Promoting Developmental Potential in Early Childhood: A Global Framework for Health and Education

In the early years of life, children’s interactions with the physical and social environment- including families, schools and communities—play a defining role in developmental trajectories with long-term implications for their health, well-being and earning potential as they become adults. Importantly, failing to reach their developmental potential contributes to global cycles of poverty, inequality, and social exclusion. Guided by a rights-based approach, this narrative review synthesizes selected studies and global initiatives promoting early child development and proposes a universal intervention framework of child-environment interactions to optimize children’s developmental functioning and trajectories.

Measuring family-centred practices of professionals in early intervention services in Taiwan

BACKGROUND

Family-centred practices emphasize professional supports for forming partnerships with families in early intervention. The Measure of Processes of Care for Service Providers (MPOC-SP) measures the perceptions of paediatric service providers in supporting children and families. This study aimed to establish reliability of the Chinese version of the MPOC-SP (C-MPOC-SP) and to examine professional perceptions of family-centred practices in relation to professional discipline and years of experience.

METHODS

A convenience sample of 94 physical therapists, occupational therapists, speech-language pathologists, social workers and early childhood educators completed the C-MPOC-SP. Thirty-seven professionals completed the measure a second time within 2-4 weeks for test-retest reliability. Internal consistency and test-retest reliability were examined by Cronbach's α and intra-class correlation coefficient. Comparisons were made across professional disciplines by multivariate analyses of variance followed by analyses of variance. Relationships between years of experience and ratings of family-centred practices were examined by Pearson's correlation coefficients (r).

RESULTS

Cronbach's α for items on each of the four scales of the C-MPOC-SP ranged from 0.80 to 0.92, indicating adequate internal consistency. Intra-class correlation coefficient between the initial and repeat completion of the C-MPOC-SP for each scale ranged from 0.56 to 0.77, indicating adequate to excellent test-retest reliability. Mean ratings for the Communicating Specific Information were significantly higher for physical therapists, occupational therapists and speech-language pathologists than for social workers (P = 0.001). The C-MPOC-SP scores were positively correlated with years of experience for all four scales (r = 0.23-0.38; P < 0.05).

CONCLUSIONS

This study established adequate internal consistency and adequate to excellent test-retest reliability of the C-MPOC-SP in measuring perceptions of family centeredness of early intervention service providers. Cross-discipline differences were found in communicating specific information about the child. Higher perceptions of family centeredness were associated with more years of experience. The results support the utility of the C-MPOC-SP in professional education and programme evaluation of early intervention services in Taiwan.

The Burn Model Systems outcome measures: a content analysis using the International Classification of Functioning, Disability, and Health

BACKGROUND

The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Injury Model Systems (BMS) is a nationwide database that uses patient-reported outcome measures to collect data. Though the outcome measures demonstrate good psychometric properties, the question remains whether or not these measures collect data that encompass the entire experience of burn patients over time.

METHODS

Each meaningful concept included in the BMS assessments was linked to the International Classification of Functioning, Disability and Health (ICF) in order to classify and describe the content of each measure. The linking was completed by two experienced coders. The perspective of each assessment was also determined.

RESULTS

The body function component was most frequently addressed overall followed by the activities and participation component. The component body structures and environmental factors are not extensively covered in the BMS assessments. ICF chapter and category distribution varied greatly between assessments. The assessments were of the health status perspective.

CONCLUSION

This study suggests a need to revisit the item composition of the BMS assessments to more evenly distribute ICF topics and subtopics that are pertinent to burn injury which will ensure a broader but more precise understanding of burn injury recovery. Implications for Rehabilitation A better understanding of the data collected through the Burn Model Systems (BMS) project may contribute to improve data collection tools and ultimately lead to clinical practice innovations and improvements. Clinicians interested in using BMS data for research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed. This study highlights the need for burn clinicians around the world to lend their expertise to the WHO for the development of a much needed burn injury International Classification of Functioning, Disability and Health Core Set.

Critical Issues Underlying Research and Intervention with Families of Young Handicapped Children

Although family involvement is a fundamental premise of early intervention, effective implementation has been hampered by a number of critical needs: (1) the need for a defensible rationale for family involvement, consistent with both research and practice, (2) the need for caution in defining desired family outcomes, (3) the need to view families from a developmental perspective, (4) the need to view families within ecological contexts, (5) the need to account for variability in family composition or structure, and (6) the need for an adequate system for assessing family needs. In this article each need is elucidated, research pertinent to each is reviewed, and the implications of each for researchers and practitioners are discussed.

