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A comparative study of pathways to care for children with specific learning disability and mental retardation
Suhash Chakraborty1, John Vijay Sagar Kommu2, Shoba Srinath2
1HAL Hospital, Bangalore, India.
Insights
Pathways to care for children with specific learning disability (SpLD) and mental retardation (MR) often involve multiple carers, including traditional healers, reflecting cultural beliefs. Early intervention is crucial for better outcomes in SpLD.
Area of Science:
- Child Psychology
- Developmental Pediatrics
- Public Health
Background:
- Early intervention for specific learning disability (SpLD) improves outcomes and prevents comorbidities.
- Understanding care-seeking pathways is vital for timely diagnosis and support.
Purpose of the Study:
- To compare the pathways to care for children with SpLD and mental retardation (MR) prior to tertiary care referral.
- To identify differences and similarities in care-seeking behaviors between SpLD and MR groups.
Main Methods:
- Cross-sectional study involving 100 children (50 SpLD, 50 MR) aged 8-16 years.
- Utilized MINI-KID for comorbidity assessment and Goldberg's pathway to care instrument.
- Categorized participants into early (≤3 carers) and late (>3 carers) contact groups.
Main Results:
- SpLD children's first contact was often 'others' (e.g., teachers), while MR children first consulted allopathic practitioners.
- Both groups consulted traditional healers, indicating belief in supernatural causes.
- Referrals to tertiary centers were predominantly made by 'others' (62% SpLD, 56% MR).
- Younger age was associated with early contact in SpLD (P=0.01).
- Mother's education significantly impacted early contact (P=0.036), while comorbidity was linked to late contact (P=0.038).
Conclusions:
- Care pathways for SpLD children resemble those for MR children when MR is recognized late.
- The frequent consultation of traditional healers highlights strong beliefs in supernatural causes for developmental disorders in India.
- Findings underscore the need for culturally sensitive interventions and improved awareness regarding developmental disorders.
Context:
Early intervention in specific learning disability (SpLD) results in better outcome and prevents comorbidity. Understanding the pathways is therefore important.
Aims:
To study and compare the pathways to care for children with SpLD and mental retardation (MR) before reaching a tertiary care center.
Settings And Design Material And Methods:
A cross-sectional study was conducted for pathways to care of two groups: SpLD and MR with 50 children in each group from 8 to 16 years. MINI-KID for comorbidity and Goldberg's pathway to care instrument was used. The groups were divided into early contact (up to three carers) and late contact (more than three carers) and compared.
Statistical Analysis:
Data were analyzed using Statistical Packages for Social Sciences (SPSS) version 10.0 software.
Results:
Majority (n = 24 or 48%) of SpLD children visited "others" (teachers, neighbors, relatives, and guardians of fellow classmates) as first carer. Allopathic practitioners were the first choice for MR children (n = 31 or 62%). Six children (12%) in SpLD group and 10 of MR (20%) group have seen either traditional practitioner or healer as first carer. Maximum referral to the tertiary center in both groups was done by others (62% in SpLD and 56% in MR group). Early contacts in SpLD group belonged to younger age group (P = 0.01). While comparing both groups on the basis of early and late contact, mother's education was found to be significant in early contact group (P = 0.036) and having comorbidity was significant among late contacts (P = 0.038).
Conclusions:
The pathways to care for SpLD children are more or less similar to MR children whose parents recognize MR late. Both the groups visit multiple carers including traditional healers substantiating the strong belief for supernatural causation of developmental disorders in India.
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