Developmental Exam
Isolated v Global Developmental Delay = intellectual and adaptive impairment <5yo
Intellectual disability = Intellectual AND Adaptive skills impairment (at least one domain) >5yo
Adaptive: conceptual, social, or practical
Syndromic v non Syndromic
IWS
IPEP
EWGOD
Short: PWS
Obese: PWS
Dysmorph: Exprem (correct), Kabuki, Fetal Alcohol Syndrome, Fragile X
Vision
NB age range from 25th to 90th centile can be 2m to 2.5y depending on the criteria
Fine
6w: follow to midline
3mo: follow past midline
4mo: grasp cube placed in hand, brings hands together
5mo: follow 180
6mo: reach for cube Regards raisin
8mo: transfer cube Rake raisin/ look for yarn
9mo: 1 cube each hand Pincer
12mo: Bangs 2 cubes
14mo: Block in cup
18mo: scribble
21mo 2 cube tower Dump raisin from bottle
2y: 4 cube tower
3y: 6 cube tower
3.5y 8 cube tower I
4y: O thumb wiggle
5y: +, 3 part person
5.5y ☐ demonstrated pick longer line
6y: ☐, 6 part person
??
4.5 X
5y ▽
Social
4wo: regards face
6wo: smile responsively
2mo: smile spontaneously
4mo: regards hand
6mo: work for toy
7mo: feed self (can mouth
12mo: pat-a-cake
13mo indicate wants
14mo wave bye-bye
16mo play ball
17mo: drink from cup
21mo: spoon/fork
2y: feed doll Removes a garment
2.5y: Helps dress t-shirt / pants
3y: Brush teeth with help
3.5y Puts on t-shirt
4.5y: Dress no help
5y: Brush teeth no help
Language
3wo: responds to bell (receptive)
1mo: vocalises (expressive)
3mo: ooo/aah/laughs
5mo: squeal
6mo: turn to rattle
7mo: turn to voice
8mo: single syllables
9mo: Imitates syllables, nonspecific mama/dada
10mo: Combines syllables
12mo: Jabber
15mo: mama/dada specific
16mo: 1 word
17mo: 2 words
18mo: 3 words
22mo 6 words
2y: combine 2 words point 2 objects
2.5y: 6 body part name 1 object
3y: ½ speech understood name 4 objects
3.5y know 2 actions
4y: name 1 colour use of 2 object count 1
4.5y speech understood know 4 actions use of 3 objects
5y: name 4 colours know 4 prepositions
5.5y: 3 adjectives count to 5 define 5 words
6yo define 7 words 2 opposites
Gross
3w: lift head
3mo: head up 45
4mo: head up 90 and steady
5mo: wt on arms (chest up), wt through legs
6mo: roll
7mo: pull to sit, no lag
8mo: sit no support
9mo: stand holding on
10mo: Get to sitting pull to stand
12mo: stand 2s (crawling nb some skip)
14mo: stand alone
15mo: Squat (stoop and recover) walk well
17mo: walk backwards
20mo: runs
22mo: walk up 2 stairs
2y: walk and kick a ball
2.5y: Jump up
3y: throw over arm (3pointer)
3.25y: Jump forward
3.5y: balance each foot 1s
4y: balance each foot 2s
4.5y: hops
5y: balance each foot 3s
5.5y: balance each foot 5s
6y: balance each foot 6s Heal-toe
Summarise
Stem
Hearing/vision
Isolated v Global Delay (<5) v Intellectual Disability
Age for each domain
Cause and DDx
Further Ex
Ix
Any delay
Bloods
FBE, EUC, CMP, LFTs, TSH T3 T4, Fe studies, B12, folate, Vitamin D, Zinc, Lead (restricted diet add Vitamin A/C)
CK (Muscular dystrophy) if up > panel
Urate (screen for nucleic acid metabolism disorders)
Genetics
EEG
MRI
Developmental assessment
Moderate – IQ between 35 and 55
Severe – IQ between 20 and 40
Profound – IQ less than 25
(nb overlap of 5, cut offs 20-25, 35-40, 50-55)
GDD
- mild <⅓ below chronological age
- mod ⅓- ⅔ below chronilogical age
- severe >⅔ below chronological age
Rx
Early intervention (SP, OT, Physio, Psychologist, with Paediatrician/Teacher/Aid)
(Irlen syndrome controversial reading difficulty corrected by coloured lenses see UTD)
Genetics
Milestones
Intellectual disability = Intellectual AND Adaptive skills impairment (at least one domain) >5yo
Adaptive: conceptual, social, or practical
Syndromic v non Syndromic
IWS
IPEP
EWGOD
Short: PWS
Obese: PWS
Dysmorph: Exprem (correct), Kabuki, Fetal Alcohol Syndrome, Fragile X
Vision
- 6mo: Hundreds and thousands at 33cm
- VA (8-age = VA ie 20/60 at 2, 50 at 3, 40 at 4, 30 at 5, 20 at 6)
- Reading
- Distract with visual stimulus in front, then hide
- Bell, each ear from behind
- Note for head turn, or facial expression change
- 166
NB age range from 25th to 90th centile can be 2m to 2.5y depending on the criteria
Fine
6w: follow to midline
3mo: follow past midline
4mo: grasp cube placed in hand, brings hands together
5mo: follow 180
6mo: reach for cube Regards raisin
8mo: transfer cube Rake raisin/ look for yarn
9mo: 1 cube each hand Pincer
12mo: Bangs 2 cubes
14mo: Block in cup
18mo: scribble
21mo 2 cube tower Dump raisin from bottle
2y: 4 cube tower
3y: 6 cube tower
3.5y 8 cube tower I
4y: O thumb wiggle
5y: +, 3 part person
5.5y ☐ demonstrated pick longer line
6y: ☐, 6 part person
??
