User:R.kumar31/sandbox

Developmental Delay

Overview
The term developmental delay is defined as a severe lag in a child’s development. It refers to children between the ages of 0- 8 years, however, developmental delay can continue into later childhood. The term is used when children do not meet their developmental milestones, such as walking and talking, at the expected time. For example, typically developing children are usually able to say words such as ‘mama’ and ‘dada’ between the ages of nine and 15 months. A child with developmental delay may not be able to form such words until much later, like 24 months. It is important to note that children who are temporarily behind in meeting their milestones are not developmentally delayed. Developmental delay is a continuous issue that is observed across the developmental process. There are five key areas in which a child can be delayed. These include: Developmental delay can occur in one or more of these areas and is known as global developmental delay.
 * Cognitive skills
 * Social and emotional skills
 * Speech and language skills
 * Fine and gross motor skills

Cognitive Skills
These skills include the ability to learn, think, remember, and problem solve. A delay in this area can impact a child’s knowledge acquisition. There are warning signs that could signal a cognitive delay. For instance, infants engage with the world around them through reaching for objects, pointing, and gaze following. A lack of curiosity with their surroundings may suggest a delay. In toddlers, this may be presented in the form of inability to learn new words, how to count, and follow directions, like ‘put your pencil down’.

Emotional and social skills
Social skills are needed to interact with others. They also allow us to relate to others. Individuals can do this by listening and maintaining eye contact, among others. Typically developing infants show social skills through smiling and making noises to communicate with others. toddlers show their social skills by engaging in social play with other children and behaving cooperatively. Good emotional skills allow children to express and control their emotions effectively. This also includes recognising emotions in themselves as well as others. A delay in emotional development may lead to disruptive behaviour and not getting along with others. A delay in social and emotional development may affect many areas of an individual’s life. A plethora of research has found that delay in social and emotional development negatively impacts quality of relationships, academia, professional life, decision making, and pro-social behaviour.

Speech and language skills
Speech and language differ from one another subtly. Language is the entire system of communication that can be spoken, written or expressed through gestures. Language allows us to convey and understand meaning. Speech refers to the vocalisation of language. Good speech and language skills are important in effective communication with those around us. Typically developing children do this by using and understanding language. Babies show speech and language development by cooing and babbling, while toddlers and older children use words correctly and understand what is being said to them. Children with a developmental delay in this area may not be able to understand what is said to them and they may not be able to form sentences correctly and convey their meaning. It is important to note that some children may be able to pronounce words well but not be able to put them together. This is known as a language delay. Alternatively, a child with speech delay may be able to put words together coherently but not be able to pronounce them.

Fine and gross motor skills
Fine motor skills require the use of smaller muscle group to perform more precise tasks while gross motor tasks are performed with the use of bigger muscles. Delays in motor development can affect anything from holding a pencil (fine motor skill) to running or hopping (gross motor skills). Coordination and balance are also often affected. Early motor development is important because it serves as a foundation for more complex motor behaviours such as jumping up to catch a ball.

Causes
Specific causes of developmental delay are currently unknown. However, there are several risk factors that could contribute to the occurrence of developmental delay. Chief among them are birth complications, environmental factors and medical issues. Birth complications- Difficulties during the gestation period as well as during birth has an adverse effect on development. Babies who are born preterm, for example at 32 weeks, are slow to develop in their first year. Children born very early generally show developmental delay in motor abilities and growth rate compared to infants who are born at full term. A reason for slower growth rate is that babies born prematurely are smaller, therefore the development that takes place during the gestation period occurs after birth. Premature births may cause cognitive developmental delay because only 60% of the brain volume has developed. External issues such as infections and conditions like hypoxia (oxygen deprivation) can affect synaptic formation and brain maturation which can lead to cognitive deficiencies.

Environmental factors- environmental factors can have a profound effect on child development. Certain influences such as prenatal drug use can lead to delayed development. Several studies have found that that prenatal cocaine use leads to significant cognitive delay in the first two years of a child’s life. Another outcome of prenatal drug exposure is motor delay. Research has found that children exposed to drugs prenatally performed worse than children who were not exposed to drugs on motor tasks. Prenatally exposed children also have poor balance and muscle coordination. Factors such as poor socioeconomic background and lack of parental education can also play a role in developmental delay. Poor socioeconomic background is likely to impact the quality of nutrition which may lead to poor child development overall. Essential food groups such as fatty acids may be missing from diet and therefore can lead to cognitive delay. Children of parents with lower levels of education may not be provided with enough cognitive stimulation which may prolong cognitive delay. Families with lower socioeconomic status also tend to live in poorer areas that have a high lead content and other toxic substances which may increase risks of development delay (Bellinger, 2008).

Medical issues- issues such as hearing loss may lead to language development impairment because it affects acquisition of language, which in turn affects production of speech. Language delay may be more serious if the hearing loss occurs earlier in a child’s life. Additionally, prolonged hospitalisation in early toddlerhood may delay motor development because that is the period in which motor skills are developed and these are important because future motor skills build on these abilities.

Identification
Developmental delay is usually identified by the parent before any professional steps in. This is because a parent knows what is normal for their child. When concerns are raised with a professional, like a GP, about the presence of developmental delay, the child may be referred to a specialist such as developmental paediatrician or psychologist, for further assessment. Developmental assessment consists of three aspects: Developmental screening- It consists of a test that shows whether the child is developmentally delayed and needs more in-depth assessment. Developmental surveillance- A child is observed for a period to identify where the delay may lie. Diagnostic assessment- a child who has been identified as developmentally delayed will then be given a diagnostic assessment which identifies the child’s strengths. This information is used to plan the next steps to intervention.

Management
Currently there is no specific cure for developmental delay. However, delays in specific areas can be managed through various therapies, such as language and speech, physical, and occupational therapies. Successful management and treatment is possible if interventions are administered early on in childhood or as soon as the delay is identified. However, it is important to note that if developmental delay is a symptom of underlying condition, such as Down Syndrome, then the delay may only improve so much before plateauing. In that case, the underlying conditions need to be managed.

Differences between developmental delay and developmental disability
Developmental disability refers to physical and mental impairment that affects cognitive, language, motor functioning and independent living. Developmental disability occurs in 5-10% of the population. The two terms are often used interchangeably and indeed share similarities. However, there is a major difference between the two. Developmental delay is a temporary impairment that children can grow out of with appropriate treatment, whereas developmental disability is a chronic, lifelong impairment. Developmental disability can be managed but individuals cannot grow out of it.

Epidemiology
According to research, developmental delay affected 1-3% of children aged five years in the US in 2003. In 2011, roughly 11% of children aged four months to five years were at risk of having developmental delay. It was also found that boys were at an increased risk of developmental delay compared to girls.