Mijna Hadders-Algra’s research while affiliated with University of Groningen and other places

Early childhood is foundational for optimal and inclusive lifelong learning, health and well-being. Young children with disabilities face substantial risks of sub-optimal early childhood development (ECD), requiring targeted support to ensure equitable access to lifelong learning opportunities, especially in low- and middle-income countries. Although the Sustainable Development Goals, 2015–2030 (SDGs) emphasise inclusive education for children under 5 years with disabilities, there is no global strategy for achieving this goal since the launch of the SDGs. This paper explores a global ECD framework for children with disabilities based on a review of national ECD programmes from different world regions and relevant global ECD reports published since 2015. Available evidence suggests that any ECD strategy for young children with disabilities should consists of a twin-track approach, strong legislative support, guidelines for early intervention, family involvement, designated coordinating agencies, performance indicators, workforce recruitment and training, as well as explicit funding mechanisms and monitoring systems. This approach reinforces parental rights and liberty to choose appropriate support pathway for their children. We conclude that without a global disability-focussed ECD strategy that incorporates these key features under a dedicated global leadership, the SDGs vision and commitment for the world’s children with disabilities are unlikely to be realised.

Aim To compare the predictive values of the General Movements Assessment (GMA) and the Standardized Infant NeuroDevelopmental Assessment (SINDA) neurological scale for atypical neurodevelopmental outcome in 3‐month‐old at‐risk infants. Method A total of 109 infants (gestational age 30 weeks; range: 24–41; 52 males) attending a non‐academic outpatient clinic were assessed with the GMA and the SINDA at 3 (2–4) months corrected age. The GMA pays attention to the complexity of general movements and presence of fidgety movements. Atypical neurodevelopmental outcome at 24 months corrected age (and older) implied cerebral palsy (CP) or a Bayley Mental Development Index or Bayley Psychomotor Development Index lower than 70. Results At 24 months corrected (and older) age, 16 children had an atypical outcome, including 14 children with CP. Regarding markedly reduced general movement complexity in combination with absent or sporadic fidgety movements, the GMA predicted an atypical outcome with specificity, positive, and negative predictive values greater than 0.900, and sensitivity of 0.687 (95% confidence interval [CI] = 0.460–0.915). SINDA predicted an atypical outcome with sensitivity, specificity, and negative predictive value greater than 0.900 and a positive predictive value of 0.652 (95% CI = 0.457–0.847). Regarding absent fidgety movements only or markedly reduced general movement complexity, the GMA predicted the outcome less well than both general movement criteria. Interpretation The SINDA and GMA both predict neurodevelopmental outcome well, but SINDA is easier to learn than the GMA; being a non‐video‐based assessment, it allows caregiver feedback during the consultation whereas the GMA usually does not. What this paper adds The General Movements Assessment (GMA) and Standardized Infant NeuroDevelopmental Assessment (SINDA) neurological scale predict atypical neurodevelopmental outcome equally well. The GMA and SINDA neurological scale predict CP and atypical neurodevelopmental outcome well. The GMA works best to predict neurodevelopmental outcome when based on both general movement complexity and fidgety movements.

Aim While deformational plagiocephaly (DP) is suspected to be associated with comorbidities, their nature and prevalence are unclear. This scoping review aims to report DP comorbidities occurring until the age of 2 years, their prevalence and whether they depend on the child's age and sex. Methods Relevant studies were identified by searching the Cochrane, MEDLINE, EMBASE, PubMed and EBSCO databases from 1992 to 30 April 2021. Data on study characteristics, comorbidities and assessment instruments were extracted and qualitatively synthesised. Risk of bias was assessed and studies with high risk of bias were excluded. Results Studies meeting selection criteria ( n = 27) often evaluated groups from tertiary clinics, implying selection bias. Studies reported on developmental delay ( n = 16), limited speech production ( n = 1), auditory ( n = 3), visual ( n = 3), mandibular ( n = 3) and neurological impairments ( n = 1). The data did not allow prevalence calculation or modifying effect of sex. Due to biased data, the review provided no evidence on DP comorbidities. Weak evidence suggested that in the selective samples, DP was associated with motor and language delays in the first year. Conclusion Due to biased data, no evidence on comorbidity in infants with DP was available. Our study underlined the need of risk of bias assessment in scoping reviews.

Motor skills and movement-related functioning significantly shape how children experience and interact with the world around them. Among infants and young children, developmental motor disorders contribute to delays with motor, cognitive, and psychosocial development. Early and accurate identification of these disorders is necessary to facilitate timely access to therapeutic interventions that minimize the long-term effects of disability on everyday activities and participation. In the United States, motor assessments commonly used among children 0 to 3 years focus on completion of specific motor skills at a single point in time, which provides only a part of the greater picture that is a child’s motor and movement-related functioning. Video-capture methods, like the General Movements Assessment (GMA) and the Infant Motor Profile (IMP), offer greater accuracy and predictive power to (1) identify motor deficits in young children and (2) facilitate early access to supportive, therapeutic intervention.

Our correspondence discusses the launch of the UNICEF Disability Inclusion Policy and Strategy 2022-30. It highlights the need to utilize existing evidence and accelerate global commitments on early childhood development for inclusive education for children with disabilities. We emphasize the importance of school readiness, robust funding schemes, measurable benchmarks, and tangible benefits in inclusive early childhood development programs. We raise concerns about the UNICEF-sponsored Nurturing Care Framework and the need to transform systems to be inclusive of everyone. We welcome the initiative but urge rapid implementation of disability-focused early childhood development to achieve global commitment on inclusive education by 2030.