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in Paediatrics
Neurodisability
and Community
Child Health
SECOND EDITION
edited by
Srinivas Gada
Consultant Paediatrician in Neurodevelopment and
Neurodisability, Nuffield Health Oxford and HCA
Healthcare London
Honorary Senior Clinical Lecturer, University of Oxford
Honorary Consultant, Oxford University Hospitals NHS
Foundation Trust, Oxford, UK
1
1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2022
The moral rights of the author have been asserted
First Edition published in 2012
Second Edition published in 2022
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2021945282
ISBN 978–0–19–885191–2
DOI: 10.1093/med/9780198851912.001.0001
Printed in Great Britain by
Ashford Colour Press Ltd, Gosport, Hampshire
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
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otherwise stated, drug dosages and recommendations are for the non-pregnant
adult who is not breast-feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
v
Dedication
I dedicate this book to my parents, Sulochana and Shankerappa,
for their countless sacrifices for my education, and without whom
I would not be here.
vii
Foreword
It is a privilege to offer a foreword to this new Handbook for the ever-
expanding field of neurodisability—what I like to call the field of ‘Applied
Child Development’.
As Dr. Gada rightly notes in his Preface, child-onset neurodisability and
community child health has seen remarkable change and development in
the past decade. Fundamental shifts—more accurately characterized as ex-
pansions in our thinking—have made the field almost unrecognizably richer
than was ever imagined possible by those of us trained in twentieth-century
thinking! Among the contributing forces in these developments one can cite,
in no implied order of priority, the WHO’s 2001 International Classification
of Functioning, Health, and Disability (ICF) framework for health; the rec-
ognition that parents must be equal partners with professionals, and the
importance of our engagement with them at every step of the journey;
seeking and heeding the voices of children; seeing ‘childhood’ issues in a
life-course perspective; and promoting the functioning and participation of
young people with impairments who were traditionally assumed to be sen-
tenced to lives of limited possibility.
This Handbook provides readers with accessible notes and guides to a
myriad of topics, with detailed cross-linking of each section to many others.
In this respect, the Handbook is a refreshing complement to the traditional
textbook, with discursive writing on background, placing ideas in context
with the history of the topic, detailed explanations, justifications, interpret-
ations of the arguments, and so on. (Full disclosure, I have experience with
such textbooks and believe they also have a place!)
What makes this current volume so useful is the immediacy of access to
whatever the user seeks to know right now. As a Handbook, the focus is
on the practical application of the available knowledge and ideas it offers.
As noted, there are always links to other parts of the text where the reader
can recognize the ways that concepts discussed in relation to a particular
impairment or diagnosis almost always have wide-ranging ‘non-categorical’
relevance across the field.
Finally, I believe it is essential to celebrate, with this Handbook, the ac-
cumulation of what Dr. Gada notes as the ‘insights, experience, and know-
ledge’—indeed, it is fair to call this ‘clinical wisdom’—of colleagues across a
wide range of disciplines and from many countries. Their rich contributions
blend together the modern scientific developments of our ever-expanding
field with the humanism and art of caring for children with complicated lives
and their families. This is a much-appreciated achievement.
Peter Rosenbaum, MD, FRCP(C), DSc (HC)
Professor of Paediatrics, McMaster University
Canada Research Chair in Childhood Disability 2001–2014
Co-Founder, CanChild Centre for Childhood Disability Research
Editorial Board, Mac Keith Press
ix
Preface
A lack of a concise, easy-to-use, and updated resource on child neurodisability
and community child health motivated me to write this book. This book is
a sequel to the Oxford Specialist Handbook of Community Paediatrics, pub-
lished in 2012, but this edition focuses more on neurodevelopmental dis-
orders. Thus, this book contains hundreds of topics on neuroplasticity, child
development, neurobehavioural disorders, sensory impairments, neuro-
orthopaedics, neuro-genetics, neurorehabilitation, mental health and allied
therapies.
This book is a culmination of my twenty plus years of clinical experience
in child neurodisability and community child health at Oxford University
Hospitals NHS Foundation Trust, Oxford and previously at Royal Free
Hospital and Royal London Hospital in London. During the past two dec-
ades, I have had the privilege to work with my colleagues in Oxford and
learn in my various professional capacities, such as consultant community
paediatrician, child development team lead, course director, hon senior
clinical lecturer, educational supervisor, clinical governance lead, editor, re-
viewer and a team member. This book contains all my clinical experience
enriched with informative, up-to-date and concise summaries on hundreds
of topics written by experts across the globe. I have been honored to work
with this team of specialists from the USA, Canada, Australia, India, and the
UK who have decades of medical experience and abundant clinical wisdom.
