I. Definition of global developmental delay This refers to the lagging and restricted development in at least 2 of the domains of adaptive behavior, motor, language, and social interaction during the course of a child’s development. It may later be diagnosed as mental retardation. It may be a symptom or manifestation of a particular disorder, or it may exist independently for unknown reasons. Developmental Diagnosis Geisel Developmental Scale: For children aged 4 weeks to 6 years. Includes five domains: adaptive behavior, gross motor, fine motor, language, and personal-social. Developmental quotient indicates the level of development: <75 diagnosis of developmental backwardness 76~85 not borderline status 85 or above is normal III. Developmental Diagnosis Developmental outcomes vary with pediatric development Review at 3 months~6 months Examples: 1. Pediatric A: only gross motor backwardness and low fine motor by 6~10 months, but backwardness in language and social adaptive skills by 18 months review, and mental retardation by 4~5 years of age. 2, Pediatric B: Diagnosis of comprehensive backwardness at 8~10 months, comprehensive rehabilitation treatment for 1~2 years, normal at 3~4 years of age at follow-up. IV. Wechsler Intelligence Quiz: IQ 50~69 mild mental retardation IQ 35~49 moderate mental retardation IQ 20~34 severe Correlation between total developmental delay and future mental retardation Adaptive ability and fine motor development in the scale correlate more with intelligence. Language comprehension and personal-social competence in young children can be used to some extent as predictors of intelligence. Gross motor correlations alone are less relevant. V. OVERALL DEVELOPMENTAL DELAY OUTCOMES Mental retardation or borderline intelligence: Often comorbid with other disorders such as hyperactivity, epilepsy, cerebral palsy, autism. Autism Cerebral palsy Associated with specific disorders Normal range VI. Diagnostic Medical Evaluation History: Family history Maternal pregnancy history: previous pregnancy history, current pregnancy experience, etc. Perinatal: prenatal, at delivery, and postnatal neonatal period. Pediatric developmental history: including milestones, developmental process, progression or stagnation or regression. Physical Examination: 1. Observation: in natural state, provide toys, observe communication with parents, communication, attention, and skills when handling objects. 2. 2, head circumference, body surface abnormalities, such as the face, features of the five senses, hand and foot features, external genitalia, skin pigmentation or mottled changes in the presence or absence of the liver and spleen is enlarged, etc.. Laboratory and ancillary tests: Because there are many etiologic factors, the choice of tests based on the history and physical examination findings, the purpose is to clarify the etiology or diagnosis of the syndrome. Chromosomal testing: routine chromosomal testing may reveal abnormalities in children with distinguishing features, but routine chromosomal analyses are still often negative, and high-resolution testing can increase positive results. 2011 American Academy of Neurology evaluated existing neurodevelopmental tests and stated that microarrays were able to identify the genetic cause of 8% of children with generalized developmental delay. Genetic testing: testing may be chosen for those who have a family history of distinguishing features. Optional for those with family history, significant characteristic changes, not helpful for treatment, used for genetic counseling and prenatal diagnosis. Routine tests: blood test, blood glucose, urine test, ketones, electrolytes, blood gases, cardiac enzymes, liver and kidney functions. Electrophysiological examination: Electroencephalography (EEG) is not very helpful in the diagnosis of global developmental delay. Visual evoked potentials (VEP) can help to determine the status of visual pathways. Auditory evoked potentials (AEP) can be used to determine auditory pathways and hearing. Etiology and Diagnosis of Disease Classification: Static: The developmental delays are in a relatively stable state, progressing slowly. Progressive: stagnation or regression in all areas of development. Common causes of static developmental delay Perinatal diseases: Before birth: hypoxia and diseases caused by various reasons. At birth: asphyxia, birth injury, etc. After birth: craniocerebral injury, encephalitis, nutritional deficiency, socio-cultural backwardness, etc. XI. Common causes of static retardation Brain malformations: There are many causes of malformations, and sometimes it is difficult to find out the causes. Common malformations: abnormal development of corpus callosum, abnormal development of cerebral cortex, absence of septum pellucidum, various syndromes and so on. Common causes of static growth retardation Intrauterine infections: megaloblasts, toxoplasmosis, syphilis, etc. Maternal factors: mother's disease factors, such as hyperemesis gravidarum, hyperthyroidism, after infertility. Various poisonings: chemical, physical factors, drugs, etc. Common causes of static global developmental delay Chromosomal disorders: Trisomy 21, chromosomal translocations, deletions, etc. Common microdeformities of chromosomal disorders Abnormal head size, wide eye spacing, upward slanting of the eyes, small jaw, low ear position, high palatal arches, curved little finger, through hand, wide gap between the first and second toes, long middle toes, rocking chair feet, abnormal skin pattern. Neuromuscular disease: such as: congenital muscular dystrophy case: female, more than 6 months, muscle tone is significantly low, knee reflex +, cardiac muscle enzyme CK9000U, normal range of intellectual development, 2 years of age, sitting alone, intelligence is lower than normal, 4-5 years of age, walking alone, myopathic facial features, intellectually backward. Common causes of static global developmental delay Unknown cause: The exact cause is often undetectable in more than 50% of mild backwardness. As technology advances, more will be found. XII. Progressive developmental delay Clues suggesting progressive global developmental delay: 1. History: stagnation or regression of developmental milestones 2. feeding difficulties, eating disorders, lack of weight gain 3. hypotonia, motor abnormalities. 4, Abnormal odor. 5, Skeletal changes, peculiar appearance. 6. Hepatomegaly. 7. Difficulty in controlling epileptic seizures. Thirteen, preventive treatment Prevention: prenatal preconception examination for the cause of the disease, genetic counseling. Already sick early detection, early intervention, reduce the damage caused by the disease, improve the prognosis, such as phenylketonuria. Already disease and injury, active rehabilitation treatment, promote development, improve function. Treatment and Rehabilitation The pediatric brain is highly plastic before the age of 2~5 years old, especially under the age of 2 years old. Early intervention and rehabilitation can greatly improve the prognosis and future quality of life, and is decisive. Treatment and rehabilitation 1. Treatment of etiology Comprehensive rehabilitation treatment for the disorder aims at improving cognitive development: hand function training, hand-eye coordination training to improve perceptual and spatial cognitive ability. Hand function training, hand-eye coordination training to improve perceptual and spatial cognitive ability, and language training to improve operation and cognitive ability from concrete to abstract. 2, treatment and rehabilitation of children with suspected developmental backwardness, guide home training, regular follow-up. Critical development and developmental delayed children should have a combination of professional training and family guidance training. In the course of rehabilitation and treatment, regular assessment will be made, and plans and immediate and long-term goals will be formulated according to the child's condition, family, environment and so on. 3.Therapeutic Rehabilitation Drugs to promote brain and nerve development: Brain protein hydrolysate, nerve growth factor, ganglioside, etc. have the effect of promoting brain development and repair after injury, but we can not rely too much on the role of drugs.