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What does the DOHaD theory suggest?

  • Maternal behavior has no impact on fetal development
  • Environmental factors influence offspring health (correct)
  • Genetic factors are the only determinants of health
  • All pregnancy outcomes are predictable

    • The prevalence of autism spectrum disorder (ASD) in the US is reported as 1 in 54.

    True

    What are well-known environmental factors that can affect the future health of offspring?

    Maternal immune activation, stress, undernutrition, and drug exposure

    The critical period for organ development occurs during the ______ period.

    <p>embryonic</p> Signup and view all the answers

    Which of the following substances is known to be a human teratogen?

    <p>Lead</p> Signup and view all the answers

    Advanced maternal age is associated with lower risks of intellectual disability.

    <p>False</p> Signup and view all the answers

    What is the definition of low birth weight (LBW)?

    <p>Less than 2500 grams at birth</p> Signup and view all the answers

    According to meta-analysis, low birth weight is associated with a ______ times higher likelihood of intellectual disability.

    <p>3.56</p> Signup and view all the answers

    Which complication is likely to lead to mild/moderate developmental delay?

    <p>Breech Presentation</p> Signup and view all the answers

    What are early signs of cerebral palsy (CP)?

    <p>Increased or decreased muscle tone, poor head control, difficulty sitting up</p> Signup and view all the answers

    What is a primary risk factor for cerebral palsy?

    <p>Premature birth</p> Signup and view all the answers

    Match the following complications with their associated risk factors:

    <p>Spastic Hemiplegia = Affects one side of the body Ataxic CP = Results in balance problems Dyskinetic CP = Involuntary movements Spastic Quadriplegia = Affects all four limbs</p> Signup and view all the answers

    Which selection technique is more efficient?

    <p>Direct Selection</p> Signup and view all the answers

    Indirect selection techniques require more precise and accurate motor movements.

    <p>False</p> Signup and view all the answers

    What type of displays are context-based displays similar to?

    <p>Activity grid displays</p> Signup and view all the answers

    Indirect selection techniques require ______ steps between motor act and message generation.

    <p>intermediary</p> Signup and view all the answers

    Match the selection technique with its characteristic:

    <p>Direct Selection = Requires greater visual or auditory acuity Indirect Selection = Can be used by individuals with significant visual or auditory deficits</p> Signup and view all the answers

    What is impairment in communication ability?

    <p>Impairment of the ability to change communication to match context or the needs of the listener.</p> Signup and view all the answers

    Which of the following are difficulties faced by individuals with pragmatic difficulties? (Select all that apply)

    <p>Using verbal and nonverbal signals to regulate interaction</p> Signup and view all the answers

    The onset of symptoms related to pragmatic difficulties can manifest after the early developmental period.

    <p>False</p> Signup and view all the answers

    What does AAC stand for?

    <p>Augmentative and Alternative Communication</p> Signup and view all the answers

    Which of the following are populations that may require AAC? (Select all that apply)

    <p>Individuals with autism spectrum disorder</p> Signup and view all the answers

    What are the two broad categories of AAC users?

    <p>Congenital disabilities and acquired disabilities</p> Signup and view all the answers

    Which condition is NOT considered a congenital disability that may require AAC?

    <p>Amputation</p> Signup and view all the answers

    What is the estimated prevalence of children with special health care needs who have a speech difficulty?

    <p>2.9%</p> Signup and view all the answers

    What is one of the primary components of an AAC system?

    <p>User interface</p> Signup and view all the answers

    Match the following types of speech output with their characteristics:

    <p>Synthesized Speech = Less natural-sounding, requires less memory Digitized Speech = More closely resembles natural speech, requires more memory</p> Signup and view all the answers

    Symbols in AAC represent ______, actions, concepts, and emotions.

    <p>objects</p> Signup and view all the answers

    What is a significant risk factor for cerebral palsy?

    <p>Preterm birth</p> Signup and view all the answers

    What percentage of individuals with cerebral palsy may experience seizures?

    <p>20%–30%</p> Signup and view all the answers

    Which of the following is NOT a medical complication associated with cerebral palsy?

    <p>Hypertension</p> Signup and view all the answers

    What is the purpose of the Gross Motor Function Classification System (GMFCS)?