Therefore, this book will serve as an essential companion and first point of
reference to both established practitioners and trainees in neurodisability,
community child health, paediatrics, general practice and professionals from
multidisciplinary and multiagency teams.
Changes in the field of neurodisability and community child health can
seem slow, feel imperceptible and even go unnoticed. Yet, so much has
changed since this book’s predecessor in 2012. There has been the launch
of the DSM-5, ICD-11 and numerous new guidelines from authoritative
sources such as NICE, AAP, RCPCH, and EACD. This book has been com-
pletely revamped to reflect this updated guidance. In addition, this book has
been presented in an intuitive, easily readable format, with extensive use
of bullet points, tables, boxes, flow charts, sample reports, clinical tips, and
signposting to valuable resources.
This book is a portable guide focusing on practical advice that is clinically
effective, helping you know what to do and how to do it. Furthermore,
this book contains the insights, experience, and knowledge of experts from
various disciplines such as neurodevelopmental paediatricians, neurology,
psychiatry, orthopaedics, genetics, rehabilitation specialists, child protec-
tion, safeguarding, adoption and fostering, special educational needs, and
x Preface
therapists from multidisciplinary teams. Consequently, this book supports
you in working collaboratively with other professionals, thus enabling you
to deliver holistic care and make a positive difference in the lives of children
and the families you serve.
Dr Srinivas Gada
Oxford
November 2021
xi
Acknowledgements
After serving at Oxford University Hospitals NHS Foundation Trust from
2005, I stopped working at this prestigious institute in 2019 to focus on
completing this handbook and be more available to my ageing parents.
I want to offer my special thanks of gratitude to my parents, both of whom
passed away during the writing of this book and couldn’t be around to
see this book in print. Like many around the globe, the COVID-19 pan-
demic was brutal, and it affected the production of this book in many ways.
Nevertheless, reminding myself of the patience and perseverance of my
parents helped me to conclude this book.
This book would not have come into being without the expertise and as-
sistance of the editorial team at OUP, namely Nicola Wilson, Nic Williams
(freelance copyeditor), Clement Raj (Newgen Knowledge Works), and es-
pecially Sylvia Warren. Sylvia’s patience and support were crucial for this
project.
As a practising neurodevelopmental paediatrician, much of the informa-
tion in this handbook was drawn from my two decades in clinical practice.
Therefore, my utmost thanks go to all the children and their families who
shared their challenges with me.
I would like to extend my sincere gratitude to all the contributors for
their hard work and for offering their valuable time and expertise, despite
challenging work conditions at their institutes due to the pandemic. Their
commitment was crucial for the conclusion of this project.
My special thanks go to Professor Georg Hollander, Dr Ivor Byren, Dr
Martin Smith, and Nicki Sullivan for offering me professional support. My
thanks also go to all my ex-colleagues at Oxford University Hospitals NHS
Foundation Trust.
I am indebted to my wife, Vaishali, and my daughters, Ritu and Pooja, for
their numerous sacrifices, encouragement, and practical help while I spent
countless evenings and weekends working on this book.
Dr Srinivas Gada
Oxford
October 2021
xiii
Contents
Contributors xv
Symbols and abbreviations xvii
1. Working with child and family 1
2. Child development and neuroplasticity 29
3. Neurodevelopmental disorders and neurodisability 89
4. Sensory impairments 167
5. Neurological disorders 217
6. Mental health and behaviour 285
7. Therapies in neurodisability 373
8. Care of the child with a disability 433
9. Genetics and syndromes in neurodisability 483
10. Neuro-orthopaedics 523
11. Child protection and safeguarding 559
12. Adoption, fostering, and looked after children 619
13. Special educational needs and disability 649
14. Working with multiagency professionals 675
Index 685
Another Random Document on
Scribd Without Any Related Topics
Abb. 153. J o h a n n i s f e s t . Aus „Neuer Strauß fürs
Haus“. 1864. (Zu Seite 85.)
Abb. 154. E r s t e s O f e n f e u e r . Aus „Neuer Strauß fürs Haus“. 1864. (Zu Seite
85.)
Abb. 155. G r u s e l i g e G e s c h i c h t e n .
Aus „Neuer Strauß fürs Haus“. 1864. (Zu Seite 85.)
