Monthly Archives: May 2012

Prevention of Disability in Children: The Role of the Environment

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Over the past fifty years, the number of reported childhood disabilities has steadily increased and the nature and consequences of disability have changed drastically. Prior to 1960, the poster child for childhood disabilities would have been a child with polio, wearing leg braces and using crutches for support. Today’s poster child could be a child with autism. Where the pre-60s child wore his disability for the world to see, in many cases today’s child experiences his disability internally. Over the past several decades, predominant childhood disabilities have shifted away from physical disorders toward mental health disorders. (Future of Children: Childhood Disabilities)

Much public attention and many resources are focused on medical research to identify risk factors and mitigate symptoms of disability for individual children. However, Stephen Rauch and Bruce Lanphear, in their chapter “Prevention of Disability in Children: Elevating the Role of the Environment,” argue for a broader focus on environmental influences that put entire populations at risk. “Identifying and eliminating or controlling environmental risk factors that incrementally increase the prevalence of disability is the key to preventing many disorders,” they write.

When seeking to prevent disability, there are three levels that need to be considered. Primary prevention seeks to keep disabilities from developing. Secondary prevention utilizes methods of screening and early detection to identify problems before they can do “too much damage.” Tertiary prevention focuses on restoring health and function to people who have already developed a disability. Tertiary and secondary prevention are the primary efforts of the clinical community. But in order to reduce the prevalence of disability in the population, primary prevention is essential.

The causes of many disabilities in childhood are complex and result from the interplay of environmental risk factors and genetic susceptibility. Purely genetic and purely environmental disabilities exist, but they are rare. Children are particularly vulnerable to environmental stressors; they pass through several delicate developmental stages and, pound for pound, they eat and breathe more environmental contaminants than adults. An exposure that is harmless in adults can have a dramatic effect when it occurs during fetal development or early childhood.

One example of an environmental risk for disabilities in children is lead in house paint. Lower IQ and ADHD in children have both been linked back to lead as has criminal behavior in adulthood. A cost-benefit analysis of requiring lead based paint to be removed concludes that every $1 spent to reduce lead hazards in housing would produce between seventeen and two hundred twenty one dollars in benefits by reducing screening and treatment for lead toxicity, ADHD treatment, and special education.

(Rauch and Lanphear Future of Children: Childhood Disabilities)

In a long awaited move, the CDC recently cut the threshold for lead poisoning. This new lower threshold “means public health agencies have a bigger job to screen children for lead and to prevent exposure in the first place,” said Lanphear in an interview with John Ryan of Seattle station KUOW “The new standard from the Centers for Disease Control and Prevention nearly doubles the number of children considered to have lead poisoning. Now, one out of 40 American kids has what’s deemed a dangerous level of lead in their blood, reported Northwest public radio.” (http://www.nwpr.org/post/cdc-cuts-lead-poisoning-threshold)

This change in lead level standards is just one example of how our regulations and knowledge about environmental risk factors changes over time. In the face of such changes, it makes sense to consider a preventive approach that shifts the entire population’s health curve in a positive direction. As Issue Editors Janet Currie and Robert Kahn summarize in the introduction to Children with Disabilities, “the heart of [Rauch/Lanphear’s] argument is that societal choices can shift the curve of child health outcomes to increase the probability that some children will be moved from a nondisabled to a disabled state. Exposure to chemicals in the environment, for example, may decrease the attentiveness of all children, but in a subset of more vulnerable children, the exposure may lead to symptoms and impairment that warrant an ADHD diagnosis. The implication is that society should pay attention to shifting the entire distribution of health outcomes in a positive direction and that doing so will reduce the toll of childhood disability. Such a public health focus on prevention is a useful comple­ment to the usual medical focus on improving technology or the quality of medical care for children who already have disabilities.”

For more information, read our Children with Disabilities volume: www.futureofchildren.org.

The Hidden Costs of the Prison Boom for the Mental Health of Women

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By Christopher Wildeman, Assistant Professor of Sociology at Yale University

This blog originally appeared on May 16, 2012 in Social Science Space. Chris received his Ph.D. in Sociology and Demography from Princeton University in 2008.

The consequences of the prison boom for poor, minority men are almost undeniable. According to recent estimates, about 25 percent of African-American men experience imprisonment by their mid-30s, with rates increasing to 60 percent to 70 percent for African-American men who did not complete high school. Lifetime risks for white men who dropped out of high school are also high–about 15 percent of them are imprisoned at some point–but not even in the same ballpark as the risks for comparable African-American men.