Consistency and Correspondence of Mothers' and Teachers' Assessments of Young Handicapped Children

Due to the recognition of the limitations of standardized, formal assessment instruments and the mandates of Public Law 94-142, teachers, direct care staff, and parents are becoming Involved in assessment of young handicapped children. If the evaluation and judgments of parents are to be valid sources of information about the child, the utility of clinical judgment must be documented. Typically, parents tend to overestimate their child's general intelligence or ability; however, this may be a function of the specific test, measure, or rating scale used. The study described in this article was designed to determine (a) the degree of correspondence between mothers' and teachers' ratings on the same version of the same assessment instrument and (b) the degree of correspondence between mothers' ratings across a period of time. The data support the reliability of maternal assessment and provide evidence for the contributions of parents to the assessment process in early intervention.

Inservice Training in Family Assessment and Goal-Setting For Early Interventionists: Outcomes and Issues

Public Law 99-457 mandates that early interventionists working with handicapped infants write an Individualized Family Service Plan. Most early Interventionists, however, have insufficient preservice training in working with families. This article evaluates the effects of inservice training in family assessment and collaborative goal-setting based on the Family-Focused Intervention model. The training increased interventionists' use of family assessment tools and increased the proportion of family goals written as part of a comprehensive plan. The focused interview, a specific step in Family-Focused Intervention, significantly affected the goals ultimately specified. The study raises several important issues related to increasing a family focus in early intervention. These issues are discussed and directions for future research are suggested.

Family-Focused Intervention: A Functional Model for Planning, Implementing, and Evaluating Individualized Family Services in Early Intervention

The provision of Individualized services to families with young handicapped children has been hampered by the lack of a practical model. This article describes a functional model for assessing family needs, specifying family goals, implementing family services, and evaluating effectiveness. The model draws on the "goodness-of-fit" concept to individualize family services in order to optimize the "fit" between family, child, and services provided.

Preparing Infant Interventionists: Interdepartmental Training in Special Education and Maternal and Child Health

The provision of services to handicapped newborns, Infants, and their families challenges traditional approaches to preparing special educators. Early childhood special educators working with handicapped infants increasingly must assume new roles and work In a variety of settings, Including homes, daycare centers, and medical settings. Furthermore, they work intensively with families and must work within the context of broader community systems. This article describes one alternative approach to preparing infant Interventionists by providing Interdepartmental training In Special Education and Maternal and Child Health. The program recognizes the transactional nature of Infant development, the fact that Infants are a part of a family system, and the ecological notion that the family system is nested within larger systems.

The Communication Supports Inventory-Children & Youth (CSI-CY), a new instrument based on the ICF-CY

PURPOSE

Two studies are presented that evaluated the Communication Supports Inventory-Children & Youth (CSI-CY), an instrument designed to facilitate the development of communication-related educational goals for students with complex communication needs (CCN). The CSI-CY incorporates a code set based on the ICF-CY. The studies were designed to determine the effect of using the CSI-CY on IEP goals for students with CCN and to evaluate consumer satisfaction.

METHOD

In Study 1, sixty-one educators and speech-language pathologists were randomly assigned to either (a) provide a student's current IEP (control group) or (b) complete the CSI-CY prior to preparing a student's next IEP and to submit the new IEP (experimental group). Study 2 was a field test to generate consumer satisfaction data.

RESULTS

Study 1 showed that IEP goals submitted by participants in the experimental group referenced CSI-CY-related content significantly more frequently than did those submitted by control participants. Study 2 revealed high satisfaction with the instrument.

CONCLUSIONS

The code set basis of the CSI-CY extends the common language of the ICF-CY to practical educational use for children with CCN across diagnostic groups. The CSI-CY is well regarded as an instrument to inform the content of communication goals related to CCN. Implications for Rehabilitation The CSI-CY will guide rehabilitation professionals to develop goals for children with complex communication impairments. The CSI-CY is a new instrument that is based on the ICF-CY for documentation of communication goals.

Participation of Children with Disabilities in Taiwan: The Gap between Independence and Frequency

BACKGROUND

Independence and frequency are two distinct dimensions of participation in daily life. The gap between independence and frequency may reflect the role of the environment on participation, but this distinction has not been fully explored.

