Early Diagnostics and Early Intervention in Neurodevelopmental Disorders—Age-Dependent Challenges and Opportunities

Abstract

This review discusses early diagnostics and early intervention in developmental disorders in the light of brain development. The best instruments for early detection of cerebral palsy (CP) with or without intellectual disability are neonatal magnetic resonance imaging, general movements assessment at 2–4 months and from 2–4 months onwards, the Hammersmith Infant Neurological Examination and Standardized Infant NeuroDevelopmental Assessment. Early detection of autism spectrum disorders (ASD) is difficult; its first signs emerge at the end of the first year. Prediction with the Modified Checklist for Autism in Toddlers and Infant Toddler Checklist is possible to some extent and improves during the second year, especially in children at familial risk of ASD. Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries. At around 3 months the cortical subplate has dissolved in primary motor and sensory cortices; around 12 months the cortical subplate in prefrontal and parieto-temporal cortices and cerebellar external granular layer have disappeared. This review stresses that families are pivotal in early intervention. It summarizes evidence on the effectiveness of early intervention in medically fragile neonates, infants at low to moderate risk, infants with or at high risk of CP and with or at high risk of ASD.

Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review

“…Some children with CP may have near normal milestone attainment over the first year of life [ 2 , 9 ], and this is especially true for children with mild unilateral CP [ 9 ]. Merely assessing how far the child has come in its development can lead to a false impression of typical development, and this is why assessing quality of movement is recommended [ 7 , 9 , 16 ]. Children with unilateral or bilateral spastic CP, especially those with a milder motor impairment, are usually identified late [ 18 , 28 ].…”

“…To intervene during the child’s first months of life, to capitalize on the enhanced neuronal plasticity during this critical developmental period, is considered as best practice [ 3 , 4 , 6 – 8 ]. Motor training incorporating active, child-initiated, goal-oriented and task-specific movements, as well as family involvement and environmental enrichment, have shown promising results [ 3 , 7 , 8 ]. Early motor interventions aim to advance motor skills and children’s learning potentials as well as to prevent secondary negative consequences of the disorder [ 3 , 6 , 8 , 11 ].…”

Early, intensive rehabilitation improves gross motor function after perinatal stroke: results of a randomized controlled trial

“…As the efficacy of early interventions is established, early diagnosis of perinatal stroke, and CP in general, is increasingly important (reviewed in [44][45][46] ). Facilitating early detection and diagnosis is especially important for perinatal strokes where approximately half of cases are not identified at the time of birth and children often have few risk factors for CP 47 .…”

Development of muscle tone impairments in high-risk infants: Associations with cerebral palsy and cystic periventricular leukomalacia

“…In addition, it is important to realize that in the majority of infants at risk of neurodevelopmental disorders neonatal MRIs are lacking. 8 Hypotonia in a single part of the body is rather prevalent in the general infant population. 9,10 Without other accompanying neurological signs, it has little clinical significance.…”