Prevalence of neurodevelopmental disorders and their impact on the health and social well-being among looked after children (LAC): a systematic review protocol

Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability contribute to one-tenth of the global burden of mental and neurologic disorders. The burden of NDDs is not well documented in Africa. To assess the prevalence, risk factors, and comorbidities of NDDs in young Kenyan children. This cross-sectional study was conducted among children aged 6 to 9 years residing in the Kilifi Health and Demographic Surveillance System in Kenya. In stage I of the study, children were screened for NDDs from March 16, 2015, to September 14, 2016; those with a positive screening result and a randomly selected proportion of those with a negative screening result were invited to undergo clinical evaluation to confirm the diagnosis (stage II). Adverse perinatal events, medical and family history, and socioeconomic status. Prevalence of NDDs was estimated, and risk factors and medical comorbidities associated with NDDs were assessed using generalized linear models and link functions. Of the 11 223 children screened in stage I, 5646 (50.3%) were males, and mean (SD) age was 7.6 (0.96) years. A total of 522 children had an NDD confirmed in stage II, with an overall adjusted prevalence of 9.1% (90.8 [95% CI, 83.4-98.6] cases per 1000 children), which differed by sex (237 of 5577 females [4.2%] vs 285 of 5646 males [5.0%]; P = .045). The NDDs with the highest prevalence were ADHD (50.8 [95% CI, 45.2-57.1] cases per 1000 children) and cognitive impairment (27.1 [95% CI, 22.9-31.9] cases per 1000 children); ASD was also common (15.6 [95% CI, 12.6-19.1] cases per 1000 children). Co-occurrence of NDDs was reported in 118 children (22.6%; 95% CI, 19.2%-26.5%). Key factors associated with occurrence or onset of NDDs included adverse perinatal events (adjusted risk ratio [ARR], 1.64; 95% CI, 1.29-2.09), febrile infections (ARR, 1.28; 95% CI, 1.05-1.56), eating soil (ARR, 1.45; 95% CI, 1.13-1.85), snoring (ARR, 1.50; 95% CI, 1.27-1.76), and being landless (ARR, 1.32; 95% CI, 1.12-1.56). Head injuries were unique to developmental conditions and febrile infections to neurologic conditions, with many risk factors shared. Common medical comorbidities for NDDs after adjusting for attrition and screening specificity included motor neuron dysfunction (ARR, 2.79; 95% CI, 2.18-3.56) and malnutrition (ARR, 1.80; 95% CI, 1.37-2.39). NDDs were common in school-aged children in this rural area of Kenya, and the findings suggest their occurrence was associated with preventable environmental risk factors. These disorders and associated comorbidities should be identified and addressed in children in Africa.

BackgroundConcerning the changes in the prevalence of neurodevelopmental disorders (NDDs), we estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disorder (ID), and learning disability (LD) among US children and adolescents aged 3–17 years in 2019 and 2020.MethodsThe study includes 14,983 US children and adolescents aged 3–17 years in 2019 and 2020 from the National Health Interview Survey (NHIS). Parents were interviewed about whether their children ever and/or currently had NDDs diagnosed. Prevalence estimates of NDDs were calculated with a survey-based weighting scheme. Logistic regression models were used to estimate the associations between NDDs prevalence and subgroups.ResultsThe weighted prevalence of ADHD, ASD, ID, and LD was 8.5% (95% CI: 7.9–9.2%), 2.9% (95% CI: 2.6–3.4%), 1.4% (95% CI: 1.2–1.7%), and 6.4% (95% CI: 5.8–7.0%), respectively. A higher prevalence of ADHD, ASD, ID, and LD was observed in boys, those who ever had anxiety or depression symptoms, those with lower family income, those living in a rented house, ever been bullied, and ever lived with anyone mentally ill.ConclusionThe study found the prevalence of ADHD, ASD, ID, and LD was different by demographics, comorbidity/mental problems, household/parental characteristics, and stressful life events.