METHODS

A total of 18,119 parents or primary caregivers of children with disabilities aged 6.0-17.9 years were interviewed in a cross-sectional nationwide survey with the Functioning Scale of the Disability Evaluation System - Child version (FUNDES-Child). A section consisting of 20 items measured the children's daily participation in 4 environmental settings: home, neighborhood/community, school, and home/community. Higher independence and frequency restriction scores indicated greater limitation of participation in daily activities. Scores for independence, frequency and independence-frequency gaps were examined across ages along with trend analysis. ANOVA was used to compare the gaps across settings and diagnoses for children with mild levels of severity of impairment.

FINDINGS

A negative independence-frequency gap (restriction of frequency was greater than that of independence) was found for children with mild to severe levels of impairment. A positive gap (restriction of independence was greater than that of frequency) was found for children with profound levels of severity. The gaps became wider with age in most settings of children with mild impairment and different diagnoses. Widest negative gaps were found for the neighborhood/community settings than for the other three settings for children with mild to severe impairment.

CONCLUSIONS

Children's participation and independence-frequency gaps depend not only on the severity of their impairments or diagnoses, but also on their age, the setting and the support provided by their environment. In Taiwan, more frequency restrictions than ability restrictions were found for children with mild to moderate severity, especially in the neighborhood/community setting, and increased with age. Further identification of environmental opportunities that positively impact frequency of participation is needed.

Health and functioning in the everyday lives of young children with cancer: documenting with the International Classification of Functioning, Disability and Health--Children and Youth (ICF-CY)

BACKGROUND

Health care focus is shifting for children from surviving childhood cancer to living with it on a daily basis. There is a need to document health and function in the everyday lives of young children with cancer using the multidimensional framework and language of the International Classification of Functioning, Disability and Health--Children and Youth (ICF-CY).

AIMS

The aims of this study were (1) to document health and functioning in the everyday lives of young children with cancer using ICF-CY codes and (2) to identify a comprehensive code set that can aid clinical assessment.

METHOD

Interviews with children diagnosed with cancer and their parents, were transcribed, reviewed for content and coded to the ICF-CY using linking procedures.

RESULTS

A comprehensive code set (n = 70) for childhood cancer was identified. The majority of content identified to codes was related to activity and participation describing social relations with family, peers and professionals, preschool attendance and play, as well as issues related to support and independence.

CONCLUSIONS

The ICF-CY can be used to document the nature and range of characteristics and consequences of cancer experienced by children. The identified comprehensive code set could be helpful to health care professionals, parents and teachers in assessing and supporting young children's health and everyday life through the cancer trajectory. The comprehensive code set could be developed as a clinical assessment tool for those caring for young children with cancer. The universal language of the ICF-CY means that the utility of a clinical assessment tool based on identified codes can have wide reaching effects for the care of young children with cancer.

The Chinese version of the Child and Adolescent Scale of Environment (CASE-C): validity and reliability for children with disabilities in Taiwan

Measurement of children's participation and environmental factors is a key component of the assessment in the new Disability Evaluation System (DES) in Taiwan. The Child and Adolescent Scale of Environment (CASE) was translated into Traditional Chinese (CASE-C) and used for assessing environmental factors affecting the participation of children and youth with disabilities in the DES. The aim of this study was to validate the CASE-C. Participants were 614 children and youth aged 6.0-17.9 years with disabilities, with the largest condition group comprised of children with intellectual disability (61%). Internal structure, internal consistency, test-retest reliability, convergent validity, and discriminant (known group) validity were examined using exploratory factor analyses, Cronbach's α coefficient, intra-class correlation coefficients (ICC), correlation analyses, and univariate ANOVAs. A three-factor structure (Family/Community Resources, Assistance/Attitude Supports, and Physical Design Access) of the CASE-C was produced with 38% variance explained. The CASE-C had adequate internal consistency (Cronbach's α=.74-.86) and test-retest reliability (ICCs=.73-.90). Children and youth with disabilities who had higher levels of severity of impairment encountered more environmental barriers and those experiencing more environmental problems also had greater restrictions in participation. The CASE-C scores were found to distinguish children on the basis of disability condition and impairment severity, but not on the basis of age or sex. The CASE-C is valid for assessing environmental problems experienced by children and youth with disabilities in Taiwan.

Psychometric properties of the Young Children's Participation and Environment Measure

OBJECTIVE

To evaluate the psychometric properties of the newly developed Young Children's Participation and Environment Measure (YC-PEM).

