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OBJECTIVES

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  • 1) Differentiate the pathophysiology of common developmental disorders

  • 2) Distinguish the diagnostic criteria of common developmental disorders

  • 3) Compare the treatment needs of children with common developmental disorders from those discussed for children with cerebral palsy

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INTRODUCTION

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The term “developmental disorder” or “developmental disability” refers to any injury or disease that occurs prior to the age of 18 and disrupts the acquisition of typical developmental milestones, including motor, cognitive, language, and psychosocial skills.1 Thus, this term includes a vast number of disorders; however, in this chapter, we are going to focus on those disorders commonly seen by physical therapists. We have separated out the two most common developmental disorders in their own chapters – cerebral palsy and myelomeningocele; however, it should be remembered that these are also developmental disorders.

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As the time of onset (birth–18 years) indicates, developmental disabilities can occur throughout childhood and adolescence. However, many are present at birth (congenital), occurring prenatally (prior to birth) or perinatally (during or close to the time of birth). Others occur postnatally, often the result of trauma or disease processes that impact the nervous system (e.g., meningitis). In this chapter, we will focus on those that are congenital; it should be noted that many congenital disorders are not diagnosed until much later in the developmental period. Causes of congenital disorders may be known (genetic – chromosomal anomaly or inherited, birth trauma, environmental exposure) or unknown (e.g., developmental coordination disorder), yet their presentations may be quite similar or highly unique. This chapter will focus on the common and unique elements of these disorders.

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CASE A, PART I

Pauli Sabat is a 40-month-old little girl of Latino heritage, whose parents immigrated to the United States from Argentina a year before her birth, initially on student visas but now on work visas; both are college educated – Dr. Sabat as a PhD in physics and Mrs. Sabat as a computer scientist. They have scheduled an appointment at a diagnostic clinic for children with developmental disorders. They report that Pauli is not keeping up with the other kids at daycare; she doesn’t run, doesn’t catch or throw a ball like her peers, continues to walk up and down stairs with a two-step/stair pattern, while holding the railing, and tends to be easily distracted, rushing from one toy to another without spending more than 30 seconds with any one of them. She also has limited verbal language skills, mostly repeating syllables of words that she hears but not really initiating speech; she does say mama and papa appropriately but infrequently. Although she is being raised in a bilingual home, her parents report that her speech development is much slower than her two older siblings. However, she does seem to understand what is said to her, following directions like “come here” but inconsistently, both in English and Spanish. She feeds herself but prefers ...

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