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Kurbatfinski S, Komanchuk J, Dosani A, Letourneau N. Validity, Reliability, Accessibility, and Applicability of Young Children's Developmental Screening and Assessment Tools across Different Demographics: A Realist Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:745. [PMID: 38929324 PMCID: PMC11201752 DOI: 10.3390/children11060745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/09/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
Valid and reliable developmental screening and assessment tools allow professionals to identify disabilities/delays in children, enabling timely intervention to limit adverse lifelong impacts on health. However, differences in child development related to culture, genetics, and perinatal outcomes may impact tool applicability. This study evaluated the validity, reliability, and accessibility of multidomain developmental screening tools for young children, analyzed the applicability of tools across different contexts, and created a compendium of tools. Employing adapted realist review methods, we searched APA PsycInfo, MEDLINE, CINAHL, ERIC, and Google to identify relevant articles and information. We assessed accessibility, validity, reliability, and contextual applicability (N = 4110 evidence sources) to create tool ratings and make recommendations. Of 33 identified tools, 22 were screening and 11 were assessment tools. Fewer screening tools than assessment tools were rated highly overall. Evidence for use in different cultures was often lacking for both types of tools. The ASQ (screening) and BDI (assessment) tools were rated most favorably and are recommended for use, though other tools may be more applicable in different contexts (e.g., NEPSY among children with Asperger's Syndrome). Future research should focus on assessing the validity and reliability of tools across different demographics to increase accessibility and ensure all children are properly supported.
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Affiliation(s)
- Stefan Kurbatfinski
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Jelena Komanchuk
- Faculty of Health and Social Development, School of Nursing, University of British Columbia Okanagan, Kelowna, BC V1V 1V7, Canada;
| | - Aliyah Dosani
- Faculty of Health, Community and Education, School of Nursing and Midwifery, Mount Royal University, Calgary, AB T3E 6K6, Canada;
| | - Nicole Letourneau
- Faculties of Nursing & Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
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Kukka AJ, Bhattarai P, Sundelin HEK, Gurung R, Brown NJW, Litorp H, Axelin A, Kc A. 'We did everything by phone': a qualitative study of mothers' experience of smartphone-aided screening of cerebral palsy in Kathmandu, Nepal. BMC Pediatr 2024; 24:357. [PMID: 38778316 PMCID: PMC11110401 DOI: 10.1186/s12887-024-04829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND International guidelines recommend early intervention to all children at risk of cerebral palsy, but targeted screening programs are often lacking in low- and middle-income settings with the highest burden of disease. Smartphone applications have the potential to improve access to early diagnostics by empowering parents to film their children at home followed by centralized evaluation of videos with General Movements Assessment. We explored mothers' perceptions about participating in a smartphone aided cerebral palsy screening program in Kathmandu, Nepal. METHODS This is an explorative qualitative study that used focus group discussions (n = 2) and individual interviews (n = 4) with mothers of term-born infants surviving birth asphyxia or neonatal seizures. Parents used the NeuroMotion™ smartphone app to film their children at home and the videos were analysed using Precthl's General Movements Assessment. Sekhon et al.'s framework on the acceptability of health care interventions guided the design of the group discussions and interviews, and the deductive qualitative content analysis. RESULTS Mothers were interested in engaging with the programme and expressed hope it would benefit their children. Most felt using the app was intuitive. They were, however, unclear about the way the analysis was performed. Support from the research team was often needed to overcome an initial lack of self-confidence in using the technology, and to reduce anxiety related to the follow-up. The intervention was overall perceived as recommendable but should be supplemented by a face-to-face consultation. CONCLUSION Smartphone aided remote screening of cerebral palsy is acceptable in a lower middle-income population but requires additional technical support.
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Affiliation(s)
- Antti J Kukka
- Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden.
- Department of Pediatrics, Gävle Regional Hospital, Gävle, Region Gävleborg, Sweden.
| | | | - Heléne E K Sundelin
- Department of Biomedical and Clinical Sciences, Division of Children's and Women´S Health, Linköping University, Linköping, Sweden
- Department of Women's and Children's Health, Neuropediatric Unit, Karolinska University Hospital, KarolinskaInstitutet, Stockholm, Sweden
| | - Rejina Gurung
- Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden
- Golden Community, Lalitpur, Nepal
| | - Nick J W Brown
- Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden
- Department of Pediatrics, Gävle Regional Hospital, Gävle, Region Gävleborg, Sweden
| | - Helena Litorp
- Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Axelin
- Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, SE-751 85, Sweden
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Luke C, Mick-Ramsamy L, Bos AF, Benfer KA, Bosanquet M, Gordon A, Williams H, Taifalos C, Smith M, Leishman S, Oakes E, Kentish M, McNamara L, Ware RS, Boyd RN. Relationship between early infant motor repertoire and neurodevelopment on the hammersmith infant neurological examination in a developmentally vulnerable First Nations cohort. Early Hum Dev 2024; 192:106004. [PMID: 38636257 DOI: 10.1016/j.earlhumdev.2024.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/20/2024]
Abstract
AIM To implement a culturally-adapted screening program aimed to determine the ability of infant motor repertoire to predict early neurodevelopment on the Hammersmith Infant Neurological Examination (HINE) and improve Australian First Nations families' engagement with neonatal screening. METHODS A prospective cohort of 156 infants (55 % male, mean (standard deviation [SD]) gestational age 33.8 (4.6) weeks) with early life risk factors for adverse neurodevelopmental outcomes (ad-NDO) participated in a culturally-adapted screening program. Infant motor repertoire was assessed using Motor Optimality Score-revised (MOS-R), captured over two videos, 11-13+6 weeks (V1; <14 weeks) and 14-18 weeks (V2; ≥14 weeks) corrected age (CA). At 4-9 months CA neurodevelopment was assessed on the HINE and classified according to age-specific cut-off and optimality scores as; developmentally 'on track' or high chance of either adverse neurodevelopmental outcome (ad-NDO) or cerebral palsy (CP). RESULTS Families were highly engaged, 139/148 (94 %) eligible infants completing MOS-R, 136/150 (91 %), HINE and 123 (83 %) both. Lower MOS-R at V2 was associated with reduced HINE scores (β = 1.73, 95 % confidence interval [CI] = 1.03-2.42) and high chance of CP (OR = 2.63, 95%CI = 1.21-5.69) or ad-NDO (OR = 1.38, 95%CI = 1.10-1.74). The MOS-R sub-category 'observed movement patterns' best predicted HINE, infants who score '4' had mean HINE 19.4 points higher than score '1' (95%CI = 12.0-26.9). Receiver-operator curve analyses determined a MOS-R cut-off of <23 was best for identifying mild to severely reduced HINE scores, with diagnostic accuracy 0.69 (sensitivity 0.86, 95%CI 0.76-0.94 and specificity 0.40, 95 % CI 0.25-0.57). A trajectory of improvement on MOS-R (≥2 point increase in MOS-R from 1st to 2nd video) significantly increased odds of scoring optimally on HINE (OR = 5.91, 95%CI 1.16-29.89) and may be a key biomarker of 'on track' development. INTERPRETATION Implementation of a culturally-adapted program using evidence-based assessments demonstrates high retention. Infant motor repertoire is associated with HINE scores and the early neurodevelopmental status of developmentally vulnerable First Nations infants.
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Affiliation(s)
- Carly Luke
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia; Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
| | - Leeann Mick-Ramsamy
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Arend F Bos
- General Movements Trust, Beatrix Children's Hospital, Division of Neonatology, University of Groningen, Groningen, the Netherlands
| | - Katherine A Benfer
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Margot Bosanquet
- Department of Health and Wellbeing, Townsville Hospital and Health Service District (THHS), Townsville, Australia
| | - Anya Gordon
- Townsville University Hospital (TUH), Townsville Hospital and Health Service District (THHS), Townsville, Australia
| | - Hailey Williams
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Chloe Taifalos
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Maria Smith
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Shaneen Leishman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Ellena Oakes
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Megan Kentish
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Lynda McNamara
- Cairns Base Hospital (CBH), Cairns and Hinterland Hospital and Health Service (CHHHS), Cairns, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Kukka AJ, Sundelin HEK, Basnet O, Paudel P, Upadhyay Subedi K, Svensson K, Brown N, Litorp H, Gurung R, Bhattarai P, Wrammert J, Kc A. NeuroMotion smartphone application for remote General Movements Assessment: a feasibility study in Nepal. BMJ Open 2024; 14:e080063. [PMID: 38431302 PMCID: PMC10910581 DOI: 10.1136/bmjopen-2023-080063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES To evaluate the feasibility of using the NeuroMotion smartphone application for remote General Movements Assessment for screening infants for cerebral palsy in Kathmandu, Nepal. METHOD Thirty-one term-born infants at risk of cerebral palsy due to birth asphyxia or neonatal seizures were recruited for the follow-up at Paropakar Maternity and Women's Hospital, 1 October 2021 to 7 January 2022. Parents filmed their children at home using the application at 3 months' age and the videos were assessed for technical quality using a standardised form and for fidgety movements by Prechtl's General Movements Assessment. The usability of the application was evaluated through a parental survey. RESULTS Twenty families sent in altogether 46 videos out of which 35 had approved technical quality. Sixteen children had at least one video with approved technical quality. Three infants lacked fidgety movements. The level of agreement between assessors was acceptable (Krippendorf alpha 0.781). Parental answers to the usability survey were in general positive. INTERPRETATION Engaging parents in screening of cerebral palsy with the help of a smartphone-aided remote General Movements Assessment is possible in the urban area of a South Asian lower middle-income country.
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Affiliation(s)
- Antti Juhani Kukka
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Gävle Regional Hospital, Region Gävleborg, Gävle, Sweden
| | - Heléne E K Sundelin
- Division of children's and women's health, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Prajwal Paudel
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | | | - Katarina Svensson
- Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Nick Brown
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Gävle Regional Hospital, Region Gävleborg, Gävle, Sweden
| | - Helena Litorp
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rejina Gurung
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Golden Community, Lalitpur, Nepal
| | | | - Johan Wrammert
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Horridge KA, Bretnall G, Fraser LK. Hospital admissions of school-age children with an intellectual disability: A population-based survey. Dev Med Child Neurol 2023; 65:1511-1519. [PMID: 37132257 DOI: 10.1111/dmcn.15592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/04/2023] [Accepted: 03/07/2023] [Indexed: 05/04/2023]
Abstract
AIM To describe the profiles of hospital admissions of school-age children identified with a learning disability (ICD-11 intellectual developmental disorder) and/or safeguarding needs compared to children without learning disability, in a population where proactive identification of learning disabilities in children is embedded in practice. METHOD Data were collected about the reasons for and duration of hospital admissions of school-age children living in the study catchment area between April 2017 and March 2019; the presence (or absence) of learning disability and/or safeguarding flags in the medical record was also noted. The impact of the presence of flags on the outcomes was explored using negative binomial regression modelling. RESULTS Of 46 295 children in the local population, 1171 (2.53%) had a learning disability flag. The admissions of 4057 children were analysed (1956 females; age range 5-16 years, mean 10 years 6 months, SD 3 years 8 months). Of these, 221 out of 4057 (5.5%) had a learning disability, 443 out of 4057 (10.9%) had safeguarding flags, 43 out of 4057 (1.1%) had both, and 3436 out of 4057 (84.7%) had neither. There was a significantly increased incidence of hospital admissions and length of stay in children with either or both flags, compared to children with neither. INTERPRETATION Children with learning disabilities and/or safeguarding needs have higher rates of hospital admissions than children without. Robust identification of learning disabilities in childhood is required to make the needs of this group visible in routinely collected data as the first step towards needs being appropriately addressed. WHAT THIS PAPER ADDS Children with learning disabilities must be consistently identified in populations so that their needs are made visible. Information about these needs must be collected from educational, health, and social care sources and scrutinized systematically. Children with learning disabilities and safeguarding needs have an increased incidence of hospital admissions and length of stay.