DESIGN

Cross-sectional study.

SETTING

Data were collected online and by telephone.

PARTICIPANTS

Convenience and snowball sampling methods were used to survey caregivers of children (N=395, comprising children with [n=93] and without [n=302] developmental disabilities and delays) between the ages of 0 and 5 years (mean age±SD, 35.33±20.29 mo) and residing in North America.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The YC-PEM includes 3 participation scales and 1 environment scale. Each scale is assessed across 3 settings: home, daycare/preschool, and community. Data were analyzed to derive estimates of internal consistency, test-retest reliability, and construct validity.

RESULTS

Internal consistency ranged from .68 to .96 and .92 to .96 for the participation and environment scales, respectively. Test-retest reliability (2-4 wk) ranged from .31 to .93 for participation scales and from .91 to .94 for the environment scale. One of 3 participation scales and the environment scale demonstrated significant group differences by disability status across all 3 settings, and all 4 scales discriminated between disability groups for the daycare/preschool setting. The participation scales exhibited small to moderate positive associations with functional performance scores.

CONCLUSIONS

Results lend initial support for the use of the YC-PEM in research to assess the participation of young children with disabilities and delays in terms of (1) home, daycare/preschool, and community participation patterns; (2) perceived environmental supports and barriers to participation; and (3) activity-specific parent strategies to promote participation.

Agenesis of the corpus callosum: classifying functional manifestations with the ICF-CY

PURPOSE

Agenesis of the corpus callosum (ACC) is a congenital condition in which the corpus callosum fails to develop fully. In the literature, ACC has been broadly conceptualized and inconsistently described. This article demonstrates how the universal language of the International Classification of Functioning, Disability and Health-Children and Youth can increase the specificity with which researchers and clinicians describe the variable manifestations of ACC.

METHODS

The database for this article was based on a review of 83 studies on developmental and neuropsychological manifestations of congenital ACC in children and adolescents. First, the extent to which the findings on ACC could be documented using the taxonomic codes in the ICF-CY was examined. Next, the findings from each study were mapped onto the ICF-CY to summarize the distribution of clinical features reported in the literature.

RESULTS

There was a high degree of correspondence between the reported findings and the taxonomic codes of the ICF-CY. The distribution of clinical features was discussed.

CONCLUSIONS

This taxonomic application advances the ICF-CY as a common language for researchers and clinicians who work with children who have ACC. Implications for Rehabilitation Agenesis of the corpus callosum (ACC) is a condition that has been broadly conceptualized and inconsistently described in research and practice. The variable clinical manifestations of children with ACC can be most effectively described using the ICF-CY. The application of the ICF-CY to conditions with highly variable clinical manifestations, like ACC, positively impacts research and practice.

Comparing children's self-report instruments for health-related quality of life using the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY)

Children with chronic conditions often experience a long treatment which can be complex and negatively impacts the child's well-being. In planning treatment and interventions for children with chronic conditions, it is important to measure health-related quality of life (HrQoL). HrQoL instruments are considered to be a patient-reported outcome measure (PROM) and should be used in routine practice. Purpose: The aim of this study was to compare the content dimensions of HrQoL instruments for children's self-reports using the framework of ICF-CY. Method: The sample consist of six instruments for health-related quality of life for children 5 to 18 years of age, which was used in the Swedish national quality registries for children and adolescents with chronic conditions. The following instruments were included: CHQ-CF, DCGM-37, EQ-5D-Y, KIDSCREEN-52, Kid-KINDL and PedsQL 4.0. The framework of the ICF-CY was used as the basis for the comparison. Results: There were 290 meaningful concepts identified and linked to 88 categories in the classification ICF-CY with 29 categories of the component body functions, 48 categories of the component activities and participation and 11 categories of the component environmental factors. No concept were linked to the component body structures. The comparison revealed that the items in the HrQoL instruments corresponded primarily with the domains of activities and less with environmental factors. Conclusions: In conclusion, the results confirm that ICF-CY provide a good framework for content comparisons that evaluate similarities and differences to ICF-CY categories. The results of this study revealed the need for greater consensus of content across different HrQoL instruments. To obtain a detailed description of children's HrQoL, DCGM-37 and KIDSCREEN-52 may be appropriate instruments to use that can increase the understanding of young patients’ needs.

