Child Development Dr Arthur Paynter Community Paediatrician (retired!) July 2014

Plan for today  Introduction  Demonstration  Developmental milestones –Development at a glance –DVD of normal development  Developmental delays and disorders  Some common behavioural problems  Learning & thinking

Attention Deficit Hyperactivity Disorder Hyperactivity Hyperactivity Impulsivity Impulsivity Inattention Inattention (Note all these are normal in young pre school children, & children with learning difficulties) When is it abnormal? (6+) (Note all these are normal in young pre school children, & children with learning difficulties) When is it abnormal? (6+)

ADHD Management Understand the whole child Understand the whole child Assessment of child, family, environment Assessment of child, family, environment Environmental changes Environmental changes Medication Medication

Autistic Spectrum Disorders Triad of impairments: Triad of impairments: –Communication –Social interaction –Imagination Attachment to routine & dislike of change Attachment to routine & dislike of change Range of ritualistic behaviours Range of ritualistic behaviours Range of sensory issues Range of sensory issues

Autistic Spectrum Disorders It's a wide spectrum with classical autism with no communication and severe disability at one end to the cleaver but socially awkward individual at the other. It's a wide spectrum with classical autism with no communication and severe disability at one end to the cleaver but socially awkward individual at the other. Management! Management!

(Developmental Coordination Disorder, DCD Dyspraxia ) Hopping Tandem walking Throwing & catching a ball Hopping Tandem walking Throwing & catching a ball Lack of reciprocal movement arms & legs Lack of reciprocal movement arms & legs Associated movements Associated movements 'clumsy ' children have both learning & social difficulties at school. 'clumsy ' children have both learning & social difficulties at school.

Speech & Language Disorders Simple speech delay Simple speech delay Disorders due to sensory or physical problems Disorders due to sensory or physical problems –Hearing impairments –Motor & neurological problems –Cognitive problems Specific language impairments Specific language impairments –Semantic pragmatic (overlap ASD) Emotional behavioural Emotional behavioural –Elective mutism

Behavioural problems Tantrums Tantrums Enuresis Enuresis Encorpresis Encorpresis School refusal School refusal Sleep & the parasomnias Sleep & the parasomnias

Stages of communication  Touch  Movement  Music (melody & rhythm)  Speech (words & grammar)  Literacy Numeracy (symbolic)

Enuresis Diurnal or nocturnal? Primary or secondary? Diurnal or nocturnal? Primary or secondary? –Medical causes UTI Diabetes Renal failure Ten% at 5 yrs 5% at 10 yrs Ten% at 5 yrs 5% at 10 yrs More common in boys more persistent in girls More common in boys more persistent in girls

Enuresis management Sympathetic & non punitive Sympathetic & non punitive Bladder training Bladder training Star Charts & rewards Star Charts & rewards Alarms (cautions!) Alarms (cautions!) Medication Medication –Desmopressin Imipramine!

Encorpresis Constipation with overflow Constipation with overflow A fissure may have triggered withholding A fissure may have triggered withholding Tightly structured toilet & behaviour management Tightly structured toilet & behaviour management Laxatives Laxatives Specialist referral Specialist referral

Sleep disorders Obstructive sleep apnoea Obstructive sleep apnoea Confusional states (deep sleep) Confusional states (deep sleep) Somnambulism Somnambulism Night terrors Night terrors Nightmares (in REM sleep) Nightmares (in REM sleep)

Sleep EEG