Global Developmental Delay DSM­-5 315.8 (F88)


DSM-5 Category: Neurodevelopmental Disorders


Previously known in DSM-4 as “Mental Retardation, Severity Unspecified”, the term global developmental delay (GDD) in DSM-5 is used to explain developmental disability in children who are under five years of age (Thomaidis, et al., 2014). It refers to an important developmental milestone delay in regards to motor, speech and language; cognition; social functioning; and activities of daily living (Perna & Loughan, 2013). GDD is seen as a temporary diagnosis for children who are unable to undergo standardized IQ evaluation (American Psychiatric Association, 2013). Research has shown that a good number of children with GDD ultimately meet the diagnosis for Intellectual Disability once they reach school age. It is estimated that approximately five to ten percent of the pediatric population experience developmental delay (Thomaidis, et al., 2014). It remains hard to have an accurate estimate as GDD is affected by multiple factors such as age and socioeconomic status. This result in a higher number being reported in the developing world compared to westernized countries (Thomaidis, et al., 2014). GDD is seen in about fifteen percent of children below the age of five.

Some children are diagnosed under a year of age, while others become evident when the parents compare their children to others of the same age. Delays can show up as multiple issues and end in diverse prognosis with children. The research on early delays appears to be a bit unclear in regards to persistence of impairments or how they can progress to other disorders. Precise determination of the primary etiology symbolizes a vital step in handling young children with GDD. This can be hard to pin point as the actual determinants are very variable. These classifications can be labeled as prenatal, perinatal, and postnatal. They range from genetic abnormalities such as syndromes and anomalies to hypoischemic encephalopathy, to Central Nervous System (CNS) infections. Some research has shown that being diagnosed with GDD can result in an elevated risk of ensuing cognitive, behavioral, or academic issues (Perna & Loughan, 2013). Increasing amount of research implies that speech and language delays are frequently connected with consequent challenges with reading, writing, attention, and socialization.

As a result, early diagnosis of GDD is crucial, to ensure early intervention, especially in children with more severe delays. This is also needed to prevent future socio-behavioral problems, such as social anxiety, bipolar affective disorder, and psychotic depression (Moeschler & Shevell, 2014). Early diagnosis and intervention has been shown to decrease the risk of developing Attention Deficit Hyperactive Disorder (ADHD) in children (Perna & Loughan, 2013).

Symptoms of Global Developmental Delay

According to DSM-5, the Global Developmental Delay diagnosis is set aside for children under the age of 5 when clinical severity point cannot be consistently evaluated during early childhood (American Psychiatric Association, 2013). The diagnosis pertains to children who are unable to meet developmental targets in a number of areas of intellectual performance but who are not capable or too young to take part in methodical/standardized evaluations of intellectual functioning. This diagnosis involves reconsideration following a phase of time.

Diagnosis of Global Developmental Delay

There are multiple tests used in the diagnosis of Global developmental delay. These consist of the following below.

Genetic, molecular, and metabolic tests-These tests are usually conducted via urine or blood samples, and are able to detect hereditary types of global developmental delay (American Academy of Neurology, 2014). In addition, blood and urine tests also allow for the evaluation of abnormalities in body chemistry, which can contribute to developmental delay. In children born to mothers with a history of alcoholism, tests can be conducted to check for fetal alcohol syndrome.

Chromosome testing- These tests help in inherited problems and genetic defects that can contribute to global developmental delay. Some specific genetic testing can be done to evaluate certain rare disorders. One of the most common genetic causes of GDD is Fragile X, and conducting this test can eliminate this possible cause (Moeschler & Shevell, 2014). Rett syndrome is a high ranking cause of GDD among girls. The screening of girls for Rett Syndrome can be beneficial in eliminating this possibility of GDD.

Children can be tested for other disorders. One such test is that of lead, which is quite toxic, and easily found in the environment. It can affect the nervous system, and has been associated with mental deficits. Older houses are linked with high lead exposure, and in children at risk for this exposure, a blood test can be conducted to check for elevated lead levels (American Academy of Neurology, 2014).

An important blood chemistry level that can contribute to GDD is the thyroid hormone. Decreased amounts of thyroid hormone levels can result in irregular growth and development, as well as slower mental ability. Normally new born babies are screened for this, but if this was not done at birth, it can be conducted in at risk children.

Neuroimaging tests such as CT and MRI can be conducted to evaluate any possible injury to the central nervous system and the brain. By looking at these detailed images, doctors can be provided insight regarding some children with GDD. While MRI offers more detailed images, CT brain scans are faster to do, and much cheaper for the patient.

Treatment of Global Developmental Delay

To ensure early intervention for children diagnosed with GDD, the diagnosis must take place early. Early intervention has been shown to improve outcomes in treatable causes of GDD.

The treatment foundation would mean targeting the cause of the developmental delay. With children with speech delays, it would be imperative to seek the help of a speech pathologist. Children, who are experiencing delays in fine motor and daily living skills, will benefit from occupational therapy and physical therapy interventions. Those with hearing and vision delays, may benefit from the use of a hearing aid, correctional lenses/eye glasses.

In children with GDD due to metabolic causes, such as Phenylketonuria (PKU), dietary modification can help the children lead relatively normal lives. Behavioral and educational therapies can assist those with syndromes such as Fragile X, while extensive behavior modifications, parent training, and speech and language intervention, occupational and physical therapies may be indicated in a lifelong disability such as Down syndrome.

Living with Global Developmental Delay

It is important for children with GDD to be evaluated early, since some children ultimately end up with intellectual disability. Some children with GDD end up with a plethora of mental health issues such as ADHD, which can prove challenging if unidentified in school age children. On the other hand, some children with GDD may be remedied if the problem is identified. In some cases, some children with GDD were adopted from developing countries which lacked adequate individual attention, resulting in poor motor, language, social and cognitive skills. (Perna & Loughan, 2013) Once placed in an environment where this is encouraged, such deficits can be corrected before starting school.

School age children with GDD face great stigma within the community at large, and bullying may be an issue in school and even at home (Perna & Loughan, 2013). Family support is crucial to help these children with activities of daily living as needed. Older children with GDD can experience difficulty handling simple tasks such as eating, dressing, brushing their teeth or using the bathroom.

As individuals with GDD can be prone to develop Intellectual Disability, which is associated with increased suicide attempts, it is important for the community to be involved in the intervention. There should be continuity of treatment and collaboration between all medical professionals from the pediatrician or family physician, to the neurologist, speech pathologist and therapists.

As stated, some children with GDD may have a permanent lifelong medical condition, like Down’s syndrome, Fragile X syndrome, Prader-Willi syndrome, Angelman syndrome or Williams syndrome which would mean having a more comprehensive treatment plan. Most importantly each child with GDD regardless of cause should be seen as an individual, and personal needs should always be considered in helping maintain a normal life.


American Academy of Neurology. (2014). Testing For The Cause of Global Developmental Delay. Retrieved from AAN Guideline Summary for Parents and Caregivers.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Moeschler, J., & Shevell, M. (2014, August). s Comprehensive Evaluation of the Child With Intellectual Disability or Global Developmental Delay. Pediatrics, e903-e918.

Perna, R., & Loughan, A. (2013). Early Developmental Delays: A Cross Validation Study. J Psychol Abnorm Child, 1(2).

Thomaidis, L., Zantopoulos, G., Fouzas, S., Mantagou, L., Bakoula, C., & Konstantopoulos, A. (2014). Predictors of severity and outcome of global developmental delay without definitive etiologic yield: a prospective observational study. BMC Pediatrics, 14(40), 1471-2431.

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