17/10/2017
Global experiences
 

Some literature on developmental disabilities of children in developed countries acknowledge that the prevalence of disorders such as cerebral palsy, mental retardation, hearing impairment, visual impairment, and learning disorders has been 2-3, 10-25, 0.8- 2, 0.3-0.6 and 75 in 1000 children respectively; and behavioral disorders and attention disorder with hyperactivity have been 6-13 and 3-5 percent in school-age children, respectively. Other scientific resources estimate that the prevalence of developmental disorders in communication (speech), learning, cognitive and psycho-social affairs as well as autism, along with educational failure has been approximately 20 to 25 percent among children. Generally, this figure varies in different countries, and has been estimated between 5 to 35 percent of children.

For example, developmental disorders in children have been announced between 12 to 16 percent in the in the United States

In most developing countries, there is little information on the prevalence and causes of developmental disabilities. Although most children with disabilities worldwide live in countries with low to moderate level of economic development, relevant studies in these countries are very poor.

However, in some studies, the prevalence of severe mental retardation in children has been mentioned to be more than 5 in thousand children in these countries, which are attributed to hereditary diseases, high gestational age, kinship marriage, specific micronutrient deficiencies and infections as the main risk factors in this regard. Studies have shown that although biomedical factors (such as low birth weight, premature birth, asphyxia, and perinatal events, childhood infections, lead poisoning, chronic diseases and malnutrition) are the most important risk factors, at the individual level, to develop mental retardation, movement disorders and other developmental disorders, the complex interaction of individual biological factors with environmental and social factors actually causes the big impact on the evolution, behavior, school readiness and academic success of the individual, and consequently his/her public health in the future during the lifetime.

In other words, the importance of psychological-social factors at family and community level is not less than biomedical factors.

For example, the impact of different factors (such as low socioeconomic status and poverty, illiteracy or low education of mother, social involvements, refuge or immigration, teen parents, domestic violence, single parents or parents without guardian, addicted parents and child abuse or harassment) on children's cognitive and behavioral development has been identified in several studies; and the amount of cognitive and socio-emotional development of children in the early years of life in turn will show their educational status in the next few years. Thus, an increase of one standard deviation in IQ (9) or the child's developmental factor causes a significant increase in the child's academic success in the next few years of life.

In addition, many sources have stressed the important influence of family and family circumstances (in terms of economic status, public health, mental and nutritional health and educational level), on the health, child development and school readiness.

Studies on animals have even shown that growth and development of brain are influenced by the quality of the environment. Factors such as malnutrition, deficiency of iron and iodine, presence of toxins in the environment, environmental stress, lack of environmental stimuli, and lack of social interactions can have adverse impact on both brain structure and function, having with permanent effects on emotional intelligence.

Other studies on animals and humans have shown that the quality of care provided by parents and parenting practices of parents can cause permanent changes in response to stress, the incidence of anxiety and performance of children’s memory, so that maternal depression has a negative impact on children's cognitive performance, and can cause their behavioral problems.

Therefore it is essential that early intervention and prevention programs and research for developmental disorders simultaneously address all physical, mental and social aspects of the issue.

In fact, scientists in this field emphasize that, considering the complexity of the issue in human evolution, no intervention alone could not fully and permanently protect the child from the negative effects of risk factors. Therefore, as part of a comprehensive services and support systems, the interventions are needed to target the factors at all personal, interpersonal, and environmental (even including housing, employment and transportation), social and political levels, instead of focusing on one or more determinants of health and the natural evolution.

Significant point about the relationship between the natural evolution of the child and psychological-social factors is their bilateral relations, so that today we can consider the prediction of required care, services and training in early childhood as the most effective strategy to reduce poverty and social inequalities, because it essentially targets the causes of poverty and social inequality.

But despite the brain's vulnerability to the risk factors mentioned above, in case of damage and disorder, it is often possible to improve and compensate the disorder with appropriate and timely interventions in the early years of childhood, which is linked to the principle of the brain neuroplasticity.

After 90s, the phenomenon of neuroplasticity of the brain was proven; and contrary to the previous theories, it was clear that brain cells continue their development especially through synaptogenesis, after the birth for a few years. The main driver of the growth and development are neural signals that arise due to environmental stimuli.

With this new knowledge, significant changes emerged in attitude to motor, mental, physical and psychological-behavioral disabilities with the origin of brain and possible diagnosis and early intervention for secondary prevention of them on the one hand; and on the other hand, the way was paved for some measures to improve and promote the development of the healthy human nervous system in the neonatal period and infancy.

the issue of early intervention, of course, raised in earlier years (i.e. from about 1930) as well.

For example, different approaches - from Colby and Rood method in the U.S (70-1930) and Katona method in Hungary (1970) to the NDT approach (which is also known as Bobath method), in England (the 90s-1940) - can be cited.

But in recent years, neuroscience and neurophysiology and new imaging techniques allowed us to know more the mechanisms and neuropathophysiology of disorders and their associated interventions. Thus, the possibility of more informed and more scientific use of newer methods of intervention has been developed.

In recent years, newer techniques (such as kangaroo care and massage therapy) has also been added to the collection of timely interventions.

