- 7 months ago
- #considerthis
International studies estimate between 10-15% of all children have a developmental delay or disability, but most are only identified when they enter formal primary education. By then, it’s often too late. When a child isn’t school-ready, they quickly fall behind their peers, and the trajectory of their academic future is compromised. Could technology help close the early developmental screening and intervention gap? On this episode of #ConsiderThis Melisa Idris speaks with Datuk Dr Amar Singh HSS, Consultant Paediatrician, and child and disability rights activist. He’s also an Advisor to the National Early Childhood Intervention Council.
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00:00Hi, welcome back to Consider This. I'm Melissa Idris. Let's continue our discussion about the
00:15need for a coordinated nationwide system for the early detection of developmental delays in
00:21children. Joining me now is Dr. Amar Singh, HSS, a consultant paediatrician and child and
00:27disability rights activist. He's also an advisor to the National Early Childhood Intervention Council.
00:33Amar, thank you so much for being on the show with me today. We just heard from a startup that's
00:38trying to fill the gap with a digital screening tool, and I understand that you've been working
00:43with them. But before we get into how this might be a solution to bridge the gap, the early intervention
00:51gap, could you maybe begin by describing what your observations have been about the state
00:57of early childhood screening and support in Malaysia today? Are we diagnosing developmental
01:02delays early enough?
01:04Thanks, Melissa. Good to be here with you. And let me take a step back and say how common
01:09developmental problems are. Developmental problems are, from good studies, 10 to 15% of all children.
01:15In fact, CDC in the US and even WHO quotes one in six children. And we're talking about 16%
01:22of all children have a developmental problem. So it's not a small problem. We're talking here about
01:27children with autism, children with attention deficit hyperactive disorder, and especially
01:31the ones that are harder to find, the learning disorders like dyslexia. And of course, the ones
01:36that are easier to see, Down syndrome, subopalsy, and the others.
01:39So for Malaysia, I think we have a good program in the under two. That's when a child is born,
01:47that's a newborn check. We examine a child. At that time, we pick up most of the significant
01:51physical abnormalities and the congenital problems. And then when they come for the immunization
01:56program until the age of about 18 months, each time there's a developmental surveillance where we
02:01check their milestones while we do their growth and their vaccines. And that picks up quite a number
02:07of children. But these are the ones with significant problems, severe problems. I don't like the word
02:11very much, but I use it here for this program. So that amounts are probably about 3%. So if we talk
02:17about that 10-15%, we are doing this 3% pickup in that period. And then between 2 and 6, nothing much
02:24is happening. And that's our crisis. We've advocated with Ministerial Health that we need developmental
02:29screening at this time. But at the present moment, it hasn't really taken place. So some children,
02:36of course, might see a private pediatrician, but that's a bit of an expensive thing to happen.
02:42So if you look at data from MOE, I think that's the most valuable data. MOE quotes for last year
02:48that 122,000 children reached school, which is about 24% of all children reaching 701 who couldn't
02:56read, write, or had other counting problems. So these are 24% of our children reaching 701 not school-ready.
03:04I think I like that word from Australia, they're not school-ready. And these are the children
03:08we're talking about here, possibly. And after intervention by MOE, about half of them, which
03:14means about 12%, still not school-ready. So you can see this figure of 12% that MOE has
03:19got is quite similar to the one that WHO, CDC, and the one research has done. So we're thinking
03:25between 10% to 15% of all children who have a development problem, and we are not picking
03:29them up, especially the milder and moderate ones, they turn up in school, and they're just not ready
03:34for school. So that would mean if they're not being identified and supported early enough,
03:41their entire academic future can be in jeopardy. Can I? Not just the academic future, you're talking
03:48about employment, you're talking about long-term independent living, many other things as well.
03:53So the tool that we discussed earlier, using tech to identify early enough some of these early
04:04childhood developmental delays, how concerned are you as a paediatrician, this might replace
04:11clinical diagnosis? Not even not replace, but could there be a complexity in identifying some
04:19of these developmental conditions that even trained specialists may, you know, may need nuance to
04:25identify? Can technology efficiently identify, screen for developmental issues?
04:33Well, Melissa, I think of technology as a tool to support, not to replace. So I don't think it's going
04:38to replace the role of a general paediatrician, developmental paediatrician, but we need to
04:43recognize that right now the waiting time is enormous. If you want to see a developmental paediatrician
04:48in Malaysia, the waiting time sometimes can be up to two years, usually it's one year plus. By that
04:53time, I think it's almost no value because a child with developmental problem needs to be seen now.
