While all children grow and develop in unique ways, some children experience delays in their development. Recent estimates in the U.S. show that about one in six children between the ages of 3 and 17 have one or more developmental disabilities. Minor, temporary delays are usually typical and have no cause for alarm. Alternatively, significant ongoing delays or a halt in development can be a sign of greater challenges to come. Early intervention is key! With the right interventions, children with developmental delays can learn the necessary skills to have a better quality of life.
Diagnosing a Developmental Delay
If you suspect your child has a developmental delay, it is important to speak with your child’s pediatrician. He or she can perform some basic screening tests in the office. Developmental delays sometimes indicate an underlying condition that only doctors can diagnose. Oftentimes, your child’s pediatrician will refer you to a developmental pediatrician. A developmental pediatrician is a sub-specialty of pediatrics with expertise in developmental disorders in adolescence. In the school setting, developmental pediatricians often act as advocates, by providing documentation and support to assist your child in receiving necessary services.
After the Diagnosis
Once you get a diagnosis of a developmental delay, you can set a plan for therapies or other early interventions to help your child’s development into adulthood. Treatment often includes occupational therapy, speech therapy, and physical therapy services. Individual states are responsible for defining what a developmental delay is, the services they provide, and the ages the services apply to.
The IDEA gives individual states the option to use a definition of developmental delay in addition to specific disability categories in order to determine eligibility for special education and related services. States are able to use this definition for children ages three to nine, or a portion of this age range. Here in Pennsylvania, children from birth to age 5 with developmental delays and disabilities benefit from a state-supported collaboration between parents and service practitioners (*from birth to age 3 are early intervention home-based services often provided by states).
For states that define the term ‘developmental delay’, children may qualify for special education and related services using that state-determined definition even if they do not fall under one of the specific disability categories. Once the child ages out of the state’s age range, in order to continue receiving services they must fall under one of the specific disability categories. At this point, a new evaluation must be completed to determine if your child falls under one of the IDEA disability categories.
Developmental delays include delays in one or more areas of development including communication, cognition, social-emotional, behavioral, physical, adaptive, or motor skills. You may often hear the term “global developmental delay” which is a significant delay occurring in two or more of these areas.
Cognitive Developmental Delays
Cognitive developmental delays affect a child’s intellectual functioning and adaptive behaviors, interfering with awareness and causing learning difficulties. You may find this term used interchangeably with intellectual disability, cognitive impairment, and cognitive/intellectual disorder. Cognitive developmental delays are the most common types of developmental disorders. Children with cognitive delays may also have difficulty communicating and playing with others.
Some intellectual delays are more evident after a child is in school but others are apparent at a younger age. Observing your child regularly will allow you to spot delays in milestones. By six months, your child should be able to watch and follow moving objects with their eyes, smile at people or bring things to their mouth. By twelve months your child should start to know familiar faces and show affection. In toddlers, look out for difficulty understanding instructions, remembering things, and challenges in using actions to communicate.
Cognition is the process of acquiring and understanding knowledge through our thoughts, experiences, and senses. If a child lags in their ability to acquire and understand the information received through their thoughts, experiences, and senses, it is often a sign there is a cognitive delay. The cognitive delay is not caused by the child’s senses but rather their perception. For example, a child with a cognitive delay may have perfect hearing, but she may not be able to listen or understand when you speak with her. Her perception may be that the sound is too low, too high, or just too difficult to decode.
Cognitive delays can also be a symptom of an underlying developmental disorder so it is important to follow up with a developmental pediatrician. Such underlying disorders include dyslexia, ADHD, autism spectrum disorder and other genetic disorders.
In most cases, it is not possible to identify a clear reason for this type of delay. Possible medical reasons that could lead to an increased risk of a cognitive delay include, but are not limited to, a brain injury due to an infection causing swelling in the brain (encephalitis), shaken baby syndrome, seizure disorders, prenatal medical problems, and chromosomal disorders that affect intellectual development.
In many cases, children diagnosed with cognitive developmental delay will be referred to an Occupational Therapist (OT). An OT will help your child develop skills required for everyday activities and interactions with people and the environment. The OT should work together with your team of experts including a psychologist, a special educator, and a pediatrician for accurate evaluation and for charting out an effective intervention plan.
Motor Developmental Delays
Motor skill developmental delays may be related to problems with gross motor skills or fine motor skills. Delays in gross motor skills interfere with a child’s ability to coordinate large muscle groups, such as those in the arms and legs. Infants with gross motor delays may have difficulty rolling over or crawling; older children with this type of delay may seem clumsy or have trouble walking up and downstairs. and smaller muscles, such as those in the hands. Children with fine motor delays may have difficulties holding onto small objects, such as toys, and a spoon, or doing tasks such as tying shoes or brushing their teeth.
