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## Complete Summary

#### GUIDELINE TITLE

Practice parameter: evaluation of the child with global developmental
delay: report of the Quality Standards Subcommittee of the American
Academy of Neurology and The Practice Committee of the Child Neurology
Society.

#### BIBLIOGRAPHIC SOURCE(S)

Shevell M, Ashwal S, Donley D, Flint J, Gingold M, Hirtz D, Majnemer A,
Noetzel M, Sheth RD. Practice parameter: evaluation of the child with
global developmental delay: report of the Quality Standards Subcommittee
of the American Academy of Neurology and the Practice Committee of the
Child Neurology Society. Neurology 2003 Feb 11;60(3):367-80. \[123
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12578916)

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Non-progressive global developmental delay

#### GUIDELINE CATEGORY

Diagnosis\
Evaluation

#### CLINICAL SPECIALTY

Family Practice\
Neurology\
Pediatrics

#### INTENDED USERS

Physicians

#### GUIDELINE OBJECTIVE(S)

To make evidence-based recommendations concerning the evaluation of the
child with a non-progressive global developmental delay

#### TARGET POPULATION

Children, typically less than 5 years of age, with global developmental
delay

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Detailed history and examination

2.  Referral for auditory and ophthalmologic screening

3.  Metabolic studies (urine organic acid screen, quantitative serum
    amino acids, serum lactate and ammonia levels, capillary or arterial
    blood gas, thyroid function studies) in children who did not have
    universal newborn screening

4.  Electroencephalogram (EEG) in patients with a history of suspected
    seizures or epilepsy syndrome

5.  Screening for autism or a language disorder, as indicated

6.  Evaluation for close family members with global developmental delay
    (GDD)

7.  Evaluation for features suggestive of a specific diagnosis

    -   Tests for Down, fragile X, Rett syndrome, other genetic
        disorders, hypothyroidism in patients with historical or
        physical findings suggestive of these disorders

    -   Magnetic resonance imaging (MRI) and/or computed tomography (CT)
        scan in patients with historical (intrapartum asphyxia) or
        physical findings or focal seizures to suggest central nervous
        system (CNS) injury or malformation

    -   Lead screening in children who have identifiable risk factors
        for excessive environmental lead exposure

    -   Comprehensive evaluation with magnetic resonance imaging,
        metabolic testing, electroencephalography, cytogenetic screen,
        genetics consultation in patients with loss or regression of
        developmental milestones, history of parental consanguinity,
        prior unexplained loss of a child, or multiple miscarriages

    -   Stepwise evaluation

#### MAJOR OUTCOMES CONSIDERED

Diagnostic yield of investigations and tests in children with global
developmental delay

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Literature searches were conducted with the assistance of the University
of Minnesota Biomedical Information Services for relevant articles
published from 1980 to 2000. Databases searches included MEDLINE,
Healthstar, ERIC, and CINAHL. Depending on the particular diagnostic
test/ancillary service of interest, key words/phrases included the
following: mental retardation, developmental delay, developmental
disability, neurodevelopmental delay, physical therapy, occupational
therapy, speech therapy, audiology, ophthalmology, and psychometric
evaluation. Searches were restricted to the English language under the
subheading of infant and child.

Individual committee members reviewed titled and abstracts so identified
for content and relevance. Articles dealing with investigations in
developmental delay with reference to determining a possible etiology
were selected for further detailed review. From the bibliographies of
several articles selected for review, additional articles thought to be
relevant were identified at the discretion of committee members. A
bibliography of the 160 articles identified and reviewed for preparation
of this parameter is available at the [American Academy of Neurology Web
site](http://www.aan.com/). Relevant position papers were also sought
from professional organizations, including the consensus statement of
the American College of Medical Genetics on the evaluation of mental
retardation.

#### NUMBER OF SOURCE DOCUMENTS

160 articles

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Evidence Classification Scheme for a Diagnostic Article**

**Class I**: Evidence provided by a prospective study in a broad
spectrum of persons with the suspected condition, using a \"gold
standard\" for case definition, where the test is applied in a blinded
evaluation, and enabling the assessment of appropriate tests of
diagnostic accuracy.

**Class II**: Evidence provided by a prospective study of a narrow
spectrum of persons with the suspected condition, or a well-designed
retrospective study of a broad spectrum of persons with an established
condition (by \"gold standard\") compared to a broad spectrum of
controls, where test is applied in a blinded evaluation, and enabling
the assessment of appropriated tests of diagnostic accuracy.

