Development

Question 1

DDx/mimics for ADHD

Answer 1

• Organic: Neuro (CN injury/infection, mass lesion, epilepsy, FASD), genetic, sensory (hearing, vision), med conditions (iron def, thyroid disease, DM, sleep d/o, malnutrition)
• Meds/toxins: lead, AEDs, steroids, substances
• Dev/behaviour: autism, learning disorder, ODD
• MH: Stress, personality d/o, mood/anxiety
• Enviro/psychosocial: poverty, family dysfunction

Question 2

2 month milestones

Answer 2

• GM: neck control, head up to 45 deg when prone
• FM: hands open 1/2 the time, bats at objects
• Language: turns to voice, coo-ing
• Social: prefers usual caregiver, social smile

Question 3

4 month milestones

Answer 3

• GM: sits with support, head up to 90 deg when prone, roll from front to back
• FM: palmar grasp, bring objects to midline
• Language: laughs, razz, “ga”, squeal
• Social: explores environment/faces

Question 4

9 month milestones

Answer 4

• GM: pulls to stand, starting to cruise
• FM: pincher grasp
• Language: specific mama/dada, says “bye”
• Social: separation anxiety, object permanence

Question 5

15 month milestones

Answer 5

• GM: walks well
• FM: using spoon, stacks 2 blocks
• Language: 1 step command, 5 words, 1 body part
• Social: experiment with toys, shared attention

Question 6

18 month milestones

Answer 6

• GM: running
• FM: undress, carries toys when walking, fisted pencil grasp
• Lang: 25 words, follow 1-2 step commands, point to object, name x3 body parts
• Social: parallel play, symbolic play

Question 7

4 year old milestones

Answer 7

• GM: alternating down stairs, one foot jump
• FM: buttons, draw square
• Lang: sentences, 100% intelligible, tells story, past tense
• Social: fantasy play, preferred friend

Question 8

Handedness - when does it normally develop + when is it a concern?

Answer 8

• 18-24 months

- Red flag if before 1 year

Question 9

x2 risk factors for DCD?

Answer 9

• Preterm

- Male

Question 10

x5 co-morbidities associated with DCD?

Answer 10

• ASD
• ADHD
• Language impairments
• Specific learning disabilities
• Mental health

Question 11

Diagnostic criteria for DCD

Answer 11

A: Acquisition + execution of coordinated motor skills are substantially below expectations for child’s age + opportunities for motor skill learning.
B: Motor skills deficit significantly/persistently interferes with activities of daily living + impacts school/activities.
C: Onset of symptoms in the early developmental period.
D: Deficit is not better explained by another disorder.

Question 12

Examples of “soft” neuro findings on exam associated with DCD?

Answer 12

• Overflow movements
• Mirror movements
• Finger agnosia
• Coordination difficulties
• Behaviour -avoidance/excuses
• Hyper-mobility
• Low normal tone

Question 13

When should you no longer have fists and raises concern for CP?

Answer 13

Past 4 months

Question 14

Up to what point do you expect normal development in Rett Syndrome?

Answer 14

Until 6-9 months

Question 15

For the pincer grasp, when do you develop (a) inferior grasp (with straight fingers) vs (b) true grasp?

Answer 15

(a) 9 months

(b) 12 months

Question 16

Shapes that children can draw from 2-7 yeras

Answer 16

2 = straight line
3 = circle
4 = cross
5 = square
6 = triangle
7 = diamond

Question 17

x5 genetic syndromes associated with Autism Spectrum Disorder

Answer 17

• TSC
• NF
• T21
• Rett Syndrome
• Angelman
• Fragile X

Question 18

Diagnostic criteria for Autism Spectrum Disorder

Answer 18

A = impairments in social communication (3/3)

1) Socio-emotional reciprocity
2) Deficits in developing/understanding/maintaining friendships
3) Deficits in non-verbal communication

B = Behaviours (2/4)

1) Stereotyped/repetitive behaviours
2) Strict adherence/rigidity to routine
3) Intense, fixated, restricted interests
4) Atypical sensory reactivity

