Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006–2010☆
Highlights
► We examined the health of US children with 4 distinct developmental disabilities (DDs). ► Mutually exclusive DDs were: autism; intellectual disability; ADHD; learning disability/other delay. ► Each DD was associated with increased prevalence of many medical conditions. ► These included respiratory, gastrointestinal, dermatologic, and neurologic conditions. ► Each DD was associated with increased health service use, delays in care, and unmet needs.
Introduction
Developmental disabilities (DDs) profoundly affect children's health and functioning. Although patterns of health care use among children with special health care needs including DDs, have been generally described, there are limited population-based studies that examined health effects associated with multiple specific DDs side by side. In a previous study, we assessed children in the 1997–2005 National Health Interview Surveys (NHIS) who had a range of DDs and found that children with DDs were 4–32 times more likely than children without DDs to have one or more health impact indicators such as limitations in movement, needing help with personal care, and regular prescription medication use (Boulet, Boyle, & Schieve, 2009). Children with DDs were also 2–8 times as likely to have used various health care services in the previous year and to have had a high number of total annual health care visits. While we did assess individual DDs separately, sample size constraints precluded us from thoroughly examining children with single versus multiple DD diagnoses by specific DD types. Moreover, we did not assess associations with specific medical conditions.
Using a separate U.S. population-based sample, Bitsko et al. (2009) found that parents of children with special health care needs with neurologic conditions were more likely to report unmet health care needs than parents of children without special health care needs, especially if the child was affected with two or more conditions. Similarly, Kogan et al. (2008) studied children with autism from the same 2005 to 2006 survey and found they were more likely to have unmet needs for specific health care and family support services and their families were more likely to report financial problems compared with other children with special health care needs without emotional, developmental, or behavioral problems. Schieve et al. (2011) found that US parents whose child had a special health care need associated with an emotional, behavioral, or developmental disorder, and those whose child had autism in particular, were substantially more likely to report parental aggravation than parents of children without developmental problems and that lack of a medical home was one of the strongest predictors of parenting aggravation within the autism group. Thus, developing a better understanding of the health care needs of children with DDs and providing improved health care supports might measurably impact family stress and coping ability in addition to having direct impacts on the child's health.
It is well documented that children with DDs often meet the diagnostic criteria for multiple DDs (Bitsko et al., 2009, Boulet et al., 2009, Levy et al., 2010); thus, it is often difficult to disentangle which condition or aspect of a given condition is associated with an identified increased health risk or health care impact. In our previous study (Boulet et al., 2009) we reported that subsets of children with attention-deficit/hyperactivity disorder (ADHD) or learning disability (LD) without other developmental diagnoses including intellectual disability (ID) had increased rates of health care use, but it was beyond the scope of the study to explore specific “isolated” DDs in depth with full consideration of concurrent medical conditions and potential socio-demographic confounding factors. While Bitsko et al. (2009) more thoroughly assessed children with a single developmental condition versus two or more conditions, analyses were not conducted for specific types of developmental conditions; nor were specific medical conditions assessed. Thus, overall, there is a need for more in depth population-based assessments of health care needs among children with DDs that more thoroughly evaluate both the specific types of DDs and the medical conditions that underlie health care needs. Those population-based studies that have assessed the prevalence of concurrent medical conditions in children with DDs were generally limited to an assessment of a single DD, rather than a fuller spectrum of developmental problems, and thus, comparisons across studies are difficult.
In the current study, we assessed concurrent medical conditions, health care use, health impact, and unmet health needs among children aged 3–17 years with and without select mutually exclusive behavioral and learning DDs included in the NHIS child samples in 2006–2010. This is a more recent cohort of U.S. children than past studies. Given the increases in prevalence of some DDs, such as autism and ADHD (Boyle et al., 2011), it is important to re-examine health risks in this population of children. It is possible that the functional effects and needs of this changing population have also changed. We also more carefully considered individual DDs by creating a hierarchy that considered whether the child had autism, ID, ADHD, LD, and/or other developmental delays.
Section snippets
Study population and sample
This study used data from the 2006 through 2010 National Health Interview Surveys. The annual household samples are selected to be representative of the civilian non-institutionalized U.S. population. In sampled households with children, a child <18 years of age was randomly selected and information was collected with the Sample Child Core questionnaire via in-person interviews with a knowledgeable parent or guardian. For this study, data were primarily derived from the set of health-related
Description of study population
Of the 41,244 children included in our final sample, 5469 had one or more of the DDs examined in this study. Overall (i.e. in non-mutually exclusive categories), the most commonly reported DDs were LD (7.8%) and ADHD (7.9%) followed by other developmental delay (4.3%), autism (0.9%), and ID (0.7%). Because many children had more than one DD, the prevalence estimates for our mutually exclusive categories were lower than the total prevalence estimates for each condition: 0.9% for autism; 0.5% for
Discussion
We found that children with learning and behavioral DDs had higher prevalence estimates for a range of medical conditions than children without DDs. In this study, we examined mutually exclusive DD categories, and thus, examined ADHD and LD/other developmental delay without the co-contributing effects of the generally more pervasive disabilities of autism and ID. Still, we found children with ADHD, and LD and “other developmental delay” without ADHD had increased estimates for many medical
Conflict of interest statement
Dr. Catherine Rice conducts a limited number of training sessions to professionals on the diagnosis of the autism spectrum disorders as an approved outside activity separate from employment with the Federal government. The other authors report no conflicts of interest.
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Disclaimer statement: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease and Control and Prevention.