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INTRODUCTION:
In pediatric primary health care, one of the basic activities is
the prevention of diseases and conditions that endanger the quality
of life of the child and his daily functioning in the environment.
According to world data , about 17% of children have some
developmental difficulties, which are discovered in only 50% of them
before they start school [1]. That would mean that today in Serbia
there are 60,000 children with developmental risks and disabilities.
Data on the situation in Serbia, obtained during the standardization
of the questionnaire "Age and development of the child" - URD in
2019, indicate that 8-13% of children need constant monitoring in
some area of development, 4-5% of children need to be referred to a
detailed research, as well as that 16.5% of children do not live in
a developmentally supportive environment [2]. If nothing is done at
the societal level to reduce the prevalence of retardation to 15% or
lower and if retardation is not addressed through pre-school
education and public health nursing, the costs are several times
higher than the current allocations of most countries for health and
education [ 2]. At the individual level, 43% of children at risk do
not reach their developmental potential and are likely to lose 26%
of average annual income as adults, resulting in poverty [3].
Therefore, the processes of assessment, monitoring and support of
the development of each child are in the focus of the work of the
pediatric service.
Objective of development assessment
The goal of development assessment is systematic and precise early
detection of deviations from normative development, timely
undertaking of appropriate interventions, as well as elimination or
mitigation of disorders [4]. Assessment of developmental achievement
and age of development is a comparison, standardization of
developmental achievements in relation to the age at which certain
behaviors are manifested in the development of a healthy child, who
lives in adequate (stimulating) environmental conditions, ie.
comparing the behavior of the examined child with typical (expected,
normative, common) behaviors that occur in the development of a
healthy child [5].
In order for these processes to take place to the satisfaction of
children, parents, and professionals themselves, modern
pediatricians can not rely solely on professional but insufficiently
systematic clinical examination, but need to use additional
information that can provide various tools in the form of
questionnaires. tests and scale. With their help, a more
comprehensive insight into the child's abilities and health is
gained in a shorter time, and if there are minor deviations and
delays in development, they are detected early and the help of
health workers and associates arrives on time, when it is most
effective [3].
Research results
Research has shown that the use of instruments has increased the
early detection of developmental delays or developmental disorders
(in this way, 70-80% of children with developmental problems are
detected) and provided an opportunity for early application of
intervention measures. The use of instruments eliminates the
uncontrolled effects of personal and subjective standards and
reduces the inconsistencies of standards applied by different
evaluators [6]. It is possible to monitor the results by repeating
the application of certain instruments.
The set of 21 Ages & Stages Questionnaires ASQ-3 has been used for
more than 30 years worldwide to screen and evaluate children's
development by observing how children progress in important areas
such as speech, physical ability, social and problem-solving skills
for children aged 2 months to 5.5 years [7]. It is filled in by
parents and returned to professionals, and they further make an
assessment based on clear instructions on the procedure of writing
results in the domains of development, scoring (graphical and
tabular) interpretation and communication, as well as training
parents to stimulate development through play, ie. how and what to
do next with the child [8].
In the past ten years, the Association of Pediatricians of Serbia,
together with its partners, has advocated for a comprehensive
assessment and monitoring of children's development using valid
instruments within preventive pediatric examinations.
Standardized questionnaire ASQ-3 - "Age and development of the
child" (URD)
Through a series of projects in this area, through education of
pediatricians and associates, application in practice, the
standardized questionnaire ASQ-3, entitled "Age and development of
the child" (URD) was tested and adapted in 2019. After
standardization and entry of our borderline values, the Serbian
version was approved by the author of the original ASQ-3, and is
available on the publisher's portal (https://brookespublishing.com/product/asq-3/).
The association also prepared an expert-methodological instruction
along with the Serbian version of the URD questionnaire with a
description of its use as a screening [8]. Our results and
recommendations of the American Academy of Pediatrics were used to
select three ages at which it is necessary to do universal screening
for all children in Serbia, using the Serbian version of
standardized URD-3 questionnaires at the ages:
- 10 months (age period from 9 months and 0 days to 10 months and 30
days) or 12 months (if not implemented in the 10th month)
- 18 months or 24 months (if not implemented in the 18th month)
- 30 months or 36 months (if not implemented in the 30th month).
Targeted screening (at any age, regardless of age) can be performed
when a doctor, parent or other professional close to the child
expresses concern for the child's development or the child is
exposed to multiple risks that could jeopardize development [9]. Our
research on the standardization of this instrument indicates that it
would be desirable to do screening at the age of 48 and 60 months
[10].
