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The foster care clinic: a community program to identify treatment needs of children in foster care.

A community-based multiagency and multidisciplinary clinic was developed to perform comprehensive evaluations of preschool children in foster care. One hundred thirteen children, ages 1 month to 6 years old, were seen during the first 2 years. Forty-seven percent of the children were known to the social service agency from birth; however, the mean age at placement was 19 months. Fifty-seven percent of the children were in their first foster home at the time of their initial evaluation, but 17% has already been placed in three or more homes. Behavioral problems were found in 39% of the children, and chronic medical problems in 35%. Sixty-one percent of the children were delayed in one or more portions of the developmental assessment. Developmental delay was associated with older age. Sixty percent of the children with developmental delays were not involved in any community educational or therapeutic program, although they had been in foster care for a mean of 6 months. Because of the high mobility of this population, continuity of care by social workers, foster parents, and physicians is hard to achieve. The evaluation model developed by the clinic appears to facilitate the identification of children in need of additional services, enhances cooperation between various community agencies, and provides a constant site for monitoring the status and progress of children in foster care.

Child Abuse↗

Developmental gains in early intervention based on conductive education by young children with motor disorders.

The purpose of the study was to evaluate the developmental gains of 26 young children with cerebral palsy and three children with other disorders attending early intervention based on the principles of conductive education (NZCE) or community-based (CB). Conductive education was implemented by parents supervised by a conductor an average of 7.4 hours per week. Developmental skills were objectively measured in functional contexts at home and school before the child entered the programme and after 12 months. Skill gains by children with spastic quadriplegia, cerebral palsy and severe developmental delay who were not able to sit independently (n = 6) who participated in NZCE were significantly greater (p < 0.001) than skill gains by children with similar disabilities who participated in CB (n = 6). Children with quadriplegic cerebral palsy, severe developmental delay, epilepsy and sensory disabilities (n = 7) also achieved significant gains in functional skills in NZCE (p < 0.005). Conductive education may benefit young children with motor dysfunction as well as concomitant disorders and severe developmental delay. Gains were not related to intensity, age, or a product of maturation, but may be related to changed patterns of maternal-child interactions.

Cerebral Palsy↗

Neurodevelopmental outcome, growth and health of extremely low-birthweight survivors: how soon can we tell?

A three-year cohort of extremely low-birthweight (ELBW, less than 1000g) survivors born between 1st January 1979 and 31st December 1981 were followed prospectively at one, two and five years of age, corrected for preterm birth. 57 of 110 infants survived, and 53 children were still alive at five years. The diagnoses of cerebral palsy, blindness, deafness and developmental delay fluctuated markedly according to age at developmental assessment. Although 13 of the 53 children were found to have impairments at five years, only seven were identified at one year, while 17 were identified at two years. In relation to the five-year assessment, impairments were underestimated at one year and developmental delay was overestimated at two years, which suggest that valid and reliable estimation of adverse neurodevelopmental sequelae among ELBW survivors may not be possible until school-age.

Blindness↗

Parenting stress and depression in children with mental retardation and developmental disabilities.

Although many types of behavioral and emotional disorders are prevalent in children with developmental delays, the phenomenology of childhood depression in this population remains poorly understood. This study examined the relationships among symptoms of depression, child problem behaviors, and parenting stress in a sample of 29 children with developmental delays. Results supported the usefulness of the Children's Depression Inventory (CDI) in assessing depression in these children initially reported by Matson, Barrett, and Helsel (1988). Parent ratings from the CDI were significantly associated with maternal depression, an index of DSM-III-R depression criteria, and negative self-image, anxiety, and conduct problems in children. A matched subsample of children (n = 12) with high versus low depression ratings revealed significant differences in total scores from the Parenting Stress Index (Abidin, 1986) and the index of DSM-III-R depression criteria. Together, these data suggest that children with developmental delays exhibit a similar pattern of symptoms and associated characteristics to those found in normal children with diagnoses of depression.

Child↗

A review of neurological disorders presenting at a paediatric neurology clinic and response to anticonvulsant therapy in Gambian children.