Linkage of ICF-CY codes with environmental factors in studies of developmental outcomes of infants and toddlers with or at risk for motor delays

PURPOSE

Environmental variables have been explored in studies of the development of young children with motor delays. Linking environmental variables to the International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY), environmental factors (EFs) categories can provide a common language for documenting their contribution to developmental outcomes. This review of studies aimed to (1) link EFs for developmental outcomes in infants with or at risk for motor delays to ICF-CY categories and (2) synthesize the influences of EFs (with ICF-CY linkage) on developmental outcomes.

METHOD

A systematic literature search was performed of multiple databases. After applying selection criteria, environmental variables in 28 articles were linked to ICF-CY categories and underwent qualitative synthesis.

RESULTS

Results indicated that physical environmental variables could be linked successfully to ICF-CY EFs categories, but not social environmental variables. Multiple environmental variables were associated with motor and other developmental outcomes.

CONCLUSION

Difficulties in linking social factors to ICF-CY categories indicate that additional EFs codes may need to be considered in the ICF-CY revision processes. The review provides empirical data on relationships between EFs and developmental outcomes in children with or at risk for motor delay.

Portugal's special education law: implementing the International Classification of Functioning, Disability and Health in policy and practice

PURPOSE

The International Classification of Functioning, Disability and Health (ICF) was introduced in Portuguese education law as the compulsory system to guide eligibility policy and practice in special education. This paper describes the implementation of the ICF and its utility in the assessment process and eligibility determination of students for special education.

METHODS

A study to evaluate the utility of the ICF was commissioned by the Portuguese Ministry of Education and carried out by an external evaluation team. A document analysis was made of the assessment and eligibility processes of 237 students, selected from a nationally representative sample.

RESULTS

The results provided support for the use of the ICF in student assessment and in the multidimensional approach of generating student functioning profiles as the basis for determining eligibility. The use of the ICF contributed to the differentiation of eligible and non eligible students based on their functioning profiles.

CONCLUSIONS

The findings demonstrate the applicability of the ICF framework and classification system for determining eligibility for special education services on the basis of student functioning rather than medical or psychological diagnose.

IMPLICATIONS FOR REHABILITATION

The use of the International Classification of Functioning, Disability and Health (ICF) framework in special education policy is as follows: • The functional perspective of the ICF offers a more comprehensive, holistic assessment of student needs than medical diagnoses. • ICF-based assessment of the nature and severity of functioning can serve as the basis for determining eligibility for special education and habilitation. • Profiles of functioning can support decision making in designing appropriate educational interventions for students.

Constructing and testing a disability index in a US sample of preschoolers with disabilities

PURPOSE

To develop and test an index of disability severity in a heterogeneous population of preschoolers with disabilities.

METHOD

Using a nationally representative sample of 3,104 children receiving special education services in the US, questions from a parent interview were used to develop an index of disability severity consisting of domains of functioning defined by gradients of severity. Regressions were used to examine the association between 15 functional domains and 8 cognitive, social/behavioural, and functional outcomes. Full and abbreviated versions of this disability index were compared. Correlations with proxy measures of disability in this population were used to establish concurrent validity, and the predictive ability of this measure was compared with that of the federally defined disability categories.

RESULTS

Of the 15 domains examined, most were significant predictors of at least two outcomes. A shortened index of only six variables was found to be as effective as the longer version in characterising children's level of severity. The index was significantly correlated with intervention variables such as the age at which children began receiving special education or therapy service, r(2802) = -0.22, p <or= 0.0001, the extent of modification of curriculum materials needed for the child, r(248) = 0.42, p <or= 0.0001 and the number of services the child received in the school, r(2014) = 0.37, p <or= 0.0001. Adding severity to special education category significantly increased the amount of variance in outcomes over special education category alone.

CONCLUSIONS

These results provide evidence for the importance of the construct of severity of disability and its measurement, particularly when conducting research with very young children.

Dimensions of behavior of toddlers entering early intervention: Child and family correlates

This study examined the nature and correlates of the behavioral characteristics of a nationally representative sample of 1612 toddlers 18-31 months of age entering Part C early intervention services in the U.S. Factor analysis of 15 items describing child behavior collected as part of an extensive telephone interview of parents yielded four dimensions of behavior: difficult behaviors, lack of persistence, distractible, and withdrawn. Demographic and personal characteristics of the child and family were found to be related to the four behavioral dimensions. Parent reports of behavior of toddlers with fair or poor health or those with communication difficulties were less positive for all behavioral dimensions, suggesting the development of toddler behavioral characteristics is influencing or being influenced by other facets of development.

