Rennie Brandon J, Bishop Somer L, Leventhal Bennett L, Zheng Shuting, Geib Ellen, Kim Young Shin, Burnette Courtney, Salzman Emma, Nozadi Sara S, Kim Hosanna, Ence Whitney, Park Mina, Ghods Sheila, Welch Maria, MacKenzie Debra, Lewis Johnnye L
University of New Mexico, Center for Development and Disability.
University of California San Francisco Weill Institute for Neurosciences.
JAACAP Open. 2023 Nov;1(3):184-195. doi: 10.1016/j.jaacop.2023.06.003. Epub 2023 Jul 5.
Native American children disproportionally face many risk factors for poor developmental outcomes; these factors include poverty, environmental toxicant exposure, and limited medical, and intervention services. To understand these risks, comprehensive documentation of developmental and behavioral phenotypes are needed. In the current descriptive study, we assessed the neurodevelopment of young Diné (Navajo) children using standardized assessment instruments in combination with expert clinician judgment.
As part of an ongoing, population-based, prospective birth cohort study, we conducted comprehensive neurodevelopmental assessments of 138, 3-5-year-old, Diné children residing on or near the Navajo Nation. We report results from standardized parent reports, psychiatric examinations, and direct assessments of children's language, cognitive, adaptive, and social-emotional development, as well as best estimate clinical diagnoses.
Forty-nine percent of our sample met DSM-5 criteria for a neurodevelopmental disorder (NDD) diagnosis. Language and speech sound disorders were most common, although autism spectrum disorder (ASD) was also elevated compared to the general population. Though language performance was depressed amongst all groups of children with, and without, NDDs, those meeting criteria for certain NDDs performed significantly lower on all language measures, when compared to those without. Social-emotional, behavioral, and nonverbal cognitive ability were in the average range overall.
Diné children in our study were found to have a high percentage of clinically significant developmental delays. Overall, children presented with a pervasive pattern of depressed language performance across measures, irrespective of diagnosis (or no diagnosis), while other domains of functioning were similar to normative samples. Findings support the need to identify appropriate intervention and educational efforts for affected youth, while also exploring the causes of the specific developmental delays. However, longitudinal studies are necessary to establish best practices for identifying delays and delineating resilience factors to optimize development of Diné children.
美国原住民儿童面临诸多不利于良好发育结果的风险因素，且比例失衡；这些因素包括贫困、接触环境毒物以及医疗和干预服务有限。为了解这些风险，需要对发育和行为表型进行全面记录。在当前的描述性研究中，我们使用标准化评估工具并结合专家临床判断，对年轻的迪内（纳瓦霍）儿童的神经发育进行了评估。
作为一项正在进行的、基于人群的前瞻性出生队列研究的一部分，我们对居住在纳瓦霍族或其附近的138名3至5岁的迪内儿童进行了全面的神经发育评估。我们报告了标准化家长报告、精神病学检查以及对儿童语言、认知、适应性和社会情感发展的直接评估结果，以及最佳估计临床诊断。
我们样本中有49%符合精神疾病诊断与统计手册第5版（DSM - 5）神经发育障碍（NDD）诊断标准。语言和语音障碍最为常见，不过与一般人群相比，自闭症谱系障碍（ASD）的比例也有所升高。尽管在患有和未患有NDD的所有儿童组中语言表现都有所下降，但与未患NDD的儿童相比，符合某些NDD标准的儿童在所有语言测量指标上的表现明显更低。总体而言，社会情感、行为和非语言认知能力处于平均水平。
我们研究中的迪内儿童被发现有很高比例的具有临床意义的发育迟缓。总体而言，无论诊断情况（或未诊断）如何，儿童在各项测量指标上都呈现出普遍的语言表现下降模式，而其他功能领域与正常样本相似。研究结果支持有必要为受影响的青少年确定适当的干预和教育措施，同时也需要探索特定发育迟缓的原因。然而，需要进行纵向研究以确立识别发育迟缓并描绘恢复力因素的最佳实践方法，从而优化迪内儿童的发育。
