Decreased tone which is not associated with cerebral palsy • Decreased tone which may be associated with cerebral palsy • Unable to accurately assess tone from this maneuver

  24. Cerebral Palsy • Disorder of movement and posture resulting from injury to the brain • No etiology known in 20-30% • No progression or regression of motor problems • May be confusing as motor deficits manifest in different ways as pt grows and develops • Cannot diagnose <1y/o (<18mos if preemie)

  25. CP: Diagnosis • The Levine (POSTER) Criteria for Diagnosis of Cerebral Palsy • Posturing and abnormal movement patterns-extensor thrusts • Oropharyngeal problems- tongue thrusts, grimacing, swallowing difficulties • Strabismus • Tone-increased or decreased in muscles • Evolutional responses- persistent primitive reflexes or failure to develop equilibrium and protective responses • Reflexes- increased deep tendon reflex and extension of the toes during plantar reflexes

  26. Question 8 An individual with moderate mental retardation may be expected to: • read, write, simple math, live independently, hold a job • Read/write at 2ndgrade level, live and work semi-independently • Require substantial support in daily life • Obtain a Bachelor’s Degree

  27. Mental Retardation • Significant limitations both in intellectual functioning and adaptive behavior that arises before age 18. • Intellectual functioning: 2 or more SD below norm • Mild (IQ 69-55): read, write, simple math, live independently, hold a job • Mod (IQ54-40): 2nd Grade level, live and work semi-independently • Severe (IQ <39): substantial support

  28. Question 9 Which of the following is TRUE of autistic disorder? A. It has been linked to vaccinations B. Regression of milestones is never an associated sign C. Medications are often used to manage associated symptoms D. No therapies or early interventions have been proven to be effective

  29. Autism • 3 Core Characteristics (Impairments): • Social interactions • Communication • Repetitive, restrictive, or stereotyped behaviors • Perhaps multiple genes involved, environmental triggers

  30. Autism • 2 Presentation patterns: • Abnormal social and communicative behaviors from infancy • Low tone, never look at face, never look to voice • Normal infant development with regression in second year of life • Loss of vocabulary, disinterest in social interaction • Nature of presentation not tied to prognosis

  31. Autism • Typically have normal physical and neuro exam • Associated with increased head circumference • Associated conditions: Fragile X, Rett, Tuberous Sclerosis • Benefit from intense early intervention • Medication only for associated findings: inattention, hyperactivity, mood lability, outbursts

  32. Language Disorders • Language impairment: language difficulty in otherwise normal child • Syndromes assoc with hearing loss: Treacher Collins, Waardenburg, OI • May be progressive in cong Rubella or CMV • Otitis media with effusion- mild, variable, intermittent hearing loss.

  33. Conditions Associated with Sensorineural Hearing Loss • Family history of childhood hearing impairment • Congenital perinatal infection (CMV, rubella, herpes, toxoplasmosis, syphilis) • Anatomic malformations of the head or neck • Birth weight <1500g • Hyperbilirubinemia above levels indicated for exchange transfusion • Bacterial meningitis • Severe asphyxia • Exposure to ototoxic medications

  34. Question 10 Which of the following is NOT true of ADHD? A. Impulsivity is a feature B. Children may have poor organization and planning skills C. Symptoms rarely persist into adulthood D. Children may show age appropriate attention in highly motivating situations (eg. Playing a video game)

  35. ADHD • Dx: Symptoms longstanding, present <7y/o, multiple settings • Act age-appropriate in motivating environment • 80% do not demonstrate sx in MD’s office • Multiple genetic, neuro, toxic, and psychosocial conditions associated • Prematurity and MR • Assoc w/ anxiety, depression, conduct d/o, oppositional defiant d/o, learning disabilities • Inattention persists into adulthood

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