Disability in Middle Childhood and Adolescence

Excerpt

Worldwide, people with disabilities have difficulty accessing education, health services, and employment. Disability is an economic development issue because it is linked to poverty: disability may increase the risk of poverty, and poverty may increase the risk of disability (Sen 2009). A growing body of evidence indicates that children with disabilities and their families are more likely than their peers to experience economic disadvantage, especially in low- and middle-income countries (LMICs).

Approximately 15 percent of the world’s adult population lives with some form of disability (WHO and World Bank 2011). Children ages 0–14 years account for slightly less than 6 percent of persons with disabilities globally, but the number of disabled children is grossly underestimated in LMICs (UNICEF 2008). The estimates for prevalence of disability among children fall in a wide range because the methods for identifying them in surveys have varied (Cappa, Petrowski, and Njelesani 2015). This variation results from the complexity of identifying childhood disability (Meltzer 2010, 2016). However, new international standards offer hope for good quality, internationally comparable data moving forward.

This chapter expands on a central theme of this volume: the need for a multisectoral approach to addressing the complex interactions between child and adolescent development and physical and mental health. In particular, we have focused on the relationship with education—the gateway to participating fully in society, securing a livelihood, and capitalizing on the opportunities that society offers. Children with disabilities are less likely to attend school; when they do attend school, they are less likely to stay in school and be promoted (Filmer 2005; Mizunoya, Mitra, and Yamasaki 2016; WHO and World Bank 2011). They account for a large proportion of children who do not complete a primary education, reducing their employment opportunities and productivity in adulthood (Burchardt 2005; Filmer 2008; Mete 2008).

The literature has focused on advocacy, reflecting the relative neglect of this important area. This focus is beginning to change, at least with regard to the availability of information, and efforts to provide more quantitatively rigorous information are increasing (see, for example, WHO and World Bank 2011). However, information for children and adolescents ages 5–19 years is notably lacking, especially from LMICs. In this age group, the focus has been on schoolchildren and the development consequences of excluding children from education. In the absence of a comprehensive economic analysis or review of disability and development in children and adolescents, this chapter makes extensive use of case studies, which document real-world efforts in LMICs to address disability in this age group in poor communities.

Through the use of these case studies, this chapter provides examples of how deprivations can become disability if children are excluded from school in LMICs. The case studies emphasize interventions to ensure that children with disabilities gain access to education, and they examine the design of supportive education systems and the use of school health programs to address the needs of children with impairments. Most assessments have focused on physical disability, especially mobility, and they provide this specific perspective on barriers to education. Little is known about these common forms of disability in LMICs; even less is known about the impact of sociobehavioral constraints, such as those associated with autism, which we know to be prevalent and important constraints in high-income countries (HICs). This chapter explores this issue in a case study of a rare program in a lower-middle-income country in Sub-Saharan Africa. Definitions of age groupings and age-specific terminology used in this volume can be found in chapter 1 (Bundy, de Silva, and others 2017).