Children with neurodevelopmental disorders and disabilities: a population-based study of healthcare service utilization using administrative data (original) (raw)
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Epidemiology and health, 2018
The aim of this study is to identify the association between levels of severity of nurodevelopmental disorders and disabilities (NDD/D) in children, their household socio-economic status (SES), and the frequency of visits to a healthcare provider; and (2) to examine how the severity of disability differs with these determinants among NDD/D subgroups, to make a social policy change and improve access to health care system. The data from the 2006 Participation and Activity Limitation Survey (PALS) on children (5-14y), collected by Statistics Canada, was analyzed (n= 7,072 and weighted n = 340,340). Children with NDD/D constitute those with impairments in motor, speech, neurosensory, and psychological functioning as well as those who have issues with learning-cognition and social interactions. The weighted sample size for this group is n=111,630 (total sample size for children with limitations: n=174,810). We used logistic regression to assess the association between household SES, fre...
Disability and Rehabilitation, 2013
To identify and describe selected key characteristics of children with neurodevelopmental disorders and disabilities (NDD/D) in a national disability survey database. Method: Secondary analysis of data on children aged 5-14 years in the Canadian Participation and Activity Limitation Survey (PALS). Children with NDD/D were ascertained from ICD-10 diagnoses "fine-tuned" with functional limitation information, and classified into six predetermined NDD/D subtypes by independent expert evaluators. Results: Children with NDD/D accounted for 73.5% of children with disabilities. Amongst children with a single NDD/D type, 28.8% were in the Cognition-Learning subgroup, 22.2% Psychological, 19.9% Social interactive, 13.3% Sensory, 10.6% Motor and 5.2% Speech-Language disorders/disabilities. Complexity, both diagnostic (more than one ICD-10 diagnosis) and functional (more than one parent-identified functional limitation), was encountered frequently though variably across NDD/D subtypes. In aligning parent-identified functional limitation information with researcher-ascertained assignment of children to NDD/D subgroups, matching with additional limitations (61.3% of children) occurred far more commonly than simple 1:1 matches (14.0%) or non-matching (24.7%). Conclusions: Conceptual, definitional and terminology issues affect populationbased research on children with NDD/D. Ascertainment methods can use diagnostic as well as functional information. Diagnostic information alone is likely to under-represent the complexity and needs of children with NDD/D and their families.
Journal of Intellectual Disability Research, 2019
Background Little is known about the sociodemographic and clinical characteristics of adverse drug events (ADEs) in patients with neurodevelopmental disorders (NDD). Objective The objective of this study was to describe and compare the demographic details of people with and without NDD hospitalised due to ADEs. Methods The all-inclusive New South Wales Admitted Patient Data Collection from 2001 to 2014 was employed to identify ADE-related hospitalisations in patients with NDD using the International Classification of Diseases 10th revision Australian modification codes. We derived case sets specific to different clinical groups and patient characteristics and compared proportional differences between patients with and without intellectual disability using chi squared tests. Results A total of 2173 patients with NDD were admitted for acute care of ADEs, accounting for 0.7% of all ADE-related hospitalisations. Hospitalised ADEs among patients with NDD increased by twofold over the 14-year study period. Psychotropic medications and opioid analgesic medications were leading causes of ADE-related hospitalisations in patients with NDD. Compared with their counterparts, patients with NDD were younger, experienced more socioeconomic disadvantage and less private insurance coverage, suffered with less severe but different co-morbid clinical conditions and incurred more challenges in the acute hospital care setting. Conclusion Although the pattern of ADE-related hospitalisations in patients with NDD differed from that in patients without NDD, there is a lack of targeted healthcare programmes to meet their special needs. This study suggests the need for countermeasures in primary healthcare settings to reduce the burden of ADEs in this vulnerable group.
Maternal and Child Health Journal, 2011
The objective of this study is to determine whether achievement of the Maternal and Child Health Bureau core outcome ease of use of health services differs between children with developmental disabilities, mental health conditions and physical disorders. We analyzed data from the 2005 National Survey of Children with Special Health Care Needs. Children with special health care needs were classified into 4 health condition groups: developmental disabilities (DD), mental health conditions (MH), physical disorders (PD) and multiple conditions. The outcome measure was 'difficulty using services'. We conducted bivariate and multivariate analyses to determine the associations between the health condition groups and the outcome. Of the CSHCN included in the study, 2.6% had DD, 12.9% had MH, 49.9% had PD and 34.6% belonged to multiple conditions group. Four percent of CSHCN with PD, 17% of those with DD, 13% of those with MH and 20% of those in the multiple conditions group had difficulty using services. In multivariate analyses, CSHCN with DD had 2.3 times and MH conditions had 2.6 times the odds of having difficulty using services compared to those with PD. Existing programs for CSHCN should be evaluated for the adequacy of services provided to children with DD and MH. Future studies should evaluate how developmental disabilities and mental health policies affect navigating the health care system for this population.
