Global developmental delays are a subset of developmental disabilities defined as a significant delay in 2 or more of the following developmental domains;

  • Gross/fine motor
  • Hearing, speech/ language
  • Cognition
  • Social/personal
  • Activities of daily living.

GDD usually follows the usual pattern of development, but with a delay. According to DSM 5, Diagnosis of GDD is limited to children under 5 years of age. GDD is a common problem with wide etiology.  A selective investigation is useful for finding the cause. Finding the exact cause is important for further rehabilitation.

Causes of GDD (adapted from Forsyth & Newton, 2007)

  • Genetic or syndromic- eg; Down’s syndrome, fragile X syndrome
  • Metabolic – eg; urea cycle disorder
  • Endocrine
  • Traumatic- acquired brain injury
  • Environmental causes- eg; poor stimulation at home
  • Cerebral malformation – eg; neuronal migration disorder
  • Cerebral palsy and developmental coordination disorder
  • Infections – eg; perinatal rubella, CMV, Neonatal meningitis
  • Toxins – eg; maternal alcohol in pregnancy, childhood lead toxicity


Diagnostic evaluations

A comprehensive history and physical examination are the basic investigation procedures.  Laboratory testings can be considered after conducting proper basic evaluations.

Recommended laboratory investigations are,

  • Metabolic screening
  • Cytogenic testing
  • Fragile X testing
  • Rest syndrome testing
  • Thyroid screening
  • Neuroimaging
  • Lead screening
  • EEG evaluation
  • Hearing and visual testing




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