Global developmental delay is an umbrella term used when children are significantly delayed in two or more areas of development. It can be diagnosed when a child is delayed in one or more milestones, categorised into motor skills, speech, cognitive skills, and social and emotional development. There is usually a specific condition which causes this delay, such as cerebral palsy, Fragile X syndrome or other chromosomal abnormalities. However, it is sometimes difficult to identify this underlying condition.
Other terms associated with this condition are failure to thrive (which focuses on lack of weight gain and physical development), intellectual disability (which focuses on intellectual deficits and the changes they cause to development) and developmental disability (which can refer to both intellectual and physical disability altering development).[citation needed]
Causes
Developmental delay can be caused by learning disabilities, in which case the delay can usually be overcome with time and support - such as with physiotherapists, occupational therapists, vision therapists, and speech and language therapists. Other causes which may cause a permanent delay in development include genetic disorders such as Down syndrome, Fragile X syndrome and GLUT1 Deficiency Syndrome; childhood infections such as meningitis or encephalitis, and metabolic disorders such as hypothyroidism. Metabolic disorders are more likely to cause delayed development in older children, as many congenital metabolic problems which are easily managed are screened for in the neonatal period. Child born prematurely (born before 37 weeks). The use of toxic substances in pregnancy, particularly alcohol, can lead to developmental delay if they affect the neurological development of the fetus, such as in fetal alcohol syndrome. Even though there are many known causes of delay, some children will never receive a diagnosis.
Diagnosis
Developmental monitoring is performed during wellness visits to check a child's development. Health authorities encourage parents to monitor their child's development, the CDC's program "Learn the Signs. Act Early" provides materials for a child's development is assessed based on expected milestones for actions like how they play, learn, speak, act and move. Missed milestones may be cause for concern, so the doctor or another specialist may call for a more thorough test or exam to take a closer look, this is usually done by going through Developmental Screening.[citation needed]
Developmental Screening is a more involved process. The evaluating professional will ask a parent to complete a research-based questionnaire that asks about a child's development, including language, movement, thinking, behavior, and emotions. Developmental Screening is recommended by the American Academy of Pediatrics (AAP) to all children at 9, 18, and 30 months. The AAP also recommends that all children be screened specifically for autism spectrum disorder (ASD) during regular well-child visits at 18 and 24 months. If a Developmental Screening indicates a delay, the child should then be assessed with a Developmental Evaluation.[citation needed]
Developmental Evaluations are performed by a Developmental pediatrician, child psychologist, or other trained provider with the purpose of Identifying and diagnosing developmental delays and conditions.
- Chromosome microarray and karyotyping to look for trisomy, microdeletions, and duplications. It is the most sensitive diagnostic test available and is used first line in all cases, but can miss balanced translocations and low-level mosaicism.
- Specific gene testing is available for certain disorders such as Rett syndrome, although these are expensive tests which aren't widely available
- Selective metabolic investigations may be useful in the absence of other identifiable causes, and the specific tests done will depend on the presentation. Inborn errors of metabolism causing metabolic disorders are rare and there are limited treatment options even if they are successfully diagnosed.
- Targeted MRI brain can be considered second line in selected patients, and is more likely to contribute to a diagnosis if the child has abnormal physical signs such as microcephaly, macrocephaly, a change in head circumference, focal neurological signs, or epilepsy.
Neonatal screening is used in the UK (Guthrie test) and can diagnose certain inborn errors of metabolism before they cause significant developmental problems, with the aim to manage them so that no permanent damage occurs.[citation needed]
- Medium-chain acyl-CoA dehydrogenase deficiency
- Homocystinuria
- Congenital hypothyroidism
- Isovaleric acidemia
- Glutaricaciduria type 1
- Maple syrup urine disease
Canada, the US, and the Netherlands offer more extensive newborn screening, encompassing some other amino acid, organic, and urea cycle disorders.
