Module ~ Developmental Delays

Unit Three: Developmental Delays

Objectives:

In this Unit you will learn about…

Developmental Delays & Difficulties
Early signs of Developmental Delays
Recognising At-risk children
• Early Intervention

1. Developmental Delays and Difficulties

In the previous section, we learnt about how a healthy child grows in all areas of
development. However, all children are not happy, healthy, and free of problems.
There are several kinds of problems that children may face.
Sometimes a delay or difficulty is recognisable and diagnosed before the child
comes to a preschool. In that case, a decision needs to be taken in consultation
with all professionals involved regarding the preschool education of the child. At
other times, signs of potential delays to come are recognisable in young children.
This is the category of children who show some early signs of difficulty, but as yet
do not show a diagnosable problem. They are called children ‘At-Risk’.
Every child develops at their own pace and the word ‘normal’ can cover a wide
range. Knowing about development and paying attention to delays and difficulties
in the early years is still the best way to minimize the negative effects of
developmental delays and help children bridge the gaps in development.
As we learnt in the previous Unit, early years are the foundation for most of the
later development. So too with delays and difficulties. The earlier they are
identified, the better it is to do something about them.
It is helpful to be aware of red flags for potential developmental delays in
children. The delays may be in any of the following -

• Language or speech
• Movement, or motor skills
• Emotional and social skills
• Thinking, or cognitive skills

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Sometimes, a delay occurs in many or all of these areas. When that happens, it is
called "global developmental delay." Global developmental delay may occur for
any of the following reasons:
• A genetic defect, such as Down syndrome
• Fetal alcohol syndrome, caused by a mother drinking alcohol during pregnancy
• Fragile X syndrome, an inherited type of cognitive impairment
• Severe medical problems developing soon after birth, often associated with
prematurity
• Brain damage at the time of birth
• Often no cause can be found
• Trauma to the brain caused due to injury

1. Early signs of Developmental Delays

Possible causes
A learning
disability
Hearing loss
Language and speech delays
By 3 years, a child-Cannot talk in short phrases
By 4 years, a child- Doesn't use sentences of
more than three words// Uses "me" and "you"
incorrectly What you can do
By 5 years, a child -Has trouble understanding
two-part commands with prepositions ("under" or Get hearing
"on")// Cannot give his or her first and last name checked.
// Doesn't use plurals or past tense the right Talk, sing, read to
way// Does not talk about daily activities the child.
Encourage speech

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Signs of Motor delays Possible causes

Vision problem
By 3 years, a child- Falls often and may have Muscular coordination
trouble going up and down stairs// Drools often problems
and has unclear speech// Has trouble working
with small objects//Cannot build a tower of more
than 4 blocks
By 4 years, a child-Cannot throw a ball
What you can
overhead//Cannot jump in place //Cannot ride a
tricycle// Cannot grasp a crayon between thumb
do:
Eye checkup.
and fingers or has trouble scribbling //Cannot
stack four blocks Encourage
physical
By 5 years, a child- Cannot build a tower of six activities
to eight blocks//Seems uncomfortable holding a
crayon //Has trouble taking off clothing //Cannot
brush teeth well //Cannot wash and dry hands//

Signs of Cognitive delays

Possible causes
By 3 years, the child -Has trouble
copying a circle// Cannot understand A poor learning environment
simple instructions// Does not become Neglect during infancy or early
involved in "pretend" or "make-believe" years. A wide
play // Shows limited interest in toys range of learning disabilities
By 4 years, the child -Shows no Exposure to alcohol or toxins during
interest in interactive games // Doesn't pregnancy
become involved in fantasy play// Developmental disorder
Cannot copy a circle
By 5 years, the child - Is easily
distracted// Is unable to concentrate
on a single activity for more than five
minutes
What you can do
Individual attention
Remedial education
Stimulating all the
senses
Giving activities
through all modes-
visual, auditory, touch
and movement.