A clinical review of 128 children presenting at the paediatric neurology clinic of the Royal Victoria Hospital, The Gambia was conducted between July 2001 and January 2002. The aim was to assess the spectrum and burden of neurological disease presenting at this tertiary-level clinic and to evaluate the effectiveness of anticonvulsant therapy. The principal clinical diagnoses most frequently made were seizures (57%), neuromotor problems (15%) and developmental delay (11%). Many children also had associated developmental delay or learning difficulties (55%), speech and language problems (42%) and physical disability (36%). Although 65% were considered to need assistance in the community, only 11% were receiving such help. There were 73 children with seizures, 80% of whom had a greater than 50% reduction in seizure frequency following the start of simple anticonvulsant medication. Of the children who had experienced more than 100 convulsions during the previous year, only 50% responded similarly to treatment. This review emphasises the need for improved community services and accessible medical care for children with neurological problems in West Africa.

Adolescent↗

The timing of mother-to-child transmission of human immunodeficiency virus infection and the neurodevelopment of children in Tanzania.

OBJECTIVE: To determine the association between the timing of mother-to-child transmission of human immunodeficiency virus (HIV)-1 and neurodevelopment among children born to HIV-1 infected mothers in Tanzania. METHODS: Bayley Scales of Infant Development (2nd edition) were administered at 6, 12 and 18 months to a subset of children (N = 327). Linear regression models and Cox proportional hazard models were separately fitted for the mental development index (MDI) and the psychomotor development index (PDI). RESULTS: Children who tested HIV-1-positive at birth had significantly higher decreases per month in MDI and PDI than HIV-1-negative children; 1.1 [95% confidence interval (95% CI), 0.4, 1.8] for MDI and 1.4 (95% CI 0.0, 2.7] for PDI. Children who tested HIV-1-positive after birth had an additional 0.6 (95% CI 0.1, 1.1) point decrease in MDI per month and a 0.6 (95% CI 0.0, 1.1) higher decrease in PDI each month than HIV-1-negative children. Testing HIV-1-positive at birth was associated with a 14.9 (95% CI 5.0, 44.7) times higher rate of becoming developmentally delayed in mental function, while testing HIV-1-positive after birth was associated with a 3.2 (95% CI 1.6, 6.4) times higher rate than in uninfected children. CONCLUSIONS: HIV-1 infected infants performed worse on tests of neurodevelopment and were significantly more likely to be identified as developmentally delayed in the first 18 months of life than HIV-1-negative children. The effect of HIV-1 infection on neurodevelopment scores and the risk of developmental delay may be highest among those who are already HIV-1 infected at birth.

Adult↗

[Ophthalmological services to mentally retarded persons. A review and recommendations].

This is a survey of Nordic contributions to the study of the development of vision, visual impairment, and ocular disorders in people with developmental delay. Visual impairment and ocular pathology are frequently observed in these individuals. We give examples of various combinations of ocular and cerebral disorders. We underline the central role of the ophthalmologist in the diagnostic, therapeutic, and counselling procedures, and stress that the quality and accessibility of eye health services have definite medical, educational and social consequences for this group of people. We suggest that our countries monitor vision and eye disease in all individuals with developmental delay at the following periods of life: 1) At the first assessment of developmental delay. 2) At 2-3 years of age. 3) At the beginning and end of school. 4) At 45 years of age and every five years thereafter. 5) People with Down's syndrome should be monitored for cataract at the ages of one month, one year, 30 years, and later as the rest of the patients.

Adolescent↗

Serum immunoreactivity to S-100 in children with cerebral palsy and delayed development and in their healthy parents.

The passive immunization of pregnant female rats to S-100 protein often leads to ultra-structural abnormalities in the brain glial structures of the offspring of these rats and induces signs of delayed development in the fetal brain. Additionally passive immunization of pregnant animals with certain antigens induces permanent Ag-specific changes in the immune response of their offspring. The purpose of this study was to investigate serum immunoreactiviy (SIR) to S-100 in cerebral-palsied and developmentally-delayed children as well as in their healthy parents and to evaluate its significance related to radiologic findings of brain MRI and single photon emission computed tomography (SPECT). The subjects were children with cerebral palsy and delayed development that had abnormal findings on brain MRI or Brain SPECT. SIR to S-100 protein was measured by ELISA method in the patients, their healthy parents, 20 normal adult controls and 22 normally developed children. The SIR to S-100 protein was significantly higher in the cerebral-palsied and developmentally-delayed children when compared to that of the normal control group children. Increased SIRs were detected in healthy mothers but not in their fathers. There was no difference of SIR between the cerebral-palsied and developmentally-delayed children or any significant difference of SIRs according to the findings of the brain MRI or to developmental quotients. But, the SIRs to S-100 protein were higher in the group of more abnormal findings on brain SPECT.

