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Neuro-developmental delay

Neuro-developmental delay

Childhood is a joyous and exciting time for most children.  New and progressively complicated skills are acquired with relative ease.  The child experiences a constant feedback of achievement and satisfaction, which facilitates the growth of confidence and self-esteem.

Some children, however, find certain skills difficult or almost impossible to master.  They see their peers riding bicycles, reading, playing football, tying shoelaces, being in "the gang" while they struggle to acquire basic skills.  Comments such as "not trying", "lazy", "useless" add to their own feelings of frustration and inadequacy.

Parents and teachers wonder why the child cannot learn a skill that seems to be well within his ability.  They often sense that "something is wrong" but cannot identify a specific problem.  Many children with such difficulties have a mild neurodevelopmental delay (NDD) - some parts of the brain are late in maturing.

The brain develops in stages, beginning with lower levels of function.  Optimal function of each stage is dependent upon complete development of the preceding levels.  If there is a disruption or delay in early development, the higher brain cannot function at its potential and this can result in difficulties, particularly with learning.

Identification of a developmental delay brings great relief to the child, parents and teachers.  All too frequently, the problems associated with NDD (such as dyslexia and dyspraxia) only become obvious relatively late in childhood or early adolescence, when a cycle of failure or underachievement has developed, with subsequent emotional, psychological or behavioural problems.  In many children the early signs can be overlooked, as there is no one specific identifiable manifestation. NDD has been described as a syndrome of many and varied symptoms that co-exist in all combinations and severities. Children with a developmental delay generally have average or above average levels of intelligence and can develop compensatory mechanisms which mask the underlying problem, making its identification difficult.

However, if several of the below indicators are felt to be present, the possibility of a developmental delay should be considered:

*A family history of any manifestation of developmental delay.  It is not uncommon for one child to be enuretic (bedwetting) while a sibling has a specific learning difficulty.

*A problem during pregnancy or birth, particularly if the blood supply to the baby has been compromised.

*Problems with feeding, sleeping or activity levels in the early weeks

*Delay in reaching the early milestones (sitting, crawling, walking)

*Failure to crawl, or limited crawling with early walking.

*Slow acquisition of speech, poor vocabulary development, and difficulty with multisyllabic words

*Delayed development of laterality (beyond the age of three)-the child may have difficulty deciding which hand to use, or have mixed laterality

*Gross and/or fine motor skills - difficulties with learning to ride a bicycle, poor ball skills, unusual pencil grip, poor or inconsistent handwriting, problems using cutlery - preferring to eat with fingers, general clumsiness, difficulties tying shoelaces.  The child may have been found to be dyspraxic.  


*Academic skills - Difficulties learning to read and/or with comprehension, poor spelling, difficulties with maths.  The child may have been found to be dyslexic or have a specific learning difficulty.

*Social skills - the child may find difficulty relating to his peers, may play with younger children but often relates well with adults, rules may present a problem.  There may be bullying or aggressive behaviour or alternatively the child may be a loner.

*Behavioural problems - communication difficulties may lead to frustration in the child, with tantrums occurring frequently.  Problems with concentration and attention.  The child may be hyperactive, disruptive or the "class clown".  ADD or ADHD may be suspected.

*Enuresis (bedwetting) after the age of five.

An assessment by a neurodevelopmental therapist will quickly establish if the child has a developmental delay.  Neurodevelopmental therapy may then be considered.  This is a programme of movements, which aims to promote development of the nervous system.  By incorporating the movements used naturally by the baby and young child, the nervous system is gently encouraged to mature and thus become more open to learning.  The child performs specific movements every day for 5-10 minutes, helped and encouraged by an adult.  The child is guided through the programme by a therapist who reviews the progress every 6-8 weeks.  The programme is specific for each child and generally lasts for about 14 months.

The early identification of a developmental delay, with appropriate remediation, can greatly lessen the frustration frequently experienced by the child, parents and teachers.  Appropriate remediation can allow the child the full benefit of all the early opportunities for learning social, emotional, motor and academic skills, and thus develop into a happy, fulfilled and confident adult.

Further reading:

The Well-Balanced Child: Movement and Early Learning.  Sally Goddard.  2004.  Hawthorn Press.

Developmental Dyspraxia: Identification and Intervention.  Madeline Portwood. 1999. David Fulton Publishers.

Smart but feeling Dumb: New Research on Dyslexia.  Harold N. Levinson2003.  Warner Books.

Triona O'Farrell


Institute of Neurodevelopmental Therapy, Ireland