Practice parameter: Evaluation of the child with global developmental delay

To the Editor:

The recently published practice parameter concerning the evaluation of the child with global developmental delay (GDD) is flawed by the authors’ decision to reinterpret this perfectly clear term, which has always been understood to encompass cognitive delay, in such a fashion that a child with delays in only two of five domains would be thus classified.1 Thus a child with cerebral palsy and consequent impairment in motor and activities of daily living skills, but without cognitive, social, or language impairment, would meet the authors’ definition. This stands in contradiction to the literature that they cite (authors’ references 3–7) in support of their definition. It further contradicts the authors’ statement elsewhere that global delay is to be distinguished from autistic spectrum disorder: on the basis of their definition, such a distinction would not be possible. It is also troubling to see an unmodified recommendation for routine MRI studies in the abstract: this was appropriately modified in the text. As presented, this parameter would appear to have been approved by the Practice Committee of the Child Neurology Society (CNS) as well as the American Academy of Neurology (AAN) Quality Standards Subcommittee (QSS). As a member of the CNS Practice Committee, I would like to raise some procedural concerns. When polled at the last of the two Practice Committee meetings where this parameter was (briefly) presented, only one member expressed approval of the definition. However, abstaining votes from absent members were counted as approving (abstention from commentary has usually meant failure to read, an acknowledged problem in this committee) and request for simultaneous publication of a dissenting opinion was denied by the Co-Chair of the QSS, who …