Prevalence of Neuro-Developmental Disorders in India

Background:  Due to lack of awareness of neurodevelopmental disorders (NDDs) and resources for diagnosis and provision of services among parents as well as health care providers and educators, many children with NDDs in India remain undetected and thus untreated. . Also the services available are grossly inadequate and inappropriate as per the anticipated requirement. As noted in the 2008 UNICEF report on child disability in developing countries, clinical diagnostic evaluations for children at risk for disability are essential to developing treatment programs and other intervention programs. The current project was undertaken to address these issues and to provide an enabling environment for children with one or more of these NDDs.

Objectives:  To assess the prevalence of ten (10) common neuro-developmental disorders (NDDs) among children aged 2-9 years in India.

Methods: The prevalence was estimated using Consensus Clinical Criteria (CCC). The CCCs had been identified/ prepared and validated for diagnosing the NDDs based on universally accepted criteria like DSM IV-TR, ICD-10 and WHO. Population proportionate to size (PPS) cluster sampling technique covering 4000 children across five geographic populations at five sites in India viz [Palwal (Haryana); Kangra (HP); Hyderabad (AP); Denkanal (Orissa) and Goa (Goa)] (50 clusters in three states & 25 clusters in two states) was employed to recruit participants. Firstly, the screening tool (NDST) was applied, separately by a doctor and by social scientist, on 20 children per cluster (10 each from the 24-71 months and 72-107 months with equal number of boys and girls in each category) at their residence on two consecutive days. Following this, all these children were mobilized to a health facility for administration of the diagnostic consensus clinical criteria by a team of doctors, clinical psychologist and audiologist.

Results: The application of the CCC shall yield the overall prevalence NDDs and specific disorders. The prevalence of all nine NDD (excluding HI) in 2-5 yrs of children is 11.2 % [95% CI=0.08-14.0] and in 6-9 yrs of children is 15.2% [95% CI=12.3-18.7]. The preliminary data from one site shows 0.9% [95% CI=0.04-1.7] prevalence for ASD. Of the children who were identified as having NDD, 78.2 % [95% CI=71.5-83] had single NDD and 20.6% [95% CI=15.3-27.2] exhibited more than one NDD in 2-9 years of children (preliminary data). The analysis is ongoing and detailed result for behavioral, neurological and sensory disorders from all the sites would be presented, both an aggregate and separately.

Conclusions: The preliminary results highlight the concerning magnitude of NDDs across the country. This call for concerted policy making for appropriate resource allocation and targeted rehabilitative interventions so that these children could be brought to mainstream society without stigmatization help them achieve their maximal potential.