    <p>To classify the mobility levels of children with cerebral palsy.</p> Signup and view all the answers

    Name one treatment that helps manage spasticity in individuals with cerebral palsy.

    <p>Botulinum toxin type A injections.</p> Signup and view all the answers

    Most individuals with cerebral palsy have total immobility.

    <p>False</p> Signup and view all the answers

    What type of professionals may be involved in the intervention and therapy for individuals with cerebral palsy?

    <p>All of the above</p> Signup and view all the answers

    Children with ____ may experience difficulty articulating words.

    <p>dyskinetic cerebral palsy</p> Signup and view all the answers

    Augmentative and alternative communication systems can be used by individuals who cannot speak effectively.

    <p>True</p> Signup and view all the answers

    The use of magnesium sulfate can help reduce the risk of cerebral palsy in infants born to mothers in ____ labor.

    <p>preterm</p> Signup and view all the answers

    What is important during the first three years of life for language development?

    <p>Rich exposure to sounds, sights, and speech.</p> Signup and view all the answers

    What are the two types of language disorders mentioned in the content?

    <p>Specific language impairment (SLI) and social communication disorder.</p> Signup and view all the answers

    Communication disorders are identified equally in boys and girls.

    <p>False</p> Signup and view all the answers

    Match the type of treatment with its area:

    <p>Physical therapy = Gross motor function Occupational therapy = Fine motor function / Activities of daily living Speech-language therapy = Speech and language Educational intervention = Learning/Cognitive development</p> Signup and view all the answers

    Study Notes

    Prenatal Factors Affecting Neurodevelopment

    • Developmental Origins of Health and Disease (DOHaD) Theory:
      • Environmental factors during fetal development influence offspring health and disease risks later in life.
      • Examples: maternal immune activation (MIA), stress, undernutrition, and drug exposure
    • Fetal Programming Hypothesis:
      • Early environmental conditions during prenatal and/or postnatal development can influence future health conditions.
      • This theory suggests that prenatal environmental factors can program the fetus for specific health trajectories.
    • Neurodevelopmental Disorders (NDDs) and Prenatal Factors:
      • MIA, stress, undernutrition, and drug exposure are linked to NDDs like autism spectrum disorder (ASD), ADHD, schizophrenia, and depression.
    • ASD:
      • Characterized by social communication deficits, repetitive behaviors, and sensory sensitivities.
      • Prevalence is estimated at 1.85% in the U.S.
      • Both genetics and environment play a role.
    • ADHD:
      • Characterized by hyperactivity, attention deficits, and impulsivity.
      • Worldwide prevalence is 5.29%.
      • Both genetics and environment play a role.

    Gestational Factors: Toxins and Maternal Illness

    • Gestational Period:
      • The time from conception to birth.
      • Divided into three trimesters.
    • Embryonic Period (Weeks 3-8):
      • Critical period for organ development.
      • Highly vulnerable to environmental influences and toxins.
    • Teratogen:
      • Any agent that can disturb the development of an embryo or fetus.
      • Known teratogens include alcohol, tobacco, chemotherapy drugs, caffeine, cocaine, lead, mercury, radiation, and certain prescription medications.
    • Alcohol:
      • Associated with a 1.63 times higher risk of intellectual disability (ID).
      • Can lead to Fetal Alcohol Spectrum Disorder (FASD).
    • Tobacco:
      • Associated with a 1.10 times higher risk of ID.
      • Can also lead to irritability, poor self-regulation, and cognitive deficits.
    • Maternal Illness as a Teratogen:
      • Urinary tract infection (UTI): associated with higher risks of mild-moderate ID and severe ID.
      • Maternal diabetes, hypertension, asthma, and epilepsy are also linked to increased risks of ID.

    Developmental Stages of the Human Embryonic Brain

    • First Trimester (0-13 weeks):
      • Neural tube formation in the ectoderm.
      • Neuroepithelial cells produce neural progenitor cells and neurons.
    • Late First to Second Trimesters (14-27 weeks):
      • Neurons migrate to the cortical layer and begin forming synapses.
    • Third Trimester:
      • Production of neuronal axons and glia.
      • Integration of neurons into neural circuits.
    • Critical Periods for NDDs:
      • The first to third trimesters are considered critical periods for brain development and are more susceptible to environmental influences that can lead to NDDs.
      • MIA, drug exposure, and stress during pregnancy can increase the risk of NDDs, particularly ASD, during the first half of pregnancy.

