Global developmental delay (GDD) is defined as a delay in two or more developmental domains of gross/fine motor, speech/language, cognition, social/personal, and activities of daily living, affecting children under the age of 5 years (Mithyantha, 2017). The resulting impairments in the domains are dependent on the varied degrees of delay i.e., the gap between the chronological age and the functional age of the child.
It can be:
- Mild- when the functional age is <33% below the chronological age
- Moderate- when the functional age is 34%-66% below the chronological age
- Severe- when the functional age is >66% below the chronological age
CAUSES OF GDD
- Exogenous causes: Occurs due to external factors such as exposure to teratogens.
- Endogenous causes: These are usually genetic and are present at birth. Global developmental delays will also occur due to various syndromes such as Down’s syndrome and fragile x syndrome.
- Other causes of GDD can include premature birth, disorders such as cerebral palsy, and infections such as meningitis or congenital rubella.
DIAGNOSIS AND TREATMENT
Establishing a diagnosis of GDD requires a multi-disciplinary approach including assessments by professionals from multiple disciplines such as pediatricians, neurologists, physiotherapists, speech-language pathologists, occupational therapists, and a child psychologist. A genetic test conducted by a geneticist also will be required in syndromic cases of GDD. An accurate diagnosis will enable clinicians to define the treatment strategies required to meet the child’s needs.
The treatment for each child with GDD can vary according to the child’s delays in multiple domains. It can include physical therapy, speech, and language as well as feeding therapy, occupational therapy, etc. to help the child develop skills. Early diagnosis and intervention are crucial for children with GDD.
A comprehensive history and physical examination are the basic investigation procedures. Laboratory tests 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
ROLE OF A SPEECH-LANGUAGE PATHOLOGIST
An SLP’s role in the GDD intervention includes,
- Assessment
- Speech and language therapy
- Feeding/ swallowing therapy
- Parent counseling
The speech-language pathologist will carry out a thorough assessment first in order to determine the language age of the child and thus quantify the speech and language delay. The speech-language pathologist will assess the child’s receptive and expressive language and will also screen for any feeding and swallowing difficulties.
An SLP will work to improve the child’s understanding of the language as well as the verbal output. Other means of communication such as AACs will also be recommended as per the child’s capabilities and needs. In the case of syndromes like Down syndrome or cerebral palsy, the strength, steadiness tone, and range of movement of the oral and facial musculature can be affected too which can affect their speech and can cause difficulties in feeding. In such cases, the intervention will include oro- motor exercises to improve the muscle and help with feeding.
Most importantly, SLPs have a crucial role in parental counseling and training. Speech-language pathologists should counsel the parents about their child’s speech and related difficulties and the prognosis.
REFERENCES
- Mithyantha R, Kneen R, McCann E, et alCurrent evidence-based recommendations on investigating children with global developmental delayArchives of Disease in Childhood 2017;102:1071-1076.
- Evaluation of the child with global developmental delay and intellectual disability by, Stacey A Bélanger, Joannie Caron. Paediatrics& Child Health, Volume 23, Issue 6, September 2018, Pages 403–410, https://doi.org/10.1093/pch/pxy093
- Specialeducationalneeds.co.uk
- Momsbelief.com
- Sltforkids.co.uk
