INTRODUCTION: Adverse childhood experiences (ACEs) are associated with significant long-term impacts, yet few interventions specifically target ACE exposure, especially in Asian populations. Anchor, Singapore's first home visitation programme, addresses maltreat-ment among preschool children. This study evaluated Anchor's impact on children's developmental and behavioural outcomes. METHOD: We conducted a prospective evaluation of children under 4 years assessed for maltreatment from November 2019 to July 2023. Developmental and behavioural progress was measured every 6 months using the Ages and Stages Questionnaires (ASQ-3) and ASQ:Social-Emotional (ASQ:SE-2), and annually using the Child Behaviour Checklist (CBCL). RESULTS: The results of 125 children (mean age 20.0 months, 48% female) were analysed. The mean length of stay in programme was 21.2 (7.3) months. At baseline, 92 (73.6%) children were at risk of develop-mental delay and 25 (31.7%) children aged ≥18 months had behavioural concerns. The programme was associated with significant improvements in gross motor (P=0.002) and fine motor (P=0.001) domains of the ASQ-3 and internalising problem scale (P=0.001) of the CBCL. CONCLUSION Anchor effectively enhances develop-mental and behavioural outcomes for children exposed to maltreatment. Targeted early intervention through such programmes can mitigate adverse impacts, optimising developmental trajectories and potentially reducing the long-term clinical and economic burdens associated with ACEs.
Humans ; Female ; Male ; Child Abuse/therapy* ; Child, Preschool ; Singapore ; House Calls ; Infant ; Prospective Studies ; Child Development ; Developmental Disabilities/epidemiology* ; Program Evaluation ; Child Behavior Disorders ; Child Behavior

Autism spectrum disorder (ASD) is characterised by persistent deficits in social communication and interaction as well as restricted, repetitive patterns of behaviour and interests. Early detection and early intervention programmes improve functional outcomes. Family physicians should screen for ASD opportunistically when children attend clinics for acute issues and during scheduled well-child assessments. Early warning signs of ASD include the lack of social gestures at 12 months, using no meaningful single words at 18 months, and having no interest in other children or no spontaneous two-word phrases at 24 months. Children with suspected ASD should be referred to appropriate specialist centres as early as possible for multidisciplinary assessment and diagnosis.

Behavioural problems in children are a relatively common occurrence but are a concern for parents. Such problems are often a reflection of the child's social stressors, environment and developmental state. Although a majority of behavioural problems are temporary, some may persist or are symptomatic of neurodevelopmental disorders or an underlying medical condition. Initial management of behaviour problems often involves helping parents to learn effective behaviour strategies to promote desirable behaviours in their children. This article highlights a general approach to evaluating and treating behavioural problems in children in the primary care setting. Sleep problems, eating disorders, and other emotional and developmental disorders, such as autism spectrum disorder and attention deficit hyperactivity disorder, are not within the scope of this article.

Developmental delays are common in childhood, occurring in 10%-15% of preschool children. Global developmental delays are less common, occurring in 1%-3% of preschool children. Developmental delays are identified during routine checks by the primary care physician or when the parent or preschool raises concerns. Assessment for developmental delay in primary care settings should include a general and systemic examination, including plotting growth centiles, hearing and vision assessment, baseline blood tests if deemed necessary, referral to a developmental paediatrician, and counselling the parents. It is important to follow up with the parents at the earliest opportunity to ensure that the referral has been activated. For children with mild developmental delays, in the absence of any red flags for development and no abnormal findings on clinical examination, advice on appropriate stimulation activities can be provided and a review conducted in three months' time.
Child ; Child, Preschool ; Developmental Disabilities ; diagnosis ; therapy ; Female ; Humans ; Male ; Mass Screening ; methods ; Parents ; Pediatrics ; methods ; Physical Examination ; Physician-Patient Relations ; Primary Health Care ; organization & administration ; Referral and Consultation ; Singapore

Child development refers to the continuous but predictably sequential biological, psychological and emotional changes that occur in human beings between birth and the end of adolescence. Developmental surveillance should be incorporated into every child visit. Parents play an important role in the child's developmental assessment. The primary care physician should educate and encourage parents to use the developmental checklist in the health booklet to monitor their child's development. Further evaluation is necessary when developmental delay is identified. This article aimed to highlight the normal child developmental assessment as well as to provide suggestions for screening tools and questions to be used within the primary care setting.
Adolescent ; Checklist ; Child ; Child Development ; Child, Preschool ; Developmental Disabilities ; diagnosis ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Infant ; Infant, Newborn ; Male ; Parent-Child Relations ; Parents ; psychology ; Physicians, Primary Care ; psychology ; Primary Health Care ; Professional-Family Relations ; Singapore