A Multidisciplinary Approach to the Assessment and Management of Pre-school Age Neuro-developmental Disorders: A Local Experience
Main Article Content
Abstract
Background: Early and effective identification of childhood neurodevelopmental disorders remains a critical task of all pediatric healthcare professionals, which is critical to the well-being of children and their families.
Methods: A retrospective review of medical records of all preschool children referred to a Child Development Centre (CDC) in North-West England, over a six-month period between Sept 2014 and Feb 2015 was conducted. The local multi-professional approach to the clinical assessment and management of preschool children was described and the published literature on this topic was reviewed.
Results: Twenty four different categories of professionals spanning the whole range of primary, secondary, and tertiary healthcare, social care and educational services were involved in the management of the patients. The largest group of professionals was the primary healthcare specialists. The ten different primary care professionals managed an average of 42% of the patients.
The secondary healthcare providers were involved in the care of an average of 17%, tertiary care providers 10%, educational specialists 25% and social care professionals were involved with 5% of all the patients.
The commonest diagnostic disorders were Speech/Language delay (56%), Global developmental delay (33%), Behavior difficulties (26%), Social communication concerns (21%) and Autistic spectrum disorder (19%).
Conclusion: The high number and specialties of various healthcare professionals at all levels of care indicates the high social and economic investment required in managing the affected preschool children in the region. Childhood neurodevelopmental disorders in the preschool age represents a high level of public health significance.
Article Details
Copyright (c) 2017 Ogundele

This work is licensed under a Creative Commons Attribution 4.0 International License.
Glascoe FP. Early detection of developmental and behavioral problems. Pediatr Rev. 2000; 21: 272-279. Ref.: https://goo.gl/PYsOjY
Demirci A, Kartal M. The prevalence of developmental delay among children aged 3-60 months in Izmir, Turkey. Child Care Health Dev. 2015; 42: 213-219. Ref.: https://goo.gl/IGcxg6
Bennett FC, Guralnick MJ. Effectiveness of developmental intervention in the first five years of life. Pediatr Clin North Am. 1991; 38: 1513-1528. Ref.: https://goo.gl/6xiqNE
Shonkoff JP, Phillips DA. From Neurons to Neighborhoods: The Science of Early Childhood Development. National Research Council and Institute of Medicine. Washington, DC: National Academy Press. 2000; Ref.: https://goo.gl/SrSmaH
Regalado M, Halfon N. Primary care services promoting optimal child development from birth to age 3 years: review of the literature. Arch Pediatr Adolesc Med. 2001; 155: 1311-1322. Ref.: https://goo.gl/PDTwIe
Council on Children with Disabilities: Section on Developmental Behavioral Pediatrics. Bright Futures Steering Committee and Medical Home Initiatives for Children with Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home. Pediatrics. 2006; 118: 405-420.Ref.: https://goo.gl/DJgWWy
Wang PJ, Morgan GA, Hwang AW, Chen LC, Liao HF. Do maternal interactive behaviors correlate with developmental outcomes and mastery motivation in toddlers with and without motor delay? Phys Ther. 2014; 94: 1744-1754. Ref.: https://goo.gl/VeVoYZ
Department of Health (UK). 2009; Healthy Child Programme – Pregnancy and the first five years. Crown Copyright License. 2009; Ref.: https://bit.ly/2FSCiih
Smith L, Strümpher J, Morton DG. Perceptions of mental healthcare professionals regarding inpatient therapy programmes for adolescents in the Eastern Cape, South Africa. J Child Adolesc Ment Health. 2015; 27: 59-73. Ref.: https://goo.gl/r0y1rV
