Introduction
The development consists of a series of events by which a child evolves from the dependent infant stage to the independent adult stage. Several factors contribute to this development process. Each child develops at different rates, and it is important to differentiate those within the normal range from those following a pathological course. Developmental neurological tests are the detailed and comprehensive evaluation of a child's abilities, difficulties, and needs. The results of neurodevelopmental assessments can be used to identify an individual's abilities and diagnose a neurodevelopmental impairment, such as autism spectrum disorder or cerebral palsy.
What Is Meant by Developmental Assessment?
Developmental assessment is the process of recording a child's developmental performance and comparing them with children of a similar age group. The comparison group will be a representative sample of the child's population. The process of development involves several factors.
Developmental assessments in children are recommended when there are concerns about a child's ability to meet expected developmental milestones and perform everyday tasks. A standard psychometric assessment is used to assess various areas of development. They are:
- Communication.
- Social skills.
- Self-care.
- Self-direction
- Motor skills.
Along with these tools, developmental history interviews with parents and teachers are also collected. The assessment results are given in a written report, and necessary recommendations are made.
Why Developmental Assessment Is Important?
Developmental assessment is an important part of identifying children at risk of poor development milestones. It addresses various aspects, including a child's physical and mental growth and development. They help us to identify and diagnose developmental and intellectual delays.
What Are Developmental Neurological Tests?
Developmental neurological tests are detailed and comprehensive assessments of a child's ability, difficulty, and needs. It is very important to carry out these tests during the initial phase with a trained person. Developmental neurological tests are part of the process of establishing a neurodevelopmental diagnosis. Every child is different. Hence these assessment tools are modified according to the needs of a child and parental inquiry and are guided by history. Pediatricians can modify the assessment sequence based on the child's condition, cooperation, interest, and motivation.
Why Are Developmental Neurological Tests Important?
Developmental neurological tests aim to assess the child's present condition and allow the professional to inform parents about their child's characteristics and how they can best promote their child's development with or without early professional intervention. It can also predict developmental disorders like cerebral palsy, Autism spectrum disorder, attention deficit, or hyperactivity disorder. The effects of neurodevelopmental disorders will last for a person's lifetime.
What Are the Goals of Developmental Neurological Tests?
- Identifies children who need comprehensive interdisciplinary assessment.
- Identifies children who need regular monitoring.
- Identify possible developmental delays and indications of possible future disability.
- Ensure the earliest possible intervention and support for infants and their families with developmental difficulties.
How Do You Access the Neurological Status of a Child?
The neurodevelopmental examination provides information about a child's learning, growth, and development over time. It includes the following.
- Developmental tests.
- Neurological examination.
- Physical examination.
- Brain imaging.
- Laboratory tests.
Healthcare providers involved in the developmental neurological examination are the following.
- Neurologist.
- Neurodevelopmental Pediatrician.
- Ophthalmologist.
- Physical Therapist.
- Nurse practitioner.
What Is Done During a Developmental Neurological Test?
Developmental neurological tests evaluate the presence of characteristic symptoms or behaviors in a child, typically after a parent, guardian, teacher, or another responsible adult has raised concerns to the doctor.
Steps involved in developmental neurological testing include the following.
- In-depth Interview - Interview with the parent or guardian regarding the child's developmental milestones and behavior patterns.
- Clinical Observation- Observing attention, concentration, behavior, dysmorphism, family interaction, eye contact, spontaneous speech, articulation, behavior, and speed of doing things. Clinical observations obtained from the assessment help us to notice anxiety, mood, sensory behaviors, and the higher mental functions of a child.
- Scoring Test Tools - Specific forms will be given to parents and the child's teachers. It includes test tools like SCQ (social communication questionnaire) for possible Autism spectrum disorder (ASD), Conners rating scales for potential attention deficit hyperactivity disorder (ADHD), or M-ABC (movement assessment battery for children) for suspected dyspraxia.
- Developmental Assessment - It helps us determine the difference in a child's response and functions from others of the same age group. These tools give an idea about a child's speech, motor, language, and cognition abilities.