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Affiliation(s)
- Karen A Horridge
- Paediatric Disability Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
- Department of Education, University of Sunderland, UK
| | - Grace Bretnall
- Paediatric Disability Department, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Lorna K Fraser
- Department of Health Sciences, University of York, York, UK
- Cicely Saunders Institute and Department of Women's and Children's Health, King's College London, London, UK
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Angulo AS, Cunningham M, Domek G, Friedman S, Talmi A. Cultural relevance of fine motor domain of the ASQ in Guatemala. Infant Ment Health J 2023; 44:794-802. [PMID: 37899298 DOI: 10.1002/imhj.22088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023]
Abstract
Previous research suggests that the Ages and Stages Questionnaire-3rd ed. (ASQ) fine motor domain (FMD) may not be culturally relevant for developmental screening in a rural Guatemalan community, as the FMD accounts for 40% of all abnormal screenings after a needs assessment in this community. We hypothesize this is due to a lack of exposure to objects assessed in the questionnaire, such as blocks or light switches. The FMD scores of rural Guatemalan children (n = 56) participating in a child development program were compared with Spanish- and English-speaking Latinx-American children attending a US primary care clinic and screened at yearly well-child checks. Groups were matched for age gender, and socioeconomic status. Item-level analyses explored differences across the three groups. In the Guatemalan sample, the FMD abnormal score rates were 16%, 62%, and zero in the 12-, 24-, and 36-month-old children, respectively. Abnormal scores for the Guatemalan sample on the 24-month ASQ-3 significantly differed (p = .01) when compared to the Latinx-American groups. The 24-month questionnaire has more questions about objects than the 12- and 36-month questionnaires, which may explain the higher rates of abnormal scores. Developmental screening with ASQ-3 may not adequately capture the skills of children in similar communities.
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Affiliation(s)
- Abigail S Angulo
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Maureen Cunningham
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Colorado School of Public Health, Center for Global Health, Aurora, Colorado, USA
| | - Gretchen Domek
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Colorado School of Public Health, Center for Global Health, Aurora, Colorado, USA
| | - Sandra Friedman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ayelet Talmi
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
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Smith F, Perera S, Marella M. The Journey to Early Identification and Intervention for Children with Disabilities in Fiji. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6732. [PMID: 37754592 PMCID: PMC10531044 DOI: 10.3390/ijerph20186732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
Early identification of developmental delay or disability and access to early intervention improves outcomes for children with disabilities and their families. However, in many low- and middle-income countries, services and systems to enable timely, co-ordinated care and support are lacking. The aim of this research was to explore the experiences of families of children with developmental disabilities in Fiji in accessing services for intervention and support across sectors. This qualitative study involved conducting interviews with caregivers of children with disabilities (n = 12), and relevant key stakeholders from health, education, disability, and social support sectors (n = 17). We used journey maps to identify key stages of the families' journeys, identify key barriers and enablers at each stage, and provide multi-sectoral recommendations for each stage. Enablers include proactive help seeking behaviours, the use of informal support networks and an increasingly supportive policy environment. Barriers to identification include a lack of awareness of developmental disabilities and the benefits of early intervention among service providers and the community. A lack of service availability and capacity, workforce issues, family financial constraints and a lack of collaboration between sectors were barriers to intervention once needs were identified, resulting in significant unmet needs and impacting inclusion and participation for children with disabilities. Overcoming these challenges requires a multi-sectoral approach.
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Affiliation(s)
- Fleur Smith
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne 3010, Australia;
| | - Sureni Perera
- Head Office, Frank Hilton Organization, Lot 139 Brown Street, Suva, Fiji;
| | - Manjula Marella
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne 3010, Australia;
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Jenkins G, Purbhoo-Makan M, Zipfel B. Assessing the need for a standardised paediatric assessment tool for podiatrists in South Africa. Foot (Edinb) 2023; 56:102018. [PMID: 36990014 DOI: 10.1016/j.foot.2023.102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023]
Abstract
There is no literature to support the existence of an effective standardised assessment tool in South Africa that aids the podiatrist in the early diagnosis of developmental delay in the paediatric patient from age one to five. Podiatrists in South Africa (SA) need a suitable assessment tool to evaluate child development. A potential proforma that could be used by South African podiatrists is the Gait and Lower Limb Observation Proforma (GALLOP) Assessment Tool. AIM The aim of this research was to evaluate the "ease of use" and "usefulness" of the GALLOP Assessment Tool for podiatrists to effectively assess the paediatric patient from age one to age five. METHODS The study was of a mixed methods descriptive design type, targeting all Health Professions Council of South Africa (HPCSA) registered podiatrists in the Johannesburg Metropolitan Municipal area. After allowing the participants to use the GALLOP Assessment Tool for a period of time, a survey was conducted to establish the "ease of use" and "usefulness" of the GALLOP Assessment Tool. RESULTS All participants agreed that the GALLOP Assessment Tool would be beneficial to South African podiatrists and that the assessment tool does not need to be improved upon.
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Affiliation(s)
- Gillian Jenkins
- University of the Johannesburg, PO Box 524, Auckland Park 2006, South Africa.
| | | | - Bernhard Zipfel
- Evolutionary Studies Institute, University of the Witwatersrand, Private Bag 3, Wits 2050, South Africa
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Acharya K, Rahman MS, Islam MR, Gilmour S, Dhungel B, Parajuli RP, Nishimura T, Senju A, Tsuchiya KJ. Socioeconomic and education-based inequality in suspected developmental delays among Nepalese children: a subnational level assessment. Sci Rep 2023; 13:4750. [PMID: 36959346 PMCID: PMC10036624 DOI: 10.1038/s41598-023-31629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023] Open
Abstract
Failure to meet early childhood developmental milestones leads to difficulty in schooling and social functioning. Evidence on the inequality in the burden of developmental delays across population groups, and identification of potential risk factors for suspected developmental delays (SDD) among younger children, are essential for designing appropriate policies and programs. This study explored the level of socioeconomic and maternal education-based inequality in the prevalence of SDD among Nepalese children at subnational level and identified potential risk factors. Individual-level data from the 2019 Nepal Multiple Indicator Cluster Survey was used to estimate the prevalence of SDD among children aged 3-4 years. Regression-based slope index of inequality (SII) and relative index of inequality were used to measure the magnitude of inequality, in terms of household socioeconomic status (SES) and mother's education, in the prevalence of SDD. In addition, a multilevel logistic regression model was used to identify potential risk factors for SDD. The national prevalence of SDD was found to be 34.8%, with relatively higher prevalence among children from rural areas (40.0%) and those from Karnali Province (45.0%) followed by Madhesh province (44.2%), and Sudhurpashchim Province (40.1%). The prevalence of SDD was 32 percentage points higher (SII: -0.32) among children from the poorest households compared to their rich counterparts at the national level. At the subnational level, such inequality was found to be highest in Lumbini Province (SII = -0.47) followed by Karnali Province (SII = -0.37), and Bagmati Province (SII = -0.37). The prevalence of SDD was 36 percentage points higher (SII: -0.36) among children whose mother had no formal education compared to children of higher educated mothers. The magnitude of education-based absolute inequality in SDD was highest in Lumbini Province (SII = -0.44). Multilevel logistic regression model identified lower levels of mother's education, disadvantaged SES and childhood stunting as significant risk factors for SDD. One in each three children in Nepal may experience SDD, with relatively higher prevalence among children from rural areas. Subnational level variation in prevalence, and socioeconomic and education-based inequality in SDD highlight the urgent need for province-specific tailored interventions to promote early childhood development in Nepal.
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Affiliation(s)
| | - Md Shafiur Rahman
- Research Centre for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan.
| | - Md Rashedul Islam
- Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
- National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Bibha Dhungel
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
- Department of Health Policy, National Centre for Child Health and Development, Tokyo, Japan
| | - Rajendra P Parajuli
- Central Department of Zoology, Central Campus, Institute of Science and Technology (IOST), Tribhuvan University, Kritipur‑1, Kathmandu, Nepal
| | - Tomoko Nishimura
- Research Centre for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan
| | - Atsushi Senju
- Research Centre for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan
| | - Kenji J Tsuchiya
- Research Centre for Child Mental Development, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan
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Lynch P, Nabwera HM, Babikako HM, Rasheed M, Donald KA, Mbale EW, Stockdale E, Chand P, Van den Heuvel M, Kakooza Mwesige A, Gladstone M. Experiences of identifying pre-school children with disabilities in resource limited settings - an account from Malawi, Pakistan and Uganda. DISABILITY & SOCIETY 2023; 39:2053-2073. [PMID: 39045395 PMCID: PMC11265222 DOI: 10.1080/09687599.2023.2181769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/30/2023] [Indexed: 07/25/2024]
Abstract
Although access to effective medical care for acutely sick children has improved globally, the number of children surviving but who may not be thriving due to disability, is increasing. This study aimed to understand the views of health professionals, educators and caregivers of pre-school children with disabilities in Malawi, Pakistan and Uganda regarding early identification, referral and support. Using applied thematic analysis, we identified themes relating to; limited 'demand' by caregivers for services; different local beliefs and community perceptions regarding the causes of childhood disability. Themes relating to 'supply' of services included inability to respond to community needs, and inadequate training among professionals for identification and referral. Stepwise, approaches provided to the families, community health worker and higher-level services could include training for community and primary care health workers on basic identification techniques and enhanced awareness for families and communities on the importance of early identification of children with disabilities.
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Affiliation(s)
- Paul Lynch
- School of Education & School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen M. Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Alder Hey Children’s Hospital, Liverpool, UK
| | - Harriet M. Babikako
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Muneera Rasheed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kirsten A. Donald
- Division of Developmental Paediatrics, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Emmie W. Mbale
- Department of Pediatrics and Child Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Prem Chand
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Angelina Kakooza Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Melissa Gladstone
- Alder Hey Children’s Hospital, Liverpool, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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11
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Uchitel J, Alden E, Bhutta ZA, Cavallera V, Lucas J, Oberklaid F, Patterson J, Raghavan C, Richter L, Rikard B, Russell RR, Mikati MA. Role of Pediatricians, Pediatric Associations, and Academic Departments in Ensuring Optimal Early Childhood Development Globally: Position Paper of the International Pediatric Association. J Dev Behav Pediatr 2022; 43:e546-e558. [PMID: 35980036 DOI: 10.1097/dbp.0000000000001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Early childhood (birth-8 years), particularly the first 3 years, is the most critical time in development because of the highly sensitive developing brain. Providing appropriate developmental care (i.e., nurturing care, as defined by the World Health Organization [WHO]) during early childhood is key to ensuring a child's holistic development. Pediatricians are expected to play a critical role in supporting early childhood development (ECD) through providing developmental services such as developmental monitoring, anticipatory guidance, screening, and referral to medical and/or community-based services when delay is identified. Pediatricians are also expected to serve as advocates within their clinics and communities for improved delivery of ECD services, such as advocating for increasing funding for ECD initiatives, increasing insurance coverage of ECD services, and working to increase other pediatricians' awareness of the principles of ECD and how to deliver developmental services. However, this does not always occur. Typically, pediatricians' training and practice emphasizes treating disease rather than enhancing ECD. Pediatricians are further hindered by a lack of uniformity across nations in guidelines for developmental monitoring and screening. In this article, we present the vision of the International Pediatric Association (IPA) of the roles that pediatricians, academic departments, medical training programs, and pediatric associations should fulfill to help support ECD, including raising ECD to higher levels of priority in routine pediatric care. First, we present the challenges that face these goals in supporting ECD. We then propose, with supportive literature, strategies and resources to overcome these challenges in collaboration with local and international stakeholders, including the IPA, the WHO, UNICEF, and the World Bank.
