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Development Delay in Children: What It Is, Screening, Treatment

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Children with developmental delays don’t meet developmental milestones at the same pace as their peers. These delays can involve physical, cognitive, language or social development.

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At SSM Health, we know it can be scary to learn your child may have a developmental delay. However, it's important to know there are treatment options for this diagnosis and it generally does not predict future intelligence. Every child grows and learns differently and we're here to help yours reach his or her full potential.

A developmental delay refers to a child who has not gained the developmental skills expected of him or her, compared to others of the same age. Delays may occur in the areas of motor function, speech and language, cognitive, play, and social skills. Global developmental delay means a young child has significant delays in two or more of these areas of development.

Causes of Developmental Delay

There is not one cause for delays in development. Factors that may contribute can occur before a child is born, during the birth process, and after birth. These could include:

Genetic or hereditary conditions like Down syndrome

Metabolic disorders like phenylketonuria (PKU)

Trauma to the brain, such as shaken baby syndrome

Severe psychosocial trauma, such as post-traumatic stress disorder

Exposure to certain toxic substances like prenatal alcohol exposure or lead poisoning

Some very serious infections

Deprivation of food or environment

In some cases, it may not be possible to find the cause of the developmental delay.

Signs and Symptoms of Developmental Delay

There are many different signs and symptoms of delay that can exist in children and often vary depending upon specific characteristics. Sometimes you may see signs in infancy, but in other cases they may not be noticeable until your child reaches school age. Some of the most common symptoms can include:

Learning and developing more slowly than other children same age

Rolling over, sitting up, crawling, or walking much later than developmentally appropriate

Difficulty communicating or socializing with others

Lower than average scores on IQ tests

Difficulties talking or talking late

Having problems remembering things

Inability to connect actions with consequences

Difficulty with problem-solving or logical thinking

Trouble learning in school

Inability to do everyday tasks like getting dressed or using the restroom without help

If there is an underlying medical reason that causes the developmental delay, identification and treatment of that condition may improve your child's developmental skills.

Therapies for Developmental Delays

Although there is no cure for developmental delay, therapies directed to the specific area of delay are very effective in helping children catch up to their peers. These types of therapies may include:

Physical Therapy

Physical therapy is often helpful for children with delays in gross motor skills.

Occupational Therapy

This can addresses fine motor skills, sensory processing and self-help issues.

Speech and Language Therapy

Speech therapy is typically used to address problems in the areas of understanding and producing language and speech sounds.

Early Childhood Special Education

Early childhood special education provides stimulation for early developmental skills, including play skills.

Behavioral therapy

This may be needed in some children for behavioral difficulties that affect socially appropriate behaviors.

At SSM Health, our world class team of developmental pediatricians and wide range of specialized therapists all have extensive experience working with families and children with developmental delays. Contact us today to set up an appointment or to learn more about the variety of resources we have to offer.

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Developmental Delay: Causes, Symptoms, & Therapies

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At SSM Health, we know it can be scary to learn your child may have a developmental delay. However, it's important to know there are treatment options for this diagnosis and it generally does not predict future intelligence. Every child grows and learns differently and we're here to help yours reach his or her full potential.

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Continuing Education Activity

Delay in development occurs when the child fails to attain developmental milestones as compared to peers from the same population. It is caused by impairment in any of the following distinct domains, such as gross and fine motor, speech and language, cognitive and performance, social, psychological, sexual, and activities of daily living (ADL). It can be isolated (involving a single domain), multiple (involving two or more domains, or global (affecting most developmental areas). In order to avoid long term disability, early detection, and intervention is warranted. This activity reviews the role of the interprofessional team in the comprehensive evaluation of developmental delay using standardized developmental surveillance and screening instruments in addition to lab workup and imaging.

Objectives:

Access free multiple choice questions on this topic.

Introduction

Human development refers to the physical, cognitive, and psychosocial changes occurring throughout the lifespan. Many developmental lines progress sequentially and independently over time while also interacting with each other. Examples of the many developmental lines include:

The development of the fetal brain starts during the first trimester, more specifically in the fourth week of gestation, and continues throughout pregnancy with very rapid growth in early childhood but continuing actively through adolescence and into the middle of the third decade of life with ongoing development throughout the lifespan.[1][2]