ICF and ICD codes provide a standard language of disability in young children

BACKGROUND AND OBJECTIVES

The aim of this study was to examine the utility of a hierarchical algorithm incorporating codes from the International Classification of Functioning, Disability and Health--ICF (WHO, 2001) and the International Statistical Classification of Diseases-ICD (WHO, 1994) to classify reasons for eligibility of young children in early intervention.

METHODS

The database for this study was a nationally representative enrollment sample of more than 5,500 children in a longitudinal study of early intervention. Reasons for eligibility were reviewed and matched to the closest ICF or ICD codes under one of four major categories (Body Functions/Structures, Activities/Participation, Health Conditions, and Environmental Factors).

RESULTS

The average number of reasons for eligibility provided per child was 1.5, resulting in a population summary exceeding 100%. A total of 305 ICF and ICD codes were used with most (77%) of the children having codes in the category of Body Function/Structures. Forty-one percent of the sample had codes of Health Conditions, whereas the proportions with codes in the Activities/Partipication and Environmental Categories were 10 and 5%, respectively.

CONCLUSIONS

The results demonstrate that ICD and ICF can be jointly used as a common language to document disability characteristics of children in early intervention.

Diagnosis to function: classification for children and youths

This article provides an overview of a newly approved World Health Organization framework and classification system for human functioning. The International Classification of Functioning, Disability, and Health (ICF) identifies dimensions of human functioning and describes a common language for clinical practice, research, and policy development across disciplines and service systems. This presentation highlights the development of a version of the ICF for children and youths (ICF-CY) and its potential utility in developmental and behavioral pediatrics. Clinical, research, and policy dimensions are described. Limitations related to scope and clarity of the framework are also outlined. The article proposes that serious consideration be given the ICF-CY as an integrated system to clarify constructs, improve communication, and encourage coordination of health services for children and youths.

Classification of communication disabilities in children: contribution of the International Classification on Functioning, Disability and Health

Problems in communication serve as frequent markers of developmental delay and disability in childhood. Documentation of delayed or atypical receptive or expressive communication is one of the key diagnostic factors in the identification of children for intervention and support. This paper (1) reviews issues in classification and measurement of communication disabilities, (2) presents an overview of the development and publication of the WHO International Classification of Functioning, Disability and Health (ICF), and (3) identifies the implications of the ICF for children and youths with communication disabilities. As a conceptual framework, the ICF may be used productively to define the focus for different efforts to address children's language and communication difficulties. Impairments of a physical or mental nature can be covered in the Body Function and Body Structure components, complementing the information provided by the ICD-10 with descriptive documentation. The component of Activities, encompassing performance aspects of communication, lends itself to functional assessment and intervention in habilitation and education programs. The component of Participation provides an operational basis for policy initiatives focusing on social integration and community life Finally, the Environmental Factors component serves as a framework for identifying the nature and extent of access and opportunity for individuals and populations.

Applying the International Classification of Functioning, Disability and Health (ICF) to measure childhood disability

The International Classification of Functioning, Disability and Health-ICF addresses the broad need for a common language and classification of functioning and disability. A parallel need is appropriate measures compatible with the content of the ICF to document the nature and impact of limitations of function, activities and participation. The interaction of developmental characteristics and disability among children represent special challenges for classification as well as measurement. Demographic trends emphasize the need for universal measures that encompass the components of the ICF and can be used in surveillance, screening and evaluation. This paper identifies issues related to application of the ICF to measure disability in childhood; reviews approaches and tools to assess childhood disability and identifies priorities for the development of measures of functioning and disability in children based on the ICF. The development of measures should be framed within a framework of children's rights and application of the biopsychosocial model to document profiles of functioning and disability of children.

Secondary conditions in children with disabilities: spina bifida as a case example

This paper examines the concept of secondary conditions and its application in studies of childhood disability focusing on children with spina bifida as a representative group. The "International Classification of Functioning, Disability and Health" (World Health Organization, Geneva, 2001) provides a classification of body function/structure, activities, participation and the environment to document dimensions of human functioning in context. The ICF is of value in the study of secondary conditions in two ways: as a conceptual framework for defining impairments, activity limitations and participation restrictions, and the mediating role of the environment in their expression; and as a taxonomy for coding these dimensions of disability. The ICF can yield a profile of a child's difficulties, and documentation of environmental barriers experienced by that child. Research studies with children and adolescents with spina bifida reveal that physical and mental impairments and limitations in performing activities and participating in communal life are experienced as secondary conditions. The significance of secondary conditions is that they are preventable. Identifying the mechanisms associated with their manifestation is thus an important priority for the development of effective prevention programs.

