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PubMed2002

Nursing students with learning disabilities.

Children with learning disabilities grow up to be adults with learning disabilities, who may go to nursing school. Nurse educators currently are faced with the same challenges as primary and secondary school teachers in meeting the education needs of individuals with learning disabilities. It is essential for nurse educators to be knowledgeable about learning disabilities, to understand the issues involved, and to use appropriate interventions to help these students succeed.

Civil Rights↗

PubMed2006

Financial well-being of young children with disabilities and their families.

Young children with disabilities are significantly more likely to live in poverty than their peers without disabilities. Exposure to poverty creates additional risk of adverse outcomes for these vulnerable children. In this article, the following key circumstances contributing to this increased risk of impoverishment are analyzed: elevated costs of raising children with disabilities, low levels of public income transfer benefits, difficulty balancing parental employment and caregiving responsibilities, unavailable or high-cost child care, and inadequate leave time to permit parents to meet their children's episodic care needs. The implications of these issues for social work practice and advocacy needs are discussed.

Adolescent↗

PubMed2002

Disability in children from different ethnic populations.

We report on the prevalence of severe neurodisability in children in the Southern Derbyshire Health Authority from different ethnic groups. Information was obtained from the health records of children at the Child Development Centre (CDC), and analysed according to ethnic group. There were 53 in the Pakistani group, 20 in the Indian group and 764 in a mixed group, of which 95% were of European origin. It was estimated that all children with severe disability in the area of the Health Authority had notes at the CDC, except for 10% of the mixed group living on the periphery. The numbers of children with different disabling conditions were recorded, together with a measure of the level of individual disability; the 'Disability Scores'. We also noted if the condition was genetic or chromosomal in origin. Pakistani children showed a higher prevalence than the other groups of severe learning disorder, severe and profound hearing loss and severe visual problems. They also had a slightly increased prevalence of autism and cerebral palsy. Conversely, they showed a lower prevalence of language disorder. Disability scores for Pakistani children attending the CDC were higher than for other groups. Genetic disease causing disability was 10 times more common in the Pakistani children than other ethnic groups. Disability is more common in Pakistani children probably as a result of the cultural practice of consanguineous marriages. This community needs special help for disabled children, and their families, for general support and appropriate genetic counselling.

Adolescent↗

PubMed2002

Health services research for children with disabilities.

Growing numbers of children and adolescents have long-term disabilities. Research on the epidemiology, clinical care and its improvement, organization, and financing of care for children with disabilities is very limited. Given the cost burden of the nation's chronic diseases and disabilities, the lack of investigation into necessary clinical activities seems remarkable. This article reviews recent research on health services relating to children and adolescents with disabilities and outlines a research agenda in clinical and health services for this population in these study areas.

Adolescent↗

PubMed2002

Injury prevention for children with disabilities.

Little injury data exists for children who have disabilities. There is an urgent need to address injury prevention and to improve safety standards for this group. Understanding the epidemiology of injuries will allow clinicians to accurately advise patients and their families on individual risks and counsel them in steps to take to reduce those risks. Safety information must be tailored to consider each child's functional impairments. All children who have disabilities are at risk for maltreatment. Open discussion of this problem is warranted given the immensity of the problem. Identifying parental concerns and supporting parents in the use of respite resources are appropriate. For children who have problems in mobility, falls are the number one concern. Collaboration with reliable vendors and therapists that adhere to standards for safe seating is essential for reducing the risk of wheelchair tips and falls. In addition, therapists should be directed to provide mobility training for activities from safe transfers to street crossing in a community setting. Parents should be counseled to approach their child's injury risk based on the child's cognitive and behavioral level rather than their chronological level. Knowledge of the child's developmental quotient or intelligence quotient will also allow the clinician to accurately formulate an injury prevention plan. Many children will always need supervision for tasks that put them in situations of injury risk (i.e., swimming, street crossing, bathing). Sensorineural deficits such as blindness or deafness create significant alterations in negotiating the environment and an increased risk of injury. Awareness of the special needs for fire risk reduction and street safety are critical in this population. The collection of injury data is critical to define the scope of the problem and to influence changes in policy and the development of technical standards. Educational efforts focused on safety should include pediatricians, rehabilitative therapists, social workers, teachers, parents, and--most importantly--the empowerment of children as they age injury-free into adults. SUGGESTED STRATEGIES: A national injury surveillance system for children who have disabilities should be developed to identify injury risk factors for children with disabilities. Children with disabilities should be monitored as a separate risk group in data collection regarding injuries. Parents should be aware of the cognitive level of their child and its influence on their injury risk. Crash testing on passenger restraints should include crash dummies whose physical characteristics resemble those of children who have disabilities. Families should have an emergency evacuation plan with specific consideration of their disabled child in the event of an emergency. Risk of burns to insensate skin and risks of thermal and friction trauma should be discussed when appropriate. The fire department and the police department should be notified of the presence of a child who has a disability in the home. Parents must be aware of the risk of falls to children who are mobile but cognitively impaired and to those in wheelchairs regardless of cognitive ability. Hospitals must have Child Protective Services teams with specific training in abuse to children with disabilities. Discussion of maltreatment risk should be addressed during routine office visits and appropriate resources should be made available to provide support to families. Educational programs should be developed to alert providers to the risks of abuse of children who have disabilities.