Adolescent↗

Prevalence of disabilities in a national sample of 3-year-old Israeli children.

The prevalence of chronic conditions and illnesses causing disability in Israeli Jewish children aged 2 to 3 years, born in 1980, was studied on the basis of a national sample (n = 9,854). Seventy-six principle medical conditions causing disability were defined. The study showed a total disability rate of 8.9%. Very low birth weight and family problems were considered risk factors for developmental delay or for disability. The prevalence of the children at risk was 2.4%. The disability rate among this group was 6 to 7.5 times greater than in the total population. Data were analyzed by selected demographic characteristics. Speech and language disorders and undefined developmental delay were more prevalent among children of mothers with a low educational level. Speech and language disorders were also more prevalent among children born to mothers of Asian origin. Speech and language disorders, asthma and spastic bronchitis, hearing impairment and undefined developmental delay were more prevalent among male children. This is the first comprehensive nation-wide prevalence study of children with disabilities in Israel.

Birth Order↗

Neurodevelopmental outcome of young children with extrahepatic biliary atresia 1 year after liver transplantation.

STUDY DESIGN: Forty children < 2 years of age receiving extrahepatic liver transplantation were tested with the Bayley Scales of Infant Development before transplantation and again at 3 and 12 months after transplantation. Neurodevelopmental status 1 year after transplantation was organized by a descriptive statistic of normal, suspect, or delayed. Disease and transplantation variables were investigated for association with delayed neurodevelopmental outcome. RESULTS: Before transplantation mental development was in the low-average range (92 +/- 13.2) with psychomotor development 1 SD below the norm (82.5 +/- 13). Three months after transplantation both mental (80.1 +/- 12.6) and psychomotor (69 +/- 16.1) scores dropped 1 SD, but 1 year after transplantation mental and psychomotor scores recovered to the pretransplantation level of functioning. One year after transplantation 35% of the study group was diagnosed as developmentally delayed. Delayed development was associated with decreased weight (p < 0.04), low albumin (p < 0.02), length of hospital stay (p < 0.04), and age at transplantation (p < 0.05). CONCLUSION: Young children undergoing liver transplantation are at risk for developmental delay. Aggressive nutritional support before transplantation and timing of transplantation before malnutrition develops may reduce developmental delays.

Age Factors↗

Which ocular and neurologic conditions cause disparate results in visual acuity scores recorded with visually evoked potential and teller acuity cards?

PURPOSE: We investigated whether disparity between visually evoked potential (VEP) acuity scores and Teller Acuity Card (TAC) scores varied according to presence of ocular or neurologic conditions. METHODS: Charts from 175 children (mean age, 34.8 months; range, 3 to 158 months) referred for visual acuity testing were examined. All children had been tested with pattern-alternation VEP and TAC and had undergone a complete eye examination. VEP and TAC acuity scores were relative to age-expected acuity scores for each acuity test. The absence and degree of macular abnormality, retinal abnormality, optic nerve hypoplasia, optic nerve atrophy, cortical visual impairment, developmental delay, cerebral palsy, seizures, and nystagmus were noted. Analysis of variance models were used to determine whether differences between VEP and TAC scores varied according to the presence of specific deficits. Logistic regression analysis determined whether degree of specific deficits was associated with a greater chance of inconsistency between VEP and TAC scores (>0.3 log unit difference). RESULTS: Inconsistent scores were found in 48% of children. Developmental delay was associated with relatively poorer TAC than VEP score, and the chance of inconsistency increased with severity of developmental delay. CONCLUSIONS: Diagnosis-dependent variability exists between TAC and VEP scores. Therefore knowledge of the clinical picture is necessary in interpretation of VEP and TAC scores. It is not clear which test is more useful when a disparity exists, either from this or previous studies. When visual acuity is assessed longitudinally in a given child, then consistency in method for acuity assessment is important.

