Developmental surveillance during the first 2 yrs of life
in community-based baby check-ups:
Data from 15 mths and 20 mths
Gunma Prefectural Womens University, Japan
Gunma Paz College, Japan
Results & Discussion
In Japan, community-based health checkups for babies are at 4 months, 18
months, and 36 months. These mass screenings by healthcare professionals
(doctors, nurses, etc.) at local health centers are to prevent diseases and
disorders. Attendance rates are usually high (80~99%), and these checkups
do exams for physical and developmental delays. Also now, they are
expected to play a role in early identification of developmental disorders such
as Autism Spectrum Disorders (ASDs).
A total of 221 infants were monitored at 15 months in 2012; of these, 166 who
attended both the 15 and 20 months checkups were targeted.
This study in a small town north of Tokyo, aimed to identify infants at risk
for ASDs or other developmental disorders before 2 years, and to explore
promoting early intervention to prevent or minimize deviance from typical
social development in community-based check-ups through developmental
Figure 1 shows a flowchart of the checkups at the Health Center in Tamamura
(population: 37000, number of births per year: 270). Participants are about 20
children each time; it takes about one and a half hours.
Table 1 shows the developmental assessment items for monitoring by nurses at
15, 20, and 27-months. The Social Attention and Communication Study
(SACS) conducted at the Olga Tennison Autism Research Centre in
Melbourne (Barbaro & Dissanayake, 2010 Barbaro, Ridgway, &
Dissanayake, 2011) which aimed to identify ASDs refers to these, however we
modified their task items to fit our culture and checkups. Behavioral items
focused on social attention and communication, such as Eye contact, Joint
attention, and Pointing, but also included some Motor skills. These items were
completed with each infant in the form of a social play that aimed to be a
model of interaction with infants and parents. It took about 10 -15 minutes to
examine these items and interview the parents. We started at the 15 months
check-up in 2012, and are now following these infants until 27 months.
Figure 2 shows the pass rate of 166 infants assessed at each age. Pass rates
were over 80~ 90%, except for pointing at 20 months.
We screened infants who failed more than 2 items at each age.
7.2% of 166 infants were screened at both the 15 and 20 months checkups
12.0% of 166 infants were screened only at 20 months (Group B).
10.2% of 166 infants were screened only at 15 months (Group C).
70.5% of 166 infants were not screened at either checkup (Group D).
Figures 3 show the different failure rates on items in the four groups. A chisquare analysis of each item revealed a significant difference among the four
groups (p < 0.01, df = 3) with the Group D showing higher pass rates in all
items at both 15 months and 20 months.
Figure 3. Failure Rates (%) at Each Item in the 4 Groups
Figure 1. Baby Checkup Flowchart
Interview by nurses
Dental/Medical check & Developmental
We identified three groups of infants, which each had distinctive
developmental problems and unique needs. The infants in Group A had
difficulties with social attention and communication, but also had problems
with gross and fine motor skills. Of 12 infants in Group A, we identified one
infant with severe developmental delay and two infants with suspected ASD.
(Two of these infants have been introduced to an early intervention center, but
they have not diagnosed yet. In Japan, usually pediatricians diagnose ASD, and
there are a few who diagnose ASD below two years old).
Consultations with psychologists as
Table 1. Items Checked at 15,20,and 27 Months Consultations
Joint attention (JA)
Fine motor (& Imitation)
Use/understanding of language
Turning to name call
Age at which behaviour is monitored
15 months 20 months 27 months
The infants of Group B are showing a decrease in developing social attention
and communication at 20 months. We introduced intervention programs
(individual consultation by a psychologist, group intervention programs in the
health center) to their parents. We need to follow up on these infants until 27
months to confirm whether their decrease could be temporal, in conjunction
with their increasing locomotive abilities, or not.
Figure 2. Behaviour Items and Pass Rates (%)
The infants in Group C are slow in developing social attention and
communication (or showing temporal stranger anxiety) at 15 months, but they
mostly caught up by 20 months. A high failure rate of Joint attention at 15
months in this group suggests that Joint attention with a stranger might be
harder than with parents at this developmental stage.
The most challenging point is the difficulty in motivating parents to join our
early intervention programs. Before 2 years (or 3 years), most parents are not
able to agree that their children have some developmental problems. We made
leaflets advising parents on engaging with their children. We are planning to
distribute the leaflets to all parents, not to selected parents, at the baby
checkups for wider education and also to avoid social stigma.
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