Baby Memorial Hospital, Kozhikode, Kerala,
India. PIN: 673004
Childhood developmental disorders cause
significant negative impact on the physical, intellectual and
social-emotional development of an individual. Developmental
disorders are common in pediatric practice and these children
are more likely to have comorbid behavioral disorders than
their typically developing counterparts. They are also at
greater risk for academic stress due to scholastic
backwardness. Intellectual developmental disorders,
communication disorders, autism spectrum disorder and specific
learning disorder are the common developmental disorders seen
in children. The key interventions for the management of
developmental disorders in children are parent training
interventions. Early parent training interventions are
essential for the reduction in the global prevalence and
burden of childhood developmental disorders.
Keywords:
Developmental disorders, Children, Parent training
interventions
Introduction
Childhood developmental disorders include a wide range of
conditions that impair the child's physical, intellectual,
social and emotional development. These disorders cause
significant health burden globally. Children with delay
in the developmental milestones in one or more streams of
development are commonly seen in pediatric practice. Children
with developmental delay will have impairments in any or all
of the following major domains of development: expressive and
receptive language development, motor development, self-help
skills development and social-emotional development. These
children are at high risk for developing internalizing and
externalizing behavioral problems, which in turn
will aggravate the functional difficulties [1]. The behavior
problems will have significant negative impact on the child
and the caregivers and hence early intervention is essential
[2]. The key interventions for reducing and managing
developmental disorders in childhood are parent training
interventions. Randomized controlled trial was conducted by LL
McIntyre, to evaluate parent training intervention for
caregivers of preschool-age children with developmental
disabilities. The results suggested that parent training
intervention was effective in the management of these children
[3].
Developmental Disorders in Children
The common developmental disorders in children are the
following:
1. Intellectual Developmental Disorders
The general population prevalence of intellectual
developmental disorders is 1%. The intellectual developmental
disorders are characterized by deficits in
reasoning, planning and abstract thinking. The problem solving
skill, scholastic skills as well as the ability to learn from
experience are also defective in children with intellectual
developmental disorder. These defects will lead to impairment
in adaptive functioning. The adaptive reasoning in the
academic, social and practical domains will be defective. They
will not have the ability for personal independence and they
cannot take social responsibilities in the proper way.
Children with global developmental delay will have deficits in
the developmental milestones in several areas of intellectual
functioning. The severity levels for intellectual disability
can be mild, moderate, severe or profound. Family interactions
are important
for children with intellectual developmental
disorders, in order to develop appropriate social behaviors
[4].
2. Communication Disorders
Communication disorders begin early in life and include
language disorder, social communication disorder and speech
sound disorder. These children will have deficits in the
development of language, speech and social communication.
Stuttering is also a communication disorder, characterized by
disturbances in the normal fluency and motor production of
speech. Children with communication disorders usually have
academic failure and they are also at increased risk for
isolation and ridicule by peer group. This in turn leads to
social and emotional problems [5]. The most critical period
for language development is early childhood and hence
communication disorders should be diagnosed early. The
interventions should be started as early as possible to
prevent significant morbidity in the future [6].
3. Autism Spectrum disorder
Autism spectrum disorder (ASD) is one of the severe
developmental disorders affecting social and communication
skills. Children with these disorders will have significant
defects and persistent impairment in social communication and
social interaction. The deficits in language include complete
lack of speech, language delay or poor comprehension of
speech. Reciprocal social interaction is poor. Non-verbal
communication is also defective. These children have
restricted, repetitive, stereotyped patterns of behavior. The
symptoms are usually seen during second year of life. In some
children, the symptoms can be recognized even before twelve
months of age. The neuroplasticity in young children
emphasizes the important role of very early intervention
involving the parents in children with ASD. The interventions
involving parents have been found to be effective in improving
the social-communicative behaviours of young toddlers with
autism spectrum disorder [7,8].
4. Specific Learning Disorder
Children with specific learning disorder have difficulties in
using the academic skills. They have difficulty in
reading words, difficulty in understanding the meaning of what
is read, errors in spelling, errors in grammar, difficulty in
mastering number facts or difficulties in mathematical
reasoning. The academic skills are substantially below those
expected for the age and significantly interfere with academic
performance. The learning difficulties should persist for at
least six months, in spite of providing the interventions for
these academic difficulties. In order to diagnose specific
learning disorder; the learning problem of the child should
not be due to intellectual disability, uncorrected visual
problem, uncorrected auditory problem, psychosocial problems
or other neurological disorders. Specific learning disorder
can be mild, moderate or severe. Early diagnosis and
individualized treatment plans are essential for remediation.
Parental guidance is necessary both in the diagnosis and
treatment processes [9]. Early interventions
significantly improve the outcomes for children with specific
learning disorder. The commitment and attitude of parents also
have a very important influence in bringing out positive
outcomes in children with learning disorders [10].
Parent Training Interventions
Parent training interventions enhance parent-child
interactions and have significant role in fostering children’s
development. The programs generally include two approaches.
Parents are taught the discrete skills to promote child
development and they are also taught how to manage the
behaviour problems. Parent training interventions are very
effective for children with developmental disorders. World
Health Organisation (WHO) has given public health priority for
development disorders. Parents Skills Training (PST) is
recommended by WHO as the key intervention for developmental
disorders [11].
In the management of children with intellectual disorders,
parent training interventions improve the intellectual
abilities of children. These interventions are useful to
prevent and reduce the associated behavioural problems of
children as well as to reduce the parent stress [12].
Family-centered practice has significant role in management of
communication disorders of children. Family-centered
interventions are effective in providing optimal communication
skills for the child in a positive and healthy family
environment [13]. The results of parent delivered
interventions based on applied behavior analysis for children
with autism specrtrum disorders are encouraging. These
interventions are effective in improving the social and
communication skills of children. Significant increase in eye
contact, receptive and expressive language development as well
as joint attention are seen after parent training
intervention [14]. Training of specific skills for parents
lead to positive changes in children with ASD less than seven
years of age. The parent mediated early interventions improve
the parent-child interactions, social skills and the
communicative behaviour of the child [15,16]. The parent
mediated reciprocal imitation training has significant
positive impact in improving the social interaction of
children with autism [17]. Parent training is also effective
in the remedial intervention strategies for children with
learning disorders. Results of the study by Gortmaker VJ et al
demonstrated improvement in reading fluency after parent
tutoring. Children and their parents found the interventions
as acceptable and effective[18]. Behaviour problems are common
among children with developmental disorders. Good parent–child
interactions and reinforcement of good behaviors
will lead to prosocial child behaviors. Parent training
programmes are helpful for improving the behavioural
adjustment of young children [19]. Improving parenting skills
will definitely help in reducing the disruptive behaviors in
toddlers [20].
Conclusion
Normal development during childhood is crucial for social,
emotional, educational and vocational success of an
individual. Childhood developmental disorders can cause severe
long-term morbidity for the children, if not intervened at the
earliest. The negative impact includes the individual
suffering of children, as well as the emotional and economic
burden on their families. In the management of developmental
disorders of children, especially from birth to age three,
parent training interventions have very important role. The
associated behavioral problems can also be managed effectively
through parent training programmes. Family-centered early
interventions are effective in improving the motor skills,
social skills, communication skills, self help skills and
academic skills of children. The key interventions having the
potential to reduce developmental disorders in childhood are
parenting skills training. Hence parent training interventions
are recommended to achieve significant reduction in the global
burden of developmental disorders in children.
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