Discussion: Trends in the Prevalence of Developmental Disabilities in US Children

Discussion: Trends in the Prevalence of Developmental Disabilities in US Children ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Trends in the Prevalence of Developmental Disabilities in US Children Each class, students will be responsible for reading three research articles and completing written responses to the readings for that day. These responses are meant to facilitate class discussion of the assigned material.Discussion: Trends in the Prevalence of Developmental Disabilities in US Children. For each response, students will be required to write a one-page paper synthesizing the three articles and include at least 1 discussion question per article that they are prepared to bring up in class that day. Article Response assignments must be turned in online via Canvas by 12:00 PM (noon) on the day of class (Thursday). Only assignments submitted ON TIME via the designated link on Canvas will be graded. NO EXCEPTIONS. The following factors will be considered in grading: relevance, accuracy, synthetization of the reading materials, degree to which the responses show understanding/comprehension of the material, and quality of writing . Times New Roman 12 Please find the 3 articles attached boyle_et_al.__2011___l_.pdf scherzer__chhagan__kauchali____susser__2012_.pdf shevell__2010_.pdf Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008 WHAT’S KNOWN ON THIS SUBJECT: US data on the changes in the prevalence of developmental disabilities are scarce. Although there are a few studies on individual disabilities, data examining the impact of the full range of developmental disabilities are unavailable. WHAT THIS STUDY ADDS: Developmental disabilities make a signi?cant contribution to overall childhood health. We show the health disparities that exist for speci?c populations and how selected conditions have increased over the past 10 years. OBJECTIVE: To ?ll gaps in crucial data needed for health and educational planning, we determined the prevalence of developmental disabilities in US children and in selected populations for a recent 12-year period. PARTICIPANTS AND METHODS: We used data on children aged 3 to 17 years from the 1997–2008 National Health Interview Surveys, which are ongoing nationally representative samples of US households. Parentreported diagnoses of the following were included: attention de?cit hyperactivity disorder; intellectual disability; cerebral palsy; autism; seizures; stuttering or stammering; moderate to profound hearing loss; blindness; learning disorders; and/or other developmental delays. RESULTS: Boys had a higher prevalence overall and for a number of select disabilities compared with girls. Hispanic children had the lowest prevalence for a number of disabilities compared with nonHispanic white and black children. Low income and public health insurance were associated with a higher prevalence of many disabilities. Prevalence of any developmental disability increased from 12.84% to 15.04% over 12 years. Autism, attention de?cit hyperactivity disorder, and other developmental delays increased, whereas hearing loss showed a signi?cant decline. These trends were found in all of the sociodemographic subgroups, except for autism in non-Hispanic black children. CONCLUSIONS: Developmental disabilities are common and were reported in ?1 in 6 children in the United States in 2006 –2008. The number of children with select developmental disabilities (autism, attention de?cit hyperactivity disorder, and other developmental delays) has increased, requiring more health and education services. Additional study of the in?uence of risk-factor shifts, changes in acceptance, and bene?ts of early services is needed. Pediatrics 2011;127:1034–1042 BOYLE et al aNational Center on Birth Defects and Developmental Disabilities and bNational Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, Georgia; and cMaternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland KEY WORDS developmental disabilities, prevalence, autism, attention de?cit hyperactivity disorder ABBREVIATIONS NHIS—National Health Interview Survey ADHD—attention de?cit hyperactivity disorder abstract 1034 AUTHORS: Coleen A. Boyle, PhD,a Sheree Boulet, PhD,a Laura A. Schieve, PhD,a Robin A. Cohen, PhD,b Stephen J. Blumberg, PhD,b Marshalyn Yeargin-Allsopp, MD,a Susanna Visser, MS,a and Michael D. Kogan, PhDc All authors made substantial intellectual contributions to the study, including the conception and design, acquisition of data, analysis, and interpretation. All authors participated actively in the drafting and revising of the manuscript. Discussion: Trends in the Prevalence of Developmental Disabilities in US Children Finally, all authors approved the ?nal version that was submitted for publication. Dr Coleen A. Boyle had full access to all the data and takes responsibility for the integrity of the data and accuracy of the data analysis and contributed to the study design and concept, analysis and interpretation of the data, drafting of the manuscript, critical review of the manuscript, and statistical analysis. Dr Sheree Boulet contributed to the study design and concept, acquisition of the data, analysis and interpretation of the data, and critical review of the manuscript. Dr Laura Schieve