Classification, prevalence and integrated care for neurodevelopmental and child mental health disorders: A brief overview for paediatricians

Abstract

‘Neurodevelopmental disorders’ comprise a group of congenital or acquired long-term conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations, including autism spectrum disorder, attention deficit/ hyperactivity disorder, tic disorder/ Tourette’s syndrome, developmental language disorders and intellectual disability. Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability. Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm. Together these are referred to as neurodevelopmental, emotional, behavioural, and intellectual disorders (NDEBIDs) in this paper. Varying prevalence rates for NDEBID have been reported in developed countries, up to 15%, based on varying methodologies and definitions. NDEBIDs are commonly managed by either child health paediatricians or child/ adolescent mental health (CAMH) professionals, working within multidisciplinary teams alongside social care, education, allied healthcare practitioners and voluntary sector. Fragmented services are common problems for children and young people with multi-morbidity, and often complicated by sub-threshold diagnoses. Despite repeated reviews, limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research. The recently developed “Mental, Behavioural and Neurodevelopmental disorder” chapter of the International Classification of Diseases-11 offers a way forward. In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID, enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

Keywords: Neurodevelopmental disorders; Mental health disorders; Adolescents; Child health; Mental health services; Emotional problems; Behavioural problem; Sub-threshold diagnosis; Sleep disorders; Integrated care

Core Tip: Neurodevelopmental, emotional, behavioural, and intellectual disorders (NDEBID) in this paper refers to many congenital or acquired long-term neurodevelopmental, neurological or muscular disorders, with the often co-occurring mental health disorders presenting in Community Child Health or child/ adolescent mental health settings. This paper provides a brief overview of the aetiology and prevalence of NDEBIDs, highlights common problems associated with the current classification systems and aims to stimulate discussion among professionals towards consensus agreement on how best to classify the NDEBIDs. It makes a strong case for integrated care between paediatric and mental health services for optimal assessment and management of children and young people with NDEBIDs.