What are common early signs of Cerebral Palsy?
- Hand preference <12mo
- Stiffness or tightness in the legs <12mo
- Inability to sit by 9mo
- Persistent fisting of hands >4mo
- Delays or asymmetry in movement or posture
What are signs of childhood onset fluency disorder vs. normal dysfluency?
- Stuttering: ≥2 freq of syllable repetition per word or prolongations per 100 words, +tension, +frustration, faster tempo, more broken words with stress
- DD: ≤1 freq of syllable repetition per word or prolongations per 100 words, normal tempo, airflow rarely interrupted, no tension or frustration, no change with stress, no silent pauses within a word
What are the expected milestones for gender identity in children?
- 2yo: conscious of physical differences b/w girls and boys
- < 3yo: most children can easily label themselves as either a boy or girl
- 4yo: stable sense of gender identity
- 6-7yo: many children reduce gender expression, feel confident others recognize gender → gender dysphoria may arise
- >8yo: most children will have a gender identity that matches the sex assigned at birth, however as puberty begins, some youth may realize that their gender identity is different
What are the conditions most commonly misdiagnosed as ADHD (in decreasing order of frequency)?
- Learning disorder
- Sleep disorder
- Oppositional defiant disorder
- Anxiety disorder
- Intellectual disability
- Language disorder, mood disorder, tic disorder, conduct disorder
- Autism spectrum disorder
- Developmental coordination disorder
What are genetic conditions that are at greater risk of ADHD?
Fragile X, Turner, TS, NF1, 22q11 deletion
What are risk factors for ASD?
- Genetic/familial
- Specific genetic syndromes / risk variants
- Male sex
- 1st degree relative or other family history of ASD
- Prenatal
- Older parental age (>35yo)
- Maternal obesity, diabetes, or HTN
- In utero exposure to valproate, pesticide or traffic-related air pollution
- Maternal infections (e.g. rubella)
- Close spacing of pregnancies (<12mo)
- Postnatal
- Low birth weight, extreme prematurity
What are the essential elements of an ASD diagnostic assessment?
- Step 1: Medical records review
- Step 2: Interviewing parents, family members, and other caregivers
- Step 3: Assessment for Core Features of ASD
- Step 4: Comprehensive physical exam and additional investigations
- Step 5: Consider differential diagnosis and co-occuring conditions
- Step 6: Establishing an ASD Diagnosis
- Step 7: Communicating ASD Diagnostic Assessment Findings
- Step 8: Comprehensive assessment for intervention planning
What is the management steps of infant colic as per the aap?
- Parental support and reassurance are key!
- PPI & simethicone are ineffective
- Consider probiotic or limiting maternal dairy intake
- If formula-fed: consider switching to hydrolyzed formula
What are red flags for gross motor development?
- Persistent primitive reflexes
- Abnormal tone or movement patterns at any age, spasticity, hypotonia, absent DTRs
- Asymmetry
- Poor head control at 5mo
- Not sitting independently with hands-free at 8mo
- Not rolling back-front, not taking weight well on the legs when held at 9mo
- Not walking by 18mo
What are red flags for fine motor development?
- Lack of transfer at 7 months
- Using one hand exclusively at any age
- Delayed self care (ADLs) at 4yo
- Delayed printing at school entry
What are red flags for S+L development?
- Problems with feeding and/or swallowing
- Parents suspect hearing loss, babbling stops at >6mo, lack of response to sound
- No single words by 15mo
- No combos by 24mo
- Stutter past 3.5yo (or earlier if anxiety/mannerisms)
- Idiosyncratic speech, disordered sequence of development
- Poor intelligibility for age
What are red flags for cognitive development?
- Lack of developmentally appropriate response to visual stimuli
- Immature play (like younger children)
- Stereotypic play; lack of pretend
- School failure
What are red flags for social development?
- Emotional dysregulation
- Abnormal attachment pattern (e.g. clingy)
- Limited social smiling and sharing enjoyment by 6mo
- Limited gestures like pointing, response to name, joint attention by 12mo
- Limited social imitative play by 18mo (e.g. imitating housework)
- Limited pretend play by 24mo
- No friends at school-age
What is the timing of onset and duration of primitive reflexes: Palmar grasp, rooting, moro, tonic neck, parachute
- Palmar grasp - onset at 28wk GA, duration 2-3mo postnatal
- Rooting - onset at 32wk GA, duration less prominent after 1mo post-natal
- Moro - onset 28-32wk GA, duration 5-6mo post-natal
- Tonic neck - onset 35wk GA, duration 6-7mo post-natal
- Parachute - onset 7-8mo post-natal, duration remains throughout the life
When does the following milestones occur:
- Run well
- Kick a ball
- Walk up and down stairs
- Throw a ball overhand
- Using a spoon
- Run well → 18 months
- Kick a ball → 24 months
- Walk up and down stairs → 24 months with both feet on each step
- Throw a ball overhand → 24 months
- Using a spoon → 22 months
What is considered a developmental delay?
a. no turning to name at 4 months
b. no babbling at 6 months
c. can’t follow single command without gesture at 15 months
d. no 2 words together at 2 years
Answer: D
Turns to voice at 2 months, turns to name at 6-12 months
Babbling starts at 6 months
Follows 1 step commands with gesture at 15-18 months
2 words strung together between 18-23 months
What is the diagnostic criteria for DCD?
A. Acquisition and execution of coordinated motor skills are substantially below expectations for a child’s chronological age and opportunities for motor skill learning. Difficulties may include ‘clumsy’, slow, or inaccurate motor skill performance (e.g., when catching an object, using scissors, handwriting, bike riding, or participating in sports)
B. Motor skills deficit significantly and persistently interferes with activities of daily living appropriate for age, and impacts school work, pre-vocational and vocational activities, leisure, and play.
C. Onset of symptoms in the early developmental period.
D. Motor skills deficit is not better explained by intellectual disability, visual impairment, or a neurological condition affecting movement (e.g. CP muscular dystrophy).
What is a differential diagnosis of infantile colic?
- CMPI
- GERD
- Lactose intolerance or overload
- Inguinal hernia
- Intussusception
- Infection (e.g. UTI, meningitis, AOM)
- Hydrocephalus
- Hair tourniquet
- Foreign body in eye
- Non-accidental injury
What is the diagnostic criteria of infantile colic?
- Paroxysms of crying for > 3h/day, > 3 days/wk, >3wk
- Onset < 4 months
- No FTT
How does maternal depression affect children based on age?
- Infants: insecure attachment, negative affect and dysregulated attention and arousal
- Passivity, withdrawal, self-regulatory behaviour
- Toddlers and preschoolers: poor self-control, mental health issues, and difficulties in cognitive functioning and social interactions
- School-aged: impaired adaptive functioning and psychopathology (conduct disorders, affective disorders an anxiety disorders), ADHD, and learning disabilities
- Teens: depression, anxiety, panic disorders, conduct, substance use
Which children with CP GMFCS I or II require screening hip x-rays?
GMFCS I do NOT require screening x-rays
GMFCS II: require screening if hemiplegia CP including one hip adducted and internally rotated
What is criteria for disruptive behaviour that is atypical in a child?
- Behaviours are atypical for the child’s developmental age and persist >6mo
- Behaviours occur across situations, and result in impaired functioning and/or
- Behaviours cause significant distress for both child and family
What is the 1st line management for children with significant disruptive behaviours?
Parent training programs
Why are extended-release medications preferred over immediate-release medications in ADHD?
- Improved adherence
- Reduced stigma
- Reduced problems for schools storing and administering medications
- Pharmacokinetic profiles
- Less likely to be ‘diverted’ (aka misused)
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