A Primer on Global Developmental Delay (GDD)

Your child is already three years old but his speech development appears to be slower than his peers.   You notice that he has a limited vocabulary and hasn’t started speaking in phrases. He seems to be a bit slower in meeting his major motor milestones too. Is this a concern? What should you do?

Important terms to know!

Developmental milestones: Important skills that babies and toddlers learn as they grow up (e.g. sitting up, rolling over, crawling, walking, babbling, talking, etc.), which typically occur in a certain sequence and at a certain age range.

Developmental delay: When a child reaches one or more of these milestones much later than expected as compared with peers of the same age. Developmental delays can be transient or persistent, and classified as mild, moderate or severe.

Defining Global Developmental Delay

There are many terms used to describe different patterns of developmental delay and atypical development. Global Developmental Delay (GDD) is one such term. When there are significant delays in two or more developmental domains in children under the age of 5 years, we describe this as GDD.

These domains include:

  • Gross motor (locomotor) skills, g. sitting up, crawling, walking and running.
  • Fine motor (hand manipulative) skills, g. handling tiny objects, stacking blocks, drawing and writing.
  • Expressive language and speech, g. babbling, imitating speech sounds, putting words together to form phrases and sentences, learning to converse.
  • Receptive language and comprehension, g. identifying sounds, responding to names of objects and people, taking verbal instructions.
  • Cognitive skills,g. ability to learn new things, process information to solve problems, organise thoughts, remember things.
  • Social and emotional skills,g. interacting with others, development of personal traits and feelings, understanding and responding to the needs and feelings of others.

Possible causes

GDD may be caused by various factors or conditions such as the ones:

Prenatal (during pregnancy)

  • Genetic disorders (e.g. Down syndrome, fragile X syndrome)
  • Problems with brain or spinal cord development
  • Exposure to drugs/toxic substances (e.g. alcohol, smoking)
  • Maternal infections (e.g. rubella, toxoplasmosis, malaria, HIV)

Perinatal (during or immediately after birth)

  • Premature birth
  • Complications during delivery
  • Neonatal hypoglycaemia

Postnatal (after birth)

  • Childhood infections (e.g. meningitis, encephalitis)
  • Metabolic diseases (e.g. inborn errors of metabolism, hypothyroidism)
  • Accidents (e.g. suffocation, near-drowning, head injury)


  • Psychosocial (e.g. significant and prolonged under-stimulation, severe emotional deprivation, maltreatment, malnutrition)

Identification & diagnosis

During early childhood, children’s growth and development will be monitored periodically during scheduled visits to health clinics. Parents or caregivers can raise any concerns to the doctors during the visits. Doctors will conduct a thorough physical examination, ask the parents specific questions regarding the child’s development, and perform a quick developmental screen.

If there are significant concerns, your child may be referred to specialists which often include paediatricians, psychologists, speech-language therapists or occupational therapists. Additional assessments and/or medical and genetic tests may be needed to identify the cause or ascertain a diagnosis. Evaluations by these professionals can also help us understand your child’s developmental needs as well as individual strengths.

Managing GDD

Some children with GDD may catch up to their peers with timely intervention and continue to develop without problems. Other children may need more specific and longer-term support. Every child is different. Hence, intervention or therapy needs to be tailored to each child’s unique strengths and difficulties.

Possible interventions or supports include physiotherapy, speech-language therapy and occupational therapy. Some children benefit from early intervention programs which are more intensive and incorporate multi-disciplinary supports.

A definite diagnosis may not always be clear when a child is very young. In these instances, the doctor may advise for the child to undergo a re-evaluation when he/she is older. In the meantime, pre-emptive intervention and supportive therapy should not be delayed.

Early intervention is important to provide appropriate support for a child with developmental delays. With timely and accurate support that is based on your child’s strengths and vulnerabilities, your child will have a better chance of narrowing the developmental gaps and achieve their best potential.

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