Child Psychology and Psychiatry

General patterns of development
Object oriented
exploratory play (maturing
eye-hand coordination
and object concepts)
9 months
Social smile
(90% by 6 weeks)
4–5 weeks
Social play sequence
Cognitive play sequence
Functional use of real
objects on self and other
(e.g. spoon, brush)
18 months
Social anticipation
Lap games (peek-a-boo,
pat a cake)
6–12 months
Plays with toys in a
symbolic manner (e.g. toy
tea set, doll and teddy)
24–30 months
Joint attention
Points to show
10–15 months
Pretend or imaginative
play becoming
increasingly varied and
complex
3–4 years
Social imitative role play
with other children
3–3.5 years
Figure 6.1
Developmental sequences involved in play and social skills.
Table 6.8
Investigation planning for developmental disorders.
Context
Recommended
investigations
Comments
First-line tests
Children with severe
developmental
delay or moderate
delay that is global
or is associated with
other significant
findings in history
and examination
Creatine kinase in boys
Thyroid function tests
irrespective of neonatal
screening
Array CGH (if available)
Chromosomes for
karyotype and Fragile X if
array CGH not available
MRI scan or CT scan in
more severe mental
retardation
Toxoplasma, rubella assay
and CMV urine culture in
children under 2 years
Some consensus guidelines also recommend
serum lead, urate, U&E, ferritin and
biotinidase
Microarray-based comparative genomic
hybridization (aCGH) is advanced
technology that allows detection of even
submicroscopic alterations in chromosome
balance. These very small changes are often
called microdeletions and
microduplications. This now incorporates
many individual tests, e.g. specific FISH
tests and Fragile X. aCGH is receiving
increasing support as a routine investigation
for generalized learning difficulties/mental
retardation (MR). Studies report such
chromosome subtelomere rearrangements
occurring with a frequency of 7—10% in
children with mild-to-moderate MR;
approximately 50% of cases are familial.
Positive results are eight times more likely
than Fragile X in some learning difficulty
populations.
Plasma calcium and alkaline phosphatase
may help with diagnosis and management
(
continued overleaf
)
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