Disabilities Among Children Aged less than or equal to 17 Years -- United States, 1991-1992

Disabilities among children result in substantial reductions in quality of life and are associated with increased dependence on the health-care and social-service systems. To assess the prevalence of disabilities and their associated health conditions among children, CDC reviewed data from the Survey of Income and Program Participation (SIPP) for 1991-1992, which collected information about chronic conditions, including the functional limitations related to those conditions (1,2). This report summarizes SIPP data for children aged less than or equal to 17 years.

From October 1991 through January 1992, SIPP collected information about disabilities during personal household interviews of a sample (n=97,133 persons in 34,100 households) of the U.S. civilian, noninstitutionalized population. Measures of disability were based on definitions from the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) * (3). The ICIDH extends the International Classification of Diseases (ICD) to include the personal and social consequences of diseases. Parents or legal guardians were asked about disabilities among their children aged less than or equal to 14 years. Children aged 15-17 years were asked directly about disabilities when they were available; however, for most children in this age group, information was obtained from their parents or guardians. For children reported to have a disability, parents were asked about the condition(s) that caused the functional limitation. Data were weighted to calculate national estimates representative of the U.S. population.

To ensure that the disability data were comprehensive and accounted for all developmental stages of children, the SIPP definitions of disability were varied by age group. For children aged 0-5 years, disability was defined as 1) limitation in the usual kind of activities done by most children the same age, or 2) receipt of therapy or diagnostic services by the child for developmental needs. For children aged greater than or equal to 6 years, disability was any limitation in the ability to do regular school work. Additional indicators of disability included, for children aged 3-14 years, a long-lasting condition that limited the ability to walk, run, or use stairs, and for children aged 15-17 years, measures of problems in personal care, personal management (activities of daily living ** ), and the use of assistive aids (e.g., wheelchair).

During 1991-1992, an estimated 48.9 million persons (19.4% of the total U.S. population of 251.8 million) had a disability; of these, 3.8 million (7.9%) were aged less than or equal to 17 years (1). For children aged less than 3 years, the overall estimated prevalence of disabilities was 2.2%; for those aged 3-5 years, 5.2%; for those aged 6-14 years, 6.3%; and for those aged 15-17 years, 9.3% Table_1. In all age groups, the prevalence of disabilities was higher among boys than girls; this sex-specific difference was greatest in the 6-14-year age group.

The condition most frequently reported as a cause of functional limitation among children aged less than or equal to 17 years was learning disability (29.5%), followed by speech problems (13.1%), mental retardation (6.8%), asthma (6.4%), and mental or emotional problems or disorders (6.3%) Table_2. Reported by: JM McNeil, Bur of the Census, Economics and Statistics Administration, US Dept of Commerce. Disabilities Prevention Program; Developmental Disabilities Br, Div of Birth Defects and Developmental Disabilities, National Center for Environmental Health; Behavioral Risk Factor Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: In the United States, the impact of disabilities is disproportionately higher among children because disabilities with onset during childhood account for approximately one third of the years of disability *** in the U.S. population (4). Improved characterization of the magnitude and distribution of disabilities among children is important to identify needed services and to target appropriate interventions. The findings in this report further document age and sex variations in the prevalence of disabilities among children. The increase in the prevalence of disabilities with advancing age probably reflects the ability to identify more readily academic or behavioral limitations among older children and variations in the way educational systems identify children limited in the ability to do regular school work (5). Reasons for sex-specific differences are unclear and require further study.

The approach used in this report to estimate the prevalence of disabilities was based on limitations in function resulting from chronic conditions rather than on the diagnosis of such conditions. Previous studies may have underestimated the prevalence of disabilities among children because the definitions were restricted to certain conditions (6). To improve the precision of estimates of disability, the SIPP definitions were broadened to include the functional consequences of chronic conditions. The inclusion of these functional limitations enables more accurate estimates of the prevalence of disabilities. However, the SIPP data are subject to at least two limitations. First, because children living in institutions or group homes were excluded from the study, the prevalence of disabilities among children probably is underestimated. Second, age-group-specific variations in the definitions of disability limit the basis for comparison across age groups.

In SIPP, health conditions associated with disabilities comprise a combination of diseases (e.g., asthma or diabetes), impairments (e.g., missing extremities or paralysis), and primary conditions considered to be disabilities (e.g., mental retardation or cerebral palsy). Efforts to improve the precision of national estimates of disabilities among children should distinguish between those impairments, disabilities, and handicaps that are consequences of the disabling process. One such effort is the 1999 revision of the ICIDH, which will emphasize measures of disability and handicap among children (7) and assist in standardizing collection of information about disabilities among children.

Improved estimates of the prevalence of disabilities and their associated health consequences among children are needed to develop and evaluate prevention strategies. Estimates based on analysis of data from SIPP can assist public health planners in identifying primary services for children with disabilities and in projecting long-range needs of these children. In addition, the linking of data about primary disabling conditions among children with the functional consequences of these conditions enables more precise estimation of costs required to meet the continuing needs of these children.

References

1. McNeil JM. Americans with disabilities, 1991-1992. Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census, 1993. (Current population reports; series p70, no. 33).

2. CDC. Prevalence of disabilities and associated health conditions. MMWR 1994;43:730-1,737-9.

3. World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva: World Health Organization, 1980.

4. Houk VN, Thacker SB. Program to prevent primary and secondary disabilities in the United States. Public Health Rep 1989;104:226-31.

