+ Physician Assessment of Child Developmental Problems and Relationships to Early Intervention and School Programs Jeffrey Okamoto M.D. Medical Director.

+

Physician Assessment of Child Developmental Problems and Relationships to Early Intervention and School Programs

Jeffrey Okamoto M.D.

Medical DirectorHawaii Department of Health Developmental Disabilities Division;Department of PediatricsJohn A. Burns School of Medicine

+Learning Objectives

1. Understand the role of the physician in evaluating common child developmental disabilities.

2. Illustrate the importance of genetic testing in informing parents about their children with developmental conditions.

3. Elaborate on the intersection of physicians, early intervention, and school programs around children with developmental and behavioral concerns.

+Format

Two scenarios –

You, the audience is the “doctor” – so please ask questions and I’ll role play the parent/patient

Try to figure out what is going on with the child so we can provide proper treatment and supports

This presentation is for you, we can digress some to topics of interest to you

I have a few slides about significant issues after each scenario

+Scenario 1

2 year old girl only eats certain foods

Please ask me questions! (I’m the mother). Also a 4 year old brother is here.

This girl has a medical condition…Try to figure out what is is

+Questions about what is going on

She only likes chocolate chip cookies of a certain brand, and milk, or juice

+Exam

She doesn’t say any words

She enjoys playing with the picnic basket toys

She wrings her hands occasionally

She is well dressed and well groomed

She doesn’t have good eye contact with you or her mother

Her four year old brother talks and tries to interact with her, but she doesn’t

Eyes, Mouth, Heart, Lungs, Abdomen, Skin, Strength, Tone all normal

Cannot examine her ears because of non-cooperation

+Differential Diagnoses

What do you think she has?

+Supports

This is her diagnosis: ____________________________

How can we help a two year old with problems in development?

+If you are looking at the handout before the session…

Don’t look at the Next Few Slides Until We Have Finished the

“Session”

+Possibilities (Among Many)

Autism Spectrum Disorder

Dysphagia (risk for aspiration)

Global Developmental Delay

Hearing Loss and Language Delay

Unusual caregiving practices ->Reactive Attachment Disorder

+DSM-5

The Diagnostic and Statistical Manual of Mental Disorders is one of the most important references for clinicians to make diagnoses

Has mental health diagnoses, but also a variety of neurodevelopmental diagnoses

No information about treatment

Current version is the DSM-5This changed from DSM-IV TR in May

2013

+DSM-5

Under the DSM-5: for an Autism Spectrum Disorder diagnosis requires a person to exhibit three deficits in social communication and at least two symptoms in the category of restricted range of activities/repetitive behaviors.

+DSM-5

In addition to the diagnosis, each person evaluated is also described in terms of: any known genetic cause (e.g. fragile X

syndrome, Rett syndrome), level of language and intellectual

disability and presence of medical conditions, such as

seizures, anxiety, depression, and/or gastrointestinal (GI) problems. 

+Autism Spectrum Disorder and Rett Syndrome

Current estimate from the CDC is that 1 in 68 children has been identified with autism Five times more common in boysReported to occur in all racial, ethnic and

socioeconomic groups

Rett Syndrome – only in girls – slowing of development, distinctive hand movements, loss of purposeful use of hands Possible seizures, intellectual disability and

problems with walking

+Hearing Loss

+Reactive Attachment Disorder

Often seen in children adopted from other countries, especially if in a orphanage with only a few adults for many infants/toddlers

Can be seen in families where the parents are severely incapacitated because of recreational drug use or other problem

Can resemble autism or developmental delay or other conditions

+Child Birth to Three with Delay

Early Intervention Program (Free)

Also possibly: Early Head Start

It is important to identify these children (“Child Find”) to start these services

+Scenario 2

5 year old boy “failing school”

Please ask me questions! (I’m the father or the child – direct the question to one of us)

This boy has a medical condition…Try to figure out what it is

+Information

He has not learned how to write letters or to read even simple words

+Exam

His face is longer than wide

He has a cluttering kind of speech. He answers questions appropriately but simply (one word).

He appears happy

No problems with his head, eyes, ears, nose, mouth, neck, heart, lungs, abdomen, muscles, skin or reflexes.

+Differential Diagnosis

What do you think he has?

+

This is his diagnosis: _________________________

How can we help him?

+Possibilities

ADHDBehavioral Rating Scales in a variety of contexts

Intellectual DisabilityDefinitionAdaptive FunctioningEtiologies

Learning Disabilities

+Fragile X Syndrome

Most common inherited genetic condition causing intellectual disability- estimated 1 in 5000 males

Can affect females, but they have milder symptoms

Diagnosed using a blood test for Fragile X

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+Testing and Supports

Psychoeducational Testing - Use in determining strengths and weaknesses IQ testing Achievement Testing

IDEA and the IEP process

+Child Three Years or Older with Delays or Condition

Special Education

Medical Support

SSI

Medicaid/Waiver Program

+ConclusionsChildren can have a variety of developmental issues – some are environmental, some are medical conditions that the child are born with or acquire

Genetics increasingly can give us answers to why a person has a developmental problem

Supports are available for children with developmental issues

+Contact information

 E-mails:

[email protected]

[email protected]