**Class III**: Evidence provided by a retrospective study where either
persons with the established condition or controls are of a narrow
spectrum, and where test is applied in a blinded evaluation.

**Class IV**: Any design where test is not applied in blinded evaluation
OR evidence provided by expert opinion alone or in descriptive case
series (without controls).

#### METHODS USED TO ANALYZE THE EVIDENCE

Meta-Analysis\
Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Each article was reviewed, abstracted, and classified by a committee
member. A four-tiered classification scheme for diagnostic evidence
recently approved by the Quality Standards Subcommittee was utilized as
part of this assessment.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Guideline developers provided consensus-based recommendations for the
order and timing of testing but not to the relative diagnostic yield of
the specific tests themselves.

Depending on the strength of the evidence it was decided whether
specific recommendations could be made (for specific diagnostic tests)
and, if so, the level of strength of these recommendations. Evidence
pertinent to each diagnostic test, followed by the committee\'s
evidenced-based recommendations, is presented in the original guideline
document. The committee selected a value of 1% as a clinically
meaningful cutoff point for diagnostic yield. Thus if the diagnostic
yield of a test was less than 1%, it was felt that this test should not
be performed on a routine basis whereas tests with yields greater than
1% should be considered.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Translation of Evidence to Recommendations**

**Level A** rating requires at least one convincing Class I study or at
least two consistent, convincing Class II studies.

**Level B** rating requires at least one convincing Class II study or
overwhelming Class III evidence.

**Level C** rating requires at least two convincing Class III studies.

**Rating of Recommendation**

**A** = established as effective, ineffective, or harmful for the given
condition in the specified population.

**B** = probably effective, ineffective, or harmful for the given
condition in the specified population.

**C** = possibly effective, ineffective, or harmful for the given
condition in the specified population.

**U** = data inadequate or conflicting. Given current knowledge,
treatment is unproven.

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Draft guidelines were reviewed for accuracy, quality, and thoroughness
by the American Academy of Neurology (AAN) members, topic experts, and
pertinent physician organizations.

Final guidelines were approved by the American Academy of Neurology
Quality Standards Subcommittee on April 16, 2002, the American Academy
of Neurology Practice Committee on August 3, 2002, and the American
Academy of Neurology Board of Directors on October 19, 2002. It was
published in *Neurology* 2003;3:367-380.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Definitions of the ratings of recommendations (A, B, C, U), translation
of evidence to recommendations (A-C), and the classification scheme for
a diagnostic article (Class I-IV) are provided at the end of the \"Major
Recommendations\" field.

**Recommendations**

*What is the diagnostic yield of metabolic genetic investigations in
children with global developmental delay*?

[Recommendations]{.underline}

1.  Given the low yield of about 1%, routine metabolic screening for
    inborn errors of metabolism is not indicated in the initial
    evaluation of a child with global developmental delay provided that
    universal newborn screening was performed and the results are
    available for review. Metabolic testing may be pursued in the
    context of historical (parental consanguinity, family history,
    developmental regression, episodic decompensation) or physical
    examination findings that are suggestive of a specific etiology (or
    in the context of relatively homogeneous population groups) in which
    the yield approaches 5% (***Level B recommendation; Class II and III
    evidence***). If newborn screening was not performed, if it is
    uncertain whether a patient had testing, or if the results are
    unavailable, metabolic screening should be obtained in a child with
    global developmental delay.

2.  Routine cytogenetic testing (yield of 3.7%) is indicated in the
    evaluation of the child with developmental delay, even in the
    absence of dysmorphic features or clinical features suggestive of a
    specific syndrome (***Level B recommendation; Class II and III
    evidence***).

3.  Testing for the fragile X mutation (yield of 2.6%), particularly in
    the presence of a family history of developmental delay, may be
    considered in the evaluation of the child with global developmental
    delay. Clinical preselection may narrow the focus of who should be
    tested without sacrificing diagnostic yield. Although screening for
    fragile X is more commonly done in males because of the higher
    incidence and greater severity, females are frequently affected and
    may also be considered for testing. Because siblings of fragile X
    patients are at greater risk to be symptomatic or asymptomatic
    carriers, they can also be screened (***Level B recommendation;
    Class II and Class III evidence***).

4.  The diagnosis of Rett syndrome should be considered in females with
    unexplained moderate to severe mental retardation. If clinically
    indicated, testing for the *MECP2* gene deletion may be obtained.
    Insufficient evidence exists to recommend testing of females with
    milder clinical phenotypes or males with moderate or severe
    developmental delay (***Level B recommendation; Class II and Class
    III evidence***).

