Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Language teaching hospitals. So we're doing peds today. So part one with me and then part two with San, we've got 45 minutes. So I'll just sort of get straight into it really, any questions throughout, just pop them in the chat box. Um A bit of an intro to how I'll run my first part of the session. So we'll do a mix of, of info teaching some case based discussions and then some M CQ using the pole function, which I used in the S and G lecture as well seem to work quite well. It is interactive. So if we're doing case based discussions, if you can pop it in the chat, if we're doing the MC Qs, I'll activate the poll and we can do it that way as we're going through, just pop any questions in the chat. Um a little graph there just to say about sort of active recall, which is why we try to make it as interactive as we can. So firstly, we'll start with development. So as you're probably all aware, there's four domains of development. So you've got your gross motor, your vision, your fine motor, your hearing speech language, social, emotional and behavioral. So they four gross domains within each of them. You've obviously got different developmental milestones. Now, I remember doing this in med school and just feeling really overwhelmed with it. And it is sort of one of those, if you don't know any little ones, you're not getting like little younger, sort of brothers, cousins, et cetera, it is, can be a bit difficult. Um, so it's just one of those. You'll have to sort of learn key ones that I've sort of summarized here as there are absolutely loads and you could get bombarded, but you can just remember the key ones. So if your motor, you're thinking about things like head control when they sit, when they stand, when they walk for your vision and your fine motor, like when they come to the six week baby check, they should be looking around at things you'll often see like the towers thing as well. So 18 months, they should be able to do three bricks at two years, six bricks and like build a bridge of three. We'll go through the draw on the next slide in a quick way to sort of remember that for your hearing and your speech again, probably like just knowing that the first word or generally between seven and 10 months, once they get to sort of 2024. So coming up to two, they should be able to say like a simple phrase. I ask for something. And then I think your social smile is a big one. And then another useful one to know is like about the toilet train. So toilet training a day by about two years, but that night time training can come a bit later. Well, the key thing when you learn in the development is to think about the age limits. And these are a common exam questions. So these are the points at which if the child wasn't reaching the milestones you'd need to refer on. So I've listed the main common ones here. So you've got sitting without support at nine months if they're not walking by 18 months, um if not smiling by eight weeks, et cetera. So as I say, it can be a bit overwhelming to learn all the development, but just try and pick a key few ones from each domain and then obviously remember about your limit ages and hope that should be fine. So for the fine motor skills, the way I was always taught to try and remember it was by drawing out a stick man. So start with the body. That's the first thing they'll be able to draw, they'll then be able to draw a ahead, they'll then be able to add them some arms to draw them across, then be able to give them a box to sit on or a slightly deformed skirt, whichever you prefer. And then finally a little party, how to celebrate being able to draw the whole man. So obviously, you need to remember the ages, but just as a gross sort of general rule of thumb of what comes first in terms of the drawing. So developmental delay is obviously when they aren't reaching those developmental milestones as expected. So you can categorize it into the domains or you can also look at global developmental delay, which is when they've got a delay in two or more domains. So I won't go through all of those. Um You'll get these slides after the session if you've done the feedback, but again, just doing a couple of examples from each. Um So like just the gross motor for each individual one, et cetera and then some of the global ones as well. Um And yeah, as I say, global is delay in two or more domains. So you'll see that some can sort of fit into either just one domain or into global. OK. So moving on to the first case, so a six year old child is brought to the GP by her parents due to concerns about development schools say they're concerned about a communication and lack of social interaction. She's not really got any significant history. She's got an older brother who's developing fine mom did think she was a little bit different to her brother at an early age, but it wasn't really impacting her. She didn't go to nursery. It was only when she started school. That things started to have a bit of an impact school. Tell that she doesn't really play with others at break time. She's not very imaginative, but she'd spend hours in the greenhouse just looking after the flowers. She'd become quite distressed if the routine changes and they find it a bit difficult to calm her down. So, based on that information, if you pop in the chat box, what would be your top differential and why? Lovely. So, getting lots of answers coming for. Thanks guys. Yeah. So we've got lots of you saying autism or autistic spectrum disorder, which is right. So at this point, the G suspects a diagnosis of autism. So when we're thinking about autism, what are the three sort of areas that we think of being affected by autism, we could categorize it into three different areas. What would they be? So again, just use the chat function good and getting some sort of like ideas of sort of things that are affected. So like routines in our interest. Yes. Communication, fasted behaviors, interaction. Lovely. Yeah. So there's lots of different ways you can sort of categorize it. This was the, the, the way that I was sort of taught and I think it's quite a good way it fits into most different things. So we can think about it impacting their social communication and behavioral skills. So for the social things, they'll maybe have a lack of eye contact, you won't see them interacting with people. Um They may have difficulty making friendships and have that sort of a lack of imaginative play, the communication, you might have a delay in the language, they might use repetitive words, phrases, take things sort quite literally. Um And they may have some difficulty expressing their feelings, emotions, thoughts, et cetera, and then the behavior. So any stereotypical sort of behaviors disliking any change in routine etcetera. So when you're trying to think of the three hours affected by autism, think about social communication and behavior. And obviously the key thing as suggested in the name is that it is a spectrum. So not every child with autism will have all of these features, some will be more affected than others. You will have Children with autism who mainstream school managing fine and you will have others who will need, you know, to be in sort of specialist schools need a lot of support, etcetera. So it really can vary. So thinking about autism, what conditions are often associated with it again, if you can pop them in the chat. Good. So I've got AD HD AFA CD. Depression. Good. Lovely. Getting lots coming through self harm. Yeah. So main thing is that there are lot, lots of um associated conditions with autism, both sort of mostly sort of like the mental health side of things, but they can have others as well. So we just spoke about a lot like AD HDA DD anxiety and depression, um learning disabilities, tourettes, et cetera, obviously, with the self harm, if they've got depression, et cetera. So just being aware that often autism isn't in isolation, which when it comes to the management of and supporting these Children and adults, it actually can get quite complicated. Um I've just popped a little bit there about epidemiology. So we've got male, female ratio 3.25 to 1. Does anybody have any thoughts on why that ratio is so skewed? Why it seems to have such a higher prevalence in males and females? Any thoughts in the chat? Yeah. So girls are classically, we found that girls are harder to diagnose, they tend to sort of mask it a bit better. Um So it's something that is quite hot in the top of autism and I think they are trying to address and find ways around it. But yeah, girls generally tend to mask it a bit better. So at the moment, we've got quite a big skew towards males. So who manages ASD if you ever got this in an exam, say what would be the buzzword? Sorry, my voice is going for the management of ASD. Yeah, lovely. Lots of you getting that. So if I think of buzz word, I think of MDT. Absolutely right. Camhs would be heavily involved. So as we've talked about, there can be lots of associated conditions with autism. So it takes a lot of different people to manage that CS are gonna have a real involvement. Um, your pediatricians, dieticians, social workers, school educators, charities, et cetera. Um I've just popped a little screenshot there of the sort of stom initiative which you may or may not have heard of, but it's basically to try and stop the other medication.