A Multidisciplinary Approach to the Diagnosis, Treatment and Prevention of Developmental Disorders of Children in the First Years of Life

Introduction

The earliest possible detection of deviations in child development is the most important task in both medical and psychological and pedagogical practice. More than a hundred years ago, A.L. Gesell [5] laid the foundation for the scientifically based diagnosis of early childhood development by developing a system of standardized tests and age norms for assessing the mental development of children from three months to six years of age. It was he who proposed to divide the assessment of a young child’s development into several separate areas — speech, motor skills, adaptive, social and personal behavior. Later, the technique of dividing a single developmental process into a number of spheres for the purpose of their parallel assessment acquired the status of scientific tradition and formed the basis of most subsequent approaches to diagnosing the mental development of infants and young children. The number and content of the developmental spheres have changed, but in general, this analytical approach has been retained to this day.

In modern practice, the processes of the development of speech, movements, emotions, sensorics, communication, activity, and certain specific skills in children in the first years of life are of interest not only to developmental psychologists, but also to a number of other specialists. Among them are doctors — pediatricians, neonatologists, child neurologists, child psychiatrists; correctional pedagogues — speech therapists, sign language therapists, typhlopedagogists; preschool teachers; psychologists — child, family, perinatal, neuropsychologists, and other specialists. In a situation of the underdevelopment or health impairment of a child, each specialist needs to solve their professional tasks and apply diagnostic methods relevant to them. Thus, special (correctional) teachers use the methods of pedagogical examination of hearing and vision in children with sensory deficits; the methods of studying thinking, attention and memory — in children with intellectual disabilities; the methods of studying motor development — in children with motor disorders. A doctor in a situation of sensory deficiency or intellectual disability in a child will apply a different system of assessment, a family psychologist will use another one.

As a result of this diversity of approaches, a situation has developed where the overall picture of a young child’s health and development is often vague because of numerous private assessments that are not always clear to all the professionals involved in the process of providing care. At the same time, professionals of different profiles, as a rule, strive to be aware of the diagnostic assessment and therapeutic possibilities of representatives of related professions. However, it should be noted that the organizational principles of the Russian system of help to the child and his/her family often hinders the convergence of the professional positions of different specialists. This is especially noticeable in the case of their different affiliations.

Methods

The article presents a brief comparative historical analysis of changes in the existing approaches towards the diagnosis of developmental disorders in children in the first years of life, their therapy and prevention.

Results

When speaking about the modern changes in approaches towards assessing the development of children in the first years of life, it is impossible to ignore at least two significant and striking points. First, it is the shift of emphasis from the indicators of cognitive development of a young child to the parameters of emotional and social development. Until recently, the tradition of focusing on the intellectual abilities of a child in the first years of life as a basic indicator of his or her overall mental development persisted. An example is E.A. Strebeleva’s “Diagnostics of cognitive development of young children” method [6], which is usually used in Russian kindergartens to assess the level of mental development of pupils. However, in recent decades, there has been a steady tendency to emphasize areas of emotional, social and communicative development rather than cognitive development as the basic areas of development in infancy and early childhood. Thus, in Russia in the year 2000, a team of authors of the Psychological Institute of the Russian Academy of Education developed the “Diagnosis of mental development of children from birth to three years of age” method [4], where the indicators of children’s general mental development are the levels of the development of communication and joint object activity with an adult. In Western countries, this trend was clearly manifested during the third revision of the “Bayley Scales” in 2006 — perhaps the most popular instrument for assessing the development of children in the first years of life [1]. It included the “Social-Emotional Growth Chart” developed by famous child psychiatrist and psychologist S. Greenspan [8] as an independent scale. According to his concept, it is emotions and the experience of early social relationships that are the basic components of development, that in turn affect the possibilities of intellectual development and learning [3]. Thus, we are witnessing a shift in priorities from cognitive, motor, speech, or everyday skills towards emotional and social levels. Progress in development is now increasingly judged not by the ability to draw a circle or fasten buttons, but, for example, by the ability to express wants and needs clearly to another or the ability to act together. It should also be noted that the lag in the child’s social-emotional development stages or a decrease in the level of communication are very informative indicators in the diagnosis of mental disorders, in particular, autism spectrum disorders [2].

Conclusion

Thus, the need for a broad interdisciplinary approach towards the study of the modern child during the first years of life is no longer in doubt, while the opportunities for it are still emerging. For domestic specialists working with infants and young children, the situation of a rather poor provision with modern psychodiagnostic tools and scientifically grounded correctional practices remains. This situation represents a serious scientific and practical problem and should become an object of attention for the organizers of science in the field of psychology, medicine and pedagogy.