Aging↗

Paroxysmal non-epileptic events in children: a retrospective study over a period of 10 years.

OBJECTIVE: To determine the frequency, nature and clinical characteristics of paroxysmal non-epileptic events in children diagnosed by video electroencephalogram (EEG) monitoring at a tertiary referral centre. METHODOLOGY: A retrospective study of children with paroxysmal non-epileptic events, aged 2 weeks to 17 years inclusive was undertaken. The study group consisted of children who had video EEG monitoring during a 10-year period (1988-99). Telemetry files, medical charts, events recorded on video and record sheets were reviewed. RESULTS: A total of 666 children were analysed, 269 had epileptic events recorded, 285 had non-epileptic events and 112 had no events recorded. In children with non-epileptic events, 43% were developmentally delayed, 25% had an abnormal neurological examination and 40% had epilepsy. In the study sample an epileptiform interictal EEG was common (24%). The major subgroups of non-epileptic events were: staring (34%), sleep phenomena - benign sleep myoclonus (15%), arousals (13%), motor tics (11%) and shuddering (7%). Developmental delay (57%) was common in children who presented with staring spells. A diagnosis of a specific non-epileptic event was reached in 96% of cases. CONCLUSION: Paroxysmal non-epileptic events can cause diagnostic confusion, particularly in children with developmental delay, epilepsy or an epileptiform EEG. Accurate diagnosis can be reached in the majority of cases using video EEG monitoring.

Adolescent↗

Assessment of visual acuity in children with trisomy 18.

Although 90% of children with trisomy 18 (Edwards syndrome) die in the first year of life, a small proportion survive into the second and third decade. Many do not have associated ocular abnormalities that might affect vision. Measurable visual acuity has not been reported in these profoundly developmentally delayed individuals. Five children with trisomy 18, aged six months to eight years, underwent complete eye examination including assessment of binocular grating acuity with Teller acuity cards and assessment of binocular vernier acuity with vernier cards. All children were nonverbal with profound developmental delay. Binocular grating acuity ranged from 0.9 cycles per degree (cpd) to 2.2 cpd. This represents a reduction of 1.9 to 5.1 octaves (mean 3.5 octaves, SD 1.3 octaves) compared to age matched norms. None of the children responded to any of the vernier offsets, including the largest of 64 minutes of arc. All children with trisomy 18 demonstrated a measurable grating acuity that was well below normal for age, consistent with profound developmental delay.

Child↗

Immediate effects of mainstreamed settings on the social interactions and social integration of preschool children.

The immediate effects of mainstreamed and specialized settings on the peer interactions of preschool children with and without developmental delays were examined. Mainstreamed and specialized playgroups were established involving unacquainted peers and using a methodology that ensured appropriate matching of child and family characteristics. For each 2-week playgroup, the social and play interactions of each child were observed during a designated free-play period. Peer sociometric ratings also were obtained. Results indicated higher levels of peer interactions in mainstreamed settings for both typically developing children and children with developmental delays. The immediate impact of mainstreamed settings appeared to be attributed to the social demands and higher interaction levels of the former group. Children with developmental delays were not fully accepted nor totally socially integrated based on sociometric measures and behavioral indices of peer preferences. Implications of these findings for developing intervention programs to maximize children's peer-related social competence was discussed.

Child, Preschool↗

Valproate-induced liver failure in one of two siblings with Alpers disease.

Alpers disease is a neurodegenerative disorder of childhood characterized by early developmental delay, intractable seizures, and death in childhood. Neuropathologic changes are most severe in the gray matter and consist of diffuse neuronal loss, spongiform changes, and astrocytosis. We report 2 siblings with Alpers disease who were discordant for exposure to valproate (VPA). Both had developmental delay, and a progressive seizure disorder beginning at 5 years of age. The proband died at age 8 years of complications of ongoing seizures, including epilepsia partialis continua, with only minimal liver abnormalities. Her younger brother was treated with VPA for new-onset seizures and developed fulminant liver failure 6 months later, which led to his death at 5 years of age. Neuropathologic abnormalities of both siblings were consistent with Alpers disease. These observations support classification of Alpers disease and Alpers disease with liver cirrhosis as a single disease. They also confirm previous reports indicating that VPA may accelerate fulminant liver failure in Alpers disease. We recommend that a diagnosis of Alpers disease be considered in children with unexplained early developmental delay, cerebellar signs, or partial seizures, especially epilepsia partialis continua. When Alpers disease is strongly suspected, use of VPA should be avoided.

