Workshop on Disability in America A New Look: Summary and Background Papers (2006) / Chapter Skim
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Appendix G Trends in Disability in Early Life--Ruth E. K. Stein
Appendix G Trends in Disability in Early Life--Ruth E. K. Stein
Pages 143-156
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From page 143... ...
Committee on Disability in America: A New Look. The second section reviews traditional measures of childhood disability in use over the past several decades and the trends that they show.
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From page 144... ...
At that time, children were less likely to be poor than the elderly, but today, the rate of poverty among children exceeds that among elderly people, so that about two-thirds more children than elderly people are poor.5 Among minority children in 2003, 29 to 34 percent of black and Hispanic children were poor, whereas 9 percent of white non-Hispanic children were poor.5 A recent paper also suggests a growing intergenerational inequity in public spending.6 Between 1965 and 2000, per capita public spending grew more rapidly for elders than for children, so children today are getting a smaller share of the pie. Children in poverty are much more likely to be rated as having poorer health than other children.7 Among the children in families with incomes below the FPL, 71 percent of the children are rated to be in excellent or very good health, whereas 89 percent of the children in families whose incomes are above 200 percent of the FPL are rated to be in excellent or very good health.4 DISABILITY Although the rates of disability among the young are considerably lower than those among people in older age groups, disability is neverthe
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Undoubtedly, therefore, the health of children is integrally linked to the health of the nation's and society's future. In addition, as was recently highlighted in a report of the Board of Children, Youth, and Families, Children's Health, the Nation's Wealth: Assessing and Improving Child Health,8 a child's health has been demonstrated to have effects that may reach far into adulthood.
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From page 146... ...
Within the population, all studies show higher rates of major activity limitations among older children than younger children and higher rates among males than females. At present, children over the age of 5 years are consistently reported to have rates of major activity limitations over 8 percent.4 The overwhelming majority of limitations in major activities is related to school participation and the need for special education.
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From page 147... ...
. In real instances children and youth are not considered disabled because they have previously functioned above normal, and when their functioning is impaired to the level that meets the minimum baseline expectations, they continue to be classified as being free of a disability.
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The percentage of children with chronic conditions has been estimated by the use of a variety of tools and a large number of national surveys over the years and has varied from a low in the single digits to a high in the low 30s.21,22 In the Child Health Supplement of the 1988 National Health Interview Survey, conducted by the National Center for Health Statistics, the estimate was 31 percent.23 It should be noted that these percentages are based on counts of conditions, not of children. A series of concerns surrounded these estimates, especially because a child, once he or she is labeled as having a condition, was counted forever after.
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From page 149... ...
It is based on continuing concern that the large number of individual conditions cannot be inventoried, that there have been negative effects of providing services and advocacy for each condition separately, and that there are inherent inequities in doing so.24,25,26,27 In 1993, my colleagues and I at the Albert Einstein College of Medicine proposed that children with chronic conditions could be identified by the consequences of their conditions.27 Three major types of consequences were identified: whether the conditions imposed functional limitations compared to the functioning of their age-mates, whether they produced dependence on compensatory mechanisms or assistance, or whether they required more than the usual level of services. Others have since published similar definitions28 and endorsed similar concepts,29 and a variety of noncategorical or generic approaches have been used.
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From page 150... ...
The 2005 National Survey of Children with Special Health Care Needs is in the field and is again using the CSHCN screener. Before leaving discussion of this approach to identification, it is worth noting that significant numbers of children have conditions that cause considerable consequences and are not identified by the functional limitations questions, even in the longest instrument.
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From page 151... ...
Spina Bifida Failure of the neural tube to fuse during fetal development is a cause of major childhood disability, regardless of the measure used. Another example of a success in lowering disability among children has resulted from the unraveling of the complicated interaction of genetics and environmental folic acid deficiency during pregnancy in a vulnerable subset of the population.8 The inclusion of folic acid supplements to women of childbearing age has led to marked declines in the rates of both spina bifida and anencephaly.
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From page 152... ...
The trends in low birth weight are also not evenly distributed, so that the rate of low birth weight among blacks is higher than that among the rest of the population.42 A rapid rise in multiple births is also being seen, which is another reason for the increases in the rates of low birth weight and disabilities associated with low birth weight.41 Obesity Members of the IOM committee have probably seen information from the Centers for Disease Control and Prevention depicting the rise in the proportion of the adult population experiencing obesity from less than 10 percent in most states to more than 25 percent in many states. This is an issue that has not been limited to adults.
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From page 153... ...
Current approaches to childhood disability that focus only on the severely disabled show low rates compared with those of adults, with a modest but consistent upward trend among children and youth. These disabilities have major implications for the young people who experience them, for their families, and for society as a whole.
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From page 154... ...
Changing pat terns of conditions among children receiving Supplemental Security Income disability benefits. Archives of Pediatric and Adolescent Medicine 153:80–84, 1999.
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Identifying children with special health care needs: development and evaluation of a short screen ing instrument. Ambulatory Pediatrics 2:38–48, 2002.
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Chronic conditions, functional limitations, and special health care needs of school-age children born extremely low birth weight in the 1990s. Journal of the American Medical Association 294:318-325, 2005.
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