ObjectiveTo interpret the current evidence on the prevalence of neurodevelopmental disorders (NDDs) through a systematic review based on both DSM-5 (2013) and PRISMA criteria.MethodEmpirical studies complying with the PRISMA guidelines were identified from four databases (PubMed, Scopus, Science Direct, and ProQuest) and systematically reviewed. In total, 17 articles were selected for the study.ResultsIn the scientific literature, there have been only a few studies measuring the prevalence of NDDs according to the DSM-5 (2013) criteria in people under 18 years old. The reported prevalence rates were as follows: intellectual disability (ID), 0.63%; attention-deficit/hyperactivity disorder (ADHD), 5–11%; autism spectrum disorder (ASD), 0.70–3%; specific learning disorder (SLD), 3–10%; communication disorders (CDs), 1–3.42%; and motor disorders (MDs), 0.76–17%. Although there is extensive literature on specific disorders, NDDs have rarely been assessed as a whole.All of the reviewed studies support the idea that such disorders can be considered chronic, heterogeneous, underdiagnosed conditions and that comorbidity of multiple NDDs is the norm. Likewise, it is estimated that the prevalence of the most studied disorders, such as ADHD, ASD and SLD, remains stable over time and is consistent in different cultures, ages, ethnicities and sexes.ConclusionThe studies reviewed lead us to conclude that the prevalence rate of NDDs fluctuates globally between 4.70 and 88.50%; these variations depend on methodological aspects such as estimation procedures, as well as on sociocontextual phenomena. It is also important to consider that the prevalence found is probably highly influenced by the activity of the countries in the diagnosis and training of professionals who care for children and adolescents. Hence, there is a need for a secondary intervention in the fields of public health and education to minimize socioemotional consequences, prevent academic failure, and reduce the economic cost to society.

Introduction: Arsenic exposure has been identified as a possible risk factor for neurodevelopmental disorders (NDDs). In Arica, research has been conducted to relate arsenic exposure to the prevalence of attention deficit hyperactivity disorder (ADHD). However, highlighting the need to explore other events, such as autism spectrum disorder (ASD), this study aimed to evaluate the association between current urinary arsenic concentration and the prevalence of NDDs in children from Arica.Methods: A cross‑sectional study was conducted using secondary data from the FONIS project #SA22I0119. The sample consists of 450 children born between 2013 and 2016. The outcome variable, diagnosis of NDDs, was measured through parent self‑reporting. The exposure variable corresponds to the current concentration of urinary inorganic arsenic, corrected by creatinine. A logistic regression model adjusted for confounding variables was used.Results: According to parent self‑report, the prevalence of ADHD was 9.1%, ASD 5.3%, and NDDs 12%. The mean urinary inorganic arsenic concentration was 19.8 μg/g creatinine, and 7.6% of the children had levels ≥35 μg/g creatinine. After adjusting for tutors’ education, number of household members, sex, and indigenous origin, those children with urinary arsenic ≥ 35 μg/g creatinine were more likely to present some NDDs (OR: 2.93; 95% CI 1.11, 7.75). For ADHD, the association was also elevated (OR = 3.85; 95% CI 1.44, 10.29).Conclusion: The findings suggest an association between arsenic exposure and the prevalence of NDDs in children. These results contribute to the evidence of arsenic’s effect on the neurodevelopment of the child population.

Systematic Review and Meta-Analysis: Prevalence of Neurodevelopmental Disorders Among Indigenous Children

The prevalence of neurodevelopmental disorders, including autism spectrum disorder (ASD), attention deficit/hyperactivity disorder (ADHD), and Tourette syndrome (TS), has increased over the past two decades. Currently, about one in six children in the United States is diagnosed as having a neurodevelopmental disorder. Evidence suggests that ASD, ADHD, and TS have similar neuropathology, which includes long-range underconnectivity and short-range overconnectivity. They also share similar symptomatology with considerable overlap in their core and associated symptoms and a frequent overlap in their comorbid conditions. Consequently, it is apparent that ASD, ADHD, and TS diagnoses belong to a broader spectrum of neurodevelopmental illness. Biologically, long-range underconnectivity and short-range overconnectivity are plausibly related to neuronal insult (e.g., neurotoxicity, neuroinflammation, excitotoxicity, sustained microglial activation, proinflammatory cytokines, toxic exposure, and oxidative stress). Therefore, these disorders may a share a similar etiology. The main purpose of this review is to critically examine the evidence that ASD, ADHD, and TS belong to a broader spectrum of neurodevelopmental illness, an abnormal connectivity spectrum disorder, which results from neural long-range underconnectivity and short-range overconnectivity. The review also discusses the possible reasons for these neuropathological connectivity findings. In addition, this review examines the role and issue of axonal injury and regeneration in order to better understand the neuropathophysiological interplay between short- and long-range axons in connectivity issues.

This study examined the prevalence of neurodevelopmental disorders among children receiving residential care in Japanese children’s homes (CHs). The data on 7854 children aged 18 years or younger were collected using a questionnaire for psychotherapists worked at 174 CHs in all regions of Japan. That included items of diagnostic state and experience of maltreatment. The prevalence of neurodevelopmental disorders was 24% in CHs. The most common type in CHs was intellectual disabilities (11.9%), and the next most was autism spectrum disorder (6.1%). Logistic regression models revealed the children with experience of maltreatment had high risk of autism spectrum disorder, attention deficit hyperactivity disorder, and specific learning disorder. These findings implied differential pattern from previous studies of Western countries.