contributed to the study design and concept, analysis and interpretation of the data, drafting of the manuscript, and critical review of the manuscript. Dr Robin A. Cohen contributed to the acquisition of the data and analysis and interpretation of the data. Dr Stephen J. Blumberg contributed to the analysis and interpretation of the data, drafting of the manuscript, and critical review of the manuscript. Dr Marshalyn Yeargin-Allsopp contributed to the analysis and interpretation of the data, drafting of the manuscript, and critical review of the manuscript. Dr Susanna Visser contributed to the analysis and interpretation of the data, drafting of the manuscript, and critical review of the manuscript. Dr Michael D. Kogan contributed to the analysis and interpretation of the data, drafting of the manuscript, and critical review of the manuscript. The ?ndings and conclusions in this report are those of the authors and do not necessarily represent the of?cial position of the Centers for Disease Control and Prevention or the Health Resources and Services Administration. www.pediatrics.org/cgi/doi/10.1542/peds.2010-2989 doi:10.1542/peds.2010-2989 Accepted for publication Feb 25, 2011 Address correspondence to Coleen A. Boyle, PhD, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333. E-mail: [email protected] Downloaded from pediatrics.aappublications.org by guest on June 15, 2015 (Continued on last page) ARTICLES Data on the prevalence of developmental disabilities have been used to describe the importance of these health problems and to assess the educational, medical, and social support needs for children with developmental disabilities and their families. Estimates of the prevalence of developmental disabilities in US children on the basis of the 1988 National Health Interview Survey (NHIS) indicated that 16.8% of children younger than 18 years of age had lifelong conditions arising in early childhood as a result of cognitive or physical impairment or a combination of the 2.1 Findings from more recent surveys that used a more restrictive de?nition of developmental disabilities suggested that 13.2% of children had 1 or more developmental disabilities during 1997–2005 and 1.6% had 3 or more developmental disabilities.2 These studies also documented the considerable impact of the disorders as measured by higher rates of health and special-education service use for children with developmental disabilities compared with children without developmental disabilities. Discussion: Trends in the Prevalence of Developmental Disabilities in US Children A number of factors may have in?uenced the prevalence of developmental disabilities over the past 10 to 15 years, including improved survival of the growing number of children born preterm or with birth defects or genetic disorders, such as spina bi?da and Down syndrome,3 whose improved survival may be offset by a disproportionate burden of neurologic and other impairments.4,5 Other trends and medical practice changes that might contribute to a reduction of developmental disabilities in the population include increases in prenatal diagnosis and therapeutic abortion, older maternal age, new infant vaccines, and the expansion of newborn screening.6,7 Finally, increased awareness and improved diagnosis, particularly for conditions with a behavioral phenotype, such as autism or attention PEDIATRICS Volume 127, Number 6, June 2011 de?cit hyperactivity disorder (ADHD), may have contributed to changes over time. Since 1997, the NHIS has routinely included questions on a broad array of developmental disabilities among children younger than 18 years of age. This survey, with population-based annual samples and consistent verbiage in individual disability condition questions, is ideal for monitoring trends in prevalence over time. We used data for a 12-year time period (1997–2008) to examine (1) the national prevalence of developmental disabilities according to major demographic and socioeconomic characteristics and (2) changes in the prevalence of developmental disabilities over time. PARTICIPANTS AND METHODS We used the Family Core and Sample Child Components of the NHIS from 1997 to 2008. The NHIS is an ongoing annual survey, conducted by the Centers for Disease Control and Prevention, National Center for Health Statistics, that uses a multistage probability sample to estimate the prevalence of a number of health conditions in the civilian noninstitutionalized population of the United States.8,9 Demographic and health data on family members are obtained through an in-person interview with a knowledgeable adult family member. For the Sample Child component, more detailed data are obtained for 1 randomly selected child younger than 18 years of age. For more than 90% of the children included in the NHIS Sample Child component, the knowledgeable adult interviewed was a parent or legal guardian. The current analysis was limited to children aged 3 to 17 years (total 1997–2008 unweighted sample size: 119 367). Children younger than 3 years of age were excluded because many developmental disabilities are not recognized or diagnosed before that age. The average household response rate for the NHIS was 88.3% (range of annual rates: 84.9 –91.8%); the average conditional response rate for the sample child component was 91.2% (range: 85.6 –93.7%). The speci?c conditions assessed were as follows: ADHD; cerebral palsy; autism; seizures; stammering or stuttering; mental retardation; moderate to profound hearing loss; blindness; learning disorders; and other developmental delays (see Table 1 for the survey questions).Discussion: Trends in the Prevalence of Developmental Disabilities in US Children The same set of questions were asked over the 11 survey years; the ex- TABLE 1 The NHIS Questions on Developmental Disabilities, 1997–2008 Condition Survey Question ADHD/attention de?cit disorder (ADD),a autism, cerebral palsy, mental retardation,b and other developmental delay Seizures and stuttering or stammering “Has a doctor or health professional ever told you that [survey child] had any of the following conditions?” Moderate to profound hearing loss Blindness Learning disability “During the past 12 months, has [survey child] had any of the following conditions?” “Which statement best describes [survey child’s] hearing without a hearing aid: good, a little trouble, a lot of trouble, or deaf?”c “Is [survey child] blind or unable to see at all?” “Has a representative from the school of a health professional ever told you that [survey child] has a learning disability?” a NHIS shifted from asking about ADD in 1997–1999 to asking about ADD and ADHD in 2000 and later. Referred to as intellectual disability in the text and tables. c Categories were revised in 2008 to the following: excellent; good; a little trouble; moderate trouble; a lot of trouble; and deaf. Moderate to profound hearing loss included the categories of deaf and a lot of trouble hearing for 1997–2007 and moderate trouble, a lot of trouble, and deaf for 2008. b Downloaded from pediatrics.aappublications.org by guest on June 15, 2015 1035 ception was an expansion of the hearing-loss categories in 2008 (see Table 1 for details). Although the NHIS questionnaire used the term “mental retardation,” to be more closely aligned to currently accepted terminology, we refer to this condition as “intellectual disability.”10 The time frame for the majority of the questions refers to whether the child was “ever” diagnosed with the condition; for seizures and stuttering or stammering the reference period was the “past 12 months,” and moderate to profound hearing loss and blindness referred to the current status of the child. A child was considered to currently have a condition if there was an af?rmative response, regardless of the time frame of the questions. There was substantial collinearity between learning disabilities and intellectual disabilities, and we therefore report learning disabilities as a consequence of the intellectual disability rather than a cooccurring condition. That is, children with reported intellectual disabilities and learning disabilities were only included in the intellectual disability category. We examined the prevalence of any parent-reported developmental disabilities and of each individual developmental disability for the 12-year period combined and assessed how the estimates varied by a number of demographic and socioeconomic characteristics, including the child’s age; gender and race/ethnicity; mother’s education; total family income level from all sources, including supplemental security income (with income de?ned relative to the federal poverty level); and health insurance status (any public, private-only, no health insurance reported). Children covered by both private insurance and the state’s Medicaid programs are included under “any public.” We also assessed secular trends for each disability over 4 3-year 1036 BOYLE et al time intervals (1997–1999; 2000 –2002; 2003–2005; and 2006 –2008). For the disabilities with statistically signi?cant temporal trends, we conducted additional analyses to determine whether trends were uniform within the demographic and socioeconomic subgroups. Income strati?cation in this report is based on both reported and imputed income.11 Prevalence estimates were weighted using NHIS weights to represent the US noninstitutionalized population of children. Variance estimates were produced using Sudaan software to account for the complex NHIS sample design.Discussion: Trends in the Prevalence of Developmental Disabilities in US Children ?2 Tests were used to determine whether the prevalence estimates differed among the various groups being compared. Wald-F tests were used to assess linear trends over the 4-calendar-year time periods. All associations and differences described in the text were statistically signi?cant at the P ? .05 level. Human subject review was not required for this analysis of publicly available data. RESULTS Prevalence and Demographic Characteristics The prevalence of any developmental disability in 1997–2008 was 13.87% and ranged from 0.13% for blindness to 6.69% for ADHD and 7.66% for learning disabilities (Table 2). In general, there was higher prevalence in older children for conditions likely to be ?rst recognized or con?rmed in the school years, including ADHD and learning disabilities. Little change across age groups was noted for cerebral palsy, moderate to profound hearing loss, and other developmental delays. There was a lower prevalence in older children for stuttering or stammering. Hispanic children had a lower prevalence of several disorders relative to