1. Comments by Nancy E. Reichman April 14, 2011
The Changing Landscape of Disability in Childhood By: Neal Halfon, Amy Houtrow, Kandyce Larson & Paul Newacheck
Comments by Nancy E. Reichman
April 14, 2011

2. The Changing Landscape of Disability in Childhood
Paper appears Accurate
Balanced; presents different viewpoints
Comprehensive, but may want to consider giving more attention to certain issues/topics and connecting a few dots
Generally Differentiates between strong and weak evidence
Passes the Everyone test

3. Areas that may warrant more attention
#1 Neurodevelopmental and behavioral conditions appear to be driving increases in child disability over time
#2 Potential role of education legislation
#3 Public resources available to disabled children and their families
#4 Role of obesity
#5 Comparisons to other countries

4. #1
Neurodevelopmental and Behavioral Conditions Appear to be Driving Increases in Child Disability over Time

5. Trends in Limitation of Activity due to Chronic Conditions for U. S
Trends in Limitation of Activity due to Chronic Conditions for U.S. Children
(Figure 1 in paper)

6. Speech, Learning, Behavioral, Emotional Problems Driving Trend
Almost 90% of child disability cases (activity limitations) in 2008/2009 (Table 3)
Up from XX% in 19XX?
Learning disabilities grew over 200 percent between 1977 and 2006 (from NCES statistics)
Could make it clearer that these conditions are (or appear to be) driving trend
Show trend by gender?

7. Potential Role of Education Legislation#2
Potential Role of Education Legislation

8. % Children with Activity Limitations Over Time
HCEEA Act
EAHC Act
IDEA
NCLB

9. #3 Resources
Public resources available to children with disabilities and their families:
Medicaid/SCHIP, SSI
Early intervention, Head Start, special education
Public assistance
Provide brief summary (including how landscape has changed)?
(recognize that other chapters will cover specific types)

10. #4 Obesity Huge increases in child obesity over past few decades
Obesity is associated with depression, Type 2 diabetes, sleep apnea, etc. among children
Could obesity be driving (or related to) some of the increase in child disability rates?
Will obesity-related problems drive increases in future?

11. #5 International Context
Present rates/trends in child disability in other developed countries?

12. Summary of Recommendations
Make clearer that neurodevelopmental and behavioral conditions appear to be driving increases in child disability over time
Tie in potential role of education legislation in explaining increase in child disability over time
Add brief summary of public resources available to disabled children and their families
Add section on obesity
Place U.S. child disability rates in international context