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Affiliation(s)
- Julie Uchitel
- Department of Paediatrics, University of Cambridge, The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, Durham, NC
| | - Errol Alden
- International Pediatric Association, Uniformed Services of Health Sciences, Bethesda, MD
| | - Zulfiqar A Bhutta
- International Pediatric Association; Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | - Jane Lucas
- Consultant in International Health and Child Development to UNICEF and the World Health Organization, New York, NY
| | - Frank Oberklaid
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, Australia
| | - Janna Patterson
- Global Child Health and Life Support, American Academy of Pediatrics, Chicago, IL
| | - Chemba Raghavan
- Early Childhood Development Specialist/Acting Chief, UNICEF, New York, NY
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Blaire Rikard
- Division of Pediatric Neurology and Developmental Medicine, Duke University Health System, Durham, NC
| | - Robert Ross Russell
- European Board of Paediatrics, European Academy of Paediatrics; Paediatric Respiratory Paediatrics, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Mohamad A Mikati
- Early Childhood Development Standing Advisory Group, International Pediatrics Association; Department of Pediatrics, Division of Pediatric Neurology and Developmental Medicine Duke University Medical Center, Durham, NC
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12
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Screening for Intellectual Disabilities and/or Autism Amongst Older Children and Young Adults: a Systematic Review of Tools for Use in Africa. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
There are many well-developed screening tools for both intellectual disabilities and autism, but they may not be culturally appropriate for use within Africa. Our specific aims were to complete a systematic review to (1) describe and critically appraise short screening tools for the detection of intellectual disabilities and autism for older children and young adults, (2) consider the psychometric properties of these tools, and (3) judge the cultural appropriateness of these tools for use within Africa. Six screening tools for intellectual disabilities and twelve for autism were identified and appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. We identified two screening tools which appeared appropriate for validation for use within African nations.
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13
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Achmat B, Gerber B. Challenges to infection control in early communication intervention: A scoping review. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2022; 69:e1-e14. [PMID: 36073070 PMCID: PMC9453695 DOI: 10.4102/sajcd.v69i2.911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/13/2022] [Accepted: 05/19/2022] [Indexed: 12/18/2022] Open
Abstract
Background: Personal protective equipment (PPE) and infection prevention and control (IPC) measures are crucial to preventing the spread of coronavirus disease 2019 (COVID-19). This study used a scoping review to investigate the challenges that exist when speech–language therapists (SLTs) use IPC measures for providing early communication intervention (ECI).Objectives: To describe existing, recent literature on PPE and IPC measures used in early intervention through a scoping review (steps 1–5) and to consult local clinicians to investigate how SLTs who provide ECI in South Africa relate to these findings (step 6 of the scoping review).Method: A scoping review was performed which followed the PRISMA-ScR framework. Because of limited literature on PPE and IPC measures used by SLTs in providing ECI, the inclusion criteria were adjusted to include PPE and IPC measures used by healthcare workers (HCWs) who provide early intervention to the population of infants and toddlers up to 3 years old. At the time of the review, articles were not older than 10 years and were published between 2011 and 2020. The scoping review included a consultation with South African SLTs who provide ECI, including during the COVID-19 pandemic. A pilot study was conducted prior to the consultations. Seventeen clinicians were included in total. Data from both the pilot study and main consultation were transcribed and analysed in the results using thematic analysis.Results: Fourteen articles were included in the study. The scoping review of existing literature identified challenges to implementing IPC measures, namely the care and behaviour of young children, infrastructure and system challenges, poor compliance and lack of training and a lack of standard IPC protocols. Clinicians in the consultation phase confirmed these challenges and reported that IPC measures did not consider ECI populations nor the settings in which services were provided. Suggestions from the literature for improved infection control included hand hygiene, improved supplies and infrastructure and education and training. Clinicians in the consultation added practical suggestions for implementing IPC measures within ECI, which included an increase in parent-led intervention as well as cleaning and disinfection strategies.Conclusion: This study identified challenges and recommendations of SLTs who use PPE and IPC measures whilst providing ECI. Understanding these challenges can benefit ECI services and future research efforts focused on improving ECI services whilst maintaining IPC standards.
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Affiliation(s)
- Bilqees Achmat
- Division of Speech-Language and Hearing Therapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg.
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La Valle C, Johnston E, Tager-Flusberg H. A systematic review of the use of telehealth to facilitate a diagnosis for children with developmental concerns. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 127:104269. [PMID: 35636261 PMCID: PMC10521149 DOI: 10.1016/j.ridd.2022.104269] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Telehealth can reduce the gap between developmental concern and diagnosis. Evaluation of telehealth methods is needed for providers to make decisions about using telediagnostic assessments. AIM This systematic review examined telehealth in facilitating a diagnosis for children with developmental concerns and assessed 1) study characteristics and type of diagnostic evaluation; 2) comparison of telehealth technologies to in-person diagnostic methods; 3) feasibility and acceptability of telehealth technologies; and 4) methodological quality. METHOD AND PROCEDURES Peer-reviewed studies from PsycINFO, CINAHL, Web of Science, PubMed, Embase, and Cochrane published January 2000-July 2021 were searched using "telehealth" AND "developmental concern" AND "diagnosis". Data extraction included study characteristics, diagnostic evaluation, technology, diagnostic accuracy, feasibility, and acceptability. Methodological quality was assessed using NHLBI tools. OUTCOMES AND RESULTS Nine studies met inclusion. Children with suspected FAS, social-emotional concerns, suspected genetic conditions, and failed hearing screenings received a telediagnosis. Evaluations included dysmorphology, feeding, neurological, developmental, audiological, and psychiatric. Seven studies used videoconferencing in real-time and two used Store-and-Forward methods. High diagnostic agreement occurred between face-to-face and remote methods. Stakeholders reported high satisfaction and feasibility. Many of the studies were rated as fair quality. CONCLUSIONS AND IMPLICATIONS Findings underscore partnership models between local providers and remote specialists. Rigorous study designs with larger samples covering a wider range of developmental domains are needed to provide a stronger empirical base for providers.
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Affiliation(s)
- Chelsea La Valle
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Emily Johnston
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
| | - Helen Tager-Flusberg
- Department of Psychological & Brain Sciences, Boston University Center for Autism Research Excellence, 100 Cummington Mall, Boston, MA 02215, USA.
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15
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Physician Voices on ECHO Autism India-Evaluation of a Telementoring Model for Autism in a Low-Middle Income Country. J Dev Behav Pediatr 2022; 43:335-345. [PMID: 35013067 DOI: 10.1097/dbp.0000000000001060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Training pediatricians in low- and middle-income countries (LMICs) in early diagnosis and comprehensive management of autism spectrum disorder (ASD) is crucial to ensure optimal developmental outcomes for a substantial number of children with ASD in this region. This study evaluates the relevance and effectiveness of an evidence-based telementoring model Extension for Community Healthcare Outcomes (ECHO) Autism in increasing pediatricians' access to best-practice care for children with ASD in LMIC contexts. METHODS ECHO Autism was launched by a ‟hub" team of multidisciplinary ASD experts at a child development center in Mumbai, India. The culturally modified model included 13 biweekly sessions conducted annually using video-conferencing technology. Sessions combined expert-delivered didactics and facilitated case-based discussions on best-practice methods in screening, diagnosing, and managing autism and its comorbidities. Sixty-two physicians, including 59 pediatricians across 2 cohorts (2019-2020), participated in the mixed-methods study to evaluate participants' reactions, knowledge, behaviors, and impact on children and families. RESULTS Participants represented a broad geographic reach across India (n = 47) and other LMICs (n = 15). Both quantitative and qualitative data revealed high levels of participant satisfaction and improved knowledge and self-efficacy in ASD diagnosis and management. Qualitative themes highlighted the adult-learning processes of ECHO Autism that participants considered novel and beneficial, such as reflective discussions, respectful mentoring, having a parent as ‟expert," and cultural relevance, alongside changes in practice behaviors. CONCLUSION ECHO Autism clinics facilitated by local experts in LMICs can improve access to early diagnosis and evidence-based, comprehensive management for children with ASD and their families by positively influencing pediatricians' knowledge, attitudes, and practice behaviors.
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16
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Yu X, Xu X. The future of care and clinical research in autism - recommendations from the 2021 Lancet Commission. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:216-218. [PMID: 37724192 PMCID: PMC10388786 DOI: 10.1515/mr-2022-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 09/20/2023]
Abstract
At least 78 million people worldwide are affected by autism, a neurodevelopmental disorder characterized by deficits in social interactions, and repetitive behaviors and/or interests. Autism typically manifests in early childhood, and affects social communications and behaviors throughout the lifespan of the individual. Under the umbrella of autism spectrum disorder, it is a highly heterogeneous disorder, with some individuals profoundly affected and needing care every day, while others can live highly independent lives, with some adjustments. The past 60 years has seen a major influx of interest in autism, and significant advances in many areas. However, a large gap remains between current scientific knowledge and the help and support that people with autism and their families need. To address these concerns, the Lancet commissioned a report on the "future of care and clinical research in autism". The Commission calls for government coordination between health-care, education and social sectors, as well as active participation from people with autism and their families. The Commission proposes personalized, evidence-based assessments and intervention, that is accessible and affordable to all, and call for increased appreciation of neurodiversity and prioritization of research that can improve the lives of people with autism and their families. How to support each and every autistic individual and their families is highly challenging. The 64-page Lancet Commission Report, published on December 2021, was written jointly by 32 authors from 6 continents and 13 disciplines, including clinicians, other health-care providers, researchers, advocates, autistic individuals and their parents.
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Affiliation(s)
- Xiang Yu
- State Key Laboratory of Membrane Biology, School of Life Sciences, Peking-Tsinghua Center for Life Sciences, IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Autism Research Center of Peking University Health Science Center, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Xiu Xu
- Department of Child Healthcare, Children’s Hospital of Fudan University, Shanghai 201102, China
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17
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Abuga JA, Kariuki SM, Abubakar A, Nyundo C, Kinyanjui SM, Van Hensbroek MB, Newton CRJC. Neurological impairment and disability in children in rural Kenya. Dev Med Child Neurol 2022; 64:347-356. [PMID: 34536290 PMCID: PMC9292953 DOI: 10.1111/dmcn.15059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 01/02/2023]
Abstract
AIM To investigate geographical change over time in the burden of neurological impairments in school-aged children in a demographic surveillance area. METHOD We investigated changes in neurological impairment prevalence in five domains (epilepsy and cognitive, hearing, vision, and motor impairments) using similar two-phase surveys conducted in 2001 (n=10 218) and 2015 (n=11 223) and determined changes in location-level prevalence, geographical clustering, and significant risk factors for children aged 6 to 9 years (mean 7y 6mo, SD 1y) of whom 50.4% were males. Admission trends for preterm birth, low birthweight (LBW), and encephalopathy were determined using admission data to a local hospital. RESULTS Overall prevalence for any neurological impairment decreased from 61 per 1000 (95% confidence interval [CI] 48.0-74.0) in 2001 to 44.7 per 1000 (95% CI 40.9-48.6) in 2015 (p<0.001). There was little evidence of geographical variation in the prevalence of neurological impairments in either survey. The association between neurological impairments and some risk factors changed significantly with year of survey; for example, the increased association of adverse perinatal events with hearing impairments (exponentiated coefficient for the interaction=5.94, p=0.03). Annual admission rates with preterm birth (rate ratio 1.08, range 1.07-1.09), LBW (rate ratio 1.08, range 1.06-1.10), and encephalopathy (rate ratio 1.08, range 1.06-1.09) significantly increased between 2005 and 2016 (p<0.001). INTERPRETATION There was a significant decline in the prevalence of neurological impairments and differential changes in the associations of some risk factors with neurological impairments over the study period. Limited geographical variation suggests that similar interventions are appropriate across the defined area.
