This document discusses prevalence rates for various childhood developmental, intellectual, behavioral, and learning disorders. It provides statistics on conditions such as cerebral palsy (1.5-2 per 1000 births), mild to moderate intellectual disability (1-3% of the population), autism spectrum disorders (ranging from 0.5-2.6% in different countries), and language disorders (7.4-18% in various studies). It also addresses the need for organizational changes to child development services to improve cost-efficiency and increase support for common problems through a primary care model and a proposed "Pediatric Home".

1. Child Development Services –
?where do we belong
Boaz Porter

2. Prevalence of Cerebral Palsy
United States
The prevalence of cerebral palsy is approximately 1.5-2 cases per 1000 live births. The
incidence of cerebral palsy has not changed in more than 4 decades, despite significant
advances in the medical care of neonates.
International
The prevalence of cerebral palsy is approximately 1.5-2 cases per 1000 live births.
Mortality/Morbidity
Cerebral palsy is the leading cause of childhood disability affecting function and
development

3. Prevalence of Intellectual Deficiency
United States
• The frequency of MR/ID of all degrees ranges from 1-3%
of the population. The statistical definition of subaverage
intelligence (2 SDs below the mean) would indicate a
predicted prevalence of 2.5%.
International
• A study with excellent ascertainment conducted in
Aberdeen, Scotland, yielded a prevalence of 1 in 300 for
severe MR and 1 in 77 for mild MR.

4. Autistic Spectrum
• US and Canada: 1%
(Lazoff et al 2011)
• South Korea: 2.6%
(Kim et al 2011)
• Israel 0.5%
(Davidovitch et al 2012)

5. The Common vs The Uncommon

6. Learning Disability
Approximately 10% of children have some
learning impairment, while as many as 3%
manifest some degree of MR/ID. The
population prevalence of these combined
disorders of learning rivals that of the
common childhood disorder asthma.

7. Developmental Coordination
Disorder
Prevalence of
Developmental
Coordination Disorder
has been estimated to
be as high as 6% for
children in the age
range of 5 -11 years.

8. Prevalence of Language Disorders
• Beitchman, Nair, Clegg, and Patel
(1986) found a prevalence of
12.6% for language disorders, using a
definition that did not exclude other
developmental disabilities or require
nonverbal intelligence within the normal
range.
• Tomblin et al. (1997) reported a
prevalence of 7.4% for specific
language disorders
• For 6- and 7-year-old children, Law et
al. (2000) noted median prevalence
estimates of 5.5% and 3.1%,
respectively.

9. Expressive Language Disorder
Prevalence of expressive language disorder in young children 18 to
39 months of age:
13.5% at 18 to 23 months,
15% at 24 to 29 months
18% at 30-39 months.
(Horwitz et al, 2003)

10. Developmental-Behavioral
Pediatrics

11. An estimated 9 to 13% of American children
and adolescents between ages nine to 17
have serious diagnosable emotional or
behavioral health disorders resulting in
.substantial to extreme impairment
( Friedman, 2002)

12. Campbell )1995( estimated that approximately 10-15%
of all typically developing preschool children have
chronic mild to moderate levels of
behavior problems.
Children who are poor are much more likely to develop
behavior problems with prevalence rates that approach
30% )Qi & Kaiser, 2003(.

13. Children who are identified as hard to
manage at ages 3 and 4 have a high
probability (50:50) of continuing to have
difficulties into adolescence (Campbell &
Ewing, 1990; Campbell, 1997; Egeland et
al., 1990).

14. …….No time to lose

15. Vocabulary growth - first 3 years
Vocabulary High SES
1200
Middle SES
600
Low SES
0
12 16 20 24 28 32 36
Age - Months
Hart & Risley 1995-

16. Rates of return to human development: Investment
across all ages
8
Pre-school programs
6
School
Return
per $ 4
invested
R
2 Job training
Pre-
school School Post school
0 6 18 Age
Carneiro & Heckman, Human Capital Policy, 2003-

17. ”Need to think “Outside the Box

18. ….I Have a Dream
• Training pediatricians and
workforce re common
developmental/behavioral
problems
• Group vs Solo Practice
• Parent involvement
• Family centered practice
• The “Pediatric Home”
• Relationships with community
providers (education, welfare)
• Continuity between providers

19. Organizational Change of Child
Development Services
• Primary care: Initial evaluation of
behavioral/developmental problems:
manages common issues e.g. crying,
sleep issues in infants
• Secondary care level community
pediatrician: Manages mild speech delay,
DCD, ADHD, common behavior problems
• CDC – manages more serious
developmental spectrum

20. Changes within CDC
?Can we be more cost-efficient
• Staff: All therapists should be
trained to advise re common problems
• Patients: increase group interventions for
DCD, speech and behavioral problems
• Parents: include them as part of
therapeutic team,volunteers

21. A Pediatric Home

22. Where is the “Pediatric
”?Home
• Primary care pediatrician-
according to ability and time
• Secondary Care: most of the
common lower severity
problems
• Tertiary Care center: for
complicated problems with
ongoing need for followup tests
and treatment