"We were interested in finding out whether specific physical limitations and family stressors placed disabled children at greater risk for psychosocial problems," says Whitney P. Witt, PhD, MPH, of the Center for Child and Adolescent Health Policy at MassGeneral Hospital for Children, who led the study.
The study's authors note that, as medical advances allow more children to survive birth defects or chronic diseases, concern has shifted from their survival to their quality of life. Other studies have found that children with special health needs and their families are at increased risk for psychological disorders; one study found the risk was three times greater than that of healthy youngsters. But most of those studies were small and may not have been broadly representative of the U.S. population.
The current study analyzed information from the National Health Interview Survey, an annual survey of households across the country conducted by the National Center for Health Statistics (NCHS). Because the 1994 and 1995 surveys contained special sections addressing disability among household members, particularly children, information from both years was used for this study.
The researchers analyzed information on more than 3,300 children aged 6 to 17, who were identified as having a disability, according to NCHS criteria, and whose mothers had completed the survey. Children whose disability was primarily psychiatric were excluded from the study. About 11 percent of the disabled children were described as having psychosocial problems, such as anxiety or depression, hostility or poor interaction with their peers.
An analysis of characteristics of the children's disabilities and family factors identified the strongest predictors of psychosocial problems. Children whose disabilities limited their ability to communicate or to learn were at increased risk, while children who were limited in mobility or ability to care for themselves had no significant increase in risk. In addition, children whose mothers reported being distressed or depressed themselves and those whose disability placed additional stresses on their families – specifically problems with work, sleep or finances – were at greater risk of poor psychosocial adjustment.
"This study clarifies that physical limitations in themselves are not detrimental to psychosocial adjustment, and that there needs to be a stronger focus on the whole family when treating children with disabilities," says Witt. "Paying more attention to the family environment and providing appropriate support services could make a significant difference in how these children adjust." She and her colleagues also are examining the use of mental health care services by disabled children.
Witt has just finished a postdoctoral fellowship in pediatric health services research at Harvard Medical School. In August 2003 she will join the faculty of Feinberg School of Medicine at Northwestern University. Her coauthors are Anne Riley, PhD, and Mary Jo Cairo, PhD, of the Bloomberg School of Public Health at Johns Hopkins University. This study was supported by grants from the U.S. Agency for Healthcare Research and Quality.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $350 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, medical imaging, neurodegenerative disorders, transplantation biology and photomedicine. In 1994, MGH and Brigham and Women's Hospital joined to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups, and nonacute and home health services.
Journal
Archives of Pediatrics and Adolescent Medicine