Child Disability

Question 1

What is childhood disability associated with?

Answer 1

Limited development and social participation
Poorer educational, health and employment outcomes
Pain and sometimes death

Question 2

What are the 3 models of disability?

Answer 2

Medical
Social
Interactional/integrated

Question 3

What is the medical model of disability?

Answer 3

Intrinsic to individual (individual deficit) and restrictions due to child’s impairment so services must focus on changing or curing individual with deficit so medical/health-care professional is central to treatment - ICD10/DSM (impairments/conditions)

Question 4

What is the social model of disability?

Answer 4

Extrinsic to individual so social, attitudinal and physical barriers prevent disabled people from participating in society to same extent at others, not the individuals impairment so its a public issue that needs socio-political responses - concept of limiting long-standing illness/disability (UK census and Equality Act) or activity limiting conditions (US)

Question 5

What is the integrated most preferred model of disability?

Answer 5

Disability results from interactions of an individuals impairments and conditions with the context in which they live AKA physical, social and attitudinal barriers - International Classification of Functioning: Children and Youth (ICF-CF)

Question 6

What is an impairment?

Answer 6

Bodily, mental or intellectual limitation or condition

Question 7

What is disability?

Answer 7

Loss of or limitation of opportunities to take part in society on equal babies

Question 8

What type of data is used for child disability?

Answer 8

Prevalence data available from a no. of sources but incidence data is rarely available

Question 9

What is incidence?

Answer 9

Rate at which new cases appear in a given period of time

Question 10

What is prevalence?

Answer 10

Proportion with the impairment/condition at a given point in time

Question 11

What are the best sources of data for looking at prevalence?

Answer 11

Cross-sectional surveys

Administrative sources e.g. registers of conditions

Question 12

What are the best sources of data for looking at risk factors?

Answer 12

Cross-sectional surveys
Cohort studies of whole populations
Case-control studies

Question 13

What is the UK Equality Acts definition of disability?

Answer 13

A person is disabled if they have a physical or mental impairment or condition that has a substantial and long-term effect on their ability to carry out normal day-to-day activities

Question 14

How many disabled children are there?

Answer 14

8% of people aged 0-18 years old (2% increase in last 10 years) with neurodevelopmental impairments forming the largest group

Question 15

Why does the prevalence of ADHD and autism appear to be increasing?

Answer 15

ADHD: rise in prevalence partly ass. with increased recognition and diagnostic practices

Autism: increase in prevalence likely to be attributable in part, to increased awareness, new administrative classifications and diagnostic practices

Question 16

What are some of the functional impairments experienced by disabled children?

Answer 16

Mobility
Stamina/breathing/fatigue
Dexterity
Mental health
Memory
Hearing
Vision
Learning
Social/behavioural

Question 17

What causes child disability?

Answer 17

Causes often not clear but most are as a result from social and genetic factors coming together in complex ways often across generations - rare to be purely genetic or social/environmental

Question 18

What are risk factors for childhood disability?

Answer 18

Pregnancy outcomes (BW and prematurity)
Age
Sex
Ethnicity
Socio-economic disadvantage
Parental behaviours
Communicable disease
Unintentional injuries

Question 19

What does a low birthweight (LBW) increase the risk of?

Answer 19

Cerebral palsy

Question 20

What does prematurity increase the risk of?

Answer 20

Extremely premature babies are at greater risk of poor health outcomes and neurodevelopmental diseases that babies born at term

Question 21

What classes as premature and how common is?

Answer 21

Premature: <37 weeks - 7%

Extremely premature: 22-26 weeks

Question 22

What does the EPIcure 1 and 2 study state about pre-term births?

Answer 22

1 : children > than 1/2 of children aged 11 years born in 1995 had no or only minor impairment

2: more children born in 2006 extremely prematurely are surviving disability free

But NO reduction in proportion of children at 3 years old w/ moderate or severe impairments/conditions

Question 23

How is sex related to child disability?

Answer 23

All-cause disability prevalence is higher in boys in early years but by late years, prevalence of girls and boys are similar. Neurodevelopmental disabilities are also more common in boys. This may be ass. with genetic differences and under-identification in girls due to diagnostic characteristics.

Question 24

How is ethnicity related to childhood disability?

Answer 24

If socio-economic status is controlled for, an increased risk of all-cause disability is shown among children of mixed ethnicity and African/Caribbean origin only

Question 25

How is ethnicity related to neurodevelopmental disability?

