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This content is taken from the London School of Hygiene & Tropical Medicine, International Centre for Evidence in Disability & Fundação Oswaldo Cruz (Fiocruz)'s online course, Integrated Healthcare for Children with Developmental Disabilities. Join the course to learn more.

Skip to 0 minutes and 12 seconds NATHANIEL SCHERER: According to the World Health Organisation, 15% of the world’s population live with a disability. This equates to one billion people, of whom at least 150 million are under the age of 18. Of this population, 80% live in low- and middle-income countries. As we have learned, the term developmental disabilities covers a broad range of conditions. And as this term is used differently across different settings, countries, and cultures, it is difficult to accurately estimate the number of children with developmental disabilities across the world. Evidence from the United States indicates that one in six children under the age of 17 have a developmental disability.

Skip to 0 minutes and 54 seconds When looking at children in the critical period of early childhood, global data suggests that 8% of children under the age of five have a developmental disability. This equates to roughly 53 million children worldwide. Although our best available data,

Skip to 1 minute and 10 seconds this figure is based on just six conditions: epilepsy, intellectual disability, vision loss, hearing loss, autism, and attention deficit hyperactivity disorder. Now, as we know, this is not a comprehensive overview of all of the conditions associated with developmental disability, and we can say that the prevalence of developmental disability in children under five years of age is likely much higher than this. It’s clear that we need more accurate data on the prevalence of developmental disability split across countries and regions. What this data does show, however, is that the magnitude of developmental disability is much higher in low- and middle-income countries, especially in sub-Saharan Africa, where the prevalence of developmental disability increased by 70% from 1990 to 2016.

Skip to 2 minutes and 2 seconds So what are the causes of conditions such as cerebral palsy, autism, and hearing loss associated with developmental disability? Unfortunately, there is no easy answer. We’re talking about a broad range of conditions, and this means a broad range of causal factors that often interact with one another. In general, causes are split across two domains, environmental and genetic. Let’s start with environmental factors. These can have an adverse effect on a child before, during, and after birth. There are a variety of factors to consider, but for now, let’s think about the most common. The first is nutritional deficiencies of both a mother during pregnancy and a child in early development. Iodine deficiency, for example, is associated with congenital blindness, deafness, and intellectual impairments.

Skip to 2 minutes and 58 seconds Another commonly known issue is that of folate deficiency, which can cause various neural tube defects, such as spina bifida. The second factor to consider is infection. Infections can damage a developing nervous system and cause a range of developmental disabilities. These infections can affect a child in utero, should a mother be infected, or in a child’s early years. Common examples include the Zika virus, which can cause microcephaly, meningitis, which may cause hearing loss, and measles, which may result in blindness. Another important point to consider is environmental toxins, which are well recognised to affect a developing nervous system.

Skip to 3 minutes and 38 seconds A child is commonly exposed to such toxins through a mother’s health and behaviour patterns during pregnancy, the most common of which would be consuming alcohol or drugs. Children may also ingest toxins once born. Lead is a common example, and can be ingested through paint, batteries, and even gasoline. So these are the environmental factors we should be considering, but what about genetic factors? Congenital anomalies can occur as a result of genetic inheritance from one or both parents, or they may simply be spontaneous. These genetic conditions will commonly cause syndromes that typically manifest as a group of identifying characteristics. The most commonly recognised of these is Down syndrome, which is caused by an additional copy of chromosome 21.

Skip to 4 minutes and 22 seconds However, there are many other syndromes caused by genetic conditions, such as Fragile X syndrome, Williams syndrome, and DiGeorge syndrome. Genetic syndromes and other genetic conditions can cause impairments across any domain, whether physical, intellectual, or sensory. For instance, children with Down syndrome typically experience intellectual impairment, but also difficulties with motor skills, as well as having a greater risk of heart defects and thyroid problems. When thinking further on the causes of a condition associated with developmental disability, it’s important to consider the interaction between genetic causes and environmental influences. Environmental factors may well increase the severity of impairments in children with genetic developmental disabilities, or they may produce comorbid conditions.

Skip to 5 minutes and 13 seconds For example, a child born with phenylketonuria, a genetic condition, would develop intellectual disability and other conditions, but only if they eat foods containing the amino acid phenylalanine. If they avoid this amino acid, then the risk of these complications is much reduced. This is one way in which environmental and genetic causes together can contribute towards the development of impairments. Having discussed causes, let us now consider risk factors. While causes and risk factors sound like one and the same, they are, in fact, very different. Risk factors exacerbate the likelihood of a developmental disability, but they are not the underlying cause. For instance, a chromosomal abnormality causes Down syndrome, and increased maternal age is a risk factor for this chromosomal abnormality.

Skip to 6 minutes and 3 seconds Many risk factors are as a result of social determinants. Evidence into the social determinants of health are clear, children and adults from a lower socioeconomic background are at an increased risk of poor health and disability. Difficulty accessing healthcare, for example, will increase the risk of infection, and increased poverty may increase the risk of malnutrition and nutritional deficiencies. In this way, the social determinants of health can increase the risk of many causes of developmental disability. Thinking on these factors, we can understand why the prevalence of developmental disabilities are higher in low- and middle-income countries.

Skip to 6 minutes and 40 seconds It is not because they are genetically predisposed to having a developmental disability, but because the risk of environmental causes is heightened, as they may experience high levels of poverty and exclusion from healthcare and education. We will discuss this concept in further detail later in the course, when we think about the cycle of disability and poverty.

Causes of developmental disability

In this step, Nathaniel Scherer describes the causes of developmental disability, including environmental and genetic factors.

Nathaniel begins the presentation by discussing the global prevalence of developmental disability, a difficult figure to predict, given the data available (it should be noted that these figures are our best estimate at the current time and it appears that new data will become available soon).

After discussing the causes of developmental disability, Nathaniel concludes the presentation by exploring the risk factors for developmental disability and how these risk factors differ from causes.

Nathaniel is a Research Assistant at the International Centre for Evidence in Disability and the London School of Hygiene & Tropical Medicine, with experience developing interventions for adults and children with intellectual disabilities.


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This video is from the free online course:

Integrated Healthcare for Children with Developmental Disabilities

London School of Hygiene & Tropical Medicine