Accident Prevention↗

PubMed2006

[Analysis of certain oral health parameters in children with disabilities].

The first permanent molars which show the presence of congenital malocclusions, orthodontic treatment need and habits were studied in children with disabilities and healthy children. The examination covered 80 disabled children and 80 healthy ones (control group) of the age from 3 to 17 (mean age 10) years. Caries of the first permanent molars, bad habits and malocclusions were more common in children with disabilities than in healthy children. It was established that higher orthodontic treatment need was in children with disabilities who were less covered with orthodontic care.

Adolescent↗

PubMed2002

The prevalence of disability among children: paradigms and estimates.

Every examination of disability among children must first grapple with definition of disability. The challenges to identifying disability among children involve not only determining the appropriate paradigm for defining disability, but also applying that paradigm to children in a meaningful way. This discussion of the prevalence of disability among children starts by examining the various paradigms utilized to identify disability and how they are interpreted when applied to children. Estimates of the prevalence of childhood disability, under different definitions of disability are presented. The goal of the discussion is to illustrate the sensitivity of the estimates of disability prevalence to the particular definition and data set used. Finally, the potential influence of the choice of paradigm on further measurement and service delivery is outlined.

Activities of Daily Living↗

PubMed2004

Inhibition and shifting in children with learning deficits in arithmetic and reading.

The executive functions of inhibition and shifting were studied in arithmetic-disabled children, reading-disabled children, reading plus arithmetic-disabled children, and controls (N = 74). Measures involved the rapid naming of objects, digits, letters, or quantities with or without additional task requirements that reflected inhibition or shifting. Also, the Making Trails task, reflecting shifting, was administered. For tasks without executive demands, arithmetic-disabled children were slower in the naming of digits and quantities, whereas reading-disabled children were slower in the naming of digits and letters. For the executive tasks, arithmetic-disabled children as well as reading plus arithmetic-disabled children were impaired on the Making Trails task and on an object naming task that required both inhibition and shifting. Reading-disabled children exhibited no problems in executive functioning. Furthermore, it was shown that reading plus arithmetic-disabled children experienced the combination of problems that characterize children with a single learning deficit.

Child↗

PubMedDate not supplied

Play therapy and children with disabilities.

Play therapy allows children with developmental and health disabilities to discover what physical and emotional strengths they have in relation to their disabilities. Play therapy may be directive or nondirective, emotionally or physically focused. Suggestions for specific activities are presented for providing play therapy for children with disabilities.

Child↗

PubMed1994

The prevalence of autistic disorder among children with a learning disability.

