Diagnosing Developmental Disabilities

8/10/2019 Diagnosing Developmental Disabilities

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DIAGNOSING

DEVELOPMENTAL

DISABILITIES.

Dr Saim Ali Soomro.


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Goals of & Outlines of Present

Develop an understandingof the goals fordevelopmental monitoring.

Have a better appreciationof the major developmentaldisabilities and their

associated deficits. Have a better appreciation

of the clinical presentationof developmentaldisabilities in earlychildhood.

Outline of Presen

Goals of DeveloMonitoring

Introduction toDevelopmentaDisabilities

Streams of Dev


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Developmental History Physical Examination

DefiningDevelopmental Delay

Approaches toDiagnosis

Basic ManagementStrategies


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Goals for Developmental

Monitoring

DevelopmentalDisabilities

CommunicationDisorders:

- DevelopmentalLanguage Disorders

Intellectual Disability

Autism

Learning Disabilities

Cerebral Palsy

Identification of developmental delays sbe the primary goal

Developmental monitoring, including a

histories and observations, should be d

identifying infants and children with or a

risk for developmental disabilities, or otor progressive disorders affecting devel


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.

Approaches to Developmental

Diagnosis

Four Major Streams of

Development Language

Verbal: Expressive and Receptive Pragmatics:

Cognition(visual learning) Motor

Gross and Fine Motor

Adaptive or Functional Skills


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Principles of Early

Neurodevelopment

Development isgenerally orderly andsequential.

Diagnosis is largelydependent accurate

developmental historiesand observations.

Developmentaldisabilities by and largepresent during infancy.


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Nature of DeveloDelays

Avoid reliance odeterminingdevelopmentalat one point in

A developmental historthe following:

1. Static Process

2. Progressive Process

Developmental

Delay:

Developmental

Quotient:Developmental Age * 100 : DQ

Chronological Age

Developmental Delay:

DQ < 70 in any

developmental stream


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Developmental Dissociation

Dissociation is manifested by a difference

between the developmental rates of two

streams of development, with one stream

significantly more delayed.Developmental Deviancy

Manifested by non sequential unevenness in

the achievement of milestones within one or

more streams of development.

Examples:1. Child is reported to speaking short

sentences and has a 30 word vocabulary.

2. A child who pulls to stand before sitting.

A

(

DSAS.

2014

4x3


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Delayed developmental goIntellectual Disability Communication Disorders C

Seizures

Neuro sensory Impairments

Feeding and Growth Problems

Attention Deficit

Hyperactivity

Poor Peer RelationshipsConduct and Oppositional Disorders


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Assessment Motor Developm

Develop a better understandingof the risk factors for cerebralpalsy & Neuro muscular defects.

Increase knowledge regardingnormal motor milestones in the

first 15 months of life. Appreciate the normal evolution

of the neurological examinationduring the first year of life.

I. Focus: first 9-12 mo

II. History

A. Risk Factors

B. Static vs ProgressiPresentation

C. Motor Milestones

D. Parents perception

Evaluation Outlines:

A M t l S


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Age Motor language Soc

2 months Head up in prone Smilefollow

3months Head/chest up in prone,

grasps placed object

coos Laugh

4months Rolls & reaches --- ---

6 months Sites with support,

weight bears

Babbles, turns to sound Mouth

8months Sites without support, weight

bears

Turns to name

10 months Pincer grasp, starting to

cruise, crawling

Waves Bye bye Drink

12months Walks but falls easily First words Fingeand o

15months Walks steadily,

scribbling

Pointing, multiple

single words

Spoo

18months Up/down stairs with

assistance, climbs,

throws ball

Two-word phrases,

pointing to body

parts

Build

with o

24 months Up/down stairs, one

step at a time,

Three-word phrases,

pronoun


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III. Physical

Examination

A. Muscle tone and

posture B. Primitive Reflexes

C. Movement

Risk FactorCerebral P

Although a number

recognized risk f

cerebral palsy hadocumented, most

cerebral palsy

remain unexplainab


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Motor Delays

Static

1. Reduced rate of motor milestones

2. Motor quotient less than 70

MQ = Motor Age X 100

Chronologic Age

Progressive

1. Loss of previously acquired motor

milestones

Equilibrium in


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Equilibrium in Prone..


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Normal Neuro-motor Development(Cortical Superceding

Control)

Passive muscle tone1. Relaxation of flexortone is first observed inupper limbs and later inlower limbs. Physiologic

hypo tonia by9 months.2. Extensor tone ofextremities notobserved.


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Passive Flexor Tone

- Resistance to passiveextension of the

extremity

- Appearance:

1. Prenatal

Caudal to Cephalic

appearance

2. Postnatal

Cephalic to Caudal

dissipation

Passive Extensor

Tone- Resistance to

passive flexion of the

extremity

- Consistent extensor

tone is never normal

- Examination ofelbows, knees and

ankles


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Truncal Tone

- Prone suspension

- Axillary suspension

- Pull to sit


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Truncal Tone


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Primitive Reflexes

Brain stem mediated reflexes,that are predominatelymanifested during the first sixmonths of life. These areelicited by positions of thehead and neck in space.

1. Moro Reflex

2. Asymmetric Tonic Neck

3. Tonic Labyrinthine

4. Positive Support


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Primitive reflexes


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Spontaneous Movements

Quantitative 1. Normally, alert states

accompanied by

an abundance ofextremity movements

2. Red Flags

Paucity of movements orasymmetries

Qualitative

1. Normally, trunk anmovement are variab

2. Red Flags

- Lack of independenmovements

- Repetitive posturesmovements

- Jerky movements

- Extensor postures

- Persistent fisting at


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Diagnosing Developmental Disabilities

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