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Clinical Features Two clinical types can be recognized based on the adequacy of motor skills that are acquired in parallel with cognitive skills In the rst type, the essential characteristic is that, almost from birth, the infant is delayed in all aspects of development There is a tendency to sleep more, to be less demanding of nourishment, to move less than normal, and to suck poorly and regurgitate Parents comment on how good their baby is, how little he troubles them by crying As the months pass, every expected achievement is late The baby is usually more hypotonic and turns over, sits unsupported, and walks later than the normal infant Yet despite these obvious motor delays, there is later no sign of paralysis, ataxia, chorea, or athetosis These babies do not smile at the usual time and take little notice of the mother or other persons or objects in their environment They are less attentive to visual and often to auditory stimuli, to the point where questions may be raised about blindness or deafness Certain phases of normal development, such as hand regard, may persist beyond the sixth month, when they are normally replaced by other activities Mouthing (putting everything in the mouth) and slobbering, which should end by 1 year of age, also persist There are only eeting signs of interest in toys, and the impersistence of attention becomes increasingly prominent Vocalizations are scant, often guttural, piercing, or high-pitched and feeble Babbling is not replaced by attempts at word formation at the usual time In the second type, early motor milestones (supporting the head, rolling over, sitting, standing, and walking) may be attained at their normal times, yet the infant is inattentive and slow in learning the usual nursery tricks It seems as though motor development had somehow escaped the retardation process There may, however, be aimless overactivity and persistence of rhythmic movements, grinding of the teeth (bruxism), and hypotonia Because the developmental sequence of motor function and speech may be normal, even to the point where the baby acquires a few words by the end of the rst year, the examiner may be misled into thinking that the mentally retarded infant was at rst normal.

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