Presented in Child Psychiatry, Niloufer Hospital in 2010.

1. Behavioral development, DQ, IQ G SRINATH

3. Gross Motor Age in months Activity 3 Neck holding 5 Roll over 6 Sits with support 8 Sits without support, crawling, 9 Stands with support 12 Creeps, walks but falls, stands without support 15 Walks alone, creeps upstairs 18 Running 24 Walks stairs 2 feet at a time 36 Walks up stairs alternate feet, rides tricycle 48 Walks down stairs alternate feet, hopping

4. Fine Motor Age in months Activity 4 Bidextrous reach 6 Unidextrous reach and transfer, biscuit to mouth (Mouthing) 9 Immature pincer 12 Mature pincer, feeds from cup with spilling 15 Imitates Scribbles, 2 blocks, picks up glass and drinks 18 Scribbles, 3 blocks, feeds with spoon without spilling 24 Copies straight line, 6 blocks 36 Copies circle 48 Copies plus 60 Copies triangle 72 Copies rectangle 84 Copies diamond

5. Language Age in months Activity 1 Alerts to sounds 3 Cooing 4 Laughs aloud 6 Mono syllables 9 Bi syllables 12 1-2 words with meaning 18 8-10 words 24 2 word sentences 36 Gender identity, full name 48 Story telling, songs, poems 60 Asks meaning of words

6. Personal Social skills Age in months Activity 2 Social smile 3 Recognizes mother 6 Stranger anxiety 9 Waves bye-bye 12 Plays ball game 18 Copies parents in task 24 Asks for food 36 Shares toys 48 Plays in a group 60 Dressing, undressing, shoe lace tying

8. DQ

10. MENTAL RETARDATION/ INTELLECTUAL DISABILITY G SRINATH

17. Classification Degree of MR with IQ Adult attainment Mild (50-69) 85% Literacy ++ (6 th grade)- educable Self-help skills ++ Good speech ++ Semi-skilled work + Moderate (35-49) 10% Literacy + (2 nd -3 rd grade) Self-help skills ++-Trainable Domestic speech + Unskilled work with or without supervision + Severe (20-34) 3-4% Assisted self-help skills + Minimum speech + Assisted household chores + Profound (Below 20) 1-2% Speech: Utterances of words +/- Self-help skills +/- Sensory- motor impairments+

26. Behavioral phenotypes: Examples Behavior Syndrome Hyperphagia, obsessions & compulsions, skin-picking Prader-Will syndrome Hand-wringing Rett syndrome Self mutilation Lesch-Nyan syndrome Inappropriate laughter Angelman syndrome Cat cry Cri-du-chat syndrome Social anxiety, gaze aversion Fragile X syndrome Psychosis VCFS, Prader-Willi Syndrome

39. Common syndromes Syndrome Key features Downs syndrome Typical facies, short stature, slanting eyes, simian crease, cup-shape ears, clinodactyly, CHD, Fragile X syndrome Elongated triangular face, protruding or prominent ears, macro-orchidism Angelman syndrome Dysmorphic face - wide mouth, large tongue, thin upper lip, seizures, ataxia Prader-Willi syndrome Obesity, short stature, small hands/ feet, hypotonia Tuberous sclerosis Sebaceous adenomas, ash-leaf macules, shagreen patches

40. Common syndromes Syndrome Key features MPS I& II Typical facies, coarse skin, skeletal anomalies, corneal clouding, hepatosplenomegaly Phenylketonuria Light colored hair, abnormal smell of urine, microcephaly and seizures Autosomal recessive microcephaly Severe congenital microcephaly with mild to mod MR Rubinstien Taybi syndrome Prominent beak-shaped nose, broad thumb and hallux Cong Hypothyroidism Lethargy, growth failure, coarse and dry skin, constipation, feeding problems, prominent abdomen, bradycardia

41. Course and Prognosis

45. Management

53. Aggression and its various causes Medical illness Treat medical condition Pre-seizure irritability Anticonvulsants Mood disorders SSRIs or mood stabilizers Task related anxiety CBT and anti anxiety drugs Associated with delusions Anti-psychotics Inability to express needs Teach functional communication skills