    Preterm Birth and Low Birth Weight (LBW)

    • Preterm Birth:
      • Birth before 37 weeks of gestation.
      • Leading cause of perinatal mortality in developed countries.
      • Frequency varies between countries, but is typically 12-13% in the USA.
      • Associated with a 2.03 times higher likelihood of intellectual disability.
      • IQ scores generally decrease as gestation shortens.
    • LBW:
      • Birth weight less than 2,500 grams (5 lbs 8 oz).
      • Can be preterm, but also occurs in full-term babies.
      • Risk factors include maternal hypertension, smoking, drug use, and poor weight gain during pregnancy.
      • Associated with a 3.56 times higher likelihood of intellectual disability.
      • Very low birth weight (<1,500 grams) is a greater risk factor than moderately low birth weight (1,500-2,499 grams).

    Perinatal Complications and Neurodevelopmental Risks

    • Breech Presentation:
      • Increased risk of mild or moderate neurodevelopmental difficulties.
    • Placenta Previa:
      • Increased risk of mild or moderate neurodevelopmental difficulties.
    • Meconium Aspiration:
      • Risks unclear, but likely low.
    • Nuchal Cord:
      • Risks unclear, but likely low.

    Hypoxic Ischemic Encephalopathy (HIE)

    • Definition:
      • Brain damage caused by a shortage of oxygenated blood to the brain.
      • Occurs when there is both hypoxia (lack of oxygen) and ischemia (lack of blood flow).
      • Can lead to Cerebral Palsy (CP).

    Cerebral Palsy (CP)

    • Definition:
      • Group of motor disorders affecting movement and posture.
      • Caused by non-progressive disturbances in the developing brain.
      • Can impact activities of daily living, cognition, language, and physical health.
    • Affected Areas of the Brain:
      • Spastic CP:
        • Most common type (75% of cases).
        • Caused by damage to the motor cortex.
        • Characterized by stiff and jerky movements, limb rigidity, and increased reflexes.
        • Divided into spastic quadriplegia, spastic diplegia, and spastic hemiplegia.
      • Dyskinetic CP:
        • Caused by damage to the basal ganglia.
        • Characterized by involuntary movements.
        • Divided into dystonic and choreoathetotic types.
      • Ataxic CP:
        • Caused by damage to the cerebellum.
        • Characterized by poor balance and decreased muscle tone.
    • Risk Factors:
      • Prenatal: Brain malformations, congenital infections, toxins, prematurity, stroke, toxemia.
      • Perinatal: Placenta separation, neonatal encephalopathy, cord prolapse, brain hemorrhage, stroke.
      • Postnatal: Asphyxia, head injury, brain infections.
    • Diagnosis and Prevalence:
      • Diagnosis is typically made by a pediatrician when motor milestones are delayed.
      • Prevalence is approximately 2 per 1,000 children in developed countries.
      • Prevalence has remained stable despite improvements in obstetrical care.
    • Causes:
      • Combination of genetic vulnerability and environmental stressors.
      • Prematurity is a risk factor, but most children with CP are born at term.
    • Early Signs of CP:
      • Increased or decreased muscle tone.
      • Arching of the back.
      • Poor head control.
      • Difficulty sitting up by 8 months.
      • Seizures.
      • Uncontrolled body movements.
      • Balance and coordination problems.
      • Difficulty eating or swallowing.
      • Learning difficulties.
      • Behavioral problems.
      • Visual or hearing problems.
      • Sleep problems.

    Gross Motor Function Classification System (GMFCS)

    • Categorizes CP mobility limitations into five levels:
      • Level 1: Walks independently in most settings, limited in more advanced motor skills.
      • Level 2: Walks independently, but may need assistance in some environments.
      • Level 3: Walks with assistive devices, such as a walker or cane.
      • Level 4: Self-mobility limited; requires powered mobility or transport in some settings.
      • Level 5: Self-mobility extremely limited, requires full support for mobility.