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Affiliation(s)
- Jonathan A Abuga
- Department of Clinical Research (Neurosciences)Kenya Medical Research Institute‐Wellcome Trust Research ProgrammeKilifiKenya,Global Child Health GroupAcademic Medical CentreEmma Children’s HospitalUniversity of AmsterdamAmsterdamthe Netherlands
| | - Symon M Kariuki
- Department of Clinical Research (Neurosciences)Kenya Medical Research Institute‐Wellcome Trust Research ProgrammeKilifiKenya,Department of PsychiatryUniversity of OxfordOxfordUK
| | - Amina Abubakar
- Department of Clinical Research (Neurosciences)Kenya Medical Research Institute‐Wellcome Trust Research ProgrammeKilifiKenya,Institute for Human DevelopmentThe Agha Khan UniversityNairobiKenya
| | - Christopher Nyundo
- Department of Clinical Research (Neurosciences)Kenya Medical Research Institute‐Wellcome Trust Research ProgrammeKilifiKenya
| | - Samson M Kinyanjui
- Department of Clinical Research (Neurosciences)Kenya Medical Research Institute‐Wellcome Trust Research ProgrammeKilifiKenya,Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Michael Boele Van Hensbroek
- Global Child Health GroupAcademic Medical CentreEmma Children’s HospitalUniversity of AmsterdamAmsterdamthe Netherlands
| | - Charles RJC Newton
- Department of Clinical Research (Neurosciences)Kenya Medical Research Institute‐Wellcome Trust Research ProgrammeKilifiKenya,Department of PsychiatryUniversity of OxfordOxfordUK
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18
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Mwangi LW, Abuga JA, Cottrell E, Kariuki SM, Kinyanjui SM, Newton CRJC. Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review. Wellcome Open Res 2022; 6:61. [PMID: 35299711 PMCID: PMC8902259 DOI: 10.12688/wellcomeopenres.16593.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Neurological impairments (NI) and disability are common among older children in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical and rehabilitative care by children and adolescents with NI in LMICs. Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all studies reporting on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches. Results: Our literature searches identified 3,258 reports of which 20 were included in the final analysis. Fifteen studies (75.0%) originated from diverse settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=17, 85.0%), geographical and physical inaccessibility (N=14, 70.0%), inadequate healthcare resources (N=14, 70.0%), prohibitive culture and beliefs (N=12, 60.0%), and inadequate education/awareness (N=11, 55.0%). Factors reported in <50% of the studies included competing domestic roles (N=4, 20%) and a lack of confidentiality for personal information (N=2, 10.0%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level. Conclusions: Financial constraints, geographic and physical inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs. PROSPERO registration: CRD42020165296 (28/04/2020).
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Affiliation(s)
- Lucy W. Mwangi
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Jonathan A. Abuga
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Global Child Heath Group, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, AHTC, Tower C4, Paasheuvelweg 25 1105 BP Amsterdam, The Netherlands
| | - Emma Cottrell
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Symon M. Kariuki
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
| | - Samson M. Kinyanjui
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxford OX3 7BN, UK
| | - Charles RJC. Newton
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
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19
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Kakooza-Mwesige A, Bakare M, Gaddour N, Juneja M. The need to improve autism services in lower-resource settings. Lancet 2022; 399:217-220. [PMID: 34883050 DOI: 10.1016/s0140-6736(21)02658-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/15/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda.
| | - Muideen Bakare
- Childhood Neuropsychiatric Disorders Initiatives, Enugu and Federal Neuropsychiatric Hospital, Enugu State, Nigeria
| | - Naoufel Gaddour
- University of Monastir, CHU Fattouma Bourguiba, Monastir, Tunisia
| | - Monica Juneja
- Department of Paediatrics and Child Development Centre, Centre of Excellence-Early Intervention Centre, Maulana Azad Medical College, New Delhi, India
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Lin LY, Yu WH, Lin WP, Chen CC, Tu YF. Agreement Between Caregivers' Concerns of Children's Developmental Problems and Professional Identification in Taiwan. Front Pediatr 2022; 10:804427. [PMID: 35295704 PMCID: PMC8918581 DOI: 10.3389/fped.2022.804427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Early detection of developmental delays relies on the accuracy of the caregivers' concerns of children's developmental problems. The aim of this study was to investigate the agreement between the caregivers' awareness of children's developmental problems and professional identification. METHODS Caregivers of 1,963 children (age range: 5-71 months; mean: 38.4 months) younger than 6 years old who were at risk of developmental delays and referred to the center for a comprehensive evaluation were enrolled in this study. Children were identified by a transdisciplinary team including a pediatric neurologist, a pediatric psychiatrist, two psychologists, two occupational therapists, two physical therapists, two speech therapists, a social worker, and a special instructor. A series of standardized developmental assessments were used to identify children with developmental delay. Retrospective chart reviews were conducted on all children to confirm specific developmental disorders. RESULTS The caregivers' initial concerns of cognitive, speech/language, emotional/behavioral, and motor and global development showed low agreement with the results of professional identification. The major disagreement was observed in the cognitive domain. Speech/language developmental concern was an important red-flag indicator of cognitive and emotional/behavioral developmental delays. The presence of intellectual disability, autism spectrum disorder, and attention deficit hyperactivity disorder was high in this study. When having caregivers' concerns about speech/language and emotional/behavioral development, the odds of children with autism spectrum disorder was 2.37 and 2.17 times greater than those without autism spectrum disorder, respectively. The presence of attention deficit hyperactivity disorder was significantly associated with concerns about cognitive and emotional/behavioral developmental delays. Child's age and mothers' level of education were significant indicators for detecting the child's developmental problems. CONCLUSION It is recommended that assessing the cognitive developmental status is essential for all children in the identification process. Practitioners should not overlook caregivers' concern about speech/language and emotional/behavioral development. Transdisciplinary practitioners provide educational guidance to caregivers, especially in the domains of cognitive, speech/language, and emotional/behavioral development.
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Affiliation(s)
- Ling-Yi Lin
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Wen-Hao Yu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Wei-Pin Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Chih-Chia Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Yi-Fang Tu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
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21
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Kim S. Worldwide national intervention of developmental screening programs in infant and early childhood. Clin Exp Pediatr 2022; 65:10-20. [PMID: 34592802 PMCID: PMC8743433 DOI: 10.3345/cep.2021.00248] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/26/2021] [Indexed: 11/27/2022] Open
Abstract
The prevalence of developmental disabilities is increasing worldwide over time. Developmental issues in infancy or early childhood may cause learning difficulties or behavioral problem in school age, further adversely affecting adolescent quality of life, which finally lead to low socioeconomic status in family, increase in medical expenses, and other relevant issues in various ways. Early childhood has brain plasticity, which means there is a high chance of recovering from developmental issues by early detection and timely intervention. Pediatricians are placed an ideal position to meet with young children till 6 years of age, of which age range is the time applicable to early intervention. Determining child’s developmental status can be made by 2 pathways such as developmental surveillance and developmental screening tests. For better results, pediatricians should update their knowledge about developmental issues, risk factors, and screening techniques through varying educational program or other relevant educating materials. This paper will update reports on the prevalence of developmental disabilities and review the recent results of the Korean developmental screening test and discuss relevant issues. Finally, it will be addressed the pediatrician’s role in early detecting developmental issues and timely intervention.
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Affiliation(s)
- Seunghyo Kim
- Department of Pediatrics, Jeju National University Hospital, Jeju, Korea
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Bonney E, Abbo C, Ogara C, Villalobos ME, Elison JT. Sex differences in age of diagnosis of autism spectrum disorder: Preliminary evidence from Uganda. Autism Res 2022; 15:183-191. [PMID: 34826197 PMCID: PMC8755597 DOI: 10.1002/aur.2645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 09/15/2021] [Accepted: 11/16/2021] [Indexed: 01/03/2023]
Abstract
This study was performed to determine (a) the age at which autism spectrum disorder (ASD) is first diagnosed in Ugandan children receiving mental health services, (b) whether age at diagnosis varies by sex and clinical presentation, and (c) the average age of ASD diagnosis in children manifesting comorbid conditions. A retrospective chart review was performed and demographic as well as clinical data were collected from children with ASD diagnoses who attended two mental health clinics in Uganda between 2014 and 2019. Descriptive statistics such as percentages, means, and standard deviations were used to summarize the data. Independent t-test was also performed to determine differences in the mean age of diagnosis between males and females. Two hundred and thirty-seven (156 males, 81 females) children with ASD were identified. The average age of ASD diagnosis was (6.9 ± 4.0) years. A statistically significant difference in age of ASD diagnosis was found between males and females (t = -2.106, p = 0.036), such that on average females received a diagnosis at least 1 year later than males. Of the 237 participants, 53.6% were identified with ASD only, 16.0% had ASD and ADHD, 10.5% were diagnosed with ASD and epilepsy, and 7.2% had a diagnosis of complex ASD. The results confirm delays in access to ASD diagnosis and suggest that females are more likely to receive a ASD diagnosis later than males within the Ugandan context. ASD awareness should be intensified to improve public or professional knowledge about ASD to enhance early identification in Uganda.
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Affiliation(s)
- Emmanuel Bonney
- Institute of Child Development, University of Minnesota, MN, USA.,Department of Pediatrics, University of Minnesota, MN, USA.,Department of Psychiatry, School of Medicine, Makerere University, Kampala, Uganda.,Corresponding author: Emmanuel Bonney,
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, Makerere University, Kampala, Uganda
| | - Collin Ogara
- Department of Psychiatry, School of Medicine, Makerere University, Kampala, Uganda
| | | | - Jed T. Elison
- Institute of Child Development, University of Minnesota, MN, USA.,Department of Pediatrics, University of Minnesota, MN, USA
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Linder CL, Atijosan-Ayodele O, Chokotho L, Mulwafu W, Tataryn M, Polack S, Kuper H, Pandit H, Lavy C. Childhood musculoskeletal impairment in Malawi from traumatic and non-traumatic causes: a population- based assessment using the key informant method. BMC Musculoskelet Disord 2021; 22:1058. [PMID: 34933673 PMCID: PMC8693487 DOI: 10.1186/s12891-021-04942-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Musculoskeletal impairment (MSI) in children is an under-recognised public health challenge. Although preventable, road injuries and other traumas continue to cause significant impairments to children worldwide. The study aimed to use the Key Informant Method (KIM) to assess prevalence and causes of MSI in children in two districts in Malawi, estimating the associated need for services provision, with a focus on traumatic aetiology. Methods The KIM was conducted in the districts of Thyolo (Southern Malawi) and Ntcheu (Central Malawi) in 2013. Five hundred key informants were trained to identify children who may have one of a range of MSI. The identified children were referred to a screening camp where they were examined by medical experts with standardised assessment protocols for diagnosing each form of impairment. Results 15,000 children were referred to screening camps. 7220 children were assessed (response rate 48%) for an impairment of whom 15.2% (1094) had an MSI. 13% of children developed MSI from trauma, while 54% had a neurological aetiology. For MSI of traumatic origin the most common body part affected was the elbow. Less than half of children with MSI (44.4%) were enrolled in school and none of these children attended schools with resources for disability. More than half of children with MSI (60%) had not received required services and 64% required further physical therapy. Conclusions The KIM method was used to identify a high prevalence of MSI among children in two districts of Malawi and estimates an unmet need for dedicated MSI services.
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Affiliation(s)
- Cortland L Linder
- Royal London Hospital, Whitechapel Rd, Whitechapel, London, E1 1FR, UK
| | | | - Linda Chokotho
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Blantyre, Malawi.
| | - Wakisa Mulwafu
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Blantyre, Malawi
| | - Myroslava Tataryn
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | | | - Chris Lavy
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
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Salah El-Din EM, Monir ZM, Shehata MA, Abouelnaga MW, Abushady MM, Youssef MM, Megahed HS, Salem SME, Metwally AM. A comparison of the performance of normal middle social class Egyptian infants and toddlers with the reference norms of the Bayley Scales -third edition (Bayley III): A pilot study. PLoS One 2021; 16:e0260138. [PMID: 34855785 PMCID: PMC8638870 DOI: 10.1371/journal.pone.0260138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Developmental assessment is an important facility for early detection and intervention of developmental delay in children. Objective: to assess the performance of a sample of middle social class Egyptian infants and toddlers on Bayley Scales of Infant and Toddler Development-third edition (Bayley III), and to compare their cognitive, motor, and communication scores with that of the reference norms. METHODS It was a cross-sectional pilot study, included 270 children aged 18-42 months. Mothers filled a questionnaire including questions about family socioeconomic background, perinatal history, and family history. Physical examination and growth assessment of children were performed. Developmental assessment of cognitive, language and motor skills was performed using the Bayley III scales and compared the American norm scores with the Egyptian mean scores. RESULTS The mean cognitive, language and motor composite scores were 92.5+18.5, 91.76+ 15.6, and 95.67+18.9 respectively. All were lower than the American mean (100+ 15) with highly significant differences. About one-fourth of the enrolled Egyptian children had below-average composite scores according to the US cutoff point. The ranks of Egyptian children on the American versus the Egyptian percentile curves were significantly different. CONCLUSION Mean values of all assessed developmental domains of Egyptian children are within the norm-referenced average of Bayley III, but lower than the recorded American mean. Assessing Egyptian children according to the American norms may result in overestimating developmental delay. This pilot study raised the question about using different cutoff points suitable for the developmental trajectory of Egyptian children. Answering this question needs further studies on Bayley-III after cultural adaptation and standardization, using a larger, more diverse, and representative sample of the Egyptian population.
