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Trajectories and outcomes among children with special health care needs
Jon Quach1, Pauline W Jansen2, Fiona K Mensah3
1Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Carlton, Victoria, Australia; jon.quach@mcri.edu.au.
Insights
Children with special health care needs (SHCN) show distinct patterns over time. Persistent SHCN significantly impacts child and parent outcomes, highlighting the need for ongoing support.
Area of Science:
- Pediatric Health
- Developmental Psychology
- Public Health
Background:
- Childhood special health care needs (SHCN) exhibit varied patterns and persistence.
- Understanding these trajectories is crucial for predicting child and parent outcomes.
Purpose of the Study:
- To empirically define typical SHCN trajectories throughout childhood.
- To investigate the predictive relationships between these trajectories and child/parent outcomes.
Main Methods:
- Utilized 2 cohorts (B and K) from the Longitudinal Study of Australian Children (n ≈ 10,000).
- Employed latent class analysis to identify SHCN trajectories based on parent-reported data across 4 biennial waves.
- Compared child and parent outcomes (behavior, quality of life, learning, cognition, mental distress) across trajectories using linear regression.
Main Results:
- Identified four replicated SHCN trajectories: persistent, emerging, transient, and none.
- Persistent and emerging SHCN groups showed similarly poor outcomes from infancy to age 6-7.
- Outcomes worsened incrementally with increasing SHCN burden (none < transient < emerging < persistent), particularly for behavioral, learning, and psychosocial aspects.
Conclusions:
- Cumulative burden of SHCN, rather than point prevalence, significantly shapes adverse outcomes.
- Prioritizing care for persistent SHCN may yield the greatest benefits for children and parents.
- Care provision should consider the dynamic nature and cumulative impact of SHCN.
Background And Objective:
Outcomes for children with special health care needs (SHCN) can vary by their patterns and persistence over time. We aimed to empirically establish typical SHCN trajectories throughout childhood and their predictive relationships with child and parent outcomes.
Methods:
The 2 cohorts of the nationally representative Longitudinal Study of Australian Children were recruited in 2004 at ages 0 to 1 (n = 5107, B cohort) and 4 to 5 years (n = 4983, K cohort). The parent-reported Children With SHCN Screener (Short Form) was completed at each of 4 biennial waves. Wave 4 outcomes were parent-reported behavior and health-related quality of life, teacher-reported learning, and directly assessed cognition. Both parents self-reported mental distress. We derived intracohort trajectories by using latent class analysis in Mplus. We compared mean outcome scores across trajectories by using linear regression, adjusting for socioeconomic position.
Results:
Four distinct SHCN trajectories were replicated in both cohorts: persistent (B 6.8%, K 8.7%), emerging (B 4.1%, K 11.5%), transient (B 7.9%, K 4.2%), and none (B 81.3%, K 75.6%). Every outcome was adversely affected except fathers' mental health. From infancy to age 6 to 7 years, the persistent and emerging groups had similarly poor outcomes. From age 4 and 5 to 10 and 11 years, outcomes were incrementally poorer on moving from none to transient to emerging and to persistent SHCN. Effect sizes were largest for behavior, learning, and psychosocial outcomes.
Conclusions:
Adverse outcomes are shaped more by cumulative burden than point prevalence of SHCNs. In addition to providing care according to a child's need at any given time, prioritizing care toward persistent SHCNs may have the biggest benefits for children and parents.
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