Aims This study explores 40 years (1974–2014) of CDC activity and outcomes data. Predating the Court Report (1976)(1), it demonstrates the evolution of CDC practice and diagnostic outcomes.
Methods Case notes of 2014 CDC referrals were reviewed, with referral data collected by the CDC Manager. This was compared to data previously collected from 1974–2004 with the authors’ permission.
Results The 2014 CDC referral rate of 9 per 1000 pre-school children compares to 5.5–7.2 per 1000 children for 1988–1998 and 4 per 1000 for 1999–2004 (Table 1).
Until 1985 children under sixteen were accepted for assessment. The median age for assessment gradually lowered from 5–6 years in 1974, to 2–3 years in 1985 and remains unchanged. From 1999–2004, 56% of referrals were from a community paediatrician and by 2014 this had increased to 85.9%.
Referrals for behavioural problems increased from 9.7% of children in 1999–2004 to 18% in 2014, alongside referrals for social and communication problems; 10% in 1999–2004 compared with 26.7% in 2014. Numbers of referrals for developmental delay and complex medical problems fell to 12.2% and 5% in 2014 compared with 22% and 12.4% in 1999–2004. These trends are reflected in the diagnosis given, with a two-fold increase in children receiving a diagnosis of autism spectrum disorder since 1999 and the proportion being given a diagnosis of developmental delay halving, as demonstrated in Table 2.
Conclusions Increased numbers of CDC referrals and assessments over 40 years reflect not only changing presentations and outcomes but increased awareness of behavioural and social communication disorders. More work is needed to explore further how the educational outcomes of these children have changed.
We would like to thank those people who donated the original 1974–1999 material, but who declined authorship.
Ni Bhrolchain, C. ‘Referral patterns to a District Child Development Centre: 25 years experience.’ Public Health 2002;116:300–303
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