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Global Developmental Delay

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Background

Babies and children usually learn important skills such as sitting up, rolling over, crawling, walking, babbling (making basic speech sounds), talking and becoming toilet trained as they grow up. These skills are known as developmental milestones and happen in a predictable order and usually at a fairly predictable age. While all children reach these stages at different times, a child with developmental delay may not reach one or more of these milestones until much later than expected.

A child may be described as having global developmental delay (GDD) if they have not reached two or more milestones in all areas of development (called developmental domains). These areas are:

  • motor skills - either gross motor skills like sitting up or rolling over and fine motor skills, for example picking up small objects
  • speech and language - which also includes babbling, imitating speech and identifying sounds, as well as understanding what other people are trying to communicate to them
  • cognitive skills - the ability to learn new things, process information, organise their thoughts and remember things
  • social and emotional skills - interacting with others and development of personal traits and feelings, as well as starting to understanding and respond to the needs and feelings of others.

You may also find it helpful to read Contact a Family's guide 'Developmental Delay'.

Credits

Last updated July 2012 by Professor J Turk, Professor of Developmental Psychiatry, St George's and the Institute of Psychiatry, University of London and Consultant Child and Adolescent Psychiatrist, Child and Adolescent Mental Health Neurodevelopmental Services, South London and Maudsley Foundation NHS Trust, London, UK.

What are the causes?

The most common causes of GDD are problems with the child's genes or chromosomes, for example Down syndrome or fragile X syndrome. Sometimes, problems with the structure or development of the brain or spinal cord may be the reason for a child having GDD. Other causes can include prematurity (being born too early), childhood infection (for example meningitis) or metabolic diseases, such as having an underactive thyroid gland (hypothyroidism) or other problems affecting babies before they are born. Toxic (poisonous substances) such as alcohol in the case of fetal alcohol syndrome can also contribute. For some children, the cause of the GDD is never identified.

How is it diagnosed?

As they grow, children's developments will be assessed regularly and if they aren't meeting the expected development milestones and levels of abilities, they may be referred for further more specialist assessment. It is likely a paediatrician (children's doctor) will see your child and if they suspect GDD they may ask questions regarding the child's progress. They may look at a child's development (checking out what exactly a child is able to do and when they became able to) and carry out medical tests to try to identify a cause for the developmental difficulties. Some families will be referred to a genetics service to see if there is a genetic cause for the difficulty.  Some children may be referred to further specialists such as psychologists, speech and language therapists or occupational therapists for further evaluations.

How is it treated?

Some children who do not reach developmental milestones may catch up later. Sometimes this happens without any additional support and these children have no permanent problems and go on to develop as expected.

Some children will require additional support to allow them to catch up with other children. Support may be with speech and language therapy, physical therapy, occupational therapy or other methods of support. Special educational input is a common and useful support. Your doctor or paediatrician will be able to discuss the type of support that is right for your child and how to go about getting it.  Children and young people with generalised developmental delay experience higher rates of emotional and behavioural difficulties than other children, so some of them may benefit from seeing a clinical child psychologist or a child and adolescent psychiatrist.

As a parent, it is natural to want to find ways to help your child develop as much as you can. You may want to speak to your GP, nurse or health visitor about strategies.

Some children may never catch up with the expected development milestones. This could be because there is an underlying condition that has not been diagnosed yet. For some families it can take many years to get a firm diagnosis or reason why their child is behind others.

Inheritance patterns and prenatal diagnosis

Inheritance patterns
This will depend on the underlying cause of the GDD. Infections are never inherited, although an infected mother can pass on an infection to her unborn child or during the birth. Down syndrome, the most common identifiable cause of significant developmental delay, is a condition caused by a change in the chromosomes so that there is one too many. However, it is usually not inherited - the main risk factor being increasing maternal age.  Conversely fragile X syndrome, the most common identifiable cause of inherited developmental delay is always passed on from one or other parent who may be unaware that they are at risk of doing so.

Prenatal diagnosis
This is dependent on the underlying cause of the condition. If there is a strong family history of individuals having GDD, then your doctor should refer you to a genetics specialist to discuss testing.

Is there support?

Brainwave

Tel: 01278 429089
Email: enquiries@brainwave.org.uk
www.brainwave.org.uk

Brainwave is a registered Charity in England and Wales No. 1073238, established in 1982. It works with children under 12 with a range of conditions including Autism, brain injuries including Cerebral Palsy and genetic conditions such as Down's Syndrome. Parents are shown how to carry out a daily exercise programme with their child.

Group details last confirmed June 2013.

If the underlying cause is known, then support can be offered by the relevant condition group. Information and support in the UK for general developmental delay is provided by Mencap and Enable (see entry Learning Disability). Information and support in the UK for developmental delay, brain injury and other conditions affecting development is provided by bibic (see entry Brain Injuries).

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