Delay in development is generally determined with a child does not attain developmental milestones as compared to peers from the same population. Statistical terms are often used to classify the degree of delay into mild (functional age (FA) <33% below chronological age (CA), moderate (FA 34% to 66% of CA), and severe (FA <66% of CA).[3][4] "Developmental delay" is a general descriptor of a broad phenotype that must then be specified by carefully determining one or more elements linked with the area of disrupted development. Developmental delay is not a diagnosis by itself rather a categorical, illustrative term used in the clinic.[5] Further, the terms often used to specify a developmental delay may vary by country or area of practice. For example, the term "mental retardation is no longer in use with "learning disability" being used in the UK and Intellectual Disability being used in the US to define a group of individuals with a significant delay defined by "performance equal or greater than two standard deviations below the mean on age-appropriate standardized norm-referenced testing" (IQ or intelligent quotient testing). There are three types of developmental delay based on the number of domains involved: 1) Isolated developmental delay (involving single domain); 2. Multiple Developmental Delays - 2 or more domains or developmental lines affected; and, 3) Global developmental delay (GDD) -significant delay in most developmental domains.[1][3] Other entities with abnormal developmental models are:

Intellectual disability (ID) -is a developmental disability that mainly affects cognitive functioning. As per American Association on Intellectual and Developmental Disabilities (ID) guidelines, it is characterized by significant lifelong developmental deficits in areas that are responsible for learning, problem-solving, adaptive skills development, and independence, generally with onset prior to age 18 years of age.[3][6]

Developmental disorders - are a very large group of syndromes in which the typical sequences or patterns of development are disrupted with delays in developmental steps and/or deviations in development processes.[3] Despite the American Academy of Pediatrics policy on early screening, a significant number of developmental disorders remain undiagnosed and untreated.[7]

Etiology

The etiology of developmental delay is multifactorial. The etiology for the vast majority of developmental delay is idiopathic. When known, etiology may include genetic, environmental, and/or psychosocial factors.

Genetic: There is no known genetic substrate for developmental delay, per se. However, developmental patterns are often familial, including late walking and talking. Nonetheless, these developmental delays can also represent risks for syndromes or developmental disorders. There is a considerable variation in the genetics of developmental disorders, ranging from copy number variants (CNV's), insertions, deletions, and duplications. While most are rare variants, some represent common variants. The most common, known genetic factor for ID is Fragile X syndrome, a trinucleotide repeat disorder (CGG) targeting the Fragile Mental Retardation 1(FMR1) gene located on X-chromosome. Fragile X appears to confer risk for ASD, as well. Imprinting can also be seen as is the case of Prader-Willi and Angelman syndrome, which vary with paternal (Prader-Willi) and maternal (Angelman) loss of function on chromosome 15q. Both developmental delay and physical phenotypes can be associated with other disorders in which there are extra chromosomes or pieces of chromosomes, for example, Down syndrome (trisomy 21), Edward syndrome(trisomy 18) & Patau syndrome (trisomy 13).[8][9][10][11] Other X-linked disorders include Coffin-Lowry syndrome predominantly in males and Rett syndrome in females.[6]

Environmental: A wide number of environmental factors can lead to developmental delays and subsequent developmental disorders. These factors can affect development at a single of multiple points in the developmental process.

Antenatal:

Perinatal:

Intrauterine growth restriction (IUGR), prematurity, periventricular leukomalacia

Hypoxic-ischemic encephalopathy (HIE), perinatal asphyxia

Metabolic - Hypoglycemia, bilirubin-related neurotoxicity, etc.

Postnatal:

Epidemiology

Globally, in 2016, approximately 52.9 million children reportedly had identifiable developmental problems delay. Since 95% of the population resides in low and middle-income countries (LMICs), there is an increased risk for developmental delays and disorders.[13] Although the exact prevalence of developmental delay is unknown, according to the World Health Organization (WHO), 10% of the population in each country population has a disability of one or another kind.[14] In the United States, roughly 15% of children have been reported to have at least one developmental problem.[15] In England, the prevalence of ID in children under age five and adults is 2.7% and 2.17%, respectively. The GDD incidence rate is 1% to 3% in school-age children or younger.[6] Autism prevalence is approximately 2.5%.[16]

The prevalence of delay in development involving respective domains among children (which is based on data reported in children getting services in 2007 by USPSTF on their respective website) is given below:[15]

According to Drakenstein Child Health Study (DCHS) conducted in Western Cape, South Africa, the risk of low developmental performance in the high-risk environment was high among boys. Likewise, several other studies have also reported a slightly increased incidence in males, possibly due to genetic variability on the X-chromosome.[6][12]

Pathophysiology

Except for specific syndromes that include developmental delay, the vast majority of developmental delay is idiopathic. Although the exact underlying pathophysiology is unknown, several mechanisms have been proposed by epidemiologic studies that lead to some sort of developmental delay and/or disabilities. Since some forms of developmental delay may run in families, genes have been assumed to play a significant role in developmental delay.

