1. Normal and abnormal psychomotor development
Katalin Hollody

2. Developmental milestones

4. Gross motor milestones
mean age (months)
Head up in prone position 1
Chest up in prone position 2
Up on elbows in prone position 3
Head control 3
Up on hands or wrists in prone position 4
Roll over prone to supine 4
Roll over supine to prone 5
Sit supported (tripod) 5
Creep
Get to sit 7
Crawl

5. Gross motor milestones
mean age (months)
Pull to standing 8
Cruise
Walk
Walk backward 14
Run

6. FINE MOTOR MILESTONES age (months) Fisted birth Unfisted 3
Reach and grab 4
Transfer 5
Rake from the surface 6
Immature pincer 9
Mature pincer 10
Voluntary release 12

9. INDICATIONS FOR REFERRAL FOR DELAYS AND DISORDERS
OF LANGUAGE AND SPEECH
Age
Finding
Birth and at any age
Lack of response to sound
Lack of interest in interaction with people
4 months
Lack of any drive to communicate
6 to 9 months
Loss of the early ability to coo or babble
Poor sound localization or lack of responsiveness
12 months
No verbal routines
Failure to use ma-ma or da-da
Loss of previous language or social milestones

10. INDICATIONS FOR REFERRAL FOR DELAYS AND DISORDERS
OF LANGUAGE AND SPEECH
Age Finding
15-18 mo
No single words
Poor understanding of language
24 mo
Vocabulary less than 50 words
No two-word phrases
Less than 50% of speech intelligible to strangers
36 mo
Rote memorization of words or phrases
Frequent immediate or delayed repetition of others’ speech
Flat or stilted intonation
More than 75% of speech unintelligible to strangers

11. AUDIOLOGIC EVALUATION
INDICATIONS FOR
AUDIOLOGIC EVALUATION
Family history of deafness
Prematurity
Perinatal complications
Ototoxic drugs
Congenital anomalies
Intrauterine infection
CNS infection
Delayed speech or language development
Parental concern about hearing loss

12. EYE EVALUATION SCREENING
congenital intrauterine infection
cerebral palsy
strabismus
nystagmus
cornea problems
cataracta
prematurity

13. RISK FACTORS FOR COGNITIVE DEVELOPMENTAL DELAY
2-3 mo not alert to mother, with special interest
6-7 mo not searching for dropped object
8-9 mo not interest in peek-a-boo
12 mo does not search for hidden object
15-18 mo not interest in cause-and-effect games
2 y does not categorize similarities
3 y does not know own full name
4 y can not pick shorter or longer of two lines
4,5 y can not count sequentially
5 y does not know colors or any letters
5,5 y does not know own birthday or address

14. RISK FACTORS FOR PSYCOSOCIAL DEVELOPMENTAL DELAY
3 mo not smiling socially
6-8 mo not laughing in playful situation
1 yr hard to console, stiffens when approached
2 yr kicks, bites, screams easily and without provocation
rocks back and forth in crib
no eye contact or engagement with other children and adults
3-5 yr in constant motion
resists discipline
does not play with other children

15. SLEEP REQUIREMENTS IN CHILDREN

16. PREVALENCE OF DEVELOPMENTAL DISABILITIES

17. EVALUATION OF THE PATIENT
History
detailed family history
search for other affected family members
consanguinity
prior gestational history (early postnatal death ?)
pregnancy with the affected child
timing, mode of delivery
birth weight, head circumference, Apgar score
duration of postnatal hospital stay
timing of developmental milestones
scholastic history
coexisting medical problems (sz, feeding, sleeping, behavior)

18. PHYSICAL EXAMINATION Careful observation Dysmorphology
Cutaneous markers
Hepatosplenomegaly
Height, weight
Head circumference, shape, fontanels, sutures
Focal neurological findings
Vision, hearing

19. EXAMINATIONS Cytogenetic/molecular genetic examinations
Metabolic work-up
Imaging (UH, CT, MRI, SPECT, PET)
Histology
Evoked potentials
EEG
Tests (Bayley, Brunet-Lezine, Budapest-Binet)

20. IDENTIFICATION RATES OF DEVELOPMENTAL DISABILITIES
Prevalence
cases/1000
MD is first
to make dg
Mean age at
identification (mo)
Ment. retardation 25 76 39
Learning disab. 75 12 69
ADHD
150 44 59 CP
2-3 99 10
Visual disab.
0,3-0,6 87 55
Hearing disab.
0,8-2 64

21. CO-MORBIDITIES
Behavior challenges     Psychiatric disorders      Seizures    Sensory impairments   Motor impairments      Sleep disorders      Recurrent vomiting      Autism

22. EVALUATION OF THE CHILD WITH GLOBAL DEVELOPMENTAL DELAY
Obtain a detailed history and examination
Refer for auditory and ophthalmologic screening
Consider metabolic studies
Obtain EEG, if history of seizures
Consider screening for autism or a language disorder
Is there a close family member with GDD?
yes no
Obtain specific tests for that disorder
(cytogenetic screen, subtelomeric rearrangements)
Are there features suggesting a specific dg?
-genetic diagnosis (e.g. dysmorphic features)?
specific test
-CNS injury or malformation (aphyxia, seizures, CP)?
MRI
-environmental problems (lead exposure)?
lead screen
-loss or regression of dev. milestones?
comprehensive evaluation: MRI, metabolic testing, EEG, cytogenetic screen

23. Multidisciplinary, comprehensive evaluation !
Consultation !
Multidisciplinary, comprehensive evaluation !
Second visit !
Early intervention !
Follow-up !