Children with developmental and behavioural concerns in Singapore.

INTRODUCTION: Childhood developmental and behavioural disorders (CDABD) have been increasingly recognised in recent years. This study evaluated the profiles and outcomes of children referred for developmental and behavioural concerns to a tertiary child developmental centre in Singapore. This is the first such regional database. METHODS: Baseline information, obtained through a questionnaire, together with history at first consultation, provided information for referral, demographic and presentation profiles. Clinical formulations were then made. Definitive developmental and medical diagnoses, as well as outcomes based on clinical assessment and standardised testing, were recorded at one year post first consultation. RESULTS: Out of 1,304 referrals between January 1, 2003 and December 1, 2004, 45% were 2-4 years old and 74% were boys. The waiting time from referral to first consultation exceeded four months in 52% of children. Following clinical evaluation, 7% were found to be developmentally appropriate. The single most common presenting concern was speech and language (S&L) delay (29%). The most common clinical developmental diagnosis was autism spectrum disorder (ASD) (30%), followed by isolated S&L disorder, global developmental delay (GDD) and cognitive impairment (CI). Recommendations included S&L therapy (57%), occupational therapy (50%) and psychological/behavioural services (40%). At one year, ASD remained the most common definitive developmental diagnosis (31%), followed by S&L disorder, CI and GDD. Most were children with high-prevalence, low-moderate severity disorders who could potentially achieve fair-good prognosis with early intervention. CONCLUSION: Better appreciation of the profile and outcome of children with CDABD in Singapore could enable better resource planning for diagnosis and intervention.

Child development programme in Singapore 1988 to 2007.

Early childhood intervention programmes can shift the odds toward more favourable outcomes in development, especially for children at risk. However, there is no quick fix in the world for early childhood interventions. Programmes that work are rarely simple, inexpensive, or easy to implement. Each country must decide its own model and strategies and develop its resources based on existing infrastructures. Since its independence to become a sovereign nation in 1965, Singapore has undergone significant socio-economic changes. The infant and under-5 childhood mortality rates are among the lowest in the world. A number of "new morbidities" have been identified to pose major challenges to child health in the next decades. They are chronic medical illnesses, developmental disabilities, learning problems, injuries and neglect, behavioural disturbances and disorders, sequelae associated with unhealthy life-styles, and social and emotional disorders. The need for a comprehensive child development programme is therefore obvious. The main objectives are identification and treatment of children with developmental and behavioural problems so as to correct developmental dysfunctions, minimise the impact of a child's disability or of prevailing risk factors, strengthen families, and establish the foundations for subsequent development. A child development programme has evolved in Singapore over the last 20 years. The programme is multi-disciplinary, community-based, family-focused, and child-centric, with partnership and integration between government and voluntary community organisations.