Students with disabilities: a national survey of participation in school activities

INTRODUCTION

The policies of integration and full inclusion in school activities have been enacted to promote the independence and social participation of students with disabilities. This study examined the nature and extent of participation in schools by students with disabilities in the context of the physical, social and psychological features of the school environment.

METHOD

A national survey was completed by 1180 teachers of students with disabilities in the US describing student participation in school activities encompassing involvement in social activities, sports, academic and artistic/creative endeavours.

RESULTS/CONCLUSIONS

Multivariate analysis revealed that school life in elementary, middle and high school could be defined by six distinct factors describing individual and group roles. Structural equation modelling yielded a second order latent variable that captured the complex and multi-dimensional aspect of participation, accounting for availability, eligibility, student characteristics/status, and student choice within a larger framework of participation.

Measures of outcomes for children and youth

OBJECTIVE

To provide an overview of the issues related to the measurement of disability outcomes among children and on an assessment of selected instruments.

DATA SOURCES

Published scientific English literature in the area of child development, public health, and outcomes research.

STUDY SELECTION

Studies selected were those that provide global measures of health outcomes focusing on children. Those selected allowed data collection to address the effects of intervention on individual children or populations of children. Psychometric characteristics were also a part of the selection process.

DATA EXTRACTION

Specific guidelines for assessing the instruments include the number of scales and index capability, breadth of domains, inclusion of norms, capacity to measure elements of the World Health Organization model of functioning and disability, item and scaling bias, respondent burden, administrative burden, and retest reliability.

DATA SYNTHESIS

Thirteen instruments were included. The measures vary in their utility for broad versus specific applications, eg, clinical and public health uses. Children themselves are often not part of the assessment process. In addition, environmental influences on health outcomes of children are not adequately addressed.

CONCLUSION

Although it is challenging to evaluate outcomes associated with children with disabilities, there are frameworks and instruments that will advance outcome measurement. Approaches that include children should be explored further, and the environmental influences including and beyond the family require further measurement development.

Revision of the International Classification of Impairments, Disabilities, and Handicaps: developmental issues

Variability in approaches to define and classify disability has constituted persistent problems in documenting the epidemiology of disability and providing appropriate services. The major institutions of health care, mental health, and welfare often have separate systems of classification and terminology related to defining eligibility for programs and funding for services. In 1980, the International Classification of Impairments, Disabilities and Handicaps-ICIDH was published by the World Health Organization as a companion document of the International Classification of Disease to document the consequences of illness or injury. Current problems concerning the classification of childhood disability in health, education, and related services have resulted in growing interest in the revision of the ICIDH as a classification tool. The strengths and limitations of the ICIDH are examined in general, as well as with specific reference to its ability to document the nature and epidemiology of childhood disability. This paper (1) describes the ICIDH taxonomy and representative contributions; (2) reviews issues and concerns contributing to its revision; (3) summarizes changes in the revised ICIDH2 draft document, and (4) identifies issues of particular relevance to children and public health applications.

Functional assessment of Chinese children with the ABILITIES index

The diagnosis and classification of children with disabilities are persistent concerns in paediatric and habilitative services. These concerns are magnified in international contexts and restrict comparative research and policy development. Even within classifications such as mental retardation, hearing impairment and physical impairment, children can vary widely in the nature and severity of manifested conditions. In the fields of disability and rehabilitation there is a growing interest in functional measurement. Accompanying this awareness is a corresponding recognition of the value of classification approaches which are compatible with the WHO framework of the International Classification of Impairments, Disabilities, and Handicaps. This paper examines issues pertaining to the classification of children with disabilities and describes the development of the ABILITIES Index, a functional assessment measure yielding a profile of individual characteristics. The cross-cultural applicability of the measure is documented on the basis of data for children in the People's Republic of China.

