Child Disability Flashcards
What is childhood disability associated with?
Limited development and social participation
Poorer educational, health and employment outcomes
Pain and sometimes death
What are the 3 models of disability?
Medical
Social
Interactional/integrated
What is the medical model of disability?
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)
What is the social model of disability?
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)
What is the integrated most preferred model of disability?
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)
What is an impairment?
Bodily, mental or intellectual limitation or condition
What is disability?
Loss of or limitation of opportunities to take part in society on equal babies
What type of data is used for child disability?
Prevalence data available from a no. of sources but incidence data is rarely available
What is incidence?
Rate at which new cases appear in a given period of time
What is prevalence?
Proportion with the impairment/condition at a given point in time
What are the best sources of data for looking at prevalence?
Cross-sectional surveys
Administrative sources e.g. registers of conditions
What are the best sources of data for looking at risk factors?
Cross-sectional surveys
Cohort studies of whole populations
Case-control studies
What is the UK Equality Acts definition of disability?
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
How many disabled children are there?
8% of people aged 0-18 years old (2% increase in last 10 years) with neurodevelopmental impairments forming the largest group
Why does the prevalence of ADHD and autism appear to be increasing?
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
What are some of the functional impairments experienced by disabled children?
Mobility Stamina/breathing/fatigue Dexterity Mental health Memory Hearing Vision Learning Social/behavioural
What causes child disability?
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
What are risk factors for childhood disability?
Pregnancy outcomes (BW and prematurity) Age Sex Ethnicity Socio-economic disadvantage Parental behaviours Communicable disease Unintentional injuries
What does a low birthweight (LBW) increase the risk of?
Cerebral palsy
What does prematurity increase the risk of?
Extremely premature babies are at greater risk of poor health outcomes and neurodevelopmental diseases that babies born at term
What classes as premature and how common is?
Premature: <37 weeks - 7%
Extremely premature: 22-26 weeks
What does the EPIcure 1 and 2 study state about pre-term births?
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
How is sex related to child disability?
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.
How is ethnicity related to childhood disability?
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
How is ethnicity related to neurodevelopmental disability?
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
How does socio-economic status relate to disability?
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
What parental behaviours are damaging to children?
- Smoking esp. maternal smoking: LBW, pre-term and autism
- Alcohol: problems with growth before and after birth, educational outcomes and FAS
- Unsupportive/unstimulating: intellectual disabilities and conduct disorders
A lot of these behaviours are linked to poor personal and household resources
What communicable diseases increase the risk of child disability?
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
What types of injuries are risk factors for child disability?
- Unintentional: risk increases as child gets older and more risk in poorer households/neighbourhoods
- Intentional injuries
What are the 3 levels of prevention (Leavell and Clark) of disability?
- Primary (pre-disease): preventing disease in 1st place
- Secondary (latent/early stage disease): find and treat impairment early to halt/slow progression of disease
- Tertiary (symptomatic disease that’s irreversible): manage associated health problems of disease to prevent further deterioration, achieve highest functioning level and maximise QoL
What primary prevention methods can be used to reduce childhood disability?
Strategic interventions at national and local levels to:
- Reduce SE disadv. across lifecourse through ‘living wages’, employment and adequate welfare benefits
- Improve material environments making housing, schools and workplaces safe and healthy
- Reduce exposure to environmental hazards inc. air pollutants, environmental/industrial pollutants esp. lead
- Reduce exposure to parental and other sources of environmental tobacco in utero, infancy and childhood
- Promote safe alcohol consumption in pregnancy
- 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)
- 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
What are the issues of reducing the incidence of preventable impairments/conditions?
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
What secondary prevention strategies are used to prevent child disability?
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)
What is screened for in antenatal and newborn children?
- Infectious diseases in pregnancy: HBV, HIV, syphilis and rubella susceptibility
- Antenatal/newborn sickle cell and thalassaemia
- Newborn physical exam to look for developmental dysplasia of hips, eye disease and congenital heart disease
- Newborn blood spot to look for PKA, congenital hypothyroidism and medium chain acyl-CoA dehydrogenase deficiency
- Newborn hearing screen
- Children: vision screening for 4-5 year olds and diabetic eye screening at aged 12 years and over
What tertiary prevention exists for childhood disability?
Tailored medical care Physio Speech therapy Early development play groups Personal carers Adequate disability payments
How is disability measured?
Different definitions of disability underpin prevalence estimates but common definitions underpinning prevalence estimates come from:
- ICD10/DSM: some impairments and conditions (medical model)
- Concept of limiting long-standing illness/disability (UK census and Equality Act) or activity limiting conditions (US) (social model)
- International Classification of Functioning: Children and Youth (ICF-CY) (integrated model)