04:58So even for a general paediatrician, I think the waiting time is three to six months. So one good
05:03thing about the tool is it identifies there is a problem, gets you started with the intervention
05:07program, and then you can aim for the assessment with a paediatrician or a speech therapist or
05:13developmental person down the road. So I don't think it's aim every place. The second thing I would like
05:18to say is that I think that there's probably going to be an under diagnosis rather than over
05:22diagnosis, even with this tool, because the really mild children are going to be very hard
05:27to pick up. I think usually most doctors actually dismiss them and say nothing's wrong with your
05:33child. The tool probably is slightly better at picking them up, but still there is going to be
05:37a little bit of under diagnosis. I think many people are worried, is this tool going to over
05:41diagnose? I think that's not really a concern here. I must say also here that about one in three
05:47children right now in Malaysia have got expressive speech problems. That means they don't speak on
05:51par with their peers. And part of this is not the fact that they have a developmental problem,
05:56but we have a screen explosion in young children's lives and that's affected them. So one good thing
06:01about the tool is saying, hey, your child's speech is not up to the park, let's boost it. So I think
06:06that's good. Picking up a child early is going to help. I think it's not going to replace
06:11pediatricians or doctors. Right. So once there has been kind of an early screening and then
06:19that hopefully leads to a diagnosis, what then would you like to see, Amar, in terms of interventions?
06:25What would an ideal system look like where children are supported from the earlier sign of developmental
06:32delay? So let's say we don't have this program. The ideal system is that we have a screening program,
06:39first of all, accessible to all children in Malaysia, irregardless whether they're Malaysian
06:43or not. And that's free. Government funded, of course. Secondly, it's something that can be done
06:48very simply and has to be done by teachers because there's no way this volume of children can come to
06:52the health service. It's just too huge. So teachers, the preschool teachers are the best person. So
06:58they need to apply this tool. Thirdly, you can't apply the tool once only. You need to do it at age three,
07:04four and five because some development problems like dyslexia take time to appear. And so you need
07:09to do multiple times. So then, OK, we have identified this child. What we want to do next in the ideal
07:15real Finland kind of situation is keep the child in mainstream. And to do that, we then have to bring
07:22an early intervention practitioner to this classroom to support the teacher and the child,
07:27to help the teacher understand the child's needs, work with them like a shadow aid kind of thing.
07:32And then, of course, you might need some support when you're in school, when you're in university,
07:37and then you need an inclusive employer. And probably what we're really looking for in Malaysia
07:42is an inclusive society where all of us are accepted. So I think that's a really ideal situation.
07:48I think Finland does it well because they call it something called universal design for learning,
07:53where every child is accepted and taught according to how they learn, not how we teach them.
07:57That's a very powerful concept there. In Finland, for example, 98% of all children are mainstream.
08:02And that's our target right now with screening tool. So I think this is a very difficult ideal to achieve
08:09because where are you going to find all those early child intervention practitioners?
08:12Already right now, we are choked. Our intervention centers, even in the NSIC, all call waiting lists.
08:17Many parents know that. So we need to, you know, have a method of stratifying children.
08:24Perhaps this screening tool and the intervention can then support children who have mild-mordered problems
08:30and the most severe ones then go to the early intervention practitioners who can do more hands-on work.
08:36And because with this tool, we are benchmarking children frequently,
08:41the children without a problem are being seen every year,
08:43the children with a problem are being seen every three months, assessed every three months.
08:48So we will know if the intervention is not working.
08:51We could then fast track the ones who are having difficulty on to receive therapy or see a professional.
08:58Amar, for those who are still skeptical of this new digital tool,
09:05and often any new innovation comes with their own host of skeptics,
09:10do you think there could be any unintended consequences,
09:13any danger of governments outsourcing this maybe, you know, to a private tech company?
09:20How do you view this innovation?
09:24Is this something we should embrace with open arms or are there red flags that you would pay attention to?
09:33I think that, you know, I think we should embrace it.
09:36This is not the only company trying this.
09:38I'm also involved with a company called Angsana Health, which is a Malaysian startup company,
09:43where what they are doing is using video recordings to try and identify children with autism,
09:48where parents upload selected videos and then they have a professional see them.
09:51So I think different people are trying different models.
09:54Again, the reason we're doing this is the backlog.
09:56We don't have enough people doing the screening.
09:59Waiting time is too long.
10:00And we don't have people doing the therapy.
10:02So I think to people who are skeptics, I would say, give us a solution.
10:06We're happy to take any solution that works.
10:10We're not people who are, you know, heavily dependent on tech or AI.
10:14We don't think that's the ultimate solution.
10:16But this is a very exciting tool because it's fun-based.
10:20Both the screening and the intervention tool are fun-based.
10:23And children enjoy doing it.
10:26I think that's a good part.
10:28Amar, thank you so much for speaking with me.
10:29I appreciate your time.
10:32Datuk Dr. Amar Singh, HSSD, wrapping up this episode of Consider This.
10:37I'm Melissa Idris, signing off for the evening.
10:39Thank you so much for watching.
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