Diagnosing Developmental Delays in Children

Pediatric specialists at Hassenfeld Children’s Hospital at NYU Langone are experienced in identifying children with developmental delays—a group of conditions that can affect a child’s physical, cognitive, communication, social, emotional, or behavioral skills.

Rolling over, smiling, babbling, sitting up, crawling, and walking are a few of the milestones that emerge on a fairly predictable timetable during infancy and early childhood. For example, at three months of age, a baby should be able to lift his or her head and smile. By six months, most babies can grasp small objects and roll over.

Pediatricians check children for these milestones during routine well-child visits and alert parents about any concerns. Although attainment of these milestones varies from child to child, pediatricians may suspect a developmental delay when a child has difficulty meeting them.

Risk factors include a family history of developmental delays or birth defects. Babies who are born after a prolonged or traumatic labor—especially if they are born prematurely or are underweight—are at increased risk. Having certain infections while pregnant, such as cytomegalovirus or toxoplasmosis, or being exposed to certain medications, alcohol, and environmental toxins such as lead can also raise the risk of having a child with a developmental delay.

Some types of developmental delays, such as speech, gross motor, and fine motor delays, may be apparent during infancy or in the toddler years. Other types, such as high-level cognitive, sensory processing, social and emotional delays, may only become obvious when a child begins school.

An early diagnosis is key to getting children the help they need. Our doctors evaluate children of all ages. Our specialists use information from these assessments to develop an individualized treatment plan for your child.

Medical History and Parent Interview

Our pediatricians, child psychologists, and child psychiatrists use a detailed medical history form to gain insight into a number of factors that could affect your child’s development.

Our doctors ask for details about your child’s birth and medical history, including information about any medical conditions, medications, or surgery your child may have had. They may ask about a mother’s medical history while pregnant. They also inquire about any family history of birth defects or neurological, developmental, or mental health conditions.

Depending on your child’s age, the doctors may also ask if your child has been evaluated or treated for a developmental delay or related problem, such as a learning disorder.

Physical Exam

The pediatrician performs a physical exam to assess your child’s health. In addition, he or she looks for atypical growth patterns or anything unique about the child’s general appearance. An unusually shaped head or eyes or skin markings could be a sign of a genetic syndrome that affects cognitive skills, such as Down syndrome, microcephaly, or neurofibromatosis.

The physician also looks for problems that may cause gross and fine motor delays, such as a discrepancy in leg length or unusually shaped fingers. He or she also checks your child’s mouth and palate to see if there is a problem with the muscles or other structures in the mouth that is interfering with eating or speech.

Other tests involve examining your child’s reflexes, muscle tone, and balance to determine if he or she has a neurological problem. The doctor may ask your child to demonstrate or describe his or her ability to perform age-appropriate physical tasks, such as walking, standing on one foot, throwing and catching a ball, or climbing and descending stairs.

Developmental Assessment

During a developmental assessment, a neuropsychologist or developmental-behavioral pediatrician, who specializes in identifying developmental delays, observes your child’s behavior and social skills during interactions with adults and play with peers.

For school-age children and even preschoolers, this assessment is usually conducted over the course of two or three visits in the doctor’s office. In some instances, a developmental assessment may also take place in your child’s classroom, or in both locations. Throughout the assessment, the doctor observes your child’s ability to relate socially and remain focused on tasks, which can help identify conditions such as autism spectrum disorder and attention deficit hyperactivity disorder.

The specialist also observes your child’s language skills, motor skills, ability to pay attention and follow directions, and learning ability. This information enables the expert to obtain an overall picture of your child’s ability to function. The results of this comprehensive evaluation can help determine your child’s need for therapeutic services, intervention, or school placement.

For younger children, the doctor may request a home visit to see how your child behaves and functions there. If your child attends school, the doctor may ask for your permission to meet with teachers and observe him or her in the classroom.

Based on the results of the developmental assessment, our doctors may refer your child to NYU Langone’s Rusk Rehabilitation so physical and occupational therapists can provide an additional evaluation. This evaluation usually focuses on specific problems, such as speech, language, motor or feeding problems.

If your child shows signs of autism spectrum disorder, attention deficit hyperactivity disorder, learning disorders, or anxiety, our doctors may refer your child to specialists at the Child Study Center, part of Hassenfeld Children’s Hospital, or to our developmental behavioral pediatricians for further evaluation.

Hearing Test

Your pediatrician may refer you to an audiologist to evaluate your child’s hearing, which may affect speech and language skills. This doctor performs a test to measure otoacoustic emissions—faint vibrations that are normally produced by a structure in the ear called the cochlea when stimulated by sound. Children whose ears do not produce these vibrations may have a blockage in the ear canal or cochlear damage, which causes hearing loss.

The audiologist may perform another test to measure auditory brainstem response, which shows whether the brain can respond to sound. In this test, he or she attaches painless electrodes to your child’s scalp. The electrodes help locate the area of the brain that is not responding to sound, causing hearing loss.

For young children between nine months and three years old, the audiologist may recommend a behavioral hearing test called visual response audiometry. During this test, your child listens to different sounds, such as speech or music, while seated in a sound booth. When the sound is played, the child is shown a toy in a far corner of the room. The child learns to look for the toy each time he or she hears the sound, which gets softer each time it is played. The audiologist observes your child’s response to determine if he or she can hear the sounds.

For older children, our doctors use more conventional audiometric tests to diagnose hearing problems. For instance, your child may be asked to raise his or her hand or press a button after a sound is played.

If your child has a hearing problem, the audiologist can refer you to a specialist to determine if he or she may benefit from a cochlear implant or other hearing devices.