Choy YS, Bhattacharya K, Balasubramaniam S, Fietz M, Fu A, et al. Identifying the need for a multidisciplinary approach for early recognition of mucopolysaccharidosis VI (MPS VI). Mol Genet Metab. 2015; 115: 41-47. Ref.: https://goo.gl/hFIUV4
Woolfenden S, Short K, Blackmore R, Pennock R, Moore M. How do primary health-care practitioners identify and manage communication impairments in preschool children? Aust J Prim Health. 2015; 21: 176-181. Ref.: https://goo.gl/pu57vh
Tirosh E, Jaffe M. Global developmental delay and mental retardation--a pediatric perspective. Dev Disabil Res Rev. 2011; 17: 85-92. Ref.: https://goo.gl/fnzh9q
McDowell M. Neurodevelopmental and behavioural paediatrics. J Paediatr Child Health. 2015; 51: 113-117. Ref.: https://goo.gl/4EevJ5
Witton C. Childhood auditory processing disorder as a developmental disorder: the case for a multi-professional approach to diagnosis and management. Int J Audiol. 2010; 49: 83-87. Ref.: https://goo.gl/3sztfm
Lynch BA, Weaver AL, Starr SR, Ytterberg KL, Rostad PV, et al. Developmental Screening and Follow-up by Nurses. MCN Am J Matern Child Nurs. 2015; 40: 388-393. Ref.: https://goo.gl/yOfkRf
Nair MK, Lakshmi MA, Latha S, Lakshmi G, Harikumaran Nair GS, et al. CDC Kerala 15: Developmental Evaluation Clinic (2-10 yr.)-developmental diagnosis and use of home intervention package. Indian J Pediatr. 2014; 81: 142-150. Ref.: https://goo.gl/OiBUF7
Tsai JT, Kuo HT, Chou IC, Tsai MY, Tsai CH. A clinical analysis of children with developmental delay. Acta Paediatr Taiwan. 2005; 46: 192-195. Ref.: https://goo.gl/SRjpOU
Shevell M, Majnemer A, Rosenbaum P, Abrahamowicz M. Profile of referrals for early childhood developmental delay to ambulatory subspecialty clinics. J Child Neurol. 2001a; 16: 645-650. Ref.: https://goo.gl/szojXa
Lawrence R, Bateman N. 12 minute consultation: An evidence-based approach to the management of a child with speech and language delay. Clin Otolaryngol. 2013; 38: 148-153. Ref.: https://goo.gl/QEW74n
Chin RY, Moran T, Fenton JE. The otological manifestations associated with autistic spectrum disorders. Int J Pediatr Otorhinolaryngol. 2013; 77: 629-634. Ref.: https://goo.gl/m32Un0
Craig F, Lamanna AL, Margari F, Matera E, Simone M, et al. Overlap between Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder: Searching for Distinctive/Common Clinical Features. Autism Res. 2015; 8: 328-337. Ref.: https://goo.gl/j6okKR
Andersson GW, Miniscalco C, Gillberg C. Preschoolers assessed for autism: parent and teacher experiences of the diagnostic process. Res Dev Disabil. 2014; 35: 3392-3402. Ref.: https://goo.gl/9HBnbn
Orinstein AJ, Helt M, Troyb E, Tyson KE, Barton ML, et al. Intervention for optimal outcome in children and adolescents with a history of autism. J Dev Behav Pediatr. 2014; 35: 247-256. Ref.: https://goo.gl/Onn1UL
Moilanen I, Mattila ML, Loukusa S, Kielinen M. [Autism spectrum disorders in children and adolescents]. Duodecim. 2012; 128: 1453-62. Ref.: https://goo.gl/wJD5w5
Dykens EM, Fisher MH, Taylor JL, Lambert W, Miodrag N. Reducing distress in mothers of children with autism and other disabilities: a randomized trial. Pediatrics. 2014; 134: 454-463. Ref.: https://goo.gl/gHUPg6
Singh z AK, Kumar R, Mishra CK, Khera A, Srivastava A. Moving from Survival to Healthy Survival through Child Health Screening and Early Intervention Services Under Rashtriya Bal Swasthya Karyakram (RBSK). Indian J Pediatr. 2015; 82: 1012-1018. Ref.: https://goo.gl/KofNwf
Abrahamsson A, Samarasinghe K. Open pre-schools at integrated health services-A program theory. Int J Integr Care. 2013; 13: Ref.: https://goo.gl/yMFTQF
Lagström H, Rautava P, Kaljonen A, Räihä H, Pihlaja P, et al. Cohort profile: Steps to the healthy development and well-being of children (the STEPS Study). Int J Epidemiol. 2013; 42: 1273-1284. Ref.: https://goo.gl/qrnjCI
Department of Health. Improving Chronic Disease Management. 2004.
