Strategies for addressing the needs of children with or at risk of developmental disabilities in early childhood by 2030: a systematic umbrella review

Abstract

Background: There are over 53million children worldwide under five with developmental disabilities, necessitating effective interventions to alleviate the impact of these conditions. However, challenges in delivering interventions persist due to various barriers, particularly in low-income and middle-income countries. Methods: We conducted a global systematic umbrella review to assess the evidence on early detection, prevention, and rehabilitation interventions for child functioning outcomes related to developmental disabilities in children under five years. We focused on prevalent disabilities worldwide and identified evidence-based interventions at the primary, secondary, and tertiary levels. We searched Medline, Embase, PsychINFO, and Cochrane Library for relevant literature from 1st January 2013 to 14th April 2023. A narrative synthesis approach was used to summarise the findings of the included meta-analyses. The results were presented descriptively, including study characteristics, interventions assessed, and outcomes reported. Further, we presented the global prevalence of each disability in 2019 from the Global Burden of Disease study, identified the regions with the highest burden and the top ten affected countries. This study is registered with PROSPERO, number CRD42023420099. Results: We included 18 reviews from 883 citations, which included 1,273,444 children under five with or at risk of developmental disabilities from 251 studies across 30 countries. The conditions with adequate data were cerebral palsy, hearing loss, cognitive impairment, autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder. ASD was the most prevalent target disability (n=8 reviews, 44%). Most reviews (n=12, 67%) evaluated early interventions to support behavioural functioning and motor impairment. Only 33% (n=10/30) of studies in the reviews were from middle-income countries, with no studies from low-income countries. Regarding quality, half of reviews were scored as high confidence (n=9/18, 50%), seven as moderate (39%), and two (11%) as low. Conclusion: We identified geographical and disability-related inequities. There is a lack of evidence from outside high income settings. The study underscores gaps in evidence concerning prevention, identification, and intervention, revealing a stark mismatch between the available evidence base and the regions experiencing the highest prevalence rates.