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Developmental Disabilities

What are Developmental Disabilities?

     According to the Centers for Disease Control and Prevention, developmental disabilities are a “group of conditions due to an impairment in physical, learning, language or behavior areas.” They begin in early childhood during the development phase of life and continue throughout the lifespan. Children with developmental disabilities do not reach certain developmental milestones as quickly or sometimes ever as compared to other children their same age. 

 

[Developmental milestones are things like crawling, walking, talking, etc.]

 

     Developmental disabilities can start at any point during childhood, including before or immediately after birth. The cause of most seems to be a mixture of factors including genetics, parental health and habits during pregnancy, complications during birth, environmental exposures, infections during pregnancy or after birth, or exposure to drinking alcohol during pregnancy.  However, for many the cause is not known. It just happens. Early detection and monitoring with intervention helps improve the child’s chances of developing skills more quickly.  One in six children ages 3-17 have one or more developmental disabilities.

 

https://www.cdc.gov/ncbddd/developmentaldisabilities/facts.html

language and Speech Disorders in Children

Children are born ready to learn a language, but they need to learn the language or languages that their family and environment use. Learning a language takes time, and children vary in how quickly they master milestones in language and speech development. Typically developing children may have trouble with some sounds, words, and sentences while they are learning. However, most children can use language easily around 5 years of age.

Parents and caregivers are the most important teachers during a child’s early years. Children learn language by listening to others speak and by practicing. Even young babies notice when others repeat and respond to the noises and sounds they make. Children’s language and brain skills get stronger if they hear many different words. Parents can help their child learn in many ways, such as

  • Responding to the first sounds, gurgles, and gestures a baby makes.
  • Repeating what the child says and adding to it.
  • Talking about the things that a child sees.
  • Asking questions and listening to the answers.
  • Looking at or reading books.
  • Telling stories.
  • Singing songs and sharing rhymes.

This can happen both during playtime and during daily routines.

Some languages are visual rather than spoken. American Sign Language uses visual signals, including gestures, facial expressions, and body movement to communicate.

Some children struggle with understanding and speaking, and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.

Language development has different parts, and children might have problems with one or more of the following:

  • Understanding what others say (receptive language). This could be due to
    • Not hearing the words (hearing loss).
    • Not understanding the meaning of the words.
  • Communicating thoughts using language (expressive language). This could be due to
    • Not knowing the words to use.
    • Not knowing how to put words together.
    • Knowing the words to use but not being able to express them.

Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:

  • Speech disorders
    • Difficulty with forming specific words or sounds correctly.
    • Difficulty with making words or sentences flow smoothly, like stuttering or stammering.
  • Language delay – the ability to understand and speak develops more slowly than is typical
  • Language disorders
    • Aphasia (difficulty understanding or speaking parts of language due to a brain injury or how the brain works).
    • Auditory processing disorder (difficulty understanding the meaning of the sounds that the ear sends to the brain)

Language or speech disorders can occur with other learning disorders that affect reading and writing. Children with language disorders may feel frustrated that they cannot understand others or make themselves understood, and they may act out, act helpless, or withdraw. Language or speech disorders can also be present with emotional or behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety. Children with developmental disabilities including autism spectrum disorder may also have difficulties with speech and language. The combination of challenges can make it particularly hard for a child to succeed in school. Properly diagnosing a child’s disorder is crucial so that each child can get the right kind of help.

If a child has a problem with language or speech development, talk to a healthcare provider about an evaluation. An important first step is to find out if the child may have a hearing loss. Hearing loss may be difficult to notice particularly if a child has hearing loss only in one ear or has partial hearing loss, which means they can hear some sounds but not others. 

A language development specialist like a speech-language pathologist will conduct a careful assessment to determine what type of problem with language or speech the child may have.

Overall, learning more than one language does not cause language disorders, but children may not follow exactly the same developmental milestones as those who learn only one language. Developing the ability to understand and speak in two languages depends on how much practice the child has using both languages, and the kind of practice. If a child who is learning more than one language has difficulty with language development, careful assessment by a specialist who understands development of skills in more than one language may be needed.

Children with language problems often need extra help and special instruction. Speech-language pathologists can work directly with children and their parents, caregivers, and teachers.

Having a language or speech delay or disorder can qualify a child for early intervention (for children up to 3 years of age) and special education services (for children aged 3 years and older). Schools can do their own testing for language or speech disorders to see if a child needs intervention. An evaluation by a healthcare professional is needed if there are other concerns about the child’s hearing, behavior, or emotions. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.

Children with specific learning disabilities, including language or speech disorders, are eligible for special education services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and Section 504, an anti-discrimination law.

Cerebral Palsy

Cerebral palsy (CP) is a group of disorders that affect a person’s ability to move and maintain balance and posture. CP is the most common motor disability in childhood. Cerebral means having to do with the brain. Palsy means weakness or problems with using the muscles. CP is caused by abnormal brain development or damage to the developing brain that affects a person’s ability to control his or her muscles.

