Variation in identifying children and adolescents with disability and developmental disability in population-based public health surveys

BACKGROUND

The term "developmental disability" (DD) is inconsistently defined and applied depending on purpose and across sources, including in legislation.

OBJECTIVE

This project aimed to identify existing definitions of disability and DD and to determine the extent to which each definition could be operationalized to produce prevalence estimates using data from U.S. national surveys.

METHODS

Using data among children <18 years from the 2016-2018 National Health Interview Survey (NHIS) and National Survey of Children's Health (NSCH), we estimated the prevalence of two definitions of disability (Washington Group Short Set on Functioning, American Community Survey) and seven definitions of DD [Health and Human Services (ever/current), Developmental Disabilities Assistance and Bill of Rights Act of 2000 (1+, 2+, or 3+ components), and Diagnostic and Statistical Manual of Mental Disorders, 5th ed (ever/current)]. Complex sample design variables and weights were used to calculate nationally representative prevalence.

RESULTS

Disability (NHIS: 5.2-6.3%; NSCH: 9.2-11.9%) and DD prevalence (NHIS: 0.6-18.0% and NSCH: 0.2-22.2%) varied depending on the definition and data source. For the same definition, NSCH prevalence estimates tended to be higher than NHIS estimates.

CONCLUSIONS

The substantial variability in estimated prevalence of disability and DD among children in the United States may be in part due to the surveys not representing all components of each definition. Different or additional questions in national surveys may better capture existing definitions of disability and DD. Considering the data collection goals may help determine the optimal definition to provide useful information for public health action.

Definitions, concepts, and measures of disability

The term "disability" is a shorthand expression or as explained in the International Classification of Functioning, Disability and Health an umbrella term. It has been used to identify the impairments that result from disease and injury, the physical, and mental or emotional functional limitations or difficulties a person has as a result of the impairments, as well as the participation restriction they experience when the environment is not supportive. Thus the term disability has been used to represent almost any of the conceptual components associated along the ability continuum that impacts the person, but it also includes the environmental effects that create a limiting impact from the context outside the person. This paper examines those concepts and definitions to provide insight into the measurement process to represent this important element of health and participation.