Evaluation of Developmental Delay

The estimated prevalence of developmental delay is 10%. Some children present with delays in multiple areas, or global developmental delay. Global developmental delay is defined as significant delay in two or more areas of development (gross or fine motor, speech and language, cognition, social and personal, and activities of daily living). The more severe the delay, the more likely a cause can be determined (Roberts et al., 2004). Once significant delay is recognized, parents are often eager to know the cause. The family physician can be instrumental in referring for appropriate intervention, as well as overseeing an initial workup.

Although many physicians refer to specialists (e.g., developmental pediatricians, neurologists) for further evaluation, these specialists may have long waiting lists. Some aspects of the workup can easily be ordered by the family physician. Guidelines from the American Academy of Neurology and Child Neurology Society for the workup of the child with global developmental delay are shown in Table 23-10 (Shevell et al., 2003). The guidelines listed in the table are evidence based and could be readily used by family

Table 23-9 Developmental Screening Tools


Age range



0-60 mo

~7 min

Paul H. Brooks, Publishers www.pbrookes.com


Development Inventories

3-72 mo

~10 min

Behavior Science Systems*

Parents' Evaluations of Developmental Status (PEDS)

Birth-8 yr

~2 min

Ellsworth & Vandermeer www.pedstest.com

*PO Box 580274, Minneapolis, MN 55458.

physicians to start the workup while waiting for a specialist appointment. Results of the workup may facilitate more specific referrals. Even if not globally delayed, all children with language delay should have a formal audiology assessment to rule out hearing impairment.

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