Anticonvulsants↗

Airway complications in CHARGE association.

The association between catastrophic airway events and developmental delay was examined in patients with CHARGE (coloboma, heart disease, atresia choanae, retarded growth and/or development, genital hypoplasia, and ear anomalies and/or deafness) association. A retrospective chart analysis was performed from The Children's Hospital in Boston, Mass. Sixteen patients were identified with CHARGE association. Nine patients had at least one respiratory arrest, and 7 had no airway difficulties. Some degree of developmental delay was seen in 14 patients, but was most severe in those patients who suffered a respiratory arrest. We conclude that children with CHARGE association have a propensity for airway instability and that cerebral hypoxia contributed to the developmental delay in some of our patients. We recommend early tracheotomy rather than early choanal atresia repair in these patients to protect the central nervous system.

Abnormalities, Multiple↗

A study on nesidioblastosis in hyperinsulinemic hypoglycemia--diagnosis, treatment, and neurologic sequelae.

The medical records of six cases of nesidioblastosis were examined to determine the diagnostic approach, treatment, and neurologic sequelae. All six patients were male, and their ages at the onset of the disease ranged from one day to six months (mean 3.36 +/- 2.5 mo.). Initial clinical features were seizure, cyanosis, poor feeding, and apnea. Other subsequent symptoms were developmental delay, hyperactivity, and cold sweating. The Birth weight of the neonatal onset group was heavier than the postneonatal onset group (4.4 +/- 0.3 vs 3.26 +/- 0.04 kg). Before the diagnosis of hyperinsulinism, steroids of ACTH proved effective for seizure control. Initially, hyperinsulinemia (serum insulin greater than 10 microU/ml) was detected in four cases, but another two cases also showed hyperinsulinism by insulin/glucose(I/G) ratio greater than 0.3 during the fasting test. The glucagon response performed in 2 cases, showed normal and partial responses. Euglycemia was obtained by near total pancreatectomy (95% pancreatic resection)without malabsorption or persistent diabetes. In one case, nesidioblastoma coexisted with nesidioblastosis. Developmental delay was noted in three cases. In this group, the mean duration between symptom onset and operation was longer than the group without developmental delay (1.25 +/- 0.47 vs 0.38 +/- 0.19 yr).

Brain Damage, Chronic↗

Outcomes of prenatal antidepressant exposure.

OBJECTIVE: This study evaluated the effects of prenatal antidepressant exposure on perinatal outcomes, congenital malformations, and early growth and development. METHOD: Within a group-model health maintenance organization, all infants with apparent prenatal exposure to tricyclic or selective serotonin reuptake inhibitor (SSRI) antidepressants were frequency matched to an unexposed comparison group by year of birth, maternal age, and mother's lifetime use of antidepressant drugs and mental health care. A structured blind review of mothers' and infants' medical records examined perinatal outcomes, congenital malformations, and developmental delay. RESULTS: Tricyclic antidepressant exposure was not associated with any significant difference in perinatal outcomes. Exposure to SSRIs was associated with a 0.9-week decrease in mean gestational age, a 175-g decrease in mean birth weight, and a 0.29 decrease in mean Apgar score at 5 minutes, but differences in birth weights and Apgar scores were not significant after adjustment for gestational age. Differences in gestational age and birth weights were unrelated to length of exposure, but differences in Apgar scores were limited to those with third-trimester exposure. Neither tricyclic antidepressant nor SSRI exposure was significantly associated with congenital malformations or developmental delay. CONCLUSIONS: The authors found no association between tricyclic antidepressant or SSRI exposure and either congenital malformations or developmental delay. SSRI exposure during pregnancy was associated with earlier delivery and consequent lower birth weight. Third-trimester SSRI exposure was also associated with lower Apgar scores. Women considering taking SSRIs during pregnancy may balance any higher fetal risk against the risk of persistent or recurrent depression.

Adult↗