Mental, neurological and psychosocial development

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Mental, neurological and psychosocial development
Why. to provide additional support and counseling to families of children with problems of development, and referral to any special services available in the community , health centre or district, in order to minimize impairments and their consequences. Counseling and referral may involve highly specialized diagnostic and treatment resources. however, emphasis should be placed on primary care measures at the community level ,promotion of parents, skills in child –rearing  according to local norms, and early stimulation of children, s learning capacity. Teenage parents and parents isolated from their extended family may be in particular need of support.
How. Restandardization of the denver developmental screening test (DDST)for use in northern china has been the subject of an apparently successful large-scale study (collaborative study group of child develop mental test 1986) such formal developmental testing is , however, expensive, and is not recommended as an initial screening technique by either the us preventive services task force (USPSTF,1989) or the UK working party ( macfarlane et al., 1989) it seems rational for parents and according to culturally appropriate milestones, e.g., speech, crawling, walking, dressing self, feeding self. The home –based child s health card can be a useful tool in developmental screening, with pictorial aids for assessing the milestones. Children found to have abnormalities on initial screening by primary care workers, or whose parents express concern about their development, should be referred for formol testing if the relevant diagnostic and treatment services are available on a population-wide basis.
When . frequency will depend on culture –specific milestones for acquisition of skills. The immunization schedule would be a rational determinant of the  developmental screening schedule, with a culturally appropriate milestone being selected for each stage.
Resource levels required. Low for detection by primary care workers guided by the pictorial symbols on the home based child s record. Medium, high , or very high for definitive diagnosis and intervention by trained personnel.
Recommendation on use of screening early detection. Screening and early detection are recommended, using simple culturally appropriate milestones that can be assessed by primary care workers. Formal developmental testing is not recommended. Parents and child care workers should be taught to refer for evaluation any child who is not progressing according to community standards, and health care provider should be trained to ask parents and other care-givers about any subject of concern during routine well-baby and well- child visits. Even where resources are not available for definitive diagnosis and specialized intervention, primary care workers can train family members and care providers to give special attention and support in order to minimize impairments and prevent child abuse.
Research priority . developing primary care methods of screening and intervention.

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