A multitude of genes and mechanisms for genetic transmission have been proposed. While some causes of developmental delay such as Fragile X or Down syndrome have known genetic etiologies, for most others, it is unclear. Even for well-characterized disorders like autism spectrum disorder, there are over 100 risk alleles. Perinatal complications, profound deprivation, and poverty, among other environmental stressors, can play a role in causing developmental delays, but special causal links remain elusive.

The hypothalamic-pituitary axis ( HPA) is responsible for the normal regulation of stress response in progenies. Psychosocial stressors during pregnancy, maternal immune activation ( MIA), and modification of HPA may significantly affect fetal brain development, but there are no specific cause and effect relationships for most disorders. Boyce and his colleagues offered the concept of differential susceptibility. This suggests that the risk for developmental anomalies is increased by a variety of factors that create a biological vulnerability to environmental stressors but are only expressed when the environmental stresses occur. Furthermore, even vulnerable children can do well if environmental circumstances are highly favorable and foster resilience.[17][18]

History and Physical

A comprehensive history and thorough physical examination are essential elements of the examination of children with developmental delays. Additional information can also be gathered by a play interaction with the child us age-appropriate toys (e.g., toy cars, blocks, crayons, and paper) as well as watching the child move around the clinic. Additionally, home videos may prove to be useful.[1]

History

Physical Examination

Growth parameters - such as occipitofrontal circumference, weight, height, and BMI.

General physical examination involving head-to-toe assessment.

Detailed neurologic exam, including hearing and vision evaluation.

Evaluation

Assessment of developmental delays often requires the work of a team with experts in general and specific areas. This should start with primary care providers followed by pediatric subspecialists such as neurologists, child and adolescent psychiatrists, developmental and behavioral pediatricians, and other pediatric subspecialists as indicated. Besides, the skills from other disciplines may be necessary, for example, psychology, genetics, speech and language pathology, occupational therapy, physical therapy, nutritionists, etc. The United States Preventive Services Taskforce ( USPSTF) offers specific recommendations for speech and language delays and autism but does not explicitly cover other developmental delays. Clinicians, particularly primary care providers, must have a sound understanding of developmental milestones and patterns, as well as up-to-date knowledge about screening tests and their strengths & limitations, to ensure proper screening for a referral if the clinical suspicion of developmental screening is high.[1][15][20]

During each well-child encounter, a PCP should encourage parents to express their concerns about their child's behavior or developmental milestones.[3] Furthermore, since developmental delay can be due to normal variations or can be an indicator of a developmental disorder such as sensory or cognitive impairment, cerebral palsy, or autism, thorough evaluation and follow-up is warranted. Therefore, in addition to direct physical examination and observation, the use of validated screening instruments at every well-child visit can aid in the early detection of problematic developmental delays. Developmental screening should take place in response to parental concerns or clinicians' observations as well as during every well-child visit at 9, 18, and 30 months of age. An autism-specific screening test is recommended at 18 and 24 months. Among many general developmental screening instruments, The Ages and Stages Questionnaire, Third Edition ( ASQ-3), and the Parents' Evaluation of Developmental Status ( PEDS) are commonly used parent-report tools for use during well-child encounters. Hamilton et al. 2016, cited by Vitrikas, reported the sensitivity and specificity of PEDS questionnaires for all ages 75% and 74%, respectively. Although the sensitivity and specificity for ASQ-3 vary among different age groups; however, overall sensitivity is 85%, and specificity is 86%.[15][21][22][23]

Laboratory Workup

Laboratory evaluations of children with developmental delays should be done judiciously. There should be careful attention to resource utilization and the risk-benefit analysis for each test. Since most causes of developmental delay are idiopathic, it is rare to obtain significant or pathognomonic findings in laboratory testing. Therefore, aside from routine healthcare assessments, testing should only be completed if there is a specific indication.

Blood: Routine complete blood count (CBC), electrolytes, and lead screening are appropriate for most children, along with a lipid panel. If indicated, additional testing may include a metabolic chemistry panel(CMP), iron, calcium, phosphate, creatinine kinase (CK) enzyme. Additionally, uric acid level, thyroid function tests, lactic acid, very-long-chain fatty acids (VLFA), transferrin, lead, copper, ceruloplasmin level, ammonia, and acylcarnitine levels.

Urine: A routine urinalysis is appropriate but additional studies may be added to include organic acids, amino acids, oligosaccharides, sialic acids, glycosaminoglycans, urea, urine purine, and pyrimidines, etc.

Cerebrospinal fluid ( CSF): CSF analysis is rarely appropriate for developmental assessment delay. If there is a specific indication for a lumbar puncture, it can be considered. The particular indication will largely determine appropriate assessments of the spinal fluid, which may include glucose, lactic acid, glycine, pyruvate, etc.

