Diagnosis Of Developmental Delay Research Articles

Assessment of cortical gyrus and sulcus formation using MR images in normal fetuses.

The purpose of this study was to estimate the development of the gyrus and sulcus formation in normal fetuses on the basis of the neuroanatomical findings using MR images in relation to gestational age. The MR images were obtained from 109 normal fetuses from 18 to 39 weeks of gestation with no neurological problems. The MR images were classified into 8 stages of development for the gyrus and sulcus formation in the frontal and temporal lobes on the basis of the neuroanatomical findings reported by Chi et al. (1977) and Dorovini-Zis and Dolman (1977). We examined retrospectively the relationship between our classification and gestational age in comparison with the five-stage classification proposed by McArdle et al. (1987). There were significant differences in the gestational age among the 8 groups (P < 0.001). Multiple comparison of individual groups revealed significant differences in the gestational age among the groups (P < 0.05). Images from 28 to 34 weeks of gestation were classified into 4 stages in our classification, while being covered by one stage in McArdle's classification. Our classification is useful for the assessment of fetal cerebral maturation during the third trimester of pregnancy and may contribute to the prenatal diagnosis of developmental delay of the gyrus and sulcus formation.

Démarche diagnostique devant une déficience mentale de l’enfant en 2002

The identification of an etiology in children with mental deficiency is a major challenge in routine pediatrics. As the result of a workshop leaded by the Société française de neurologie pédiatrique (SFNP), we propose a three steps diagnostic procedure, taking into account several frequent clinical observations leading to further targeted investigations. The yield of systematic imaging and biological screening remains very low, when performed for a non specific isolated mental retardation, without any characteristic clinical features. Yet, it is mandatory for an accurate genetic counseling to know not only the clinical diagnosis of developmental delay, but also the pathophysiology and the underlying molecular mechanism. The SFNP’s proposal points out the necessity of a comprehensive clinical process including cautious neurodevelopmental assessment, reliable cognitive and adaptive skills evaluation, and collaboration between different specialists.

Health Care Use by Children Diagnosed as Having Developmental Delay

Although children with developmental delay are known to have increased health care use, it is unclear what proportion of that health care use is related to associated chronic health conditions. To assess the prevalence of isolated developmental delay and to determine the role of developmental delay in health care use controlling for chronic health conditions. Retrospective cohort study using Washington State Medicaid claims records from November 1, 1990, to December 31, 1997, an administrative data set that contains both International Classification of Diseases, Ninth Revision, Clinical Modification codes and billed services. Children born between November 1, 1990, and December 31, 1992, diagnosed as having developmental delay before the age of 5 years, enrolled in Medicaid within 1 month of birth, and continuously enrolled for at least 12 months. Four control subjects per case were matched on date of birth and duration of continuous enrollment in Medicaid. Visits to physicians, emergency departments, other practitioners, or hospitals by year of life. One thousand two hundred forty-two children having developmental delay and 5370 children without developmental delay were included. One percent of those who met study criteria had developmental delay without chronic health conditions and 30% of the children with developmental delay had no associated chronic health conditions. Boys were 1.6 times as likely to have a diagnosis of developmental delay. Developmental delay was independently associated with increased health care use by all 4 measures used. Developmental delay increases health care use apart from associated chronic health conditions.

Oropharyngeal airway diameter during sedation in children with and without developmental delay

Study Objective: To determine whether children with developmental delay would have closer apposition of upper airway tissues during sedation, perhaps because of poor coordination of upper airway musculature. Design: Case-control and retrospective chart review. Setting: Tertiary-care pediatric teaching hospital. Patients: 40 children 3 to 6 years of age, with and without a diagnosis of developmental delay. Measurements: Subjects received only pentobarbital sedation by a protocol. Magnetic resonance imaging (MRI) scans of the head were reviewed, and transverse airway diameters at the soft palate and tongue were determined from midline sagittal images. Main Results: Age, weight, sedative dose, MRI window level, and window width were not different between patients with and without developmental delay. We found the airway diameter at the level of the soft palate was decreased 40% in children with developmental delay compared with those children without delay, 3 mm (1.4, 5.5 interquartile range) versus 5 mm (3, 8); p = 0.035, power 76%. Conclusions: The anteroposterior oropharyngeal airway diameter was smaller in children with developmental delay than in those without developmental delay, in static MRI images. It is possible that children with developmental delay are at higher risk for airway obstruction during sedation.