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Affiliation(s)
- Ebtissam M. Salah El-Din
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Zeinab M. Monir
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Manal A. Shehata
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
- * E-mail:
| | - Marwa W. Abouelnaga
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Mones M. Abushady
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Mai M. Youssef
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Hala S. Megahed
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Samar M. E. Salem
- Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
| | - Ammal M. Metwally
- Department of Community Medicine Research, Medical Research and Clinical Studies Institute, National Research Centre, Giza, Egypt
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Salah El-Din EM, Monir ZM, Shehata MA, Abouelnaga MW, Abushady MM, Youssef MM, Megahed HS, Salem SME, Metwally AM. A comparison of the performance of normal middle social class Egyptian infants and toddlers with the reference norms of the Bayley Scales -third edition (Bayley III): A pilot study. PLoS One 2021; 16:e0260138. [DOI: https:/doi.org/10.1371/journal.pone.0260138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Background
Developmental assessment is an important facility for early detection and intervention of developmental delay in children. Objective: to assess the performance of a sample of middle social class Egyptian infants and toddlers on Bayley Scales of Infant and Toddler Development-third edition (Bayley III), and to compare their cognitive, motor, and communication scores with that of the reference norms.
Methods
It was a cross-sectional pilot study, included 270 children aged 18–42 months. Mothers filled a questionnaire including questions about family socioeconomic background, perinatal history, and family history. Physical examination and growth assessment of children were performed. Developmental assessment of cognitive, language and motor skills was performed using the Bayley III scales and compared the American norm scores with the Egyptian mean scores.
Results
The mean cognitive, language and motor composite scores were 92.5+18.5, 91.76+ 15.6, and 95.67+18.9 respectively. All were lower than the American mean (100+ 15) with highly significant differences. About one-fourth of the enrolled Egyptian children had below-average composite scores according to the US cutoff point. The ranks of Egyptian children on the American versus the Egyptian percentile curves were significantly different.
Conclusion
Mean values of all assessed developmental domains of Egyptian children are within the norm-referenced average of Bayley III, but lower than the recorded American mean. Assessing Egyptian children according to the American norms may result in overestimating developmental delay. This pilot study raised the question about using different cutoff points suitable for the developmental trajectory of Egyptian children. Answering this question needs further studies on Bayley-III after cultural adaptation and standardization, using a larger, more diverse, and representative sample of the Egyptian population.
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Garibaldi A, Venkatesh L, Bhat JS, Boominathan P. Relationship between parental report of language skills and children's performance among 3-year-olds: Implications for screening language among preschoolers. Int J Pediatr Otorhinolaryngol 2021; 151:110943. [PMID: 34700297 DOI: 10.1016/j.ijporl.2021.110943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
AIM The study compared parental ratings of children's language abilities at 3-years of age with observations of children's language performance by Speech Language Pathologists (SLPs). METHOD Children (n=85) around 3-years of age were recruited from a child development clinic. Detailed speech and language assessments were completed during a one-hour semi-structured clinician-child interactive session. Language assessment was carried out using a criterion-referenced checklist and the language sections of the Bayley Scale for Infant Development- 3rd Edition (BSID-III). All parents rated their children's language skills using seven statements related to reception and expression domains of language on a 7-point rating scale. The language status of the child (typical language vs delay) determined by the parental report was matched with the language status as per the child's performance during the SLP assessment. RESULTS AND DISCUSSION Mean parental ratings of children assessed as having language delay by an SLP were significantly lower than children with typical language. Total parental rating score correlated highly with overall language scores on BSID-III; the highest correlation was observed for ratings of statements related to expressive language skills focusing on formation of sentences. Parental report of below normal performance on any one of the seven statements demonstrated acceptable sensitivity (0.95) and a high negative predictive value (0.98) with the child's performance as the gold standard. CONCLUSION Parental ratings of language skills correlated with child's performance at 3-years of age with a higher agreement for identifying children with delays. Parental reports can be useful to red-flag children for further assessment and continued monitoring of language development in busy developmental clinics and preschools, especially in the context of low-resource settings.
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Affiliation(s)
- Adhirai Garibaldi
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600116, India.
| | - Lakshmi Venkatesh
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600116, India.
| | - Jayashree S Bhat
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Manipal Academy of Higher Education and Research (Deemed to be University), Manipal, Karnataka, 576104, India.
| | - Prakash Boominathan
- Department of Speech, Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai, Tamil Nadu, 600116, India.
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Xu H, Xuan X, Zhang L, Zhang W, Zhu M, Zhao X. New Approach to Intelligence Screening for Children With Global Development Delay Using Eye-Tracking Technology: A Pilot Study. Front Neurol 2021; 12:723526. [PMID: 34803871 PMCID: PMC8595207 DOI: 10.3389/fneur.2021.723526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: There has become a consensus for detecting intellectual disability in its early stages and implementing effective intervention. However, there are many difficulties and limitations in the evaluation of intelligence-related scales in low-age children. Eye-tracking technology may effectively solve some of the pain points in the evaluation. Method: We used an eye-tracking technology for cognitive assessment. The subjects looked at a series of task pictures and short videos, the fixation points of which were recorded by the eye-movement analyzer, and the data were statistically analyzed. A total of 120 children aged between 1.5 and 4 years participated in the study, including 60 typically developing children and 60 children with global development delay, all of whom were assessed via the Bayley scale, Peabody Picture Vocabulary Test (PPVT), and Gesell scale. Results: Cognitive scores from eye-tracking technology are closely related to the scores of neuropsychological tests, which shows that the technique performs well as an early diagnostic test of children's intelligence. Conclusions: The results show that children's cognitive development can be quickly screened using eye-tracking technology and that it can track quantitative intelligence scores and sensitively detect intellectual impairment.
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Affiliation(s)
- Hong Xu
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyan Xuan
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wenxin Zhang
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Min Zhu
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoke Zhao
- Department of Rehabilitation, Children's Hospital of Nanjing Medical University, Nanjing, China
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Tesfay H, Sebsibe G, Tesfaye T. Practice of Early Childhood Developmental Milestone Assessment and Its Determinants Among Health Professionals Working at Public Hospitals in Addis Ababa, Ethiopia: A Cross-Sectional Study. Pediatric Health Med Ther 2021; 12:521-532. [PMID: 34866960 PMCID: PMC8638751 DOI: 10.2147/phmt.s300397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Early childhood developmental assessment refers to the continual process of observing, gathering, recording, and interpreting information to make developmental and instructional decisions and measure young children’s performance over time. Significant changes in the physical and neuropsychomotor developmental milestones take place in the first 2 years of life. Children younger than 3 years of age (36 months) who are at risk of having developmental delays may be eligible for early intervention treatment services. The study aimed to assess practice in early childhood developmental assessment and its determinants among health professionals working in public hospitals in Addis Ababa, Ethiopia. Methods This facility-based descriptive cross-sectional study was conducted from September to April 2018, with a total sample size of 268 health professionals from six public hospitals in Addis Ababa, Ethiopia. The data were entered into EpiData software version 4.2, and analyzed by SPSS version 23 software for bivariate and multivariable logistic regression analysis. Significant associations were taken as p<0.05 and the strength of associations was expressed using odds ratios. Results The practice of early childhood developmental milestone assessment was found to be 27.8%. Being a general practitioner (AOR=23.826, 95% CI: 6.77–83.9, p=0.000) or health officer (AOR=11.02, 95% CI: 2.1–58.812, p=0.005), and work experience greater than 11 years (AOR=20.897, 95% CI: 1.5–291.49, p=0.024) were significantly associated with good practice of early childhood developmental milestone assessment. Conclusion Practice of early childhood developmental milestone assessment remains poor. Training and sharing experiences among different professions, and assigning professionals with the highest levels of work experience in the service could improve the practice levels.
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Affiliation(s)
- Haileslassie Tesfay
- College of Medicine and Health Sciences, Debre Birhan University, Debre Birhan, Ethiopia
| | - Girum Sebsibe
- Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Tesfaye
- Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Tewodros Tesfaye Department of Nursing, School of Nursing and Midwifery, Addis Ababa University, PO Box 4412, Addis Ababa, EthiopiaTel +251 913 69 80 81 Email
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Oo NNL, Ng DCC, Ostbye T, Allen JC, Agarwal PK, Yeleswarapu SP, Chong SL, Guo X, Chan YH. Novel two-tiered developmental screening programme for Singaporean toddlers: a quality improvement report. BMJ Open Qual 2021; 10:bmjoq-2020-001327. [PMID: 34711585 PMCID: PMC8557273 DOI: 10.1136/bmjoq-2020-001327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 10/15/2021] [Indexed: 11/03/2022] Open
Abstract
Early identification of developmental delays with timely intervention, especially before the age of 3 years, can improve child development. In Singapore, however, diagnosis and intervention for developmental delays occur at a median age of 44 months. As early detection and intervention depends on an effective developmental screening programme, we aimed to improve the detection of developmental delays before the age of 3 years in a primary care setting. We did this by implementing a novel two-tiered screening programme which uses three standardised screening tools (Parents' Evaluation of Developmental Status, PEDS-Developmental Milestones and Ages and Stages Questionnaire-3). We used quality improvement methods to integrate and optimise this two-tiered programme into the existing 9-month and 18-month screening schedule, with an additional screening at 30 months to replace the pre-existing 36-month screening of the National Child Health Surveillance Programme. A total of three Plan-Do-Study-Act cycles were performed to ensure programme feasibility and sustainability. They focused on adequately training the primary care nurses, targeting an 80% screening rate and aiming for 20 min screening tool administration time per child. We assessed the proportion of children referred to the child development units after positive screening for developmental concerns under the new programme, with a pre-post and with-without intervention comparison, and reviewed the screening rates and screening tool administration time. The proportion of 18-month old children referred for developmental concerns improved from 3.5%-7.1% over a 6-month period. For those who received further assessment by developmental specialists after the two-tiered screening, 100% received a definitive diagnosis of developmental delays, similar to the situation before programme introduction. Our quality improvement efforts facilitated successful integration of the two-tiered programme into the pre-existing screening schedule with minimal impact to the clinic workflow. While we highlight challenges in implementation that need to be addressed, our findings support a potential nationwide adoption of the two-tiered programme.
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Chu SY, Lee J, Wong YY, Gan CH, Fierro V, Hersh D. Knowledge mediates attitude in autism spectrum disorders? Data from Malaysia. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 69:568-577. [PMID: 37346250 PMCID: PMC10281351 DOI: 10.1080/20473869.2021.1975254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 06/23/2023]
Abstract
Limited efforts have been made in middle- and low-income countries to raise public awareness of autism spectrum disorders (ASD) over the past ten years. We report data from a general population survey exploring the relationship between awareness, knowledge, and attitudes regarding autism in Malaysia. A questionnaire consisting of items related to awareness, knowledge, and attitudes regarding ASD was distributed. The scores of knowledge of ASD and attitude towards ASD were 6.87 (SD = 4.17; with a total possible score of 12) and 6.39 (SD = 2.77; with a total possible score of 9), respectively, indicating that, on average, the participants had moderate levels of knowledge and attitude. Structural equation modeling showed that improving awareness and knowledge about ASD will enhance more positive attitudes towards ASD. Efforts should be geared towards disseminating information about ASD, in order to increase acceptance of the disorder.