Other tests need to be done to rule out TORCH (Toxoplasma, Others (HBV, HIV), Rubella, CMV, and Herpesvirus) infections.

Genetic: In general, genetic testing is not indicated for developmental delay unless there is a specific indication or evidence of a discrete syndrome. If further genetic testing is indicated, this should begin with a chromosomal microarray (CMA). Since the most commonly known genetic cause of intellectual delay is Fragile X, FraX screening may be appropriate. As per Moeschler et al., CMA is required for Fragile X syndrome. The detection of significant copy number variants and approximated diagnostic yield of microarray tests are 15-20% and 12%, respectively. If further genetic testing is indicated, referral to a geneticist is indicated. Consideration of a whole exome scan (WES) or whole-genome scan will determine the clinical syndromes being considered.[6][11][15]

Additional Assessments

Magnetic resonance imaging (MRI) brain - In the absence of discrete family history, specific injury, or focal neurological finding, MRI is rarely indicated in the routine assessment of children with developmental delay. This is because children under the age of 7 or 8 will have difficulty being still, and so movement artifacts will make interpretation of the scans difficult to impossible. Examinations can be completed using anesthesia, but, in most cases, the risk of anesthesia outweighs the potential benefit of the MRI scan. MRI is used to evaluate for microcephaly, macrocephaly, seizures, abnormal neurologic signs and symptoms, and hydrocephalus. One prospective and observational study compared the MRI findings of eighty-one (n=81) pediatric patients. Among them, 68% of cases showed abnormal MRI findings compared to 32% normal MRI results. The abnormal 68% MRI results demonstrated by traumatic/ neurovascular diseases (31%), congenital & developmental (17%), neoplastic (2.5%), metabolic & degenerative (10%), and non-specific (7.5%).

Electroencephalography(EEG) - In the absence of discrete family history, specific injury, or focal neurological findings, EEG studies are rarely indicated in the routine assessment of children with developmental delay. EEG may be useful if there is a clear history of regression and/or directly observed seizure activity.[3][6][24]

To summarize, children with developmental delays are usually identified as a result of parental concern, school/daycare observation, or during the course of routine care in primary care settings. When there is information from parents and/or teachers, the primary care provider should take it seriously and carefully assess the developmental delay and its possible causes.

Treatment / Management

The management of developmental delay is a team effort that includes primary care providers as well as pediatric subspecialists such as neurologists, child and adolescent psychiatrists, developmental and behavioral pediatricians, and other pediatric subspecialists as indicated. Also, the skills from other disciplines may be necessary, for example, psychology, genetics, speech and language pathology, occupational therapy, physical therapy, nutritionists, etc. In short, treatment strategies are usually multi-modal.

Treatment strategies require that the lead member of the team, often the primary care provider, establishes a therapeutic partnership with the pediatric care team, educating and providing parents/families with necessary information about the developmental delay and any evidence of an evolving syndrome, including the course of the disorder, diagnosis, prognosis, and complications. Additionally, psychosocial support and parental counseling/guidance are essential elements of care. Information should be provided at a level consistent with the ability of the parents to understand as this will enhance acceptance and adherence to care plans.[6]

For some families, social work support services may be necessary for coordination and transportation services, regular home visits, and other services essential to complete evaluations.[15] If there is significant clinical concern that the developmental delay represents an evolving clinical syndrome and the parents appear to not understand or be in denial, then follow-up appointments with the primary care provider during the developmental evaluation will be helpful.[3] Other recommendations for early interventions and referrals are given below:

1. Early childhood education

2. Early intervention programs

3. Early and periodic screening, diagnostic, and treatment (EPSDT)

4. Parenting problems - consider referral for parent training. This might include parent-child interaction therapy (PCIT) consisting of two phases, such as parent-directed interaction (PDI) and child-directed interaction (CDI). Additionally, parents may need help in providing their children with appropriately stimulating environments at home, school, and daycare. Many children with developmental delays are eligible for community-based services. Primary care providers should be familiar with these services, eligibility, and how to make referrals. Among many, these include:

5. Behavior Problems - consider referral to child and adolescent psychiatrist and/or behavior therapist (BCBA board-certified behavior analyst)

6. Social skills problems - consider referral for social skills training (individual and group_

7. Auditory impairment - consider referral to audiology (15)

8. Visual impairment - consider referral to ophthalmology.

9. Gross or fine motor delay- consider referral to physical therapy and/or occupational therapy (PT/OT)

10. Speech & language delay - consider referral to a speech and language pathologist.

11. Special Education (via Individualized Education Program (IEP) or 504 Plan)

Differential Diagnosis

Most developmental delay is idiopathic and time-limited. There is no differential diagnosis, per se. However, for some children, developmental delay is the first step toward a "development disorder," one of a large group of syndromes for which there are specific diagnostic procedures undertaken by specialists to arrive at a diagnosis. Examples of these progressions include;[1][3][19][26]

