O'Connor Meredith, O'Connor Elodie, Quach Jon, Vashishtha Rakhi, Goldfeld Sharon
Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2019 Mar;55(3):312-319. doi: 10.1111/jpc.14192. Epub 2018 Aug 30.
Some children's special health-care needs (SHCN) are formalised at the start of schooling (established SHCN), but a larger proportion start with difficulties that are milder or not yet diagnosed (emerging SHCN). This study explores whether: (i) the prevalence of teacher-identified SHCN (both overall and according to type of needs) and (ii) distribution across disadvantaged communities have changed over three successive population cohorts of Australian children.
We draw on repeated cross-sectional data from the Australian Early Development Census, a teacher-reported checklist completed on full populations of Australian school entrants in 2009, 2012 and 2015. It includes a measure of SHCN, as well as demographic information.
The proportion of children with emerging and established needs was mostly stable from 2009 to 2015 (emerging needs: 17.1-18.9%; established needs: 4.4-4.9%). Change over time was observed in the prevalence of some specific types of impairment. Speech impairment rose by 14.7% for children with emerging needs, and emotional problems rose by 13.7% for children with established needs. Children living in the most disadvantaged neighbourhoods had higher odds of SHCN in all years (e.g. emerging needs relative risk ratio 1.65 (99% confidence interval 1.55-1.75) in 2015; established needs relative risk ratio 1.88 (99% confidence interval 1.71-2.06) in 2015).
A large proportion of children starting school each year have SHCN. The types of SHCN that children present with increasingly reflect complex difficulties that require input from both the health and education sectors. Effective responses also need to consider the added impact of disadvantage.
一些儿童的特殊保健需求（SHCN）在入学伊始就被正式确认（已确诊的SHCN），但更大比例的儿童一开始存在的困难较轻或尚未被诊断出来（新出现的SHCN）。本研究探讨：（i）教师确认的SHCN的患病率（总体以及按需求类型），以及（ii）在连续三个澳大利亚儿童人口队列中，不同弱势社区的分布情况是否发生了变化。
我们利用澳大利亚早期发展普查的重复横断面数据，这是一份由教师填写的清单，针对2009年、2012年和2015年澳大利亚全体入学儿童完成。它包括SHCN的一项测量指标以及人口统计学信息。
从2009年到2015年，有新出现需求和已确诊需求的儿童比例大多保持稳定（新出现需求：17.1 - 18.9%；已确诊需求：4.4 - 4.9%）。某些特定类型损伤的患病率随时间有所变化。有新出现需求的儿童言语损伤患病率上升了14.7%，有已确诊需求的儿童情绪问题患病率上升了13.7%。在所有年份，生活在最弱势社区的儿童患SHCN的几率更高（例如，2015年有新出现需求的相对风险比为1.65（99%置信区间1.55 - 1.75）；2015年有已确诊需求的相对风险比为1.88（99%置信区间1.71 - 2.06））。
每年大量入学儿童存在SHCN。儿童出现的SHCN类型越来越多地反映出复杂的困难，这需要卫生和教育部门的共同投入。有效的应对措施还需要考虑弱势状况带来的额外影响。
