ABSTRACT
Justification: Global developmental delay (GDD) is a relatively common neurodevelopmental disorder; however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. Process: Seven subcommittees of subject experts comprising of writing and expert group from among members of Indian Academy of Pediatrics (IAP) and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of IAP. Guidelines: GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/ hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.
ABSTRACT
Background: Student's assessment is a systemic process of determining the extent to which the student has achieved the desired competency. Mini'Clinical Evaluation Exercise (Mini-CEX) is an assessment tool applicable in broad range of settings. Very little data is available in Indian settings about Mini-CEX in undergraduate. This study has been undertaken to understand its role in formative assessment.Methods: In this interventional study 47 students and 7 faculty of pediatrics participated. Students were assessed for two encounters of Mini-CEX. Assessment was as per Mini-CEX rating form followed by feedback.Results: Mean score range for different competency of data gathering were 1.76 to 2.5 during first mini-CEX and 4.38 to 5.14 during second Mini-CEX. Difference was significant (Cohen's d >0.8). More than 90% of students felt that Mini-CEX is better way to assess clinical skills and would like to be assessed by Mini-CEX. One to one interaction was most important advantage felt about Mini-CEX. Though nearly all faculties felt that Mini-CEX is a better way for assessment half of them disagree to continue using it in future due to time constraints.Conclusions: In this study we found Impact of Mini-CEX in formative assessment is significant to improve clinical competency at undergraduate level. Improvement in Mini-CEX scores in consecutive encounter signifies its role even as Teaching Learning tool. Need to consider issues about its feasibility for Undergraduate level in settings with limited staff strength.