Question Title: child neurodevelopmental delay

Forum: Neurology Forum
Topic: Speech

Posted by ccf neuro M.D.* on August 18, 1997 at 18:35:48:

In Reply to: child neurodevelopmental delay posted by Patrick FU on August 18, 1997 at 10:27:54:

My son, Eugene, is about 4 1/2 years old now. He was found to be
developmentally delay in communication, speech and social skills,
and to have abnormal behavior (ADDH, echolalia, self-stimulation,
etc.) when he was 3 years old. The pediatrician then referred him
for the pediatrical and psycholigical assessment. The result was
"mild autistic behavior" and "developmental delay". A series of
tests have done to excluded the possibility of genetic or metabolic
disorders. Eugene`s behavior is somewhat different from the typical
autistics, for instance, he`s quite sociable (prefer to play with
adults because his difficulty to develop peer relationships with
children in his age group), and have a precocious ability to read
words and numbers. For the latter reason, I thought he is "hyperlexic".

Recently, Eugene has undergone both CATscan and EEG. The CATscan
shows a normal picture, while the brain waves of the EEG are abnormal.
The new pediatrician then asked for Eugene`s history. Eugene was a
preterm baby (32 weeks) with the born weight of 2.11kg. He was sent
into the intensive care center, given the oxygen mask for 24 hours
and put into the incubator for one week. The pediatrician`s opinion
is that Eugene has problem with the neurodevelopment and that the
trouble might have been avoided should Eugene was on the oxygen mask
longer, say, for 36 hours, instead of 24 hours after birth, because
the nervous systems of the preterm babies are usually underdeveloped,
and sufficient supply of oxygen is critical for their catch-up in the
brain formation.

Now I would like to have some advise for the treatment which
Eugene needs, and the daily life care in the future. I guess it is
necessary for him to have high oxygenation in his brain to help the
brain cells to proliferate. I have read an article in SCIENCE which
says the the first three years are critical for the neurons, is it too
late for a 4 1/2 y-o child to catch up?

I am looking forward to your early reply.
--------------------------------------------------------------------------------------------------------------

Patrick,

Let me first express my understanding of the challenges you must face on a daily basis in helping your son achieve the best possible level of development and behavioral functioning. Your son's case is obviouly a complex one, and well beyond the scope of the forum to answer in the comprehensive way it ideally deserves. Developmental delay is a nonspecific term used to describe any situation where a child's brain fails to mature as rapidly as anticipated. Such delay may affect cognitive functioning, language function, coordination or motor functioning, and social or behavioral functioning, depending on the precise nature of the underlying condition causing the delay. The delay is ALWAYS a SYMPTOM of some underlying problem, although, we are often unable to identify the exact cause of the problem, or do not understand it, even if we are. Autism is an example of the latter. Unfortunately, there is no way to know how much if any amount of additional oxygen may have helped your son. The insult to his brain responsible for his delay may well have occurred entirely in utero and be beyond any help after birth, howver great or small. At any rate, I think you are wise to not dwell on hypothetical theories and are rightly devoting your attention to helping Eugene now. CT scans will show gross abnormalities of the barin, especially bleeding. MRI scans are generally much more sensitive at detecting more subtle underlying abnormailities of the brain such as malformations of the cortex of the brain or abnormalities in the way developing nerve cells migrated when they first formed. Depending on the underlying cause, how much a child can "catch up" or fall further behind is variable. Unfortunately, there is no foolproof way to assess such potential. I think that you need to find your son a PEDIATRIC NEUROLOGIST, the type of doctor who is an expert in handling these types of problems and who often has knowledge of and access to therapy and intervention modalities that can help a child achive his or her best possible level of functioning. Such a person may also have access to special FUNCTIONAL MRI studies that are being experimantally done in select medical centers to discover which parts of the brain are not functioning properly, which may eventually shed light on understanding the cause of such diseases. Unfortunately, in the case of premature infant perinatal asphyxia (oxygen deprivation), often although the injury occurs at or before birth, the effect are played out slowly over the rest of the child's life, and nothing can magically regenerate the original injury or its long term effects, much as no one can repair damage done to a house after it has already burned down, and long term damage to the house may not be realized for many years after. Information provided on the neurology forum is intended for general medical informational purposes only. Actual diagnosis and treatment of your son's specific medical condition should be strictly in conjunction with his treating physician(s). We hope you find the information provided useful. If you would be intersted in an evaluation at the Cleveland Clinic's department of Pediatric Neurology, you may call 1-800-223-2273 and ask to be connected to the pediatric neurology appointmant desk.

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