Much research on the costs of the prison boom focuses solely on men. In one regard, this makes good sense. These men are, after all, the ones who will be held in a local jail or a state or federal prison. Likewise, they are the ones whose labor market prospects will suffer, whose romantic relationships might fail, and whose children will inquire about them. Yet in another sense, focusing only on these men misses much of the picture, as their incarceration may also influence the well-being of the women attached to them, including their mental health. The financial well-being of their romantic partners and children suffers as well. Similarly, if men’s romantic relationships suffer or end altogether, then these women also experience the pain of breaking up or the struggle to keep their faltering relationships going. And if the time apart from children is difficult for men, imagine how difficult it is for their children–especially since many of these men might have been inconsistently involved in their children’s lives even before going away. All of these effects may add up to a partner’s incarceration having serious consequences for women’s mental health, as finances and family life strongly affect women’s well-being.

In a recent article (Christopher Wildeman, Jason Schnittker, and Kristin Turney. 2012. “Despair by Association? The Mental Health of Mothers with Children by Recently Incarcerated Fathers.” American Sociological Review 77:216-243), we considered how the incarceration of a father affects mother’s mental health utilizing data from the Fragile Families and Child Wellbeing Study–a data set that captures the experiences of about 5,000 fathers and mothers, living in American cities, who have children together.

The results were sobering. For these women, the incarceration of their children’s fathers made a bad situation worse. Already at elevated risk of poor mental health for many of the same reasons that the fathers of their children were at risk of incarceration, their mental health took an additional hit as a result of the fathers’ recent incarceration. And this hit was heavy. For the women in our study, having the father of her child incarcerated increased her risk of experiencing major depression by about 25 percent, an especially substantial increase considering how elevated these women’s risk of being depressed would have been even if the fathers of their children had not experienced incarceration. Effects on life dissatisfaction were comparable, suggesting that incarceration increases these women’s risks not just of experiencing a severe mental health condition such as major depression, but also of feeling less good about their lives even if they were not actually depressed.

So what explains this effect? According to our analysis, the very same forces that have received so much attention from those interested in the consequences of incarceration for men explained much of these damaging effects on women’s mental health. The incarceration of a father leads to greater financial instability among mothers, deterioration of their already-vulnerable romantic relationships, and increases in parenting difficulties. These effects, in turn, are associated with mental health. Interestingly, we find that changes in family life–the quality and structure of romantic relationships and the circumstances surrounding parenting their child–rather than the well-documented economic effects of incarceration explain much of this association, suggesting the loss of a father and partner hurts these women’s mental health more than the loss of a paycheck.

As we consider the various costs and benefits of incarceration, our calculator shouldn’t get turned off after we consider its crime-fighting benefits, budgetary costs, and implications for the lives of marginalized young men. Indeed, our results suggest that a potentially even greater cost of incarceration may be how it damages the women and children left in its wake. These hidden costs of the prison boom should be considered, as the mental health of the women and children who face such substantial obstacles already is important for our national wellbeing.

Dr. Christopher Wildeman

Dr. Jason Schnittker

Dr. Kristin Turney

For more research focused on fragile families, see the Future of Children’s Fragile Families volume.

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The Transition to Adulthood for Children with Disabilities

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Prior Future of Children research underlines the challenges faced by youth approaching adulthood, particularly among those from disadvantaged backgrounds with no postsecondary education on the horizon. Even thornier is the pathway to adulthood for youth from more vulnerable populations such as those challenged with a chronic illness, mental health issues, or physical disabilities. A recent study highlighted by CBS News indicates that one in three young adults with autism has completed no college or technical schooling and has no paid work experience seven years after graduating high school. This is urgent news considering that roughly half a million autistic children will be reaching adulthood in the next ten years.

Recognizing the importance of education for children with disabilities before and throughout the transition to adulthood, the United States has made many advances in special education over the past few decades. The special education system gives children with disabilities greater access to public education and provides an infrastructure for their schooling. Moreover, some services even extend through early adulthood, which is more than can be said for other vulnerable populations. The federal Individuals with Disabilities Education Act (IDEA) requires that secondary schools develop individualized transition plans including long-term education goals, vocational training, and general life skills.

Despite these advancements in special education, Laudan Aron and Pamela Loprest indicate in their chapter Disability and the Education System, that many problems remain, including the over- and under-identification of some subgroups of students, delays in providing service to students, as well as bureaucratic and financial barriers that often complicate effective service provision. In addition, some needed services may not be available when children have reached adulthood. A recent article in US News and World Report indicates that families of children with autism often describe leaving high school as “falling off a cliff” because of the lack of services for adults on the autism spectrum.