non-Hispanic white and black children, including ADHD and learning disabilities; the prevalence of other developmental delays was higher only in comparison to non-Hispanic white children. Stuttering or stammering was reported more often in nonHispanic black children than nonHispanic white children. Boys had twice the prevalence of any developmental disability and excess prevalence for ADHD, autism, learning disabilities, stuttering or stammering, and other developmental delays, speci?cally. There was a nearly twofold higher prevalence of any reported developmental disability among children insured by Medicaid relative to those insured by private insurance, and this pattern was statistically signi?cant for ADHD, learning disabilities, intellectual disabilities, seizures, stuttering or stammering, and other developmental delays. Family incomes below the federal poverty level were associated with a higher prevalence of parent-reported developmental disabilities overall and learning disabilities, intellectual disabilities, stuttering or stammering, and other developmental delays, speci?cally. Lower maternal education (ie, any attainment less than a college degree) was associated with a higher prevalence of any developmental disabilities, learning disabilities, and stuttering or stammering. Time Trends For all developmental disabilities combined, there was a small, but statistically signi?cant, linear increase in the prevalence over the 4 time periods, from 12.84% in 1997–1999 to 15.04% in 2006 –2008 (Table 3). Of the individual disorders, ADHD and autism showed signi?cant and successive increases over time. Other developmental delays, a catch-all category, also showed signi?cant increases over the time period, but the increase was observed only between the most recent 2 intervals (from 2003–2005 to 2006 –2008). Downloaded from pediatrics.aappublications.org by guest on June 15, 2015 Although the magnitude of the change varied somewhat among the various descriptive factors (Table 4), in general, we observed upward trends in the parent-reported prevalence of ADHD and autism and a decrease for moderate to profound hearing loss. Discussion: Trends in the Prevalence of Developmental Disabilities in US Children One exception was race/ethnicity and autism, with a lack of a signi?cant increase in non-Hispanic black children. DISCUSSION Developmental disabilities affect a signi?cant proportion of children in the United States. We found that 15% of children aged 3 to 17 years, or nearly 10 million children in 2006 –2008, had a developmental disability on the basis of parent report. The 17% increase in prevalence over the 12-year period represents ?1.8 million more children with developmental disabilities in 2006 –2008 than a decade earlier. It is dif?cult to corroborate the overall prevalence reported in this study because of the lack of comparable studies using a similar grouping of conditions. In comparing the prevalence for individual disorders, however, we ?nd good agreement for some of the prevalence estimates. A comparable high prevalence of ADHD recently was reported from the 2003–2007 National Survey of Children’s Health, using a similar set of parent-reported survey questions.12 Prevalence rates for au- PEDIATRICS Volume 127, Number 6, June 2011 Downloaded from pediatrics.aappublications.org by guest on June 15, 2015 5.07 0.59 0.72 1.99 3.86 7.66 0.71 0.67 1.60 3.65 1.27 1.15c 3.97 7.58 0.62 0.66 9.27c 0.84 0.61 3.41 14.99 7.82 0.52 0.12 0.39 0.51 16.24c 8.93c 0.37 0.16 0.37 0.46 3.62 2.63f 7.62 1.06 0.91 14.77 6.30 0.41 0.13 0.36 0.41 2.25a 4.64c 2.64d 8.97c 0.78 0.73 18.04c 9.51c 0.74c 0.16 0.36 0.54 2.61 0.91 5.01 0.63 0.62 9.50 3.73 0.19 0.10 0.37 0.35 Girls Gender,% Boys 1.96 5.50d,e 0.70 0.61 10.65d,e 3.87d,e 0.32 0.15 0.33 0.32 Hispanic 3.19 2.57 8.06 0.93 0.73 13.89 5.46 0.25 0.16 0.33 0.56 3.91 1.59 7.50 0.70 0.75 14.78 7.26i 0.50 0.13 0.35 0.50 High School/ Some College b 3.32 0.96g,h 4.85g,h 0.48 0.45 10.88g,h 5.35 0.61 0.07 0.42 0.28 College Graduate or Higher Maternal Education,% Less Than High School We excluded cerebral palsy from the analysis for 2004 –2007 because of the high likelihood of interviewer error arising from a questionnaire change in 2004. The survey question asked about mental retardation, but we refer to the condition as intellectual disability. c P ? .05, ages 3–10 vs 11–17 years. d P ? .05, non-Hispanic white versus Hispanic. e P ? .05, non-Hispanic black versus Hispanic. f P ? .05, non-Hispanic white versus non-Hispanic black. g P ? .05, less than high school versus college graduate. h P ? .05, high school versus college graduate. i P ? .05, less than high school versus high school graduate. j P ? .05, ?200% versus ?200% poverty level. k P ? .05, private insurance versus Medicaid. l P ? .05, Medicaid versus uninsured. a 11.78 4.72 0.56 0.10 0.36 0.44 13.87 6.69 0.47 0.13 0.39 0.45 Any developmental disability ADHD Autism Blind/unable to see at all Cerebral palsya Moderate to profound hearing loss Learning disabilities Intellectual disabilitiesb Seizures in the past 12 months Stuttered or stammered in the past 12 months Other developmental delay Non-Hispanic Black Race and Ethnicity,% Non-Hispanic White 11–17 Age, %, y 3? … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

RECOMMENDED: Discussion: Dissemination of Evidence