Objectives/Background: Aarskog–Scott syndrome (AAS), also known as faciogenital dysplasia, is a rare X-linked genetic disorder primarily characterized by its diverse physical manifestations. Previous evidence suggests a potential association between AAS and neurodevelopmental disorders, including autism spectrum disorder (ASD). Methods: This case study presents a male adolescent with ASD and a novel genetic variant in FGD1 underlying AAS. We conducted comprehensive clinical, genetic, and behavioral assessments to characterize the neurodevelopmental presentation. Moreover, we examined the existing literature on AAS and comorbid neurodevelopmental disorders. Results: The patient demonstrated features consistent with both AAS and ASD, presenting with characteristic physical features of AAS and meeting diagnostic criteria for ASD on both ADI-R and ADOS-2. Cognitive assessment revealed above-average nonverbal IQ (Leiter-3, NVIQ = 115), while adaptive functioning was notably impaired (Vineland composite score = 65). Executive function deficits were identified through several assessments, though ADHD diagnostic criteria were not met. The literature review considered 64 studies, including 151 individuals with AAS. ASD was observed in 4.0%, Attention Deficit/Hyperactivity Disorder (ADHD) in 10.6%, and Intellectual Disability (ID) in 14.2% of cases. Conclusions: The combination of ASD with preserved nonverbal intelligence but impaired adaptive functioning in this AAS case demonstrates the complex neurodevelopmental manifestations possible in this rare genetic condition. The prevalence of neurodevelopmental disorders among people with AAS may be higher than their prevalence in the general population. However, a comprehensive assessment of developmental progress was rarely performed in previous studies, which may lead to systematic underestimation of co-occurring neurodevelopmental difficulties in AAS.

The prevalence of neurodevelopmental disorders (NDs) and allergic diseases(ADs) has increased in recent years. This study aimed to analyse the association between them among children registered at primary healthcare units in Izmir. For this retrospective cross-sectional study, primary healthcare units in Izmir were selected by randomisation conducted between January 1, 2023 and December 31, 2023. The dependent variables are attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). The risk factors are respiratory allergies and skin allergies. Logistic regression models were adjusted for age, sex, socioeconomic level. There were 20,557 children registered in 26 primary healthcare units. Skin allergy was detected in 7.8%, respiratory allergy in 6.8%, ADHD in 1.2% and ASD in 0.0%. ADHD comorbidity was found to be high in both children with respiratory allergies and children with skin allergies (p<0.001). The rate of ASD comorbidity was 1.8% in boys with respiratory allergies and 1.6% in boys with skin allergies (p>0.01). The analysis could not be performed due to the low number of girls with ASD. The logistic regression models showed a higher odds ratio for respiratory allergies (OR:6.2, 95% CI: 4.6-8.3) than for skin allergies (OR:2.2, 95% CI: 1.5-3.2) for ADHD. It would be beneficial to increase awareness among healthcare providers and parents about the co-occurrence of NDs and ADs.

Sex differences are prominent defining features of neurodevelopmental disorders. Understanding the sex biases in these disorders can shed light on mechanisms leading to relative risk and resilience for the disorders, as well as more broadly advance our understanding of how sex differences may relate to brain development. The prevalence of neurodevelopmental disorders is increasing, and the two most common neurodevelopmental disorders, Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) exhibit male-biases in prevalence rates and sex differences in symptomology. While the causes of neurodevelopmental disorders and their sex differences remain to be fullyunderstood, increasing evidence suggests that the immune system plays a critical role in shaping development. In this chapter we discuss sex differences in prevalence and symptomology of ASD and ADHD, review sexual differentiation and immune regulation of neurodevelopment, and discuss findings from human and rodent studies of immune dysregulation and perinatal immune perturbation as they relate to potential mechanisms underlying neurodevelopmental disorders. This chapter will give an overview of how understanding sex differences in neuroimmune function in the context of neurodevelopmental disorders could lend insight into their etiologies and better treatment strategies.

An exploration into the prevalence of neurodevelopmental disorders in looked after children and the effects on health and social wellbeing.