5.  In children with unexplained moderate or severe developmental delay,
    additional testing using newer molecular techniques (e.g.,
    fluorescence in situ hybridization \[FISH\], microsatellite markers)
    to assess for subtelomeric chromosomal rearrangements (6.6%) may be
    considered (***Level B recommendation; Class II and Class III
    evidence***).

*What is the role of lead and thyroid screening in children with global
developmental delay?*

[Recommendations]{.underline}

1.  Screening of children with developmental delay for lead toxicity may
    be targeted to those with known identifiable risk factors for
    excessive environmental lead exposure as per established current
    guidelines (***Level B recommendation; Class II evidence***).

2.  In the setting of existing newborn screening programs for congenital
    hypothyroidism, screening of children with developmental delay with
    thyroid function studies is not indicated unless there are systemic
    features suggestive of thyroid dysfunction (***Level B
    recommendation; Class II evidence***).

*What is the diagnostic yield of electroencephalogram (EEG) in children
with global developmental delay?*

[Recommendations]{.underline}

1.  An electroencephalogram can be obtained when a child with global
    developmental delay has a history or examination features suggesting
    the presence of epilepsy or a specific epileptic syndrome (***Level
    C recommendation; Class III and IV evidence***).

2.  Data are insufficient to permit making a recommendation regarding
    the role of electroencephalogram in a child with global
    developmental delay in whom there is no clinical evidence of
    epilepsy (***Level U recommendation; Class III and IV evidence***).

*What is the diagnostic yield of neuroimaging in children with global
developmental delay?*

[Recommendations]{.underline}

1.  Neuroimaging is recommended as part of the diagnostic evaluation of
    the child with global developmental delay (***Level B
    recommendation; Class III evidence***). As the presence of physical
    findings (e.g., microcephaly, focal motor findings) increases the
    yield of making a specific neuroimaging diagnosis, physicians can
    more readily consider obtaining a scan in this population (***Level
    C recommendation; Class III evidence***).

2.  If available, magnetic resonance imaging (MRI) should be obtained in
    preference to computed tomography (CT) scanning when a clinical
    decision has been made that neuroimaging is indicated (***Level C
    recommendation; Class III evidence***).

*Are vision and hearing disorders common in children with global
developmental delay?*

[Recommendations]{.underline}

1.  Children with global developmental delay may undergo appropriate
    vision and audiometric assessment at the time of their diagnosis
    (***Level C recommendation; Class III evidence***).

2.  Vision assessment can include vision screening and a full
    ophthalmologic examination (visual acuity, extraoculo-movements,
    fundoscopic) (***Level C recommendation; Class III evidence***).

3.  Audiometric assessment can include behavioral audiometry or
    brainstem auditory evoked response testing when feasible (***Level C
    recommendation; Class III evidence***). Early evidence from
    screening studies suggests that transient evoked otoacoustic
    emissions should offer an alternative when audiometry is not
    feasible (***Level A recommendation; Class I and II evidence***).

[Recommendations for a Staged Approach to the Evaluation of the Child
with Global Developmental Delay]{.underline}

Although there is insufficient evidence to recommend the optimal
sequence of tests to determine the etiology of global developmental
delay, taking into account diagnostic yield and potential treatability,
the guideline committee members propose the following consensus-based
schedule of testing as outlined in the algorithm in the original
guideline document. Consensus-based recommendations relate to the order
and timing of testing but not to the relative diagnostic yield of the
specific tests themselves (refer to table 5 titled \"Diagnostic yield of
tests in children with global developmental delay\" in the original
guideline document).

All children should undergo a detailed history and physical examination,
which may in itself suggest specific diagnostic possibilities. For all
children with global developmental delay, auditory and visual integrity
should be ascertained. If a child was born in a locale without universal
newborn screening, a screening metabolic evaluation including capillary
blood gas, serum lactate and ammonia levels, serum amino acids and urine
organic acids, and thyroid function studies (thyroxine \[T4\] and
thyroid stimulating hormone) may be considered. If a history of events
suggestive of possible seizures, paroxysmal behaviors, or an underlying
epilepsy syndrome is elicited, one can consider an electroencephalogram.
In addition, screening for autism or a language disorder should be
considered in any child presenting with global developmental delay
(GDD). If there is a family history of a close family member (sibling,
aunt/uncle, or first cousin) with global developmental delay on a known
basis, testing specific for the known disorder may be ordered. When
there is a family history of unexplained developmental delay,
cytogenetic testing (which may include testing for subtelomeric
rearrangements) may be obtained.