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 Module ~ Developmental Delays

Signs of social-emotional
delays Possible causes
By 3 years, the child -Shows Neglect
little interest in other children Ineffective
//Has extreme trouble parenting
separating from parents or
caregivers // Has poor eye
contact
By 4 years, the child -Clings
or cries whenever parents What you can do
leave // Ignores other children Enriched understanding
// Doesn't respond to people Accept the child as he/she is
outside of the family // Lashes Listen when the child wants
out when angry or upset to communicate
//Resists dressing, sleeping, or Encourage the child
using the toilet
By 5 years, the child - Is
very fearful, timid, sad, or
aggressive much of the time,
or doesn't show a wide range
of emotions // Is unable to
separate from parents without
difficulty // Shows little
interest in fantasy play or
playing with other children

2. Recognising At-risk children

The presence of the below list of difficulty need not always mean that the child
has a delay, but you as a teacher will definitely have to do something
additional if your child/children are displaying any of these signs. Some early
signs of warning that teachers should look out for –

• Not being able to walk without falling down.

• Bumping and crashing into furniture and thresholds repeatedly.
• Not talking in any language.
• Not responding to name call.
• Not responding to loud noises.
• Not making eye contact with you even after a month of attending school.

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• Stay withdrawn from other children.

• Not showing much interest in any of the centre materials.

• Late talking, compared to other children

• Pronunciation problems
• Slow vocabulary growth, often unable to find the right word
• Difficulty rhyming words
• Trouble learning numbers, the alphabet, days of the week
• Extremely restless and easily distracted
• Trouble interacting with peers
• Poor ability to follow directions or routines.

4. Some commonly diagnosed disabilities

[from www.mayoclinic.org ]

Sometimes it is known at the time of the child’s birth that there is a difficulty/
disability. There may be several causes for the difficulties, genetic, prenatal
difficulties, perinatal (at the time of birth) difficulties or neonatal difficulties.
This section describes some of the common disorders diagnosed in early childhood.

A. Sensory Impairment
• Visual Impairment There are 4 levels of visual function, according to the
International Classification of Diseases -10 (Update and Revision 2006):
India uses similar classification based on the WHO classifications.
http://www.medindia.net/health_statistics/general/visualimpairment.asp
http://www.pbhealth.gov.in/pdf/DISABILITY%20GUIDELINES_With%20TOC_Version%204.pdf

a. Normal vision
b. Moderate visual impairment
c. Severe visual impairment
d. Blindness
Moderate visual impairment combined with severe visual impairment
are grouped under the term “low vision”: low vision taken together
with blindness represents all visual impairment.

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Signs of difficulty with vision are easily recognisable in the classroom.

Rubbing eyes, keeping objects very close to the eyes to see, bumping
into objects, complaining of blurring and watering of the eyes are some
signs to look out for. Complete blindness is of course easier to identify.

It is mandatory to consult an ophthalmologist as early as possible in

cases of visual impairment and follow the given instructions to the
letter.

▪ Hearing Impairment: Hearing impairment is the inability to hear as

well as someone with normal hearing. Hearing impaired people can
be hard of hearing (HOH) or deaf. If a person cannot hear at all,
then they have deafness. Hearing impairment may be inherited,
caused by maternal rubella or complications at birth, certain
infectious diseases such as meningitis, use of ototoxic drugs,
exposure to excessive noise and ageing. Around half of all deafness
and hearing impairment can be prevented if common causes were
dealt with at primary health care level. Early detection and
intervention are crucial to minimizing the impact of hearing loss on
a child’s development and educational achievements. In infants and
young children with hearing loss, early identification and
management through infant hearing screening programmes can
improve the linguistic and educational outcomes for the child.
Children with deafness should be given the opportunity to learn sign
language along with their families. Pre-school, school and
occupational screening for ear diseases and hearing loss is an
effective tool for early identification and management of hearing
loss. People with hearing loss can benefit from the use of hearing
devices, such as hearing aids, cochlear implants, and other
assistive devices. Thus a visit to an ENT specialist and specialised
institutes for Speech and Hearing deficits is mandatory.

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B. Neuromuscular disabilities

Cerebral palsy is a disorder of movement, muscle tone or posture that is caused

by an insult to the immature, developing brain, most often before birth.
Signs and symptoms appear during infancy or preschool years. In general, cerebral
palsy causes impaired movement associated with exaggerated reflexes, floppiness
or rigidity of the limbs and trunk, abnormal posture, involuntary movements,
unsteadiness of walking, or some combination of these.
People with cerebral palsy may have difficulty with swallowing and commonly have
eye muscle imbalance. People with cerebral palsy may have reduced range of
motion at various joints of their bodies due to muscle stiffness.
The effect of cerebral palsy on functional abilities varies greatly. Some people are
able to walk while others aren't able to walk. Some people show normal to near
normal intellectual function, but others may have intellectual disabilities.
Epilepsy, blindness or deafness also may be present.
People with cerebral palsy often have underlying developmental brain
abnormalities.

