Child Development Services –where do we belong?

Boaz Porter

United StatesThe prevalence of cerebral palsy is approximately 1.5-2 cases per 1000 live births. The incidence of cerebral palsy has not changed in more than 4 decades, despite significant advances in the medical care of neonates.

InternationalThe prevalence of cerebral palsy is approximately 1.5-2 cases per 1000 live births.

Mortality/MorbidityCerebral palsy is the leading cause of childhood disability affecting function and development

Prevalence of Cerebral Palsy

Prevalence of Intellectual Deficiency

United States• The frequency of MR/ID of all degrees ranges from 1-3%

of the population. The statistical definition of subaverage intelligence (2 SDs below the mean) would indicate a predicted prevalence of 2.5%.

International• A study with excellent ascertainment conducted in

Aberdeen, Scotland, yielded a prevalence of 1 in 300 for severe MR and 1 in 77 for mild MR.

Autistic Spectrum

• US and Canada: 1% (Lazoff et al 2011)

• South Korea: 2.6% (Kim et al 2011)

• Israel 0.5% (Davidovitch et al 2012)

The Common vs The Uncommon

Learning Disability

Approximately 10% of children have some learning impairment, while as many as 3% manifest some degree of MR/ID. The population prevalence of these combined disorders of learning rivals that of the common childhood disorder asthma.

Developmental Coordination Disorder

Prevalence of Developmental Coordination Disorder has been estimated to be as high as 6% for children in the age range of 5 -11 years.

Prevalence of Language Disorders

• Beitchman, Nair, Clegg, and Patel (1986) found a prevalence of

12.6% for language disorders, using a definition that did not exclude other developmental disabilities or require nonverbal intelligence within the normal range.

• Tomblin et al. (1997) reported a prevalence of 7.4% for specific language disorders

• For 6- and 7-year-old children, Law et al. (2000) noted median prevalence estimates of 5.5% and 3.1%, respectively.

Expressive Language Disorder

Prevalence of expressive language disorder in young children 18 to 39 months of age:

13.5% at 18 to 23 months,

15% at 24 to 29 months

18% at 30-39 months.

(Horwitz et al, 2003)

Developmental-Behavioral Pediatrics

An estimated 9 to 13% of American children and adolescents between ages nine to 17 have serious diagnosable emotional or behavioral health disorders resulting in substantial to extreme impairment.

(Friedman, 2002 )

Campbell )1995( estimated that approximately 10-15% of all typically developing preschool children have chronic mild to moderate levels of behavior problems.

Children who are poor are much more likely to develop behavior problems with prevalence rates that approach 30% )Qi & Kaiser, 2003(.

Children who are identified as hard to manage at ages 3 and 4 have a high probability (50:50) of continuing to have difficulties into adolescence (Campbell & Ewing, 1990; Campbell, 1997; Egeland et al., 1990).).

No time to lose.……

Vocabulary growth - first 3 yearsVocabulary

Age - Months

1200

600

012 16 20 24 28 32 36

High SES

Middle SES

Low SES

-Hart & Risley 1995

Rates of return to human development: Investment across all ages

6

8

4

2

0

Return per $

invested

Age

R

6

Pre-school School Post school

Pre-school programs

School

Job training

18

-Carneiro & Heckman, Human Capital Policy, 2003

Need to think “Outside the Box”

I Have a Dream.…

• Training pediatricians and workforce re common developmental/behavioral problems

• Group vs Solo Practice• Parent involvement • Family centered practice • The “Pediatric Home”• Relationships with community

providers (education, welfare)• Continuity between providers

Organizational Change of Child Development Services

• Primary care: Initial evaluation of behavioral/developmental problems: manages common issues e.g. crying, sleep issues in infants

• Secondary care level community pediatrician: Manages mild speech delay, DCD, ADHD, common behavior problems

• CDC – manages more serious developmental spectrum

Changes within CDCCan we be more cost-efficient?

• Staff: All therapists should be

trained to advise re common problems

• Patients: increase group interventions for DCD, speech and behavioral problems

• Parents: include them as part of therapeutic team,volunteers

A Pediatric Home

Where is the “Pediatric Home?”

• Primary care pediatrician- according to ability and time

• Secondary Care: most of the common lower severity problems

• Tertiary Care center: for complicated problems with ongoing need for followup tests and treatment