The Pediatrician's Role in Caring for the Developmentally Disabled Child
Gregory S. Liptak MD, MPH1
1 Associate Professor of Pediatrics, University of Rochester School of Medicine and Dentistry, and Medical Director, Andrew J. Kirch Center for Children Who Have Physical Disabilities, Rochester, NY.
Definition
The term "developmental disabilities" is used to describe a broad array of conditions that delay development and includes individuals who have "mental retardation." In 1992, the American Association on Mental Retardation defined mental retardation as an intelligence quotient (IQ) less than 70 or 75, with onset before age 18 years and limitations in two or more of the following adaptive skills: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work. This definition assumes that the testing performed was sensitive to differences in culture, language, communication, and behaviors and that the child's broadly defined environment was considered. Developmental disabilities may be isolated, as in the child whose vision is impaired, or may be multiple, as in the child whose fine motor, gross motor, and social functioning are delayed.
Epidemiology
Mental retardation has a prevalence of 10 in 1000 children. Specific common conditions and their prevalence per 1000 children include: cerebral palsy, 2; Down syndrome, 1; hearing impairment, 1; visual impairment, 1; and fragile X syndrome, 1. Delayed development is more frequent among children from low socioeconomic conditions. Developmental disabilities are encountered commonly in pediatric practice: Horwitz et al found that 5.3% of the patients encountered in a study of pediatric practices had cognitive and language disorders and that 4.0% had motor abnormalities.