Familial and environmental factors contribute to neurodevelopmental disorders (NDDs). Prenatal psychotropic exposure may influence the risk of NDDs in children. As these medications are prescribed to women with mental disorders, which are genetically and environmentally linked to NDDs, accounting for familial confounding is essential when studying medication safety in pregnancy. To compare the prevalence of NDDs in pregnant women using psychotropics, their partners, and their previous children, with those not using these medications. We included data from the most recent pregnancy of Norwegian women with mental disorders who gave birth between 2010 and 2018, using Norwegian registries. Maternal psychotropic use included antidepressants, antipsychotics, anxiolytics, hypnotics, and sedatives, as recorded in the Norwegian Prescription Database. NDDs were identified using ICD-10 codes for intellectual disabilities, language/scholastic disorders, pervasive developmental disorders, and attention-deficit hyperactivity disorders (ADHD) from the Norwegian Patient Registry. Modified Poisson regression estimated crude and adjusted relative risks (aRRs) for the association between psychotropic use and family history of NDDs. The study included 27,638 women. Among psychotropic users, NDDs prevalence was 9.6% in women, 5.4% in partners, and 10.0% in previous children, compared to 5.7%, 4.6%, and 8.0% in non-users, respectively. ADHD was the most prevalent NDD. Psychotropic use in pregnancy was associated with any NDD, particularly ADHD, in the women [any NDD aRR 1.77 (95% CI 1.60, 1.95); ADHD aRR 1.79 (95% CI 1.61, 1.98)], previous children [any NDD aRR 1.25 (95% CI 1.07, 1.47); ADHD aRR 1.26 (95% CI 1.02, 1.54)], and partners [any NDD aRR 1.21 (95% CI 1.06, 1.37); ADHD aRR 1.22 (95% CI 1.07, 1.39)]. Prenatal psychotropic use was associated with a higher prevalence of NDDs in mothers and their previous children, highlighting the need to account for familial neurodevelopmental patterns to distinguish the effects of psychotropics from underlying genetic or familial factors.

BackgroundOver the last decade, several studies investigated the outcomes in children born very preterm. Only recently there has been an increasing interest in the late preterm infants (born between 34 + 0 and 36 + 6 weeks). This population is at high risk of morbidity and mortality in the first years of life. Other studies reported that they are also at risk of long-term developmental problem. Therefore, the aim of this study is to describe the neurodevelopmental and emotional-behavioral outcome in a sample of late preterm patients.MethodsThe study included late preterm children and adolescents who had neuropsychiatric and/or neurological symptoms. They underwent a general, neurocognitive and an emotional-behavioral assessment. Exclusion criteria included: patients affected by Central Nervous System congenital abnormalities, neurodegenerative diseases, genetic disorders, epilepsy, or in pharmacological treatment, or adopted children. A descriptive statistics analysis was performed to describe the sociodemographic and clinical characteristics of patients. Risk factors related to late preterm birth, prevalence of neurodevelopmental disorders, and cognitive functioning were recorded and analyzed.ResultsThe sample included 68 LPI (45 males and 23 females) aged from 2 to 16.3 years (mean age 7,5 years), who were affected by one or more neurodevelopmental disorder, including Language Disorder, Attention Deficit Hyperactivity Disorder, Specific Learning Disorder, Developmental Coordination Disorder, Intellectual Disability and Autism Spectrum Disorder. Moreover, in 30.8% of patients, internalizing problems (affective and social skills problem) were detected.ConclusionsOur results support the importance of a long-term surveillance of late preterm and the great need for more longitudinal large population studies in order to collect data on the neurodevelopmental outcomes of this population.

