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Results for “developmental delay”

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PubMed2004

How do primary care physicians manage children with possible developmental delays? A national survey with an experimental design.

OBJECTIVE: Although early detection and treatment of developmental delays can improve outcome, little is known about factors that influence how primary care physicians manage young children with probable developmental delays. The objective of this study was to describe physician referral practices for children with developmental delays and to test whether the probability of referral is increased by 1) the expression of parental concern; 2) female gender in a child with language delay; 3) disruptive, as opposed to avoidant behaviors; and 4) physician characteristics, including female gender or being a pediatrician. METHODS: A cross-sectional survey was mailed to a national random sample of 800 pediatricians and 800 family practice physicians in primary care practice, using an experimental randomized block design. Recipients randomly received alternative variants of clinical vignettes, which differed only in regard to the variable specific to each of the first 3 hypotheses. Physicians answered questions about the likelihood of referral on a 5-point scale for listed referral options. Hypotheses were tested using multivariable logistic regression modeling. A total of 55% of pediatricians and 43% of family practice physicians returned the survey, for an overall response rate of 49%. RESULTS: A girl with language delay was 60% more likely to be referred to audiology than a boy (odds ratio: 1.6; 95% confidence interval: 1.1-2.3), and respondents who were female or pediatricians were more likely to refer patients. The expression of parental concern did not increase the probability of referral to diagnostic and treatment services, and avoidant rather than disruptive patient behaviors were associated with an increased probability of referral. CONCLUSIONS: Patient gender and type of behavioral presentation seem to influence referrals to diagnostic and treatment services for young children with probable developmental delays described in clinical vignettes. These findings can guide targeted educational interventions to increase rates of detection and referral for young children with developmental delays.

Child, Preschool↗
PubMed2005

Incidence of brain creatine transporter deficiency in males with developmental delay referred for brain magnetic resonance imaging.

Several case reports describe children with global developmental delay who have brain creatine deficiency, where the deficiency was due to a lack of creatine transport into the brain or altered creatine synthesis. The purpose of this study was to determine what percentage of males with developmental delay referred for brain magnetic resonance imaging (MRI) at the authors' institution in a 12-month period was found to have brain creatine deficiency due to a defect in the creatine transporter gene. In the authors' facility, single voxel proton magnetic resonance spectroscopy (MRS) is routinely performed on any male child age 2 to 18 years with a history of language and/or developmental delay referred for a brain MRI. Charts for the 12-month time period were retrospectively reviewed. Fourteen subjects met inclusion criteria for global developmental delay. Two of the 14 patients had brain creatine deficiency on MRS. In the remaining 12, other structural and white matter abnormalities were identified. This study suggests that brain creatine deficiency is an important consideration in the differential diagnosis of males with global developmental delay referred for brain MRI; brain MRS should be considered in such cases.

Adolescent↗
PubMed1995

[Effect of early intervention on the interaction of developmentally delayed infants and their mothers].

The purpose of this study was (1) to examine the interaction patterns of mothers and their developmentally delayed infants during free play and instructional episodes; (2) to investigate the influence of an early intervention program on the interaction patterns of mothers and their developmentally delayed infants; and (3) to investigate to what extent the maternal perceptions and expectations, perceived stress and involving motivation were associated with maternal behavior while interacting with their developmentally delayed infants. The participants of this study were twenty-one developmentally delayed infants and their mothers. Each mother-child dyad was videotaped in a laboratory playroom for 10-minutes of free play and a 5-minute instructional session. Mental and psychomotor development of the child were measured by Bayley scale. The perception of child development, expectation, and the stress of mothers were measured by a self-report questionnaire which was designed by a researcher in this study. The mothers' motivation of involvement was evaluated by teachers. On year after early intervention, it was found that (1) developmentally delayed infants increased locomotion, (2) mothers demonstrated more positive emotional expression during mother-child interaction, and (3) the score of HOME, mother's involvement, and the quality of mother-child interaction which was evaluated by teachers were significantly increased. Furthermore, the differences between situations indicated that the developmentally delayed infants were more toy-oriented during play than instruction. The mothers tended to be more helpful in attitude while they instructed their children. The mother's perception of child development and stress were found to be the critical factors affecting maternal teaching, controlling, and caring behavior.

Child Development↗
PubMed2006

Bilateral medial rectus muscle recession: results in children with developmental delay compared with normally developed children.