In the absence of a familial history of global developmental delay,
specific historical or physical findings can be utilized to direct
testing. Observed dysmorphic features may prompt specific testing for
such entities as Down syndrome (karyotype), fragile X *(FMR*1), Rett
syndrome (*MECP*2), Prader-Willi/Angelman (FISH), or hypothyroidism.
Historical documentation of intrapartum asphyxia or ascertainment of
physical findings such as microcephaly, cerebral palsy, or focal
findings or focal seizures may suggest acquired central nervous system
(CNS) injury or an underlying cerebral malformation and thus prompt
neuroimaging study (magnetic resonance imaging preferable to computed
tomography). Risk factors for lead exposure or findings suggestive of
lead intoxication mandate lead screening.

Parental consanguinity, documentation of loss or regression of
developmental milestones, or unexplained prior parental loss of a child
are likely to be caused by a definable disease process and thus a
comprehensive evaluation may be considered. This can include careful
metabolic evaluation together with neuroimaging studies,
electroencephalogram, cytogenetic studies, and genetic and
ophthalmologic consultations.

The absence of any clinical features that suggest a specific diagnosis
is less likely to be associated with a definable disease and thus a
stepwise approach is recommended. This may include initial neuroimaging
(magnetic resonance imaging preferred) and cytogenetic and fragile X
screening. If these tests are negative, consideration may be given to
metabolic evaluation, testing for subtelomeric rearrangements, and
genetic consultation.

**[Definitions]{.underline}**:

**Evidence Classification Scheme for a Diagnostic Article**

**Class I**: Evidence provided by a prospective study in a broad
spectrum of persons with the suspected condition, using a \"gold
standard\" for case definition, where the test is applied in a blinded
evaluation, and enabling the assessment of appropriate tests of
diagnostic accuracy.

**Class II**: Evidence provided by a prospective study of a narrow
spectrum of persons with the suspected condition, or a well-designed
retrospective study of a broad spectrum of persons with an established
condition (by \"gold standard\") compared to a broad spectrum of
controls, where test is applied in a blinded evaluation, and enabling
the assessment of appropriated tests of diagnostic accuracy.

**Class III**: Evidence provided by a retrospective study where either
persons with the established condition or controls are of a narrow
spectrum, and where test is applied in a blinded evaluation.

**Class IV**: Any design where test is not applied in blinded evaluation
OR evidence provided by expert opinion alone or in descriptive case
series (without controls).

**Translation of Evidence to Recommendations**

**Level A** rating requires at least one convincing Class I study or at
least two consistent, convincing Class II studies.

**Level B** rating requires at least one convincing Class II study or
overwhelming Class III evidence.

**Level C** rating requires at least two convincing Class III studies.

**Rating of Recommendation**

**A** = established as effective, ineffective, or harmful for the given
condition in the specified population.

**B** = probably effective, ineffective, or harmful for the given
condition in the specified population.

**C** = possibly effective, ineffective, or harmful for the given
condition in the specified population.

**U** = data inadequate or conflicting. Given current knowledge,
treatment is unproven.

#### CLINICAL ALGORITHM(S)

An algorithm is provided in the original guideline document for the
evaluation of the child with global developmental delay.

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each
recommendation (see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   These guidelines may assist physicians in making appropriate
    clinical decisions regarding the evaluation of the child with global
    developmental delay.

-   A specific etiology can be determined in the majority of children
    with global developmental delays. Refer to the \"Major
    Recommendations\" field or the original guideline document for
    specific diagnostic yields of various tests.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

This statement is provided as an educational service of the American
Academy of Neurology. It is based on an assessment of current scientific
and clinical information. It is not intended to include all possible
proper methods of care for a particular neurologic problem or all
legitimate criteria for choosing to use a specific procedure. Neither is
it intended to exclude any reasonable alternative methodologies. The
American Academy of Neurology recognizes that specific patient care
decisions are the prerogative of the patient and the physician caring
for the patient, based on all of the circumstances involved.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

#### IMPLEMENTATION TOOLS

Clinical Algorithm\
Patient Resources\
Quick Reference Guides/Physician Guides\
Slide Presentation

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Shevell M, Ashwal S, Donley D, Flint J, Gingold M, Hirtz D, Majnemer A,
Noetzel M, Sheth RD. Practice parameter: evaluation of the child with
global developmental delay: report of the Quality Standards Subcommittee
of the American Academy of Neurology and the Practice Committee of the
Child Neurology Society. Neurology 2003 Feb 11;60(3):367-80. \[123
references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12578916)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2003 Feb 11