Several studies worldwide have demonstrated the effectiveness of interventions in reducing various motor, mental, emotional and psychological-behavioral disturbances and disabilities.

However, there is unfortunately no comprehensive and specific style sheet for early intervention in all societies and countries; and ways of functioning differ in various countries.

With the advent of this new approach to brain structure and function (neuroplasticity) and new hopes for the possibility of early action and secondary prevention of morbidity (if diagnosed on-time), the importance of screening in children was clearer for a variety of disorders that had a brain and central nervous origin, so that the American Association of Pediatrics recommended that all children and infants under 3 years should be evaluated periodically and regularly by one of standard screening tools; and if any further problem was observed in the screening, they should be referred to specialized centers for diagnostic evaluation, in order that finally, children with developmental disorders or delays are duly identified, and benefit from early intervention or rehabilitation programs.

However, we must emphasize the importance and need for early beginning of intervention (either of primary or secondary prevention type or promotional type), i.e. up to the first 3 years of childhood. Currently, long-term benefits of early intervention programs for children with developmental disorders in developed countries have been proved.

These studies suggest the positive impact of early intervention on cognitive development, school readiness, academic achievement, employment, ownership of housing, social communication, social success and reduced risky behaviors, drug abuse, crime and arrests, pregnancy in adolescence, dependence on rehabilitation and supportive services, and the use of education for exceptional children.

Some longitudinal studies have shown that the positive effects of cognitive stimuli have remained at the early years of the child's life, even until the age of 17.

In 1987, a specialized agency, "High Scope", in the in the United States showed after a 27-year longitudinal study that children who had benefited from the coordinated program in the development of young children were more successful and, healthier adults with more positive family and social trends in the future, and were placed in more effective jobs in the community.

It also calculated that every dollar invested for young children can lead to financial savings of $ 7 for subsequent years.

Studies have shown that interventions of the type of environmental stimuli (especially when combined with proper nutrition, and for smaller and more deprived children) can create a higher evolutionary rates in physical, cognitive, speech and language, emotional-emotional and social areas, better cognitive level, increased concentration levels, higher academic skills and self-esteem and reduced violent behaviors.

For this reason, some believe that investment in the programs of the natural evolution for children plays a very important and powerful role in establishing social justice.

On the other hand, in the last two decades, the results of studies on hearing and speech - as one of the major developmental areas – have proved a favorable period for speech and language development in the first three years of a child's life, suggesting that the early auditory rehabilitation has a positive impact on hearing impaired children under 6 months, compared to the age group over 6 months.

This draws attention to the importance of early intervention for hearing impairment in newborns and infants.

Although since about 40 years ago, some methods have been introduced in the world for early recognition to perform rehabilitation and medical intervention in cases of hearing loss, each of them had been abandoned for reasons, until finally in 1991, the use of electrophysiological tests (such as "acoustic emission and auditory responses of brainstem) for newborn hearing screening was confirmed by the "Joint Committee on Infant Hearing" in the United States, and was implemented in that country.

Assessment of speech and language development in hearing loss and deaf children is now done in the English-speaking Western countries by several methods such as MacArthur communication development test, Minnesota child development test.

According to the approvals of one hundred and eighty-sixth session of the Council for the Development of Universities of Medical Sciences dated 02.07.1387, articles of association of the Rehabilitation Research Center for Pediatric Neurosurgery was confirmed, which included 9 articles and 1 note to promote research and provide solutions in health issues with the following objectives:

1 - Development and application of human knowledge in the field of the science of “Pediatric Neurology Rehabilitation"

2 - Performing basic clinical and epidemiological research in order to reform the health care system to meet the needs of Islamic community

3 - Collecting, arranging and classifying related documents, papers and documents, and publishing them

4 - Training researchers in the field of “Pediatric Neurology Rehabilitation"

5 - Encouraging, promoting, and utilizing researchers

6 - Making effort to attract and cooperate with relevant research and executive centers within the country

7 – Doing scientific cooperation with research and training centers of other countries and international organizations in compliance with laws and regulations of the Islamic Republic of Iran

 

As a research center at the University of Social Welfare and Rehabilitation, the center began to start its work under the supervision of Research Deputy since 1380; and several research projects, workshops, training and research congresses, and also many books and articles have been done by this center.

On 09.28.1390, the Council for the Development of Universities of Medical Sciences agreed with the establishment of Pediatric Neurorehabilitation Research Center, and its license was notified on 21.10.1390 by the Minister of Health Dr. Mrs. Vahid Dastjerdi.

 

1 - Development and application of human knowledge in the field of “Pediatric Neurology Rehabilitation"

2 - Doing basic epidemiological and clinical research to reform the health care system to meet the needs of Islamic community

3 - Collecting, arranging and classifying related documents, papers and documents, and publishing them

4 - Training researchers in the field of "Neurology Pediatric Rehabilitation"

5 - Encouraging, promoting and utilizing researchers

6 - Making effort to attract and cooperate with relevant research and executive centers within the country

7 – Doing scientific cooperation with research and training centers of other countries and international organizations in compliance with laws and regulations of the Islamic Republic of Iran

 

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