Management
The specific management of children with global developmental delay will depend on their individual needs and underlying diagnosis. Early intervention is essential to support the child to reach their full potential. Specialists involved in the management of GDD in children include:
- Speech therapists
- Physical therapists
- Orthotists
- Vision therapist
- Occupational therapists
- Music therapists
- Hearing specialists (Audiologist)
- Developmental paediatricians
- Neurologists
- Providers of Early Intervention Services (depending on location)
As well as involving professionals, parents can support the development of their child by playing with them, reading with them, showing them how to do tasks, and supporting them to participate in activities of daily living such as washing, dressing, and eating.
See also
- Specific developmental disorder
References
- "Global development delay". Mencap. Retrieved 2018-11-25.
- Srour, Myriam; Mazer, Barbara; Shevell, Michael I (2006). "Analysis of Clinical Features Predicting Etiologic Yield in the Assessment of Global Developmental Delay". Pediatrics. 118 (1): 139–145. doi:10.1542/peds.2005-2702. PMID 16818559. S2CID 19036421.
- "Global Developmental Delay (GDD) – Information & Support – Contact". contact.org.uk. Retrieved 2018-11-25.
- CDC (2020-06-25). "Developmental Monitoring and Screening – CDC". Centers for Disease Control and Prevention. Retrieved 2020-10-23.
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This article incorporates text from this source, which is in the public domain. - CDC (2020-05-14). ""Learn the Signs. Act Early." has FREE child development tools". Centers for Disease Control and Prevention. Retrieved 2020-10-23.
- CDC (2020-06-10). "What is a Developmental Milestone?". Centers for Disease Control and Prevention. Retrieved 2020-10-23.
- "Early Childhood Development". AAP.org. Retrieved 2020-10-23.
- Mithyantha, Renuka; Kneen, Rachel; McCann, Emma; Gladstone, Melissa (2017-11-01). "Current evidence-based recommendations on investigating children with global developmental delay". Archives of Disease in Childhood. 102 (11): 1071–1076. doi:10.1136/archdischild-2016-311271. ISSN 0003-9888. PMC 5738593. PMID 29054862.
- "Development Delay in Children What It Is, Screening, Treatment". Cleveland Clinic. Retrieved 2018-11-25.
- "Developmental Delay – Therapies For Kids". therapiesforkids.com.au. Retrieved 2018-11-25.
Global developmental delay is an umbrella term used when children are significantly delayed in two or more areas of development It can be diagnosed when a child is delayed in one or more milestones categorised into motor skills speech cognitive skills and social and emotional development There is usually a specific condition which causes this delay such as cerebral palsy Fragile X syndrome or other chromosomal abnormalities However it is sometimes difficult to identify this underlying condition Other terms associated with this condition are failure to thrive which focuses on lack of weight gain and physical development intellectual disability which focuses on intellectual deficits and the changes they cause to development and developmental disability which can refer to both intellectual and physical disability altering development citation needed CausesDevelopmental delay can be caused by learning disabilities in which case the delay can usually be overcome with time and support such as with physiotherapists occupational therapists vision therapists and speech and language therapists Other causes which may cause a permanent delay in development include genetic disorders such as Down syndrome Fragile X syndrome and GLUT1 Deficiency Syndrome childhood infections such as meningitis or encephalitis and metabolic disorders such as hypothyroidism Metabolic disorders are more likely to cause delayed development in older children as many congenital metabolic problems which are easily managed are screened for in the neonatal period Child born prematurely born before 37 weeks The use of toxic substances in pregnancy particularly alcohol can lead to developmental delay if they affect the neurological development of the fetus such as in fetal alcohol syndrome Even though there are many known causes of delay some children will never receive a diagnosis DiagnosisDevelopmental monitoring is performed during wellness visits to check a child s development Health authorities encourage parents to monitor their child s development the CDC s program Learn the Signs Act Early provides materials for a child s development is assessed based on expected milestones for actions like how they play learn speak act and move Missed milestones may be cause for concern