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Global Delays
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A child with a global delay will have delays in all areas of development.  Global delays usually include delays in cognitive skills as well as delays in other areas of development (gross motor, fine motor, language). It is usually caused by a static encephalopathy caused by a disorder before or near the time or birth.
Causes of global delays include prematurity, cerebral malformations, chromosomal disorders, infections, and progressive (may worsen with time) encephalopathies (metabolic diseases, hypothyroidism, neurocutaneous syndromes (neurofibromatosis, tuberous sclerosis), Rett syndrome, and hydrocephalus).
Testing to look for the cause of a global developmental delay may include a head MRI. Parents are usually the first ones to think that there is a problem with their child's motor, social, and/or speech and language development, and this parental concern should be enough to initiate furthur evaluation by a physician.
Some signs that your infant may not be meeting his normal motor milestones include not being able to bring his hands together by 4 months, not rolling over by 6 months, having head lag when pulled to a sitting position after 6 months, not sitting by himself without support by 8 months, not crawling by 12 months, and not walking by 15 months. Remember that mild delays in motor development can be normal, and there is a range during which these milestones are usually met, so your child may not meet each one at the same time as other children. Delayed motor development, with normal language skills, can be caused by a neuromuscular disorder or mild cerebral palsy.

A delay in fine motor skills in older children may be manifested by not being able to use a spoon or fork, tie his shoes, button his clothes, write his name, draw shapes, color inside the lines, or hold a pencil correctly at the age appropriate time, or by having poor handwriting. A delay in gross motor skills in older children may include not being able to ride a tricycle or bicycle, being clumsy, or not walking correctly.

The early speech and language milestones which are listed below include the upper limit of when 75% of infants meet this milestone, so your child may still be developing normally if he has not mastered a milestone by the age indicated. These milestones should be used as a general guideline to help identify infants that are at risk for having speech and language problems so that their development can be watched closely. Among the screening tests available that your Pediatrician may perform are the Early Language Milestone (ELM) Scale-2 and the Clinical Linguistic and Auditory Milestone Scale (CLAMS). Delayed speech and language development can be caused by a developmental language disorders (DLD), hearing loss, mental retardation and autism.

Early speech and language milestones:

  • Newborns can localize a sound to their right or left side shortly after being born and will turn their head or look in the direction of a sound. This works best with loud noises when your baby is awake and alert, but they should also be able to hear soft sounds. They can also begin to smile spontaneously and in response to someone by 1 month. Infants learn to recognize their parents by 1-2 1/2 months.
  • Infants can imitate speech sounds by 3-6 months.
  • Monosyllabic babbling, or making isolated sounds with vowels and consonants (ba, da, ga, goo, etc) usually begins by 4-8 months.
  • Polysyllabic babbling, or repeating vowels and consonants (babababa, lalalalala, etc) usually begins by 5-9 months.
  • Comprehending individual words (mommy, daddy, no) usually occurs by 6-10 months.
  • By 5-10 months, most infants can say mama/dada nonspecifically, using the words as more than just a label for his parents.
  • Many infants can follow a one step command with a gesture (for example, asking for an object and holding your hand out) by 6-9 months. He should be able to follow a one step command without a gesture by 7-11 months.
  • The correct use of mama/dada as a label for a parent usually occurs by 7-12 months.
  • The first word (other than mama/dada) is usually spoken by 9-14 months.
  • By 10-15 months, he should be able to point to an object that he wants.
  • Your child will be able to say 4-6 words (other than mama/dada and names of family members or pets) by 11-20 months.
  • He should be able to follow a two step command without a gesture by 14-21 months.
  • Two word combinations or sentences are used by 18-22 months and can include phrases like 'Want milk', 'More juice', etc.
  • A vocabulary spurt leading to a 50+ word vocabulary occurs by 16-24 months.

Parents are usually the first ones to think that there is a problem with their child's motor, social, and/or speech and language development, and this parental concern should be enough to initiate furthur evaluation. In addition to a formal hearing test (for children with speech delays), neurological exam (which will look at your child's muscle tone, strenght, reflexes, coordination, etc), and developmental assessment by their Pediatrician, children with developmental delays should be referred to an early childhood intervention program (for children under 3), so that an evaluation can be initiated and a treatment plan developed, including physical therapy, occupational therapy and possible speech therapy. He may also need a referal to a Pediatric Neurologist and/or a Developmental Pediatrician for furthur evaluation and treatment.

In addition to the screening tests described above, your Pediatrician may be able to calculate your child's motor quotient (MQ), which is his motor age (his age as calculated by what milestones he has met) divided by his chronological age and multiplied by 100. A motor quotient above 70 is considered normal, and between 50-70 is suspicious and requires furthur evaluation, although it is probably normal, and below 50 is considered abnormal. For example, if your child is 12 months old and has just begun to pull to a stand (motor age of 9 months, the age when most children are pulling to a stand), his MQ would be (9/12)*100 or 75, which is probably normal. On the other hand, if he has just begun to roll over (motor age of 5 months), then his MQ is (5/12)*100 or 42 and this is probably abnormal.


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