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Affiliation(s)
- Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jaehoon Lee
- Department of Educational Psychology and Leadership and Counseling, Texas Tech University, Lubbock, TX, USA
| | - Yee Yan Wong
- Faculty of Health Sciences, Speech Sciences Programme, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chun Hong Gan
- Faculty of Health Sciences, Centre for Rehabilitation & Special Needs Studies, Programme of Clinical Psychology and Behavioural Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Veronica Fierro
- Department of Communication Sciences and Disorders, Rockhurst University, Kansas City, MO, USA
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Allied Health Science and Practice, Adelaide University, Adelaide, Australia
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Govender P, Govender V, Naidoo D. Developmental delay in a resource-constrained environment: An approach to early intervention. S Afr Fam Pract (2004) 2021; 63:e1-e4. [PMID: 34476967 PMCID: PMC8424733 DOI: 10.4102/safp.v63i1.5355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 12/05/2022] Open
Abstract
With a reduction in mortality rates of children under 5 years, in low- and middle-income countries, the responsibility to provide quality care to the increased number of surviving children becomes essential. Many of these children present with developmental delay and the onus inevitably rest on the healthcare system. There is, therefore, the need for recognising timely intervention as routine care for these children, who may have potential for a better quality of life with intervention. The authors advocate for early referral and intervention, and provide a brief overview of a holistic approach to developmental delay in low resourced settings from their perspective.
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Affiliation(s)
- Pragashnie Govender
- Discipline of Occupational Therapy, College of Health Sciences, University of KwaZulu-Natal, Durban.
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Shrestha R, Dissanayake C, Barbaro J. Implementing and evaluating Social Attention and Communication Surveillance (SACS) to prospectively identify autism in very young children in Nepal. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 115:104013. [PMID: 34144316 DOI: 10.1016/j.ridd.2021.104013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/31/2021] [Accepted: 06/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Although Autism Spectrum Disorder (ASD) can be identified as early as 12 months and diagnosed by 24 months, the mean age of diagnosis of ASD in Nepal is ∼58 months, with children missing the opportunity for early intervention. AIMS This study implemented and evaluated a Nepali version of the Social Attention and Communication Surveillance (SACS-N) tool, to identify children between 11-30 months who are at "high likelihood" of ASD in a local community in Nepal. METHODS Sixty Female Community Health Volunteers (FCHVs) were trained to monitor and identify the early signs of ASD using SACS-N. RESULTS Overall, 1926 children were monitored with the SACS-N, with 11 children (0.57 %) referred for further assessments at 11-15 months (n = 4), 16-21 months (n = 4), and 22-30 months (n = 3). Of these children, 10 children had a developmental disorder, including ASD and Global Developmental Delay; no information was available on one child who migrated. Hence, the positive predictive value (PPV) of SACS-N for all developmental disorders was 100 %. Of seven children attending a gold standard diagnostic/ developmental assessment, three had ASD (43 % PPV for ASD). The estimated prevalence of ASD ranged between 0.16 % to 0.26 %. CONCLUSION Community-based developmental monitoring of ASD and other developmental delays by FCHVs is a feasible, cost-effective and sustainable approach to promoting early identification of ASD in Nepal. Further training and awareness of autism is needed for more accurate and increased referral rates using the SACS-N, including regular supervision of FCHVs.
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Affiliation(s)
- Rena Shrestha
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.
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Smythe T, Zuurmond M, Tann CJ, Gladstone M, Kuper H. Early intervention for children with developmental disabilities in low and middle-income countries - the case for action. Int Health 2021; 13:222-231. [PMID: 32780826 PMCID: PMC8079317 DOI: 10.1093/inthealth/ihaa044] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 12/22/2022] Open
Abstract
In the last two decades, the global community has made significant progress in saving the lives of children <5 y of age. However, these advances are failing to help all children to thrive, especially children with disabilities. Most early child development research has focussed on the impact of biological and psychosocial factors on the developing brain and the effect of early intervention on child development. Yet studies typically exclude children with disabilities, so relatively little is known about which interventions are effective for this high-risk group. In this article we provide an overview of child development and developmental disabilities. We describe family-centred care interventions that aim to provide optimal stimulation for development in a safe, stable and nurturing environment. We make the case for improving opportunities for children with developmental disabilities to achieve their full potential and thrive, including through inclusive early childhood development intervention. Finally, we call for the global research community to adopt a systematic approach for better evidence for and implementation of early interventions for children with developmental disabilities in low-resource settings.
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Affiliation(s)
- Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Maria Zuurmond
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Cally J Tann
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Melissa Gladstone
- Institute of Translational Medicine, University of Liverpool, Liverpool, L69 7TX, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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Elliott C, Alexander C, Salt A, Spittle AJ, Boyd RN, Badawi N, Morgan C, Silva D, Geelhoed E, Ware RS, Ali A, McKenzie A, Bloom D, Sharp M, Ward R, Bora S, Prescott S, Woolfenden S, Le V, Davidson SA, Thornton A, Finlay-Jones A, Jensen L, Amery N, Valentine J. Early Moves: a protocol for a population-based prospective cohort study to establish general movements as an early biomarker of cognitive impairment in infants. BMJ Open 2021; 11:e041695. [PMID: 33837094 PMCID: PMC8043010 DOI: 10.1136/bmjopen-2020-041695] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/30/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The current diagnostic pathways for cognitive impairment rarely identify babies at risk before 2 years of age. Very early detection and timely targeted intervention has potential to improve outcomes for these children and support them to reach their full life potential. Early Moves aims to identify early biomarkers, including general movements (GMs), for babies at risk of cognitive impairment, allowing early intervention within critical developmental windows to enable these children to have the best possible start to life. METHOD AND ANALYSIS Early Moves is a double-masked prospective cohort study that will recruit 3000 term and preterm babies from a secondary care setting. Early Moves will determine the diagnostic value of abnormal GMs (at writhing and fidgety age) for mild, moderate and severe cognitive delay at 2 years measured by the Bayley-4. Parents will use the Baby Moves smartphone application to video their babies' GMs. Trained GMs assessors will be masked to any risk factors and assessors of the primary outcome will be masked to the GMs result. Automated scoring of GMs will be developed through applying machine-based learning to the data and the predictive value for an abnormal GM will be investigated. Screening algorithms for identification of children at risk of cognitive impairment, using the GM assessment (GMA), and routinely collected social and environmental profile data will be developed to allow more accurate prediction of cognitive outcome at 2 years. A cost evaluation for GMA implementation in preparation for national implementation will be undertaken including exploring the relationship between cognitive status and healthcare utilisation, medical costs, health-related quality of life and caregiver burden. ETHICS AND DISSEMINATION Ethics approval has been granted by the Medical Research Ethics Committee of Joondalup Health Services and the Health Service Human Research Ethics Committee (1902) of Curtin University (HRE2019-0739). TRIAL REGISTRATION NUMBER ACTRN12619001422112.
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Affiliation(s)
- Catherine Elliott
- Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, West Australia, Australia
| | | | - Alison Salt
- Perth Children's Hospital, Perth, Western Australia, Australia
| | | | - Roslyn N Boyd
- The University of Queensland, Brisbane, Queensland, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Sydney, New South Wales, Australia
- Grace Centre for Newborn Intestive Care, The Childrens Hospital at Westmead, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Desiree Silva
- University of Western Australia, Perth, Western Australia, Australia
| | | | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Alishum Ali
- Curtin University, Perth, Western Australia, Australia
| | - Anne McKenzie
- University of Western Australia, Perth, Western Australia, Australia
| | - David Bloom
- Harvard University, Cambridge, Massachusetts, USA
| | - Mary Sharp
- University of Western Australia, Perth, Western Australia, Australia
| | - Roslyn Ward
- Curtin University, Perth, Western Australia, Australia
- University of Notre Dame, Perth, WA, Australia
| | - Samudragupta Bora
- The University of Queensland, Brisbane, Queensland, Australia
- Mothers, Babies and Women's Health Program, Mater Research Institute, Brisbane, Queensland, Australia
| | - Susan Prescott
- University of Western Australia, Perth, Western Australia, Australia
| | - Susan Woolfenden
- University of New South Wales, Kensington, New South Wales, Australia
| | - Vuong Le
- Deakin University, Geelong, Victoria, Australia
| | | | - Ashleigh Thornton
- Perth Children's Hospital, Perth, Western Australia, Australia
- University of Western Australia, Perth, Western Autralian, Australia
| | - Amy Finlay-Jones
- Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, West Australia, Australia
| | - Lynn Jensen
- Curtin University, Perth, Western Australia, Australia
| | - Natasha Amery
- Curtin University, Perth, Western Australia, Australia
| | - Jane Valentine
- Perth Children's Hospital, Perth, Western Australia, Australia
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Abuga JA, Kariuki SM, Kinyanjui SM, Boele van Hensbroek M, Newton CR. Premature Mortality, Risk Factors, and Causes of Death Following Childhood-Onset Neurological Impairments: A Systematic Review. Front Neurol 2021; 12:627824. [PMID: 33897590 PMCID: PMC8062883 DOI: 10.3389/fneur.2021.627824] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Neurological impairment (NI) and disability are associated with reduced life expectancy, but the risk and magnitude of premature mortality in children vary considerably across study settings. We conducted a systematic review to estimate the magnitude of premature mortality following childhood-onset NI worldwide and to summarize known risk factors and causes of death. Methods: We searched various databases for published studies from their inception up to 31st October 2020. We included all cohort studies that assessed the overall risk of mortality in individuals with childhood-onset epilepsy, intellectual disability (ID), and deficits in hearing, vision and motor functions. Comparative measures of mortality such as the standardized mortality ratio (SMR), risk factors and causes were synthesized quantitatively under each domain of impairment. This review is registered on the PROSPERO database (registration number CRD42019119239). Results: The search identified 2,159 studies, of which 24 studies were included in the final synthesis. Twenty-two (91.7%) studies originated from high-income countries (HICs). The median SMR was higher for epilepsy compared with ID (7.1 [range 3.1-22.4] vs. 2.9 [range 2.0-11.6]). In epilepsy, mortality was highest among younger age groups, comorbid neurological disorders, generalized seizures (at univariable levels), untreatable epilepsy, soon after diagnosis and among cases with structural/metabolic types, but there were no differences by sex. Most deaths (87.5%) were caused by non-epilepsy-related causes. For ID, mortality was highest in younger age groups and girls had a higher risk compared to the general population. Important risk factors for premature mortality were severe-to-profound severity, congenital disorders e.g., Down Syndrome, comorbid neurological disorders and adverse pregnancy and perinatal events. Respiratory infections and comorbid neurological disorders were the leading causes of death in ID. Mortality is infrequently examined in impairments of vision, hearing and motor functions. Summary: The risk of premature mortality is elevated in individuals with childhood-onset NI, particularly in epilepsy and lower in ID, with a need for more studies for vision, hearing, and motor impairments. Survival in NI could be improved through interventions targeting modifiable risk factors and underlying causes.
