Developmental surveillance of young children in clinical settings: Time to step out or step up?

A 9-year retrospective cohort study of the monitoring and screening of childhood developmental delay in Thailand

BACKGROUND

Developmental delay in early childhood can have negative long-term cognitive and psychiatric sequelae, along with poor academic achievement, so early screening and surveillance are paramount. The aim of this study is to evaluate the impact of screening and surveillance on child developmental delay using the Developmental Surveillance and Promotion Manual (DSPM) and the Thai Early Developmental Assessment for Intervention (TEDA4I) for Thai children aged 0-5 years old.

METHODS

Data were obtained from the routine developmental screening for specific disorders at ages 9, 18, 30, 42 and 60 months conducted using DSPM and TEDA4I from 2013 to 2021. Descriptive statistics were used to analyse the data, and the results are visualised graphically herein.

RESULTS

Only 56% of the children were screened for child developmental delay using DSPM. The proportion of children screened increased from <1% in 2013 to 90% in 2021. Suspected developmental delay prevalence increased significantly from 3.91% in 2013-2015 to 10.00% in 2016-2018 and 26.48% in 2019-2021. Moreover, of the children with suspected developmental delay who received developmental stimulation within a month, only 87.9% returned for follow-up visits when they were evaluated again using TEDA4I to ascertain any abnormalities and specific areas of deficit. The overall proportion of children diagnosed with developmental delay was 1.29%. During the pandemic, the proportion of screening tests for child developmental delay at routine vaccination visits and follow-ups decreased but was still at least 80% in each region.

CONCLUSIONS

Since 1%-3% of children have suspected developmental delay, early detection is key to treating it as soon as possible. We anticipate that our findings will raise awareness in parents and caregivers about childhood developmental delay and lead to the implementation of early intervention and follow-up at the rural level in Thailand.

Training packages for the use of child development tools in low/middle-income countries: a review

BACKGROUND

We are now moving beyond the focus of 'child survival' to an era which promotes children thriving and developing rather than simply 'surviving'. In doing so, we are becoming more aware of the large variation of child development screening tools available globally, but in particular, those in low/middle-income countries (LMICs).

METHODS

This narrative review identifies 24 child development tools used in LMICs. We aimed to identify information on training accessibility and training design, assessment methods and cost of training. For those tools with no training information identified or for any tools identified as providing online training, the tool author was contacted individually to obtain information on the features of the tool's training package.

RESULTS

Information on training features was identified for 18 tools. All of the tools are identified as screening tools with some also identified as surveillance or assessment tools. The training material for the majority of the tools was not readily accessible and most training packages were proprietary and only available with a face-to-face training design. Other training options included a user manual, training videos or training through an online platform.

CONCLUSIONS

Training is a key factor when selecting a child development screening or surveillance tool particularly in a low-income or middle-income setting where funds may be limited. The accessibility of training can have a key impact on the implementation and utilisation of tools desperately needed for use in LMICs.

Developing Preschool Language Surveillance Models - Cumulative and Clustering Patterns of Early Life Factors in the Early Language in Victoria Study Cohort

BACKGROUND

Screening and surveillance of development are integral to ensuring effective early identification and intervention strategies for children with vulnerabilities. However, not all developmental skills have reliable screening processes, such as early language ability.

METHOD

We describe how a set of early life factors used in a large, prospective community cohort from Australia are associated with language abilities across the preschool years, and determine if either an accumulation of risk factors or a clustering of risk factors provide a feasible approach to surveillance of language development in preschool children.

RESULTS

There were 1,208 children with a 7-year language outcome. The accumulation of early life factors increased the likelihood of children having low language skills at 7-years. Over a third of children with typical language skills (36.6%) had ≤ two risks and half of the children with low language (50%) had six or more risks. As the number of factors increases the risk of having low language at 7-years increases, for example, children with six or more risks had 17 times greater risk, compared to those with ≤ two risks. Data collected from 1,910 children at 8- to 12-months were used in the latent class modeling. Four profile classes (or groups) were identified. The largest group was developmentally enabled with a supportive home learning environment (56.2%, n = 1,073). The second group was vulnerable, both developmentally and in their home learning environment (31.2%, n = 596); the third group was socially disadvantaged with a vulnerable home learning environment (7.4%, n = 142); the final group featured maternal mental health problems and vulnerable child socio-emotional adjustment (5.2%, n = 99). Compared to developmentally enabled children, the risk of low language at 7-years was greater for children in the three other groups.

CONCLUSION

The cumulative and cluster risk analyses demonstrate the potential to use developmental surveillance to identify children within the first years of life who are at risk of language difficulties. Importantly, parent-child interaction and the home learning environment emerged as a consistent cluster. We recommend they be adopted as the common focus for early intervention and universal language promotion programs.