Practice parameter: Evaluation of the child with global developmental delay [RETIRED]
Report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society
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Abstract
Objective: To make evidence-based recommendations concerning the evaluation of the child with a nonprogressive global developmental delay.
Methods: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a four-tiered scheme of evidence classification.
Results: Global developmental delay is common and affects 1% to 3% of children. Given yields of about 1%, routine metabolic screening is not indicated in the initial evaluation of a child with global developmental delay. Because of the higher yield (3.5% to 10%), even in the absence of dysmorphic features or features suggestive of a specific syndrome, routine cytogenetic studies and molecular testing for the fragile X mutation are recommended. The diagnosis of Rett syndrome should be considered in girls with unexplained moderate to severe developmental delay. Additional genetic studies (e.g., subtelomeric chromosomal rearrangements) may also be considered in selected children. Evaluation of serum lead levels should be restricted to those children with identifiable risk factors for excessive lead exposure. Thyroid studies need not be undertaken (unless clinically indicated) if the child underwent newborn screening. An EEG is not recommended as part of the initial evaluation unless there are historical features suggestive of epilepsy or a specific epileptic syndrome. Routine neuroimaging, with MRI preferred to CT, is recommended particularly if abnormalities are found on physical examination. Because of the increased incidence of visual and auditory impairments, children with global developmental delay may undergo appropriate visual and audiometric assessment at the time of diagnosis.
Conclusions: A specific etiology can be determined in the majority of children with global developmental delay. Certain routine screening tests are indicated and depending on history and examination findings, additional specific testing may be performed.
This guideline is retired. The recommendations and conclusions are no longer considered valid and no longer supported by the AAN. Retired guidelines should be used for historical reference only. Please see AAN current guidelines here: https://www.aan.com/policy-and-guidelines/guidelines/.
- Received May 15, 2002.
- Accepted in final form July 16, 2002.
Letters: Rapid online correspondence
- Practice parameter: Evaluation of the child with global developmental delay: Report of the Quality
- M A Whelen, Cooperstown New Yorkmahelan@capital.net
Submitted June 19, 2003 - Reply to both Letters to the Editor
- Stephen Ashwal, Loma Linda University Schol of Mediciane CAsashwal@ahs.llumc.edu
- Michael Shevell, Carmela Tardo and Gary Franklin
Submitted June 19, 2003 - Practice parameter: Evaluation of the child with global developmental delay: Report of the Quality
- Thomas O Crawford, Johns Hopkins University School of Medicine Baltimore MDtcrawfo@jhmi.edu
- Anne Comi, John M Freeman, Eric H Kossoff, Harvey Singer, Eileen P G Vining and Kaleb Yohay
Submitted June 19, 2003
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