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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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