Neuro-Developmental Delay
Information
Neuro-Developmental Delay
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Neuro-Developmental Delay (NDD) refers to immaturity in the central nervous system. One of the main things to look for is the presence of retained infant (primitive) reflexes and underdeveloped adult (postural) reflexes.
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In utero, babies develop a set of infant reflexes that help to facilitate the birth process and that help them to survive outside of the womb. These reflexes are also critical in helping them achieve developmental milestones. During the first year, these reflexes should systematically disappear and are eventually replaced with mature, adult reflexes. There are many things that can happen during pregnancy, birth, and the first year that interrupt this process and prevent proper development. The presence or absence of these reflexes provides us with reliable landmarks that show how the child's central nervous system is functioning. Often times, there is a mismatch between a child’s physical age and the maturity of their nervous system.
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The impact of NDD varies from person to person. Symptoms will depend on which infant reflexes are present, which adult reflexes are absent, what other areas in the body are affected, and how the child has learned to cope.
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Poor attention
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Poor balance and coordination
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Emotional instability
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Poor hand-eye coordination
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Difficulties in school
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Anxiety
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Hypersensitivity
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Motion Sickness
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Decreased immune system
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Inflexibility
Common Causes
Pregnancy
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Medical Problems
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Sickness
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Injury requiring bed rest
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Extreme emotional stress
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Alcohol or drug use
Birth
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Difficulty with the birth process
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Vacuum or forceps delivery
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Cesarean birth
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Birth trauma
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Prematurity
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Breech presentation
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Loss of oxygen / Low heart tones
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Very long or very fast labor
Infancy
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Skipping motor stages such as crawling
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Ear nose and throat problems
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Restricted movement
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Negative reaction to medications or vaccines
Primitive Reflexes
Moro (startle) Reflex
Children with a retained Moro are consistently put in a state of heightened arousal. This can have a huge impact on their ability to function. Children learn to cope with this in different ways. Some become very anxious, fearful of things that might trigger this reflex, while other become over-excitable, using the reflex like an adrenaline rush.
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Symptoms if retained
- Emotional immaturity - Over-reactive
- Poor balance and coordination - Anxiety
- Low self-esteem - Stimulus bound
- Hypersensitive - Motion sickness
- Hyposentitive - Visual-perception problems
- Immune issues - Poor impulse control
- Hyperactive
Stimulus
Any sudden change in head position or any of the five senses: light, sound, touch, smell, or taste
Response
The baby’s arms first stretch open and then grasp forward. Their sympathetic nervous system is also activated and it triggers a physiological fight-or-flight response.
Function
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Helps baby survive during the first few months after birth
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Alerts caregiver to possible danger
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Helps stimulate breathing after birth
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Early fight-or-flight response
Tonic Labyrinthine Reflexx (TLR)
The TLR is triggered by a specific change head position (detected by the vestibular system). The vestibular system also has connections to the child’s visual, auditory, and motor control systems. Children with a retained TLR have an immature vestibular system and often have immaturity in these other systems as well. Their brain receives mismatched information from each of these sensory systems.
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Symptoms if retained
- Visual-perception problems - Poor posture
- Under or over developed muscle tone - Motion sickness
- Poor balance and coordination - Toe walking
Stimulus
Flexion or extension of the head
Response
The arms and legs flex when the head flexes and extend when the head extends
Function
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Helps baby get into a good position for birth
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Helps baby adapt to a world with gravity
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Helps develop muscle tone
Spinal Galant Reflex
Children with a retained Spinal Galant often have trouble staying still, particularly while seated. They may be very uncomfortable sitting in chairs that touch the lumbar region of their back or wearing tight pants or pants with tags.
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Symptoms if retained
- Difficulty sitting still
- Hypersensitivity in the lumbar region
- Some connection to bed wetting (tags, waist bands, etc.)
Stimulus
Flexion or extension of the head
Response
The arms and legs flex when the head flexes and extend when the head extends
Function
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Helps baby get into a good position for birth
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Helps baby adapt to a world with gravity
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Helps develop muscle tone
Asymmetrical Tonic Neck Reflex (ATNR)
Children with a retained ATNR often have to adjust their posture in order to accomplish everyday tasks. This becomes particularly evident during school when they are using cognitive effort and when they are often required to sit at a desk. Children with a retained ATNR often have “bad” posture and may even be labeled as “lazy” because of it.
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Symptoms if retained
- Poor balance and coordination - Difficulty reading
- Avoid crossing the midline - Poor hand-eye coordination
- Difficulty tracking visual information - Difficulty writing
Stimulus
Rotation of the head to either side
Response
The arm and leg on the “face” side extend and the arm and leg on the “skull” side flex
Function
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​​Encourages movement in the womb
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Helps facilitate the birth process
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Develops homolateral movement
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Helps keep airway clear
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Early hand-eye training
Symmetrical Tonic Neck Reflex (STNR)
Similar to the ATNR, Children with a retained STNR often have to adjust their posture during everyday activities like school. Their postural and visual systems work against rather than with them. Many children try to accommodate this by adjusting their position e.g. they may tuck their legs under them when they sit in a chair.
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Symptoms if retained
- Poor posture
- Prevent proper crawling
- Poor body control
​- Poor hand-eye coordination
- Difficulty with attention and concentration
- Difficulty with vertical tracking
Stimulus
Rotation of the head
Response
When the head extends, the arms extend and the lower body flexes. When the head flexes, the arms flex and the legs extend.
Function
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​Helps the infant defy gravity (move from the floor to standing)
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Helps with spine alignment
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Helps with visual accommodation