 

The symptoms of CP vary from person to person. A person with severe CP might need to use special equipment to be able to walk or might not be able to walk at all and might need lifelong care. A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person’s lifetime.

 

All people with CP have problems with movement and posture. Many also have related conditions such as intellectual disability; seizures; problems with visionhearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures).

Doctors classify CP according to the main type of movement disorder involved. Depending on which areas of the brain are affected, one or more of the following movement disorders can occur:

  • Stiff muscles (spasticity)
  • Uncontrollable movements (dyskinesia)
  • Poor balance and coordination (ataxia)

There are four main types of CP:

Spastic Cerebral Palsy

The most common type of CP is spastic CP. Spastic CP affects about 80% of people with CP.

People with spastic CP have increased muscle tone. This means their muscles are stiff and, as a result, their movements can be awkward. Spastic CP usually is described by what parts of the body are affected:

  • Spastic diplegia/diparesis―In this type of CP, muscle stiffness is mainly in the legs, with the arms less affected or not affected at all. People with spastic diplegia might have difficulty walking because tight hip and leg muscles cause their legs to pull together, turn inward, and cross at the knees (also known as scissoring).
  • Spastic hemiplegia/hemiparesis―This type of CP affects only one side of a person’s body; usually the arm is more affected than the leg.
  • Spastic quadriplegia/quadriparesis―Spastic quadriplegia is the most severe form of spastic CP and affects all four limbs, the trunk, and the face. People with spastic quadriparesis usually cannot walk and often have other developmental disabilities such as intellectual disability; seizures; or problems with vision, hearing, or speech.

Dyskinetic Cerebral Palsy (also includes athetoid, choreoathetoid, and dystonic cerebral palsies)

People with dyskinetic CP have problems controlling the movement of their hands, arms, feet, and legs, making it difficult to sit and walk. The movements are uncontrollable and can be slow and writhing or rapid and jerky. Sometimes the face and tongue are affected, and the person has a hard time sucking, swallowing, and talking. A person with dyskinetic CP has muscle tone that can change (varying from too tight to too loose) not only from day to day, but even during a single day.

Ataxic Cerebral Palsy

People with ataxic CP have problems with balance and coordination. They might be unsteady when they walk. They might have a hard time with quick movements or movements that need a lot of control, like writing. They might have a hard time controlling their hands or arms when they reach for something.

Mixed Cerebral Palsy

Some people have symptoms of more than one type of CP. The most common type of mixed CP is spastic-dyskinetic CP.

 

Early Signs

The signs of CP vary greatly because there are many different types and levels of disability. The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking). Following are some other signs of possible CP. It is important to note that some children without CP also might have some of these signs.

In a Baby Younger Than 6 Months of Age

  • His head lags when you pick him up while he’s lying on his back
  • He feels stiff
  • He feels floppy
  • When held cradled in your arms, he seems to overextend his back and neck, constantly acting as if he is pushing away from you
  • When you pick him up, his legs get stiff and they cross or scissor

In a Baby Older Than 6 Months of Age

  • She doesn’t roll over in either direction
  • She cannot bring her hands together
  • She has difficulty bringing her hands to her mouth
  • She reaches out with only one hand while keeping the other fisted

In a Baby Older Than 10 Months of Age

  • He crawls in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg
  • He scoots around on his buttocks or hops on his knees, but does not crawl on all fours

Tell your child’s doctor or nurse if you notice any of these signs. 

Diagnosing CP at an early age is important to the well-being of children and their families. Diagnosing CP can take several steps:

Developmental Monitoring

Developmental monitoring (also called surveillance) means tracking a child’s growth and development over time. If any concerns about the child’s development are raised during monitoring, then a developmental screening test should be given as soon as possible.

Developmental Screening

During developmental screening a short test is given to see if the child has specific developmental delays, such as motor or movement delays. If the results of the screening test are cause for concern, then the doctor will make referrals for developmental and medical evaluations.

Developmental and Medical Evaluations

The goal of a developmental evaluation is to diagnose the specific type of disorder that affects a child.

There is no cure for CP, but treatment can improve the lives of those who have the condition. It is important to begin a treatment program as early as possible.

After a CP diagnosis is made, a team of health professionals works with the child and family to develop a plan to help the child reach his or her full potential. Common treatments include medicines; surgery; braces; and physical, occupational, and speech therapy. No single treatment is the best one for all children with CP. Before deciding on a treatment plan, it is important to talk with the child’s doctor to understand all the risks and benefits.

Intervention Services

Both early intervention and school-aged services are available through our nation’s special education law—the Individuals with Disabilities Education Act (IDEA). Part C of IDEA deals with early intervention services (birth through 36 months of age), while Part B applies to services for school-aged children (3 through 21 years of age). Even if your child has not been diagnosed with CP, he or she may be eligible for IDEA services.

