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Diagnosing Developmental Delays

Today, children are examined at the hospital or birthing center for potential difficulties and when none are apparent, they are sent home(29). Sometimes, developmental delays are picked up on through regular pediatric check-ups. Doctors and child care specialists are focusing more on uncovering the following potential problem areas: functional skills, potential behaviour problems and problematic medical, birth and family conditions(29). The early years are crucial for making a diagnosis as they set the stage for the rest of the child’s life(29).

Pediatricians try to locate the source of the delay and design a treatment plan based upon this information(30). Once the cause is identified, the family and pediatrician better know what to expect and the child can receive appropriate support(30). There are various components to the pediatric assessment(30). In a developmental assessment, the doctor reviews the child's current competencies (including skills, knowledge and personality) and considers the best ways to help with future development. A family assessment is also undertaken allowing for family members to interpret the child’s behaviors and identify priorities and concerns.

A multidisciplinary assessment utilizes a group of professionals that work directly or indirectly with the child and family. Professionals interpret different phases of the child's development and types of skills and behavior. For example, a team including a pediatrician, speech-language pathologist, physiotherapist, neurologist and early intervention caseworker may all work on one case collectively with each professional focusing on their specific area of expertise. Play-based assessments can also be informative. They can involve observations of the child playing alone, with caregivers or peers, in free play or special games. Play provides a framework for diagnosis that can be used to encourage the child to show his abilities, learning style, feelings and social skills.



Dianosing Developmental Delays:
Different Age Groups (30)


Infancy
Infants with medical problems at birth have a greater chance of developing developmental disabilities/delays. High-risk infants should be in programs to track their progress due to this increased likelihood of delay that may gradually appear in the first years of life. The majority of children speak their first words before 18 months, and by three years, most speak short sentences. Therefore, a child that is not speaking words or sentences by three years of age may have a developmental delay/disability.


Toddlerhood

Between 12 and 30 months, a child begins to show independence from a secure base with her primary caregiver. Toddlers learn to walk and explore new territory with energy and curiosity that lead to exploration and skill mastery. Children with developmental delays may be identified as being less adventurous and more reserved. Typically, toddlers tend to struggle for autonomy, display egocentricism, negativism and temper tantrums. Toddlers that do not evidence such behaviours, may be delayed in development. Dramatic growth of cognitive skills and language in the second year allows toddlers to think and problem solve. Children that are not progressing in language skills may be identified readily as having a developmental delay.


Preschool
This relatively tranquil period, from three to five years of age is a time when preschoolers typically become more independent. They master several motor skills and develop greater emotional and social maturity. Children in this period are generally creative, imaginative and curious. The preschooler with a developmental delay may act more egocentrically and show demanding behavior during this time period.


School age
Six to twelve year olds experience slow and steady physical growth and rapid social and cognitive development. They develop a sense of industry and learn the basic skills required in society. Children begin to appreciate rules and develop a conscience, influencing their compliance. Thinking becomes less egocentric and more mature, supporting the ability for school-age children to solve problems and make independent decisions. Self-esteem and competence increase with the child’s achievements, however, children with developmental delays may not show signs of this growing competence and self-esteem.




Glossary of Disorders

The following link provides a glossary of various developmental disorders.

Download Glossary of Disorders




Commonly Used Developmental Screening Tools

Name of Screening Tool

Age Range

Description Time
       
Ages and Stages Questionnaire
2nd Edition

0-60
months

Parents indicate children's skills in language, personal-social, fine and gross motor, and cognition

Clear drawings and simple directions

Approximately 30 items for each age range

10-15 minutes
       
Parents’ Evaluations of Developmental Status 0-8 years Designed to detect and address a wide range of developmental issues including behavioral and mental health problems

10 carefully constructed questions eliciting parents' concerns

Identifies when to refer, screen further or refer for additional screening, counsel, reassure, temporize, or monitor behaviour, development and academic progress

~2 minutes
       
Infant Toddler Checklist for Language and Communication 6-24 months Parents complete 24 multiple/choice questions

Screening for delays in language development as the first evidence that development is atypical

5-10 minutes
       
Bayley Infant Neuro-developmental Screener 3-24 months 10 - 13 directly elicited items per 3 – 6 month age range

Assesses 1) neurological processes (reflexes, and tone); 2) neurodevelopmental skills (movement, and symmetry) and 3) developmental accomplishments (object permanence, imitation, and language)

10-15 minutes
       
Brigance Screens 0-90 months Tap speech-language, motor, readiness and general knowledge, and social-emotional skills

Nine separate forms, approximately one for each 12 month age range

Screens use direct elicitation and observation except the Infant and Toddler Screen which can be administered by parent report

10 minutes
       
Battelle Developmental Inventory Screening Test 12-96 months Items use a combination of direct assessment, observation, and parental interview

Taps a range of discrete domains include receptive and expressive language, fine and gross motor, adaptive, personal-social, and cognitive/academic

15-35 minutes
       
Pediatric
Symptom Checklist
4-18 years 35 short statements of problem behaviors including both externalizing (conduct, attention, etc.) and internalizing (depression, anxiety, adjustment, etc.)

D/K


DSM-IV Diagnosis

The DSM-IV is a frequently used tool for assessing developmental disabilities. For each disorder, there are a specific number of criteria that must be met in order to be classified as having the disorder. The following links provide the criteria for various developmental disorders according to the DSM-IV diagnostic system.

DSM-IV criteria for Asperger's Disorder
DSM-IV criteria for Autistic Disorder
DSM-IV criteria for Cerebral Palsy
DSM-IV criteria for Childhood Disintegrative Disorder
DSM-IV criteria for Dyslexia
DSM-IV criteria for Speech/Communication Disorders
DSM-IV criteria for Down Syndrome
DSM-IV criteria for Mental Retardation
DSM-IV criteria for Rett's Disorder
DSM-IV criteria for Tourette's Disorder

 

 
 
 
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