When to Seek Medical Care

Developmental delays

A child should be evaluated as soon as a developmental delay is suspected. The Individuals with Disabilities Education Act (IDEA) mandates that all children have the right to an appropriate education regardless of any disabilities they might have. Thus, for children aged birth to three years of age with a developmental delay, each state has a program that evaluates and treats them for free. For children older than three years of age, the individual school districts are responsible for the child's evaluation and treatment. Children may be evaluated in the following skill areas:

• Social-emotional

• Adaptive (ability to adjust to changes)

• Cognitive (awareness and judgment)

• Language

• Gross motor (control of large movements)

• Fine motor (control of small movements)

Early evaluations can detect developmental delays and lead to the provision of intervention services. These services are designed to assist children in building skills during this time of greatest brain development.

In addition to a psychoeducational evaluation, the child with developmental delays should have a medical evaluation. In some cases, a specific cause for the cognitive impairment may be identified. If a cause is found, there may be health implications for the child, family planning issues, or both. For example, fragile X syndrome is a condition that usually develops in boys and is associated with cognitive deficits that are inherited from the child's mother. Girls can also be affected, but they are usually carriers, meaning that they could pass on the condition to their children.

Behavioral issues

Both children and adults with cognitive deficits have a higher risk of both psychiatric disorders and behavioral problems than people in the general population. Treatment may be necessary for behavioral issues. For example, a child might have problems with the following:

• Attention

• Sleep

• Aggression

• Self-harming behaviors

Psychologists and other therapists can address some of these issues through behavioral modification. Other children might benefit from medications that may allow therapeutic and behavioral strategies to be more effective.

Children with cognitive deficits go through puberty at a similar age as that of their peers without cognitive deficits. During puberty, physiologic and emotional changes occur that are similar in both children with cognitive deficits and those without cognitive deficits. However, a child with cognitive deficits has increased difficulty in coping with the social and emotional demands of puberty. At this time, children with cognitive deficits may become more aggressive or oppositional. With girls, hormonal methods to manage menstruation and to ease hygiene issues may be considered.