C. Speech and Language

Some of the early signs of speech and language defects, other than absence
of speech are:
Inconsistent response to being called by his or her name

Inconsistent response to sounds and simple verbal commands

Good response when instructions are given one on one, but poor response
when a general instruction is given.

Speech is not clear or is understood only by parents

Does not show interest in or interact and play with peers

Does not initiate activities or conversation spontaneously

Reacts inappropriately to touch, movement, sound or light

Is poor in imitating actions and words

Seems to be in a world of his own and talks or laughs to himself

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D. Autism Spectrum Disorders

Autism spectrum disorder is a serious neurodevelopmental disorder that impairs a
child's ability to communicate and interact with others. It also includes restricted
repetitive behaviors, interests and activities. These issues cause significant
impairment in social, occupational and other areas of functioning.
Autism spectrum disorder (ASD) is now defined by the American Psychiatric
Association's Diagnosis and Statistical Manual of Mental Disorders (DSM-5) as a
single disorder that includes disorders that were previously considered separate —
autism, Asperger's syndrome, childhood disintegrative disorder and pervasive
developmental disorder not otherwise specified.
The term "spectrum" in autism spectrum disorder refers to the wide range of
symptoms and severity. Although the term "Asperger's syndrome" is no longer in the
DSM, some people still use the term, which is generally thought to be at the mild
end of autism spectrum disorder.
The number of children diagnosed with autism spectrum disorder is rising. It's not
clear whether this is due to better detection and reporting or a real increase in the
number of cases, or both.
While there is no cure for autism spectrum disorder, intensive, early treatment can
make a big difference in the lives of many children.
Autism spectrum disorder impacts how a child perceives and socializes with others,
causing problems in crucial areas of development — social interaction,
communication and behavior.
Some children show signs of ASD in early infancy. Other children may develop
normally for the first few months or years of life, but then suddenly become
withdrawn or aggressive or lose language skills they've already acquired.
Each child with ASD is likely to have a unique pattern of behavior and level of
severity — from low functioning to high functioning. Severity is based on social
communication impairments and the restrictive and repetitive nature of behaviors,
along with how these impact the ability to function.
Because of the unique mixture of symptoms shown in each child, severity level can
sometimes be difficult to determine.

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However, within the range (spectrum) of symptoms, below are some common ASD
actions and behaviors.

Social communication and interaction

• Fails to respond to his or her name or appears not to hear you at times
• Resists cuddling and holding and seems to prefer playing alone — retreats into his
or her own world
• Has poor eye contact and lacks facial expression
• Doesn't speak or has delayed speech, or may lose previous ability to say words or
sentences
• Can't start a conversation or keep one going, or may only start a conversation to
make requests or label items
• Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like
speech
• May repeat words or phrases verbatim, but doesn't understand how to use them
• Doesn't appear to understand simple questions or directions
• Doesn't express emotions or feelings and appears unaware of others' feelings
• Doesn't point at or bring objects to share interest
• Inappropriately approaches a social interaction by being passive, aggressive or
disruptive

Patterns of behavior
• Performs repetitive movements, such as rocking, spinning or hand-flapping, or
may perform activities that could cause harm, such as head-banging
• Develops specific routines or rituals and becomes disturbed at the slightest
change
• Moves constantly
• May be uncooperative or resistant to change
• Has problems with coordination or has odd movement patterns, such as
clumsiness or walking on toes, and has odd, stiff or exaggerated body language
• May be fascinated by details of an object, such as the spinning wheels of a toy
car, but doesn't understand the "big picture" of the subject
• May be unusually sensitive to light, sound and touch, and yet oblivious to pain

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• Does not engage in imitative or make-believe play

• May become fixated on an object or activity with abnormal intensity or focus
• May have odd food preferences, such as eating only a few foods, or eating only
foods with a certain texture