Providing these children with needed support before and after the transition to adulthood has substantial immediate and long-term economic costs and benefits. A recent article in CNN Health reports that out-of-pocket medical expenses are growing fastest among Americans 18 years old and younger. The Future of Children volume, Children with Disabilities indicates that these expenses are higher among families caring for a child with a special health care need. In their chapter, The Economic Costs of Childhood Disability, Mark Stabile and Sara Allin suggest that due to these high costs to children and families, the benefits of effective interventions to prevent and reduce childhood disability might well outweigh the societal costs of such programs.

On May 23, 2012, the Anderson Center for Autism hosted an event for more than 350 practitioners and parents, which featured research from the Future of Children’s Children with Disabilities volume, and discussed effective early interventions for children with disabilities. For more discussion on evidence-based policies and intervention programs for special needs children and those making the transition to adulthood, see the Future of Children volumes Children with Disabilities and Transition to Adulthood. Add your voice by commenting on the Future of Children blog.

Minority Birth Rate Surpasses Whites in US

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New 2011 census estimates show that for the first time, racial and ethnic minorities make up more than half of the children born in the U.S. For these newborns of America’s first “majority minority” generation, and for all Americans under 50, Hispanics are the second-largest population group after whites of European descent (Wall Street Journal).

These findings come amidst data from the Pew Hispanic Center, which show that net immigration from Mexico has stopped, or possibly reversed. “The current congressional and Supreme Court interest in reducing immigration – and the concerns especially about low-skilled and undocumented Hispanic immigration – represents issues that could well be behind us,” notes William H. Frey, a demographer at the Brookings Institution who analyzed the census data, in the Huffington Post.

In fact, census data reveal that immigration is not the main driving force behind America’s growing diversity. Data for 2010 show Hispanic women give birth to 2.4 babies on average compared to 1.8 babies for non-Hispanic whites, and minority women are younger on average, so more of them are of childbearing age (Wall Street Journal). In addition, as Princeton professor and director of the Mexican Migration Project Doug Massey notes in Reuters, “net zero migration doesn’t just mean undocumented migrants are staying in Mexico; it also means those already here aren’t going home…” The census has forecast that non-Hispanic whites will be outnumbered in the United States by 2042.

This demographic shift has implications for United States’ policy, particularly in the area of education.

A substantial percentage of minority children, especially those with Latin American origins, are falling behind in school. Evidence from the Future of Children’s volume on Immigrant Children shows that three policy reforms – increased attendance in quality preschool, improved instruction in English, and increased attendance in postsecondary education – would lift their wellbeing as adults and increase their economic and social contributions in American society.

“Today’s minority youth are coming of age in an aging society… which will depend increasingly on the productivity of younger workers,” write Immigrant Children issue editors Marta Tienda of Princeton and Ron Haskins of Brookings. “At a critical juncture in its history, the United States has an opportunity to invest in [minority] youth and enable them to contribute to national prosperity.”

For more information on the country’s changing demographics, immigrant children, and education reform, see the Future of Children volumes on Fragile Families, Immigrant Children, Transition to Adulthood, and America’s High Schools.

How Do We Define and Measure Disabilities in Children?

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On Tuesday, May 8th 2012, the Brookings Institution hosted an event featuring the Future of Children’s most recent volume, Children with Disabilities and its corresponding policy brief, “The SSI Program for Children: Time for Change?“

Issue Editor Janet Currie, the Henry Putnam Professor of Economics and Public Affairs and director of the Center for Health and Wellbeing at Princeton University, highlighted the major themes from the volume including the documented increase in disabilities; the recent shift in disabilities from physical to mental health disorders; the significant costs associated with disabilities for individuals and families; the fragmentation of services; and the possibilities for improving the wellbeing of children with disabilities with the medical home model, new technologies, and prevention efforts.

Researchers’ efforts to track trends in disability and understand the causes and implications of the recent increase in diagnoses have been seriously complicated by changes over time in how disability is defined, which criteria should be used for screening, which services should be made available, and to what extent particular conditions are actually considered disabling.

These fundamental challenges of definition and measurement over time became more important as the discussion continued to the Supplemental Security Income (SSI) cash assistance program for children with disabilities. Ron Haskins, Co-Director of the Center on Children and Families at the Brookings Institution, asked a panel including keynote speaker Kenneth Apfel of the University of Maryland and former commissioner of the Social Security Administration, who presented on the history of the program, if it was time to change SSI.

