How to detect developmental delay/intellectual disability in children early?

Author: Xie Han, deputy chief physician, Peking University First Hospital

Reviewer: Jiang Yuwu, Chief Physician, Peking University First Hospital

What is Developmental Delay/Intellectual Disability?

Developmental delay/intellectual disability is a group of common neurodevelopmental disorders, which refers to cognitive and adaptive behavioral disorders that occur during the development process (before the age of 18), and are often comorbid with autism spectrum disorder, attention deficit hyperactivity disorder, epilepsy and other diseases. Global developmental delay is used for the diagnosis of children aged 5 years or less, referring to the significant delay in the development of two or more areas (gross or fine motor, language, cognition, personal-social and daily living activities) in children; intellectual disability is used for the diagnosis of children over 5 years old, when the relevant intelligence assessment methods are relatively stable and reliable. The causes of developmental delay/intellectual disability are diverse, including genetic factors, perinatal brain damage, sequelae of encephalitis, etc. This disease has a significant and lasting impact on children's body and mind, and imposes a heavy psychological and economic burden on the families of children and society.

For most children with developmental delays/intellectual disabilities, if they can be detected, diagnosed and intervened early, the prognosis may be better and the patients will have a better quality of life. Therefore, it is very important to find out whether a child has developmental delays/intellectual disabilities as early as possible.

How to detect developmental delay/intellectual disability in children early?

Simply put, we follow the laws of normal child development and use multi-dimensional indicators such as motor skills, personal-social interaction, language, hand-eye coordination, visual performance, practical reasoning, etc. at different age groups to preliminarily determine whether a child has developmental delay or intellectual disability.

For example, "lift at two months, turn over at four months, sit at six months, roll at seven months, crawl at eight months, and walk at one year old." This is the normal pattern of motor development in infancy. Specifically, a child will lift his head at two months old (with a vertical head stable), roll over at four months old, sit alone at six months old, roll at seven months old, crawl at eight months old, and walk alone at one year old. It should be noted that a child's motor development is not necessarily uniform, and some children may develop faster or slower at certain ages. Therefore, follow the formula to match your child's development. If the child develops a little slower at a certain time period, you should not be overly nervous.

Figure 1 Original copyright image, no permission to reprint

If a child, according to the above motor development rules, has a significant gap with other children of the same age at the corresponding age, we need to be alert to the possibility of motor development retardation. For example, if a child cannot lift his head at 3 to 4 months old or cannot sit at 8 months old, we should pay attention to the possibility that there is a problem with the child's development.

In addition to motor development, we also need to pay attention to language development in the early stages. Language development is an important reference indicator for early intellectual development. Babies will cry in the neonatal period, begin babbling at 3 to 4 months old, start learning to speak at 7 months old, have their first meaningful word at 1 year old, speak in short phrases at 1.5 to 2 years old, be able to use simple sentences to describe their daily life experiences at 3 years old, and be able to answer simple questions about the story after listening to it at 4 years old. Language development covers three aspects: pronunciation, comprehension, and expression, which is particularly important for early judgment of children's intelligence.

In addition to language, we can also make a preliminary judgment on the child's intelligence level by observing the child's reaction to the things around him. A 2-month-old child can smile, 3-month-old child starts to look at his hands, 4-5-month-old child starts to actively reach out for things, 6-month-old child can recognize acquaintances and strangers, 7-month-old child can understand his own name, 10-month-old child can imitate adult actions and wave, and 1-year-old child can have likes and dislikes for people and things.

In short, if parents observe their children's movements, language, external reactions, etc. and find suspicious performance that is lagging behind their peers, it is recommended that parents take their children to see a doctor in time and let the doctor determine whether the child may have developmental delay/intellectual disability so that the child can receive timely and effective treatment.

How are patients with developmental delay/intellectual disability treated?

Generally speaking, intellectual disability cannot be cured (parents should not believe in misleading propaganda that claims to cure intellectual disability and use unproven treatments to avoid harming children or causing significant economic losses); and the developmental delay of a considerable number of children is temporary and transient, and these children can return to normal more quickly through early detection and early active intervention. Although intellectual disability cannot be completely cured, early detection and early comprehensive treatment including symptomatic treatment, behavioral therapy, and rehabilitation training can significantly improve the quality of life.

The first is to treat the cause. We need to actively look for treatable causes. Eliminating the cause is often the most important way to improve a child's development and intelligence. If a child has a genetic metabolic disease, special diet therapy may have a good effect; if frequent epileptic seizures lead to intellectual disability, then actively controlling epileptic seizures is likely to significantly improve the patient's cognition.

The second is rehabilitation training. Rehabilitation training for patients with developmental delay/mental disability needs to be carried out under the guidance of professional physicians. This is a multidisciplinary collaborative treatment. Participants may include pediatricians, child neurologists, physical therapists, speech therapists, audiologists, psychotherapists, nutritionists, etc. At present, rehabilitation treatment for patients with developmental delay/mental disability is divided into two parts according to the treatment location: the first part is the corresponding training completed in the children's rehabilitation center of the hospital, including cognitive ability training, language ability training, social ability training, sensory integration training, etc. Because this part of the training often requires the assistance of corresponding equipment and is more dependent on the real-time guidance of rehabilitation therapists, it is generally recommended to go to the children's rehabilitation center in the hospital for treatment regularly. The second part is daily training that can be carried out at home, and perseverance is the key. For example, gradually cultivate children's daily living skills (such as independent eating, toileting, washing, etc.). For patients with developmental delay/mental disability, parents must be patient and encourage their children in the daily teaching process. They can first orally describe the method, and then gradually teach according to the decomposed movements. If necessary, give prompts or help, so that children can continuously improve their life skills in daily life.