Answer 25

Rates of identification in 7-15 year olds are lower in minority ethnic groups Higher rates of less severe intellectual disability amongst Gypsy/Roma and Traveller children of Irish heritage More severe forms of intellectual disability amongst Pakistani and Bangladeshi heritage

Question 26

How does socio-economic status relate to disability?

Answer 26

Prevalence of disability increases as socio-economic status as decreases and in these groups intellectual disability was 2x higher, cerebral palsy was 50% higher and activity-limiting asthma was 2x higher - early socio-economic disadvantage predisposes later onset disability due to higher exposure to social and environmental risk factors in prenatal and early childhood periods

Question 27

What parental behaviours are damaging to children?

Answer 27

1. Smoking esp. maternal smoking: LBW, pre-term and autism 2. Alcohol: problems with growth before and after birth, educational outcomes and FAS 3. Unsupportive/unstimulating: intellectual disabilities and conduct disorders A lot of these behaviours are linked to poor personal and household resources

Question 28

What communicable diseases increase the risk of child disability?

Answer 28

Rubella and other infections acquired during pregnancy Measles and mumps acquired later in childhood Greatest risk for unimmunised children, not registered with GP, looked after children and some minority ethnic children

Question 29

What types of injuries are risk factors for child disability?

Answer 29

1. Unintentional: risk increases as child gets older and more risk in poorer households/neighbourhoods 2. Intentional injuries

Question 30

What are the 3 levels of prevention (Leavell and Clark) of disability?

Answer 30

1. Primary (pre-disease): preventing disease in 1st place 2. Secondary (latent/early stage disease): find and treat impairment early to halt/slow progression of disease 3. Tertiary (symptomatic disease that's irreversible): manage associated health problems of disease to prevent further deterioration, achieve highest functioning level and maximise QoL

Question 31

What primary prevention methods can be used to reduce childhood disability?

Answer 31

Strategic interventions at national and local levels to: 1. Reduce SE disadv. across lifecourse through 'living wages', employment and adequate welfare benefits 2. Improve material environments making housing, schools and workplaces safe and healthy 3. Reduce exposure to environmental hazards inc. air pollutants, environmental/industrial pollutants esp. lead 4. Reduce exposure to parental and other sources of environmental tobacco in utero, infancy and childhood 5. Promote safe alcohol consumption in pregnancy 6. Ensure adequate dietary intake of key nutrients inc. folic acid, vits and mins among women of childbearing age to protect against neural tube conditions and other consequences (give vulnerable groups supplementation around conception) 7. Achieve population coverage of immunisation against common communicable diseases esp. rubella sufficient to ensure herd immunity of foetus from pregnancy acquired-infection and children from complications of disease

Question 32

What are the issues of reducing the incidence of preventable impairments/conditions?

Answer 32

It can be seen as contentious as its associated with devaluating the lives of disabled children but disability can cause pain and restrictions and there is ethical reasons to reduce preventable impairments/conditions

Question 33

What secondary prevention strategies are used to prevent child disability?

Answer 33

Antenatal and newborn screening by the current UK NHS foetal abnormality screening programme Developmental assessment by Healthy Child Porgramme Parents Contact with other services (non-health)

Question 34

What is screened for in antenatal and newborn children?

Answer 34

1. Infectious diseases in pregnancy: HBV, HIV, syphilis and rubella susceptibility 2. Antenatal/newborn sickle cell and thalassaemia 3. Newborn physical exam to look for developmental dysplasia of hips, eye disease and congenital heart disease 4. Newborn blood spot to look for PKA, congenital hypothyroidism and medium chain acyl-CoA dehydrogenase deficiency 5. Newborn hearing screen 6. Children: vision screening for 4-5 year olds and diabetic eye screening at aged 12 years and over

Question 35

What tertiary prevention exists for childhood disability?

Answer 35

``` Tailored medical care Physio Speech therapy Early development play groups Personal carers Adequate disability payments ```

Question 36

How is disability measured?

Answer 36

Different definitions of disability underpin prevalence estimates but common definitions underpinning prevalence estimates come from: 1. ICD10/DSM: some impairments and conditions (medical model) 2. Concept of limiting long-standing illness/disability (UK census and Equality Act) or activity limiting conditions (US) (social model) 3. International Classification of Functioning: Children and Youth (ICF-CY) (integrated model)