Multidisciplinary Collaboration in Care for Early Child Development

Transcription

1 Multidisciplinary Collaboration in Care for Early Child Development Fan Jiang Shanghai Children s Medical Center Shanghai Jiaotong University School of Medicine

2 DBP in China 1.History 1999 ~ Premature 1980 ~ 1998 Incubation 1970 Concept formation

3 Establishment In March of 2011, of Committee of Developmental Pediatrics was formally approved by Chinese Academy of Pediatrics.

4 Team The committee members of DBP are pediatricians from over 10 provinces, who have various backgrounds, like developmental and behavioral pediatricians, neurologists, psychologists, psychiatrists, general pediatricians, et al.

5 Pediatricians-Educators Collaboration Program Since 2008, Dr. Shen started to call for a campaign across Shanghai, which invited the Pediatricians to spend half day/week in the schools instead always being in clinics, to consult our parents about child health care strategies. Collaboration was also starting with early identification for developmental and behavioral delay or disorders

6 Collaboration with other AUSP team Implement a program "Mental Health Needs Assessment for the Children in Shanghai". Aim to evaluate child mental health status as well as mental health needs assessment of children across the city. Results are expected to submitted to government and support the government to improve the public awareness and medical service for the parents of children with mental health need.

7 Care for Early Development Program in rural area Starting from this year, we re going to expand this program; In addition, we will train the child health work to use the simple developmental screening tool in the clinic

8 Early Screening for ASD in the Shanghai Community Xu Xiu, MD, PhD Children s Hospital of Fudan University

9 Epidemiology NIH:Incidence of ASDs 1/150 Hong Kong(Virginia Wong 2005): Incidence of ASD age 0-14: 3/1000 WHO estimated: million ASD children in China Epidemiology study in China (2001): Autism is the primary psychiatrical disorder among disabled children aged 0-6

10 Background ASD is a genetic disorder The phenotype of ASD may depend on the environment Experience likely affect the phenotype of ASD Importance of early intervention Early intervention could help most ASD children by ameliorating their clinical phenomenon Some children may be sufficiently cured or improved to be able to live independently Without early intervention and help, these children may become handicapped for life

11 Aim Explore the feasibility of early screening of ASD in the community Design a easy to follow program for screening high risk ASD children in community healthcare centers

12 Subject Subjects:All children aged months, who routinely visit one of four community healthcare centers in Luwan District in Shanghai in Total number: 535 children

13 Methods Selection of the screening scale Checklist for Autism in Toddlers ( CHAT 23 ) Part A: self-administered questionnaires with 23 questions Part B: direct observations of 5 items by trained investigators Criterion of failing: For part A: failing any 2 of 7 key questions, or Failing any 6 of all 23 questions For part B: failing any 2 of 4 items Criterion for diagnose: DSM- IV Development assessment: Developmental screening test for children aged 0-6 years.

14 Flowchart of Screening CHAT-23 questionnaire for First screening Subjects: Children aged mth in Luwan district, Shanghai Pass Failing Normal Follow-up Pass CHAT-23 Section B Second screening Failing Pass Reference for further assessment Diagnosed Intervention

15 Result 1:Completed Questionnaire Received completed questionnaire (rate 90.5%) 回收途径 未回收 51 电话询问 79 当场填写 103 寄信回收 302

16 Result 1:Completed Questionnaire Distinct Completion Rate(%) 1st screening positive rate(%) Da-pu 159(90.3%) 19(11.9%) Huai-hai 119(93.7%) 18(15.1%) Rui-jin 115(87.1%) 11(9.6%) Wu-liqiao 91(91.0%) 10(11.0%) Total 484(90.5%) 58(12.0%)

17 Results:Number of failing in First screening Total 58 boys : girls = 34 : 24 Average age: 21.23±2.32 months ( months)

18 Results 2:Section B - interview A total of 31 children participated in Section B of the screening, including face-to-face interview and developmental assessment ( dropout rate 46.6%)

19 Results of CHAT-23 screening Pass 426 Normal CHAT-23 Questionaire 1st screening 484 children(completion rate 90.5%) Failing 58 CHAT-23 Section B Face-to-face interview 31 人 Dropout rate 27 * * 25 pass, and 2 failing by telephone interview Pass 25 Developmental assessment Pass 6 Developmental assessment and Autism test Normal 20 Language delay 7 MR 2 人 Telephone interview 9 High risk ASD 2 人 Intensive follow up

20 Discussion:The feasibility for early screening for ASD CHAT-23 Questionnaire:filled by parents (about 5-10 mins) and assessed by trained personnel (less than 2 mins) (finished in community healthcare center) Section B (Face-to-face interview):trained personnel (doctor, medical student or nurse), about 5-10 mins (finished in District- hospital)

21 Discussion and Future directions High risk ASD children: 4.1/1000(2/484) Limited resources: relatively low number of children screened 2 high risk ASD children found, because of their young age, need intensive follow up Some children who are normal at 18 months may still develop ASD at a later age Need to perform screening in more community centers in order to get a more precise rate of ASD occurrence in Shanghai

22 Summary Using CHAT-23 at community healthcare centers is a effective method for screening high risk ASD children

23 Recommend ASD screening procedure Normal children pass Community Center CHAT-23 Questionnaire* *At the 18 months visit Failing Return to normal Further assessment at 24 months pass Pass District Hospital Section B Failing Refer to Children s Hospital Specialist Any other children that parents or teachers believe are high risk for ASD Abnormal Intervention Follow-up

24 Thanks for attention!