McManus B M, Carle A C, Rapport M J
Department of Health Systems, Management & Policy, Colorado School of Public Health, Children's Outcomes Research Group, Children's Hospital Colorado, Aurora, CO, USA.
Child Care Health Dev. 2014 Mar;40(2):205-14. doi: 10.1111/cch.12013. Epub 2012 Dec 5.
Infants and toddlers with developmental difficulties represent a heterogeneous group who often receives early intervention (EI). Notable population heterogeneity exists and complicates unmet need and effectiveness research. However, a mix of relatively homogeneous clinically policy relevant 'subgroups' may create the apparent heterogeneity. To date, methodological challenges have impeded identifying these potential groups and their policy-relevance.
From the 2005-2006 National Survey of Children with Special Health Care Needs, we derived a sample (n = 965) of infants and toddlers with parent-reported developmental difficulties. We used latent class analysis (LCA) to identify subgroups of developmental vulnerability based upon functional, social and biological characteristics that would make children eligible for EI. Mixture modelling estimated the likelihood of each subgroup receiving parent-reported EI, controlling for race/ethnicity, child's age, and state of residence.
LCA identified four distinct subgroups of developmental vulnerability: developmental disability (Group 1), mild developmental delay (Group 2), socially at risk with behaviour problems (Group 3), and socially at risk with functional vision difficulties (Group 4). Black, non-Hispanic children are significantly more likely than their white counterparts to be in Group 3 (β = 1.52, P = 0.001) or group 4 (β = 1.83, P < 0.001). Compared with children with a mild developmental delay (Group 2), children in group 1 (β = -0.61, P < 0.001), group 3 (β = -0.47, P = 0.001) and group 4 (β = -0.38, P = 0.009) are significantly less likely to receive EI.
Racial and ethnic differences exist with regard to membership in developmental vulnerability subgroups. Observed inconsistencies in access to EI suggest the need for improved surveillance, referral and outreach.
有发育困难的婴幼儿是一个异质性群体，他们经常接受早期干预（EI）。显著的人群异质性存在，这使得未满足的需求和有效性研究变得复杂。然而，相对同质的、与临床政策相关的“亚组”的混合可能造成了明显的异质性。迄今为止，方法学上的挑战阻碍了识别这些潜在群体及其政策相关性。
从2005 - 2006年全国特殊医疗需求儿童调查中，我们抽取了一个样本（n = 965），这些婴幼儿的父母报告其有发育困难。我们使用潜在类别分析（LCA），根据使儿童符合早期干预条件的功能、社会和生物学特征，识别发育脆弱性的亚组。混合模型估计了每个亚组接受父母报告的早期干预的可能性，并控制了种族/民族、儿童年龄和居住州。
潜在类别分析识别出四个不同的发育脆弱性亚组：发育障碍（第1组）、轻度发育迟缓（第2组）、有行为问题的社会风险组（第3组）和有功能性视力困难的社会风险组（第4组）。黑人、非西班牙裔儿童比白人儿童更有可能属于第3组（β = 1.52，P = 0.001）或第4组（β = 1.83，P < 0.001）。与轻度发育迟缓儿童（第2组）相比，第1组（β = -0.61，P < 0.001）、第3组（β = -0.47，P = 0.001）和第4组（β = -0.38，P = 0.009）的儿童接受早期干预的可能性显著更低。
在发育脆弱性亚组的成员构成方面存在种族和民族差异。在获得早期干预方面观察到的不一致表明需要改进监测、转诊和外展服务。
