Atik Indryani, Corina lisa, Eggy Argumi, Suriviana

 Delay is said to exist when a child does not reach developmental

milestones at the expected age.
 There are five main groups of skills that make up the
developmental milestones. A child may have a developmental
delay in one or more of these areas
1. Gross motor: using large groups of muscles to sit, stand, walk,
run, etc., keeping balance, and changing positions.
2. Fine motor: using hands and fingers to be able to eat, draw,
dress, play, write, and do many other things.
3. Language: speaking, using body language and gestures,
communicating, and understanding what others say.
4. Cognitive: Thinking skills including learning, understanding,
problem-solving, reasoning, and remembering.
5. Social: Interacting with others, having relationships with family,
friends, and teachers, cooperating, and responding to the
feelings of others.
 This may seem to be a simple definition but in actual
clinical practice may be a complicated process to
determine.
 The reasons behind this are as follows:

1.There is a wide variation as to what constitute

'normal'. Indeed, normality is infinitely more variable
than abnormality and allowance has to be given to
cover a broad variation in children's abilities.
2.Children's developmental skills are continuously
evolving making it difficult to decide if the delay is
something permanent or transient in nature.
3. A common pitfall committed even by doctors is to
say that 'the child will outgrow' the delays even
before an extensive evaluation has been made
1. Genetics : Down syndrome, fragille X, etc
2. Enviromental
Prenatal Maternal Factors Substance abuse (drug/alcohol)
Chronic illness (diabetes)
Previous stillbirths or miscarriage
Perinatal factors Prematurity
Low birth weight
Obstetrical problems (toxemia, bleeding)
Neonatal factors Sepsis, meningitis
Seizures
Bleeding
Hypoxia
Jaundice
Postnatal factors Exposure to lead, other toxins
Seizures
Meningitis/Encephalitis
Growth retardation
Socio-environmental Factors
Child abuse/neglect
Poverty
Stressful life events (death, divorce)
Single, teenage parent
The family history
 There are two types of tests that can be done, developmental
screening and developmental evaluation.
 Developmental screening is the administration of a brief
standardized tool that aids the identification of children at risk of a
developmental disorder.
 A diagnosis cannot be made simply by using a screening test. If the
results of screening test suggest a child may have a developmental
delay, the child should be referred for a developmental evaluation.
 Standardized evaluation of development is indicated in the
comprehensive evaluation of a child who has developmental delay.
These may include tests of general intelligence, language, fine
motor skills, gross motor skills and social adaptation. The selection
of test should relate to the child's condition and should provide a
profile of the child's strengths and weaknesses, not just a series of
scores.
 The tests to be valid must also be administered by competent and
trained
 Developmental Surveillance: recognizing children who may be at
risk of developmental delay
 Developmental surveillance & screening
algorithm
within a pediatric preventive care visit

Copyright ©2006 American Academy of Pediatrics Council on Children With Disabilities, et al. Pediatrics
 Developmental Disabilities
Mental Health Problems
Without tools: 20%
Without tools: 20%
With tools: 80-90%
With tools: 80-90%

Palfrey et al. JPEDS.1987.

The Prevalence of Children with Disabilities

Approximately 12-16% of children have disabilities
Only 30% of children with disabilities are detected before school entrance
Earls & Shackelford, Pediatrics, 2006; Glascoe, Pediatr Review, 2000
 7 out of 10 pediatricians always identified potential
problems via clinical assessment (e.g., surveillance)
without the use of a screening instrument

 Only 23% use a standardized tool

 Of those tools used, Denver II was used most

frequently

Sand et al., Pediatrics, 2005

 sensitivity specificity
 ASQ 72% (51-90%) 86% (81-92%)

 Denver II 56%-83% 43-80%

 PEDS 75% (74-79%) 74% (70-80%)

Squires, 1999; Glascoe, 2006; Glascoe, Pediatrics, 1992

 There are no standard or routine laboratory
studies indicated for a child with developmental
delay.
 The decision to choose a particular diagnostic test

will depend on the etiologic cause being

implicated as a cause of developmental delay.
 The test selections are varied and wide-ranging

which includes genetic studies, imaging studies,

metabolic studies, and electrophysiologic tests
(EGG, BEERA)
 Multidisciplinary approach involving many disciplines providing a variety of
effective educational and therapeutic interventions depending on the
specific nature and/or etiologic cause of developmental delay.
 Early intervention services may include: Speech and language therapy,
Occupational therapy, Physical therapy, and Sensory integration.
 Additional treatment includes : health maintenance, treatment of underlying
cause (if possible), treatment of associated conditions, relief of symptoms,
anticipatory guidance to prevent secondary complications and
environmental support (Lipak, 1996)
 The prognosis of a child with developmental delay varies widely according
to the type and severity of the underlying disorder.
Through early
identification
of
developmental
delays
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