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Children’s special health care needs affected more by persistence than point prevalence
Poor outcomes among children with special health care needs were associated more with how persistent their needs were rather than point prevalence, according to a recent study.
Researchers estimated the trajectory of special health care needs (SHCN) in children and the effect such trajectories had on them at home and in school. They also assessed whether the mental health of parents correlated with their children’s trajectories.
Two cohorts, enrolled in the Longitudinal Study of Australian Children, were followed from 2004 to 2010. The first cohort (cohort B, n = 5,107) included infants and toddlers who were aged 0 to 1 year when enrolled in 2004 and 6 to 7 years in 2010. The second cohort (cohort K, n = 4,983) included children who were aged 4 to 5 years when enrolled and 10 to 11 years when the study concluded.
Parents and teachers reported children’s behavior and academic development every other year. Parents also reported their own mental health status.
The final reports showed that both cohorts had similar trajectories and represented children as either having no SHCN (81.3% vs 75.6%), transient SHCN (7.9% vs 4.2%), emerging SHCN (4.1% vs 11.5%) or persistent SHCN (6.8% vs 8.7%).
In both cohorts, academic ratings in math and literacy, learning approaches, psychosocial function, physical function (P < .001 for all), verbal cognition (cohort B, P = .009; cohort K, P = .004) and nonverbal cognition (cohort B, P = .01; cohort K, P < .001) were adversely affected. Among parents, the mothers’ mental health status was poorly affected by SHCN trajectories in both cohorts (P < .001), while the fathers’ mental health was not.
Participants with persistent and emerging SHCN had the most adverse effects in cohort B. The outcomes affected most were psychosocial functioning (mean difference = –0.6; 95% CI, –0.75 to –0.44) and behavior difficulties reported by parents (mean difference = 0.59; 95% CI, 0.44–0.74) in those with persistent SHCN.
“For infants and preschoolers, we found that nearly half of SHCN are transient and that these children resemble those who never had an SHCN at 6 to 7 years; however, those with emerging and persistent SHCN had poorer outcomes with similarly substantial effect sizes,” the researchers wrote.
Cohort K showed a gradual decline in outcomes of participants with no SHCN to transient SHCN to emerging SHCN and to persistent SHCN (P < .001 for all), those with no SHCN having the best outcomes and those with persistent SHCN having the worst outcomes. The outcomes affected the most were behavior difficulties reported by parents (mean difference = 0.78; 95% CI, 0.62-0.93) and teachers (mean difference = 0.62; 95% CI, 0.45-0.78), psychosocial function (mean difference = –0.69; 95% CI, –0.82 to –0.55) and learning difficulties reported by teachers (mean difference = –0.48; 95% CI, –0.63 to –0.32) in those with persistent SHCN.
“Given that the most persistent SHCN had the poorest outcomes in both groups, cumulative burden during childhood may play an important role in shaping adverse child and family outcomes,” the researchers concluded. “Those with persistent SHCN may need more preventive therapeutic input throughout their life course to maximize their function and their own and their parents’ well-being.”
Disclosure: The researchers report no relevant financial disclosures.