Most children with ASD are slow to gain knowledge or skills, and some have signs of
lower than normal intelligence. Other children with ASD have normal to high
intelligence — they learn quickly, yet have trouble communicating and applying
what they know in everyday life and adjusting to social situations. A small number
of children with ASD are savants — they have exceptional skills in a specific area,
such as art, math or music.
As they mature, some children with ASD become more engaged with others and
show fewer disturbances in behavior. Some, usually those with the least severe
problems, eventually may lead normal or near-normal lives. Others, however,
continue to have difficulty with language or social skills, and the teen years can
bring worse behavioral problems.
Typically, a doctor has to be consulted if a child-
• Doesn't respond with a smile or happy expression by 6 months
• Doesn't mimic sounds or facial expressions by 9 months
• Doesn't babble or coo by 12 months
• Doesn't gesture — such as point or wave — by 14 months
• Doesn't say single words by 16 months
• Doesn't play "make-believe" or pretend by 18 months
• Doesn't say two-word phrases by 24 months
• Loses previously acquired language or social skills at any age

E. Attention Deficit / Hyperactivity Disorders

Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects
millions of children and often persists into adulthood. ADHD includes a
combination of problems, such as difficulty sustaining attention, hyperactivity and
impulsive behavior.
Children with ADHD also may struggle with low self-esteem, troubled relationships
and poor performance in school. Symptoms sometimes lessen with age. However,

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some people never completely outgrow their ADHD symptoms. But they can learn
strategies to be successful.
While treatment won't cure ADHD, it can help a great deal with symptoms.
Treatment typically involves medications and behavioral interventions. Early
diagnosis and treatment can make a big difference in outcome.
Attention-deficit/hyperactivity disorder (ADHD) has been called attention-deficit
disorder (ADD) in the past. But ADHD is now the preferred term because it
describes both of the primary features of this condition: inattention and
hyperactive-impulsive behavior. In some children, signs of ADHD are noticeable as
early as 2 or 3 years of age.
Signs and symptoms of ADHD may include:
• Difficulty paying attention
• Frequently daydreaming
• Difficulty following through on instructions and apparently not listening
• Frequently has problems organizing tasks or activities
• Frequently forgetful and loses needed items, such as books, pencils or toys
• Frequently fails to finish schoolwork, chores or other tasks
• Easily distracted
• Frequently fidgets or squirms
• Difficulty remaining seated and seemly in constant motion
• Excessively talkative
• Frequently interrupts or intrudes on others' conversations or games
• Frequently has trouble waiting for his or her turn
If the symptoms are persistent across situations and are preventing a normal
development in the child, a doctor needs to be consulted.

5. Early Intervention
Early Intervention (EI) programs are programs designed for children below school
age as a remedial or preventive initiative. They are basically aimed at children
thought to be “at-risk” for or having a developmental delay/ difficulty or children
having special needs which may lead to developmental delays. These programs
typically attend to children from birth to school entry, which may translate to
birth to 4-6 years.

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They may focus on intervention for existing problems or be planned as

interventions for preventing their occurrence. Such programs may typically involve
the whole family and may be center-based, home-based or be a combination of
both depending upon the population being attended to.

The basic areas of intervention would focus on the overall development of the
child and include physical development, motor development, communication
skills, social-emotional development, cognitive skills and self-help skills training.
In addition to all of these, it is imperative that EI programs start monitoring basic
health and hygiene, nutrition status and physical and psychological safety and
security of the children.

Sometimes it is known at the birth of the child that he/she has special needs and
will need early intervention programs. Specific programs should be started for
these children so that the overall development of the child and family can be
maximized and weaknesses can be minimized.

At other times it is slowly over the first few years of the children’s growth that
developmental difficulties/ delays become manifest. There may be some major
milestones like sitting, talking, standing walking etc. which may be delayed. These
will lead to the diagnosis of a special need which may later lead to problems. For
such children too, early intervention programs should start as soon as diagnosis is
confirmed or even suspected.

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Practicum 3.1
Observe any child and complete the table

Observation √ X
Is able to walk without
falling down
Is able to avoid bumping
and crashing into
furniture and thresholds
repeatedly
Not talking in any
language
Is able to responds when
called by name
Is able to respond to loud
sounds
Began speaking late
Is able to pronounce
Vocabulary growth
according to age
Is able to rhyme words
Is able to learn numbers,
the alphabet, days of the
week
Is able to focus and pay
attention
Is able to interact with
peers

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