BACKGROUND: It has been suggested recently that the prevalence of autistic disorder may be rising. No prevalence study specifically among learning disabled children exists and so this study was prompted. METHOD: 767 children with a learning disability who attended 16 different special schools in the Grampian region of north-east Scotland were studied for a diagnosis of autistic disorder according to the DSM-III-R criteria. The study was conducted in three stages. In the first screening stage, a questionnaire was completed for each child by their teachers. In the second stage, teachers completed another questionnaire based on DSM-III-R criteria for autistic disorder. A final diagnosis was made on the basis of examination and information gathered from the questionnaires. RESULTS: Questionnaires were completed for 634 (82.7%) children. 14.3% of children with a learning disability fulfilled the diagnostic criteria for autistic disorder. There was a male:female ratio of 3:1. This gave a 9 per 10,000 minimum prevalence of autistic disorder among all school-age children in the Grampian region. There was a higher prevalence of autistic disorder in the cities compared with rural areas. The prevalence did not change with age but increased with decreasing IQ. CONCLUSION: The results of the study support the view that there may be an increasing prevalence of reported cases of autistic disorder.

Adolescent↗

PubMed2006

Risperidone: new indication. Behavioural disorders in children with autism or mental disabilities: no progress.

(1) Sedative drugs are one option when autistic or mentally disabled children have behavioural disorders that place them (or other people) in physical danger. Among the classic neuroleptics, haloperidol is the drug with the best-documented efficacy and safety. Placebo-controlled trials have also shown lithium to be effective for this use. (2) Clinical evaluation of risperidone in children with mental disabilities includes 3 placebo-controlled double-blind trials, 2 of which involved 118 and 110 children aged from 5 to 12 years who were treated for 6 weeks. All 3 trials showed a partial behavioural improvement in about 75% of children receiving risperidone, versus about 30% of children in the placebo groups. (3) Clinical evaluation of risperidone in autistic children includes 2 placebo-controlled double-blind trials involving 110 and 79 children who were treated for 8 weeks. One of these studies has been published in detail: 69% of children partially improved with risperidone, versus 12% of the children on placebo. (4) Given the absence of clinical trials comparing risperidone with haloperidol or lithium, there is no evidence that risperidone is more effective than these other treatments. (5) The principal adverse events observed in short-term trials of risperidone were drowsiness (affecting about 50% of children), weight gain (about 1.2 kg per month during the first months of treatment), and hyperprolactinaemia (affecting about 12% of children). Extrapyramidal disorders were infrequent during short-term trials, but their incidence reached about 25% after a year of risperidone treatment. (6) The impact of long-term risperidone therapy on growth and mental development is not known. (7) In France treatment is about 7 times more expensive with risperidone than with haloperidol. (8) In practice, the risk-benefit balance of risperidone in the treatment of autistic or mentally disabled children with behavioural disorders is no better overall than that of older products such as haloperidol and lithium, which, in the absence of anything better, remain the standard drugs.

Adolescent↗

PubMed2006

Prevalence of four developmental disabilities among children aged 8 years--Metropolitan Atlanta Developmental Disabilities Surveillance Program, 1996 and 2000.

PROBLEM/CONDITION: In the United States, developmental disabilities affect approximately 17% of children aged <18 years, resulting in substantial financial and social costs. REPORTING PERIOD: 1996 and 2000. DESCRIPTION OF SYSTEM: The Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) monitors the occurrence of mental retardation, cerebral palsy, hearing loss, vision impairment, and autism spectrum disorders among children aged 8 years in the five-county metropolitan Atlanta area (Clayton, Cobb, DeKalb, Fulton, and Gwinnett). MADDSP uses a multiple source ascertainment methodology. RESULTS: During 1996, the prevalence of mental retardation was 15.5 per 1,000 children aged 8 years; it decreased to 12.0 per 1,000 in 2000. The overall prevalence of cerebral palsy was 3.6 per 1,000 in 1996 and 3.1 per 1,000 in 2000. The prevalence of mental retardation and cerebral palsy was highest among males and black children. The prevalence of hearing loss was 1.4 per 1,000 in 1996 and 1.2 per 1,000 in 2000; the prevalence of vision impairment during 1996 was 1.4 per 1,000 and 1.2 per 1,000 in 2000. Minimal differences by study year were observed in the prevalence of all four disabilities when examined by sex, race, and severity. INTERPRETATION: The prevalence of these four select developmental disabilities in MADDSP was higher in 1996 than the annual average prevalence estimates for these disabilities during previous MADDSP study years (1991-1994) study years; the highest increase was observed among children with mental retardation. However, prevalence estimates during 2000 were more consistent with the estimates from the early 1990s. Data from additional surveillance years (2002 and beyond) are needed to determine if the prevalence for 1996 was an anomaly and to continue to monitor trends in the prevalence of developmental disabilities over time. PUBLIC HEALTH ACTIONS: MADDSP data will continue to be used to examine trends in the occurrence of these disabilities over time, facilitate the development and implementation of appropriate intervention programs, and provide a framework for conducting population-based etiologic studies.

