Screening for developmental disabilities in developing countries
Highlights
► This study reports on children in 16 developing countries who screened most at-risk in 4 broad domains of child development. ► Overall, the percentages of children who screened positive for at least one disability was 20.4%, range = 3.1–45.2%. ► Variability emerged by disability type, child age, and country, with relations between prevalence and standard of living. ► More language disabilities were reported than motor, more motor than cognitive, and more cognitive than sensory. ► Younger children and countries with lower living standards were more likely to be screened as having some type of impairment.
Introduction
Early childhood is a critical period in ontogeny, and early physical, cognitive, and socioemotional growth constitute foundations of future development. In consequence, disabilities sustained in early childhood can have lasting effects. In this study, we investigate four domains of developmental disabilities in under-researched and underserved populations in developing countries, paying special attention to their distributions by child age.
Section snippets
Developmental disability
The UN Convention on the Rights of Persons with Disabilities (UN CRPD) defines disabilities as “long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder [a person's] full and effective participation in society on an equal basis with others” (United Nations Enable, 2009a, 2009b). Thus, developmental disabilities are impairments to functioning attributable to physical and/or mental delays or deficiencies usually beginning in early life (
Participants
Approximately 172,000 families in 16 developing countries provided data. (Bosnia did not provide data for one cognitive indicator question.) If there was more than one child between the ages of 2 and 9 years in a family, we randomly selected a target child.
The sample used for analyses comprised 101,250 children, approximately equal numbers of girls and boys, averaging 5 years of age (Table 1). For full details for MICS sampling, training, and household selection see Bornstein et al. (2012).
The MICS3 and the TQS
This
Covariates
Table 1 shows descriptive statistics by country for child age and gender. Number of children in the family aged 2–9 was used as a covariate because it varied across country, F(15) = 950.88, p < 0.001, η2p = 0.12, and point-biserial correlations between number of children 2–9 and the disability composites ranged from rpb = −0.005 to 0.061.
Descriptive statistics
Fig. 1 and Table 2 show the proportions of children, overall and by country grouped according to HDI, respectively, who screened positive for the composite
Discussion
Variability emerged by disability type, by child age, and by country in the proportions of mother (or caregiver) reports of cognitive, language, sensory, and motor disabilities and their individual components in children 2–9 years of age in 16 developing counties. Significantly, 1 in 5 children was identified by their primary caregiver to screen positive for a cognitive, language, sensory, or motor disability. Language disability was most prevalent, and sensory least. Younger children were
Causes of developmental disabilities
There are many physical, social, and environmental causes of developmental disabilities. Children residing in developing countries tend to have worse physical health (Grantham-McGregor et al., 2007) that constitutes a risk factor for childhood disabilities (Biritwum, Devres, Ofosu-Amaah, Marfo, & Essah, 2001; Gottlieb, Maenner, Cappa, & Durkin, 2009; McPherson & Swart, 1997). Our cross-national findings augment individual field studies that have been conducted in a number of countries in which
Covariation and consequence of developmental disabilities
One health condition may be related to other coexisting conditions. However, our data suggest possible dissociations among disabilities. In accord with conceptual models that treat disabilities as essentially modular, we found that the likelihood of screening positive for one kind of disability was unrelated or negatively related to the likelihood of screening positive for a second kind. A primary goal of clinical practice is to describe the individual child's developmental needs and determine
Limitations
A disadvantage of the MICS is its cross-sectional design that restricts inferences about direction of effects; however, the multivariate nature of the MICS presents the opportunity to assess associations between specific disabilities and other variables. Disability is also a complex multidimensional construct, whereas the TQS only classifies disabilities nominally, using one set of indicators, and so does not permit nuanced insights into levels of developmental disability. The MICS domains of
Conclusion
Discrete disabilities in children can be reliably measured for purposes of identification and intervention. However, developmental disabilities are also systemic in nature. Society's response should be to remediate disabilities and also forecast and thus prevent or arrest developmental progressions so that they do not lead to more widespread and significant maladaptive outcomes. Interventions need to be oriented toward discrete disabilities as well as any potential developmental cascade
Acknowledgments
We thank D. Breakstone, P. Horn, and C. Padilla. The authors contributed equally to the work, and authorship is alphabetical. This research was supported by the Intramural Research Program of the NIH, NICHD.
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