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Affiliation(s)
- Jonathan A. Abuga
- Kenya Medical Research Institute (KEMRI-Wellcome Trust Research Programme), Clinical Research (Neurosciences), Kilifi, Kenya
- Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Symon M. Kariuki
- Kenya Medical Research Institute (KEMRI-Wellcome Trust Research Programme), Clinical Research (Neurosciences), Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Samson M. Kinyanjui
- Kenya Medical Research Institute (KEMRI-Wellcome Trust Research Programme), Clinical Research (Neurosciences), Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Michael Boele van Hensbroek
- Global Child Health Group, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Charles R. Newton
- Kenya Medical Research Institute (KEMRI-Wellcome Trust Research Programme), Clinical Research (Neurosciences), Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Saloojee G, Ekwan F, Andrews C, Damiano DL, Kakooza-Mwesige A, Forssberg H. Akwenda intervention programme for children and youth with cerebral palsy in a low-resource setting in sub-Saharan Africa: protocol for a quasi-randomised controlled study. BMJ Open 2021; 11:e047634. [PMID: 34006038 PMCID: PMC7942240 DOI: 10.1136/bmjopen-2020-047634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood-onset motor disorder accompanied by associated impairments, placing a heavy burden on families and health systems. Most children with CP live in low/middle-income countries with little access to rehabilitation services. This study will evaluate the Akwenda CP programme, a multidimensional intervention designed for low-resource settings and aiming at improving: (1) participation, motor function and daily activities for children with CP; (2) quality of life, stress and knowledge for caregivers; and (3) knowledge and attitudes towards children with CP in the communities. METHODS This quasi-randomised controlled clinical study will recruit children and youth with CP aged 2-23 years in a rural area of Uganda. Children will be allocated to one of two groups with at least 44 children in each group. Groups will be matched for age, sex and motor impairment. The intervention arm will receive a comprehensive, multidimensional programme over a period of 11 months comprising (1) caregiver-led training workshops, (2) therapist-led practical group sessions, (3) provision of technical assistive devices, (4) goal-directed training and (5) community communication and advocacy. The other group will receive usual care. The outcome of the intervention will be assessed before and after the intervention and will be measured at three levels: (1) child, (2) caregiver and (3) community. Standard analysis methods for randomised controlled trial will be used to compare groups. Retention of effects will be examined at 12-month follow-up. ETHICS AND DISSEMINATION The study has been approved by the Uganda National Council for Science and Technology (SS 5173) and registered in accordance with WHO and ICMJE standards. Written informed consent will be obtained from caregivers. Results will be disseminated among participants and stakeholders through public engagement events, scientific reports and conference presentations. TRIAL REGISTRATION NUMBER Pan African Clinical Trials Registry (PACTR202011738099314) Pre-results.
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Affiliation(s)
| | - Francis Ekwan
- Department of Occupational Therapy, Mulago National Referral Hospital, Kampala, Uganda
| | - Carin Andrews
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Diane L Damiano
- Department of Rehabilitation Medicine, The National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | | | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Mulay KV, Aishworiya R, Lim TS, Tan MY, Kiing JS, Chong SC, Kang YQ. Innovations in practice: Adaptation of developmental and behavioral pediatric service in a tertiary center in Singapore during the COVID-19 pandemic. Pediatr Neonatol 2021; 62:70-79. [PMID: 33028511 PMCID: PMC7475770 DOI: 10.1016/j.pedneo.2020.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/30/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND As the coronavirus 2019 pandemic continues, healthcare services need to adapt to continue providing optimal and safe services for patients. We detail our adaptive framework as a large Developmental and Behavioral Pediatrics service in a tertiary academic institution in Singapore. METHODS The multidisciplinary team at our unit implemented various adaptations and workflow processes during this evolving pandemic in providing continued clinical care tailored to the challenges specific to our patient population. Services were continued via teleconsultation mode during the 'Circuit Breaker' (enhanced movement restriction) period. Specific workflow processes, IT infrastructure, and staff training were put in place to support smooth running of this service. Segregation of services into two teams based at two separate sites and implementation of stringent infection control measures surrounding the clinic visit by providers, patients and their families were incorporated to ensure safety. Measures were also taken to ensure providers' mental wellbeing. RESULTS The clinical service was continued for the majority of our patients with a lowest reduction in patient consultations to half of baseline during the 'Circuit Breaker' period. We received positive feedback from families for teleconsultation services provided. CONCLUSION We have been able to continue services in our DBP clinics due to our dynamic reassessment of workflow processes and their prompt implementation in conjunction with the hospital and national public health response to the pandemic. Given that this pandemic is likely to be long drawn, our unit remains ready to constantly adjust these workflows and make adaptations as we go along, together with the support for mental health of patients, parents and staff. Continual improvements in workflows will be helpful even beyond the pandemic to ensure good continuity of care for our patients and families.
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Affiliation(s)
| | | | - Tammy S.H. Lim
- Corresponding author. Department of Paediatrics, National University Health System, NUH Tower Block Level 12, 5 Lower Kent Ridge Road, 119074, Singapore. Fax: +65 6665 0158
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Lewis AK. Cultural and Linguistic Diversity Among Children and Families Referred for Diagnostic Evaluation of Developmental Delay and Disability: Implications for Service Delivery. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Amelia K. Lewis
- Disability Specialist Unit Sydney Local Health District Sydney New South Wales Australia
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Faruk T, King C, Muhit M, Islam MK, Jahan I, Baset KU, Badawi N, Khandaker G. Screening tools for early identification of children with developmental delay in low- and middle-income countries: a systematic review. BMJ Open 2020; 10:e038182. [PMID: 33234622 PMCID: PMC7684835 DOI: 10.1136/bmjopen-2020-038182] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To systematically review, identify and report the screening tools used for early identification of developmental delay in low- and middle-income countries. DESIGN Systematic review. DATA SOURCES Four bibliographic databases: Medline (1946 to 13 July 2020), Embase (1974 to 13 July 2020), Scopus (1823 to 11 July 2020) and PsycINFO (1987 to July week 1 2020). ELIGIBILITY CRITERIA Peer-reviewed original articles published in English addressing validated culturally sensitive developmental screening tools among children aged <5 years were included in this review. DATA EXTRACTION AND SYNTHESIS One author (CK, medical librarian) developed the search strategy. Three authors conducted the database search (phase I: CK; phase II: IJ and MKI). Three authors (TF, IJ and MKI) independently screened the title and abstracts. TF, MKI and GK independently performed the full-text review of the screened articles. During each step of the study selection process, disagreements were resolved through discussion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used to guide the systematic review. Data extraction and analysis were performed using MS Excel. Meta-analysis was not possible due to heterogeneity of the study findings. RESULTS We identified 3349 articles, of which 18 studies from 10 countries, reporting 16 screening tools, were selected for qualitative synthesis. Six cultural contexts were explored. Twelve general, two motor and two speech-language tools were identified. Seven of them found to be parent-completed ones. Five screening tools (American Speech-Language and Hearing Association, Guide for Monitoring Child Development, Infant Neurological International Battery, New Delhi-Development Screening Questionnaire and Woodside Screening Technique) reported relatively higher sensitivity (82.5%-100%) and specificity (83%-98.93%). CONCLUSIONS Limited number of culturally sensitive developmental screening tools were validated for children aged <5 years in low- and middle-income countries. Revising existing screening tools in different ethnic and cultural settings and subsequent validation with normative value should be a research priority.
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Affiliation(s)
- Tasnuva Faruk
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- Department of Public Health, Independent University Bangladesh, Dhaka, Bangladesh
| | - Catherine King
- The Children's Hospital at Westmead Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammad Muhit
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
| | - Md Kafiul Islam
- Department of Electrical and Electronic Engineering, Independent University Bangladesh, Dhaka, Bangladesh
| | - Israt Jahan
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Kamran Ul Baset
- Department of Public Health, Independent University Bangladesh, Dhaka, Bangladesh
- Road Safety and Driving School, BRAC, Dhaka, Bangladesh
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gulam Khandaker
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
- CSF Global, Dhaka, Bangladesh
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
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Rah SS, Hong SB, Yoon JY. Screening Effects of the National Health Screening Program on Developmental Disorders. J Autism Dev Disord 2020; 51:2461-2474. [PMID: 32989511 DOI: 10.1007/s10803-020-04712-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As the prevalence of developmental disorders (DDs) has increased, many OECD countries provide a national screening examination for early detection and intervention for DDs. This study examined effects of the National Health Screening Program in Korea. 65,334 children (39%) were DD-screened and 35,466 children (21%) received a false negative among the 167,050 study subjects. The DD-screened rate had increased from 3208 (27.2%) in 2008 to 8471 (47.3%) in 2012, then decreased to 5544 (29.8%) in 2017. Changes in the false negative rates increased from 2.7% in 2008 to 23.8% in 2017 were one of the most influential factors in these fluctuations. The DD-screened rate was influenced by demo-geographic and economic factors as well as by age-related characteristics of the subconditions.
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Affiliation(s)
- Sung Sil Rah
- College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Soon-Beom Hong
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ju Young Yoon
- Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Faridi MMA. Growth and Development of Preterm/Very Low Birthweight Infants at 12 to 24 Months of Corrected Age: A Marker of Quality Survival. Indian Pediatr 2020. [PMID: 32284472 DOI: 10.1007/s13312-020-1775-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M M A Faridi
- Dean, Faculty of Medicine, Era University, Lucknow
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Kalantarian H, Jedoui K, Dunlap K, Schwartz J, Washington P, Husic A, Tariq Q, Ning M, Kline A, Wall DP. The Performance of Emotion Classifiers for Children With Parent-Reported Autism: Quantitative Feasibility Study. JMIR Ment Health 2020; 7:e13174. [PMID: 32234701 PMCID: PMC7160704 DOI: 10.2196/13174] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/03/2019] [Accepted: 02/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social communication and interaction, and restricted and repetitive behaviors and interests. The incidence of ASD has increased in recent years; it is now estimated that approximately 1 in 40 children in the United States are affected. Due in part to increasing prevalence, access to treatment has become constrained. Hope lies in mobile solutions that provide therapy through artificial intelligence (AI) approaches, including facial and emotion detection AI models developed by mainstream cloud providers, available directly to consumers. However, these solutions may not be sufficiently trained for use in pediatric populations. OBJECTIVE Emotion classifiers available off-the-shelf to the general public through Microsoft, Amazon, Google, and Sighthound are well-suited to the pediatric population, and could be used for developing mobile therapies targeting aspects of social communication and interaction, perhaps accelerating innovation in this space. This study aimed to test these classifiers directly with image data from children with parent-reported ASD recruited through crowdsourcing. METHODS We used a mobile game called Guess What? that challenges a child to act out a series of prompts displayed on the screen of the smartphone held on the forehead of his or her care provider. The game is intended to be a fun and engaging way for the child and parent to interact socially, for example, the parent attempting to guess what emotion the child is acting out (eg, surprised, scared, or disgusted). During a 90-second game session, as many as 50 prompts are shown while the child acts, and the video records the actions and expressions of the child. Due in part to the fun nature of the game, it is a viable way to remotely engage pediatric populations, including the autism population through crowdsourcing. We recruited 21 children with ASD to play the game and gathered 2602 emotive frames following their game sessions. These data were used to evaluate the accuracy and performance of four state-of-the-art facial emotion classifiers to develop an understanding of the feasibility of these platforms for pediatric research. RESULTS All classifiers performed poorly for every evaluated emotion except happy. None of the classifiers correctly labeled over 60.18% (1566/2602) of the evaluated frames. Moreover, none of the classifiers correctly identified more than 11% (6/51) of the angry frames and 14% (10/69) of the disgust frames. CONCLUSIONS The findings suggest that commercial emotion classifiers may be insufficiently trained for use in digital approaches to autism treatment and treatment tracking. Secure, privacy-preserving methods to increase labeled training data are needed to boost the models' performance before they can be used in AI-enabled approaches to social therapy of the kind that is common in autism treatments.
