INTRODUCTION: This study aimed to examine patterns of diagnosis, cognitive and adaptive functioning, and school placement outcomes in autistic children in Singapore, and to assess earlier predictive factors of cognitive outcomes. METHOD: Retrospective data were extracted from medical records of a specialist developmental paediatrics service for children born in 2008-2011 and referred to the autism clinic or were given a diagnosis of autism. Data items included demographic data, diagnostic methods, psychological assessment results, early intervention attendance and school placement outcomes. RESULTS: A total of 2124 children (82.6% male; 66.4% Chinese, 13.4% Malay, 9.8% Indian and 10.5% Others) were diagnosed with autism from the 4 birth-year cohorts. The mean (SD) age of the first clinical diagnosis of autism was 3.56 (1.14) years, with 81.0% of children receiving a concordant initial clinical diagnosis. A total of 1811 (85.2%) had a formal diagnostic assessment using the Autism Diagnostic Observation Schedule (ADOS) at a mean (SD) age of 4.16 (1.11) years. Of 1326 with cognitive and adaptive assessment results, 16.6% had mild and 19.8% had moderate-severe cognitive impairment. Of 1483 with school placement outcomes, 45.9% went to mainstream schools, 21.8% entered SPED schools offering the national curriculum and 32.3% required customised curriculum SPED schools. Logistic regression showed that factors predicting intellectual impairment included higher ADOS scores (aOR 95% CI 1.13 [1.08-1.19] for Comm+SI total and 1.53 [1.33-1.75] for SBRI total), higher social communication level of support (based on the DSM-5 criteria) (aOR [95% CI] 2.14 [1.10-4.16] for level 2 and 14.94 [5.77-38.64] for level 3), and minority race (aOR [95% CI] 2.82 [1.52-5.20] for Malay, 5.19 [2.36-11.44] for Indian, and 4.54 [1.91-10.79] for Others). CONCLUSION These findings could guide policymakers and practitioners worldwide to strategically allocate diagnostic, intervention and educational resources, maximising developmental outcomes for autistic children across diverse settings.
Humans ; Singapore/epidemiology* ; Male ; Female ; Retrospective Studies ; Child, Preschool ; Autistic Disorder/complications* ; Child ; Early Intervention, Educational ; Cognitive Dysfunction/diagnosis* ; Cognition

Under the guidance and support of national policies in recent years, the community medical system has been developed rapidly, among which primary child healthcare is carried out routinely in community hospitals, greatly alleviating the pressure of specialized pediatric hospitals and departments of pediatrics in secondary and tertiary general hospitals. However, due to the lack of professional training for primary child healthcare personnel in community medical institutions, early symptoms of children with cerebral palsy cannot be identified and so children with cerebral palsy are often unable to receive early diagnosis and intervention, which may affect their prognosis. An article about international expert consensus and recommendations on early identification and referral of cerebral palsy in community medical institutions was published in
Cerebral Palsy/diagnosis* ; Child ; China ; Early Intervention, Educational ; Family ; Humans ; Referral and Consultation

BACKGROUND: The Asian population is rapidly aging and a concomitant exponential rise in the number of elderly people with dementia is expected. Early diagnosis of dementia and recognition of concomitant psychiatric symptoms have profound implications for the patient. In our local setting, majority of elderly individuals live with their families due to cultural influence on family ties. However, institutionalization of elderly individuals is gradually being recognized due to the increasing demands of the society on caregivers who usually belong to the working class.

OBJECTIVE: This pilot study evaluates the cognitive status of Filipino elderly individuals residing at Hospicio De San Jose which aims to examine the prevalence of cognitive impairment and neuropsychiatric manifestations in an institutionalized environment and to determine the rate of progression of cognitive decline.

METHODOLOGY: This is a research study evaluating all Filipino elderly individuals residing at Hospicio de San Jose aged 60 years and above, with or without objective memory complaints. Only literate individuals are included. Exclusion criteria include the presence of acute confusional state or altered sensorium, severe expressive and receptive aphasia, vegetative state, blindness, deafness, and denise hemiplegia in the dominant upper limb. Cognitive status was assessed using the following tests: Mini Mental State Exam (MMSE), US Second Version of Isaac's Set Test of Verbal Fluency (IST), Zasso Cancellation Task, 4-item version of Instrumental Activities of Daily Living: Modified Lawton's Scale (I-ADL). Neuropsychiatric manifestations were evaluated with the use of the Neuropsychiatric Inventory (NPI) and Modified Geriatric Depression Scale (MGDS). Patients were assessed at baseline (BS) and after 6 months (MO). The patients were classified accordingly based on set criteria as follows: Not Cognitively Impaired (NCI), Cognitive Impairment Not Demented (CIND), and Dementia (DEM).

RESULT: There were eighty elderly individuals at Hospicio De San Jose. There were twelve male patients and sixty-eight female home dwellers in total. Twenty-five (25) were included in the study based on the set criteria. Majority were female (84%) and previously employed (70%). The mean age of the population was 70.92 years old and mean level of education (in years) was 10.52. Seventy-two percent (72%) of patients subjectively complained of progressive and insidious memory impairment with an onset ranging from 6 months to 17 years. This pilot study shows that the prevalence of CIND and dementia in an institutionalized care center in our local setting like Hospicio De San Jose is 52% and 8%, respectively.

CONCLUSION: The presentation of the patients is progressive cognitive decline so that careful clinical monitoring is essential. The rate of conversion to dementia within 6 months is negligible. Amongst the several domains evaluated, it is the verbal fluency and speed that is greatly affected which is more compatible with sub cortical white matter changes in an aging brain. The identification of  Filipino home care dwellers at potential risk of dementia is important to lessen caregiver burden, to address early intervention both pharmacologic and non-pharmacologic including improvement of facilities and in-house program to prevent neuropsychiatric complications

Human ; Male ; Female ; Cognitive Dysfunction ; Caregivers ; Activities Of Daily Living ; Persistent Vegetative State ; Prevalence ; Deaf-blind Disorders ; Early Intervention (education) ; Hemiplegia ; Pilot Projects ; Aphasia, Wernicke ; Depression ; White Matter ; Dementia ; Memory ; Memory Disorders ; Institutionalization ; Home Care Services ; Early Diagnosis ; Confusion ; Educational Status ; Cognition