Are the rates of special health care needs changing?

Many children who start school have or are at risk of having a special health care need, which requires more medical, educational, or related services than their peers.

Schools need an accurate picture of whether the levels of these needs are changing over time in order to plan for future services and uncover any service gaps.

Research Summary

  • The rate of special health care needs has remained largely stable over time.
  • Roughly 17-18% of children have emerging needs and 4-5% have established needs.
  • Although the overall rate remains stable there has been an increase in language, behavioural, and emotional problems.
  • Children from disadvantaged neighbourhoods were at higher risk of having special health care needs.

What is the research about?

Some children’s special health care needs are well known at the start of school, but a larger proportion start with difficulties that are milder or are not yet diagnosed.

A group of researchers from the University of Melbourne explored whether the prevalence of teacher‐identified special health care needs and its distribution across communities has changed over three population cohorts of Australian children.

What did the researchers do?

By using the Australian Early Development Census (AEDC), researchers were able to look at the trends in special health care needs for 853,123 children over three years of data collection (2009, 2012, and 2015).

Whether a child had special health care needs was determined from AEDC teacher‐reported data. Children were categorized as having either established special health care needs or emerging special health care needs.

Established needs: If teachers responded ‘yes’ the child required ‘special assistance due to chronic medical, physical, or intellectually disabling conditions (e.g. autism, cerebral palsy, down syndrome)’, with instructions to base their answer on an established medical diagnosis.

Emerging needs: If teachers responded ‘yes’ to a broad list of impairments which impacted each student’s ability to do school work in a regular classroom OR if the child needed further assessment and/or was currently being assessed due to these difficulties.

What did the researchers find?

The proportion of children with emerging and established needs was mostly stable from 2009 to 2015. Children with emerging needs varied from 18.0% in 2009 to 17.1% in 2015. Children with established needs only varied from 4.4% in 2009 to 4.7% in 2015.

A larger change was observed for some specific types of impairment. For children with emerging needs, speech impairment (14.7%) and learning disability (5.3%) increased the largest. For established needs, emotional problems (13.7%) and behavioural problems (7.1%) increased the largest.

Disadvantage also played a role in the odds of a child having a special health care need. Children living in the most disadvantaged neighbourhoods had a 65% increased risk of having an emerging need in 2015 and an 88% increased risk of having an established need in 2015.

What does this research mean?

Overall, these findings suggest that a substantial number of children with special health care needs enter schools each year, even more so for schools in disadvantaged areas.

Better promotion of healthy childhood development before children start school is needed. The authors suggest this could be achieved through high‐quality early childhood education and care, sustained nurse home visiting, or in-home learning interventions. School funding structures also must account for the large number of children with emerging needs to provide early help and take advantage of the brain’s ability to adapt more easily when children are young.