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Affiliation(s)
- Haik Kalantarian
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Khaled Jedoui
- Department of Mathematics, Stanford University, Stanford, CA, United States
| | - Kaitlyn Dunlap
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Jessey Schwartz
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Peter Washington
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Arman Husic
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Qandeel Tariq
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Michael Ning
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Aaron Kline
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Dennis Paul Wall
- Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
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Murphy R, Jolley E, Lynch P, Mankhwazi M, Mbukwa J, Bechange S, Gladstone MJ, Schmidt E. Estimated prevalence of disability and developmental delay among preschool children in rural Malawi: Findings from "Tikule Limodzi," a cross-sectional survey. Child Care Health Dev 2020; 46:187-194. [PMID: 31925814 PMCID: PMC7027747 DOI: 10.1111/cch.12741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/05/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Early childhood development (ECD) is a critical stage in children's lives, influencing future development and social integration. ECD research among children with disability and developmental delay in low- and middle-income countries is limited but crucial to inform planning and delivery of inclusive services. This study is the first to measure and compare the prevalence of disability and developmental delay among children attending preschool centres in rural Malawi. METHODS A cross-sectional survey was conducted in 48 preschool centres in Thyolo district, Malawi. Data were collected from parents or guardians of 20 children per centre. Disability was ascertained using the Washington Group/UNICEF Child Functioning Module. Child development was measured using the language and social domains of the Malawi Development Assessment Tool. RESULTS A total of 960 children were enrolled; 935 (97.4%) children were assessed for disability and 933 (97.2%) for developmental delay; 100 (10.7%) children were identified as having a disability. The prevalence of disability was higher among children 5+ years (n = 60; 29.3%) than children 2-4 years (n = 40; 5.5%); 109 of 933 (11.7%) children were classified as having developmental delay, 41 (4.4%) in "language" and 77 (8·3%) in "social" domains. CONCLUSIONS This study found that disability and developmental delays are common among preschool children in Malawi. It is one of the first to measure disability and delay among children in a preschool setting in Africa.
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Affiliation(s)
| | - Emma Jolley
- Health and Disability ResearchSightsaversChippenhamUK
| | - Paul Lynch
- Vision Impairment Centre for Teaching and ResearchUniversity of BirminghamUK
| | | | | | | | | | - Elena Schmidt
- Strategic Programme Innovation, Development and Research, Sightsavers, ChippenhamUK
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Woolfenden S, Milner K, Tora K, Naulumatua K, Mataika R, Smith F, Lingam R, Kado J, Tuibeqa I. Strengthening Health Systems to Support Children with Neurodevelopmental Disabilities in Fiji-A Commentary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030972. [PMID: 32033233 PMCID: PMC7037281 DOI: 10.3390/ijerph17030972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/17/2020] [Accepted: 01/31/2020] [Indexed: 12/27/2022]
Abstract
Supporting children with neurodevelopmental disabilities (NDDs) is recognized as an increasing priority in Fiji, a middle-income Pacific Island country. Our objective was to describe our approach to developing a model of care and strengthening local leadership in developmental paediatrics in Fiji to ensure high-quality identification, assessment and management of children with NDDs. Paediatric staff at Colonial War Memorial (CWM) Hospital in Suva have worked in partnership with Australian paediatricians to develop the model of care. The platform of continuing medical education during biannual 3 to 4 days of clinic-based teaching with visiting developmental paediatricians from Australia has been used. Since 2010, there have been 15 local and regional paediatric trainees trained. Since 2015, our two local lead paediatric trainees have run a weekly local developmental clinic. In total, 370 children aged 0 to 18 with NDDs have been comprehensively assessed with a detailed history and standardised tools. The model is extending to two divisional hospitals. Research engagement with the team is resulting in the development of a local evidence base. Local, regional and international leadership and collaboration has resulted in increased capacity in the Fijian health system to support children with NDDs.
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Affiliation(s)
- Sue Woolfenden
- Population Child Health Group, University of New South Wales, Sydney 2031, Australia;
- Department of Community Child Health, Sydney Children’s Hospital Network, Sydney 2031, Australia
- Correspondence:
| | - Kate Milner
- Neurodevelopment & Disability, Royal Children’s Hospital, Melbourne 3052, Australia;
- Neurodisability & Rehabilitation Research & Melbourne Children’s Global Health, Murdoch Children’s Research Institute, Melbourne 3052, Australia
| | - Kali Tora
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
| | - Kelera Naulumatua
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
| | - Reapi Mataika
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
| | - Fleur Smith
- Nossal Institute for Global Health, University of Melbourne, Melbourne 3000, Australia;
| | - Raghu Lingam
- Population Child Health Group, University of New South Wales, Sydney 2031, Australia;
- Department of Community Child Health, Sydney Children’s Hospital Network, Sydney 2031, Australia
| | - Joseph Kado
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
- Telethon Kids Institute, Perth 6009, Australia
| | - Ilisapeci Tuibeqa
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji; (K.T.); (K.N.); (R.M.); (J.K.); (I.T.)
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Bufteac EG, Andersen GL, Spinei L, Jahnsen RB. Early intervention and follow-up programs among children with cerebral palsy in Moldova: potential impact on impairments? BMC Pediatr 2020; 20:29. [PMID: 31969109 PMCID: PMC6975064 DOI: 10.1186/s12887-020-1931-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 01/16/2020] [Indexed: 11/21/2022] Open
Abstract
AIM To study whether early intervention services (EI) and a follow-up program (FU) influence outcomes of children with cerebral palsy (CP) in Moldova. METHODS Records from 351 children with CP in Moldova born during 2009 and 2010 were retrieved from hospital and orphanage archives between 1 July 2016 and 30 September 2017. We investigated the proportion enrolled in EI and FU at the Early Intervention Centre Voinicel and at the Institute of Mother and Child in 2009-2012. Logistic regression analyses were applied to calculate crude and adjusted odds ratios (OR) with 95% confidence intervals (CI) for outcomes in children enrolled and not enrolled. RESULTS Among all children with CP, 166 (47%) were enrolled in EI and FU. Of the 51 children born extremely preterm (gestational age ≤ 31 weeks), 46 (90%) were enrolled, compared to 97 (39%) of the 250 children born at term. Among 110 non-walking children with CP, 82 (74%) were enrolled into EI and FU, compared to 84 (35%) of 241 able to walk. There was no difference in outcomes of cognition, communication, vision and hearing impairments between those enrolled or not enrolled in EI and FU. However, the subgroup analyses showed that the risk of contractures was 11 times higher among non-walking children who were not enrolled in EI and FU programs (OR = 10.931, 95% CI 2.328-51.328, p = 0.002). CONCLUSION In Moldova, EI and FU seem to be offered mostly to extremely preterm and non-walking children with CP. The results indicate a decreased risk for contractures in these children.
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Affiliation(s)
- Ecaterina Gincota Bufteac
- CEI Voinicel - Center of Early Intervention Voinicel, Chisinau, Moldova
- Oslo Metropolitan University, Oslo, Norway
| | - Guro L. Andersen
- Cerebral Palsy Registry of Norway, Vestfold Hospital Trust, Tonsberg, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Larisa Spinei
- State University of Medicine and Pharmacy Nicolae Testimitanu, Chisinau, Moldova
| | - Reidun Birgitta Jahnsen
- Oslo University Hospital and University of Oslo, Institute of Health and Society, CHARM, Oslo, Norway
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Chando S, Craig JC, Burgess L, Sherriff S, Purcell A, Gunasekera H, Banks S, Smith N, Banks E, Woolfenden S. Developmental risk among Aboriginal children living in urban areas in Australia: the Study of Environment on Aboriginal Resilience and Child Health (SEARCH). BMC Pediatr 2020; 20:13. [PMID: 31931753 PMCID: PMC6956483 DOI: 10.1186/s12887-019-1902-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/23/2019] [Indexed: 12/05/2022] Open
Abstract
Background Most Australian Aboriginal children are on track with their development, however, the prevalence of children at risk of or with a developmental or behavioural problem is higher than in other children. Aboriginal child development data mostly comes from remote communities, whereas most Aboriginal children live in urban settings. We quantified the proportion of participating children at moderate and high developmental risk as identified by caregivers’ concerns, and determined the factors associated with developmental risk among urban Aboriginal communities. Methods Study methods were co-designed and implemented with four participating urban Aboriginal Community Controlled Health Services in New South Wales, Australia, between 2008 and 2012. Caregiver-reported data on children < 8 years old enrolled in a longitudinal cohort study (Study of Environment on Aboriginal Resilience and Child Health: SEARCH) were collected by interview. The Parents’ Evaluation of Developmental Status (PEDS) was used to assess developmental risk through report of caregiver concerns. Odds ratios (OR) were calculated using multinomial logistic regression to investigate risk factors and develop a risk prediction model. Results Of 725 children in SEARCH with PEDS data (69% of eligible), 405 (56%) were male, and 336 (46%) were aged between 4.5 and 8 years. Using PEDS, 32% were at high, 28% moderate, and 40% low/no developmental risk. Compared with low/no risk, factors associated with high developmental risk in a mutually-adjusted model, with additional adjustment for study site, were male sex (OR 2.42, 95% confidence intervals 1.62–3.61), being older (4.5 to < 8 years versus < 3 years old, 3.80, 2.21–6.54), prior history of ear infection (1.95, 1.21–3.15), having lived in 4 or more houses versus one house (4.13, 2.04–8.35), foster care versus living with a parent (5.45, 2.32–12.78), and having a caregiver with psychological distress (2.40, 1.37–4.20). Conclusion In SEARCH, 40% of urban Aboriginal children younger than 8 years were at no or low developmental risk. Several factors associated with higher developmental risk were modifiable. Aboriginal community-driven programs to improve detection of developmental problems and facilitate early intervention are needed.
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Affiliation(s)
| | - Jonathan C Craig
- University of Sydney, Sydney, Australia.,Flinders University, Adelaide, Australia
| | - Leonie Burgess
- Sax Institute, Sydney, Australia.,Australian National University, Canberra, Australia
| | - Simone Sherriff
- University of Sydney, Sydney, Australia.,Sax Institute, Sydney, Australia
| | | | - Hasantha Gunasekera
- University of Sydney, Sydney, Australia.,Sydney Children's Hospitals Network, Sydney, Australia
| | - Sandra Banks
- Tharawal Aboriginal Medical Service, Campbelltown, Australia
| | - Natalie Smith
- Riverina Medical and Dental Corporation, Wagga Wagga, Australia
| | - Emily Banks
- Australian National University, Canberra, Australia
| | - Sue Woolfenden
- Sydney Children's Hospitals Network, Sydney, Australia. .,University of New South Wales, School of Women and Children's Health, Sydney, Australia.
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Scior K, Hamid A, Hastings R, Werner S, Belton C, Laniyan A, Patel M, Kett M. Intellectual disability stigma and initiatives to challenge it and promote inclusion around the globe. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang LJ, Hsieh HY, Chen LY, Ko KL, Liu HH, Chou WJ, Chou MC, Tsai CS. Adjunctive sensory integration therapy for children with developmental disabilities in a family-based early intervention program. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_26_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Raffa L, Algethami M. Health literacy and attitudes of caregivers of intellectually disabled children towards eye care. SAUDI JOURNAL FOR HEALTH SCIENCES 2020. [DOI: 10.4103/sjhs.sjhs_215_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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50
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Villagomez AN, Muñoz FM, Peterson RL, Colbert AM, Gladstone M, MacDonald B, Wilson R, Fairlie L, Gerner GJ, Patterson J, Boghossian NS, Burton VJ, Cortés M, Katikaneni LD, Larson JCG, Angulo AS, Joshi J, Nesin M, Padula MA, Kochhar S, Connery AK. Neurodevelopmental delay: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2019; 37:7623-7641. [PMID: 31783983 PMCID: PMC6899448 DOI: 10.1016/j.vaccine.2019.05.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Adrienne N Villagomez
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Flor M Muñoz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Robin L Peterson
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Alison M Colbert
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Rebecca Wilson
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Gwendolyn J Gerner
- Kennedy Krieger Institute, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jackie Patterson
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Vera Joanna Burton
- Kennedy Krieger Institute, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Jennifer C G Larson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Abigail S Angulo
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Jyoti Joshi
- Center for Disease Dynamics Economics & Policy, Amity Institute of Public Health, Amity University, India
| | - Mirjana Nesin
- Division of Microbiology and Infectious Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Padula
- Children's Hospital of Philadelphia, Department of Pediatrics, Philadelphia, PA, USA
| | - Sonali Kochhar
- Global Healthcare Consulting, India; University of Washington, Seattle, USA; Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Amy K Connery
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA.
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