PURPOSE: We sought to compare bimedial rectus muscle recession (BMR) results for esotropia in children with developmental delay with the results in normal children. METHODS: A retrospective analysis of all the children that underwent standard BMR surgery for esotropia during a 10 year period was undertaken. The surgical results of children with developmental delay were compared with those of normal children. RESULTS: In the developmentally delayed group, the mean angle of esotropia before surgery was 53+/-12 PD, the mean amount of medial rectus recession was 5.4+/-0.56 mm, 0.84 mm less than the standard amount of recession, and at the last follow-up visit only 56% achieved surgical success (within 10 PD of orthophoria). Among the failures, 86% were undercorrected, only one patient developed consecutive exotropia after surgery. In the developmentally intact group, the mean angle of esotropia before surgery was 37.4+/-8 PD, the mean amount of medial rectus recession was 5.2+/-0.65 mm, and 94% achieved surgical success. Among surgical failures, we observed only a single case of overcorrection. CONCLUSION: A higher rate of surgical failure was found in developmentally delayed children who received a smaller recession amount of the medial rectus muscles when compared with the developmentally normal children who received a standard amount of recession. The main reason for surgical failure in the developmentally delayed group, in a follow-up period of 2 years, was undercorrection of the angle of esotropia. It seems that decreasing the surgical table by a certain amount in children with developmental delay may lead to undercorrection. Therefore, we need to delineate the ideal amount of surgery in this unique group of individuals.

Child↗
PubMedDate not supplied

Comparison of grating and Vernier acuity in infants with developmental delay.

BACKGROUND: Grating acuity measured by Teller cards is mildly reduced in children with developmental delay. Vernier acuity, the ability to detect offsets, also can be measured, but has not been studied in children with developmental delay. METHODS: In a prospective cross-sectional pilot study, 12 nonverbal children with developmental delay established by pediatric assessment of developmental milestones were tested binocularly with vernier and Teller cards. Ages ranged from 4 to 24 months. Vernier offsets ranged from 2 to 64 minutes of arc. RESULTS: All children were testable with Teller acuity cards. Binocular grating acuity ranged from 1.7 to 7.4 cpd (median, 1.0 octaves below normal). Binocular vernier acuity ranged from unrecordable to 8 minutes of arc (median, "unrecordable"). Only four of the 12 children demonstrated a measurable vernier acuity. Normal children of this age have a vernier acuity of 2 to 16 minutes of arc measured by this technique. CONCLUSION: The response to vernier acuity cards appears to be more severely degraded by developmental delay than the response to Teller cards.

Child, Preschool↗
PubMed2001

Imaging of the developmentally delayed child.

Neuroimaging can aid in determining the causes of developmental delay in a child. Information from neuroimaging examinations may help guide further testing and treatment in these children. This article emphasizes the neuroimaging approaches, modalities, and features in the child with developmental delay. The common causative categories of developmental delay are reviewed.

Brain↗
PubMed1992

Social skills and their correlates: preschoolers with developmental delays.

Fifteen preschool-age children with mild mental retardation (developmental delays) from mainstreamed schools were observed during two structured play sessions with matched peers without mental retardation. Children with developmental delays spent more time alone and when they played, showed less social play. The two groups did not differ on communication behaviors that maintained play or in negative affect; however, the children with developmental delays evidenced more disruptive entry, more regressive behaviors, and less positive affect. Families were interviewed concerning their attitudes about, and teaching of, social skills. For the children without mental retardation, level of social play was positively related to the family's teaching and the child's communication abilities. For the children with delays, social play related to developmental age and communication ability but not to family teaching.

Child, Preschool↗
PubMed2006

The economic impact of early life environmental tobacco smoke exposure: early intervention for developmental delay.

BACKGROUND AND OBJECTIVES: Early-life exposure to environmental tobacco smoke (ETS) can result in developmental delay as well as childhood asthma and increased risk of cancer. The high cost of childhood asthma related to ETS exposure has been widely recognized; however, the economic impact of ETS-related developmental delay has been less well understood. METHODS AND RESULTS: The Columbia Center for Children's Environmental Health (CCCEH) has reported adverse effects of prenatal ETS exposure on child development in a cohort of minority women and children in New York City (odds ratio of developmental delay = 2.36; 95% confidence interval 1.22-4.58). Using the environmentally attributable fraction (EAF) approach, we estimated the annual cost of one aspect of ETS-related developmental delay: Early Intervention Services. The estimated cost of these services per year due to ETS exposure is > Dollars 50 million per year for New York City Medicaid births and Dollars 99 million per year for all New York City births. CONCLUSION: The high annual cost of just one aspect of developmental delay due to prenatal exposure to ETS provides further impetus for increased prevention efforts such as educational programs to promote smoke-free homes, additional cigarette taxes, and subsidizing of smoking cessation programs.

Air Pollution, Indoor↗
PubMed2001

Profile of referrals for early childhood developmental delay to ambulatory subspecialty clinics.