Developmental Delay Milestones Risks

Delayed Speech and Language

Sensory Impairment

Behavior Problems

Attention deficit hyperactivity disorder (ADHD)

Oppositional defiant disorder (ODD)

Disruptive mood dysregulation disorder (DMDD)

Autism spectrum disorder (ASD)

Childhood-onset schizophrenia

Mood/Affect Regulation

Learning Problems

Movement Disorders

Motor Delays

Prognosis

Since most developmental delays resolve spontaneously, the prognosis is generally good. However, developmental delay is a significant and powerful risk for progression to a neurodevelopmental disorder or syndrome. As a result, it is critical that each developmental delay is carefully followed until it resolves or evolves into a developmental disorder. There are many factors associated with both poor and better developmental outcome. Some of the prognostic factors associated with poor behavioral outcomes or serious delay in the development of children ranging from 18 to 30 months are lack of parental education, anemia during pregnancy, malnutrition, premature babies, male gender, low birth weight (LBW), prenatal and postnatal depression, intimate partner violence (IPV), use of drugs, tobacco or alcohol in pregnancy, and poverty.[12][27]

Moreover, some other alarming features (if not effectively addressed, may result in significant developmental deficit) are hearing and/or vision loss at any age, loss of previously learned developmental skills, persistent hypotonia or hypertonia, asymmetrical movements, no communicative speech at 16 months, and disproportionate head circumference (either > 99.6 percentile or <0.4 percentile).[1] In contrast, maternal education, access to basic life and health resources, and older child age have been associated with a better outcome.[12]

Complications

Most developmental delays resolve without complications. Those that evolve into developmental syndromes require careful assessment by skilled experts in the areas affected by the developmental disruption.[3][7]

Deterrence and Patient Education

Most developmental delays are time-limited. However, prevention of the delays themselves and shortening their duration may respond to environments that stimulate cognitive, motor, sensory, psychological, social, and emotional development across setting (home, school, daycare, etc.) It appears that parent training can foster a proper understanding of the functional impact of the needs of children and the risks intrinsic to development developmental delay. Parent guidance should be a part of every prenatal and well-child visit. Several well-designed parent training programs may also foster skills in other caregivers. One such program is the caregiver skills training program (CST) devised by the World Health Organization (WHO) for families of children suffering from developmental delays or disorders. It consists of the following modules:

Engagement -2 sessions,

Communication - 2 sessions

Management of behavior - 2 sessions

Play and home routine -1 session

Adaptive behavior -1 session

Caregiver self-care and continuing practice - 1session[13]

Additionally, communities need to provide support services for parents and children:

Most parents are competent and concerned about their children. Clinicians need to foster competence and support parents in the difficult task of childrearing. This includes encouraging parents to voice concerns and for clinicians to take very seriously all parental comments and concerns.[6][7]

Enhancing Healthcare Team Outcomes

The developmental outcome for all children can be greatly enhanced by systematic examination and developmental monitoring of all children. Even in relatively well-developed countries like the USA, as few as 1 in 5 children have been offered an acceptable parent completed developmental screening by a health care provider in the past year. According to the NSCH report in 2016, 30.4% of children aged 9 to 35 months were provided with parent-completed developmental screening instruments in addition to evaluation for behavior and interaction in the past year, which was confirmed by the parent/caregiver. Among them, only 19.2% had obtained both developmental screening and surveillance.[20]

The results are far worse in LMIC, where the majority of children live. An extensive medical and developmental evaluation is warranted to detect developmental delays at an early age. If this is done, it is possible that, through a collaborative effort between health care providers, parents, and society, children will have more favorable outcomes in the face of developmental delays.[15]

References

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Delay in development occurs when the child fails to attain developmental milestones as compared to peers from the same population. It is caused by impairment in any of the following distinct domains, such as gross and fine motor, speech and language, cognitive and performance, social, psychological, sexual, and activities of daily living (ADL).

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Children reach developmental milestones at their own pace, and some move faster than others. Two siblings in the same family may reach milestones at different rates.

Minor, temporary delays are usually no cause for alarm, but an ongoing delay or multiple delays in reaching milestones can be a sign there may be challenges later in life.

Delay in reaching language, thinking, social, or motor skills milestones is called developmental delay.

Developmental delay may be caused by a variety of factors, including heredity, complications during pregnancy, and premature birth. The cause isn't always known.

If you suspect your child has developmental delay, speak with their pediatrician. Developmental delay sometimes indicates an underlying condition that only doctors can diagnose.