    Implications and Impact of CP

    • Movement:
      • CP affects motor control and planning.
      • Most individuals with CP have some mobility.
      • Individuals with spastic quadriplegia or dyskinetic CP may require a wheelchair.
    • Cognitive and Language Abilities:
      • About 30-60% of individuals with CP may have developmental disabilities.
      • Communication can be affected, and some may require assistive devices.
    • Physical Health:
      • Individuals with CP often experience medical complications.
    • Social-Emotional Development:
      • CP can affect self-esteem, social relationships, and participation in activities.
    • Impact on Families:
      • CP requires significant time and resources from families.
      • Access to support and services is crucial for families.

    Cerebral Palsy

    • Cerebral palsy (CP) is a disorder that affects muscle movement and coordination due to brain damage.
    • It is usually caused by brain injury that occurs before, during, or shortly after birth.
    • CP is a non-progressive disorder, meaning that the brain damage does not worsen over time.
    • Individuals with CP often experience varying degrees of physical disabilities, ranging from mild to severe.
    • CP is the most common motor disability in childhood.
    • CP is characterized by a range of symptoms, including spasticity (tight muscles), difficulty with movement and coordination, problems with balance and posture, and speech difficulties.
    • Seizures are a common complication, occurring in approximately 20%–30% of individuals with CP.
    • Other common medical complications include visual impairment, strabismus, hearing loss, dental cavities, drooling, swallowing difficulties, poor growth/nutrition, aspiration pneumonia, gastroesophageal reflux disease, constipation, and orthopedic complications.
    • Treatment and rehabilitation focus on promoting health, wellness, and participation, aiming to achieve the individual's developmental potential.
    • Many people with CP have typical intellectual functioning.
    • Some individuals with CP experience developmental delays or learning disabilities.
    • Reported rates of intellectual disability in people with cerebral palsy range from 30% to 60%.
    • Speech and language difficulties are common, but many individuals with CP are able to speak fluently.
    • Some have difficulty with articulation, while others may be unable to speak due to motor problems and require alternative communication strategies such as picture or symbol displays or computer voice output systems.

    Interventions & Therapies

    • Treatment involves a multidisciplinary team of professionals including nurses, occupational therapists (OTs), physical therapists (PTs), orthopedic surgeons, orthotists, pediatricians, psychologists, recreation consultants, social workers (SWs), speech-language pathologists (SLPs), and teachers.
    • Interventions focus on promoting health, wellness, and participation with the goal of achieving the individual's developmental potential.
    • Professionals utilize the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) as a framework for intervention.
    • ICF emphasizes the interplay between body functions and structures, activities, participation, and contextual factors (personal and environmental factors).

    Treatment Options

    • Examples of treatment interventions for individuals with CP include physical therapy, occupational therapy, and speech therapy.
    • Occupational therapy focuses on fine motor function and activities of daily living, promoting hand control and independence.
    • Physical Therapy focuses on gross motor function, improving strength, flexibility, and functional movements such as walking, sitting, and rolling.
    • Physical therapy may also involve the use of adaptive equipment, such as walkers, wheelchairs, splints, and braces.
    • Management of spasticity is often a part of CP treatment, often utilizing botulinum toxin type A (Botox) injections.
    • Speech therapy addresses speech and language development, improving articulation and promoting language acquisition.
    • Augmentative and alternative communication (AAC) systems are employed for individuals who are unable to communicate effectively through speech.
    • Learning and cognitive development is supported through infant stimulation programs, preschool programs, special education services, psycho-educational assessments, vocational programs, and individualized education plans.
    • Psychosocial development and wellness are addressed through family support, participation in recreational activities, and promotion of peer interactions.

    Preventability of CP

    • Preterm birth is a significant risk factor for CP.
    • Treatment of women who are in preterm labor with magnesium sulfate can substantially reduce the risk of CP in infants.
    • Cooling therapy for newborns born at term who have neonatal encephalopathy may reduce the frequency and severity of CP.
    • Research is ongoing for other potential preventative therapies, including melatonin, stem cells, and erythropoietin.