The panel, which also included Marty Ford, Chief Public Policy Officer for the Arc of the United States, Matt Weidinger, Majority Staff Director of the Committee on Ways and Means, U.S. House of Representatives, Jonathan Stein, General Counsel at Community Legal Services of Philadelphia, and Michael Wiseman of the Office of Retirement and Disability Policy, emphasized the need to create a new vision for SSI. They contend that SSI should maintain the income stability it provides for severely disabled children (and there was debate as to how this should be done). It should also look more carefully at reviewing SSI recipients over time to better understand their differing disability levels, and to support them, particularly as they transition to adulthood.

Eventually, the conversation turned to the inevitable: budget constraints. As Ron Haskins and Matt Weidinger noted, Congress is going to cut funding, possibly looking even to means-tested programs such as SSI.

Given that, what is realistic? “And, what are the outcomes that show that SSI is working?” Weidinger asked.

Janet Currie’s response brought the conversation back to one of the volume’s key findings: without a consistent definition of disability and data that tracks children over time, it is difficult to discuss research-based outcomes of SSI. This is not because the program does not work, but because the data simply does not exist. But the credibility of the program should not be discounted simply because of a lack of evidence.

In the meantime, as the volume notes, “researchers must pay attention to how disability is defined and develop workable definitions that can be implemented in national surveys and maintained over time. Only in this way can they learn whether the increasing numbers of children with disabilities represent an exploding epidemic or an emerging, more nuanced understanding of what it means to be disabled… policy makers should be mindful that whether or not the number of special needs children is growing, large numbers of children must live with a diagnosed disability and these children merit attention.”

To listen to the panel’s recommendations for improving the SSI program, click here.

To read the Children with Disabilities volume, click here.

Fragile Families Research at PAA 2012

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This week, demographers from around the world are gathering in San Francisco at the annual meeting of the Population Association of America (PAA), to discuss their research findings on issues related to migration, health, and population wellbeing. Princeton University’s Center for Research on Child Wellbeing is presenting three main initiatives at the conference: The Future of Children, The Fragile Families and Child Wellbeing Study, and the Princeton Global Network and Child Migration. The Future of Children published a volume on Fragile Families in fall 2010 and researchers continue to build on these findings using the Fragile Families Study data. One example of such work being presented at PAA is the investigation of the role of genes in explaining child behavior outcomes.

In the Future of Children volume on Fragile Families, Jane Waldfogel, Terry-Ann Craigie, and Jeanne Brooks-Gunn suggest that several factors play important roles in explaining why children in families with unmarried parents may have poorer outcomes than those of two married parents. These likely include parental resources, parent relationship quality, parenting quality, parental mental health, and father involvement. Another key element that should be considered is family instability, which refers to whether children grow up with the same parent(s) that were present at birth and tends to be higher among unmarried parents. It is assumed that children will have more positive behavioral outcomes when there are fewer disruptions or new partners entering and exiting the household, but researchers continue to investigate this hypothesis.

One element that has recently gained attention regarding its influence on family stability and child outcomes is genes. To examine the role of genes in child behavior and wellbeing, the Fragile Families and Child Wellbeing Study, an ongoing birth cohort study of about 5,000 children and their parents, the majority of whom are unmarried, collected DNA samples from the children and their mothers around the time of the child’s ninth birthday. These genetic data, which will made available through a contract process this fall, are being analyzed with respect to their role in the relationship between family stability and child behavioral outcomes. Early analyses find evidence that genes moderate the relationship between family instability and children’s prosocial behavior. As presented at the Population Association of America, authors Colter Mitchell, Sara McLanahan, Daniel Notterman, and Jeanne Brooks-Gunn find evidence that for some genotypes, larger increases in prosocial behavior occur among cases in which a non-resident biological father enters the household and larger decreases in prosocial behavior in cases in which the biological father exits the household.

As indicated in the Future of Children, there are several observable factors that likely explain why children with unmarried parents often fare worse than those of two-parent families, and the link between family instability and genes is only one component of this complex issue. Future research should provide further insight into the role of these and other elements. More literature on the impact of family structure and instability can be found in the Future of Children volumes on Fragile Families and Marriage and Child Wellbeing. Visit the Fragile Families and Child Wellbeing website or email ffdata@princeton.edu for information on the Study and updates on the new genetic data. Also, check out www.futureofchildren.org for more publications on child wellbeing.