Screening challenges

The importance of fixing developmental issues early

June 24, 2018 12:10 am | Updated 12:10 am IST

Little child with mother at pediatrician reception. Physical exam cute infant portrait baby aid healthy lifestyle ward round child sickness clinic test high quality and trust concept

Little child with mother at pediatrician reception. Physical exam cute infant portrait baby aid healthy lifestyle ward round child sickness clinic test high quality and trust concept

A developmental disability is a condition that has an impact on the daily life of an individual owing to a physical or mental impairment. It starts during the early years of life. The impact is lifelong. Approximately 15% of children have disabilities that include intellectual impairment, autism, cerebral palsy and learning disabilities. These are apparent even in infancy but many parents choose to wait and watch or may not even be aware of the delay or difference in development.

Developmental screening, a brief test, will provide information on whether the child is acquiring skills at age-appropriate rates. Children who do not meet age-appropriate milestones can then be referred for an in-depth assessment to determine the nature and extent of the developmental delay. Developmental screening is important to ensure that parents seek early action.

India is now a sought-after destination for medical tourism, but in the area of early screening and intervention it is still lagging behind, and early developmental screening is more the exception than the rule. Paediatric clinics and pre-schools, the first point of contact for children beyond their family unit, rarely take up screening in a formal way. It’s not uncommon for doctors in busy clinics to brush aside maternal concerns about development or even suggest they wait. A few who do take the parental concern seriously, refer them out rather than carry out a screening themselves, leading to loss of time. Developmental paediatricians who are trained to carry out screening are few in India. In their absence, psychologists or psychiatrists are relied upon. But, given the stigma attached to these fields many parents hesitate to approach them.

The pre-school stage

Another frequent point of contact for a young child is pre-school. These schools should equip themselves to correctly identify developmental delays. Empathetic counselling will then ensure that the parent seeks timely help. In the days of Google it is not hard to find early screening tools which will give us a clear picture on the child’s development. There are also paid sites which will generate reports with suggestions that the schools could use to help the parents. Once early screening is done, developmental concerns can be addressed by a more qualified professional.

Alternatively, the child could also be referred to an early intervention centre to focus on intervention rather than labelling the child.

One of the reasons that pre-schools avoid broaching the subject with the parent is the stigma. They fear upsetting the parent and would rather brush aside the problem. Some pre-school teachers are not aware that developmental difficulties can be identified before the age of three. Delays/differences can easily by identified by a skilled practitioner as early as 15 months for some disorders and even earlier for others.

Early intervention can help address the difficulties the child is facing and is specific to the nature of the difficulty. The earlier we take action to prevent the effect of developmental difficulties, the better are the chances of optimum development. It will enable the brain to “repair faulty connections”.

These services may be provided by developmental psychologists, special educators, physiotherapists, occupational therapists or speech therapists. Early intervention will minimise the difficulties faced by the child due to the developmental delays.

The early years are critical to the development of language and communication. Children who do not get the necessary services to enable language development on time tend to develop behavioural issues, which hamper later development. It is the child’s best hope for the future.

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