Role #4: Search for Etiology
Search for etiology. Consider reasons why this child's development might be delayed? However, it is important to recognize that (a) often, you will never know the etiology, and (b) you do not need to know the etiology before proceeding with referral for comprehensive developmental assessment and beginning a plan of intervention.
- Are there identifiable risk factors which predict a development delay? Was there a prenatal or birth history that added a risk for developmental disorder? Examples: prematurity may predict higher level cognitive deficits (executive functioning) and attention problems; prenatal drug/alcohol exposure may be associated with disorders of impulse control and/or executive functioning.
- Was there a difficult attachment period in the first year? Examples: infant illness, maternal illness (including mental illness); other separation from the mother
- Is there a family history of developmental disorder (i.e. a genetic component that may or may not be detected with chromosomal evaluation)?
- Is there likelihood that that child did not receive sufficient and appropriate developmental stimulation?
- Are there sensory deficits resulting in delays? Be sure to consider hearing and vision.
- Are there motor deficits resulting in other delays? If motor skills are delayed, other development may also be affected.
- Are there other medical conditions that are interfering with optimal development. Examples: certain genetic disorders are be associated with learning disabilities and/or behavioral characteristics; sickle cell disease is associated with learning disabilities because of multiple micro-infarcts.
- Is the caregiver simply not aware of an expected skill, and thus not promoting this area of development? It is surprising how many adults do not realize one must talk to an infant in order for an infant to develop language or that an infant cannot learn to hold a cup if she is never given the opportunity.
Role #5: Facilitate Intervention
Pediatricians can advise families about strategies that can be used at home to foster development; but perhaps more importantly, pediatricians can help families access resources designed to help with developmental delays. Generally, comprehensive developmental assessment (see role #2 above), leads directly to intervention. Recommendations for intervention are given when the results of the assessment are explained to the family.
The sources for developmental interventions are the same as those listed above for assessment, with the addition of families-as-interventionists. Whereas a parent may not be able to assess development, the parent can intervene and apply appropriate guidance. Sometimes that guidance can come from the pediatrician, sometimes from a developmental specialist.