5. US Department of Education. 11th Annual report to Congress on the implementation of the Individuals with Disability Education Act. Washington, DC: US Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs, 1989.

6. Verbrugge LM. The disability supplement to the 1994-95 National Health Interview Survey (NHIS-Disability). Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1993.

7. Badley EM. An introduction to the concepts and classifications of the International Classification of Impairments, Disabilities, and Handicaps. Disabil Rehabil 1993;15:161-78.

* Based on the ICIDH, an impairment is an abnormality of an organ system, a disability is a person's limitation in function resulting from an impairment, and a handicap is the social consequence(s) or disadvantage(s) resulting from impairment and disability that a person experiences while interacting in the physical and social environment. 

** Ability to 1) "get around inside the home"; 2) "get in and out of bed or a chair"; 3) "take a bath or shower, dress, and eat;" and 4) "get to and use the toilet." 

*** Years of disability are calculated by multiplying the number of persons with new cases of disabilities by the expected lifespan of each person with a disability per year. Because years of disability reflect both prevalence and duration of disability, it is useful in assessing the impact of preventive interventions.

TABLE 1. Number * and percentage of children aged <=17 years with disabilities, by sex,
age group, and criteria of the definition -- Survey of Income and Program Participation,
United States, 1991-1992 +
===========================================================================================

                                        Male               Female            Total
                                     (n=33,879)          (n=32,256)        (n=66,135)
Age group/                           -----------         -----------      ------------
  Criteria of definition &            No.   (%)           No.   (%)        No.    (%)
-------------------------------------------------------------------------------------------
<3 yrs                                 (n=6,000)           (n=5791)       (n=11,791)
  Limited in usual kind
    of activities                      72 ( 1.2)          76  (1.3)        149 (1.3)
  Received services
    for developmental needs           106 ( 1.8)          77  (1.3)        183 (1.6)
  With autism/cerebral palsy/
    mental retardation                 32 ( 0.5)           8  (0.1)         41 (0.4)

 Total with a disability              133 ( 2.2)         121  (2.1)        254 (2.2)

3-5 yrs                               (n= 5,946)         (n= 5,565)       (n=11,511)
  Limited in usual kind
    of activities                     184 ( 3.1)         110  (2.0)        294 (2.6)
  Received services
    for developmental needs           323 ( 5.4)         176  (3.2)        498 (4.3)
  Limited in ability to walk,
    run, or use stairs                 76 ( 1.3)          71  (1.3)        147 (1.3)
  With autism/cerebral palsy/
    mental retardation                 54 ( 0.9)          21  (0.4)         75 (0.7)

  Total with a disability             370 ( 6.2)         228  (4.1)        597 (5.2)

6-14 yrs                              (n=16,761)         (n=16,005)       (n=32,766)
  Limited in ability to do
    regular school work             1,197 ( 7.1)         567  (3.5)      1,764 (5.4)
  Limited in ability to walk,
    run, or use stairs                301 ( 1.8)         223  (1.4)        524 (1.6)
  With autism/cerebral palsy/
    mental retardation                250 ( 1.5)         163  (1.0)        412 (1.3)

  Total with a disability           1,373 ( 8.2)         689  (4.3)      2,062 (6.3)

15-17 yrs                             (n= 5,172)         (n= 4,895)       (n=10,067)
  Limited in ability to do
    regular school work               321 ( 6.2)         116  (2.4)        438 (4.4)
  With autism/cerebral palsy/
   mental retardation @               159 ( 3.1)         150  (3.1)        309 (3.1)

  Total with a disability             558 (10.8)         374  (7.7)        933 (9.3)
-------------------------------------------------------------------------------------------
* In thousands.
+ Unweighted sample size=66,135.
& Categories are not mutually exclusive.
@ For these older children, this category includes additional measures of limitations
  in functional activity.
===========================================================================================

TABLE 2. Conditions reported as the cause of disability among
children aged <=17 years -- Survey of Income and Program
Participation, United States, 1991-1992
===============================================================
Condition                               No. *     (%)
---------------------------------------------------------------
Learning disability                     1435    ( 29.5)
Speech problems                         634     ( 13.1)
Mental retardation                      331     (  6.8)
Asthma                                  311     (  6.4)
Mental or emotional problem
  or disorder                           305     (  6.3)
Blindness or vision problems            144     (  3.0)
Cerebral palsy                          129     (  2.7)
Epilepsy or seizure disorder            128     (  2.6)
Impairment deformity of back, side,
  foot, or leg                          121     (  2.5)
Deafness or serious trouble hearing     116     (  2.4)
Tonsilitis or repeated
  ear infections                         80     (  1.6)
Hay fever or other respiratory
  allergies                              76     (  1.6)
Paralysis of any kind                    73     (  1.5)
Missing legs, feet, toes,
  arms, hands, or fingers                70     (  1.4)
Autism                                   48     (  1.0)
Drug or alcohol problem or disorder      48     (  1.0)
Head or spinal cord injury               45     (  0.9)
Heart trouble                            44     (  0.9)
Impairment deformity of finger,
  hand, or arm                           27     (  0.6)
Cancer                                   26     (  0.5)
Diabetes                                 14     (  0.3)
Other                                   653     ( 13.4)

Total                                  4858     (100.0)
---------------------------------------------------------------
* In thousands.
===============================================================

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