Physiotherapists focus more on gross motor skills, which are the movements using the large muscles of the body. The therapy focuses more on skills like walking and problems like poor balance and muscle weakness.
Occupational therapists focus on fine motor skills, the movements of the small muscles of the body. Fine motor skills refer to precision, dexterity, and coordination of the hands. An OT will help develop fine motor areas including bilateral coordination, pinch and grip strength, separation of the sides of the hand, arch development, and finger isolation.
Motor skill developmental delays are often due to underdeveloped muscles or can be due to other possible causes including, but not limited to, premature birth, ataxia, cerebral palsy, spina bifida, cognitive delays, and myopathy.
Social-Emotional (Behavioral) Developmental Delays
Children with developmental delays, including those with related neurobehavioral disorders such as autism spectrum disorder and attention deficit hyperactivity disorder, often have social, emotional, or behavioral delays as well. Due to differences in brain development, they may process information or react to their environment differently than children of the same age. These delays can have an impact on a child’s ability to learn, communicate, and interact with others.
It is common for children with developmental delays to have difficulty with social and emotional skills. For example, they may have trouble understanding social cues, initiating communication with others, or carrying on two-way conversations. They may also have difficulty dealing with frustration or coping with change.
Children with social-emotional delays often find the classroom environment a confusing and stressful place, instead of a safe, inclusive learning environment. When the environment becomes too socially or emotionally demanding, children with social-emotional developmental delays may have trouble adapting (i.e. prolonged tantrums, take longer than other children to calm down). Often feeling misunderstood, delayed students may be unable to form meaningful relationships with peers, bond with the teacher or control their emotions, which in turn may lead to uncontrollable emotional behavior. This behavior is often a signal that the child needs more support by modifying his or her environment or learning skills to cope with social and emotional challenges.
These students can be taught the skills they need in order to adapt positively in the classroom and beyond. One of the most important ways a teacher and support staff can encourage self-control and appropriate social interaction for social-emotionally delayed students is to model the desired behavior. Other ways in which to help these students is by role-playing “conflicting situations” and how they can be solved in an appropriate positive manner. It is important to have individual and group therapy time so that during group the child has the opportunity to apply what they have learned.
Communication and Speech Developmental Delays
Language and speech developmental delays in children are very common in toddlers and early adolescents. Speech refers to verbal expression, including the way words are formed. Language is the broader system of expressing and receiving information, such as being able to understand gestures.
Some speech delays are receptive language disorders, in which a child has difficulty understanding words or concepts. Children with this type of speech delay may have trouble identifying colors, body parts, or shapes. This communication disorder affects a child’s ability to understand what others say, what one’s actions mean, identify objects, and follow instructions. The meaning of language is often unclear and a child may respond in ways that may not make sense to the question directed to them.
The other type of speech delay is an expressive language disorder, in which a child has a reduced vocabulary of words and complex sentences for his or her age. A child with this type of speech delay may be slow to babble, talk, and create sentences. There are often weaknesses in using words independently and most of the time a child with this type of delay will require modeling by repeating after someone else says the word. Often, a child with a speech delay has a combination of receptive and expressive delays.
Children with an oral motor problem—such as weakness in the muscles of the mouth or difficulty moving the tongue or jaw—that interferes with speech production have what is known as a speech production disorder.
Children may have speech delays due to a multitude of reasons including, but not limited to, physiological causes (brain damage, hearing loss, genetic syndromes), environmental factors (lack of stimulation, exposure to more than one language), a learning disability and neurological disorders. Sometimes a delay can be due to a physical weakness in the muscles controlling speech, a disorder called dysarthria. In many instances, however, the cause of a child’s speech delay is unknown.
If you or your child’s doctor suspects a speech delay, seek out an evaluation by a speech-language pathologist. This specialist may test your child’s hearing, assess your child’s receptive and expressive language, and then plan for speech therapy sessions with your child. If the delay is mild, it may just be a matter of small tweaks like communicating and reading more with your child and reinforcing speech and language throughout the day. If it is more severe, a speech therapy plan will be developed and your child will have individual and/or group speech therapy sessions. Group speech is helpful with both receptive and expressive language disorders so never discount the group!
I know it can be worrisome when you believe your child may have a developmental delay but be sure to share any concerns about development with your health care provider. They see children every day and will be best equipped to tell you if they believe there are concerns regarding development and if you need to be referred to a specialist. If you’re interested in an evaluation, they can also give you a referral to an early intervention agency in your state. It is never too early to get services to help accommodate your child and provide them the resources to help them grow.