L4.2 Developmental Delay

Question 1

define DSM-V

Answer 1

• Intellectual or Global Developmental Delay Not Further Specified
• can be used in situations where there is clear evidence of significant intellectual or general developmental delay or disability, but criteria for another specific disorder are not fully met
• could be because additional clarifying data are required before one can make a diagnosis of Intellectual Disability, or because the individual is too young to fully manifest specific symptoms or unable to complete requisite assessments.
• is for individuals for whom severity has not been determined.

Question 2

describe global developmental delay

Answer 2

• reserved for individuals under the age of 5 years
• when the clinical severity level cannot be reliably assessed during early childhood
• diagnosed when an individual fail to meet expected developmental milestones in several areas of intellectual functioning, and applies to individuals who are unable to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardized testing
• requires reassessment after a period of time

Question 3

what are the causes of developmental delay

Answer 3

• transient: premature, illness or hospitalisation, family stress, lack of opportunity to practice skills
• persistent: unknown, developmental disabilities (5-10%)= cerebral palsy, autism, language disorders, Intellectual disability; Chromosomal (trisomy 21, Fragile X); Genetic (Tuberose Sclerosis, Metabolic); Syndromes – Williams, Sotos, Prader-Willi; Congenital and postnatal infections (Rubella, CMV, meningitis and encephalitis); Toxins (Fetal Alcohol Syndrome); Trauma ( Head Injury); Perinatal (Low Birth weight, hypoxia,)

Question 4

where do you see children with developmental delay?

Answer 4

• Government organisations: QLD health (hospital, community health, CYMHS), education QLD (schools, EDU’s), disability services QLD (FECS)
• Non-government organisations (NGOs)
• Private practice

Question 5

what occupations are likely to be affected by developmental delay?

Answer 5

• Toddlerhood: Feeding, play, sleep
• early childhood: Play and pre academic tasks, Self-care tasks
• Middle childhood: Self-care tasks, Academic tasks, Social skills and Community participation
• Adolescence: Self-care, Social skills and participation, Leisure, Pre-vocational skill development, Emotional health

Question 6

what are the challenges for children and youth regarding developmental delay

Answer 6

• Impact across multiple areas of occupational performance
• Variable severity (revealed over time)
• Wide range of diagnoses – accompanying impact on body structures and function – e.g. cardiac, musculoskeletal
• Cognitive impairment – ability to learn skills, importance of context
• Transfer of skills

Question 7

what are the challenges for caregivers regarding developmental delay

Answer 7

• Time to diagnosis, uncertainty about what is going on??, what is the prognosis???
• Parental adjustment to changed expectations and new roles
• Often a long-term problem/diagnosis – long term burden of care
• Involvement of multiple professionals

Question 8

when information gathering, how can you decide on what tools and methods to use & approaches? (for developmental delay)

Answer 8

tools and methods:

• The reason for referral or the client’s presenting functional problems interfering with participation in daily occupations determine structure of information gathering: Establishing if a significant delay exist; Determining a baseline; Basis for goal setting and intervention
• Child’s diagnosis, age and other related factors (context).
• Evaluation methods chosen (observation, history, objective) will depend on the frame of reference utilized. NB -All these are not mutually exclusive.

information gathering approaches:

• Interview
• Goal setting tools
• Analysis of activities and skills, occupational performance: Understanding of typical development and performance essential.
• Assessment of specific performance components to develop understanding of performance in relation to specific aspects, e.g., sensory processing
• Developmental assessment if needing to establish if delay exists, or baseline for intervention/change

Question 9

what are the goals for client/family centered intervention for children with developmental delay?

Answer 9

goals: purposeful and meaningful to client (parent/child?); family centred and measured functionally; Child’s occupational goals need to relate to daily family routines; Often targeted to family members rather than child
intervention: range of strategies available to address goals

Question 10

what are some approaches and frames of reference used by OTs for children with developmental delays

Answer 10

• Coaching (with parent): Occupational Performance Coaching
• Acquisitional Approaches – Teaching and learning, e.g., 4QM; Compensatory Approach; Psychosocial Approaches
• What probably won’t be effective: Cognitive Approaches (CO-OP); Neurodevelopmental Approaches

Question 11

what are different service models? (developmental delays)

Answer 11

• One to one – often most required for specific remediation
• Consultative – where service is being delivered by another person (caregiver, teacher etc)
• Group based – when children’s needs are best addressed by use of group dynamics
• Variety of intervention settings to meet needs:
  o Centre based- gross and fine motor and language
  o Home based- self-help and social skills
  o Community- participation focus
• Evidence suggests that early therapy and family intervention is beneficial for children with developmental delays

Question 12

why is early intervention the best for developmental delays?

Answer 12

• Greatest benefit when started in first year of life
• Enhances school achievement, more confident parenting, greater independence
• Better outcomes if child and parent focused

Question 13

what are some natural environments and naturalistic learning opportunities for children with developmental delays?

Answer 13

• Working in the most ecologically valid setting is desirable. This enables skill transfer to parents, preschool teachers, teachers etc.
• If working in a clinical setting ensure that strategies employed are transferable to home and community environments.
• Learn best through naturalistic learning opportunities – everyday activities
• Authentic activities – meaningful and developmentally appropriate for child
• Need to practice new skills in different environments to generalise and strengthen learning

Question 14

what are some home programmes for children with developmental delay?

Answer 14

• Participation related to outcomes
• Collaborative, goal oriented
• parents want support, interdisciplinary coordination, and prognostic information, without pressure to comply
• Partnership
• help parenting their child
• ongoing support to parents vital for motivation

Question 15

what are some things to consider when working with families with children with developmental delay?

Answer 15

• Often part of long-term involvement across multiple agencies
• Importance of sharing information with parents in timely manner and in format that is meaningful: Information literacy
• Underlying nature of child’s delay is often unknown – issues with coping with ongoing intervention
• Family need for support: Perceive greater support comes from centre based programmes

OTs often partner with community organisations to scaffold skills which enable community participation – THE ULTIMATE GOAL