The objective of this study was to determine the profile and pattern of referral to subspecialty clinics of young children with suspected developmental delay together with the factors prompting their referral. All children under 5 years of age referred to either developmental pediatrics or pediatric neurology clinics at a single tertiary hospital over an 18-month period were prospectively identified. Standardized demographic and referral information were collected at intake, final developmental delay subtype diagnosed was identified, and referring physicians were surveyed regarding factors prompting referral. A total of 224 children met study criteria. There was a marked male preponderance (166/224), especially among those with either cognitive or language delay. Two delay subtypes, global developmental delay and developmental language disorder, accounted for two thirds of the diagnoses made. For slightly more than one third of the children (75/224), the delay subtype diagnosed following specialty evaluation was different from that initially suspected by the referring physician. A mean delay of 15.5 months was observed for the cohort as a whole between initial parental concern and specialty assessment. For referring physicians, the major factor prompting referral was the severity of the observed delay. The most important aspects of the specialty evaluation according to referral sources were the identification of a possible etiology and confirmation of delay. A profile of referrals and the rationale thereof for a cohort of children with suspected developmental delay is presented that, although locale specific, has implications for service provision and training.

Ambulatory Care↗
PubMed1999

Effects of testing context on ball skill performance in 5-year-old children with and without developmental delay.

BACKGROUND AND PURPOSE: Physical therapists often test ball-playing skills of children with disabilities using standardized testing, which may not predict performance of ball skills in games with peers. This type of testing is used by physical therapists to determine whether children have delays in ball-handling skills. The purpose of this study was to compare ball skill performance of children with and without developmental delay in a one-to-one testing situation and in a structured game with peers. SUBJECTS: Five-year-old children with developmental delay (n=20) and 5-year-old children without disabilities (n=20) participated in the study. METHODS: We used the Peabody Developmental Motor Scales receipt and propulsion scale to test children one-to-one with a therapist and during a structured game with peers. RESULTS: Subjects without developmental delay performed better than subjects with developmental delay under both testing conditions. Children with developmental delay performed better in the one-to-one testing condition than in the game with peers. The performance of children without developmental delay did not differ under the 2 conditions. Boys performed better than girls. CONCLUSION AND DISCUSSION: Physical therapists should consider the potential effect of environment on the ball-handling skills of children with disabilities.

Analysis of Variance↗
PubMed2006

Value of gadolinium in brain MRI examinations for developmental delay.

The aim of this study was to evaluate the added utility of gadolinium administration in the magnetic resonance imaging evaluation of developmental delay in children less than 2 years of age. A computerized retrospective study identified all brain magnetic resonance imaging examinations using gadolinium performed at our institution from 1995-2002 for children under the age of 2 years. Review of the clinical records and magnetic resonance imaging reports identified 170 brain magnetic resonance imaging examinations that were performed for developmental delay. Magnetic resonance imaging studies with enhancing lesions were reviewed by two staff neuroradiologists and two radiology residents. Contrast administration was rated as essential, helpful, or not helpful for each study. In the 107 patients in whom developmental delay was the primary concern, there were no cases in which the findings would have been missed without gadolinium administration. In the 63 patients in whom developmental delay was a secondary concern, there were several cases (11%) where contrast was helpful but not essential in reaching a radiologic diagnosis. In conclusion, intravenous gadolinium has an extremely low yield in children under the age of 2 where developmental delay is the primary concern. In young children for whom developmental delay is a secondary concern, we advocate the use of gadolinium particularly where tumor or infection is clinically suspected.

Age Factors↗
PubMed1982

Developmental delay in infants with congenital heart disease. Correlation with hypoxemia and congestive heart failure.

The mental and motor development of 173 infants with congenital heart disease was assessed by means of the Bayley Scales of Infant Development and clinical neurological examinations. The relationship between age, sex, congestive heart failure, hypoxemia, hospitalization, and test results was evaluated. The presence of congestive heart failure was found to be significantly associated with both mental and motor development delay. Hypoxemia and hospitalization were associated with delayed motor development. Developmental delay could be recognized as early as 2 months of age.

Age Factors↗
PubMed2005

Controlled exertion of force by developmentally delayed young men and women.

Present purposes were to examine the characteristics of controlled force exertion in 28 developmentally delayed young people (14 men, 14 women), and sex differences compared to 28 normal young students (14 men, 14 women). The subjects matched their submaximal grip strength to changing demand values displayed in a bar chart on the display of a personal computer. The total sum of the differences between the demand value and grip exertion value for 25 sec. was used as an evaluation parameter for the test. The controlled force exertion was significantly poorer for he developmentally delayed group than for controls, and there were large individual differences. The developmentally delayed men scored poorer than women in coordination. Like the controls, the means between trials did not decrease significantly. For these developmentally delayed subjects, performance did not improve after only a few trials. The controlled force-exertion test is useful as a voluntary movement-function test for developmentally delayed subjects.