CP is caused by abnormal development of the brain or damage to the developing brain that affects a child’s ability to control his or her muscles. There are several possible causes of the abnormal development or damage. People used to think that CP was mainly caused by lack of oxygen during the birth process. Now, scientists think that this causes only a small number of CP cases.

The brain damage that leads to CP can happen before birth, during birth, within a month after birth, or during the first years of a child’s life, while the brain is still developing. CP related to brain damage that occurred before or during birth is called congenital CP. The majority of CP (85%–90%) is congenital. In many cases, the specific cause is not known. A small percentage of CP is caused by brain damage that occurs more than 28 days after birth. This is called acquired CP, and usually is associated with an infection (such as meningitis) or head injury.

If you think your child is not meeting movement milestones or might have CP, contact your doctor or nurse and share your concerns.

If you or your doctor is still concerned, ask for a referral to a specialist who can do a more in-depth evaluation of your child and assist in making a diagnosis.

At the same time, call your state’s public early childhood system to request a free evaluation to find out if your child qualifies for intervention services. This is sometimes called a Child Find evaluation. You do not need to wait for a doctor’s referral or a medical diagnosis to make this call.

Where to call for a free evaluation from the state depends on your child’s age:

  • If your child is not yet 3 years old, contact your local early intervention system.
    You can find the right contact information for your state by calling the Early Childhood Technical Assistance Center (ECTA) at 919-962-2001 or visit the Early Childhood Technical Assistance Center.
  • If your child is 3 years of age or older, contact your local public school system.
    Even if your child is not yet old enough for kindergarten or enrolled in a public school, call your local elementary school or board of education and ask to speak with someone who can help you have your child evaluated.
    If you’re not sure who to contact, you can call the Early Childhood Technical Assistance Center (ECTA) at 919-962-2001 or visit the Early Childhood Technical Assistance Center.

Muscular dystrophies

Muscular dystrophies are a group of muscle diseases caused by mutations in a person’s genes. Over time, muscle weakness decreases mobility, making everyday tasks difficult. There are many kinds of muscular dystrophy, each affecting specific muscle groups, with signs and symptoms appearing at different ages, and varying in severity. Muscular dystrophy can run in families, or a person can be the first in their family to have a muscular dystrophy. There may be several different genetic types within each kind of muscular dystrophy, and people with the same kind of muscular dystrophy may experience different symptoms.

 

Muscular dystrophies are rare, with little data on how many people are affected. The Centers for Disease Control and Prevention (CDC) is working to estimate the number of people with each major kind of muscular dystrophy in the United States.

Duchenne muscular dystrophy and Becker muscular dystrophy

Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) can have the same symptoms and are caused by mutations in the same gene. BMD symptoms can begin later in life and be less severe than DMD. However, because these two kinds are very similar, they are often studied and referred to together (DBMD).  DMD symptoms usually begin before 5 years of age and appear later in childhood, even into adulthood. It affects about 14 in 100,000 males ages 5 – 24 years of age. It affects the upper legs and upper arms but may also affect the heart, lungs, throat, stomach, intestines, and spine.

Myotonic Dystrophy

Affects about 8 in 100,000 people of all ages and genders equally. Symptoms begin between 10–30 years of age but can range from birth to 70 years old. Myotonic Dystrophy causes weakness in the face, neck, arms, hands, hips, and lower legs and is known to also affect the heart lungs, stomach, intestines, brain, eyes, and hormone-producing organs.

Limb-Girdle Muscular Dystrophy (LGMD)

LGMD affects about 2 in 100,000 men and women of all ages in equal numbers and can strike during childhood or adulthood, depending on the type of LGMD. It affects the upper arms and legs, as well as the heart, spine, hips, calves, and trunk.

Facioscapulohumeral Dystrophy

 

Males and females are equally affected among the 4 in 100,000 people who acquire the condition usually during early adulthood.  It causes weakness in the face, shoulders, and upper arms, in addition to the eyes, ears, and lower legs.

Congenital Muscular Dystrophy

 

Typically seen at birth or in early infancy, it affects 1 in 100,000 people and affects boys and girls equally. It presents a weakness in the neck, upper arms, upper legs, and lungs and may cause weakness in the brain, heart, and spine.

Distal Muscular Dystrophy

Affects less than 1 in 100,000 people.  Both men and women are affected equally during their adult years. Feet, hands, lower legs, and lower arms show weakness first with the heart, and the rest of the arms and legs also potentially being affected.

 

Oculopharyngeal Muscular Dystrophy

 

Less than 1 in 100,000 people men and women acquire this condition. It affects the genders equally and usually occurs after age forty, causing weakness in the eyes, throat, shoulders, upper legs, and hips.

 

Emery-Dreifuss Muscular Dystrophy

 

EDMD targets less than 1 in 100,000, primarily male children causing weakness in their arms, legs, heart, joints, throat, shoulders, and hips.