Exploration of Referral Patterns and Diagnoses in Relation to Native Versus Foreign Background in Children with Suspected Neurodevelopmental Disorders

Abstract

Recent studies have suggested that there is an increase rate of neurodevelopmental disorders (NDDs) among children with foreign backgrounds. Within the last 15 years, the number of children in Iceland with foreign backgrounds with suspected NDDs has grown exponentially. The current study is an extension of previous research on this increase in referrals, examining new referrals to the Counselling and Diagnostic Centre (RGR) within a five-year period (N = 1,367). The primary purpose of this work was to present and explore the difference between the referral patterns of native children and children with foreign backgrounds with suspected NDDs. Various potentially associating factors were investigated, including the age group of the referred child, the type of foreign background, and the source of the referral – the referrant – as well as possible interactions among these factors. Potential differences in diagnosis of autism spectrum disorder (ASD), intellectual disability (ID), cerebral palsy (CP), and developmental language disorder (DLD) by RGR for children with native and foreign backgrounds were also explored. Examination of referral patterns for children with native and foreign backgrounds with suspected NDDs revealed that children with foreign backgrounds, more specifically, second-generation immigrants, were indeed referred at a higher rate than native children. Preschool aged children with foreign backgrounds were consistently referred at a higher rate than preschool aged native children, and the school system referred children with foreign backgrounds at a higher rate than native children. Examination of the combined effects of age and referrant revealed that the elevated rate of referral of children with foreign backgrounds likely stems from the school systems referral of pre-school aged children. Conclusive differences were not found between the rates of ASD, ID and CP diagnoses of children with native and foreign backgrounds. DLDs, however, were found to be diagnosed at a significantly higher rate among children with foreign backgrounds than native children. Further research is required to better understand the association between NDDs and foreign background.Keywords: autism spectrum disorder, intellectual disability, cerebral palsy, developmental language disorders, diagnosis, referral, children, foreign background.

Nýlegar rannsóknir hafa bent til þess að auknar líkur séu á taugaþroskaröskunum meðal barna af erlendum uppruna. Hérlendis hefur grunur um taugaþroskaraskanir aukist mikið síðustu 15 árin meðal barna með erlendan bakgrunn. Þessi rannsókn er framhald af fyrri rannsókn sem kannaði þessa aukningu með því að skoða nýjar tilvísanir á fimm ára tímabili til Ráðgjafar- og greiningastöðvar ríkisins (N = 1.367). Meginmarkmið þessarar rannsóknar var að kanna mun á tilvísanamynstrum meðal barna með grun um taugaþroskaröskun, eftir því hvort að barnið hafi íslenskan eða erlendan bakgrunn. Hugsanlega tengdir þættir voru kannaðir. Þar á meðal var aldur barnanna, tilvísandi og nákvæm flokkun á erlendum bakgrunni skoðuð. Þar að auki var möguleg samvirkni milli aldurs og tilvísanda athuguð. Einnig var kannað hvort að munur væri á greiningum á einhverfu, þroskahömlun, heilalömun og málþroskaröskunum, eftir því hvort að börn hafi erlendan eða íslenskan bakgrunn.Niðurstöður rannsóknarinnar sýndu að börn með erlendan bakgrunn, þá sérstaklega börn af annarri kynslóð innflytjenda, var vísað í marktækt hærra hlutfalli miðað við íslensk börn. Börn á forskólaaldri með erlendan bakgrunn var vísað í hærra hlutfalli miðað við íslensk börn á forskólaaldri og vísaði skólakerfið börnum með erlendan bakgrunn í hærra hlutfalli en íslensk börn. Þegar samverkandi áhrif tilvísana og aldurs voru könnuð sást að skólakerfið var sérstaklega að vísa börnum á forskólaaldri með erlendan bakgrunn í hærra hlutfalli miðað við íslensk börn. Ekki var hægt að greina á milli tíðni þess sem einhverfa, þroskahömlun og heilalömun greindust meðal barna af íslenskum og erlendum uppruna. Hins vegar greindust börn af erlendum uppruna með málþroskaröskun í hærra hlutfalli en íslensk börn. Þörf er á frekari rannsóknum til þess að skilja betur tengsl milli taugaþroskaraskanna og erlends bakgrunns.Lykilhugtök: einhverfa, þroskahömlun, hreyfihömlun, málþroskaröskun, greining, tilvísun, börn, erlendur bakgrunnur.