Neurodevelopmental Disorders
Global Developmental Delay (GDD)
What is it?
A condition where a child under 5 seems to be falling behind developmentally, but the degree of impairment cannot be reliably assessed.
A child is diagnosed with GDD when they fail to meet expected developmental milestones in several areas of functioning. This applies to children who are unable to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardised testing. Here are the various developmental domains where delays can occur:
1) Fine & Gross Motor skills:
Ψ Movements related to smaller muscle groups (e.g. muscles in the hand & wrist, usually requires more control and precision) and
Ψ Large muscles (e.g. muscles in legs and arms, used for broader movements)
E.g., Inability to sit without support by 9 months or inability to bear weight on legs and stand up by 12 months
2) Cognitive skills:
Ψ Ability to think, learn, problem-solve, recall and retain information
3) Speech and Language skills:
Ψ Ability to use, express and understand language
E.g., unable to say a few simple words by 12 – 15 months of age, or having difficulty understanding others
4) Social and Emotional skills:
Ψ Ability to express, connect and relate to other people
E.g., poor social and communication skills at 6 months, when most children would be able to make eye contact when interacting or responding to voices
5) Activities of Daily Living:
Ψ Ability to complete daily tasks in general (e.g. dressing, eating, and bathing)
To qualify for a diagnosis of GDD, a child would have to show impairment in at least 2 of the domains above. GDD manifests differently according to the rate of progress and the domains children show difficulties in. It is usually identified through routine developmental surveillance or screening following parental concerns, or after third parties like preschool teachers or nursery care professionals raise concerns.
Causes
A variety of causes, with most being genetic, biological, or environmental in nature. Here is a non-exhaustive list of some possible causes:
Ψ Genetic: Down syndrome, caused by chromosomal abnormalities; or fragile X syndrome, which is an inherited type of cognitive impairment
Ψ Biological: Premature birth is a risk factor for GDD
Poor nutrition, and alcohol and drug exposure before and during birth.
Alcohol exposure is also a contributing factor towards fetal alcohol syndrome, which is linked to intellectual impairment.
Ψ Environmental:
Growing up in a violent family environment
Experiencing traumatic events in childhood
While there are several reasons accounting for GDD, it can be challenging to pinpoint the exact factors resulting in GDD. In fact, in a significant proportion of cases, the cause of GDD is unknown.
Addressing GDD
Considering the huge impact that GDD has on various facets of life, is there any intervention available for GDD?
Ψ Early intervention
Early intervention is vital in supporting a child in reaching their full potential.
Provided by Early Intervention Programme for Infants & Children Centres (EIPIC centres), early intervention should ideally be intensive and long-term. It works best when tailored to a child’s individual needs and underlying diagnosis. Identifying developmental challenges early helps to tailor the intervention towards addressing the child’s core needs.
When it comes to facilitating learning, it is best for the process of learning to be simple, repetitive, and systematic for them to remain interested and develop knowledge. Simultaneously, children with GDD should also undergo relevant therapies depending on the difficulties they face. Common forms of therapies include physiotherapy, occupational therapy, speech and language therapy, and psychotherapy.
Ψ Psychotherapy
Behavioural intervention can be administered.
It is helpful to guide the child on what is appropriate and subsequently modify any maladaptive behaviour. There are a few ways of correcting their behaviour, such as rewarding desired behaviour and shaping behaviour towards healthier and adaptive directions rather than aggressive or self-injurious behaviour.
However, do understand that certain negative behaviours often serve a function for the child to meet some needs. For instance, a child’s aggressive or disruptive behaviour might be an attempt to express themselves in spite of their language delays.
Considering that GDD is diagnosed when one is under the age of 5, it would be good to conduct periodic reassessments at key points in the lifespan to identify ongoing difficulties (especially those that impact learning and academic performance) and target interventions and resource needs for children who continue to struggle. Periodic assessments can highlight areas of intervention working well for the child, as well as any areas that require extra resources.
Supporting the Child and Their Family
Intervention should also be focused on the family as well – after all, the family is an important system in influencing the child’s progress!
To ensure the child receives sufficient care, it is important to have the knowledge and resources for doing so. Parents should also watch out for themselves to prevent burnout – caring for a child with GDD can be stressful at times given that such children require extra help for certain tasks. Parenting support can come in the form of goal-oriented counselling to help them cope with the demands of caregiving. Likewise, parents may also undergo short-term behavioural therapy or skills training sessions to learn solutions that cater to their needs. For instance, they might be taught assertiveness skills that can help cope with their child’s tantrums.
On the family’s end, they can implement their own version of early intervention within the home itself. Some things to try out:
Ψ Play and read with them, show them how to do certain tasks or break it down into simple steps to facilitate their learning
Ψ Offer support when they participate in activities of daily living and praise them when they perform a certain task successfully
Ψ Create a stable learning environment that is sensitive to the children’s needs as this will facilitate progress
Ψ Having a clear structure of daily routines and tasks will also help children to expect what needs to be done everyday and react accordingly at appropriate times
It is important that the child is provided with nurturing and supportive familial care – this increases the chances of the child leading a healthy and full life, especially when this is provided early in life.
Prognosis
It depends on the severity. For some, the delay in development is short-term. In such cases, this delay can be addressed with additional forms of support or therapy mentioned above. These children can eventually catch up to their peers and grow up to be independent adults. However, there are also severe cases with significant developmental delays. It will be good to be prepared for the fact that some impairments may persist throughout life. In such cases, it is good to administer long-term therapy to ensure that the benefits of early intervention do not decrease over time.
Nevertheless, with the right intervention, children with GDD can learn life skills allowing them to integrate into mainstream society and enjoy an enhanced quality of life. In some cases, children with mild and moderate GDD might also be able to join mainstream schools too. Similarly, family intervention also helps a child with GDD thrive as their parents and caregivers are equipped with proper training and receive support as well.