Children With Neurodisability
Dr Lesley McDonald
Community Paediatrician
West Centre
Community Child Health
• 0-19 years
• wide range of developmental difficulties /
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disabilities
holistic approach
partnership with parents
multidisciplinary working
interagency working
communication
Settings
• Child development centres 0-5 years
• Mainstream school health
• MLD schools
• Complex needs schools
• EBD schools
Child Development Centres
• West Centre (West)
• Bridgeton (East)
• Glenfarg (North)
• Southbank (South)
Referrals
• ODER one door entry referral
• referrals from GP, HV, RHSC, nursery,
educational psychology
• referral centres for specialist
developmental assessment
• links with other agencies – education,
social work
The team around the child
Paediatrician
specialist
health
visitor
admin staff
clinical
psychology
Child and
family
physiotherapy
social work
resource
team
occupational
therapy
Other CDC services
dietician
neurologist
geneticist
CDC
community
autism team
orthoptist
speech and
language
therapy
CDC links
educational
psychology home visiting
audiology
teachers
CAMHS
social work
area teams
PACT
nurseries
CDC
GP
health visitor
RHSC
RHSC
therapists paediatricians
Children with additional needs
• ex – preterm
• autism
• Down’s syndrome
• early developmental impairment (“global
developmental delay”)
Ex – preterm infants
• EPICure study
• infants <26weeks gestation
• at 2 ½ 49% no disability
24% disability not severe
24% severe disability
2% died
1% no data
Ex-preterm infants
• at 6 years
unimpaired 20%
mild disability 34%
moderate disability 24%
severe disability 22%
boys more likely to have moderate or severe
disability
cognitive impairment most common of the
domains assessed
Neonatal follow up
• until 2 years corrected
• referral to CDC at any time if concerns
• if not, review at 3, 5, 7
• important for primary care to refer to
secondary level services if concerned
Autism
• SIGN guidelines
• multidisciplinary specialist assessment
• Community Autism Team in Glasgow
• ICD 10 criteria
General “warning signs” - preschool
• delay or absence of spoken language
• lack of awareness of / responsiveness to others, unable
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to share pleasure
lack of pretend imaginative play
qualitative impairment in non-verbal communication
lack of pointing
lack of gaze monitoring
lack of initiation of activity or social play
unusual or repetitive hand and finger mannerisms
unusual reaction to sensory stimuli
General “warning signs” – school
age
• communication impairments
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abnormalities in language development
odd intonation, pitch etc
persistent echolalia
reference to self as “you” “she/he” beyond 3
unusual vocabulary
limited use of language for communication and / or
tendency to talk only about specific topics
General “warning signs” – school
age
• social impairments
– inability to join play, or inappropriate attempts
– lack of awareness of classroom “norms”
– easily overwhelmed by social and other
stimulation
– failure to relate normally to adults
– extreme reactions to invasion of personal
space
General “warning signs” – school
age
• impairments of interests, activities,
behaviours
– lack of flexible cooperative imaginative play /
creativity
– inability to cope with change or unstructured
situations
– odd behaviours including unusual responses
to sensory stimuli
Down’s syndrome
• recommended schedule of health checks
• developmental progress slower than other
children
1. Heart Disease
• by 6 weeks
– examination and echo
– or examination, CXR and ECG at birth and 6
weeks
2. Thyroid
• 10-20% affected, any age, diagnosis
difficult
• low threshold for testing
• preventable impairment if untreated
• Guthrie at birth
• T4 TSH thyroid antibodies at 1 year
– normal: repeat 2 yearly
– increased TSH or Ab’s: repeat 6-12 monthly
3. Eyes
• increased squint, cataract
• check carefully in first year, refer if
concerns
• second year: full assessment, orthoptic,
refractory, fundoscopy
– abnormal: close follow up by ophthalmology
– normal: full review at 4 including vision, 2
yearly thereafter
4. ENT
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conductive hearing loss 60-80%
SNHL 20% by age 20
partial upper airway obstruction
sleep apnoea
catarrh
neonatal hearing screening
audiology annually until age 5
2 yearly thereafter
5. Growth
• short stature part of syndrome
• 0-2 years: check wt, ht, OFC frequently
• >2 years: check annually
• use both Downs and standard growth
charts
• red book should have Downs insert
6. Others
• atlantoaxial instability
– no screening procedure
– do not bar from sports
– at risk: GA, RTA
– refer
• neck pain / pain behind ear
• abnormal head position
• deteriorating head position
• loss of bladder / bowel control
Early developmental impairment
(EDI)
• formerly known as global developmental
delay
• unhelpful term, implies difficulties
temporary and will “catch up”
• EDI a more appropriate diagnostic term,
proposed at international consensus
conference in 2008
EDI definition
• persistent significant limitations in two or
more developmental domains
– motor
– communication
– cognitive skills
– social skills
– emotional regulation / behavioural skills
– self care skills
• onset before age 5
• not better explained by another
established developmental disorder
• reassess by school age or before age 9 to
review diagnosis
Assessment
• history
• examination
• developmental assessment
• investigations as appropriate
• multidisciplinary working
• follow up over time
• exciting advances in genetics and
neuroimaging
Summary
• wide range of disabilities which may be
encountered in general practice
• awareness of services available
• if in doubt, phone to discuss
Contact Numbers
• West 207 7100
• Bridgeton 531 6550
• Glenfarg 531 6191
• Southbank 201 0923