Petersen M C, Kube D A, Palmer F B
Department of Pediatrics, Boling Center for Developmental Disabilities, University of Tennessee, Memphis, College of Medicine, , USA.
Semin Pediatr Neurol. 1998 Mar;5(1):2-14. doi: 10.1016/s1071-9091(98)80012-0.
Developmental delay is frequently used to identify children with delay in meeting developmental milestones in one or more streams of development. There is no consensus on the specific definition. Developmental delay is best viewed generically as a chief complaint rather than a diagnosis. A child suspected to have delays should always be assessed in each of the major streams of development: expressive and receptive language, including social communication; visual problem solving (nonverbal cognition); motor development; neurobehavioral development; and social-emotional development. A model developed by the National Center for Medical Rehabilitation Research is used to compare existing classifications of developmental delays. This model defines the five domains in the disability process: pathophysiology, impairment, functional limitation, disability, and societal limitation. An etiology domain is added. This model is used to illustrate how existing classification systems of cerebral palsy, mental retardation, autism, and language delay draw on information from one or more domains. The model illustrates some of the conflicts between different systems. For example, most classification systems for cerebral palsy emphasize only impairment (spasticity, dyskinesias, and topography). The current definition and classification system for mental retardation focuses on functional limitations (IQ), disability, and societal limitations, ignoring pathophysiology and details of impairment. Given the complexity of neurodevelopmental disabilities, it is unlikely that a single classification system will fit all needs.
发育迟缓常用于识别在一个或多个发育领域中未达到发育里程碑的儿童。对于具体定义尚无共识。发育迟缓最好一般视为主要诉求而非诊断。疑似发育迟缓的儿童应始终在每个主要发育领域进行评估：表达性和接受性语言，包括社交沟通；视觉问题解决能力（非语言认知）；运动发育；神经行为发育；以及社会情感发育。国家医学康复研究中心开发的一个模型用于比较现有的发育迟缓分类。该模型定义了残疾过程中的五个领域：病理生理学、损伤、功能受限、残疾和社会限制。增加了一个病因学领域。该模型用于说明脑瘫、智力障碍、自闭症和语言迟缓的现有分类系统如何借鉴一个或多个领域的信息。该模型说明了不同系统之间的一些冲突。例如，大多数脑瘫分类系统仅强调损伤（痉挛、运动障碍和部位）。当前智力障碍的定义和分类系统侧重于功能受限（智商）、残疾和社会限制，而忽略了病理生理学和损伤细节。鉴于神经发育障碍的复杂性，单一的分类系统不太可能满足所有需求。