    Language Development & Language Disorders (LD)

    • Language development is a complex process that occurs throughout childhood.
    • Early language development is crucial, and exposure to language is vital for optimal brain development.
    • The first three years of life are a critical period for language acquisition.
    • Infants develop language skills through selective attention to parental speech sounds and by recognizing words and expressing needs and emotions.
    • Phonological awareness, the ability to recognize the relationship between sounds and letters, is essential for language development.
    • Deficits in phonological awareness can lead to communication and learning disorders.
    • Early intervention for language problems is essential.

    Types of Communication Disorders:

    • Speech Disorder: Difficulty producing speech sounds correctly, or hesitations or stuttering.
    • Language Disorder: Difficulty understanding what others say (receptive language), or sharing thoughts (expressive language).
    • Specific Language Impairment (SLI): A language disorder that delays language skills mastery.
    • Apraxia of Speech: Difficulty putting sounds and syllables together in the correct order.
    • Childhood-Onset Fluency Disorder: Repeated and prolonged pronunciation of certain syllables, interfering with communication.

    Language Disorder (LD)

    • LD is characterized by deficits in expression despite normal comprehension of speech.
    • A child's language matures at least 12 months behind their chronological age.
    • Children with LD often have delayed speech development, limited vocabulary, and speech marked by short sentences.
    • Linguistic abilities vary among individuals with LD.
    • LD is associated with higher-than-normal rates of negative behaviors.
    • Most children acquire normal language by adolescence, and about 50% fully outgrow the problems.

    Causes of Language Disorder:

    • Genetics play a role in LD.
    • Temporal processing deficits can also contribute.
    • Brain structure and function are involved, with potential problems in connections between brain areas and reduced activity in the left temporal region.

    Treatment of LD:

    • LD and other similar communication disorders typically self-correct by age 6 and may not require intervention.
    • Parents can stimulate language development by enrolling children in specialized preschools and using computer-and teacher-assisted instruction to teach academic skills.

    Childhood-Onset Fluency Disorder

    • This disorder involves repeated and prolonged pronunciation of certain syllables, interfering with communication.
    • It typically develops between ages 2 and 7, peaking at age 5.
    • About 3% of children experience stuttering.
    • Males are affected three times more often than females.
    • Many children who stutter before age 5 stop after a year in school.

    Causes and Treatment of Childhood-Onset Fluency Disorder:

    • Genetic factors account for 70% of the variance in causes.
    • Environmental factors play a role.
    • Treatment options include parental changes, contingency management procedures, and habit reversal procedures.

    Social (Pragmatic) Communication Disorder:

    • A new addition to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
    • This disorder involves persistent difficulties in pragmatics (social use of language and communication).

    Diagnostic Criteria for Social (Pragmatic) Communication Disorder:

    • Difficulties using communication for social purposes.
    • Impairment in adjusting communication to match context or the needs of the listener.
    • Difficulty following rules for language and storytelling.
    • Difficulties understanding non-literal or ambiguous meanings of language.
    • Deficits result in functional limitations in communication, social participation, relationships, academics, or work performance.
    • The onset of symptoms is early in development, but deficits may not become fully apparent until social communication demands exceed abilities.

    Other Aspects of Pragmatic Difficulties:

    • Difficulties with greetings, adapting communication style to setting, telling and understanding stories, engaging in conversation, repairing communication breakdowns, using verbal and nonverbal signals, interpreting signals from others, understanding ambiguous language, inferring, and maintaining close friendships.

    Augmentative and Alternative Communication (AAC):

    • AAC encompasses all forms of communication (other than oral speech) used to express thoughts, needs, and wants.
    • People use AAC when they make facial expressions, use gestures, symbols, pictures, or write.
    • Individuals with severe speech or language problems rely on AAC to supplement or replace speech.
    • Augmentative aids, such as communication boards and electronic devices, help people express themselves.
    • AAC may increase social interaction, school performance, and self-esteem.
    • AAC users should not stop using speech if they are able to.
    • AAC aids and devices enhance communication abilities.
    • Individuals who use AAC often have severe communication disorders characterized by impairments in speech, language, reading, and writing.

    AAC Populations:

    • Those with congenital disabilities.
    • Those with acquired disabilities.

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