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Developmental Delay

What is developmental delay?

Developmental delay can be defined as a delay in one or more developmental milestones in a child under the age of 6.

These developmental milestones include:
• Motor skills: fine and gross
• Language: expression and comprehension
• Intellectual capacities
• Daily living skills
• Social skills
• Autonomy

If the delay is minor, we refer to a lagging behind in development.
If the delay is major or concerns two or more domains of development, we refer to global developmental delay.

What are the signs of developmental delay?

Developmental delay can be detected at various ages by:
• The parents: they are often the first to be concerned that their child is not meeting the developmental milestones for their age
• The paediatrician: their role is preventative and to alert in case of developmental delay
• Primary school or kindergarten: child care workers, kindergarten assistants and teachers are familiar with observing the stages of development and in the institutional setting are able to compare with the development of other children.

How to diagnose developmental delay?

Let’s start by taking a look at how the brain works…

At any one point in time, our brain is carrying out complex procedures to gather and process the information it encounters. In order to do so, it uses what are known as "cognitive functions". Cognitive functions can be defined as the cerebral activities that lead to knowledge (cognition). They include all types of mechanisms for acquiring information, namely:

  • Functions non-focused on emotions: reasoning, attention, memory, language, motor skills, planning etc.
  • Functions focused on emotions: functions known as affective and social

It is thanks to the efficiency of our cognitive functions that we can participate in the world around us and learn. When a child has difficulties learning or being in the world, it means that there are deficits or at least difficulties with one or more of their cognitive functions.

Due to the complexity of the brain and it’s functioning, an exploration of the different capacities that may have an influence on the relationship with the world and learning, is essential. For example, children with autism often display varying difficulties that should be assessed, such as emotional, social, attention, language-based and mobility impairments.

A developmental assessment

Assessment for children under the age of 6 years

If a developmental delay is suspected before the age of 6, a developmental assessment can be carried out. This involves assessment of the child’s stage of development in relation to that of other children of the same age. The following aspects are examined:

  • Motor skills: fine and gross
  • Language: expression and comprehension
  • Intellectual capacities
  • Life skills
  • Social skills
  • Autonomy

A developmental assessment enables the detection of deficits as well as helping to make diagnostic hypotheses and to orient the therapeutic care plan as well as psychoeducational strategies at school and at home.

Under the age of 6, the child is in a stage of phenomenal neuronal and psycho-affective development. The diagnostic hypotheses based on the developmental assessment should be verified around the age of 6 once the brain functions are not in such a major phase of development.

As the brain functions are still in the process of developing, we cannot expect, for example, a 3-year-old to have fully developed attentional capacities and to be able to concentrate. For this reason, this cognitive cannot be assessed. Certain cognitive functions cannot be assessed before the age of 6.

Therefore, a full psychological and neuropsychological assessment at the age of 6 allows for the diagnosis to be confirmed or otherwise and for an evaluation of the totality of the cognitive functions in depth. In the meanwhile, psychological treatment can be offered to assist the child in their development.

Importance of a full assessment of cognitive, emotional and social functioning at the age of 6

In case of a suspected developmental delay, for children from the age of 6 and above, a full psychological and neuropsychological assessment must be carried out. The full assessment links together cognitive development with emotional and affective development.

* Neuropsychological assessment examines cognitive development. It analyses the totality of the cognitive (brain) functions. By exploring the symptoms displayed by the child, it enables deficits of any of the brains functions to be identified. It examines the following cognitive aspects of the child:

  • Attention: selective, sustained, divided / visual, auditory, audio-verbal
  • Executive functions: planning, flexibility, working memory, speed of information processing
  • Language: expression and comprehension
  • Memory: visual, verbal, visuospatial etc.
  • Reasoning: verbal, perceptual, crystallised, fluid
  • Social and emotional skills: perception and comprehension
  • Visuospatial skills
  • Motor skills

* Psychological assessment examines emotional and social development. It allows the psychologist to identify the specificities of a child’s personality and whether or not any disorder is present. It examines the following psychological aspects of the child:

  • Level of personality organization
  • Level of adaptation to reality
  • Level of emotional adaptation
  • Level of social adaptation
  • Individual issues
  • Emotional state

Assessment objectives

The assessment helps to respond to several questions.

What difficulties is my child being faced with?

The evaluation allows for difficulties to be identified and for a diagnosis or diagnostic hypothesis to be proposed. It enables:

  • Understanding the nature of the difficulties faced by the child: are signs of cognitive and/or emotional/affective/mental deficits present?
  • Evaluating the severity of the deficits and the level of skills
  • Examining the consequences on the psychological functioning and the autonomy of the child of these deficits or disorders: are they affecting learning, social interaction, emotional regulation? If so, how and to what extent?
  • Ascertaining the resources available to the child that can help them to develop

How to deal with these difficulties?

The evaluation can guide the follow-up treatment and maximise the learning potential and well-being of the child. The objective is to help the child to flourish on all levels - academic, social and emotional. The evaluation helps:

  • Parents to better understand their child, respecting the child’s limits and providing better adapted support
  • To provide parents with the knowledge required to explain their child’s needs and get them help from the relevant services
  • To develop an effective therapeutic care plan adapted to the child’s needs (benefiting from the services of neuropsychology, psychology, occupational therapy, speech therapy etc.)
  • To develop an efficient individual education plan adapted to your child’s needs (psychoeducational strategies at school and at home, teaching assistants, collaboration with teachers etc.)
  • To provide the child with a vocabulary that gives meaning to the difficulties faced. Better understanding of the causes of suffering can provide comfort. For example, a child who knows that they have difficulties learning or learns differently may feel like a failure. However if he or she understands their difficulties, they can accept them and approach things in a different way. The final stage is to help the child to feel capable of overcoming, to whatever extent is possible, their difficulties and therefore engaging in the treatment plans offered. Indeed, motivation is the central factor in the success of treatment.