*Must occur in the early developmental period

Question 19

Investigations for new dx of Autism

Answer 19

• Audiology
• Vision
• Microarray
• MECP2
• Fragile X

Question 20

Risk factors for Autism

Answer 20

• Genetic: Male, genetic syndromes, family history
• Prenatal: older maternal age (>35), maternal obesity/DM/HTN, in-utero exposure to VPA/pesticide/air pollution, maternal infection, close spacing of pregnancies
• Post-natal: low BM, extreme prematurity

Question 21

x3 components of a psychoeducational assessment

Answer 21

• Cognitive
• Academic achievement
• Adaptive/behavioural

Question 22

What is a normal score for a psychoeducational test/IQ? And what would equate to 2 SD’s?

Answer 22

100 +/-15

2SD = +/- 30

Question 23

Criteria for specific learning disorder

Answer 23

• Neurodevelopmental disorder with learning difficulty + problems acquiring academic skills
• Selective impairment with average intelligence
• Ongoing for 6 months
• Not attributed by another disorder or intellectual disability

Question 24

Investigations to do/consider in GDD?

Answer 24

• Microarray, fragile X, MECP2
• Thyroid
• Lead
• Ferritin + iron studies
• Audiology + vision
• Metabolic screen
• Neuroimaging
• EEG

Question 25

Definition/criteria for GDD

Answer 25

- Significant delay (by at least x2 SD below the mean) in 2 or more developmental areas - For children <5 years old who cannot undergo assessment yet

Question 26

x3 criteria for intellectual disability

Answer 26

- Cognitive deficits (low IQ) - Adaptive dysfunction - Onset before 18 years old (dx at >5 years old)

Question 27

When must childhood-onset fluency disorder + stuttering resolve before you get worried?

Answer 27

7 years old

Question 28

What types of dysfluency are okay?

Answer 28

- Interjection ("um") - Multi-syllabic repetitions ("I want to I want to") - Revised/abandoned utterances ("I want / hey look at that")

Question 29

When to refer a dysfluency case?

Answer 29

- Parental or child concern - Impacts functioning - Worsening in frequency/severity - Has remained for 12 months or more or >7 years of age - Presence of secondary behaviours (blinking, jaw jerks)

Question 30

Criteria for ADHD

Answer 30

- Must have 6 symptoms from 1 or both categories for 6 months - Functional impairment - Symptoms present in at least 2 settings 1. Inattention: - Careless mistakes - Trouble holding attention - Does not listen - Does not follow through - Trouble being organized - Avoids mental effort - Loses things - Easily distracted - Forgetful 2. Hyperactivity + impulsivity: - Fidgets + squirms - Leaves seat - Runs about - Cannot be quiet - Always on the go - Talks excessively - Blurts out answers - Cannot wait for turn - Interrupts

Question 31

x5 early warning signs for CP

Answer 31

- Hand preference development <12 months of age - Fisting beyond 4 months of age - Delays or asymmetry in development of movement/posture - Tightness of legs before 12 months of age - Delay in sitting by 9 months of age

Question 32

When will breath holding spells typically disappear by?

Answer 32

5 years old

Question 33

What are the two types of breath holding spells and what is the mechanism for both?

Answer 33

1. Cyanotic = hyperventilation + apnea = typically when angry 2. Pallid = vagal mediated bradycardia = typically following mild injury

Question 34

Mimics of seizures

Answer 34

- Breath holding spells - Tics - Sandifer syndrome - Self gratification - Benign sleep myoclonus of infancy - Benign myoclonus of infancy - PNES - Syncope - Migraine - Dystonia

Question 35

When do children develop a secure gender identity?

Answer 35

4 years old

Question 36

What are the different characteristic reactions to parental divorce in (a) <3 years old, (b) 4-5 year olds, (c) school-aged, and (d) adolescent?

Answer 36

(a) development regression, irritable, separation anxiety, appetite/sleep disturbance (b) blame themselves, externalizing behaviours (c) take sides (d) try to please everyone

Question 37

At what age are you able to self-soothe yourself to bed?

Answer 37

8-10 months