Kaiser Wilhelm I. hatte im Jahre 1871 dem Komponisten der
„Wacht am Rhein“ und dem Schöpfer des Hermannsdenkmals auf
dem Teutoburger Walde einen Ehrensold ausgesetzt. Der Bildhauer
von Bandel war der erste von beiden, der das Zeitliche segnete, und
nun wurde am 11. Oktober 1876 unser Altmeister vom Kaiser mit
diesem Ehrensold auf Lebenszeit bedacht. Am 1. Dezember 1876
trat unser Meister nach einer achtundvierzigjährigen Dienstzeit in
den wohlverdienten Ruhestand. Das Ministerium des Innern hatte
mit König Alberts Genehmigung in Anerkennung seines
künstlerischen Wirkens den Ausfall am Gehalt als „Ehrengehalt“
ersetzt, den die Landstände ihm dann auch bestätigten, so daß ihm
sein seither bezogener voller Gehalt als Pension verblieb. Von der
Mitgliedschaft des „Akademischen Rates“ wurde er aber noch nicht
enthoben, er mußte an den Sitzungen desselben nach wie vor noch
teilnehmen, was ihm sehr beschwerlich war; aber er blieb dadurch
doch noch in Verbindung mit der Akademie und fühlte sich nicht so
ganz abseits.
Abb. 156. B e i ß m a l a b , H ä n s c h e n !
Aus „Neuer Strauß fürs Haus“. 1864. (Zu Seite
86.)
Abb. 157. Ä h r e n l e s e . 1866. (Zu Seite 86.)
Abb. 158. Z u r M ü h l e . Aus „Unser täglich Brot“.
1866.
Verlag von Alphons Dürr in Leipzig. (Zu Seite 86.)
Vor seinem Abgänge von der Kunstakademie bereitete die
Dresdener Künstlerschaft unserem Meister am 9. März 1876 ein
wohlgelungenes Fest. Die Festteilnehmer erschienen als
Richtersche und oft recht drollige Figuren; die einzelnen
zusammengehörigen Gruppen brachten dem Meister ihre Huldigung
dar; es gab dabei sehr lustige Szenen; Hermann und Dorothea
waren wohl ein dutzendmal vertreten, und Hermann hatte dreißig
oder mehr Mütter. Obwohl er schweren Herzens — ihm waren alle
offiziellen Feiern, und nun gar ihm selbst bereitete, etwas
Unbequemes — zu der Feier sich begab, war er doch sichtlich
ergriffen ob all der Liebe und Verehrung, die ihm, wie er
liebenswürdigst behauptete, so unverdient entgegengebracht wurde.
Am 18. Februar 1878 wurde er, auf sein dringendes Ansuchen,
aus dem „Akademischen Rat“ der Kunstakademie entlassen. Die
Sitzungen waren ihm mit der Zeit eine immer schwerere und
drückendere Last geworden. Am 22. Dezember 1878 ernannte ihn
die Stadt Dresden zum Ehrenbürger.
Abb. 159. D e n n d i e s i s t d a s B r o t
G o t t e s . Aus „Unser täglich Brot“. 1866. (Zu
Seite 87.)
Abb. 160. L ä n d l i c h e s F e s t . 1866. (Zu Seite 87.)
Das Augenleiden hatte sich in den letzten Jahren so
verschlimmert, daß er kaum noch lesen konnte. Es waren auf der
Netzhaut der Augen durch Springen und Vernarbungen von
Blutgefäßen unempfindliche Stellen entstanden, die nicht mehr
funktionierten, so daß er die Dinge um sich her nur teilweise sah.
Schreiben konnte er nur noch mit Hilfe der Lupe, er fand die Zeilen
nicht mehr und schrieb oft durcheinander, wie der angefügte Brief
zeigt.
Im Jahre 1880 ungefähr schreibt er einmal: „Außer dem
Evangelium, das göttliche Gesundheit atmet, lese ich jetzt nur
Goethe und Jeremias Gotthelf, allerdings eine wunderliche
Zusammenstellung, aber mir ist wohl, wenn ich dabei bin.“ Jeremias
Gotthelf war ihm ein Lieblingsschriftsteller geworden. Dieser kernige,
gesunde Schweizer verstand es, unseren Meister zu fesseln, wie er
auch Cornelius gefesselt hatte. Die wuchtigen, markigen
Männergestalten mit all ihrem germanischen und bäuerlichen
Eigensinn und ihren Schrullen und Ecken und ihrem trefflichen
inneren Kern, die Männer, die mit dem Mist an den Stiefeln in die
Stube treten, im Gegensatz zu Berthold Auerbachs Bauern, die sich
erst säuberlich vor der Tür die Stiefeln abstreichen, — die
entzückend geschilderten Mädchen- und Frauengestalten, die
kerngesunde Charakteristik, — das alles packte und fesselte ihn. Die
reizende kleine Erzählung, das „Erdbeer-Mareili“, die ans
Romantische streift, war ihm besonders lieb. Gestalten wie Uli der
Knecht und der Hagelhans und dessen Tochter Vreneli waren nach
seinem Sinn. Fritz Reuters urgesunder Humor und ausgezeichnete
Charakteristik erfreuten ihn; er hat beim Vorlesen aus der „Stromtid“,
aus der „Franzosentid“ und den übrigen Werken oft herzlich gelacht.