Stuart K. Leading multi-professional teams in the children's workforce: an action research project. Int J Integr Care. 2012; 12: Ref.: https://goo.gl/urxqGt
Rosenberg RE, Ardalan K, Wong W, Patel S, Gold-von Simson G, et al. Postoperative spinal fusion care in pediatric patients: Co-management decreases length of stay. Bull Hosp Jt Dis. (2013). 2014; 72: 197-203. Ref.: https://goo.gl/XOyKTb
Wainwright MS, Grimason M, Goldstein J. Smith CM, Amlie-Lefond C, et al. Building a pediatric neurocritical care program: a multidisciplinary approach to clinical practice and education from the intensive care unit to the outpatient clinic. Semin Pediatr Neurol. 2014; 21: 248-254. Ref.: https://goo.gl/y8hmCp
Vowinkel T, Laukoetter M, Mennigen R, Hahnenkamp K, Gottschalk A, et al. A two-step multidisciplinary approach to treat recurrent esophageal strictures in children with epidermolysis bullosa dystrophica. Endoscopy. 2015; 47: 541-544. Ref.: https://goo.gl/NE8vlW
Fuengfoo A, Sakulnoom K. Clinical abnormalities, early intervention program of Down syndrome children: Queen Sirikit National Institute of Child Health experience. J Med Assoc Thai. 2014; 97: 152-158. Ref.: https://goo.gl/BozFkR
Bell A, Corfield M, Davies J, Richardson N. Collaborative Trans disciplinary intervention in early years - putting theory into practice. Child Care Health Dev. 2010; 36: 142-148. Ref.: https://goo.gl/MMmn1X
Oosterling IJ, Wensing M, Swinkels SH, van der Gaag RJ, Visser JC, et al. advancing early detection of autism spectrum disorder by applying an integrated two-stage screening approach. J Child Psychol Psychiatry. 2010; 51: 250-258. Ref.: https://goo.gl/4uaOM2
Charman T, Baird G. Practitioner review: Diagnosis of autism spectrum disorder in 2- and 3-year-old children. J Child Psychol Psychiatry. 2002; 43: 289-305. Ref.: https://goo.gl/fpONZD
Bent CA, Dissanayake C, Barbaro J. Mapping the diagnosis of autism spectrum disorders in children aged under 7 years in Australia.2010-2012, Med J Aust. 2015; 202: 317-320. Ref.: https://goo.gl/Pt1Bj2
Shevell M, Ashwal S, Donley D, Flint J, Gingold M, et al. Practice parameter. Evaluation of the child with global developmental delay. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2003; 60: 367-380. Ref.: https://goo.gl/7evlXm
Bailey DB Jr, Skinner D, Sparkman KL. Discovering fragile X syndrome: family experiences and perceptions. Pediatrics. 2003; 111: 407-416. Ref.: https://goo.gl/7qSTQ9
Shevell MI, Majnemer A, Rosenbaum P, Abrahamowicz M. Etiologic determination of childhood developmental delay. Brain Dev. 2001b; 23: 228-235. Ref.: https://goo.gl/aFB8qw
Guinchat V, Cravero C, Diaz L, Périsse D, Xavier J, et al. Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD): recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement. Res Dev Disabil. 2015; 38: 242-255. Ref.: https://goo.gl/n09UBf
Parry TS. Assessment of developmental learning and behavioural problems in children and young people. Med J Aust. 2005; 183: 43-48. Ref.: https://goo.gl/n5zB8a
Fernell E, Norrelgen F, Bozkurt I, Hellberg G, Löwing K. Developmental profiles and auditory perception in 25 children attending special preschools for language-impaired children. Acta Paediatr. 2002; 91: 1108-1115. Ref.: https://goo.gl/0QDBKY
Trabacca A, Vespino T, Di Liddo A, Russo L. Multidisciplinary rehabilitation for patients with cerebral palsy: improving long-term care. J Multidiscip Healthc. 2016; 9: 455-462. Ref.: https://goo.gl/ZvTBLQ
Bakheit AM, Bower E, Cosgrove A, Fox M, Morton R, et al. Opinion statement on the minimal acceptable standards of healthcare in cerebral palsy. Disabil Rehabil. 2001; 23: 578-582. Ref.: https://goo.gl/h0jZiF
Fitzgerald A, Bailey M, Smith AC, Webb K, Keating D, et al. Child development services: a multidisciplinary approach to professional education via videoconference. J Telemed Telecare. 2002; 8: 19-21. Ref.: https://goo.gl/V5NWTT
Chan DS, Callahan CW, Moreno C. Multidisciplinary education and management program for children with asthma. Am J Health Syst Pharm. 2001; 58: 1413-1417. Ref.: https://goo.gl/nSxRSS
