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שירותי התפתחות הילד – איפה מקומם?

Child Development Services – where do we belong?
 
Boaz Porter
בועז פורטר
Child Development Center, Merkaz Shalom, Maccabi Health Services
המכון להתפתחות הילד "מכבי  השלום"
מכבי שירותי בריאות
 


Child Development Centers were established to help with the diagnosis and management of significant neurological based developmental issues such as CP or mental retardation. Since the definition of many development related issues by Haggerty as the New Morbidity in the 1960's, the expectation for pediatricians to manage high prevalence, low severity problems related to parenting, the family, school related and social issues has increased. The scientific basis for early intervention has also increased the importance of early diagnosis of behavioral developmental issues.

The high prevalence of common developmental problems such as Developmental Coordination disorder (6%), or Expressive Language Disorder (as high as 18% at 30-39 months, Horwitz et al 2003), or up to 10% for ADHD, is reflected in the increasing loads and waiting times in CDC's. More worrying is the increasing incidence of Autistic Spectrum Disease in the western world, as high as 11.6/1000 in a British study in 2006. However, a population based study in Israel (Oren and Porter,2011), pediatricians listed such NM diagnoses in less than 1% of contacts. Pediatric residents reported no clinical exposure to children with school problems, ADHD or even routine preventive checkups
 
A shift in planning of services will be required to allow the high numbers of milder problems to be diagnosed and managed by primary care services, allowing the CDC's to deal with the more serious pathology. Such a change will require changes in pediatric training, more efficient use of CDC services and improving linkage between health, education and social services for children.
 
 
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