CHOC Children's
NEUROLOGICAL DISORDERS

Children with developmental delay are not achieving certain skills as quickly as expected. This means that the child is not reaching developmental milestones at the usual age. This may affect the child’s speech and language, fine and gross motor skills, and/or personal and social skills.

A child with a global delay will have delays in all areas of development. One subset of children with developmental delay includes those with early onset of their disorder. These children have delay in walking and other motor skills.

Developmental milestones are determined by the average age at which children attain each skill. As a result, statistically, about 3% of children will not meet these developmental milestones on time, but only about 15% to 20% of these children will actually have abnormal development. The rest of these children will eventually develop normally over time, although a little later than expected.

Children’s Hospital of Orange County is a leader in diagnosing and helping manage developmental delay. The multidisciplinary team at The CHOC Neuroscience Institute takes an innovative approach to children with developmental delay concerns, offering patients access to the latest alternatives.

Early Speech and Language Milestones

The following milestones can be used as a general guideline to help identify infants who are at risk for speech and language problems so that their development can be watched closely. These milestones include:

  • 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.

  • Infants begin to smile spontaneously and in response to someone by 1 month. Infants learn to recognize their parents by 1 month to 2-1/2 months.

  • Infants can imitate speech sounds by 3 to 6 months.

  • Monosyllabic babbling, or making isolated sounds with vowels and consonants (ba, da, ga, goo) usually begins by 4 to 8 months.

  • Polysyllabic babbling, or repeating vowels and consonants (babababa, lalalalala) usually begins by 5 to 9 months.

  • Comprehending individual words (mommy, daddy, no) usually occurs by 6 to 10 months.

  • By 5 to 10 months, most infants can say mama/dada nonspecifically, using the word as more than just a label for their 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 to 9 months. He or she should be able to follow a one-step command without a gesture by 7 to 11 months.

  • The correct use of mama/dada as a label for a parent usually occurs by 7 to 12 months.

  • The first word (other than mama/dada) is usually spoken by 9 to 14 months.

  • By 10-15 months, the child should be able to point to an object that he or she wants.

  • A child will be able to say 4 to 6 words (other than mama/dada and names of family members or pets) by 11 to 20 months.

  • The child should be able to follow a two-step command without a gesture by 14 to 21 months.

  • Two-word combinations or sentences are used by 18 to 22 months and can include phrases like “Want mild,” “More juice.”

  • A vocabulary spurt leading to a 50+ word vocabulary occurs by 16 to 24 months.
Signs, Causes and Diagnosis of Developmental Delay

There are numerous causes of developmental delay. One of the goals of the pediatric neurologist is to identify the cause of a child’s neurologic or developmental problem.

Some signs that infants are not meeting their normal motor milestones include not being able to bring their 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 themselves without support by 8 months, not crawling by 12 months, and not walking by 15 months. It is important to remember that mild delays in motor development can be normal, and there is a range during which these milestones are usually met, so the 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 by 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.

A global delay, which involves delays in all areas of development, is usually caused by a static (does not worsen with time) encephalopathy (brain disease) caused by a disorder before or near the time of birth. Causes of global delays include prematurity, cerebral malformations, chromosomal disorders, infections, and progressive (may worsen with time) encephalopathies (metabolic diseases, hypothyroidism, hydrocephalus). Testing to look for the cause of a global developmental delay may include a magnetic resonance imaging (MRI) scan of the head.

Delayed speech and language development can be caused by a developmental language disorder, hearing loss, mental retardation or autism. Among the screening tests used for diagnosis are the Early Language Milestone (ELM) Scale-2 and the Clinical Linguistic and Auditory Milestone Scale (CLAMS).

Other evaluation tools include:

  • Formal hearing test (for children with speech delays)

  • Neurological exam, which focuses on the child’s muscle tone, strength, reflexes and coordination)

  • Developmental assessment
Early Intervention

Early intervention is designed to identify and treat a problem or delay in an infant, toddler or preschooler as early as possible. Even young babies may benefit from early intervention. Today, there are many treatment approaches that didn’t exist just a few years ago to help babies and toddlers.

At the CHOC Neuroscience Institute, we offer highly individualized, tailored care to manage the full range of developmental disabilities. This individualized treatment may include self-care training, fine motor training, sensory processing regulation, social/play development and speech therapy and communication skills.

Infants and children who are hospitalized at CHOC with developmental concerns or disabilities receive quality, compassionate care from pediatric neurologists, registered physical and occupational therapists, child life specialists and licensed speech pathologists.

At the CHOC Neuroscience Institute, our experts have extensive experience in the diagnosis and treatment of developmental delays. They work closely with families to help maximize abilities while preventing new problems wherever possible.

A Special Program at CHOC: Early Developmental Assessment Center

The Early Developmental Assessment Center (EDAC) at CHOC is designed to detect a broad spectrum of developmental problems early--including those resulting from premature birth or illness during the first month of life--to prevent or minimize developmental delays in the future. At the Center, a comprehensive, multidisciplinary assessment is done during one office visit to screen for medical, developmental, nutritional and behavioral concerns. Our team of experts assesses your child’s progress and makes referrals to community resources. EDAC provides comprehensive assessment to infants and toddlers up to 36 months old.

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It is important to remember the health information found on this website is for reference only not intended to replace the advice and guidance of your healthcare provider. Always seek the advice of your physician with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your physician or 911 immediately.

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