Autistic Disorder↗

PubMed1995

Province-based study of neurologic disability of children weighing 500 through 1249 grams at birth in relation to neonatal cerebral ultrasound findings.

BACKGROUND: Adverse neurodevelopmental outcome in premature infants is more common in the presence of certain ultrasonographically detectable intracranial lesions. Present nomenclature and classifications of parenchymal changes in preterm infants of varying gestations have led to some confusion. Descriptive definitions may be clinically useful. Regionalized perinatal and neonatal care enables population-based studies of these lesions and subsequent outcomes. METHODS: Two- to 3-year outcomes of neonates weighing 500 through 1249 g born in Alberta to Alberta residents during 1987 through 1990 were reviewed in relation to neonatal cerebral ultrasound lesions. Odds ratios and confidence limits for disability were calculated. RESULTS: Of 960 live births in this weight group, 669 (70%) survived to 1 year adjusted age; 646 (96.6%) were assessed at follow-up, and 80 (12.4%) of these were disabled: cerebral palsy, 8.7%; vision loss, 2.9%; hearing loss, 1.3%; epilepsy, 0.6%; mental retardation, 4.8%; more than one disability per child, 3.6%; and projected dependent disability, 1.4%. Lesions considered to be predictive of disability on ultrasound (excluding germinal layer hemorrhage) were found in 79 (11.8%), parenchymal lesions in 63 (9.4%) of 1-year survivors: intraventricular hemorrhage (IVH) (n = 59), persistent or transient cerebral ventriculomegaly (n = 50), persistent or transient intraparenchymal periventricular echodensity (n = 29), and cystic periventricular leukomalacia (n = 7). All lesions except isolated IVH were associated with adverse outcome; 37% of disabled children, 61% of multiply disabled children, and all children projected to become dependently disabled had parenchymal lesions with or without IVH. Triple lesions of IVH, cerebral ventriculomegaly, and intraparenchymal periventricular echodensity gave an odds ratio for disability of 50. Transient lesions had significant risk. CONCLUSIONS: This province-based study provides a descriptive scheme of serial neonatal cerebral ultrasound lesions and outcome considered useful for clinicians caring for newborns of lowest gestational ages. The overall incidence of parenchymal lesions was lower than frequently reported. Combinations of lesions were linked to increased incidence, complexity, and severity of childhood disability.

Brain Diseases↗

PubMed1999

[Sleep disorders in healthy children follows often a "learnt" behavioral pattern. Diurnal rhythm disturbances are dominating among children with functional disabilities].

A children's sleep disorders clinic was started as a project supported by the Swedish National Board for Health and Welfare in 1994. During the first three years 71 children, 21 girls and 50 boys aged 0.5-26 years, were clinically examined by a child neurologist/somnologist and a child psychologist. Psychological follow-up was offered. Twenty-five children were healthy, in the others several types of medical conditions were found. Twenty-five children were mentally retarded. In children with physical impairments the most common sleep problems were circadian sleep disturbances, in the healthy ones habitual insomnias were the most common finding. Taking a detailed history was important for correct sleep diagnosis and was often therapeutic. In healthy children with habitual insomnia psychological support was often successful. Melatonin was of benefit in circadian sleep disorders, and only in these. Other medications were used in a restrictive way, mostly as a temporary support.

Abnormalities, Multiple↗

PubMed2004

Dental health professionals' treatment of children with disabilities: a qualitative study.

