The Developmental
Intervention Clinic
UTH-PCOE Lusaka, Zambia
Multidisciplinary Assessment & Intervention Strategies & Case Report
REPSSI PSS Forum 2 September 2015, Victoria Falls, Zimbabwe
A. Kabwe-Grollnek, & S. Shanungu
Outline1. Case Report: how health and
socio economic factors affect the well being of young children with special needs.
2. The psycho social needs of young children with special needs and their families are varied and mulitple
3. How a multidisciplinary model supports the well being of young children and their families
MARY
Background• 6y F. Referred for challenges in
communication & learning• Lives with:
– Biological mother & 1 younger sister– Father left the family soon after
birth of second child
• Mother HIV positive on HAART. – Unemployed & family has no regular
income
• Pregnancy, delivery & perinatal period– Referred uneventful– No PMTCT strategies
MARY• Developmental milestones:
– Delayed in all domains• Past medical history:
– 2mo- child severely & chronically ill– 13mo- admitted for severe
malnutrition & recurrent febrile episodes.• Diagnosed with HIV & started on HAART
– 3yr-onset of seizures• Follow up care & treatment
– Defaulted several times: on 2nd line ART
– Did not report for medical attention until 6 years of age
Factors Affecting Mary’s Development
• HIV infection in prenatal period & infancy– Recognised cause of developmental delay and neurological disorders in
infected children (HIV encephalopathy)
• Untreated epilepsy (uncontrolled seizures)– Further neurological damage with significant behavioural and cognitive
co-morbidities
• Severe malnutrition & chronic illness– Co factors in developmental delay & cognitive impairment
• Psychosocial Factors– Parental absence– Maternal health– Support– Socioeconomic insecurity
• Poor stimulation & emotional deprivation
Challenges Faced by Young Children with Special Needs & Their Families
• Acceptance• Support• Costs• Time commitment
– 24/7 consistent care– Frequent hospital visits– Difficulty maintaining employment
• Impact on parental relationship
• Well being of other siblings
• Limited rehabilitation services
• Challenges with school enrolment
Addressing the Psychosocial Needs of Families
• Psychosocial needs of adults have a direct impact on children
• Concurrent interventions need to be provided through parent or family focused intervention
• Programs should:– Focus on strengthening
families as responsive and protective spaces for children
Action for rights of children-resource pack. Foundation Module 7 Psychosocial Support, 2009. www.arc-online.org
Determinants of Wellbeing in Early Childhood Development
• Health & socio economic factors affect development
• Toxic environments = poor development
• Importance of quality caregiver-child interactionsSiddiqui,A., Irwin,L., Hertzman C. (2007)
The Developmental Intervention Clinic
• Provide support to:– Individual child’s
neurodevelopmental needs• Medical• Rehabilitative
– Caregiver’s psychosocial needs• Formal counselling• Informal counseling
The Developmental Intervention Clinic
• Early identification & intervention of children with neurological complications & other special needs
• Target age group: 0 – 7yrs– Developmental delay/disability, HIV,
Epilepsy, SCD
• Parent focused– Parent’s are key players in
intervention– Supports parent-child relationship– Quality interactions– Promote play & interaction with child
Referral
Intake
Neurological assessment
Therapy Assessment• Cognitive skills• Occupational therapy• Physiotherapy• Speech & language• Challenging behaviour• Psychosocial evaluation
for family members
Intervention• Learning support• Fine & gross motor
development• Communication skills• Behaviour management• Psychosocial support• Individual and group
therapy (parent’s support each other)
Multidisciplinary Support
Common Neurological Conditions
25%: CP (neurological sequelae) • 50%: birth asphyxia
• 50%: kernitterus, neonatal meningitis/sepsis & CNS infections
9%:Global Developmental Delay & Neurological Disorder HIV
related
20%: Epilepsy• 80% symptomatic
Speech Delay• 7 % Isolated• 24% associated with other
neurological condition
8 %: Autism Spectrum Disorder • 12%: ASD features
3%: ADHD• 6%: ADHD features
8% Behavioral Disorders
3%: Neurological Sequelae (CVA) of SCD
3%: Genetic Syndromes
12%: Global Developmental Delay of
Unknown Origin
Challenges of Families at the D.I.C.
Not in school 79%Meeting basic needs 31%
Married 80%Single 13%
5+ dependents 61%
Mary’s Assessment & Intervention
Mother’s Main Concerns• Communication
– single words only
• Behaviour:– Hyperactive & limited
attention– Unaware of danger– Follows strangers (asks for
money or food)– Has left home on several
occasions-missing for a few days at a time
Assessment Findings
Neurological evaluation• Disinhibition• Hyperactivity• Short attention span• Inability to complete age
appropriate simple tasks• Stunted: (height/age 2DS/3DS
below the median)• Diagnosis: RVD in HAART
– Developmental delay– Behavioural disorder (ADHD
features, disinhibition)– Speech & cognitive impairment– Symptomatic epilepsy
Speech & Language Assessment
• Expressive language limited to 10 – 20 single words
• Articulation challenges• Receptizve language: below
average for age– Unable to follow 2-step
directions
Assessment Findings
Cognitive Assessment• Poor performance in
abstract reasoning, cube design & analogical reasoning– Universal Non-Verbal
Intelligence Test (UNIT) full scale intelligence score: 46
– 3 standard deviations below mean
Assessment Findings
Diagnosis
• Communication, behavioural, cognitive Disorder
The Impact• Heavy consequences in:
– Educational opportunities– Social integration
• High risk of child abuse• High risk of drug resistance
(poor compliance)
Mary’s Intervention
• Counselling with Mother– Importance of adherence to medication– Prepare for disclosure of child’s status– Nutritional counselling
• Parent training:– Strategies to reduce dangerous behaviour– Strategies to enhance communication and social skills
• Developed in collaboration with parent
• Assist in educational support • Address medical concerns (HIV, epilepsy, malnutrition)
Conclusion• Multidisciplinary & targeted interventions can greatly
improve psychosocial well being and neurodevelopmental outcomes
The Developmental Intervention Clinic
• Alice Kabwe Grollnek– Clinic coordinator– [email protected]
• Sandra Shanungu– Psychosocial
counsellor/Admin– [email protected]>
• Location:– Paediatric Centre of
Excellence University Teaching Hospital, Lusaka Zambia
– 1 Nationalist Road, Lusaka Zambia
• Tel: +260211 257 535/6• Mobile: +26097 4595
361
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