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What's Behind The Stark Rise In Children's Disabilities


Six million - that's how many children are considered disabled in the U.S. today, a nearly 16 percent increase from a decade ago. And what accounts for that rise is explained in a new study out this week in the Journal of Pediatrics. The research shows that while physical disabilities are down, neurodevelopmental or mental health conditions are up, especially among children from more affluent families.

The lead author of the report is Dr. Amy Houtrow. She's associate professor at Children's Hospital of Pittsburgh. Welcome to the program.

AMY HOUTROW: Thank you very much for having me.

CORNISH: So you mine this data from the National Health Interview Survey, and I understand this is a survey where parents are reporting, right, the disabilities of their kids? How do they define disability?

HOUTROW: In this study, disability is defined as activity limitations. So that's relatively broad. It can be anything that the parent identified that their child isn't able to do in the same way other children are able to do. So for example, being able to take care of themselves, walk around without a device to help them, needing special education services or early intervention, or anything else that the parent could pinpoint where their child was limited in their activities compared to other children.

CORNISH: So help us understand the most recent data here. What disabilities are we seeing less of, and what disabilities are we seeing more of?

HOUTROW: In this study over the ten-year period, we actually saw a decrease in disability related to physical health conditions, such as asthma or having an injury. We saw an increase in disability related to neurodevelopmental and mental health conditions. Those conditions are things like ADHD or learning disabilities or any developmental problem that could be a cause of neurodevelopmental disabilities.

CORNISH: Now here's the thing, you note in the research that it's more affluent families who account for a greater increase in the cases of those disorders in particular. Talk a little bit about what those numbers actually looked like. Where did you see it? Where did it stand out?

HOUTROW: Well, the first point is that we know the experience of disability, it's just much more common among children in less-advantaged households. But the children who lived in more advantaged households had a greater relative increase of 28 percent compared to children who live in poverty, for example. They had a rate increase of 10.7 percent. But still, the absolute numbers of children who have disabilities is much higher among those who live in poverty.

CORNISH: Now what are some of the factors that might account for this?

HOUTROW: This study can't tell us exactly why these trends are occurring. We hypothesize that perhaps the rates of autism are increasing and the rates of other neurodevelopmental and mental health conditions are rising, and therefore disability related to those conditions is also on the rise. I also think there might be some shifts in terms of how society feels about talking about disability, being more open and seeking out a diagnosis.

And this brings to light something else - something about health care access. So we know children who live in poverty have less ability to access the health care system, and so therefore maybe children who are in more affluent families have better access to getting a diagnosis and therefore getting treatment.

CORNISH: You also write that doctors may be contributing to this as a result of undetected bias. In what way and what's your basis for that assessment?

HOUTROW: There's quite a bit of literature that supports the idea that the way physicians and health care providers approach families differs in terms of what the family brings to the table and the encounter. So a family from a more affluent background is able to articulate their concerns and their needs in a different way. That might raise the suspicion of the doctor to look for the condition, to make a diagnosis and recommend treatment. On the flipside, a family who is less affluent might not bring to the attention of the provider in the same way, nor may the provider ask the questions that would lead them down the path of making a diagnosis of a developmental problem or mental health problem.

CORNISH: Dr. Amy Houtrow, she's associate professor at Children's Hospital of Pittsburgh. Thanks so much for speaking with us.

HOUTROW: Thank you for having me on the show. Transcript provided by NPR, Copyright NPR.