The involvement of community pediatricians in the treatment of developmental-behavioral difficulties as perceived by directors of child development centers

Background Developmental-behavioral issues are among the most frequent and disabling conditions of children and adolescents seen in ambulatory settings. Guidelines of the Israeli Pediatric Association and the Israeli Society for Developmental Pediatrics specify the role of the primary-care pediatrician in screening and early identification of mild developmental behavioral conditions and define the criteria for referral to child development institutes. The aims of this study were to examine and describe how directors of these institutes perceive the role and involvement of community pediatricians in child development. Methods Qualitative interviews of the directors of 22 child development institutes from the ministry of health and the four health plans. Results According to the interviewees, there is little involvement of community pediatricians in detecting developmental delays, and it is mainly nurses and preschool teachers who detect such delays. They report that the key barriers that deter community pediatricians from greater involvement in child development diagnosis and treatment are lack of time, lack of compensation, and insufficient clinical knowledge. The interviewees would like to see community pediatricians conducting the primary medical evaluation, providing parental guidance, referring to therapists in mild cases, exercising discretion before referring children to child development institutes and providing relevant information to the institutes in the referral process. The mechanisms that they proposed for increasing the involvement of community pediatricians were expansion of pediatricians’ training, increased pediatricians’ use of teleconsultation with child development specialists and incentives for thorough performance of developmental assessments. Conclusions Due to the importance of the Issue, we strongly recommend that policymakers require child development principles, evaluation, and providing appropriate parental guidance in the curriculum of the Israeli pediatric residency program. In addition, health plans should compensate pediatricians who need to conduct longer visits for children with developmental delays. The health plans should also develop teleconsultation channels for pediatricians with child development specialists to reduce unnecessary referrals to child development institutes.

Parental Occupational Executive Training: Feasibility and Parental Perceptions

Young children with attention deficit hyperactivity disorder (ADHD) cope with functional difficulties attributed to executive dysfunction. This study evaluates the feasibility of the Parental Occupational Executive Training (POET) intervention. Parents of 71 children (4–7 years) with ADHD attended 8 to 10 weekly, personally tailored intervention sessions with an occupational therapist. Quantitative and qualitative measures were used to examine feasibility in four indices: parental attendance, adherence, and acceptance, and therapist fidelity. Parental attendance and home-strategy use during daily activities rates were high. Parents identified the occupational performance coaching model’s principles as supporting their ability to implement the intervention. Therapists demonstrated high fidelity to the POET’s theoretical bases. The POET is a feasible intervention with high parental attendance (98.61%), parental adherence (80.56%–94.44%), and therapist fidelity (100.00%). It can be implemented within child development centers and occupational therapy clinics and leads to parents’ increased adherence.

Effects of Dietary Intervention on Nutritional Status of Severely Undernourished Preschoolers from Ahmednagar District, Maharashtra, India

The effectiveness of nutrition intervention in severely undernourished preschool children at child development centers and during subsequent follow ups was studied. ICDS survey 2008, for under nutrition among preschoolers was conducted. Admitting severely undernourished children to Child Development Centres (CDCs) with their mothers / care takers for 2-3 weeks was undertaken. Correction of morbidities by using health protocol of WHO, training for preparation of supplementary foods from locally available raw materials and recipes, feeding of children and recording observations on nutritional improvements at CDC and subsequent follow ups upto 30 months was studied. All 14 tahasils of Ahmednagar district, India, 0-6 y preschoolers were included in this study. The application of health and nutrition protocol to severely undernourished children at CDC for 2-3 weeks and subsequent follow up showed marked improvements in their weight gain, IAP grades and SD classification parameters. A continued follow up for extended period is however essential to eliminate the under nutrition in these children.

Clinical Characteristics of Autism Spectrum Disorder in Israel: Impact of Ethnic and Social Diversities

Despite the increased global prevalence and recognition of autistic spectrum disorder (ASD), it is still scarcely reported in the Arab world. Though Israel has a higher prevalence of ASD, a previous national survey of patients diagnosed between 1972 and 2004, demonstrated that 98% of them were of Jewish ancestry. The disproportional low number of Arab children with ASD in Israel is unclear but may reflect lower awareness and cultural bias. In the present study we collected clinical and demographic characteristics of 200 children with ASD from Arab and Jewish sectors in Israel that were evaluated in two child development centers. We compared the incidence and the medical comorbidity of autism between these two ethnics groups. The medical and psychiatric comorbidity profile in these children was similar to the worldwide published studies. In the present study the prevalence of autism in the Arab sector in Israel was similar to that of the Jewish sector. The Arab patients presented with more severe autistic manifestations and higher incidence of mental retardation, familial members with autism, and consanguinity (P<0.05), while in the Jewish sector milder forms (such as Asperger syndrome and PDD-NOS) were more frequent. This discrepancy might be explained by both genetic and cultural factors.

The Effect of Physical and Environmental Factors of a “Child Development Center” on a Center’s Selection

The role of education is a key factor for an individual’s development. After the 1980s the findings of educational research has shown that preschool age is a very important period in one’s development. The single parent family structure and an increase in the number of working mothers have required children to attend schools in “child development centers” (CDC). Preschool education is becoming important in the new millennium because a child’s personality, emotions, cognitive and social abilities develop during the first five years. The purpose of this study is to investigate the reasons for selecting CDCs by parents and children by focusing on physical and environmental factors. The sample was a diverse group of 95 parents and instructors who use CDCs at two different locations in Turkey. The instrument used in the study was a self-designed standardized questionnaire. The results should enlighten later CDC design studies, and give support for architects who design preschool education centers. The study may be used for educational, governmental and advertising purposes to contribute to changing the negative situation of poorly designed centers.