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 Thus, prediction improves substantially when transient brain structures have been replaced by permanent circuitries.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.

Keywords: autism spectrum disorder; cerebral palsy; cortical subplate; early detection; early intervention; family; general movement assessment; intellectual disability; magnetic resonance imaging.

Figure 1

Schematic overview of the developmental processes occurring in the human brain. The bold lines indicate that the processes mentioned on the left side are very active, the broken lines denote that the processes still continue but less abundantly. The diagram is based on reference [17]. EGL = external granular layer; m = months; PMA = postmenstrual age; w = weeks; y = years. Figure reproduced with permission from ‘Early Detection and Early Intervention in Developmental Motor Disorders—from neuroscience to participation’ by Mijna Hadders-Algra (ed.) published by Mac Keith Press in its Clinics in Developmental Medicine Series, ISBN number 978-1-911612-43-8 [16].

Figure 2

(A). Typical general movements characterized by movement complexity and variation in a 3-month-old infant. (B). Atypical general movements characterized by marked reduction in movement complexity and variation in a 3-months-old infant later diagnosed with bilateral spastic cerebral palsy (CP). Both subfigures consist of frames sampled from a video-recording of about 2 min. Figures produced with permission of the parents.