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ARNEC Country Representative Consultant Speech-Language Pathologist K. Nadini Wickramasinghe[/caption]
The Covid-19 pandemic brought forth a need for digitising healthcare services to maintain access for children with special needs. We spoke to ARNEC (Asia Pacific Regional Network on Early Childhood) Country Representative Consultant Speech-Language Pathologist K. Nadini Wickramasinghe on the need for continued care for children experiencing developmental delays in the present circumstances.
A child is said to have a “delay” when their developmental milestones are not met compared to others of the same age. These delays may be seen in motor function, speech and language, cognitive, play, and social skills. When there are significant delays in two or more of these areas the term “global developmental delay” is used.
There has been significant visibility of developmental delays seen in recent years, globally and locally. This could be due to parents, guardians, and early educators being more aware of “delays” and alerting health professionals early. The urban sector shows a higher number of cases related to the autism spectrum and certain genetic conditions-related developmental disorders. The objective identification of a “delay” in a child is made by observing and measuring the relevant developmental domains of a child. There is a dire need to address childhood delays medically and holistically, stated Wickramasinghe.
Causes for developmental delays
A longitudinal study done in the US, that examined children aged three to 17 years who have been diagnosed with a delay, revealed that over 17% of children were at some point given a diagnosis of a delay. Attention deficit hyperactivity disorder (ADHD), learning disability, and speech and senses-related delays were the most common. Although no official data is available in Sri Lanka currently on children facing developmental delays, several preliminary studies show that increased prenatal, perinatal, and postnatal complications elevates the risk of children having delays. One study done as developmental surveillance at the Colombo North Teaching Hospital revealed that a direct impact of postnatal complications impacted cerebral palsy and other developmental disorders. Maternal stress level, socio-economic variants, and now even a pandemic situation is likely to make children vulnerable for delays.
Currently, in Sri Lanka, islandwide services are available, initiated by the Government and the private sector, to identify and treat children with or at risk for a delay or a disability early. However, the Covid-19 pandemic has posed a new challenge to all healthcare and educational professionals addressing delays presented in childhood. This called forth for innovation and evidence-based systems that would effectively address health, rehabilitative, and educational needs of children with delays. Thus, telehealth systems in the form of teletherapy and teleconsultations that provide online support directly to children and their caregivers towards their development, are currently in operation.
Importance of early identification and ROI in child development in a pandemic
Many developed economies have singularly recognised the need for investments made in early intervention and thus are reaping the benefits of a more productive labour force that contribute to the economy despite disabilities. The return on investment (ROI) of the federally/nationally funded Head Start programme in the US ranges from $ 7-9 for every dollar invested.
In a pandemic, children with a delay or those at risk for a delay remain highly vulnerable. If unaddressed, these children have a high risk of having a disability that could limit their contribution as adults, making them dependents. This poses a serious risk to any economy calling forth for proactive measures. Hence, investments made both at an institutional and individual level for children facing delays, particularly at the time of the pandemic, should remain a priority, stated Wickramasinghe.
Evidence of telehealth and teletherapy for children
Telehealth has been used by paediatric clinicians for over a century in cases of emergency. Monitoring and use of telephone facilities were an important part of the overall paediatric practice. More advanced technologies, such as video consultations, are prevalent with high usage since 2020, with the emergence of the Covid-19 pandemic.
According to a study done recently, telehealth presents the opportunity to bridge many divides including geographical and logistical challenges. It states that “many acute paediatric conditions can be managed safely and effectively through telehealth especially when remote physical exam equipment is used. Telehealth can also be especially useful in medical care of children with medical complexity. Travelling with medical equipment to multiple subspecialists can be incredibly challenging and often a similar quality visit can be conducted through telehealth in the comfort of a child’s home environment”.
Evidence suggests that the integration of telehealth into paediatric patient-centred medical home care can provide convenience while maintaining the essential relationship between the families and the health professionals.
Speech delay and teletherapy
A preliminary study conducted by Ceylon Speechie recently revealed that teletherapy, in speech and language therapy given through an online platform delivered in the form of parental training, was successful with children below the age of five. These results were even comparatively better than face-to-face consultations. Teletherapy improved the overall communication, speech, and language skills of all the children who were part of the study. The improvements were mainly identified to be due to the reduced stress levels of parents during telehealth consultations, clinicians being able to analyse the child’s natural environment in reference to the treatment plan, easy accessibility of the service, and high parental involvement.
