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Developmental Delay
What is a developmental delay?
A developmental delay means that a child under six is acquiring skills more slowly than expected in one or more areas of development:
social skills;
independence and everyday living skills;
language, both expressive and receptive;
fine and gross motor skills;
intellectual abilities.
When the delay is mild, it is described as a developmental lag. When it is significant and affects at least two areas, it is referred to as a global developmental delay.
The diagnostic evaluation
A developmental assessment looks at how a child under six grows, learns and interacts, measuring each area of development against children of the same age.
It brings out the child’s strengths, difficulties and support needs. Early intervention significantly improves the prognosis.
FAQ
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Every child develops at their own pace, and falling behind in one area does not necessarily mean a delay. The milestones below are those generally observed at each age:
Before 6 months: the baby holds their head up, begins to roll over, smiles at people, coos and laughs, and brings objects to their mouth.
6 to 12 months: sits unaided, crawls on hands and knees, pulls up to stand; picks up small objects between thumb and forefinger, responds to their name, points, and begins to say “mama” or “papa”.
1 to 2 years: walks unaided, stacks a few blocks, understands simple instructions, uses around twenty words, shows interest in other children and begins pretend play.
2 to 3 years: runs and climbs, puts two words together and then short sentences, asks questions, feeds themselves with a spoon and is usually dry during the day.
3 to 4 years: goes up and down stairs alternating feet, speaks in full sentences, stands on one foot for a few seconds and begins to play with other children.
4 to 6 years: holds a real conversation, tells stories, draws a person, gets dressed largely unaided and joins in group games.
If several of these milestones have not been reached, especially across more than one area, it is worth talking to a professional.
Milestones based on Ferland, F. (2014). Le développement de l’enfant au quotidien : de 0 à 6 ans [Child development in everyday life: from 0 to 6 years]. CHU Sainte-Justine.
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A delay may be noticed at different ages, and by different people:
parents, who are very often the first to worry that their child is not reaching the milestones expected for their age;
the paediatrician, who plays a key part in prevention and early detection;
nursery and kindergarten staff, who see many children develop, may notice that a child is falling behind their peers.
If in doubt, it is never too early to seek advice: the earlier support begins, the less likely difficulties are to become entrenched.
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The assessment draws on any previous reports, clinical observations made during the sessions, and a battery of standardized tests, both paper-based and digital, carried out at the practice. Together, these give a detailed, nuanced and objective picture of the child’s psychological functioning.
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The first appointment is usually held with both parents present, without the child. It focuses on an in‑depth discussion of the child’s history, current difficulties, and the parents’ expectations.
This interview aims to:
Determine whether a diagnostic evaluation is appropriate.
Clarify the assessment protocol (tests selected based on the information gathered beforehand).
Present the full evaluation process (number of sessions, duration, report, and feedback session).
Address any questions the parents may have.
Establish a trusting environment, essential for minimizing the impact of anxiety on test performance.
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It enables the clinician to:
Establish a provisional diagnosis.
Gain an in-depth understanding of the child’s mental functioning and its impact on daily life.
Provide tailored recommendations and accommodations for daily life, both at home and at school.
Recommend appropriate interventions such as cognitive remediation, neuropsychological rehabilitation, orthoptics, speech therapy, occupational therapy, physical therapy, or psychotherapy.
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Developmental domains assessed:
Social-emotional development
Adaptive/self-care development
Motor development
Expressive language and communication development
Overall/general development
Adaptive domains assessed:
Communication
Daily living
Socialization
Psycho-affective domains assessed:
Personality: assessment of personality organization, including pathological aspects, and identification of any underlying psychological vulnerabilities.
Autism: analysis of the behaviours, language, communication and social interaction associated with autism, together with the level of risk and of severity.
Cognitive domains assessed (for children over 4 only):
Intellectual abilities: logical, conceptual, and quantitative reasoning.
Attentional functions: selective and sustained attention.
Executive functions: cognitive inhibition, cognitive flexibility, working memory, planning.
Memory functions: short-term memory.
Visuospatial functions: visuoperceptive and visuospatial abilities
Language functions: receptive and expressive language.
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A developmental assessment is offered when a developmental delay is suspected. It is also necessary when autism spectrum disorder is suspected, so that a differential diagnosis can be made.
Before the age of six, a child’s psychological, emotional and cognitive development cannot be measured precisely, because the brain and the child’s emotional life are both still developing intensely. A three-year-old, for example, cannot be expected to have fully mature attention. A developmental assessment is therefore a partial psychological and neuropsychological assessment.
The hypotheses it raises can then be confirmed around the age of six, through a full psychological and neuropsychological assessment, once the main brain functions are no longer undergoing major development. In the meantime, support can already be put in place.