Global Developmental Delay

DEFINATION:
Global Developmental delay occurs when a child exhibits a significant delay in the acquisition of milestones or skills, in all or most of domains of development (i.e., gross motor, fine motor, speech/language, cognitive, personal/social, or activities of daily living).

EXPLANATION:
Global developmental delay is defined as a delay in two or more developmental domains. In addition to delays in development emphasis should also be on recognition deviations in development.
Deviance occurs when a child develops milestones or skills outside of the typical acquisition sequence.
Developmental dissociations may also occur. Dissociations arise when a child has widely differing rates of development in different developmental domains. For example, children with autism often have typical gross motor development but significantly delayed language development, therefore language development has dissociated from gross motor development.
Finally, developmental regression must be considered. Regression is when a child loses previously acquired skills or milestones, and although less common thanthe other
patterns, should cause the greatest concern since it is often associated with serious neurological and inherited metabolic disorders.
As estimated by the World Health Organization (WHO), about 5% of the world”s children 14 years of age and under have some type of moderate to severe disability There is definitely a gender bias when it comes to developmental delays, with more males affected than females. The higher proportion of males with developmental delay and disabilities is well documented.
This is in part due to X-linked conditions. X-linked conditions are genetic diseases affecting the sex chromosomes X and Y, and X-linked diseases usually occur in males.
There is also a racial predisposition, with black males affected more than white males, black females, or white females.
It does not have any specific age of onset; it is identified at ages when child is expected to develop those developmental milestones which are in question.

ETIOLOGY:
Causes for global developmental delay could be genetic or environmental. Some genetic causes are Fragile X syndrome, mental retardation, and Rett syndrome, environmental causes are premature birth, lead exposure, thyroid problems. Risk factors:
Perinatal factors:
age under 18 years or more than 35 years
prenatal care beginning after the third month of pregnancy
tobacco ,alcohol, active or passive smoking use during pregnancy
other medical factors (anemia, poor nutrition, infections, diabetes, hypertension to mother)
complications of labour, delivery
Child factors: gestational age less than 37 weeks
birth weight under 2,500 grams (5 ½ pounds)
Apgar score (at 5 minutes) of less than 7; this is an assessment of the physical condition of a newborn infant, with scores ranging from 0 to 10.
congenital abnormality

CLASSIFICATION:
No further classification

SIGNS AND SYMPTOMS:
Developmental delay can be difficult to diagnose. There are two types of tests that can be done
Developmental screening: Developmental screening is used to see if children are learning basic skills age appropriately. This is to see how he or she learns, speaks, behaves, and moves. the developmental screening will help in telling if child needs to see a specialist.
Developmental evaluation. A developmental evaluation is an in-depth assessment of a child’s skills and should be administered by a highly trained professional, such as a developmental psychologist; developmental paediatrician or paediatric neurologist. The results of a developmental evaluation are used to determine if the child is in need of early intervention services and/or a treatment plan. Standardized tests are the most common way to find out if a child has a developmental delay.
The tests cover areas including:
Communication
Social/Emotional
Physical/Motor development
Self-help skills Cognitive Readiness Skills
A diagnosis cannot be made simply by using a screening test. If the results of a screening test suggest a child may have a developmental delay, the child should be referred for a developmental evaluation.
ASSOCIATED PROBLEMS:
Global developmental delay with mental retardation
Global developmental delay with cerebral palsy
Global developmental delay with down”s syndrome
Global developmental delay with low birth weight.
Global developmental delay in premature babies.
Global developmental delay with epilepsy.
Global developmental delay with other problems like vision, hearing etc
MYTHS/QUERIES:
1. Global developmental delay cannot be cured. DR SUMIT (occupational therapist): When GDD not due to any other associated disorder , it is because brain myelination is slow, rate and amount of myelination is directly related with learning. Progressing development through normal developmental pattern is the only way to cure GDD. This should be done under guidance of Occupational therapist
2. Global developmental delay child remains underachiever throughout his life.
DR SUMIT (occupational therapist): Yes, though he can participate and achieve in his goals but high calibre performance is not expected. And child always shows some insufficiency. At the same time associated disorder should be taken into consideration in terms of its severity and prognosis.
3. Global developmental delay always lags behind in development and cannot achieve age appropriate development.
DR SUMIT (occupational therapist): Yes, and always the final goal to achieve is age appropriate development, or maintain its progression with age.
EARLY DETECTION, A STEP TOWARDS BETTER CURE:
The value of early identification of children with developmental delays has been well documented. Paediatrician and even more experienced clinicians have demonstrated difficulty in the identification of children with mild developmental delays, who are typically the children most amenable to early intervention. As a result, child keeps on developing slowly failing to match age appropriate milestones may even land up with “loss of brains capability” to learn those milestones after certain age. Taken early to rehabilitation services on time, child can show normal development at a faster rate.

PARENTS APPROACH TO DISORDER:
Parents are the only source which is relied upon by us [rehabilitation consultants]. Parents are the ones who get more time to spend with the child not just by physical presence but also by playing, communicating [eliciting response] from the child. So it is parent”s responsibility to keep a check on child”s developmental patterns. For parents with child at risk of developing global developmental delay or developmental delay, should study patterns of normal developmental. They should give more play and more such stimulus which will elicit desired response. Definitely for this to happen, parents need guidance which can be given to them from their treating occupational therapist. More play and communication is the only key for healthy development of a child. For children showing concomitant presence of other disorder approach from parents needs to be changed. Careful study of disorder will lead to good outcome. Results and developmental definitely depends on cause of developmental delay. But conclusion is it”s a delay which needs appropriate facilitation for acquisition of a skill.