Neurodevelopmental disorders- a challenge for health care professionals
By Dr. Sadiya Khan, Intern, Bangalore
Neurodevelopmental disorders (NDD) are chronic disorders that affect central nervous system function during the developmental period in the domains of motor skills, cognition, communication and/or behaviour. They are classified in DSM-5 (American Psychiatric Association 2013) into intellectual disability, autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), communication disorders, specific learning disorders, motor disorders and other neurodevelopmental disorders.
Nearly 1 in every 8 children in India might be suffering from atleast one of the NDDs according to a study. Effective delivery of healthcare for people affected by these disorders requires participation and coordination between professionals from different disciplines due to the wide diversity of functional impairments in these conditions. They require approaches and interventions that are adapted to their needs.
According to some studies, physicians report discomfort and underconfidence while dealing with NDD patients because of a lack of exposure and minimal focus on dealing with such patients in their curriculum. When such patients do not have their needs met by their physician, it leads to fewer hospital visits and a loss of trust in medical care.
Here are a few things that physicians and medical students can do to make the entire process less challenging:
It is imperative for medical students and doctors to identify themselves at the beginning of each appointment, as many patients can have difficulty remembering names and faces at each visit.
Addressing the patient–
It is important to remember that not all patients with neurodevelopmental disorders have disabilities affecting their speech, hearing or sight. It is best not to assume that there is a communication barrier unless a family member or provider mentions it. They should be given a chance to speak and be heard.
Be creative –
Physicians and medical students must learn to communicate with patients creatively and try their best to understand their concerns even if they are unable to do so verbally. Using pictures or diagrams to explain procedures and outcomes can be extremely helpful. The patients are valuable contributors to their care and should be involved even if their caregiver is present.
Asking a patient whether they’ve understood everything that you’ve told them might not be enough. Patients with some neurodevelopmental disorders can be asked to repeat what you’ve said in simpler words to assess whether they have retained important information. It is also important to give these patients some “wait time” to process the information and respond.
One cannot provide effective care if the basic needs of the patient aren’t met. Asking the patient whether there is any special need that you can assist them which can help make them comfortable. For example, a sign language interpreter or any adjustable medical equipment for people with wheelchairs.
Different patients will require different solutions because the nature of their disabilities will be different. Health care professionals should constantly take patient feedback and work to be more inclusive in their practice.
- Riddle, I., Romelczyk, S., & Sparling, E. (2011). Effective Communication For Health Care Providers: A Guide to Caring for People with Disabilities. Newark, DE. Center for Disabilities Studies, University of Delaware.
- Wilkinson J, Dreyfus D, Cerreto M, Bokhour B. “Sometimes I feel overwhelmed”: educational needs of family physicians caring for people with intellectual disability. Intellect Dev Disabil [Internet]. 2012 [cited 2023 May 10];50(3):243–50. Available from: http://dx.doi.org/10.1352/1934-9556-50.3.243
- Clinical communication [Internet]. Intellectualdisability.info. [cited 2023 May 10]. Available from: http://www.intellectualdisability.info/how-to-guides/articles/clinical-communication
- References for images www. pixabay.com and www.michaelneemft.com
By Dr. Sadiya Khan, Intern, Bangalore