Practice parameter: Evaluation of the child with global developmental delay: Report of the Quality
M AWhelen, Cooperstown New Yorkmahelan@capital.net
Submitted June 19, 2003
The recently published Practice Parameter concerning the evaluation
of the child with global developmental delay is unfortunately flawed by
the authors' decision to reinterpret this perfectly clear term, which has
always been understood to encompass cognitive delay, in such a fashion
that a child with delays in only two of five domains would be thus
classified [1]. Thus a child with cerebral palsy and consequent impairment
in motor and ADL skills, but without cognitive, social, or language
impairment, would meet the authors' definition. This stands in
contradiction to the literature which they cite (authors' references 3-7)
in support of their definition. It further contradicts the authors'
statement elsewhere that global delay is to be distinguished from autistic
spectrum disorder: on the basis of their definition, such a distinction
would not be possible. It is also troubling to see an unmodified
recommendation for routine MRI studies in the abstract: this was
appropriately modified in the text. As presented, this parameter would
appear to have been approved by the Practice Committee of the Child
Neurology Society as well as the AAN QSS. As a member of the CNS Practice
Committee, I would like to raise some procedural concerns. When polled at
the last of the two Practice Committee meetings where this parameter was
(briefly) presented, only one member expressed approval of the definition.
However, abstaining votes from absent members were counted as approving
(abstention from commentary has usually meant failure to read, an
acknowledged problem in this committee) and request for simultaneous
publication of a dissenting opinion was denied by the Co- Chair of the
QSS, who has implicitly endorsed such a practice elsewhere [2,3]. Space
does not permit further commentary, but both this parameter, and the
process, which led to its apparent endorsement, is in need of revision.
References:
1. Shevell M, Ashwal S, Donley, D et al. Practice parameter:
Evaluation of the child with global developmental delay. Neurology
2003;60:367-380.
2. Franklin GM, Zahn CA. AAN clinical practice guidelines: Above the
fray. Neurology 2002;59:975-976.
3. Hart RG, Bailey RD. As assessment of guidelines for prevention of
ischemic stroke. Neurology 2002;59:977-982.
The recently published Practice Parameter concerning the evaluation of the child with global developmental delay is unfortunately flawed by the authors' decision to reinterpret this perfectly clear term, which has always been understood to encompass cognitive delay, in such a fashion that a child with delays in only two of five domains would be thus classified [1]. Thus a child with cerebral palsy and consequent impairment in motor and ADL skills, but without cognitive, social, or language impairment, would meet the authors' definition. This stands in contradiction to the literature which they cite (authors' references 3-7) in support of their definition. It further contradicts the authors' statement elsewhere that global delay is to be distinguished from autistic spectrum disorder: on the basis of their definition, such a distinction would not be possible. It is also troubling to see an unmodified recommendation for routine MRI studies in the abstract: this was appropriately modified in the text. As presented, this parameter would appear to have been approved by the Practice Committee of the Child Neurology Society as well as the AAN QSS. As a member of the CNS Practice Committee, I would like to raise some procedural concerns. When polled at the last of the two Practice Committee meetings where this parameter was (briefly) presented, only one member expressed approval of the definition. However, abstaining votes from absent members were counted as approving (abstention from commentary has usually meant failure to read, an acknowledged problem in this committee) and request for simultaneous publication of a dissenting opinion was denied by the Co- Chair of the QSS, who has implicitly endorsed such a practice elsewhere [2,3]. Space does not permit further commentary, but both this parameter, and the process, which led to its apparent endorsement, is in need of revision.
References:
1. Shevell M, Ashwal S, Donley, D et al. Practice parameter: Evaluation of the child with global developmental delay. Neurology 2003;60:367-380.
2. Franklin GM, Zahn CA. AAN clinical practice guidelines: Above the fray. Neurology 2002;59:975-976.
3. Hart RG, Bailey RD. As assessment of guidelines for prevention of ischemic stroke. Neurology 2002;59:977-982.