Age adjusted analysis showed that there were no substantial differences in the associations when comparing boys and girls within each country and so the unstratified multivariable results were presented. Almost all children aged 5 and above without disabilities sponsored by Plan were attending formal education.
As a result, there was strong evidence from the age-adjusted analyses that children with disabilities were much less likely to attend formal education in comparison to children without disabilities in each of the 30 countries Table 3. For seven countries the OR was below 5, for nine countries it was 5—10, for eight it was 11—20 and for six the OR was over Stratifying the relationship between disability and school attendance by impairment type revealed important patterns Table 4.
In comparison to children without disabilities, children with learning or communication impairments were consistently among the least likely to attend school, particularly in Africa.
In many countries children with physical impairments were similarly excluded from education, while in other countries this pattern was less apparent.
Children with vision or hearing impairment were generally the most likely to attend school among children with disabilities. Among children attending school, those with disabilities were more likely to be at nursery or primary level, rather than secondary or above, in comparison to children without disabilities Table 5. This meant that the children with disabilities were at a lower level of schooling for their age compared to children without disabilities.
This pattern was generally less apparent within African countries, as opposed to countries from Latin America or Asia. There was evidence that children with disabilities were more likely to report experiencing a serious illness in the last 12 months in comparison to children without disabilities, in 29 of the countries not Niger Table 6. For 16 countries, the OR was below 5, for 10 countries it was between 5 and 10, and for 3 countries the OR was above The types of illness included those that were impairment related e.
Malnutrition was relatively rare, yet there was good evidence for an association with disability in Brazil, Colombia, Ecuador, Guatemala, Honduras, India, Indonesia, and Vietnam. However, disability was associated with not seeking care when ill in Rwanda, Senegal and Zambia. For most of the countries there was no association between being in the poorest quartile of poverty and disability Table S3. For some countries there was evidence of a positive association e. Paraguay, Peru, Egypt but for the majority this relationship was inverse indicating a protective effect of poverty on disability e.
Ecuador, Benin, Uganda, India, Philippines. When they did attend school their level of schooling was below that of their same aged peers. The exclusion from schooling varied by impairment type so that children with learning or communication impairments were least likely to attend school, while those with hearing or visual impairments generally fared better.
Children with disabilities were also much more likely to report having a serious illness in the last 12 months. In terms of socio-demographic differences, boys were more likely to be classed as having a disability, but there was no clear relationship between disability and poverty in this population.
The exclusion of children with disabilities from schooling reported in our study is consistent with findings from others across the globe [4] , [8] , [14] , [15] , including the World Health Surveys [1].
While the World Health Surveys reported that children with physical impairment generally fared better than those with intellectual or sensory impairments, we did not observe this pattern [1]. Exclusion from education has an immediate impact on a child in terms of exclusion from social participation, reduced personal well-being and welfare, and likely dependence on a family member for care during school hours [16].
The long-term impact may be even more profound. The impact may also span across generations, as a study in Vietnam showed that children are less likely to go to school if they have a parent with a disability [15]. These analyses showed a strong relationship between disability and serious illness. Intriguingly, a link was demonstrated between disability and malnutrition in some countries, although the numbers were small.
Other studies have suggested that children with disabilities are vulnerable to malnutrition [7] , [18] , although a large study by UNICEF including nearly , children across 15 studies showed that disability was linked to nutritional deficiency in eight of the countries, but not in the remainder [8].
The vast majority of children attended for treatment when ill, and so there were insufficient numbers to assess the impact of disability on access to health care.
Other studies have demonstrated the existence of barriers to uptake of health and rehabilitation services by children with disabilities in low income settings [6] , [19] , [20]. A link between poverty and childhood disability could arise as a result of the direct costs e. We did not demonstrate a relationship between disability and poverty in this study.
The link between poverty and disability may not have been apparent in this study because the children were all in a sponsorship programme, and therefore were all poor, or because the sponsorship programme itself may have alleviated the impact of disability on poverty.
The higher prevalence of disability in boys as compared to girls was a consistent finding across the countries. This finding tallies with the higher child mortality rate observed among boys in most parts of the world excepting India and China [22] , and the higher proportion of boys identified with disabilities in the UNICEF survey [8].
Support for the key findings of the study is given by the important methodological strengths in the design. The analyses were conducted in a very large data set, which included internationally comparable data across 30 countries. Multiple domains of inclusion were assessed with respect to impact of disability, such as education, health, and poverty. We therefore believe that this study makes an original and high quality scientific contribution, particularly in contrast to many of the previously conducted studies on childhood disability which are often small in scale, do not assess impact as broadly, and do not allow international comparisons to be made.
Consequently, the children in the analyses are not representative of the general population in the country and so it is not possible to make general inferences. This should not, however, compromise the internal validity of the findings. Only one type of impairment could be reported per child and there was no clinical validation of self-report. There were missing data for key variables so that these could not be assessed, including birth registration, vaccination coverage and duration of disability.
The variation in prevalence and type of disability by country implies that the interpretation of the disability question or the selection of children with disabilities into the programme varied, and we therefore did not believe that it was appropriate to conduct multi-level analyses. The impact of childhood disability often extends into adulthood as well as to other household members, and this was not assessed in the current study.
However, the sponsorship database can be used in the future to track the life course of children with disabilities longitudinally and further household level research could fill these research gaps. A central implication of our findings is for the need for renewed focus on the inclusion of children with disabilities in education, as this research highlights their low levels of participation. This finding has also been reported in previous studies [1] , [4] , [8] , [14] , [15] , as well as a recent monitoring report of the Convention on the Rights of the Child [23].
