Children With Neurodisability

1. Children With Neurodisability Dr Lesley McDonald Community Paediatrician West Centre

2. Community Child Health • 0-19 years • wide range of developmental difficulties / disabilities • holistic approach • partnership with parents • multidisciplinary working • interagency working • communication

3. Settings • Child development centres 0-5 years • Mainstream school health • MLD schools • Complex needs schools • EBD schools

4. Child Development Centres • West Centre (West) • Bridgeton (East) • Glenfarg (North) • Southbank (South)

5. Referrals • ODER one door entry referral • referrals from GP, HV, RHSC, nursery, educational psychology • referral centres for specialist developmental assessment • links with other agencies – education, social work

6. The team around the child

7. Other CDC services

8. CDC links

9. Children with additional needs • ex – preterm • autism • Down’s syndrome • early developmental impairment (“global developmental delay”)

10. Ex – preterm infants • EPICure study • infants <26weeks gestation • at 2 ½ 49% no disability 24% disability not severe 24% severe disability 2% died 1% no data

11. Ex-preterm infants • at 6 years unimpaired 20% mild disability 34% moderate disability 24% severe disability 22% boys more likely to have moderate or severe disability cognitive impairment most common of the domains assessed

12. Neonatal follow up • until 2 years corrected • referral to CDC at any time if concerns • if not, review at 3, 5, 7 • important for primary care to refer to secondary level services if concerned

13. Autism • SIGN guidelines • multidisciplinary specialist assessment • Community Autism Team in Glasgow • ICD 10 criteria

14. General “warning signs” - preschool • delay or absence of spoken language • lack of awareness of / responsiveness to others, unable to share pleasure • lack of pretend imaginative play • qualitative impairment in non-verbal communication • lack of pointing • lack of gaze monitoring • lack of initiation of activity or social play • unusual or repetitive hand and finger mannerisms • unusual reaction to sensory stimuli

15. General “warning signs” – school age • communication impairments • abnormalities in language development • odd intonation, pitch etc • persistent echolalia • reference to self as “you” “she/he” beyond 3 • unusual vocabulary • limited use of language for communication and / or tendency to talk only about specific topics

16. General “warning signs” – school age • social impairments • inability to join play, or inappropriate attempts • lack of awareness of classroom “norms” • easily overwhelmed by social and other stimulation • failure to relate normally to adults • extreme reactions to invasion of personal space

17. General “warning signs” – school age • impairments of interests, activities, behaviours • lack of flexible cooperative imaginative play / creativity • inability to cope with change or unstructured situations • odd behaviours including unusual responses to sensory stimuli

18. Down’s syndrome • recommended schedule of health checks • developmental progress slower than other children

19. 1. Heart Disease • by 6 weeks • examination and echo • or examination, CXR and ECG at birth and 6 weeks

20. 2. Thyroid • 10-20% affected, any age, diagnosis difficult • low threshold for testing • preventable impairment if untreated • Guthrie at birth • T4 TSH thyroid antibodies at 1 year • normal: repeat 2 yearly • increased TSH or Ab’s: repeat 6-12 monthly

21. 3. Eyes • increased squint, cataract • check carefully in first year, refer if concerns • second year: full assessment, orthoptic, refractory, fundoscopy • abnormal: close follow up by ophthalmology • normal: full review at 4 including vision, 2 yearly thereafter

22. 4. ENT • conductive hearing loss 60-80% • SNHL 20% by age 20 • partial upper airway obstruction • sleep apnoea • catarrh • neonatal hearing screening • audiology annually until age 5 • 2 yearly thereafter

23. 5. Growth • short stature part of syndrome • 0-2 years: check wt, ht, OFC frequently • >2 years: check annually • use both Downs and standard growth charts • red book should have Downs insert

24. 6. Others • atlantoaxial instability • no screening procedure • do not bar from sports • at risk: GA, RTA • refer • neck pain / pain behind ear • abnormal head position • deteriorating head position • loss of bladder / bowel control

25. Early developmental impairment (EDI) • formerly known as global developmental delay • unhelpful term, implies difficulties temporary and will “catch up” • EDI a more appropriate diagnostic term, proposed at international consensus conference in 2008

26. EDI definition • persistent significant limitations in two or more developmental domains • motor • communication • cognitive skills • social skills • emotional regulation / behavioural skills • self care skills

27. onset before age 5 not better explained by another established developmental disorder reassess by school age or before age 9 to review diagnosis

28. Assessment • history • examination • developmental assessment • investigations as appropriate • multidisciplinary working • follow up over time • exciting advances in genetics and neuroimaging

29. Summary • wide range of disabilities which may be encountered in general practice • awareness of services available • if in doubt, phone to discuss

30. Contact Numbers • West 207 7100 • Bridgeton 531 6550 • Glenfarg 531 6191 • Southbank 201 0923