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Prevention of Disabilities

Why in the past decade and a half has there been a significant increase in the number of children exhibiting Developmental Disabilities?

Adult hand holding infant's hand

Why in the past decade and a half has there been a significant increase in the number of children exhibiting Developmental Disabilities, such as Autism Spectrum Disorder, Vision Impairment, Hearing Impairment, Intellectual Disability, Learning Disability, and Cerebral Palsy with resulting motor disabilities and developmental delays?

How much do we not know about the causes of these Developmental Disabilities?

Developmental Disabilities

The 2011 Pediatrics report states research revealing “changes in the prevalence of developmental disabilities are scarce.” There are a few studies on individual disabilities, but data examining the impact of the full range of developmental disabilities are unavailable. The report based data collected from a study from 1998-2008 by the National Health Interview Surveys (NHIS), surveyed parents who reported diagnoses of Developmental Disabilities. This data showed an increase over the 12 year period revealing estimates in 2008 that about 1 in 6, or over 15% of children aged 3 through 17 years old had one or more Developmental Disabilities. (1)

Note: For the NHIS study above, the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS) conduct multistage probability surveys sampling U.S. Households, based on sample and in person interviews with a knowledgeable adult family member. (1) This data is mostly surveillance in scope and is not gathered at the time of birth, but possibly many years after the fact. This is one of the ways the CDC and NCHS collects data for research and policy making in the U.S. This type of surveillance gathering is subject to the accuracy of the recall of the parent. It would seem that it would be better to use a well established medical data collection system such as the U.S. Standard Certificate of Live Birth to avoid errors and to be able to review progress from birth.

Autism Spectrum Disorders (ASD)

In March 2014, the U.S. Department of Health and Human Services (DHHS) reported, “The latest figures from the Centers for Disease Control and Prevention (CDC) reaffirm that autism is a critical public health issue that deeply impacts the lives of millions of Americans.” (2)

The continuous rise in prevalence of ASD from 2000-2010 as recorded by the CDC was from1 in 166  children in 2000, 1 in 150 in 2002, 1 in 125  in 2004, 1 in 110 in 2006, 1 in 86 in 2008, and 1 in 68 in 2010.   (3)

In the past, researchers ignored this continuous rise as a consequence of better pediatric identification or over diagnosing, however, when in March 2014 the CDC reported the 2008 to 2010 rise to 1 in 68 as shown above, which is nationally, a 20% increase in ASD, it is important to note that the CDC also recognized that they did not know all the factors that could contribute to such an increase in the incidence of Autism. (4)

Cerebral Palsy (CP)

Cerebral Palsy has been identified with similar risk factors, potential causes, and developmental delays as ASD, however, CP is also defined as a neuromuscular disorder: “characterized by non-progressive abnormalities in the developing brain that creates a cascade of neurologic, motor and postural deficits that may occur before, at, or after birth in the developing child. The site of damage may be the brain, spinal cord, peripheral nerves, neuromuscular junctions or the muscle itself.” (5)

The prevalence of CP given per 1,000 live births has risen from 1.4 in 2007 to 3.3 in 2008 according to estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network.

Despite medical advances, the statistics for Cerebral Palsy have risen slightly over 30 years. Although this is believed to be partially due to better neonatal care that can now save many more preterm children, in spite of the medical communities work on the importance of delivering a healthy baby, problems still do arise in childbirth, and there are those injuries that are still considered potentially preventable. (6)

About half of all occurrences of CP are associated with underlying prenatal conditions such as intrauterine infection, perinatal anoxia, maternal metabolic disease, and birth events such as trauma or injury, infection, toxic exposure, and vascular problems. Although it was once thought CP was caused by perinatal hypoxia, it is believed hypoxia is a possible cause in less than 10 percent of children with CP. Estimating from the above prevalence rate there are 14190 children born each year with CP; 1419 CP cases a year are from hypoxia. (6)

It is important to note however, that the CDC admits that in half of all CP cases, no underlying health problem can be identified, and the CDC, recognizing there are unknown causes, has included CP in the research pursuits along with ASD in the 2014 Autism CARES Act. (7)

Developmental Disabilities are increasing yearly despite medical advances. The children with Developmental Disabilities, as well as, future children of this crisis, need and deserve our attention to prevent these disabilities. We know that many Developmental Disabilities are from injury or an anomaly at birth, which damages or causes malformation of the infant’s vulnerable developing brain, but despite medical advances the CDC does not know the causes for the incredible rise in ASD and over half of all CP cases.

We applaud the CDC for including CP in this recent research to try to fill the gaps, however, how much of the new research will be based on actual prevention? The CDC’s plans seem to be focused on surveillance, interventions, and treatments. We need to broaden and more effectively collect the data at birth, to prevent these disabilities from happening in the first place.

Review the entire NHU Spring Report on the Prevention of Disabilities at http://www.new-horizons.org/pdf/pr0315.pdf


References:

(1) Coleen A. Boyle, PHD, et al. “Trends in Prevalence report of Developmental Disabilities in US Children, 1997-2008.” Pediatrics Vol. 127 No. 6 June 1, 2011, pp.1034-1042. <http://pediatrics.aappublications.org/content/127/6/1034.long > (26 February 2013).
(2) U.S. Department of Health and Human Services, “Our Commitment to Supporting Individuals on the Autism Spectrum and their Families,” (last updated March 27 2014) pp.7 <http://www.hhs.gov/autism/factsheet_autism_support.html> (31 March 2015).

(3) CDC Prevalence Statistics for ASD. <http://www.autismspeaks.org/science/science-news/can-rise-autism-be-explained-broadened-diagnosis>

(4) Why Are Autism Spectrum Disorders Increasing? Centers for Disease Control and Prevention (CDC) <http://www.cdc.gov/Features/AutismPrevalence/&gt; (10/21/2014) (Link no longer available).

(5) Jane Case-Smith, EdD. OTR/L. Jane Clifford O’Brien, Phd., FAOTA Mosby Elsevier OTR/L, Occupational Therapy for children, (6th Edition, Maryland Heights, Missouri, 2010).

(6) Pelligrino, I., Cerebral Palsy. In M.I.Batshaw, J.Pelligrino, & N.J. Roizen (Eds.), Children with disabilities (6th ed., Baltimore: Brookes, 2007) pp. 387-408.

(7) Taryn Mackenzie Williams, “President Obama Signs Bill to Support the Needs of People with Autism,” The White House Blog (August 11, 2014).

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