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Neuro-developmental delay

Neuro-developmental delay (NDD) is a phrase or term which is used to indicate that, for some non-specific reason, the nervous system in a child has not yet fully matured. You may also see NDD referred to as neuro-motor immaturity (NMI). This ‘delay’ or ‘immaturity’ can present or show itself in a variety of ways or signs.

If your child has a specific neurological diagnosis, such as Cerebral Palsy, there will be a pathological/disease-related reason for NDD or NMI. This is because certain conditions, like CP, may interfere with ‘normal’ physical development, compromising the sequence of movements and postures needed to end up as an independent, upright individual.

However, neuro-developmental delay or neuro-motor immaturity can be seen in children for whom there is no pathology and for whom there seems to be no reason for their presenting issues.

This neuro-developmental delay or neuro-motor immaturity, if it persists, is important because the effects on a child and adult may be far-reaching. In general terms, if physical development is compromised, albeit in a small way, this can result in issues with cognition/the ability to interpret information, sensory perception/the ability to process information and expression/the ability to pass on the information received. We all learn through movement and if movement is lacking, insecure or inaccurate, the quality of our learning, both academic and social, is threatened. Thus, children with neuro-developmental delay or neuro-motor immaturity may present with learning difficulties of varying types and complexity; they may display behavioural and emotional immaturity, and have speech/language/communication and motor/movement, balance and co-ordination difficulties.

The signs of NDD/NMI and characteristics of soft neurological signs are not dissimilar. The term soft neurological signs (you may see this called NSS in some literature – Neurological Soft Signs) describes minor neurological abnormalities or dysfunction seen in the absence of an obvious cause or pathology. Some doctors are cynical about the existence of soft signs, which are poorly understood, even though a standard neurological examination will test for them. Soft neurological signs are seen in all normal young children and, in this group, their presence can be definitely attributed to nervous system immaturity. Therefore the presence of these signs may not be indicative or predictive of future learning difficulties but, in many children with learning difficulties, soft signs are found.

The main soft neurological signs include:

  • poor motor coordination and balance
  • poor speed and accuracy of movement
  • poor sequencing of complex motor tasks
  • dysrhythmia/poor timing and rhythm of movement
  • synkinesia/movement overflow
  • agraphaesthia/inability to recognise letters or numbers traced on the skin
  • astereognosis/inability to recognise shape and size of an object by touch
  • sensory-perceptual difficulties/altered processing of information
  • impaired audio-visual integration
  • poorly established laterality/functional predominance of one side of the body

It is interesting to note that similar signs may be seen in children with learning difficulties.  The documented signs include:

  • clumsiness
  • poor balance
  • poor fine motor skills
  • poor visual motor integration/hand eye coordination
  • poor motor sequencing
  • cross laterality or poorly defined laterality
  • poor attention, concentration and memory

For many children and their parents, it is in school – in the classroom and on the playing field – that the effects of NDD/NMI come to the fore. The physical and developmental issues listed above may manifest themselves as:

  • problems with reading
  • problems with writing
  • difficulties with spelling
  • trouble with presentation of information on a page
  • inability to complete tasks correctly and on time
  • difficulties with games on the field and dressing  in the changing room
  • behavioural issues, including excitability and moderation
  • anxiety

At home you may also see:

  • age-inappropriate dressing skills
  • inability to tell the time from an analogue clock
  • difficulties learning to ride a bicycle
  • messy eating

Some children will have been examined for NDD/NMI, following concerns raised by parents or the school. As a result, they may have been given a diagnosis of a Specific Learning Difficulty (SpLD), such as:

  • Dyslexia/dysfunction in ability to read, write and spell
  • Developmental Coordination Disorder (DCD) or Dyspraxia/disorder of gross and fine motor coordination
  • Dyscalculia/difficulty in learning, comprehending or acquiring arithmetic skills
  • Attention Deficit Disorder with or without Hyperactivity – ADD or ADHD
  • Dysphasia, speech and language delay and/or deficit

If your child has NDD/NMI or a SpLD as a result of immature reflexes (retained primitive reflexes or underdeveloped postural reflexes), then the INPP programme is the treatment of choice. To find out if this is the case, your first step is to fill in and submit the free Screening Questionnaire.