The Millennium Development Goal of Universal Primary Education can only be achieved with this focus, and this is likely also to be the case for future Sustainable Development Goals on education. Furthermore, countries that are signatories of the UN Convention on the Rights of the Child or the UN Convention on the Rights of Persons with Disabilities cannot fulfil their responsibilities without inclusion of children with disabilities in education, as well as the necessity of addressing their right to health care.
A twin-track approach is widely advocated for promoting inclusion of children with disabilities — whether with respect to education, health care, or in other areas.
This approach involves a focus on improving inclusion of children with disabilities in mainstream services as well as making specialist services available when needed. However, the evidence base on what works is currently very poor and needs to be strengthened substantially in order to identify scalable interventions [24] , [25] , - a recent review found only six intervention studies for children with disabilities in low and middle income countries [25].
Careful thought needs to be put into development and provision of interventions as these often requires engagement with many sectors.
In addition, there are often family level impacts of childhood disability, which need to be considered when developing interventions [25].
With respect to inclusion in education, activities to promote inclusion may focus on strengthening the capacity of the education system to meet the needs of children with disabilities, as well as providing specialist services or support e. Braille reading for children with particular needs. Qualitative studies have identified strategies that seem to be effective in improving participation of children with disabilities in education [26] , but more evidence is needed [24] , [25].
Research is also needed to understand the barriers to uptake of education and the widespread exclusionary practices facing children with disabilities [26] , [27] in order to identify strategies to overcome these barriers which may be setting specific. This study has identified a number of countries with very large disparities between children with and without disabilities that could provide useful information quite rapidly.
If a child has a developmental delay, it is important to get help as soon as possible. Developmental monitoring and screening ». Most developmental disabilities begin before a baby is born, but some can happen after birth because of injury, infection, or other factors. Most developmental disabilities are thought to be caused by a complex mix of factors.
These factors include genetics; parental health and behaviors such as smoking and drinking during pregnancy; complications during birth; infections the mother might have during pregnancy or the baby might have very early in life; and exposure of the mother or child to high levels of environmental toxins, such as lead.
For some developmental disabilities, such as fetal alcohol syndrome, which is caused by drinking alcohol during pregnancy, we know the cause. It is currently the largest study in the United States to help identify factors that may put children at risk for autism spectrum disorders and other developmental disabilities.
Developmental disabilities occur among all racial, ethnic, and socioeconomic groups. Learn more about the number of children in the U. Children and adults with disabilities need health care and health programs for the same reasons anyone else does—to stay well, active, and a part of the community. Having a disability does not mean a person is not healthy or that he or she cannot be healthy. Being healthy means the same thing for all of us—getting and staying well so we can lead full, active lives.
That includes having the tools and information to make healthy choices and knowing how to prevent illness. One need not focus exclusively on any one component, but rather use as many strategies as are relevant to that situation, particularly when the efficacy of a specific treatment approach is limited.
In designing treatment programs with the ICF in mind, one can combine interventions to try to improve many aspects of human functioning, often simultaneously, and thus enhance a person's functional status at all three levels.
In an era of systemic models and frameworks, we believe that there are great opportunities to expand traditional thinking about disability beyond the biomedical dimensions of these conditions. We would argue that it is important to promote function and child development with a wider focus on what is acceptable beyond 'normal".
We believe that therapists and intervention programs should make a concerted effort to encourage children with disabilities to participate in whatever ways are optimal for them. Such an approach challenges us to move beyond the traditional emphasis on "repair" and "normality" in favour of broader goals that promote function, participation and engagement in life. There are enormous research opportunities inherent in this emerging approach to our work with children with disabilities and their families.
These include assessing the relationships between changes in the biomedical aspects of children's disabilities and the impact of these changes on activity, participation, quality of life and satisfaction with treatments. Much remains to be done both to create therapeutic paradigms built on these current models, and to evaluate the effectiveness of new theories and systems, so that today's new ideas are well supported tomorrow with solid evidence.
This work was originally developed by the first author when she was an undergraduate student pursuing an independent course of study with the second author. For more information, please contact Dr.
Peter Rosenbaum at rosenbau mcmaster. Bandura, A. Social Cognitive Theory. Vasta Ed. Philadelphia: Jessica Kingsley Publishers. Bronfenbrenner, U. Ecological Systems Theory. Nature-nurture reconceptualized in developmental perspective: A bioecological model. Psychological Review, , Gesell, A.
Developmental diagnosis: Normal and abnormal child development - clinical methods and pediatric applications 2nd ed. Inhelder, B. Learning and the development of cognition. Cambridge: Harvard University Press. Rosenbaum, P. Variation and "abnormality": Recognizing the differences [Invited editorial]. Journal of Pediatrics, , Effects of powered mobility on self-initiated behaviours of very young children with locomotor disability [Commentary]. Putting child development back into developmental disabilities [Editorial].
Shaffer, D. Developmental psychology: Childhood and adolescence, first Canadian edition. World Health Organization. Towards a common language for functioning, disability and health: ICF. Geneva: Author. Discover CanChild. Research In Practice. Support Us. Current Studies. Shop CanChild. Close Menu. Site-wide Search. Disability and Child Development: Integrating the Concepts. Introduction "Neurodevelopmental disabilities" refer to a diverse group of conditions and disorders that begin in the early years of children's lives, and influence their development, often for life.
Theme II: Disability and its Management There are many opinions about the best approaches to the treatment of childhood developmental disabilities.
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