1868 war Richter mit Skizzen zu Gotthelfs und Fritz Reuters
Schriften beschäftigt, ließ aber diesen Plan wieder fallen und
zeichnete statt dessen die Folge „Gesammeltes“. Charles Dickens’
(Boz’) Werke, so dessen David Copperfield und andere, haben ihm
immer sehr behagt.
Abb. 161. A n d e r V i a A p p i a . Nach einer Originalphotographie. 1867. (Zu
Seite 88.)
Abb. 162. B r u n n e n b e i A r r i c c i a . Nach einer Originalphotographie. (Zu
Seite 88.)
Abb. 163. A u f d e m B e r g e . Aus „Gesammeltes“. 1869. Verlag von Alphons
Dürr in Leipzig. (Zu Seite 89.)
Abb. 164. M i t t a g s r u h e i m K o r n . 1861.
Aquarelle im Besitz des Herrn Cichorius in Dresden. (Zu
Seite 88.)
Abb. 165. K i n d e r s z e n e . Aus „Gesammeltes“. 1868. (Zu Seite 89.)
Vor allem schätzte er aber Goethe und Shakespeare, wie wir das
aus seinen Aufzeichnungen schon ersahen. Eine besondere
Vorliebe hatte er für die Romantiker, wie Tieck, Novalis, Clemens
Brentano. Hier war die romantische Richtung aus der Zeit seiner
Jugend bestimmend für sein ganzes Leben, wenn er auch in
späteren Jahren sehr klar sah, was in jener Zeit krankhaft und
gemacht war. Brentanos herrliches Fragment „Aus der Chronika
eines fahrenden Schülers“ schätzte er ganz besonders; er hat dazu
das prächtige Blatt „Die Laurenburger Els“ im „Gesammelten“
gezeichnet. Brentanos Märchen, herausgegeben von Guido Görres,
vor allem das „Vom Rhein und dem Müller Radlauf“, die Romanzen
vom Rosenkranz und die Aufzeichnungen der Visionen der Nonne
von Dülmen, Katharina Emmerich, letztere wegen des Anregenden
für die Darstellung der Leidensgeschichte Christi, interessierten ihn
sehr. Den würdigen Matthias Claudius hatte er besonders ins Herz
geschlossen; wie oft habe ich ihn rezitieren hören:
Wir stolzen Menschenkinder
Sind eitel arme Sünder
Und wissen gar nicht viel.
Wir spinnen Luftgespinste
Und suchen viele Künste,
Und kommen weiter von dem Ziel.
Gott, laß dein Heil uns schauen,
Auf nichts Vergänglich’s trauen,
Nicht Eitelkeit uns freu’n.
Laß uns einfältig werden
Und vor dir hier auf Erden
Wie Kinder fromm und fröhlich sein.
Abb. 166. D r e i k ö n i g s l i e d . Aus
„Gesammeltes“. 1869. (Zu Seite 89.)
Abb. 167. F e i e r a b e n d . Aus „Gesammeltes“.
1867. (Zu Seite 89.)
Abb. 168. Zu „G o t t s o r g t f ü r u n s “. 1865. Aus Georg Scherers „Illustriertes
deutsches Kinderbuch“. II. Band. 1869.
Verlag von Alphons Dürr in Leipzig. (Zu Seite 89.)
Die angeführten Strophen, von denen er bei Gelegenheit sagt:
„Jede Zeile eine Perle!“ — „enthielten für Richters Denk- und
Empfindungsweise die Quintessenz aller praktischen, christlichen
Lebensweisheit“. Auch für die Schriften Gottfried Heinrich von
Schuberts, die wissenschaftlichen wie die erbaulichen, hatte er das
größte Interesse; er nennt ihn in der Biographie neben Kempis und
Claudius seinen Lehrer und Führer; er lernte ihn 1850 persönlich
durch Schnorr in München kennen. „Schubert galt ihm als der
protestantische und der edle Bischof Sailer von Regensburg ( †
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