In a study published dating back to 2017, a systematic review revealed both telehealth and in-person participants made significant and similar improvements when treatment effects were measured through outcomes in speech and language therapy given for school-aged children.
Findings prior to the Covid-19 pandemic showed there is limited but promising evidence to support telehealth for delivering speech-language pathology intervention services to school-age children. In 2021, this evidence is further backed by many types of research with parents, who expressed high levels of satisfaction with telehealth programmes given for delays faced by children.
Way forward
Sri Lanka is well known for its excellent healthcare structure indicative of outcomes that are seen as exemplary to the developing world. Of the 99% of all maternal deaths occurring in the developing world, the South Asian region accounts for most of them. Sri Lanka’s closest neighbour India, on geographical as well as influential grounds, has an estimated 300 maternal deaths per 100,000 births, whilst in Sri Lanka it is less than 30 per 100,000 live births. A similar trend is also seen in the infant mortality rate. These indicators show the impact of the well-established healthcare structure of the country, which has prioritised training health professionals towards serving the poorest and the most under-resourced communities on the island. It also stands as a testament to the long-established medical education of the country ensured solely by state investments.
Nevertheless, when skilled doctors in the country save lives during the birth of infants who have odd chances to live, there remains a dire lack of trained professionals monitoring and facilitating optimal child development. In Sri Lanka too there has been a rise in the presence of developmental disabilities in children with a recent study showing one in 93 children in Sri Lanka are affected by the disorder.
Finally, Wickramasinghe stated that some of the disabilities are presented full-blown later on in a child’s life due to medical professionals and parents missing out on early presenting signs. Many children in the country have been diagnosed with childhood developmental disabilities, the effects of which could have been minimised or even reversed if early detection and treatment were provided. Within the new scenario of the pandemic, the use of telehealth platforms for both teletherapy and other pediatric needs should be acknowledged and used optimally within this context.
ARNEC Country Representative Consultant Speech-Language Pathologist K. Nadini Wickramasinghe[/caption]
The Covid-19 pandemic brought forth a need for digitising healthcare services to maintain access for children with special needs. We spoke to ARNEC (Asia Pacific Regional Network on Early Childhood) Country Representative Consultant Speech-Language Pathologist K. Nadini Wickramasinghe on the need for continued care for children experiencing developmental delays in the present circumstances.
A child is said to have a “delay” when their developmental milestones are not met compared to others of the same age. These delays may be seen in motor function, speech and language, cognitive, play, and social skills. When there are significant delays in two or more of these areas the term “global developmental delay” is used.
There has been significant visibility of developmental delays seen in recent years, globally and locally. This could be due to parents, guardians, and early educators being more aware of “delays” and alerting health professionals early. The urban sector shows a higher number of cases related to the autism spectrum and certain genetic conditions-related developmental disorders. The objective identification of a “delay” in a child is made by observing and measuring the relevant developmental domains of a child. There is a dire need to address childhood delays medically and holistically, stated Wickramasinghe.
Causes for developmental delays
A longitudinal study done in the US, that examined children aged three to 17 years who have been diagnosed with a delay, revealed that over 17% of children were at some point given a diagnosis of a delay. Attention deficit hyperactivity disorder (ADHD), learning disability, and speech and senses-related delays were the most common. Although no official data is available in Sri Lanka currently on children facing developmental delays, several preliminary studies show that increased prenatal, perinatal, and postnatal complications elevates the risk of children having delays. One study done as developmental surveillance at the Colombo North Teaching Hospital revealed that a direct impact of postnatal complications impacted cerebral palsy and other developmental disorders. Maternal stress level, socio-economic variants, and now even a pandemic situation is likely to make children vulnerable for delays.
Currently, in Sri Lanka, islandwide services are available, initiated by the Government and the private sector, to identify and treat children with or at risk for a delay or a disability early. However, the Covid-19 pandemic has posed a new challenge to all healthcare and educational professionals addressing delays presented in childhood. This called forth for innovation and evidence-based systems that would effectively address health, rehabilitative, and educational needs of children with delays. Thus, telehealth systems in the form of teletherapy and teleconsultations that provide online support directly to children and their caregivers towards their development, are currently in operation.