Diagnosis of developmental delay: the metabolic biochemist's approach

The clinical detail of 'developmental delay' or the shortened form 'Dev Delay' upon a request form often brings gloom to the heart of a Metabolic Biochemist. The comment often seems to have been written either as a detail of last resort or in such haste that other more important details are omitted. The tests required are often complex and may have to be referred to reference laboratories and all too often, the wrong sample taken at the wrong time, into an incorrect container has been sent and all from a patient in whom it is difficult to obtain samples. Cooperation and communication between all the professionals, paediatricians, biochemists, geneticists and others leads to much improved diagnosis and management of patients as well as targeting limited resources appropriately. It is important to carefully plan the investigations of a child with developmental delay early diagnosis is crucial for several reasons (Table 1). Early identification of developmental delay relies on careful clinical skills as well as developmental screening. 1 Many important treatable biochemical causes of developmental delay have a slowly progressive, almost insidious clinical course which can only be identified by careful observation and detailed assessment many children with these conditions are diagnosed extremely late. 2'3 If such assessments are

Diagnosis of developmental delay: the geneticists approach

Of the 2% of children with developmental delay, perhaps half have an underlying genetic basis for this, although in some this will be due to altered gene expression in only some cells. In some there will be identifiable single genes at fault with predictable inheritance patterns, others may have recognizable chromosome anomalies, but for 2/3 a diagnosis may remain obscure. While for the paediatrician or geneticist the lack of diagnosis may appear as 'failure', contrasting with other diagnostic 'successes', this need not necessarily be the view of the parents. The first approach to 'delay' is to explore whether the parents also recognize that their child has a problem, and if so whether they would welcome a 'label' for this or not. The second rule is to avoid offering a diagnosis unless one is certain; the removal of a 'label' particularly if this destroys a previous nurtured identity with a particular support group can be similarly traumatic.

Pediatric Assessment of the Child with Developmental Delay

With the recent mandate for early intervention services, the pediatrician is more involved than ever in the identification and evaluation of children with developmental disabilities. Developmental surveillance at routine visits and listening to parental concerns are crucial in the early diagnosis of developmental delay so that therapeutic interventions can be provided at a time when there is a good chance of decreasing disability and family stress. Medical evaluations and consultations must be prudent and based on a thorough history and physical. The pediatrician must have the knowledge and skills to coordinate medical care and to counsel and provide support to the child and family as they receive habilitative services and come to terms with the developmental diagnoses.

Impact of delayed development in premature infants on mother-infant interaction: A prospective investigation

We examined events that precede a diagnosis of developmental delay by comparing 16 very low birth weight premature infants whose condition was diagnosed as developmental delay at 18 months corrected age with 16 matched developmentally normal infants. All infants were observed with their mothers during maternal visits to the nursery and during home visits 1, 3, 6, and 9 months after discharge. The mothers' reactions to their infants were rated at these times. All the children were followed up at a neonatal clinic, and detailed clinic records were used to document the time when a physician first suspected a delay and when this delay was first mentioned to the mother. The results indicate that parents had usually been told of their child's handicap by the time the child was 6 to 9 months old; yet mothers of the delayed children changed the interaction with their children as early as 1 month after discharge from hospital. These mothers initially touched, smiled at, and talked to their developmentally delayed infants significantly more often, but by 9 months they did so much less often than mothers of nondelayed children. The degree of change in mothers' behavior was related to their psychosocial background, with better-adjusted mothers showing the most change. We conclude that mothers' statements about their infants are usually valid and that physicians may share their potential concerns about infants more freely.

Use of Denver Developmental Screening Test

In Reply.— We would agree with VanDervoort and Lee that the Denver Developmental Screening Test is a screening instrument and as such does not make a diagnosis of developmental delay. We referred to the test because it had been administered to all infants and because it represents a commonly known set of developmental landmarks. It was our purpose to emphasize the differences between the group of infants who had grade IIB or grade III hemorrhage with posthemorrhagic hydrocephalus and the infants in other categories.