Definition

Abnormal Child Development (also Developmental Disorder) refers to impairment to one or more domains of development which usually involves failing to reach developmental milestones in an acceptable time.

Incidence

[1] [2]
7.0% in Australia

Age

0-6

Gender

More common in males

Aetiology

[3] [4]

Risk Factors

[5] [6]

Signs and Symptoms

  • Failure to reach developmental milestones
  • Developmental Regression
  • Abnormal Behaviour
  • Repetitive Behaviour
  • Disruptive Behaviour

Milestones

Age
Gross Motor
Fine Motor
Communication
Cognitive
Social
Newborn
  • Yawn
  • Cough
  • Sneeze
  • Stretch
  • Salivate
  • Suck
  • Swallow
  • Primitive Reflexes

  • Cry
  • Recognise voice
  • Respond to Human Voice
  • Respond to smell of mother's milk
  • Recognise mother vs stranger (2 weeks)
6 months
  • Extend arms in prone
  • Hands held out
  • Sit unsupported
  • Rolling prone to supine
  • Weight bearing
  • Hod feet
  • Feet to mouth
  • Hold Bottle
  • Vocalises
  • Mouthing
  • Smile
  • Smile at mirror
  • Smile at image
  • Looking to pick up toy
  • Imitates facial expression
  • Response to strangers
  • Peek-a-boo
  • Solid food
9 months
  • Standing while holding
  • Cruising
  • Rolling
  • Trying to crawl
  • Pincer grip
  • Crossing midline with hands



12 months
  • Walking with support
  • Stable sitting
  • Clasps hand
  • Casting
  • Pointing
  • Clapping
  • Words with meaning
  • Object permanence
  • Interest in books
  • Covers face for peek-a-boo
  • Kiss on request
  • Interest in book
18-24 Months
  • Running
  • Climbing Stairs
  • Throw a ball
  • Kick a ball
  • Tower of cubes
  • Self-feeding
  • Scribbling
  • Turning pages
  • Copy Vertical line
  • Two word phrases
  • Talking
  • Points out body parts
  • Words
  • Body parts
  • Pointing to pictures in a book
  • Imitation
3 years
  • Climbing stairs
  • Stand on one foot
  • Ride tricycle
  • Tower of 9 blocks
  • Help with dressing
  • Undo butoons
  • Copy Circle
  • Draw a person

  • Know gender
  • Count
  • Imaginative play
  • Cooperation
  • 2 step commanfs
  • Imaginative play
  • Cooperative play
  • Follow 2 step commands
4-5 years
  • Skipping
  • Jumping
  • Fully dress
  • Tie shoe laces
  • Copy square and triangle
  • More complex drawing
  • Questioning
  • Storytelling
  • Complex drawing
  • Questioning
  • Left / Right
  • Comparisons
  • Morning and Afternoon


History

  • Collateral histories from siblings and grandparents can also be helpful
  • Did anybody in the family go to special school or require extra help at school?
  • What fears do you currently have?
  • What support do you currently have?
  • How much do you interact with the child?
  • Domains
    • What is the child's play like?
      • How do they play with their toys?
      • Is the child restricted in toy choices or how they play?
    • What are the child's movements like?
    • What is the child's vision like?
    • What is the child's hearing like?
    • How does the child interact with family or other children?
    • What is the child's language like?
    • How does the child sleep?
    • How does the child feed?
    • How does the child behave?
      • How does the child respond if a parent is hurt or upset?
    • What are the child's strengths?
  • Is there anything else that might be important?

Pathophysiology

The cause of abnormal child development is varied but often results from insults or abnormalities to the brain, the central nervous system or muscles.

Prevention

Reducing risk factors can impact on the cause of disease.

Screening

Screening should occur during routine assessment of children by a general practitioner or child specialist in the first years of life.

Investigations

[7]

Bloods

Imaging

  • MRI Head - may reveal abnormality
  • CT Head (only if looking for calcification)

Other

  • In Depth Developmental Assessment by Paediatrician
  • Hearing and Vision Testing
  • EEG (if there are concurrent seizures)

Diagnosis

Diagnosis is often made clinically but the specific cause requires a range of tests. Often in mild disability, no cause is found.

Differentials to rule out

  • Transient Developmental Delay
  • Metabolic Disorders
  • Hearing or Visual Impairment
  • Child Abuse
  • Child Neglect

Treatment

Treatment varies widely based on the underlying cause.

Management

[8]
Management of patients involves on-going follow up my multiple services including general practitioners, nurses, paediatricians, physiotherapists, audiologists, speech therapists, occupational therapists,social workers, psychologists and educational institutions. If there is evidence of child abuse then the appropriate services must be informed and involved.

Complications

  • Major Depression
  • Carer Burden
  • Premature Death (related to reduced self-care and accidental harm)

Prognosis

Prognosis varies widely based on the cause and severity. A patient with a mild disability may be completely independent but a patient with a profound degenerative disability may have poor prognosis.

See Also

Developmental Delay - Information for Parents
Univesity of Melbourne Lecture - Child Development & Developmental Disability by G Antolovich (2016)
  1. ^ http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30Jun+2012
  2. ^ http://cirrie.buffalo.edu/encyclopedia/en/article/144/
  3. ^ http://www.rch.org.au/uploadedfiles/main/content/cdr/dev_delay.pdf
  4. ^ http://cirrie.buffalo.edu/encyclopedia/en/article/144/
  5. ^ http://www.rch.org.au/uploadedfiles/main/content/cdr/dev_delay.pdf
  6. ^ http://cirrie.buffalo.edu/encyclopedia/en/article/144/
  7. ^ http://www.rch.org.au/uploadedFiles/Main/Content/MedEd/fracp/Arch%20Dis%20Child%20Educ%20Pract%20Ed-2010-Horridge-Dev%20Delay%20article.pdf
  8. ^ http://www.rch.org.au/uploadedfiles/main/content/cdr/dev_delay.pdf