The reasons why URD is recommended in our country as an instrument
for universal screening of development and why we are in favor of
its application lie in its advantages: it is easy to apply - it
contains tasks from the child's daily life and can be easily
checked; it is focused on what the child can do; contains
accompanying materials for professionals and parents (Incentive
activities); includes and trains parents to monitor and encourage
child development. The URD questionnaire can help identify a child's
talents, as well as any areas where a child may need help. It is
filled in by the child's parent or guardian. In this way, the
competence and self-confidence of the parents increase, and the
child's progress confirms the feeling that they are successfully
fulfilling their parental role [11]. Our experiences during the
application and during the research in the process of
standardization confirm that parents in our environment are also
interested in this type of joint monitoring of children's
development [2].
In addition to the above, significant reasons lie in the fact that
the Decree on the National Program for Improving Early Childhood
Development clearly defines the need to introduce instruments into
the daily practice of pediatricians and teams in development
counseling departments of health centers, and for screening of whole
population standardized URD questionnaires are recommended 12]. In
addition, over 240 pediatricians, 250 pediatric nurses, visiting
nurses, and numerous health associates have already been trained in
the courses of the Association of Pediatricians of Serbia and
partners. Pediatricians used it as a screening for over 13,000
children in Serbia. The education of future educators for the entire
territory of Serbia was also performed. It is expected that in the
next period, they will train colleagues in their districts. It is no
less important that the questionnaire is very well accepted by
parents [13].
CONCLUSION
The presented facts about screening, the importance of the
application of the standardized instrument for monitoring
development and the URD questionnaire, are sufficient reasons to
introduce it into the daily preventive work of pediatricians. In
order for it to be applied in practice for screening development in
early childhood, all pediatricians should undergo appropriate
training; a sufficient number of staff, pediatricians and nurses
should be provided for its application; by amending the relevant
regulations that should become mandatory. It is necessary to secure
the rights of use from the rights holders and procure a sufficient
number of copies of the Serbian version of the URD questionnaire,
every year.
LITERATURE:
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porodice i deteta u ranom detinjstvu. Vodič za zdravstvene
radnike i saradnike u primarnoj zdravstvenoj zaštiti. Udruženje
pedijatara Srbije, Beograd, 2017; 41-50.
- Videnović M., Stepanović Ilić I., Lozanović D. Šta smo
saznali standardizacijom upitnika Uzrasti i razvoj deteta. U:
Zbornik predavanja 23. seminara Pedijatrijske škole Srbije.
Beograd; 2021. Dostupno na: www.udruzenjepedijatara.rs. preuzeto
22. 7. 2021.
- Lozanović D. Videnović M. Stepanović Ilić I. Standardizovani
upitnik „Uzrasti i razvoj deteta“: ka uspešnoj primeni u radu
pedijatara u Srbiji. U: Bogdanović R, Radlović N. Zbornik
predavanja 23. seminara Pedijatrijske škole Srbije. Beograd,
2021; Dostupno na: www.udruzenjepedijatara.rs. preuzeto 22. 7.
2021.
- Mikov A, Lozanović D. Instrumenti za procenu i praćenje
razvoja dece do pet godina. U: Bogdanović R, Radlović N. (kancelarija):
Zbornik radova 20. seminara Pedijatrijske škole Srbije. Beograd,
2017; 7-15.
- Lozanović D, Radivojević D: Podrška razvoju dece u ranom
detinjstvu: Instrumenti za procenu razvoja. Udruženje pedijatara
Srbije, Beograd. 2013.
- Kliegman RM, St Geme JW, Blum NJ, at al. Nelson Textbook of
Pediatrics, 21st ed. Elsevier Saunders, 2019.
- Squires J, Farrell J, Clifford J, et al. ASQ and ASQ: SE
Training Materials by. Paul H. Brookes Publishing Co; 2007.
Dostupno na: http://products.brookespublishing.com/ASQSE-2-Users-Guide-P851.aspx,
preuzeto 2.5.2021.
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upitnika Ages & Stages-3/Uzrasti i razvoj deteta".
Stručno-metodološko uputstvo za primenu upitnika "Uzrasti i
razvoj deteta". Dostupno na: www.udruzenjepedijatara.rs.
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- Lozanović D. Praćenje i procena razvoja dece u ranom
detinjstvu. U: Bogdanović R, Radlović N.: Pedijatrija, udžbenik
za poslediplomsko usavršavanje lekara, II dopunjeno izdanje.
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Standardizacija instrumenta ASQ-3 za skrining razvoja male dece
u okviru pilot projekta sistema rane intervencije u Srbiji.
Institut za psihologiju Filozofskog fakulteta Univerziteta u
Beogradu. Beograd. 2019.
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Preuzeto: 7.12.2020
- Vlada Republike Srbije. Uredba o Nacionalnom programu za
unapređenje razvoja u ranom detinjstvu. Sl. Glasnik RS 22/16,
2016.
- Lozanović D. Zašto se zalažemo za primenu standardizovanog
upitnika"Ages & Stages Questionnaires"(ASQ-3) – „Uzrasti i
razvoj deteta“?. U-. Zbornik radova: 50. jubilarni Pedijatrijski
dani Srbije. Niš, 2021.
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