Adolescent↗
PubMed2000

Ocular manifestations in children with developmental delay preliminary report.

To investigate systemic diseases and ocular problems among children with developmental delay, forty-one children (28 boys and 13 girls with a mean age of 3.53 +/- 2.25 y/o) were enrolled in this study. In addition to ocular examinations, we used centrality, steadiness, fixation and flash visual evoked potentials (VEPs) tests on all of the children. We found that 23 children (56.10%) had ocular problems with optic atrophy and strabismus being the two most common ocular abnormalities. The two major clinical manifestations of developmentally delayed children were mental and motor retardation. The primary test of centrality, steadiness and fixation and visual evoked potentials could be useful tools in evaluating the visual pathway and ocular motility. Preliminary results showed that more than half of the children with developmental delay had certain ocular abnormalities. The high incidence of ocular abnormalities deserves careful attention when these children are brought to seek medical help. Further study of ocular problems among developmentally delayed children and a search for more reliable examination method should be encouraged.

Child↗
PubMed2004

The expression of pain in infants with developmental delays.

OBJECTIVE: To explore how infants with developmental delays express pain, we analysed facial expressions of infants receiving their routine immunization at around 4-6 months developmental age. The sample included eight infants with developmental disabilities (mean developmental age 4.8 months) and 30 typically developing infants (mean age 4 months). The Maximally Discriminative Facial Movement Coding system was used to code infant facial expressions during immunization. RESULTS: The pain expression was by far the most common of all facial expressions following immunization for both groups of infants. Those with disabilities produced significantly fewer discrete high-intensity expressions of pain, and significantly more blended expressions than typically developing infants. Expressions of fear, sadness and anger were relatively infrequent in both groups. Infants with disabilities used their upper face less often than typically developing infants, and their mid face was uncodeable more often. CONCLUSION: Infants with developmental delays were likely to show pain in facial expressions less clearly than typically developing infants. It is important for health care professionals to be aware that this may be the case when considering the administration of analgesia for such children.

Developmental Disabilities↗
PubMed1999

Mild developmental delay due to ring chromosome 19 mosaicism.

Children with mild developmental delay without dysmorphic features do not often have identifiable underlying aetiological factors. We report on a 5-year-old girl with mild developmental delay and dysmorphic features which were previously unrecognized. She was found to have supernumerary ring chromosome 19 mosaicism which was the likely cause of her clinical problems. Her parents' chromosomes were normal. A careful examination for dysmorphic features should be done in all children with developmental delay. However, these may not be readily apparent in babies and very young children. Chromosomal analysis to identify a genetic cause and to offer genetic counselling should be considered in all such children unless the clinician is absolutely certain that there are no dysmorphic features.

Child, Preschool↗
PubMed2005

Developmental delay--identification and management.

BACKGROUND: Developmental delay occurs in up to 5% of children under 5 years of age. This includes delays in speech and language development, motor development, social-emotional development, and cognitive development. General practitioners are in an ideal position to play a central role in the early detection of developmental and behavioural problems in young children. OBJECTIVE: This article discusses the advantages and disadvantages of various methods health professionals use to assess children's development. It recommends ongoing developmental surveillance (rather than point-in-time assessment) and a multidisciplinary approach. DISCUSSION: In a busy general practice, obtaining parent reports of development is a good "first line screen", and an efficient and effective way of selecting out children who require a more detailed assessment and/or referral. Early intervention is essential for optimising developmental progress in the delayed child.

Child Development↗
PubMedDate not supplied

Social-emotional behavior of preschool-age children with and without developmental delays.

Differences in parent and teacher ratings of social-emotional behavior among young children with developmental delays and those without significant developmental problems were examined. Participants included 198 preschool-age children identified as having a developmental delay (DD group) and 198 preschool-age children without significant developmental problems (Comparison group) who were matched to the DD group by age and gender, using a randomized block procedure. Parent and teacher perceptions of social-emotional behavior of the participants were assessed using the Preschool and Kindergarten Behavior Scale (PKBS), a social skills and problem behavior rating scale for the use with young children. PKBS scores were found to classify the participants into their respective groups with a substantial degree of accuracy. Statistically significant differences in social skills and problem behavior scores between the two groups were found, with the DD participants evidencing greater social skills deficits and problem behavior excesses than the Comparison group. Individuals in the DD group were found to be four to five times more likely to have significant social skills deficits and problem behavior excesses than individuals in the Comparison group. The critical social-emotional behaviors separating the two groups appeared to be social interaction and independence skills, and socially withdrawn and isolated behavior patterns. New validity evidence for the PKBS is discussed, as are future needs pertaining to research and clinical practice in the area of social-emotional behavior of young children with developmental delays.

Child, Preschool↗