ONE in eight children of Goa aged 2-9 suffers from one of the many neurodevelopmental disorders (NDDs), a study of children in five states has found. Children from 25 villages of Goa were screened for nine childhood disabilities – vision impairment, epilepsy, neuromotor impairments including cerebral palsy, hearing impairment, speech and language disorders, autism spectrum disorders and intellectual disability. Two more NDDs – attention deficit hyperactivity disorder and learning disorder – were added to children in the 6-9 year-old age group. Autism spectrum disorder of over one per cent was comparable to global prevalence. Hearing impairment and intellectual disability were the most common disorders among the children assessed. About 20 per cent of the children had two or more NDDs. The researchers are of the opinion that NDDs in children in the 2-9 age group would have a significant public health burden for India.
Medical science has found no permanent cure for most of the NDDs, which should be a concern for the parents whose children show signs of such disorders. Neurodevelopmental disorders are a group of disorders in which the development of the central nervous system is disturbed. This can include developmental brain dysfunction, which can manifest as neuropsychiatric problem or impaired motor function, learning, language or non-verbal communication. NDDs include attention-deficit/hyperactivity disorder (ADHD), autism, learning disabilities, intellectual disability (also known as mental retardation), conduct disorders, cerebral palsy, and impairments in vision and hearing. Studies have found that ADHD and oppositional defiant disorder (ODD) were commonest of the NDDs. ADHD can be diagnosed in early childhood and often continues into adulthood. Oppositional defiant disorder is a behavioral or defiance disorder in which children show chronic aggression, frequent outbursts and a tendency to ignore requests and purposely irritate others. Global studies have found that 40 per cent of children with ADHD also have signs of ODD, which should be of great concern to the parents and the medical fraternity. According to scientists, causes of NDDs can be deprivation, genetic and metabolic diseases, immune disorders, infectious diseases, nutritional factors, physical trauma, and toxic and environmental factors.
The problems in dealing with NDDs are compounded by lack of proper and appropriate diagnosis, which lead to cases going undetected till late and children developing various complications due to “inattentive” neglect of their health conditions. Most parents tend to ignore the abnormal behaviour of their children. It has been found that the conditions in victims of NDDs are heterogeneous. Global studies have found that although many of the NDDs can be diagnosed by standard clinical testing, more than half of the patients remain undiagnosed despite prolonged and costly evaluations. New diagnostic processes have shown that whole-exome or whole-genome sequencing, guided by the acuity of the patients’ conditions, can help solve the medical mystery for many of these children, including some who would otherwise remain undiagnosed, in much less time than traditional testing and with comparable costs. Studies in Taiwan have found that variation in cases of mental retardation, attention-deficit/hyperactivity disorder, and autism among children depended on age, birth year, period, and socioeconomic status of the parents. It has been found that the extent of the association linking age with the first diagnosis of mental retardation varies across different levels and socio-economic status.
As NDDs could lead to various problems for the children, parents have to be attentive to notice the signs and not neglect them. All efforts should be made to diagnose them at the earliest. Since prevalence of the NDDs has been found in 25 villages of the state, the state health department must conduct a survey to find out such cases in other parts of the state and set up systems so all the cases are diagnosed and appropriate steps are taken for remedial action. Many more children in Goa could be victims of NDDs. The neuro-rehab centre at the Goa Medical College should be made fully operational so that the children in need of medical and therapeutic attention could be attended to and their problems addressed. The burden of NDDs can be reduced in Goa by addressing the risk factors such as low birth weight, premature delivery, neurological or brain infections among others. The state health department has a responsibility to develop a policy and infrastructure for identification and intervention services for helping the diagnosis and treatment of NDDs among children. The department should stay updated on the research into causes of NDDs and the advances on their treatment. At the same time, the parents must become more vigilant and not neglect the early symptoms of NDDs in their children.