健診における発達障害の早期発見や介入に関する調査

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  • ケンシン ニ オケル ハッタツ ショウガイ ノ ソウキ ハッケン ヤ カイニュウ ニ カンスル チョウサ
  • Investigation about early detection and the intervention of the Developmental Disorder Child in the Infant Medical Examination

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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 medical examination at the age of three have been discovered to exhibit developmental disorders. We conducted a survey towards public health nurse (PHN) directors by randomly selecting national health centers throughout Japan investigating the present medical examination and the current state of support provided to infants with developmental disorders thereby examining the factors obstructing the early detection and intervention of developmental disorders. We received responses from 144 people (response rate of 36.0%). 　As a result, we found discrepancies in the conditions of the medical examination between regions. In the special districts, there were a large number of infants, both 18-months and 3-year olds, taking the medical examination on each occasion and the frequency of medical examinations offered annually was also high. In addition, there were numerous staff, even part-time staff, dedicated to carrying out the medical examinations. The majority of PHNs involved in the medical examination were paediatricians, but they were also in charge of internal medicine as well as otolaryngology, which suggested that securing doctors to administer the medical examination was difficult. There were extremely few child psychiatrists available, important in the early detection of developmental disorders. The number of children found to exhibit developmental disorders was 16.2% for the 18-month old infants and 14.0% for the 3-year olds on an annual basis. There was no noticeable difference between regions. It was found that in areas with high instances of children with developmental disorders, substantial time was taken to examine the child and the annual number of medical examinations was high. Furthermore, in areas with a high number of support facilities, it was found from the medical examinations of children at the 18-month stage that instances of developmental disorders were significantly higher. Therefore, it is suggested that greater enhancement of support facilities to aid in the early detection and intervention of developmental disorders is critical.

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