What is it?
Developmental Delay is the term used when a young child is slower to reach milestones than other children. Delay may occur in the way a child moves, communicates, thinks and learns, or behaves with others.

What are the features of it?
The features noted will vary according to the area(s) of delay, but can include:

• Difficulties producing controlled speech (e.g. making speech and/or sequencing).
• Difficulty controlling breathing and phonation.
  
  • Slow language development.
  • Difficulty combining physical movements into a controlled sequence, learning basic movement patterns, or difficulty remembering the next movement in a sequence.
  • Difficulty establishing the correct pencil grip, and age appropriate speed of writing.
  • Poor balance (sometimes even falling over in mid-step).
  • Problems with spatial awareness (e.g. fitting objects into appropriate sized spaces – such as puzzles, and knowing left from right).
  • Trouble picking up and holding onto simple objects due to poor muscle tone.
  • Trouble with body awareness, such as applying more force than intended, determining the distance between themselves and objects and invading other people's person space without recognizing this.
  • Difficulty achieving and maintaining continence (of bladder, bowel or both).
• Bedwetting or nocturnal enuresis is common.

Common challenges experienced by those with Global Developmental Delay:

• Lacking hand-to-eye coordination, which causes problems with basic skills such as throwing and catching.
• Heavy reliance on seeing how things are done to learn movements (verbal input is often insufficient).
• Uncoordinated physical movements, awkward postures and running styles.
• Inadequate whole body (gross motor) control skills (e.g. they may find it difficult to stand on one leg or handle equipment like a bat or racquet).
• Require more than typical time and effort to master a new physical skill.
• May not retain the skill if practice ceases (e.g. swimming lessons that cease over the school holidays can see these children needing to relearn the skills gained before the holidays).
• Unable to anticipate what might happen next (e.g. cannot 'read the play' to realise that the ball may be sent their way)
• Failure to respond quickly to their surroundings (e.g. may stand still when a ball is kicked to them).
• Have a lower level of athletic abilities compared to other children of the same age.
• Show evidence of hand dexterity (fine motor) control problems such as untidy writing.

Management strategies that supports the child with Global Developmental Delay (at preschool/school or home):

• Encouragement.
• Opportunities to succeed.
• Extra time to complete tasks.
• 'Fun' time.
• Visual cues.
• Simple language and instructions.

Occupational Therapy approaches and activities that can support the individual or their carers include:

• Develop the underlying skills necessary to support whole body (gross motor) and hand dexterity (fine motor) skills.
• Build confidence to enable a child to willingly participate in activities.
• Educate the child's carers about appropriate expectations.
• Master a skill first and then gradually increase the demands of it (much more slowly than with more typical learners).
• Present the activities at the 'Just right Challenge' level (that is not too hard for the child) or lower than this to build self confidence and encourage task engagement, (it is common for these children to shut down when they perceive the task to be too hard).
• Simplifying tasks to the smallest possible components.
• Use of simple and concise language.
• Brief instructions (where they are not required them to remember a long list of things to do).
• Physical and visual models or instructions wherever possible, not just verbal.
• 'Backwards chaining' (mastering the last step of the activity first and then the second to last).
• Chunking of information (learning to perform or associate multiple steps together, once the individual steps are mastered separately).
• Activities to support attention.

Speech Pathology approaches and activities that can support the individual or their carers include:

• Looking in depth and determining the child's strength and weaknesses in all areas of communication including play and interaction skills, attention and listening, understanding words and language, using words and language, social communication, pronunciation and talking as well as pre-literacy skills where appropriate.
• Working together with parents to devise goals and strategies to help develop areas of communication which the child is having difficulty with.
• Providing families with strategies and advice that can be utilised at home within daily activities and routines to help develop communication skills.
• Making small step by step goals that are achievable and show the child's progression within the skill areas.
• Incorporating extra visual information through use of a more formalised gesture system, pictures, symbols to aid understanding and use of language where appropriate.
• Providing lots of positive reinforcement and encouragement throughout therapy to help build confidence and self esteem.
• Liaising with educational staff where appropriate about the child's communication skills and providing information and ideas that can be used in the educational setting to help the child access the curriculum.
• Using language that is appropriate to the child's level of understanding.