A Developmental Delay is a “significant” lag in a child’s physical, cognitive, behavioral, emotional, or social development, when compared to norms or typical milestones. The term “significant” is hard to define simply. It can vary according to:

• The particular milestone being measured. For example, there is more variation in the age at which a typical child walks (9-17 months) versus displays a social interactive smile (1-3 months). Thus, saying what is a real delay for milestones with broader ranges of variation can be more difficult than for milestones with narrower age ranges.
• State laws that determine if a developmentally delayed child is eligible for services. Children with delays can qualify for services but what is needed for qualification can vary location-to-location.
• The experience and approach of the professional assessing the child. Some professionals will take a very statistical approach to defining a significant delay. For example, they may consider a child significantly delayed when he/she has failed to accomplish a milestone when some 70% of their peers have. Another professional, based on his/her experience, may not be so worried.

The important thing to remember is to watch your child develop. Explore the available information, talk to other parents, see what other children do, but bear in mind that children differ—a lot! And if you have a concern about your child’s development, seek the advice of a professional. See section below called “get help”.

• Having a Developmental Delay is not the Same as Having a Disorder
• The key thing about delays is that they are usually less severe than a disorder and that they will either go away on their own or with the help of a treatment.
• It is difficult to know ahead of time if a child will catch up on their own. Often they do. So in some cases a professional is completely correct to say “wait a while and don’t worry too much…”. However, if you feel that your concerns have been dismissed too quickly, go back and ask for a formal developmental assessment. At the very least this should include some sort of standard assessment instrument, family history and parental report.
• Delays do respond to treatments and the earlier treatments are initiated the better. Treatments may involve therapies performed by professionals outside the home. In some cases, treatments occur in the home as well. Treatments may be complex, such as physical therapies, or simple, such as advising parents to engage with the child differently or in a more stimulating way.

Remember that what appears to be a delay can be the precursor or early sign of a disorder but often it is not. Being a watchful parent and an advocate for proper assessments and services can be critical to your child’s health. If needed, the earlier treatments are started the better the outcome. Be patient, avoid anxieties, gain knowledge. See the “get help” section below.

Things That Can Cause Delays

• The culture, ethnicity and language background of the child. For instance, infants raised in multilingual homes may be behind their monolingual peers in some early aspects of language development. However, research suggests that these delays pretty much disappear by age 4 or so. See child development chart.
• The extent to which a child is raised in an impoverished environment. Studies show that delays are more common in economically depressed families and in families where in-the-home stimulation is minimal regardless of the economic standing of the household.
• Natural variation in genetics. Some children simply get the genetics predisposing them to be delayed in development although they can catch-up. The chance mixture of parental genes is a contributor in the differences we see across children making some children fast or slow developers. But just because there may be a genetic basis to the delays does not mean that the delays cannot be helped by proper treatments.
• Genetic risk factors. This type of genetics can be a bit different than natural variation mentioned above. It refers to specific genes that can put a child at risk for delays and eventual disorders. For example, there are genes that put children at risk for reading-related learning disabilities in the later years that may show their effects as delays in language when the child is quite young.
• Environmental factors. In addition to the environmental factors like economics, there are other more specific “environmental risk factors”, that like their genetic risk factor counterparts, can cause delays and perhaps yield more serious disorders later. These include things like physical and emotional abuse, toxins like lead, drugs the mother may have taken during pregnancy, and poor nutrition.

Remember that there are many causes of delays and that genetics and environment work together to produce delays as well as determining if and how a child will catch-up. For more information on this topic see child development chart.

• If you feel that your child may have a delay that concerns you may want to have your child formally assessed. After the assessment you can speak with the professional about next steps.
• These types of assessments are sometimes called “developmental screenings” or “developmental evaluations”.
• These two sites offer more information about these evaluations: Developmental Screening & Developmental Evaluations
• The resources in or near Merced County for screenings can be found here.
• You are also encouraged to speak with your child care provider, such as teachers at his or her preschools or their pediatrician. You might also speak with your own health care professional/physician for advice about how to proceed.
• Remember: Read the information in this section on delays and normal development, be a calm advocate for your needs, and know that early interventions, if needed, are usually best.

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies of twins link genes with ADHD.¹

In addition to genetics, scientists are studying other possible causes and risk factors including:

• Brain injury
• Environmental exposures (e.g., lead)
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

For more information about cause(s) and risk factors, visit the National Resource Center on ADHD or the National Institute of Mental Health.

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy is recommended as the first line of treatment. No single treatment is the answer for every child and good treatment plans will include close monitoring, follow-ups and any changes needed along the way.

Following are treatment options for ADHD:

• Medications
• Behavioral intervention strategies
• Parent training
• School accommodations and interventions

To go to the American Academy of Pediatrics (AAP) policy statement on the treatment of school-aged children with ADHD, visit the Recommendations page.

Behavioral Therapy

Research shows that behavioral therapy is an important part of treatment for children with ADHD. ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and how well they do in their classes. Behavioral therapy is a treatment option that can help reduce these problems for children and should be started as soon as a diagnosis is made. Read about effective therapies here »

Following are examples that might help with your child’s behavioral therapy:

• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
• Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
• Avoid distractions. Turn off the TV, radio, and computer, especially when your child is doing homework.
• Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn’t overwhelmed and overstimulated.
• Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
• Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child’s efforts. Be sure the goals are realistic—baby steps are important!
• Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior.
• Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it’s sports, art, or music — can boost social skills and self-esteem.

Behavior Treatment for Preschoolers

The 2011 clinical practice guidelines from the American Academy of Pediatrics recommend that doctors prescribe behavior interventions that are evidence based as the first line of treatment for preschool-aged children (4–5 years of age) with ADHD. Parents or teachers can provide this treatment.

The Agency for Health Care Research and Quality (AHRQ) conducted a review in 2010 of all existing studies on treatment options for preschoolers. The review found enough evidence to recommend parent behavioral interventions as a good treatment option for preschoolers with disruptive behavior in general and as helpful for those with ADHD symptoms.

The AHRQ review found that effective parenting programs help parents develop a positive relationship with their child, teach them about how children develop, and help them manage negative behavior with positive discipline. The review also found four programs for parents of preschoolers that include these key components:

• Triple P (Positive Parenting Program),
• Incredible Years Parenting Program
• Parent-Child Interaction Therapy
• New Forest Parenting Program—Developed specifically for parents of children with ADHD [Abstract] [Authors]

Medications

Medication can help a child with ADHD in their everyday life and may be a valuable part of a child’s treatment. Medication is an option that may help control some of the behavior problems that have led to trouble in the past with family, friends and at school.

Several different types of medications may be used to treat ADHD:

• Stimulants are the best-known and most widely used treatments. Between 70-80 percent of children with ADHD respond positively to these medications.
• Nonstimulants were approved for treating ADHD in 2003. This medication seems to have fewer side effects than stimulants and can last up to 24 hours.

Medications can affect children differently, where one child may respond well to one medication, but not another. When determining the best treatment, the doctor might try different medications and doses, so it is important to work with your child’s doctor to find the medication that works best for your child.