Abstract
To determine the etiologic yield in young children with developmental delay referred
to sub-specialty clinics for evaluation. Over an 18-month period, all children less
than 5 years of age referred to the ambulatory pediatric neurology or developmental
pediatrics clinics of the Montreal Children's Hospital for initial evaluation of a
suspected developmental delay were enrolled. Features evident on history or physical
examination were determined at intake as were the laboratory tests (and their rationale)
requested by the evaluating physicians. Six months post initial assessment, detailed
chart review was undertaken to determine if an etiology was found and the basis for
such a determination. Bivariate and multivariate logistic regression was used to test
for associations between factors present at intake and successful ascertainment of
an underlying etiology. Two hundred and twenty-four children met study criteria. Etiologic
yield varied across childhood developmental delay subtypes, and was 44/80 for global
developmental delay [GDD] (55%), 13/22 for motor delay [MD] (59.1%), 3/72 for developmental
language disorders [DLD] (4.2%), and 1/50 for autistic spectrum disorders [ASD] (2%).
For GDD, the presence of historical features or findings on physical examination was
associated with greater likelihood for successful etiologic determination with the
following items significant in multiple logistic regression analysis; microcephaly,
antenatal toxin exposure, focal findings. For MD, physical findings or the co-existence
of a cerebral palsy symptom complex predicted a successful search for etiology. For
both groups, the severity of the delay did not predict etiologic yield. For both groups,
a small number of etiologic categories accounted for the majority of diagnoses made.
Etiologic yield in childhood developmental delay is largely dependent on the specific
developmental delay subtype. Paradigms for systematic evaluation of this common child
health problem can be suggested, however they await validation.
Keywords
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Article info
Publication history
Accepted:
April 2,
2001
Received in revised form:
April 2,
2001
Received:
February 22,
2001
Identification
Copyright
© 2001 Elsevier Science B.V. Published by Elsevier Inc. All rights reserved.
