“TIME IS BRAIN”

The Importance of the Timely Evaluation of Global Developmental Delays

Assessing a child with developmental delays, including language, gross motor, and fine motor delays, must include a thorough history, a detailed neurological physical examination and full complement of ancillary testing based on the child’s presentation.  However, the standard approach to a child with developmental delays is an evaluation that determines a behavioral diagnosis, such as autism, ADHD, language delay, etc. This type of evaluation is based on behavioral history and observation.  The outcome of these evaluations is a referral for therapies.  While behavioral observations can provide valuable insight into the behavioral diagnosis, they are likely to miss clues to the underlying neurologic, metabolic, or genetic cause.

Unfortunately, many clinicians who are qualified to evaluate children with neurodevelopmental delays or autism provide only a limited or rudimentary examination, often overlooking or missing important physical clues. One key reason for this is a lack of training in how to conduct a thorough neurological assessment, as most clinicians performing neurodevelopmental evaluations do not have specialized neurologic training. Therefore, the type of training a physician has is an important consideration when seeking an evaluation. 

Time is a thief for many of our children.  The longer treatment and therapies are delayed, the more is lost.  If these delays extend beyond certain developmental windows the gap becomes more challenging to bridge. 

The guidelines from organizations such as the American College of Medical Genetics (AGME), American Academy of Pediatrics (AAP) and American Academy of Neurology (AAN) all recommend an extensive evaluation, which includes routine laboratory testing, metabolic testing, genetic testing, and, when indicated, imaging and EEG.  Despite these recommendations, most children with developmental delays do not receive the recommended comprehensive work up.  Some have never even had blood drawn. 

How important is the work up?

Obviously, when the evaluation leads to a clear diagnosis the value is immeasurable.  Pinpointing the precise cause of developmental delays allows for proper counseling, avoidance of unnecessary tests, prognostication, tailored management, and in some cases individualized treatment.  This is in addition to the therapies and services the behavioral diagnosis provides.   Recent studies now report that upwards 40% of children with global developmental delays have a diagnosable condition, and this is steadily increasing.

This is why my approach to autism and developmental delays is focused on optimizing the child’s overall health while thoroughly investigating all potential underlying causes of their symptoms.