An effective community-based approach to the identification of neurodevelopmental delay in childhood

Feasibility and validity of early screening for identifying infants with poor social-communication development in a well-baby clinic system

This study examined the feasibility and validity of implementing an autism spectrum disorders (ASD) screening for 12-month-old infants.

METHOD

Parents of 583 infants, 12months of age attending well baby clinics (WBCs), completed the First Year Inventory-Lite (FYI-L). Ten infants who failed the FYI-L and a subset of 12 infants who passed the identified FYI-L were evaluated using the Autism Observation Scale for Infants (AOSI) and the Mullen Scales of Early Learning. Information regarding social-communication development ≥24months of age was extracted from medical records of 153 of the 583 infants.

RESULTS

Mean response rate across clinics was 26.63%. Infants at risk compared to controls showed significantly higher scores on the AOSI, lower composite scores on the MSEL, and a higher rate of referral for a developmental evaluation. At 24months, 95% of infants who were negatively screened had no social-communication problems on their medical records; 60% of those who were screened positive had documented problems on medical records.

CONCLUSION

ASD screening using the FYI-L at 12months in a healthcare setting identifies infants with poor social-communication development, yet parents had low compliance with screening.

Predictive factors of early mortality in children with developmental disabilities: a case-comparison analysis

The aim of this study was to identify the risk factors for early mortality in children with neurodevelopmental disabilities. Of 1000 children who were sequentially referred to the same child developmental center over the period 1975-1985, 81 children died between the ages of 6 months and 22 years (mean, 8.04 years; 6.1 SD). A group of 81 age-matched children and another group of 81 developmentally and age-matched children also referred to the center served as comparison groups. Following multivariate analysis, low developmental quotient, restricted mobility, assisted feeding, and genetic etiology were risk factors for early mortality when compared to the age-matched group (P < .01). In comparison to the developmentally matched group, restricted mobility, genetic etiology, and hearing deficit were identified as significant risk factors (P < .01). Comprehensive treatment at the child development center was demonstrated to be a significant protective factor (P = .004). Socioeconomic variables were not significant in predicting an increased mortality risk in disabled individuals. In conclusion, in addition to mobility and feeding skills, a genetic etiology and hearing deficit are risk factors for early mortality, whereas socioeconomic variables are not. A comprehensive treatment program was found to be a protective factor.

The evaluation of the child with a global developmental delay

The child with a global developmental delay presents a diagnostic challenge to the practitioner. The spectrum of possible etiologic diagnosis and laboratory investigations that could be pursued are quite extensive. This article presents the rationale for diagnostic testing in this population and provides guidelines to those tests that should be pursued.

Fine motor deficit: an etiologically distinct entity

The prevalence of risk and adverse factors associated with fine motor disorder (n = 35) were compared with gross motor deficit (n = 158), global developmental delay (n = 336), and combined fine and gross motor deficit among 1,241 children up to 3 years of age identified in the Haifa health district. A significantly increased preponderance of males was observed among the study group as compared to the group with gross motor deficit. Intranatal problems were significantly increased among children with fine motor deficits as compared to those with gross motor deficits as were minor physical anomalies, seizures, and behavioral deficits. Less significant differences were observed between the study group and children with global developmental delay or fine and gross motor deficit. The different risk factor profiles indicated that the children with fine motor deficits constituted an etiologically distinct group highly associated with early antepartum, possibly genetic, origins.