Adherence of Well Child Visits in Relation to the Age at Diagnosis of Developmental Disorders Among 0-6 Year-Old Children in Taiwan

Introduction:Well child visit is a crucial opportunity for physicians to examine children’s growth and development and to provide timely intervention when problems are detected. Early identification of hearing loss and intellectual disability is important because of their congenital or early onset of etiology and adverse effects of delayed recognition on progress in other developmental domains. This study aims to investigate the relationship linking the adherence of well child visits with the initial age at diagnosis of hearing loss and intellectual disability; possible clinical subtype-heterogeneity in such links was also explored.

Methods:Based upon the 2000-2004 birth cohorts, 31,673 with hearing loss and 5,484 with intellectual disability were identified before age of seven years from the 2000-2010 National Health Insurance Research Database (NHIRD) in Taiwan. Adherence level of well child care before the first diagnosis is first estimated by the percentage of the number of visits utilized based on the recommended schedule; children having 75% or higher rates were categorized into “high adherence group”. The propensity score matching method was used to take into account possible endogeneity existing in the association with adherence of well child visits and diagnosis of developmental disorders, and the Cox proportional hazard models were utilized to examine the relationships between adherence of well child visits and diagnosis of developmental disorders.

Results:The average age at diagnosis of hearing loss and intellectual disability was about 38.3 and 51.2 months. Children with higher adherence were younger at diagnosis of hearing loss for one year and intellectual disability for 4 months than those with lower adherence. Higher adherence of well child visits was significantly associated with receiving an earlier diagnosis of hearing loss (adjusted Hazard Ratio [aHR]=1.5, p<0.001); the estimate for conductive and sensorineural hearing loss was 1.98 and 1.56, respectively (all p<0.001). For children with intellectual disability, the adjusted estimated hazard of diagnosis in higher adherence was 1.15 times earlier than that in lower adherence (p<0.05); however, such link for the earlier diagnosis was more prominent for moderate to profound type of intellectual disability (aHR=1.39, p<0.01).

Conclusions: Children with higher adherence of well child visits tended to receive the initial diagnosis of hearing loss or intellectual disability at an earlier age. Future research should pay more attention to the effects of quality or contents in the well child visits on children’s age of diagnosis with developmental disorders.