O'Shea TM, Nageswaran S, Hiatt DC, Legault C, Moore ML, et al. Follow-up care for infants with chronic lung disease: a randomized comparison of community- and center-based models. Pediatrics. 2007; 119: 947-957. Ref.: https://goo.gl/jrVFiH
Iannaccone ST. Modern management of spinal muscular atrophy. J Child Neurol. 2007; 22: 974-978. Ref.: https://goo.gl/GyTfnC
Acerini CL, Tasker RC. Traumatic brain injury induced hypothalamic-pituitary dysfunction: a paediatric perspective. Pituitary. 2007; 10: 373-380. Ref.: https://goo.gl/uiNLXl
Goldstein J, Plioplys S, Zelko F, Mass S, Corns C, et al. Multidisciplinary approach to childhood epilepsy: exploring the scientific rationale and practical aspects of implementation. J Child Neurol. 2004; 19: 362-378. Ref.: https://goo.gl/oqDK07
Kelishadi R, Azizi-Soleiman F. Controlling childhood obesity. A systematic review on strategies and challenges. J Res Med Sci. 2014; 19: 993-1008. Ref: https://goo.gl/w5nP8t
Sothern M, Udall JN Jr, Suskind RM, Vargas A, Blecker U. Weight loss and growth velocity in obese children after very low calorie diet, exercise and behavior modification. Acta Paediatr. 2000; 89: 1036-1043. Ref.: https://goo.gl/dr6Tm1
Mc Donagh JE, Kelly DA. Transitioning care of the pediatric recipient to adult caregivers. Pediatr Clin North Am. 2003; 50: 1561-1583. Ref.: https://goo.gl/7wp4Fa
Guy J, Persaud J, Davies E, Harvey D. Drug errors. what role do nurses and pharmacists have in minimizing the risk? J Child Health Care. 2003; 7: 277-290. Ref.: https://goo.gl/fmxd86
Giancotti A, Romanini G, Docimo R, Arcuri C. Clinical treatment of oral manifestations of Beckwith-Wiedeman syndrome in a child. J Clin Pediatr Dent. 2003; 27: 377-380. Ref.: https://goo.gl/ythBKq
Petrini P. Treatment strategies in children with hemophilia. Paediatr Drugs. 2002; 4: 427-437. Ref.: https://goo.gl/3VfQpK
Ebeling H, Tapanainen P, Joutsenoja A, Koskinen M, Morin-Papunen L, et al. A practice guideline for treatment of eating disorders in children and adolescents. Ann Med. 2003; 35: 488-501. Ref.: https://goo.gl/W5lRMe
Baker SR, Owens J, Stern M, Willmot D. Coping strategies and social support in the family impact of cleft lip and palate and parents' adjustment and psychological distress. Cleft Palate Craniofac J. 2009; 46: 229-236. Ref.: https://goo.gl/kA40sk
Webb AA, Watts R, Read-Ward E, Hodgkins J, Markus AF. Audit of a multidisciplinary approach to the care of children with unilateral and bilateral cleft lip and palate. Br J Oral Maxillofac Surg. 2001; 39: 182-188. Ref.: https://goo.gl/JdQL8d
Fishman G, Fliss DM, Benjamin S, Margalit N, Gil Z, et al. Multidisciplinary surgical approach for cerebrospinal fluid leak in children with complex head trauma. Childs Nerve Syst. 2009; 25: 915-923. Ref.: https://goo.gl/TZUm8M
Van Kuyk EM, Brugman-Boezeman AT, Wissink-Essink M, Severijnen RS, Festen C, et al. Defecation problems in children with Hirschsprung's disease: a bio psychosocial approach. Pediatr Surg Int. 2000; 16: 312-316. Ref.: https://goo.gl/0sGxAR
Bloemen MA, Verschuren O , van Mechelen C, Borst HE, de Leeuw AJ, et al. Personal and environmental factors to consider when aiming to improve participation in physical activity in children with Spina Bifida: a qualitative study. BMC Neurol. 2015; 15: 11. Ref.: https://goo.gl/LXUhdX
Marini D, Agnoletti G. Interventional treatment of congenital heart disease patients. Minerva Cardioangiol. 2010; 58: 79-96. Ref.: https://goo.gl/OY3lt0
Rubin JJ. Psychosomatic pain. New insights and management strategies. South Med J. 2005; 98: 1099-1110. Ref.: https://goo.gl/MwwZoL
Anthony KK, Schanberg LE. Juvenile primary fibromyalgia syndrome. Curr Rheumatol Rep. 2001; 3: 165-171. Ref.: https://goo.gl/QklRe2
Sharma ST, Nieman LK, Feelders RA. Cushing's syndrome. Epidemiology and developments in disease management. Clin Epidemiol. 2015; 7: 281-293. Ref.: https://goo.gl/ds8Ce1
Department for Children School and families (DCSF) Leading and managing children’s services in England a national professional development framework. London: DCSF; 2008.