Children
In the United States, 17% of children ages 3–17 have a developmental disorder. The complexity of care for such children require families to provide a significant amount of health care at home, representing a substantial economic cost. Our study identifies sociodemographic characteristics of children with neurodevelopmental disorders (NDD) that are predictive of unmet medical needs and food insecurity. We modeled the outcomes using a multivariable generalized linear model and a robust Cox proportional hazard model. Among children with NDD, 7.4% reported a delay in obtaining care, 3.6% avoided getting care and 17.3% live in a household that experienced food insecurity. Lack of health insurance and lack of usual source of care increased the risk for cost-related delay in medical care and cost-related avoidance of medical care. Children with NDD whose parents have less than a college degree and those from households with income <$75,000 had increased risk for food insecurity in the p...
Developmental Medicine & Child Neurology, 2006
Children with developmental disabilities often show a variety of associated impairments that lead to a lifelong need for additional care. Careful assessment of these impairments is required not only for diagnostic purposes but also to inform the parents about the expected additional care needs in the future. We present a systematic review of the literature to identify instruments that classify the type and amount of this care for the individual child. A literature search was performed in the Medline database (January 1966-June 2005) on instruments that classify the type and amount of expected additional care needs in the future. Seven standardized measurement instruments describing current additional care needs were identified, but none of these instruments was developed to provide information about the expected need for additional care in the future. For parents of young children with non-progressive developmental disorders it is essential to be informed on the expectations of required additional care in the future. However, comprehensive instruments providing such information are currently lacking and, thus, need to be developed. Children with permanent, non-progressive developmental disabilities, caused by disorders such as cerebral palsy (CP), spina bifida, or other neurodevelopmental and congenital disorders, show a wide variation in associated impairments, which often involve several health domains of body structures and functions. 1-6 Despite medical treatment and habilitation, these impairments may lead to limitations in the capacities of the child. According to the International Classification of Functioning, Disability and Health (ICF), 5 capacities describe the individual's ability to execute a task or an action. Capacities are defined as the highest probable level of functioning that a person may reach in a given domain at a given moment in a 'standardized or assumed' environment. Limitations in the capacities of these children lead to the need for additional care. 7-9 Stein et al. defined this additional care as 'dependency on medication or special diet, medical technology, assistive devices, personal assistance, need for medical care or related services or educational services over and above the usual for the child's age, or for special ongoing treatments, interventions or accommodations at home or in school.' 10,11 Although this definition was originally developed to identify children with chronic conditions in the general population, we have used this definition to classify the expected additional care requirements in the future to execute tasks
Trends in psychiatric disorders prevalence and prescription patterns of children in Alberta, Canada
Social Psychiatry and Psychiatric Epidemiology, 2019
Purpose To describe the trends in the prevalence and incidence of children with psychiatric disorders, the types of medication prescribed, and the type of physician providing the prescriptions. Method This retrospective study linked six population-based administrative databases (2008-2015) in Alberta, Canada. Results The prevalence of paediatric psychiatric disorders increased from 12.6 per 100 population in 2008 to 15.0 per 100 population in 2015, while the incidence rate increased from 2.0 per 100 population to 2.2 per 100 population in the same period. The proportion of patients dispensed any psychiatric medication increased from 21.4% in 2008 to 28.2% in 2015. Over the same period, dispensations for antidepressants increased from 7.0% to 11.2% and stimulants to treat ADHD, from 11.9% to 15.9%. For antidepressants, general practitioners (GPs) wrote the highest proportion of prescriptions (44.3% in 2011-48.1% in 2015), while paediatricians wrote the lowest proportion (8.7% in 2011-11.0% in 2015) and the proportion by psychiatrists decreased from 33.4% in 2011 to 27.2% in 2015. For stimulants to treat ADHD, paediatricians were the most frequent prescribers (36.9% in 2011-39.3% in 2015) followed by GPs as the second most frequent (33.1% in 2011-33.5% in 2015), while psychiatrists were the least likely to prescribe stimulants for ADHD. Conclusion The increasing trend of psychiatric diagnoses and medication prescriptions in the paediatric population is evident using population-based administrative databases. The lack of safety and adverse consequences of medication use in this cohort warrants additional monitoring data.