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Early detection of neurodevelopmental disorders in paediatric primary care: A scoping review
Paulette T O'Hara1,2, Pamela Talero Cabrejo2, Tracey V Earland2
1Department of Public Health, California Children's Services, Los Angeles, CA, United States.
Insights
Early detection of neurodevelopmental disorders in young children is crucial. Paediatric primary care models show promise, aligning with occupational therapy practices, yet often exclude occupational therapists from early detection efforts.
Area of Science:
- Paediatric primary care
- Neurodevelopmental disorders
- Occupational therapy
Background:
- Early detection of neurodevelopmental disorders in children is critical for long-term outcomes.
- Timely intervention can mitigate the lifelong impact of these conditions.
Purpose of the Study:
- To identify characteristics of paediatric primary care models that support early detection of neurodevelopmental disorders in infants and toddlers.
- To determine the healthcare practitioners involved in these models.
- To assess the alignment of these models with occupational therapy's scope of practice.
Main Methods:
- A scoping review was conducted using the Joanna Briggs Institute framework.
- Searches were performed in PubMed Central, CINAHL, and Scopus databases (January-February 2022).
- Included studies focused on children aged 0-3 years with neurodevelopmental disorders (e.g., cerebral palsy, autism spectrum disorder) in primary care settings, published 2010-2022.
Main Results:
- Twenty-two studies were included, highlighting models incorporating technology, parent/staff education, funding, flexible assessments, and extended visit lengths.
- Key practitioners were pediatricians, general/family practitioners, nurse practitioners, and office staff.
- All identified models aligned with occupational therapy's health promotion and intervention principles, but occupational therapists were not explicitly included in primary care settings.
Conclusions:
- No studies integrated occupational therapy as a provider within paediatric primary care for early detection.
- However, existing models possess characteristics that align with occupational therapy practices.
- Interdisciplinary collaboration, including potential occupational therapy involvement, is key to enhancing early detection in primary care.
Background:
Earlier detection of children at risk for neurodevelopmental disorders is critical and has longstanding repercussions if not addressed early enough.
Objectives:
To explore the supporting or facilitating characteristics of paediatric primary care models of care for early detection in infants and toddlers at risk for neurodevelopmental disorders, identify practitioners involved, and describe how they align with occupational therapy's scope of practice.
Methods:
A scoping review following the Joanna Briggs Institute framework was used. PubMed Central, Cumulative Index to Nursing & Allied Health Literature, and Scopus databases were searched. The search was conducted between January and February 2022. Inclusion criteria were: children aged 0-3 years old; neurodevelopmental disorders including cerebral palsy (CP) and autism spectrum disorder (ASD); models of care used in the paediatric primary care setting and addressing concepts of timing and plasticity; peer-reviewed literature written in English; published between 2010 and 2022. Study protocol registered at https://doi.org/10.17605/OSF.IO/MD4K5.
Results:
We identified 1,434 publications, yielding 22 studies that met inclusion criteria. Models of care characteristics included the use of technology, education to parents and staff, funding to utilize innovative models of care, assessment variability, organizational management changes, increased visit length, earlier timeline for neurodevelopmental screening, and collaboration with current office staff or nonphysician practitioners. The top 4 providers were paediatricians, general or family practitioners, nurse/nurse practitioners, and office staff. All studies aligned with occupational therapy health promotion scope of practice and intervention approach yet did not include occupational therapy within the paediatric primary care setting.
Conclusions:
No studies included occupational therapy as a healthcare provider that could be used within the paediatric primary care setting. However, all studies demonstrated models of care facilitating characteristics aligning with occupational therapy practice. Models of care facilitating characteristics identified interdisciplinary staff as a major contributor, which can include occupational therapy, to improve early detection within paediatric primary care.
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