Development of Research Strategies for Brain Mind and Behaviour: Developmental Delay, ASD, ADHD, Poor Achievement and Conduct Disorder

Abstract

Understanding of how healthy development happens, how it is derailed and what can be done to prevent and keep it on track have been deepened, thanks to advances in neuroscience, molecular biology, genetics, Epigenetics, behavioral and social science. Converging evidence from scientific research and practical experience indicates that the influence of the early years can extend over a lifetime, as it affects the foundation s of learning, behavior, both physical and mental health. Multiple developmental impediments that limit the ability of children with normal potential to benefit from available learning opportunities have been identified including emotional problems (fear, anxiety), maladaptive adjustment, disruptive behavior, impairment s in executive functioning and other socio-emotional problems. Young children encountering any combination of these difficulties or risk factors are likely to have seriously disrupted capacity to engage in productive, goal directed activity. A common underlying problem links all of these domains –diminished capacity for self regulation in the areas of attention, emotion and behavior. Toxic stress and malnutrition during pregnancy increase the risk of the offspring to maladaptive response to stress, while repeated early exposures to threatening situations in infancy and early childhood can disrupt the development of the prefrontal cortex. This leads to emotional problems and compromised working memory, attention, inhibitory control and cognitive/mental flexibility. A weak foundation can seriously undermined the lifelong health and productivity of individuals, affecting family, community, extending to social and economic vitality of the nation. In contrast, well –developed capacities in these important aspects of self –organization can help children manage adversity more effectively and acquire the biological foundation for school readiness, literacy and numerical skills, and academic success, enabling children to be actively engaged competent learners and responsible citizen in the future for the country. In Thailand, DOH‘s several early childhood developmental screening surveys during 1999 to 2010, found ,among 1-5 year old, 28-32% suspected developmental delay with 25-28% in age 1-3 and 32-43% in age 4-5. In 2010 survey, children living in municipal areas had slightly lower prevalence of delay than those in rural area 27 VS 31%. (2010). The developmental domains most affected were language and fine motor adaptive function, both of which very crucial for learning. Developmental Language Disorder in young children has been found to relate to higher risk for later learning disability in primary school. About 1 in 6 children in the United States had a developmental disability in 2006- 2008, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism. Early detection must be followed by early intervention to enhance child development, prevent serious handicapping condition and to be more cost effective. The increase of prevalence of Autistic Spectrum Disorder has been remarkable over the last two decades, for example, in USA from 1-2:1000 to 14.7 : 1,000 or about 1 in 68 children age 8 in 2010, according to CDC The Autism and Developmental Disabilities Monitoring (ADDM) Network. Studies in Asia, Europe, and North America have identified individuals with ASD with an average prevalence of about 1%. A study in South Korea reported a prevalence of 2.6%. In 2005, the average annual medical costs for Medicaid-enrolled children with ASD were $10,709 per child, which was about six times higher than costs for children without ASD ($1,812). In addition to medical costs, intensive behavioral interventions for children with ASD cost $40,000 to $60,000 per child per year. Although there is no comparable prevalence study in Thailand, there was a 2004 DMH national survey showed prevalence of 1: 1000, moreover, in 2002 Pervasive Developmental Disorder Screening Questionnaire (PDDSQ1-4 and 4-18) for children age 1-4 and 4-18 were developed in order to early detect risk group for further diagnosis. Operational research will be needed to provide effective screening, diagnostic management and appropriate intervention. Attention Deficit and Hyperactivity Disorder (ADHD) and Learning Disorders (LD) affect the learning ability of students and can lead to social problems. Worldwide-pooled prevalence of ADHD is 5.29 %. In Thailand, the prevalence was 5.01% among primary school children in Bangkok in 2002. Another study School-Based Screening for Attention Deficit and Hyperactivity Disorder (ADHD) and Learning Disorders (LD) conducted in 345 out of 30,000 primary schools under the Office of the Basic Education Commission (OBEC), the Ministry of Education. The KUS-SI screening form was used by teachers to assess primary school students, resulting in the average prevalence of ADHD was 4.1, LD-Reading, Writing and Mathematics were 7.1, 6.8 and 6.6 respectively. However, there was serious limitation in the analyzing in detail; there was a wide variety of prevalence rates so only one third of samples were categorized into acceptable range of ADHD and LD prevalence. ADHD is the highest category 38,731 cases among 58,468 cases referred to the center for student’s protection and rescue, OBEC according to the 2013 annual report. In addition, 20-40% of children diagnosed with ADHD may develop Conduct Disorder. Research has shown that children that do not receive early and comprehensive treatment have problems that are ongoing into adulthood. They may have a hard time holding a job, show aggression, act antisocially and break laws. Provided such challenging situations from prenatal period to school age and beyond, it is not a surprise to find Thai children performing flat/ stagnant, well below OECD average in all aspects: math, reading and science in PISA from 2000 to 2012. There is an urgent need for Thailand to invest in operational research to develop more effective integrated system to enhance early childhood development, early detection of vulnerable and at risk young children and provide appropriate early intervention. We need to capitalize on the scientific revolution to stimulate creative new ways of thinking, engaging much broader range of societal concerns including health promotion, family and community based care, education reform, and workforce development, protection of children from the consequences of maltreatment, violent crime and alleviation of poverty. There is a promising opportunity to mobilize evolving scientific research insights toward more effective policy and practice to promote better outcomes for vulnerable young children in Thailand.