What are Developmental Disorders?

These disorders are any neurologically, emotionally, or physically based behavioral issues, which keep a child from interacting normally with his or her peers and/or keep a child from learning skills or knowledge that his or her peers are learning. They often involve:

• The lack of full coordination of gross and fine motor skills and poor motor planning

• Lack of age appropriate speech, language and communications skills

• Lack of age appropriate social interaction

• Impaired healthy self-esteem

These conditions include:

• Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Disorder (ADD)

• Autistic Spectrum (ASD), Autism, Asperger’s Disorder

• Central Auditory Processing Disorder (CAPD)  

• Cerebral Palsy

• Downs Syndrome

• Dyslexia & Specific Learning Disabilities (SLD)  

• Epileptic or Seizure Disorders

• Genetic Syndromes

• Non-Verbal Learning Disorder  

• Pervasive Developmental Disorder (PDD), Multi-Systems Disorder (MSD)

• Motor Planning Disorder  

• Sensory Integration Disorder (SID)  

• Sensory Processing Deficits

• Spina Bifida

All of these disorders involve limitations or deficits in many of the same areas of developmental functioning, such as:

• Speech and/ or language
• Motor planning (sequencing of actions or behaviors)
• Social interactions and social relatedness
• Cognition & perceptual functioning (visual, auditory and kinesthetic).

Although label help to get funding for services, I have found in my practice that it is more important to adopt broader "functional descriptions" with broader eclectic intervention and treatment options to accommodate for each individual child’s needs, rather than the child accommodating to the unitary treatment approaches offered. Each child, no matter what label or diagnosis given by behaviors, displays unique patterns of functional deficits and must be treated as an individual rather than as a "child with a diagnosis."

A way to avoid premature incorrect labeling

Labels or diagnostic categories are needed because:

• Third party payers demand a "label" for reimbursement
• Parents often demand and find comfort in a label. They insist on knowing what's wrong and what the prognosis is.

The "RULE OUT" approach recommends a step wise model of assessment and intervention with developmental disabilities.  Step One: rule out all physiological problems which might be the real reasons for the observed behaviors. Step Two: rule out all sensory, motor planning and cognitive issues which might be the real reasons for the observed behaviors. Step Three: rule out other potential social, emotional, cognitive, sensory, motor, familial issues which might be the real reasons for the observed behaviors. Step Four: rule in what remains unchallenged to explain the reasons for the observed behaviors.

By using the Four Step Rule Out Model, we can clearly identify those behaviors, which are modifiable and potential ways to modify them. This will avoid pre-mature labeling incorrectly. Once all factors have been ruled out and only the relevant factors have been ruled in, then and only then can an accurate diagnosis and intervention program be offered.

What constitutes  "Rule Out Model" Assessment Team

General Team Evaluation by a Developmental pediatrician and developmental clinical diagnostician 

or a

Developmental Screening by Treatment Team consisting of, as needed, a child developmental psychologist, speech pathologist, occupational therapist, special education specialist, social worker, child development specialist and a developmental pediatrician or pediatric neurologist.

"Rule Out" Rules within the Assessment Process

In having a child assessed for a developmental disability it is imperative that the developmental team:

• "Rule Out" all  physiological or bodily dysfunctions
• "Rule out" all relevant sensory, motor, motor-planning and cognitive dysfunctions
• "Rule out" all social, emotional, cognitive, sensory, motor and familial issues
• "Rule in" all levels of the child's functioning before finalizing a plan of action to insure that only those issues which could not be "rule out" are the reasons for the observed developmental delays or problems

Recognize that ongoing setbacks for children in current intervention programs may be due to the presence of Physiological-Sensory-Motor planning issues, which have not been adequately identified previously.

Examples of "Rules Outs"

Rule Out Step One: Physiological and Bodily State

Rule out: Seizures, Brain Lesions, Neurological disorders, Genetic disorder, Metabolic Disorder, Allergies

Rule Out Step Two: Sensory, Motor, Cognitive Factors

Rule out: Vision problems, Hearing problems, Auditory and Visual Perceptual & processing problems, Motor control or motor planning problems, Sensory Integration problems, Intellectual and Cognitive functioning and potential

Rule Out Step Three Social, Emotional, Cognitive, Sensory, Motor, Familial issues

Rule out: Cultural deprivation, physical abuse or neglect, failure to thrive, impulse control problems, learning disabilities    

Rule Out Step Four - Rule in what remains as not ruled out

Rule in: remaining issues which have not been ruled out as the cause of the observed behaviors and functioning and planned a relevant treatment intervention based on the "rule in" factors.

Ideal Intervention Components

What is needed in providing appropriate intervention services for children with developmental disabities is to have them enrolled in programming, which is inclusionary in nature. Such programming should be eclectic and involve components many of the following components, which are selected to meet the needs of the individual children:

Overall Social/Relational Approach:  

• One on One Communications play i.e. Floor Time
• Play Therapy

Language and Communication:  

• Speech & Language Therapy  
• Listening and auditory processing programs  
• Language enhancement  
• Oral motor therapy

Sensory:  

• Sensory integration  
• Meliorate processing deficits through remediation
• Sensory modulation with a sensory diet to desensitize the child to a gradual increase of external sensory stimuli  

Motor Skills:  

• Occupational Therapy  
• Oral motor therapy  
• Motor planning intervention  
• Physical Therapy

Behavioral Approach:  

• Applied Behavioral Analysis  
• Discrete Trial Learning  
• Behavioral modification and intervention

Cognitive:  

• Educational programming  
• Classroom modification  
• Organizing skills  
• Study skills  
• Tutoring

Medical:  

• Medication for seizure, or neurological disorder in child  

Nutritional:  

• Food allergy control  
• Diet control  
• Improving eating patterns  
• Vitamin supplements