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PEDIATRICS Vol. 111 No. 3 March 2003, pp. 548-553

Functional Disability and School Activity Limitations in 41 300 School-Age Children: Relationship to Medical Impairments

Michael E. Msall, MD*, Roger C. Avery, PhD{ddagger}, Michelle R. Tremont, MA*, Julie C. Lima, MA{ddagger}, Michelle L. Rogers, PhD{ddagger} and Dennis P. Hogan, PhD{ddagger}

* Child Development Center, Rhode Island Hospital, Providence, Rhode Island
{ddagger} Population Studies and Training Center, Brown University, Providence, Rhode Island

--> Objective. Our purpose was to examine the contribution of medical impairments to functional disability and school activity limitations in 41 300 school-age children participating in the 1994–1995 National Health Interview Survey.

Methods. The 1994 and 1995 National Health Interview Survey and Disability Interview Supplement samples provide International Classification of Diseases, Ninth Revision medical impairment codes for children with functional limitations or school activity limitations in a nationally representative US sample. Functional limitations were distributed as follows: mobility 12.4/1000 (95% confidence interval [CI]: 11.1–13.6), self-care 8.8/1000 (95% CI: 7.7–9.8), communication 52.9/1000 (95% CI: 50.2–55.5), and learning 104.6/1000 (95% CI: 100.7–108.4). Functional disability status was classified as 4.1% mild, 5.9% major, and 1.9% multiple. School activity limitations included 4.1% needing or receiving special education, 0.7% unable to attend, and 0.9% limited attendance. We categorized International Classification of Diseases, Ninth Revision impairment codes reported in conjunction with medical usage as physical disorders (n = 1251; eg, leukemia, diabetes), asthma (n = 916), neurodevelopmental disorders (n = 802; eg, cerebral palsy, epilepsy, mental retardation, autism, blindness, deafness), and learning-behavior disorders (n = 806; eg, attention-deficit/hyperactivity disorder, learning disability, anxiety) for children with functional or school activity limitations. Of children with multiple functional disabilities, 29.9% had neurodevelopmental disorders, 27.1% had learning-behavior disorders, 18.1% had physical disorders, 4.2% had asthma, and 20.8% did not have an identified medical impairment because they had not received medical services in the past year. Among children requiring special education, physical disorders accounted for 9.4%, neurodevelopmental disorders for 16.7%, learning and behavior disorders for 17%, asthma for 3.4%, and 53.4% did not have an identified medical impairment because they had not received medical services in the past year.

Conclusions. Chronic health impairments, neurodevelopmental disorders, learning-behavior disorders, and functional limitations in essential activities are required to understand the complexity of disability in school-age children. A large number of children with functional disability or school activity limitations have not received ongoing medical services.

Key Words: childhood disability • functional limitations • chronic health conditions • neurodevelopmental disorders • learning-behavior disorders • special education needs • epidemiology

Abbreviations: NHIS-D, National Health Interview Survey Disability Supplement • ICD-9, International Classification of Diseases, Ninth Revision • CI, confidence interval

Received for publication Jan 28, 2002; Accepted Aug 1, 2002.




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