NDD

What is Neuro-Developmental Delay?

Neuro-development delay is a condition which describes the continued presence of a cluster of primitive reflexes in a child above six months of age along with absent or underdeveloped postural reflexes above the age of three and a half years.

The fundamental equipment essential for learning will be faulty or inefficient despite adequate intellectual ability. It is as if later skills remain tethered to an earlier stage of development and instead of becoming automatic, can only be mastered through conscious effort.

To understand why children can be essentially intelligent but fail to learn in the way that the majority do, it is necessary to understand that the brain is divided into many distinct areas of specialisation.

Each area must be connected to each other, and as a whole, to integrate all stimuli to make sense of our world and to enable us to respond to that world. This is technically called sensory motor integration or it can be called processing. And we frequently hear of children who are found to have auditory processing delay or difficulty and/or visual processing difficulty.

This simply means that the ears and eyes, the nerve pathways, and the appropriate sensory areas in the brain do not register and interpret the stimuli as quickly, or effectively, as in others. It also means that the corresponding motor or reactive centre, of the brain does not respond as effectively or quickly.

If a child cannot hear distinctly or fast enough what is presented to their ears; if they cannot see quickly and sharply what is presented to their eyes; is it surprising then that they experience difficulties with learning?

Equally, if their response time is longer than others then they are still cogitating the problem when the rest of the class has moved on. But why does this happen?

As a child is born, he is equipped with a set of primitive reflexes that are essential for the baby’s survival, as he responds to his new environment and his changing needs in the first few months of life. A reflex is an unconscious, predictable, involuntary response to a specific event or stimulus and the entire physiological process activating it.

For example the automatic movement such as grasping of objects placed in the palm. The stimulus / response, involving a simple sensory / motor loop type of nerve pathway, does not interact with the higher conscious brain and the reaction is always the same.

When a baby is developing, the brain grows from the bottom up, so that the automatic, unconscious, regions of the brain are the first to function. The brain of a foetus and newborn infant is wired in a way to promote initial survival at a reflex level.

These reflexes show us that the functioning of the Central Nervous System (CNS) is developing well. The primitive reflexes are involuntary, stereotype movements, directed by the brain stem and executed without cortical (conscious) involvement.

The primitive reflexes should only have a limited life span, and, having helped the baby during the critical first few months of life, they should be inhibited or controlled by higher centres of the brain. This enables more sophisticated neural structure to develop, which will allow the infant control of voluntary responses.

If the primitive reflexes remain uninhibited beyond 6 – 12 months of life, they are said to be aberrant, indicating evidence of a structural weakness or immaturity within the CNS.

If these reflexes are not inhibited at the correct time, they remain active in the body and can interfere with balance, motor control, eye functioning, eye-hand coordination and perceptual skills. They can result in behavioural symptoms such as frustration, hyperactivity and hypersensitivity, and failure to match performance to ability.

All reflexes must be fully developed, integrated, and then inhibited. If one reflex is still “on”, it is may be that other reflexes are “on” as well. When a cluster of aberrant primitive reflexes are present then Neuro-Development Delay (NDD) is said to exist.

“Prolonged primitive reflex activity may also prevent the development of the succeeding postural reflexes, which should emerge to enable the maturing child to interact effectively with his environment,” (Sally Goddard Blythe 2009).

As a baby grows and develops, these primitive reflexes are replaced by the postural reflexes which allow the brain to take more sophisticated control. Postural reflexes emerge after birth and take up to three and a half years to be fully developed.

As this is happening, for example, the child replaces automatic movements such as the grasping of objects placed in the palm with the developing ability to hold a pencil correctly. By the time a child reaches school age, the postural reflexes should be developed, and no obvious signs of continued primitive reflex activity should be evident.

Individual reflexes can affect posture and behaviour in many different ways, postural control and coordination is the product of all reflexes working together. Postural reflexes provide the foundation for automatic control of posture, balance and coordination in our gravity-based environment. They enable us to be master of our own movements in space by providing the postural framework for adaptive, voluntary, and skilled movements.

Assessment of primitive and postural reflexes at key stages in development can be used to identify signs of immaturity in the functioning of the nervous system. The examiner will be looking for signs of inappropriately retained primitive reflexes and under-developed postural reflexes. Aberrant reflex activity can affect one or all areas of functioning involving:-

• fine muscle co-ordination
• gross muscle co-ordination
• sensory perception
• cognition
• ways of expression

“All learning is connected in some way to the control of movement. Reading for example depends on the development of stable eye movements. Writing involves coordination between the hands and the eyes, and copying requires repeated adjustment of the head position and focused distance.” (Sally Goddard Blythe, Director INPP International)

Sometimes the change from the baby wiring of the brain to the maturing infant does not proceed as it should, so that the various specialised centres do not develop as well as normal and cannot then perform their function as well as they should. This condition is called Neuro-Developmental Delay.

Not all of those very early reflexes disappear; for instance the knee jerk reaction should remain all of our lives, as do the reflexes that promote breathing and the heart beat.

In fact, none of the developmental Primitive Reflexes truly disappear, they simply become inhibited by the stronger reactions created by the Postural Reflexes.. Very few of us are completely without some primitive reaction to head position, but INPP (The Institute for Neuro-Physiological Psychology) discovered that when a cluster remain, that is 3 or more, they are counter productive to normal neuro-development and can give rise to any number of physical, intellectual, social and emotional developmental difficulties.

Children (and adults) with specific learning difficulties may exhibit a wide range of these symptoms which may include

• clumsiness and poor gross muscle coordination,
• fine muscle coordination problems,
• lack of concentration and often extreme excitability,
• problems with bi-lateral integration,
• aberrant motor patterns of development,
• visual perceptual problems,
• visual and auditory processing difficulties
• hand-eye coordination (visual motor integration difficulty),
• poor concentration / distractibility,
• balance problems,
• stressed / withdrawn / overtired,
• lack of energy,
• impulsiveness,
• aggressive outbursts,
• hypersensitivity both physical and emotional,
• delayed speech and language disorders,
• hearing and sequencing difficulties
• daytime poor bladder control and / or bedwetting

All of these signs and symptoms are suggestive of a delay in development. An individual may have them in any number; or, in any combination. Obviously the greater the number the greater the developmental delay and the greater the difficulty for the individual and their family.

The results of such symptoms emerge in the classroom as difficulties with reading, writing, spelling, numeracy, sequencing, P.E. and memory recall.
It may also cause difficulties in learning to swim, ride a bike, tell the time, tie shoelaces, catching a ball and relate effectively with other children of similar age.

Sometimes the same difficulties are described in a more formal way, such as:

• ADD – Attention Deficit Disorder
• ADHD – Attention Deficit Hyperactive Disorder
• Dyslexia – Difficulty with language, applied by some to mean reading, writing and sometimes speech, and by others just to mean a reading difficulty.
• Dyspraxia – Difficulty with co-ordination
• Dyscalculia – Difficulty with numbers.
• Dysgraphia – Difficulty with writing
• Dystonia (Yips) – Difficulty maintaining a balanced muscle tone.
• PDD – Pervasive Developmental Disorder (more often used in the USA)
• DAMP – Deficits in Attention, Motor control and Perception (more often used in Scandinavia)

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