Parent-reported cases of disability in children rise

More parents — especially upper-income ones — are reporting that their children have a physical, developmental or mental health disability, a study finds.

The number of non-institutionalized children age 17 and younger with disabilities rose 16% between 2001 and 2011, with nearly 6 million children (8% of the population) reported as having a disability, according to the analysis, published online today in Pediatrics.

Disability due to any physical condition, such as asthma and breathing conditions, hearing problems, and bone or joint problems, declined by 12% during the decade, while cases related to any neurodevelopmental or mental-health condition, such as attention deficit hyperactivity disorder (ADHD), learning disabilities or emotional problems, increased by 21%.

Children living in the highest-income households (incomes greater than 400% above the federal poverty level) experienced the largest increase (28%) in disability over the decade. Children living in poverty experienced the highest rates of disability, 102.6 cases per 1,000 population, in 2010-11. By comparison, the rate for households in the top income bracket was 62.9 cases per 1,000.

In absolute numbers, "children living in less economically advantaged situations are across the board more likely to have disabilities. That's something we've known about health disparities for decades, and that's still true here," says Amy Houtrow, lead study author and chief of the division of pediatric rehabilitation medicine at the University of Pittsburgh School of Medicine.

However, this analysis, based on National Health Interview Survey data collected between 2001 and 2011 for nearly 200,000 children, is the first to document that the rise in prevalence "was so much more among kids who live in more advantaged households," Houtrow says.

Shifts in the type of the conditions diagnosed and financial ability to access diagnosis may account for the increase, she says.

Autism was not one of the 14 conditions of disability included in the NHIS dataset analyzed because it was established long before autism was widely recognized, Houtrow explains. "But we know from other research that the number of kids with a diagnosis of autism is increasing. We think we are capturing (them) in categories for 'other developmental problems' or 'other mental, emotional and behavior problems,' or 'intellectual disabilities.' "

According to the most recent CDC report, 1 in 68 kids has been identified with an autism spectrum disorder, up from an estimated 1 in 88 in 2012 and 1 in 150 in 2007, "so most definitely" autism cases are a factor in the trend reported in this study, says Steven Pastyrnak, chief of pediatric psychology at Helen DeVos Children's Hospital in Grand Rapids, Mich. He was not involved in the new research.

"And for higher socioeconomic-status families, there's a growing acceptance to seek out help for their child, both at school and at an outpatient setting" for this condition, Pastyrnak says. "That's why I think you see that increase so significantly."

The overall increase in childhood disability was found for all age groups and genders and among children of black, white and Hispanic origin.

The reduced prevalence of cases specifically related to physical disability, likely the result of medical, therapeutic and treatment advances, "is really good news" and should not be overlooked, Houtrow says.

But "especially for kids living in less advantaged households, we know they have less access to health care, so there's a strong possibility they could be experiencing (disability) problems, but we're not identifying them well, and therefore we're not getting them the services they need," she says.