- Specific Assessments - Depending on the nature of the parental concern and the presenting features of the child's difficulties, certain specific assessments are considered. It includes assessments such as ADOS-2 (autism diagnostic observation schedule) for autism spectrum disorder (ASD) or a diagnostic interview for attention-deficit or hyperactivity disorder (ADHD) or motor examination and an evaluation for dyspraxia that would give us an estimate of the child's functional abilities. With the above assessments' the signs of speech disorder, intellectual disability, language disorder, and any sensory impairment can be ruled out.
- Growth Assessment- The child's height, weight, and head circumference are measured and plotted on the growth charts. The growth parameter and body mass index (BMI) are calculated. Growth assessment is important to carry out, as many genetic syndromes and conditions that cause developmental delay and learning disability can also be associated with growth parameter abnormalities. Growth assessment is one aspect of looking for dysmorphology or defects.
- Dysmorphology - Abnormal differences in the body structure are noted. An examination of the child from head to toe is done. Usually, children with neurodevelopmental disorders do not have a syndrome or an identifiable genetic condition to cause their difficulties. Certain genetic syndromes, like fragile X or fetal alcohol syndrome, can present as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or both.
- General Physical Examination- A physical examination helps determine the possibility of an underlying medical disorder impacting a child's development and behavior. As part of this, cardiovascular, respiratory, gastrointestinal, neurological systems, and spine are examined.
- Neurological Examination- Neurological assessment is of prime importance in neurodevelopmental evaluation. Neurocutaneous and neurogenetic disorders can also be associated with neurodevelopmental disorders. The development and behavior of the child could be a manifestation of the underlying neurological issues. The child's movements, passive movement resistance in muscles of a joint, reflexes, hypermobility, weakness, and asymmetry of the head, neck, and face are examined. The presence of skin signs, signs of any movement disorder, and birthmarks are looked at, and it helps in the diagnosis.
- Management Plan- A diagnosis of a neurodevelopmental disorder is a lifelong one. Other investigations like vision, imaging, hearing, and genetic tests can also be done.
What Are the Most Common Developmental Neurological Disorders?
Developmental neurological disorders are a group of disorders characterized by abnormal brain function, which affects emotion, learning ability, self-control, and memory.
Developmental neurological tests are used to determine a child's brain functions at the expected level for their age. According, to the diagnostic and statistical manual of mental disorders (DSM-5), neurodevelopmental disorders include the following:
- Attention deficit hyperactivity disorder (ADHD).
- Developmental language disorder (DLD).
- Autism spectrum disorder (ASD).
- Intellectual disabilities.
- Communication, speech, or language disorders.
- Motor disorders like developmental coordination disorder and stereotypic movement disorder.
- Neurogenetic disorders like fragile X syndrome, Down syndrome, and Rett syndrome.
- Specific learning disorders, like dyslexia or dyscalculia.
- Traumatic brain injuries, including cerebral palsy, and disorders due to neurotoxicants like mercury (Minamata disease), lead, chromium, and platinum.
- Fetal alcohol spectrum disorders (FASD).
What Are the Most Common Signs and Symptoms of Developmental Neurological Disorders?
- Delayed milestones of development.
- Difficulty reading or writing.
- Visual or auditory difficulties.
- Speech difficulties.
- Poor balance or messy eaters.
- Delayed expressive language -commonly shortening words or making up words.
- Delayed verbal communication skills.
- Difficulty understanding spoken commands and being unable to execute them.
- Difficulty with fine motor skills (picking up things, putting things in place).
- Hyperactivity.
- Poor social interaction of their age.
Conclusion
Childhood is a critical period in development as different abilities and behaviors rapidly develop, including a child's cognitive, language, motor, social, emotional, behavioral, play, adaptive, and emerging academic skills. If a child is not making age-appropriate progress in one or more of these domains, they may have a delayed developmental neurological milestone. Early assessment of a child's developmental neurological status will help the healthcare provider to identify the condition and formulate necessary treatment strategies as early as possible.
