Managing Neuro - Developmental Challenges in Children, by Dr Sibongile Mbatha
A developmental paediatrician is a paediatrician who specializes in child neurodevelopmental conditions. The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 defines neurodevelopmental disorders as “a group of conditions with onset in the developmental period. The disorders typically manifest early in development, often before the child enters grade school, and are characterized by developmental deficits that produce impairments of personal, social, academic, or occupational functioning.”
The conditions include:
- Intellectual disorders, e.g., intellectual disability, global developmental delay, and unspecified intellectual disability.
- Communication disorders, e.g., language disorder, speech sound disorder, childhood-onset fluency disorder, social communication disorder, and unspecified communication disorder.
- Autism spectrum disorder.
- Attention-deficit/hyperactivity disorder (ADHD).
- Specific learning disorders, e.g., dyscalculia, dyslexia, dysgraphia, or a combination of these.
- Motor disorders, e.g., developmental coordination disorder, stereotypic movement disorder.
- Tic disorders, e.g., Tourette’s disorder, provisional tic disorder, persistent motor or vocal tic disorder, other specified tic disorders.
- Other neurodevelopmental disorders, including genetic disorders, metabolic disorders, and congenital disorders.
There are many qualities that a developmental paediatrician needs to possess to manage the neurodiversity of the children they encounter. They need to be patient, kind, understanding, and able to look past the child’s physical appearance, behaviour, and presentation. They need to work with the parents in identifying the child’s abilities and finding a path to help them reach their full potential.
The prevalence of neurodevelopmental conditions is rising, especially autism spectrum disorders and attention-deficit/hyperactivity disorders. Many factors contribute to this rise, for example, increased awareness, access to services, more children surviving due to better healthcare, screen time exposure, and environmental and epigenetic factors. There are very few developmental paediatricians in the country, whether in the public or private sector. This shortage means long waiting times for a first appointment. We need more paediatricians and healthcare workers trained in the identification and management of children with neurodevelopmental conditions. There is a 2-3-year gap from when a mother has concerns about her child’s development to when the child gets diagnosed. Early intervention needs to start as soon as concerns are raised. There is no need for a formal diagnosis to begin early intervention.
When a child is suspected to have a neurodevelopmental condition, these are some helpful investigations that may be done before the first consultation with a developmental paediatrician, along with some reports to bring: a hearing test, an eye test, and a brain scan if clinically indicated. Documents to bring may include reports from other healthcare professionals, e.g., a speech therapist, occupational therapist, psychologist, and school reports from teachers.
To avoid forgetting or losing any of these important documents, keeping them in a central cloud space may be helpful. Sharing these with the developmental paediatrician early assists them in reaching correct and appropriate diagnoses. The management plan should include a multidisciplinary approach, and long-term follow-up may be needed.
The 14th of September was National ADHD Day. Let’s celebrate our wonderful, neurodivergent ADHD individuals.
Dr Sibongile Mbatha
MBBCH (WITS), DCH (SA), FC Paed (SA), Cert Dev Paed (SA)
- Developmental Paediatrician
- Department of Paediatrics and child health
- Chris Hani Baragwanath academic hospital
- University of Witwatersrand
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