#### GUIDELINE DEVELOPER(S)

American Academy of Neurology - Medical Specialty Society\
Child Neurology Society - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Neurology (AAN)

#### GUIDELINE COMMITTEE

Quality Standards Subcommittee of the American Academy of Neurology\
Practice Committee of the Child Neurology Society

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*American Academy of Neurology (AAN) Quality Standards Subcommittee
Members*: Gary Franklin, MD, MPH (Co-Chair); Catherine Zahn, MD
(Co-Chair); Milton Alter, MD, PhD (exofficio); Stephen Ashwal, MD
(facilitator); Richard M. Dubinsky, MD; Jacqueline French, MD; Gary H.
Friday, MD; Michael Glantz, MD; Gary Gronseth, MD; Deborah Hirtz, MD;
Robert G. Miller, MD; David J. Thurman, MD, MPH; and William J. Weiner,
MD

*Child Neurology Society Practice Committee Members*: Carmela Tardo, MD
(Chair); Bruce Cohen, MD (Vice-Chair); Elias Chalhub, MD; Roy Elterman,
MD; Murray Engel, MD; Bhuwan P. Garg, MD; Brian Grabert, MD; Annette
Grefe, MD; Michael Goldstein, MD; David Griesemer, MD; Betty Koo, MD;
Edward Kovnar, MD; Leslie Anne Morrison, MD; Colette Parker, MD; Ben
Renfroe, MD; Anthony Riela, MD; Michael Shevell, MD; Shlomo Shinnar, MD;
Gerald Silverboard, MD; Russell Snyder, MD; Dean Timmns, MD; Greg Yim,
MD; and Mary Anne Whelan, MD

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: A list of American Academy of Neurology (AAN)
guidelines, along with a link to a Portable Document Format (PDF) file
for this guideline, is available at the [AAN Web
site](http://aan.com/go/practice/guidelines).

Print copies: Available from the AAN Member Services Center, (800)
879-1960, or from AAN, 1080 Montreal Avenue, St. Paul, MN 55116.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

-   American Academy of Neurology (AAN) guideline summary for
    clinicians: evaluation of the child with global developmental delay.
    St. Paul (MN): American Academy of Neurology (AAN); 2003 Feb. 2 p.
    Electronic copies: Available in Portable Document Format (PDF) from
    the [AAN Web
    site](http://aan.com/professionals/practice/guidelines/guideline_summaries/Global_Devlopmental_Delay_Clinicians.pdf).
    See the related QualityTool summary on the [Health Care Innovations
    Exchange Web site](http://innovations.ahrq.gov/content.aspx?id=897).

-   Appendix A: information regarding selected tests. St. Paul (MN):
    American Academy of Neurology. 2003. 4 p. Electronic copies:
    Available in Portable Document Format (PDF) from the [AAN Web
    site](http://www.aan.com/professionals/practice/pdfs/appendix.pdf).

-   Practice parameter: evaluation of the child with global
    developmental delay slide presentation. St. Paul (MN): American
    Academy of Neurology (AAN); 2003 Feb. Electronic copies: Available
    in a Power Point presentation from the [AAN Web
    site](http://aan.com/professionals/practice/guidelines/pwr_pnt/GDD_Educational_pres.ppt).
    See the related QualityTool summary on the [Health Care Innovations
    Exchange Web site](http://innovations.ahrq.gov/content.aspx?id=954).

-   AAN guideline development process \[online\]. St. Paul (MN):
    American Academy of Neurology. Electronic copies: Available from the
    [American Academy of Neurology (AAN) Web
    site](http://aan.com/go/practice/guidelines/development).

#### PATIENT RESOURCES

The following is available:

-   American Academy of Neurology (AAN) guideline summary for parents
    and caregivers: testing for the cause of global developmental delay.
    St. Paul (MN): American Academy of Neurology (AAN); 2003 Feb. 2 p.

Electronic copies: Available in Portable Document Format (PDF) from the
[AAN Web
site](http://aan.com/professionals/practice/guidelines/guideline_summaries/Global_Devlopmental_Delay_Patients.pdf).
See the related QualityTool summary on the [Health Care Innovations
Exchange Web site](http://innovations.ahrq.gov/content.aspx?id=855).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This summary was completed by ECRI on February 6, 2004.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original guideline, which is
copyrighted by the American Academy of Neurology.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
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<http://www.guideline.gov/about/inclusion.aspx> .

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Date Modified: 11/3/2008