Once you get a diagnosis, you can plan for therapies or other early interventions to help your child's progress and development into adulthood.

Fine motor skills include small movements like holding a toy or using a crayon. Gross motor skills require larger movements, like jumping, climbing stairs, or throwing a ball.

Children progress at different rates, but most children can lift their head by 3 months old, sit with some support by 6 months, and walk well before their second birthday.

By age 5, most children can stand on one foot for 10 seconds or longer and can use a fork and spoon.

Exhibiting some of the following signs can mean that your child has delays in developing certain fine or gross motor functions:

floppy or loose trunk and limbs

stiff arms and legs

limited movement in arms and legs

inability to sit without support by 9 months old

dominance of involuntary reflexes over voluntary movements

inability to bear weight on legs and stand up by about 1 year old

Falling outside the normal range isn't always cause for concern, but it's worth getting your child evaluated.

According to the National Institute on Deafness and Other Communication Disorders, the most active time for learning speech and language is the first 3 years of life, as the brain develops and matures.

The language learning process begins when an infant communicates hunger by crying. By 6 months old, most infants can recognize the sounds of basic language.

At 12 to 15 months old, infants should be able to say two or three simple words, even if they aren't clear.

Most toddlers can say several words by the time they are 18 months old. When they reach the age of 3, most children can speak in brief sentences.

Speech and language delay aren't the same. Speaking requires the muscle coordination of the vocal tract, tongue, lips, and jaw to make sounds.

A speech delay occurs when children aren't saying as many words as would be expected for their age.

A language delay occurs when children have difficulty understanding what other people say or can't express their own thoughts. Language includes speaking, gesturing, signing, and writing.

It can be hard to distinguish between speech and language delay in young children. A child who understands things and can express their needs (maybe by pointing or signing) but isn't speaking as many words as they should may have an isolated speech delay.

Poor hearing can cause speech and language delay, so your doctor will usually include a hearing test during diagnosis. Children with speech and language delay are often referred to a speech-language pathologist.

Early intervention can be a big help.

Autism spectrum disorder (ASD) is a term used to describe several neurodevelopmental conditions. Autistic people may think, move, communicate, and process senses differently from neurotypical people.

Autism is usually diagnosed in early childhood and includes a noticeable delay in language and social development.

Your pediatrician will ask about your child's development at each of their well visits. In fact, the American Academy of Pediatrics recommends that all children be screened for symptoms of autism at 18 and 24 months using standardized screening tools.

Symptoms are sometimes obvious early on, but may not be noticed until a child reaches 2 or 3 years of age.

Signs and symptoms of ASD vary, but usually include delayed speech and language skills and challenges communicating and interacting with others.

Every autistic person is unique, so symptoms and the way people experience them vary greatly.

Some symptoms include:

not being responsive to their name

dislike of cuddling or playing with others

lack of facial expression

inability to speak or difficulty speaking, carrying on a conversation, or remembering words and sentences

repetitive movements

development of specific routines

coordination problems

There is no cure for ASD, but therapies and other approaches can help give your child extra tools to communicate, relieve stress, and, in some cases, manage daily tasks.

According to the Centers for Disease Control and Prevention, about of children between the ages of 3 and 17 have one or more developmental disabilities.

Most developmental disabilities occur before a child is born, but some can occur after birth due to infection, injury, or other factors.

Causes of developmental delay can be difficult to pinpoint, and a variety of things can contribute to it. Some conditions are genetic in origin, such as Down syndrome.

Infection or other complications during pregnancy and childbirth, as well as premature birth, can also cause developmental delay.

Developmental delay can also be a symptom of other underlying medical conditions, including:

Remember that children develop at different rates, so it's possible that what you think of as a delay might be normal for your child. However, if you're concerned, it is important to get your child evaluated by professionals.

School-age children diagnosed with a developmental delay, may be eligible for special services. These services vary according to need and location.

Check with your physician and your school district to find out what services are available. Specialized education, especially when started early, can help your child progress and achieve more in school.

Treatments for developmental delays vary according to the specific delay. Some treatments include physical therapy for help in motor skill delays, and behavioral and educational therapy for help with ASD and other delays.

In some cases, medications may be prescribed. An evaluation and diagnosis from a pediatrician is crucial to come up with a treatment plan specially designed for your child.

Many genetic and environmental factors figure into a child's development and can contribute to delays. Even women who have a healthy pregnancy and proper care during and after pregnancy can have children with developmental delays.

Although causes of delays can be hard to pinpoint, there are many treatments and support services available to help.

The sooner you can diagnose a delay, the better it will be for your child's development into adulthood.