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessHigh Rates of Fetal Alcohol Disorders Found in Urban AreasNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:3 Apr 2015https://doi.org/10.1176/appi.pn.2015.3b6AbstractA study of patients in a Chicago clinic finds that nearly 40 percent of psychiatric patients present with a neurodevelopmental disorder due to prenatal alcohol exposure.While the cause of many mental disorders remains mysterious, there are etiologies that can be explained, which makes it even more frustrating when prevention or intervention efforts lag. Such is the case for developmental problems brought on when pregnant women drink alcohol.Roxana Gonzalez/ShutterstockFetal alcohol exposure is one of the leading causes of speech and language disorders, attention-deficit/hyperactivity disorder (ADHD), and learning disorders. Fetal alcohol-related developmental problems are entirely preventable, yet remain fairly common; a recent study of Midwestern first-graders published in Pediatrics estimated that between 2.4 percent and 4.8 percent of children have a fetal alcohol spectrum disorder (FASD).In some communities, such as poor urban areas, however, where liquor stores are a ubiquitous presence, the prevalence might be even higher, though not much research has been done related to populations of these areas. A study published online last month in Psychiatric Services in Advance provides some context on how pervasive alcohol-related developmental problems are in one such urban community. Carl Bell, M.D., a clinical professor of psychiatry and public health at the University of Illinois School of Medicine, and coauthor Radhika Chimata assessed the records of 590 adult and 21 youth psychiatric patients—who were almost all African American—who attended the Family Medicine Clinic at Jackson Park Hospital on Chicago’s Southside. They found that 237 of the 611 patients, or nearly 40 percent, had clinical profiles consistent with a neurodevelopmental disorder associated with prenatal alcohol exposure, while only 53 patients, or 9 percent, presented with a “classical” DSM-5 neurodevelopmental disorder such as intellectual disability, ADHD, or autism; the authors disagreed on the specific type of neurodevelopmental disorder in seven additional patients. As anticipated, many of the patients with FASD had been previously misdiagnosed with one of these disorders or with an illness such as bipolar disorder. Even Bell, who is a staff psychiatrist at the Family Medicine Clinic, admits to missing some cases. “I did not have a clue how prevalent this neurodevelopmental problem was, and I was seeing these people clinically.”Regardless of the past, Bell believes this issue is of paramount importance moving forward. “This is the biggest public-health issue since polio,” he told Psychiatric News. In addition to causing developmental disabilities—which were for the first time acknowledged in the new DSM-5 as neurodevelopmental disorder associated with prenatal alcohol exposure (ND-PAE)—alcohol can induce other physical and neurological problems in fetuses, including heart murmurs, facial abnormalities, and reduced size and weight. This combination of disabilities makes children with FASD frequent targets of abuse (physical, verbal, and sexual), which in turn brings on more behavioral problems and an increased risk for substance abuse.And the problem is not going away. “We identified 237 cases of fetal alcohol disorder during our assessments, but more have come through the clinic doors since then,” Bell said. “The clinic now sees more than 400 people with this condition, and like a marching band going down a dead-end street, they just keep filling up the facility.”“This work illuminates the troubles facing an underserved population in Chicago, but it also provides just a snapshot of the ‘iceberg’ that we find in our society as a whole,” said Susan Rich, M.D., M.P.H., a psychiatrist who specializes in fetal alcohol spectrum disorder and raising awareness about it. “Wherever we find social drinkers who on occasion binge alcohol, we will find ND-PAE.” As an example, Rich noted that the Centers for Disease Control and Prevention has cited college-age youth as having the highest risk of ND-PAE because they are frequently sexually active while drinking at binge rates.To tackle this problem, Rich believes that focused, preconception, prevention strategies are needed to help curb the high unplanned pregnancy rate in the U.S. She pointed out that most of the mothers interviewed in Bell’s study stopped drinking once they knew they were pregnant, so even in places with high rates of alcohol use, like disadvantaged urban areas, mothers try to protect their babies’ health once they are aware of their pregnancy.But drinking even during those first few weeks of pregnancy can lead to a lifetime of disability for the unborn child, she noted. ■An abstract of “Prevalence of Neurodevelopmental Disorders in Low-Income African-Americans at a Family Medicine Clinic on Chicago’s Southside” can be accessed here. An abstract of “Prevalence and Characteristics of Fetal Alcohol Spectrum Disorders” is available here. ISSUES NewArchived

New research shows that the prevalence of neurodevelopmental disorders, such as attention-deficit/hyperactivity disorder (ADHD), is increased in children and adolescents as well as in adults with chronic pain, compared to those without chronic pain. Children and adolescents with ADHD also have an increased incidence of various physical conditions associated with pain, and they more frequently suffer from inflammatory diseases. Moreover, parents of children with ADHD can often suffer from pain conditions. These epidemiological and clinical observations form the scientific basis of our study, which aims to map the relationships between ADHD, altered pain experiences/central sensitization, and inflammation in children and adolescents. We will investigate the presence of central sensitization in children and adolescents with newly diagnosed ADHD and compare it with those who have not been diagnosed with ADHD. Participants (and their biological parents) will complete surveys about their somatic health, pain experience, and quality of life. Biological samples (saliva and stool) will be collected, aiming to utilize proteome and metabolome data to discover disease mechanisms and to predict, prevent and treat them. The results from our investigation should enable an expanded understanding of the pathophysiology behind both ADHD and pain/central sensitization. Presently, there are no established protocols for addressing psychiatric symptoms when examining patients with pain conditions in a somatic care setting, nor is there any knowledge of offering patients with ADHD or other neurodevelopmental disorders adapted treatments for pain conditions. Our results, therefore, can contribute to the development of new treatment strategies for pathological pain conditions in children and adolescents with ADHD. They may also increase awareness about and provide opportunities for the treatment of attention and impulse control problems in children and adolescents with pain syndromes.