Early Life Breakthroughs - Advancing Child Development & Behavioral Health in Low- and Middle-Income Countries
Published on in CHOP News
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Published on in CHOP News
By Kate Wallis, MD, MPH
Approximately 15% of children in the United States are estimated to have a developmental or behavioral concern or disorder. These include conditions such as autism spectrum disorder (ASD, estimated to affect about 3% of children), attention-deficit/hyperactivity disorder (ADHD, with a prevalence between 3% and 5%), learning disabilities, cerebral palsy or other motor disorders, developmental and behavioral manifestations of neurologic and genetic conditions, and other behavioral issues and disorders.
Globally, the estimated prevalence of these conditions is thought to be similar to that in the United States. However, difficulties accessing diagnosticians may underestimate the number of children diagnosed. When there is active case-seeking, such as in research studies, it appears that children have similar rates of developmental and behavioral conditions. For example, a recent study found that globally, 52.9 million children younger than 5 years (8.4%) had developmental disabilities.
Developmental and behavioral pediatrics (DBP) is a subspecialty that helps diagnose, support and treat children with these developmental and behavioral difficulties or conditions. It considers the psychosocial contexts within which children learn and develop. Developmental and behavioral pediatricians take a developmental view of children, noting when a child is failing to meet age-expected milestones in any of the streams of development: gross motor (responsible for large movements like crawling or walking), fine motor (for smaller movements like grasping or writing), cognitive, adaptive, social-emotional and communication (including both receptive and expressive language). They can prescribe medications when appropriate and recommend academic and therapeutic supports (such as speech/language, occupational, physical and behavioral therapies). They often work in teams to provide multidisciplinary care.
Internationally, there are a limited number of practicing developmental and behavioral pediatricians. Providers in low- and middle-income countries (LMIC) often have to be creative to meet the needs of children with developmental disabilities. Frontline nurses, nurse practitioners, general practitioner doctors or general pediatricians are frequently called upon to diagnose and manage these conditions and often partner with families to help deliver some of the interventions.
I have had the privilege to meet with and work with DBP colleagues in Botswana, Brazil, India, Mexico, Nepal and Nigeria. They work with children with the same conditions we see in the U.S., including ASD and other developmental disabilities. One notable difference is that in the U.S., disability laws such as the Individuals with Disabilities Education Act (IDEA) ensure that all children have access to a free, appropriate public education. This means that children are entitled to accommodations to ensure they can participate in public school. Similar laws do not always exist in other countries, especially in LMIC, so children may be inadvertently systematically excluded from receiving an education or appropriate therapeutic supports.
Encouragingly, ensuring equal access to education for persons with disabilities is one of the United Nation’s Sustainable Development Goals (SDGs), which means identifying and supporting children with developmental conditions is a global priority. While there is still a long way to go to adequately address children’s developmental and behavioral needs worldwide, a growing network of providers is developing and sharing resources to address this need. I have highlighted a few of these resources below.