Prevention and management of sociogenic developmental disorders in primary care pediatrics

Children from families of lower socio-economic status (L-SES families; mostly lacking in stimulation, educationally distant and with low incomes) already have impairments in linguistic, cognitive and motor development to a large extent at the time of school entry and show more conspicuousness in social behaviour. This puts their schooling and further education at risk; about 20% to 25% of the affected children do not receive a secondary school diploma. Since early childhood developmental stimulation is of utmost and lasting importance for children, paediatricians and adolescent doctors (KJa) play a major role in the primary and secondary prevention of developmental impairments due to early detection examinations. The paediatricians learn about the families' need for help mainly through their own enquiries or through information provided by the parents; their share in the volume of care is estimated to be up to 20% on average. The main reasons for increased primary prevention vigilance with regard to early childhood development are less loving/responsive behaviour of parents/caregivers, difficult life circumstances (e.g. teenage mothers, mental illness, substance abuse), recognisable signs of external neglect or the presence of several children with developmental problems in the family, as well as lack of education and difficult economic circumstances. The "stimulation situation" of the child in the everyday life of the family (attendance at day care, use of picture books, media consumption without parental presence, other caregivers, etc.) is investigated. In terms of primary prevention, early intervention centres or the use of early help services are mainly recommended. Surprisingly, however, children are also referred to a SPC at an early stage. Almost 90% of the youth welfare officers identify sociogenic developmental impairments that have already occurred in the form of disturbed speech and language development and 85% in the form of conspicuous behaviour and disturbed social-emotional competence. The median ratio of somatic to sociogenic disorders is estimated at 20 to 80%. For children up to 3 years of age, early educational support measures are primarily recommended to remedy them, while for children over 3 years of age, medical therapy (remedial prescriptions) is in the foreground. Causes for this behaviour are discussed. However, paediatricians and adolescent doctors consider early educational institutions to be more important than medical measures in order to make children with sociogenic developmental impairments fit for school.