Global Developmental Delay DSM-5 Criteria

What is global developmental delay?

Global developmental delay (GDD) is a term used to describe significant delays in two or more developmental domains in children under 5 years old. These domains include motor skills, speech and language, cognition, social skills, and daily living activities (American Psychiatric Association, 2013a).

GDD is not a final diagnosis but rather a descriptive term indicating a child's current developmental status. It often serves as a provisional diagnosis when standardized testing is challenging due to the child's age. Timely identification

How is global developmental delay diagnosed?

Diagnosing GDD involves a comprehensive evaluation, as no single test can definitively identify the condition and rule out other developmental disabilities. So, the process typically begins with a thorough developmental screening during routine pediatric check-ups. If concerns arise, a more in-depth evaluation is conducted.

The diagnosis relies on clinical judgment and includes the following:

1. Detailed medical history, including prenatal, birth, and family information
2. Physical and neurological examinations
3. Developmental assessments using standardized tools
4. Observation of the child's behavior and interactions

Assessing medical genetics or genetic testing, including chromosome microarray analysis and fragile X DNA testing, is also recommended for children with GDD. Metabolic testing may also be considered, especially if clinical characteristics point to inborn metabolism errors. These tests can identify underlying genetic factors or metabolism causing intellectual disability.

Global Developmental Delay DSM-5 Criteria

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) indicates the following for the diagnosis of GDD:

This diagnosis is reserved for individuals under the age of 5 years when the clinical severity level cannot be reliably assessed during early childhood. This category is diagnosed when an individual fails to meet expected developmental milestones in several areas of intellectual functioning, and applies to individuals who are unable to undergo systematic assessments of intellectual functioning, including children who are too young to participate in standardized testing. This category requires reassessment after a period of time.

While the DSM-5 doesn't provide specific criteria, GDD is considered under neurodevelopmental disorders. It's important to note that GDD is typically used as a temporary diagnosis for children under 5, pending further diagnostic evaluation as the child develops.

For children under 5 years of age, where standardized intelligence testing may not be reliable, clinicians use the term Global Developmental Delay when a child fails to meet expected developmental milestones in multiple areas. This diagnosis requires comprehensive clinical assessment and may serve as a provisional diagnosis until a more specific determination can be made.

Our Global Developmental Delay DSM-5 Criteria is designed as a reference tool that you can use as a handout when educating clients or patients.

Differences between the DSM-4 and DSM-5 criteria

The transition from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) to the Fifth Edition brought significant changes in the conceptualization and diagnosis of developmental disorders. These changes are particularly relevant for understanding GDD and related conditions (American Psychiatric Association, 2013b):

• Terminology: The DSM-5 replaced the term "mental retardation" used in DSM-IV with "intellectual disability (intellectual developmental disorder)." This change reflects a more respectful and less stigmatizing approach to diagnosis.
• Diagnostic criteria: While the DSM-IV focused primarily on IQ scores for diagnosis, the DSM-5 emphasizes both intellectual and adaptive functioning. This shift allows for a more comprehensive assessment of an individual's abilities and challenges.

Disorders associated with global developmental delays

Global Developmental Delay is also often associated with various underlying conditions and developmental disorders. Understanding these associations is crucial for comprehensive care and management. Some of the commonly associated disorders include:

1. Intellectual developmental disorder: GDD in early childhood may progress to intellectual disability as the child ages. The DSM-5 defines intellectual disabilities as deficits in both intellectual and adaptive functioning.
2. Autism spectrum disorder: Children with GDD may also show features of autism spectrum disorder, including difficulties in social communication and restricted repetitive behaviors.
3. Metabolic disorders: Inborn errors of metabolism can lead to GDD. Examples include phenylketonuria and hypothyroidism.
4. Sensory impairments: Vision and hearing problems can contribute to developmental delays and may coexist with GDD.
5. Communication disorders: Speech and language delays are often part of GDD but can also be separate diagnoses.

How is global developmental delay treated and managed?

Global Developmental Delay (GDD) treatment and management require a comprehensive, multidisciplinary approach tailored to each child's specific needs. Early intervention is crucial for optimizing outcomes and supporting the child's development.

1. Early intervention services: These programs provide specialized support for children under 3 years old. Services may include speech therapy, occupational therapy, physical therapy, and special education. These have been shown to significantly improve developmental outcomes.
2. Individualized education programs (IEPs): For children over 3, IEPs offer tailored educational support within the school system. These programs address specific learning needs and provide necessary accommodations.
3. Speech and language therapy: This therapy focuses on improving communication skills, including both receptive and expressive language abilities.
4. Occupational therapy: Occupational therapists work on fine motor skills, sensory processing, and daily living activities to enhance independence.
5. Physical therapy: This therapy addresses gross motor skills, mobility, and overall physical development.

References

American Psychiatric Association. (2013a). Diagnostic and statistical manual of mental disorders (5th ed.). Pearson.

American Psychiatric Association. (2013b). Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Association. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM_Changes_from_DSM-IV-TR_-to_DSM-5.pdf