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Children reach developmental milestones at their own pace, and some move faster than others. Two siblings in the same family may reach milestones at different rates. Minor, temporary delays are usually no cause for alarm, but an ongoing delay or multiple delays in reaching milestones can be a sign there may be challenges later in life.

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Deeper understanding

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Current as of August 2021
See fact sheets on other disabilities
If you're reading this, perhaps you're concerned about your child's development. We're glad you're here, because there are many immediate things you can do to help your son or daughter. First, know that there's help available to find out just what the difficulties are, if any, and a ddress those difficulties.

The good news is that this help is usually free, and it's available in every state. Keep reading if you'd like to know more.

Think of all the skills that children have to learn when they come into the world: smiling, turning over, responding to people, communicating, eating solid food, crawling, standing, and on and on. We expect these skills to emerge naturally over time and know more or less when they should. At 3 months, Susana will probably be doing this, at 4 months, she'll be doing that. By a year, well, she'll be tottering around, getting into everything.

The time-table for skills to emerge is commonly called the developmental milestones. What's considered normal development is described rather broadly. That's because we know that children don't learn skills at the same pace. Two different children born on the same day may learn the same skill months apart, and both can be considered "on schedule." It's when skills emerge as expected, more or less on that broad schedule, that parents and caregivers may become concerned.

What to do? First, you may want to talk with your pediatrician about your child's development.

Talking to Your Pediatrician

Don't be surprised if the pediatrician tells you not to worry, to be patient, to give your child more time to develop. Often, that's what parents hear, especially in the early stages of investigating their child's seeming delays. And it's often true. Children develop at different rates; the pediatrician is well aware that many children show sudden bursts in development rather than slow, steady growth.

On the other hand, your pediatrician may recommend that a developmental screening be conducted. Its purpose is to see if, yes, your child is experiencing a developmental delay. The screening is a quick, general measure of your child's skills and development. It's not detailed enough to make a diagnosis, but its results show whether or not a child should be referred for a more in-depth developmental evaluation.

Developmental Evaluation

The developmental evaluation should be conducted by a highly trained professional who can use the results to create a profile of your child's strengths and weaknesses. The evaluation needs to look at five developmental areas. Those areas are:

Physical development (fine motor skills, gross motor skills)

Cognitive development (intellectual abilities)

Communication development (speech and language)

Social or emotional development (social skills, emotional control)

Adaptive development (self-care skills)

The results of the developmental evaluation will be used to decide if your child needs early intervention services and/or a treatment plan. Early intervention services are tailored to meet a child's individual needs and, as such, are a very important resource to children experiencing developmental delays. Early intervention services can include:

Assistive technology (devices a child might need)

Audiology or hearing services

Speech and language services

Counseling and training for a family

Medical services

Nursing services

Nutrition services

Occupational therapy

Physical therapy

Psychological services

Things to Know

States have an affirmative obligation to help children who are experiencing a developmental delay in one or more areas. Through the Child Find system that states operate, developmental screenings and developmental evaluations are typically provided free of charge to families.

If you're concerned about your child's development, talk to your child's pediatrician, who can refer you to the Child Find system in your area. If your child does have a developmental delay or is found to have another disability, then he or she may be eligible for services to address areas of individual need. Depending on the age of your child, those services typically are:

Early intervention services are meant for children under the age of 3. They are provided to eligible families either free of charge or on a sliding payment scale that's determined by the family's income. Find out about early intervention services in your area by talking to your child's pediatrician, calling a local hospital, or finding your state's contact for early intervention at the Early Childhood Technical Assistance Center.

Special education services are meant for children over the age of 3. Services are provided to eligible children free of charge through the public school system. If your child has passed his or her third birthday and you're concerned about a developmental delay or disability, call your local school (even if your child isn't enrolled there) and ask how and where to have your child evaluated under IDEA, our nation's special education law.

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Get to Know Your Parent Center!

You'll also want to get in touch with the Parent Center that serves your state or a given region within the state. Every state has at least one such center. Parent Centers specialize in connecting parents and others with local resources and providing them with information and training on disability topics, such as what rights you and your child have under federal and state law, how to work with service providers and schools to support your child's development and learning, the network of knowledge associated with your child's disability, and much, much more.

To find your Parent Center: Visit our Find Your Parent Center page.

