NRNP 6665: PMHNP Across the Life Span I: Study Guide Forum

NRNP 6665: PMHNP Across the Life Span I: Study Guide Forum

NRNP 6665 PMHNP Across the Life Span I Study Guide Forum

PMHNP across the Life Span I: Study Guide Forum- Global Developmental Delay

Signs and symptoms according to the DSM-5-TR

Global Development Delay (GDD) refers to a developmental disability in children below five years.
Affected children have significant developmental milestone delay in two or more of the following domains:
Speech and language
Gross and fine motor
Cognition
Personal/social
Activities of daily living.
The diagnosis applies to children who fail to meet developmental targets in several areas of intellectual performance but who cannot or are too young to participate in standardized evaluations of intellectual functioning (Bélanger & Caron, 2018).

Differential diagnoses

The differential diagnoses for GDD are: Intellectual disability, Failure to thrive, General speech delay, Developmental language disorder, Autism spectrum disorder, Attention deficit hyperactivity disorder (ADHD), Cerebral palsy, and Muscular dystrophy (Kim et al., 2020).

Incidence

About 5-10% of children experience developmental delays (Bandara & Munasinghe, 2020).
GDD is seen in approximately 15% of children under five years.

Development and course

The development of symptoms in children differs according to age and severity (Bélanger & Caron, 2018).

Prognosis

A significant percentage of children with GDD eventually meet the diagnosis of Intellectual Disability after they attain school age (Bandara & Munasinghe, 2020).
Developmental delays can appear as multiple issues and result in a different prognosis for children.

Considerations related to culture

Treatment interventions for GDD should align with the patient’s culture.
The clinician should be culturally sensitive when assessing and managing a child with GDD.

Pharmacological treatments, including any side effects

No drug therapies are available for GDD (Bélanger & Caron, 2018).

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Non-pharmacological treatments

Occupational therapy and physical therapy- for delays in fine motor and daily living skills (Bélanger & Caron, 2018).

NRNP 6665 PMHNP Across the Life Span I Study Guide Forum

Use of hearing aids and correctional lenses/eyeglasses- for hearing and vision delays.
Dietary modification- for metabolic causes like Phenylketonuria (Bandara & Munasinghe, 2020).
Behavioral and educational therapies.
Extensive behavior modifications.
Parent training.
Speech and language intervention- for speech delays (Bandara & Munasinghe, 2020).

Diagnostics and labs

Various tests are used to diagnose GDD, including:

Genetic, molecular, and metabolic tests-The tests are conducted using urine or blood samples. They detect genetic types of GDD (Djordjevic et al., 2020).
Chromosome testing- Identify inherited problems and genetic defects that can contribute to GDD (Djordjevic et al., 2020).
Lead testing- Lead poisoning affects the nervous system and is associated with mental deficits.
Thyroid Hormone Test- Low thyroid hormone levels can cause irregular growth and development (Djordjevic et al., 2020).
Head CT and MRI- To assess for any injury to the CNS and the brain.

Comorbidities

Comorbidities in children with GDD include:

Intellectual disability
ADHD
Down’s syndrome
Fragile X syndrome
Prader-Willi syndrome
Angelman syndrome
Williams syndrome

Legal and ethical considerations

The clinician should consider legal and ethical factors of autonomy, confidentiality, beneficence, and nonmaleficence when dealing with clients with GDD.

Autonomy- Seek consent before assessing and initiating treatment. Involve the parent/guardian in making treatment decisions (Bélanger & Caron, 2018).
Confidentiality- Ensure patient information is kept confidential.
Beneficence- Prescribe treatment interventions supported by evidence to have the best outcomes.
Nonmaleficence- Prevent the patient from physical or psychological harm.

Pertinent patient education considerations

The child’s parents and family should be educated on measures to support the child with GDD, especially with activities of daily living.
The family should be instructed to support the child experiencing difficulty handling simple tasks like eating, brushing their teeth, dressing, or toileting (Bélanger & Caron, 2018).

NRNP 6665: PMHNP Across the Life Span I: Study Guide Forum References

Bandara, J. M. U. A., & Munasinghe, J. (2020). Aetiological profile of global developmental delay in children under 5 years of age: experience from a tertiary referral center. Sri Lanka Journal of Child Health, 49(4), 361-368. DOI:10.4038/sljch.v49i4.9272

Bélanger, S. A., & Caron, J. (2018). Evaluation of the child with global developmental delay and intellectual disability. Paediatrics & child health, 23(6), 403-410.

Djordjevic, D., Tsuchiya, E., Fitzpatrick, M., Sondheimer, N., & Dowling, J. J. (2020). Utility of metabolic screening in neurological presentations of infancy. Annals of Clinical and Translational Neurology, 7(7), 1132-1140. https://doi.org/10.1002/acn3.51076

Kim, S. W., Jeon, H. R., Jung, H. J., Kim, J. A., Song, J. E., & Kim, J. (2020). Clinical characteristics of developmentally delayed children based on the interdisciplinary evaluation. Scientific reports, 10(1), 1-7. https://doi.org/10.1038/s41598-020-64875-8

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