so the doctor or another specialist may call for a more thorough test or exam to take a closer look this is usually done by going through Developmental Screening citation needed Developmental Screening is a more involved process The evaluating professional will ask a parent to complete a research based questionnaire that asks about a child s development including language movement thinking behavior and emotions Developmental Screening is recommended by the American Academy of Pediatrics AAP to all children at 9 18 and 30 months The AAP also recommends that all children be screened specifically for autism spectrum disorder ASD during regular well child visits at 18 and 24 months If a Developmental Screening indicates a delay the child should then be assessed with a Developmental Evaluation citation needed Developmental Evaluations are performed by a Developmental pediatrician child psychologist or other trained provider with the purpose of Identifying and diagnosing developmental delays and conditions Chromosome microarray and karyotyping to look for trisomy microdeletions and duplications It is the most sensitive diagnostic test available and is used first line in all cases but can miss balanced translocations and low level mosaicism Specific gene testing is available for certain disorders such as Rett syndrome although these are expensive tests which aren t widely available Selective metabolic investigations may be useful in the absence of other identifiable causes and the specific tests done will depend on the presentation Inborn errors of metabolism causing metabolic disorders are rare and there are limited treatment options even if they are successfully diagnosed Targeted MRI brain can be considered second line in selected patients and is more likely to contribute to a diagnosis if the child has abnormal physical signs such as microcephaly macrocephaly a change in head circumference focal neurological signs or epilepsy Neonatal screening is used in the UK Guthrie test and can diagnose certain inborn errors of metabolism before they cause significant developmental problems with the aim to manage them so that no permanent damage occurs citation needed Medium chain acyl CoA dehydrogenase deficiency Homocystinuria Congenital hypothyroidism Isovaleric acidemia Glutaricaciduria type 1 Maple syrup urine disease Canada the US and the Netherlands offer more extensive newborn screening encompassing some other amino acid organic and urea cycle disorders ManagementThe specific management of children with global developmental delay will depend on their individual needs and underlying diagnosis Early intervention is essential to support the child to reach their full potential Specialists involved in the management of GDD in children include Speech therapists Physical therapists Orthotists Vision therapist Occupational therapists Music therapists Hearing specialists Audiologist Developmental paediatricians Neurologists Providers of Early Intervention Services depending on location As well as involving professionals parents can support the development of their child by playing with them reading with them showing them how to do tasks and supporting them to participate in activities of daily living such as washing dressing and eating See alsoSpecific developmental disorderReferences Global development delay Mencap Retrieved 2018 11 25 Srour Myriam Mazer Barbara Shevell Michael I 2006 Analysis of Clinical Features Predicting Etiologic Yield in the Assessment of Global Developmental Delay Pediatrics 118 1 139 145 doi 10 1542 peds 2005 2702 PMID 16818559 S2CID 19036421 Global Developmental Delay GDD Information amp Support Contact contact org uk Retrieved 2018 11 25 CDC 2020 06 25 Developmental Monitoring and Screening CDC Centers for Disease Control and Prevention Retrieved 2020 10 23 This article incorporates text from this source which is in the public domain CDC 2020 05 14 Learn the Signs Act Early has FREE child development tools Centers for Disease Control and Prevention Retrieved 2020 10 23 CDC 2020 06 10 What is a Developmental Milestone Centers for Disease Control and Prevention Retrieved 2020 10 23 Early Childhood Development AAP org Retrieved 2020 10 23 Mithyantha Renuka Kneen Rachel McCann Emma Gladstone Melissa 2017 11 01 Current evidence based recommendations on investigating children with global developmental delay Archives of Disease in Childhood 102 11 1071 1076 doi 10 1136 archdischild 2016 311271 ISSN 0003 9888 PMC 5738593 PMID 29054862 Development Delay in Children What It Is Screening Treatment Cleveland Clinic Retrieved 2018 11 25 Developmental Delay Therapies For Kids therapiesforkids com au Retrieved 2018 11 25
