Functional difficulty, special health care needs, and participation in school activities: Findings from the 2007 National Survey of Children's Health

Identifying children at risk of limitations in their ability to participate in school activities is important for monitoring the well-being of children and guiding interventions that promote academic and social development. Methods: This analysis assesses how well the summary measures of functional difficulty (FD) and special health care needs (SHCN) identify children at risk of limitations in school activities using data from a nationally representative sample of youth aged 6 to 17 years. Estimates are based on parental reports for 63,814 children from the 2007 National Survey of Children's Health. FD is defined as difficulties in the following domains of basic actions: sensory, motor, cognitive, or behavioral/emotional functioning. SHCN is defined using responses to standard screener questions which indicate a chronic condition that requires special health care. Results: Similar percentages of children were reported by parents to have FD (26%) and SHCN (23%). Among all children: 14% had both FD and SHCN; 12% only FD; 9% only SHCN; 65% neither FD nor SHCN. Use of special education varied widely by FD and SHCN: 48% of children with both FD and SHCN used special education services; 22% with only FD; 7% with only SHCN; 2% with neither FD nor SHCN. Among all students in special education, a higher percent had FD (84%) than SHCN (65%). Other school limitations (repeating a grade, school reports of problems) followed a similar pattern. Conclusion: FD and SHCN identify different groups of children. FD, compared to SHCN, is a stronger predictor of limitations in school activities.