Importance of early identification and ROI in child development in a pandemic
Many developed economies have singularly recognised the need for investments made in early intervention and thus are reaping the benefits of a more productive labour force that contribute to the economy despite disabilities. The return on investment (ROI) of the federally/nationally funded Head Start programme in the US ranges from $ 7-9 for every dollar invested.
In a pandemic, children with a delay or those at risk for a delay remain highly vulnerable. If unaddressed, these children have a high risk of having a disability that could limit their contribution as adults, making them dependents. This poses a serious risk to any economy calling forth for proactive measures. Hence, investments made both at an institutional and individual level for children facing delays, particularly at the time of the pandemic, should remain a priority, stated Wickramasinghe.
Evidence of telehealth and teletherapy for children
Telehealth has been used by paediatric clinicians for over a century in cases of emergency. Monitoring and use of telephone facilities were an important part of the overall paediatric practice. More advanced technologies, such as video consultations, are prevalent with high usage since 2020, with the emergence of the Covid-19 pandemic.
According to a study done recently, telehealth presents the opportunity to bridge many divides including geographical and logistical challenges. It states that “many acute paediatric conditions can be managed safely and effectively through telehealth especially when remote physical exam equipment is used. Telehealth can also be especially useful in medical care of children with medical complexity. Travelling with medical equipment to multiple subspecialists can be incredibly challenging and often a similar quality visit can be conducted through telehealth in the comfort of a child’s home environment”.
Evidence suggests that the integration of telehealth into paediatric patient-centred medical home care can provide convenience while maintaining the essential relationship between the families and the health professionals.
Speech delay and teletherapy
A preliminary study conducted by Ceylon Speechie recently revealed that teletherapy, in speech and language therapy given through an online platform delivered in the form of parental training, was successful with children below the age of five. These results were even comparatively better than face-to-face consultations. Teletherapy improved the overall communication, speech, and language skills of all the children who were part of the study. The improvements were mainly identified to be due to the reduced stress levels of parents during telehealth consultations, clinicians being able to analyse the child’s natural environment in reference to the treatment plan, easy accessibility of the service, and high parental involvement.
In a study published dating back to 2017, a systematic review revealed both telehealth and in-person participants made significant and similar improvements when treatment effects were measured through outcomes in speech and language therapy given for school-aged children.
Findings prior to the Covid-19 pandemic showed there is limited but promising evidence to support telehealth for delivering speech-language pathology intervention services to school-age children. In 2021, this evidence is further backed by many types of research with parents, who expressed high levels of satisfaction with telehealth programmes given for delays faced by children.
Way forward
Sri Lanka is well known for its excellent healthcare structure indicative of outcomes that are seen as exemplary to the developing world. Of the 99% of all maternal deaths occurring in the developing world, the South Asian region accounts for most of them. Sri Lanka’s closest neighbour India, on geographical as well as influential grounds, has an estimated 300 maternal deaths per 100,000 births, whilst in Sri Lanka it is less than 30 per 100,000 live births. A similar trend is also seen in the infant mortality rate. These indicators show the impact of the well-established healthcare structure of the country, which has prioritised training health professionals towards serving the poorest and the most under-resourced communities on the island. It also stands as a testament to the long-established medical education of the country ensured solely by state investments.
Nevertheless, when skilled doctors in the country save lives during the birth of infants who have odd chances to live, there remains a dire lack of trained professionals monitoring and facilitating optimal child development. In Sri Lanka too there has been a rise in the presence of developmental disabilities in children with a recent study showing one in 93 children in Sri Lanka are affected by the disorder.
Finally, Wickramasinghe stated that some of the disabilities are presented full-blown later on in a child’s life due to medical professionals and parents missing out on early presenting signs. Many children in the country have been diagnosed with childhood developmental disabilities, the effects of which could have been minimised or even reversed if early detection and treatment were provided. Within the new scenario of the pandemic, the use of telehealth platforms for both teletherapy and other pediatric needs should be acknowledged and used optimally within this context.