Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders in Early Childhood — United States, 2011–2012

Abstract

Sociodemographic, health care, family, and community attributes have been associated with increased risk for mental, behavioral, and developmental disorders (MBDDs) in children (1,2). For example, poverty has been shown to have adverse effects on cognitive, socio-emotional, and physical development (1). A safe place to play is needed for gross motor development, and accessible health care is needed for preventive and illness health care (3). Positive parenting and quality preschool interventions have been shown to be associated with prosocial skills, better educational outcomes, and fewer health risk behaviors over time (2). Protective factors for MBDDs are often shared (4) and conditions often co-occur; therefore, CDC considered MBDDs together to facilitate the identification of factors that could inform collaborative, multidisciplinary prevention strategies. To identify specific factors associated with MBDDs among U.S. children aged 2-8 years, parent-reported data from the most recent (2011-2012) National Survey of Children's Health (NSCH) were analyzed. Factors associated with having any MBDD included inadequate insurance, lacking a medical home, fair or poor parental mental health, difficulties getting by on the family's income, employment difficulties because of child care issues, living in a neighborhood lacking support, living in a neighborhood lacking amenities (e.g., sidewalks, park, recreation center, and library), and living in a neighborhood in poor condition. In a multivariate analysis, fair or poor parental mental health and lacking a medical home were significantly associated with having an MBDD. There was significant variation in the prevalence of these and the other factors by state, suggesting that programs and policies might use collaborative efforts to focus on specific factors. Addressing identified factors might prevent the onset of MBDDs and improve outcomes among children who have one or more of these disorders.NSCH is a cross-sectional, nationally representative, random-digit-dialed telephone survey that collects information about U.S. children aged <18 years. The survey includes indicators of child health and well-being, access to quality health care, family characteristics, and school and neighborhood environment.* Participating parents or guardians completed interviews about one randomly selected child (N = 95,677) per household. The interview completion rates were 54.1%

Differences in Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders Among Children Aged 2–8 Years in Rural and Urban Areas — United States, 2011–2012

“…The onset of mental, behavioral, and developmental disorders (MBDDs) often occurs in childhood. Nationally representative data suggest that 15% of U.S. children aged 2–8 years (i.e., early childhood, as defined by Healthy People 2020 [HP2020]) ( 1 ) have a parent-reported MBDD diagnosis ( 2 ). Treating these conditions early is important; an HP2020 objective sets a national target for 76% of all children with mental health problems to receive treatment ( 1 ).…”

Targeting Parenting in Early Childhood: A Public Health Approach to Improve Outcomes for Children Living in Poverty

“…Such relationships may be especially important for children living in poverty, who are at heightened risk for poor health outcomes and delays in social, emotional, and cognitive development (Bitsko et al, 2016). Large-scale epidemiological studies, such as the Adverse Childhood Experiences study (Anda et al, 2006), and neurobiological research support the premise that early trauma and family stress have damaging consequences on development via physiological adaptations that impair neurological, metabolic, and immunologic systems (Miller, Chen, & Parker, 2011).…”

CDC Grand Rounds: Addressing Health Disparities in Early Childhood

“…Nationally representative data from 2011–2012 suggest that 15% of U.S. children aged 2–8 years have a parent-reported mental, behavioral, or developmental disorder ( 18 ), and children living in small rural areas have a higher prevalence (19%) than children living in urban areas (15%) ( 19 ). In 2012, nearly $14 billion in medical expenditures for mental disorders among children were spent across all payment types (private insurance, public insurance, out of pocket, and other); these costs were higher than those for any other health condition (e.g., chronic obstructive pulmonary disease and asthma, trauma-related conditions, and acute respiratory infections) **.…”

“…Mental, behavioral, and developmental disorders in young children have been associated with potentially modifiable family, community, and health care factors ( 18 , 19 ). Two-generation approaches that support the health, educational achievement, economic self-sufficiency, and wellbeing of both children and their caregivers have indicated some beneficial effects on early childhood literacy and language development ( 3 , 7 ).…”