健診における発達障害の早期発見や介入に関する調査

概要

論文の詳細を見る
近年、３歳児健診以降に発達障害の疑われる子どもが多く発見されるようになり、幼児健診の有り方の見直しが急務となっている。　そこで、無作為に抽出した全国の保健センターの保健師長を対象に、健診の実態や発達障害児への支援状況などを調査し、発達障害の早期発見や介入を阻害する要因の検討を行った。１４４名（回収率３６０. ％）の回答が得られた。その結果、健診の状況には地域による差がみられ、１歳６か月、３歳児健診ともに、特別区・政令市では健診１回あたりの受診者数、年間健診回数が多く、健診に携わる非常勤職員も多かった。健診医は小児科が多かったが、内科や耳鼻科もみられ、医師確保が困難であることが推察された。発達障害の早期発見に重要な児童精神科医は極めて少なかった。健診に携わる職種は、心理士、助産師は特別区・政令市に多く、保育士はその他の市、町村に多かった。支援内容は心理相談が最も多かったが、発達専門相談や親子教室の実施には地域差がみられた。また、継続支援機関はいずれの地域も療育施設が最も多く、地域差がみられた。発達障害児の年間のフォロー率は、１歳６か月が１６２. ％、３歳が１４０. ％で、地域による差は見られなかった。いずれの健診でもフォロー率の高い地域は問診時間が長く、年間健診回数が多かった。１歳６か月健診では通園施設のある地域の方が、フォロー率が有意に高かった。専門医療機関との関連は見られなかった。以上より、発達障害の早期発見や介入には、健診の状況や、健診後の受け皿となる療育施設等の有無が影響していた。 In recent years, many children in the period after having taken a medicalexamination at the age of three have been discovered to exhibit developmentaldisorders. We conducted a survey towards public health nurse (PHN) directors byrandomly selecting national health centers throughout Japan investigating thepresent medical examination and the current state of support provided to infantswith developmental disorders thereby examining the factors obstructing the earlydetection and intervention of developmental disorders. We received responses from144 people (response rate of 36.0%).　As a result, we found discrepancies in the conditions of the medical examinationbetween regions. In the special districts, there were a large number of infants, both18-months and 3-year olds, taking the medical examination on each occasion and thefrequency of medical examinations offered annually was also high. In addition, therewere numerous staff, even part-time staff, dedicated to carrying out the medicalexaminations. The majority of PHNs involved in the medical examination werepaediatricians, but they were also in charge of internal medicine as well asotolaryngology, which suggested that securing doctors to administer the medicalexamination was difficult. There were extremely few child psychiatrists available,important in the early detection of developmental disorders. The number of childrenfound to exhibit developmental disorders was 16.2% for the 18-month old infants and14.0% for the 3-year olds on an annual basis. There was no noticeable differencebetween regions. It was found that in areas with high instances of children withdevelopmental disorders, substantial time was taken to examine the child and theannual number of medical examinations was high. Furthermore, in areas with ahigh number of support facilities, it was found from the medical examinations ofchildren at the 18-month stage that instances of developmental disorders weresignificantly higher. Therefore, it is suggested that greater enhancement of supportfacilities to aid in the early detection and intervention of developmental disorders iscritical.
金沢大学つるま保健学会 = the Tsuruma Health Science Society, Kanazawa Universityの論文

健診における発達障害の早期発見や介入に関する調査

スポンサーリンク

概要

著者

関連論文

スポンサーリンク