Family involvement in multidisciplinary team evaluation: professional and parent perspectives

For many children and families, a multidisciplinary team evaluation is their introduction to special education systems. Increasingly, federal guidelines mandating parent involvement in all aspects of service provision have meant that parents are being asked to participate as part of the evaluation team. If families and professionals are to serve as partners in the evaluation process, mutual respect and understanding of one another's perspectives will be crucial. This paper uses survey data from 39 parents and 81 professionals to examine the various expectations and perceptions brought by participants to the assessment process. Results indicated that there is substantial variability of perceptions among parents and professionals about the nature of child assessment and their respective roles in it. Implications for research and practice are discussed, along with techniques for involving families in the assessment process in more meaningful ways.

Individual and team consensus ratings of child functioning

The authors examined agreement between interdisciplinary teams of professionals in rating the functional abilities of children with disabilities. 129 children were rated on the ABILITIES index by 72 professionals working in nine developmental evaluation centers. Independent individual ratings were made first, followed by a consensus rating. Team members had a high degree of agreement on independent ratings of abilities and limitations, with nearly 90 per cent of the ratings within one point of each other. More disagreement was associated with rating areas of behavior and communication, team experience and increased severity of disability. The team's consensus ratings were more likely to defer to the ratings of the expert in particular areas. Implications for team assessment and team functioning are discussed.

Child disability and family needs in the People's Republic of China

As developing countries have made progress in their efforts to reduce child mortality, there is an increasing need to address the prevention and reduction of childhood disability. The People's Republic of China has built on its success in primary health care and is extending its attention to identifying the scope of needs of individuals with disabilities. The focus of this exploratory study was to identify the nature of child and family needs among Chinese families with disabled children. A sample of 101 families from two settings (urban and rural) responded to the Family Needs Survey describing their life with a child with disabilities. The findings revealed that information was a pressing need for Chinese families. Financial help and locating a doctor were the other major expressed needs. Our discussion suggests that the type of child impairment and the setting may be factors related to variability in expressed needs. Of interest was the fact that, while some needs may be culture specific, the pattern of needs was consistent with other cultures as well.

Reliability of an index of child characteristics

The ABILITIES index provides a means to describe nine areas of functional abilities and disabilities. In this study, the authors examined the agreement between ratings made by 130 parents and teachers, 130 parents and specialists, and 125 teachers and specialists. Stability of ratings was assessed by asking 40 teachers to complete the index a second time, an average of 34 days after the first rating. The results suggest that raters who vary considerably in expertise, discipline and relationship to the child generally agree as to the child's presenting characteristics.

Prevention of childhood disability in the People's Republic of China

With a dramatic decrease in infant mortality, an emerging challenge facing modern medicine in China is chronic disabling conditions in infants and young children. According to the results of a national sampling survey in 1987, it is estimated that there are over 51 million people of all ages with disabilities, which accounts for 4.9% of the total population. One out every five families in China has a member who is disabled. For children under 14 years of age, the overall prevalence rate of disability is 2.66%. The prevalence rate of mental retardation is 1.8% which accounts for 66% of all disabled children. Mental retardation is the most frequent childhood disability. Research on factors contributing to disability indicates the complexity of the problem. The etiology of 47% of cases is unknown, 21% of cases result from damage prenatally, 3% are due to perinatal factors, 29% are acquired during infancy and early childhood. Efforts to prevent developmental disabilities among children can be classified in terms of primary, secondary and tertiary activities. The most important primary prevention activities consist of genetic counselling, immunization programmes, improved prenatal, perinatal and postnatal health care, and legislation. On the secondary preventive level, focus is primarily on prenatal diagnosis and newborn screening. Tertiary preventive efforts include special education and comprehensive rehabilitation services. While these prevention efforts have been established, they are insufficient to meet the needs of disabled children and their families. In the context of the one child per family policy in China, much more is needed, much more can be done to reduce childhood disability. In addition to strengthening prevention efforts at all 3 levels, special emphasis should be placed on (a) integration of existing primary health care systems with early intervention programmes, (b) public education and information, (c) personnel preparation, and (d) research and evaluation.

Needs expressed by mothers and fathers of young children with disabilities

One aspect of family adaptation to a young child with disabilities was investigated through comparison of expressed needs of mothers and fathers and examination of the relation of those needs with selected child and family characteristics. A diverse sample of more than 400 parents completed the Family Needs Survey (Bailey & Simeonsson, 1988). A factor analysis of the items for mothers yielded six distinct factors. A confirmatory factor analysis of needs expressed by fathers indicated a structure that differed significantly from that found for mothers. Mothers expressed significantly more needs than did fathers. Although SES and disability type accounted for significant variance in needs of mothers, an examination of mean values suggested the effect to be of limited clinical significance.