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IDEA's Definition of Developmental Delay

IDEA is the Individuals with Disabilities Education Act. Through IDEA, early intervention services and special education services are made available to our nation's children. Not surprisingly, IDEA includes a definition of developmental delay, which may be useful to know. Here it is:

Child with a disability for children aged three through nine (or any subset of that age range, including ages three through five), may...include a child-

(1) Who is experiencing developmental delays as defined by the State and as measured by appropriate diagnostic instruments and procedures in one or more of the following areas: Physical development, cognitive development, communication development, social or emotional development, or adaptive development; and

(2) Who, by reason thereof, needs special education and related services. [34 CFR §300.8(b)]

It's a good idea to find out if your state has added details to this definition of developmental delay. States are allowed to do so, if they choose. They also decide on the age range of children with whom the term may be used (3-5, 3-9, or any subset between 3-9). Your local school or early intervention program should be able to tell you the definition of developmental delay that's used in your area. It may be helpful to know that, under IDEA:

Your state may not require that your local school district also adopt and use the term developmental delay in working with children.

If your local school district decides to use the term, it must use the same definition and age range as the state does.

Your local school district may not use the term at all if your state has chosen not to use the term.

Resources for You

It's very helpful to read more about developmental delay. This has been just a brief overview, with pointers to the loads of additional info and support listed below.

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Current as of August 2021 See fact sheets on other disabilities If you're reading this, perhaps you're concerned about your child's development. We're glad you're here, because there are many immediate things you can do to help your son or daughter.

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Screenings

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Early steps

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Early Steps is Florida's early intervention system that offers services to eligible infants and toddlers, age birth to 36 months, who have or are at-risk for developmental disabilities or delays. Early intervention supports families and caregivers to increase their child's participation in daily activities and routines that are important to the family.

Positive early learning experiences are crucial for later success in school, the workplace, and the community. Research shows that children's earliest experiences play a critical role in brain development.

15 Local Early Steps (LES) throughout the state receive referrals from various primary referral sources. Infants and toddlers are assessed in the following developmental domains to determine eligibility: physical, cognitive, communication, social-emotional and adaptive.

Each child receives an Individualized Family Support Plan (IFSP) that meets his or her unique needs. Families also receive support to develop the skills and confidence needed in helping their child learn and develop.

Services will support children in their communities where they live, learn and play.

There is no income requirement to qualify for the program and although families may choose to allow access to insurance or Medicaid benefits, families are not charged for services.
For more information visit our website. To make a referral to Early Steps, contact the Local Early Steps program serving your area or call (800) 218-0001.
State Systemic Improvement Plan (SSIP)

Early Intervention programs nationally are required to develop a State Systemic Improvement Plan (SSIP). This is a multi-year plan that began July 2013 and will continue through June 2019. The purpose of the Florida Early Steps SSIP plan is to implement effective, sustainable policies and practices at the state and local levels to positively impact social-emotional development for infants and toddlers with disabilities ages 0 to 36 months.
SSIP Fact Sheet SSIP Fact Sheet (Spanish Translation)
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Early Steps, within Children's Medical Services, serves families with infants and toddlers, birth to 36 months of age, who have developmental delays or an established condition likely to result in a developmental delay. Each child receives an Individualized Family Support Plan (IFSP) that meets his or her needs.

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Programs

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Florida Disability Resources, Programs & Services

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Discover Florida’s top disability resources! Find support programs, accessible services, financial aid, & more for a barrier-free life.

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Services

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Create Visual Aids makes a whole range of visual communication resources to support both expressive communication (giving someone a voice), and receptive communication (allowing someone else to understand what is being communicated).

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Lingraphica AAC or speech-generating devices (SGDs) are simple communication devices that help people with speech and language impairments to improve their communication, speech, and quality of life. Schedule a free consultation to find out if a device is right for you or a loved on.

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Best Toddler Toys to Improve Gross Motor Skills

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KOABBIT Pencil gripper kids/toddler handwriting aid tools for beginners,Pencil Holder for preschooler 2-4 Years learning to Write for Children’s Training Pen Holding Posture Correction Tools(3 PACK)

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Importance of early intervention as it relates to developmental delay or disabilities

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School-aged children can find themselves in trouble at school. It can be hard to follow instructions, pay attention in class, and even get along with other students. While these may seem like normal behaviors of a child growing up, these signs could also point to a developmental disability, or DD, which can present in children in a variety of different ways.

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Incorporating visual supports, such as physically modeling a task, labels, or boundary markers helps a child with a developmental delay, children better understand what is expected of them, so they are less likely to engage in problematic behavior.

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Creating Consistency to Aid Brain Development in Babies

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The developing brain thrives on repetition. When a baby experiences the same things over and over, the pathways of connections in her brain become stronger and more complex. One of the best ways to provide repetition for the developing brain is to create consistency in the child's world.

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12 Disability-Friendly Home Modifications You Can Implement Yourself

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How to Help a Child with a Developmental Delay - About Play

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It can be overwhelming if your child or one in your care is exhibiting signs of developmental delays. So what can you do to help?