Developmental delay Poor School Progress. I Smuts Department of Paediatrics

Transcription

1 Developmental delay Poor School Progress I Smuts Department of Paediatrics

2 References Normal development: Handbook of Neurology: Paediatric clinical examination guideline

3 How do children present Children < 6 years of age Developmental delay Children > 6 years of age Poor school progress

4 Developmental delay Confirmation of developmental delay Evolution Aetiology Further management

5 Confirmation of the Developmental Delay Define the developmental delay Specific General with regard to: Motor development: Fine/Gross Intellectual functioning Language development and hearing skill Personal social skill Emotional behaviour How? Denver developmental scale ELM scale

6 Evolution of Developmental Delay Was the development normal up to a point? Is there a plateau? Slow from the onset? Regression/Loss of milestones

7 Specific problems Motor impairment Static encephalopathy CP Lecture. Hypotonia with weakness Hypotonia lecture

8 Specific problems Impaired Language Language delay: Expressive Receptive Cognitive component Hearing impairment Sensori-neural deafness Conductive deafness Articulation Voice Fluency

9 Specific Problems Fine motor development Vision loss Ocular problems Neurological problems Cerebellum Basal ganglia Sensation Systemic disorders Medication

10 Specific Problems Psychological/Emotional problems Neglect and deprivation Psychiatric conditions Behavioural disturbances

11 Aetiology Prenatal Perinatal onset Postnatal onset

12 Aetiology Prenatal Primary CNS defects of development Syndromes Environmental factors FAS Pb poisoning Infections Hypothyroidism

13 Aetiology Perinatal onset HIE Hypoglycaemia Infections ICH

14 Aetiology Postnatal onset HIE (Drowning) Head trauma Poisoning Metabolic disorders

15 Poor School Progress

16 Aspects to keep in mind Learner Educational System Parents

17 Learner Psychosocial aspects Depression Anxiety Behavioral problems Hunger Alcohol School phobia Neglected children Physical health CNS Hearing and vision Epilepsy Medication Syndromes Chronic disease Intellectual development IQ (MR) Learning disabilities Dyslexia Dyscalculi Dysgraphia ADHD

18 School system Poor attendance Truancy Hospital Political unrest School Motivation Results Teacher Absent Numbers Methods Learner/Teacher

19 Parents Expectations Circumstances at home Absent parents Alcohol Abuse Discipline Marital problems Over protection

20 Mental retardation

21 Mental Retardation Definition: American Association of Mental Deficiency Significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behaviour and manifested during the developmental period Presentation Symptoms arise during childhood and may present as Developmental delay Impaired learning Problematic social adjustment Economic productivity

22 Mental Retardation General In Childhood: Dynamic Disorder Adult: Static Disorder Part of a syndrome complex Acquired or congenital Usually global delay

23 Expected functional abilities Borderline Mild th grade Independent 4 th -5 th grade Relative independent Moderate Severe Profound <19 May read and count Unlikely to read and write None Trainable for ADL Partiable trainable Completely dependent

24 What should the doctor do? History Prenatal Father Mother Pregnancy Birth Neonatal period

25 What should the doctor do? History Post-neonatal period Developmental history Medical and surgical history Treatment Growth Nutritional history Behaviour School progress

26 What should the doctor do? Clinical examination General Vital signs All the other systems Vision and Hearing Neurological examination Developmental assessment

27 What should the doctor do? Problem list Special Investigations according to findings Diagnosis Referral Treatment for treatable conditions

28 What should the doctor do? Long term follow up Education Therapy General health measures Immunisation Co morbidities Family support Genetic counselling Complications

29 Developmental Regression in Children

30 Introduction Definition of developmental regression: The loss of skills that were previously acquired

31 Children Vs Adults Children have not achieved their full repertoire of cognitive and motor development thus they may show either slowing in the development or loss of previously acquired milestones Older children demonstrates progressive difficulties with their schoolwork and/or personality changes

32 Natural history Relentless progression to the burned out phase Vegetative state can continue for weeks to months or years

33 Biological perspective Aetiology Lysosomal Peroxisomal Microfilament Mitochondrial Ribosomal Unknown Disorder MPS Krabbe ALD Zellweger Neuroaxonal dystrophy Leigh MELAS Homocystinuria Ataxia telangiectasia

34 Differential diagnosis Postinfectious process: SSPE AIDS Neurotoxins AED Corticosteroids

35 Differential diagnosis Collagen vascular disease SLE Polyarteritis Neurocutaneous syndrome Sturge -Weber Cerebrovascular disease TBM Sickle cell

36 Differential diagnosis Genetic basis AD Disease AR Huntington Spinocerebellar ataxia Canavan X-linked Alexander

37 Therapy Therapy is supportive Adequate nutrition Palliative treatment for: Epilepsy Movement disorders Abnormal muscle tone Pain