4.5 X
5y ▽
Social
4wo: regards face
6wo: smile responsively
2mo: smile spontaneously
4mo: regards hand
6mo: work for toy
7mo: feed self (can mouth
12mo: pat-a-cake
13mo indicate wants
14mo wave bye-bye
16mo play ball
17mo: drink from cup
21mo: spoon/fork
2y: feed doll Removes a garment
2.5y: Helps dress t-shirt / pants
3y: Brush teeth with help
3.5y Puts on t-shirt
4.5y: Dress no help
5y: Brush teeth no help
Language
3wo: responds to bell (receptive)
1mo: vocalises (expressive)
3mo: ooo/aah/laughs
5mo: squeal
6mo: turn to rattle
7mo: turn to voice
8mo: single syllables
9mo: Imitates syllables, nonspecific mama/dada
10mo: Combines syllables
12mo: Jabber
15mo: mama/dada specific
16mo: 1 word
17mo: 2 words
18mo: 3 words
22mo 6 words
2y: combine 2 words point 2 objects
2.5y: 6 body part name 1 object
3y: ½ speech understood name 4 objects
3.5y know 2 actions
4y: name 1 colour use of 2 object count 1
4.5y speech understood know 4 actions use of 3 objects
5y: name 4 colours know 4 prepositions
5.5y: 3 adjectives count to 5 define 5 words
6yo define 7 words 2 opposites
Gross
3w: lift head
3mo: head up 45
4mo: head up 90 and steady
5mo: wt on arms (chest up), wt through legs
6mo: roll
7mo: pull to sit, no lag
8mo: sit no support
9mo: stand holding on
10mo: Get to sitting pull to stand
12mo: stand 2s (crawling nb some skip)
14mo: stand alone
15mo: Squat (stoop and recover) walk well
17mo: walk backwards
20mo: runs
22mo: walk up 2 stairs
2y: walk and kick a ball
2.5y: Jump up
3y: throw over arm (3pointer)
3.25y: Jump forward
3.5y: balance each foot 1s
4y: balance each foot 2s
4.5y: hops
5y: balance each foot 3s
5.5y: balance each foot 5s
6y: balance each foot 6s Heal-toe
Summarise
Stem
Hearing/vision
Isolated v Global Delay (<5) v Intellectual Disability
Age for each domain
Cause and DDx
Further Ex
Ix
Any delay
- Audiometry
- Optometry, Ophthalmology
- Pb (if mouthing or Pica)
- OT/PT
- Developmental Paed
- Neurologist
- Audiometry
- SP
- Psychologist
- Audio, SP, Psychologist
- Developmental Paeds ?ASD, Psychiatrist ? Mental Health
- Developmental assessment (Developmental Paed, Psychologist, SP, PT, OT)
- ? Neurologist
- Psychologist ?OC
Bloods
FBE, EUC, CMP, LFTs, TSH T3 T4, Fe studies, B12, folate, Vitamin D, Zinc, Lead (restricted diet add Vitamin A/C)
CK (Muscular dystrophy) if up > panel
Urate (screen for nucleic acid metabolism disorders)
Genetics
- Karyotype (Gen Paed)
- Downs
- Kleinfelters (hypogonadism, tall stature, gynecomastia, reduced body hair)
- CGH array all (Gen Paed) ?obsolete now genome available for gen paeds
- Genome (Gen Paed) if developmental delay <10yo syndromic or non-syndromic
- Fragile X all (below): FMR-1 (fragile-site mental retardation) gene
- Rett (Regression of fine motor, language, and gait, with stereotypes): MECP2
- 22q11 deletion (FISH)
- Noonan's panel
EEG
MRI
Developmental assessment
- Griffiths (0-3y) (Cog and adaptive)
- Wechsler Preschool and Primary Scale of Intelligence (WPPSI) (Intelligence: 2.5-7.5y)
- Wechsler Intelligence Scales for Children (WISC) (Intelligence: 6y on)
- Vineland (Adaptive 0-21y)
Moderate – IQ between 35 and 55
Severe – IQ between 20 and 40
Profound – IQ less than 25
(nb overlap of 5, cut offs 20-25, 35-40, 50-55)
GDD
- mild <⅓ below chronological age
- mod ⅓- ⅔ below chronilogical age
- severe >⅔ below chronological age
Rx
Early intervention (SP, OT, Physio, Psychologist, with Paediatrician/Teacher/Aid)
(Irlen syndrome controversial reading difficulty corrected by coloured lenses see UTD)
Genetics
Milestones