Developmental disabilities: a continuum

The development of a child is a primary indicator of neurologic integrity. The four major developmental domains are motor, language, problem-solving and adaptive skills. Failure of a child to show age-appropriate progress in any of these four areas should be acknowledged and analyzed as part of the pediatric examination. A child's neurodevelopmental pathology has two distinct but related axes: (1) a wide range of developmental diagnoses and (2) a continuum of related dysfunction. The range of development diagnoses includes the primary diagnosis, such as mental retardation or cerebral palsy, and the continuum manifests itself in such associated dysfunctions as motor clumsiness and vision and hearing deficits. If a physician can distinguish these two axes, he or she can be more effective in understanding and providing care for a person with chronic central nervous system dysfunction.