UNLABELLED: As children and adolescents with disabilities may be difficult to treat, there is a risk that the disability may constitute a barrier preventing these children from receiving good odontological treatment in the same conditions as other children. OBJECTIVES: To describe Swedish dental care professionals' understanding and knowledge of orofacial problems and treatment needs in children with disabilities. METHODS: In-depth interviews focusing on orofacial function, and carried out with 18 informants (dentists, dental hygienists, dental assistants), were transcribed verbatim and analysed in open and focused (selective) coding processes in accordance with grounded theory. RESULTS: A core category labelled variability in treatment with the dimensions professional uncertainty and professional commitment emerged from the data in the analysis. Variability in treatment could be described as forming a continuum between two end-points captured in the dimensions. The dental teams' treatment of children with disabilities and their families could be placed anywhere along this continuum depending on contributing individual strategies and/or organizational conditions. CONCLUSIONS: The dental treatment for children with disabilities varied greatly, implying a risk for inequalities in treatment as well as in oral health. There is a need for more educational opportunities, better financing, and more support on the organizational level in order to improve odontological care for young special care patients.

Adolescent↗

PubMed1990

Effects of self-evaluation on the independent work skills of preschool children with disabilities.

This study examined the effects of a self-evaluation treatment package on the independent work skills of preschool children with disabilities. Children learned to conduct self-assessments and to compare their ratings with those of the teacher. Data were collected on children's percentages of appropriate behavior, the level of teacher prompting, and the match between child and teacher ratings. Results indicated that the treatment produced immediate and substantial improvements in child behavior and that it was possible to systematically withdraw each component while maintaining a high level of appropriate child behavior.

Achievement↗

PubMed2004

The impact of stigma on maternal attitudes toward placement of children with disabilities in residential care facilities.

This study examines willingness to consider placement of children with disabilities in residential care facilities among 81 mothers of children with disabilities. Perceived stigma is added to the Andersen and Newman model of health service utilization in order to evaluate its impact on placement attitudes controlling for predisposing, enabling and need characteristics and health beliefs. Findings of regression analyses suggest that older, single mothers of more severely disabled children are more likely than other mothers to consider residential placement and that adequate finances and residential stability may reduce this willingness. When these variables are controlled, the expectation that people with disabilities will be stigmatized by others in the community increases willingness to consider placement and does so by increasing the degree of caregiver burden experienced. Results also suggest, however, that among mothers of young children, specific aspects of perceived stigma have direct affects on willingness to consider placement even when perceived burden is controlled.

Adult↗

PubMed2003

Mental health services use among school-aged children with disabilities: the role of sociodemographics, functional limitations, family burdens, and care coordination.

OBJECTIVE: To examine the use of mental health services and correlates of receiving services among community-dwelling children with disabilities, ages 6 to 17 years. STUDY DESIGN: Data are from the 1994 and 1995 National Health Interview Survey Disability Supplements (NHIS-D), conducted by the National Center for Health Statistics. The study sample is 4,939 children with disabilities, representing an estimated eight million children with disabilities nationwide. Parents of children under 16 years of age reported (17-year-olds self-reported) on health, emotional and behavioral problems, mental health services use, and who, if anyone, coordinated the child's health care. PRINCIPAL FINDINGS: Among disabled children with poor psychosocial adjustment (11.5 percent), only 11.8 percent received mental health services in the past year. Multivariate logistic regression analysis showed service use was associated with poor psychosocial adjustment; communication, social, and learning-related functional impairments; public health insurance; and financial family burdens. Younger and black disabled children were less likely to receive mental health services. The odds of service use were greater with the involvement of a health professional in coordinating care, in contrast to no one or family only. Moreover, children with disabilities were more likely to use outpatient mental health services if their care was jointly coordinated by a family member and a health professional, compared to a health professional working alone. In contrast to inpatient and outpatient care, race and family burden were not associated with the likelihood of mental health counseling in special education school settings. CONCLUSIONS: Findings indicate that only two in five disabled children with poor psychosocial adjustment receive mental health services. Differences by age, race, and insurance coverage suggest that inequalities to access exist. However, the school setting may be one in which some barriers to mental health services for disabled children are reduced. The study also shows that the involvement of health professionals in care coordination is associated with greater access to mental health care for disabled children. These findings underscore the importance of engaging both health care professionals and the family in the care process.

Adaptation, Psychological↗