Abstract
This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2–4 months and from 2–4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.
Highlights
Many children have a neurodevelopmental disorder, such as cerebral palsy (CP), intellectual disability or autism spectrum disorder (ASD)
The latter is presumably due to underdiagnostics, as suggested by the prevalence data of Taiwan, which indicated that improved diagnostics were associated with a five-fold increase in the prevalence of ASD between 2000 and Neurodevelopmental disorders form a heterogeneous group of disorders
Neuroimaging is certainly helpful in early diagnostics, especially in infants who start post-natal life in neonatal intensive care
Summary
Many children have a neurodevelopmental disorder, such as cerebral palsy (CP), intellectual disability or autism spectrum disorder (ASD). The limited data suggest that the prevalence has been increasing during the last two decades [7] They indicate that the prevalence of CP is at the high end of the prevalence range in high income countries [8,9], whereas the prevalence of intellectual disability is higher and that of ASD is lower than that in high income countries [10]. The rapid developmental changes underlying neural plasticity interfere with early detection It takes developmental time before signs of specific disorders emerge. The review’s body on the early detection of developmental disorders (Section 3) is preceded by a summary of the developmental changes in the brain in early life (Section 2) It is followed (in Section 4) by a concise review of early intervention approaches used in young children with or at high risk of developmental disorders (for details see reference [16]).
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