State of the World's Children 2013 - Unicef

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of enumeration, such as censuses, general and targeted household surveys, and interviews with key informants, have been used to estimate disability prevalence. General data collection instruments are likely to underestimate the number of children with disabilities. 124 They typically employ a generic or filter question, such as whether anyone in the household ‘is disabled’, or use the same questions for all household members regardless of their age. Children in particular are likely to be overlooked in surveys that do not specifically ask about them. 125 Targeted household surveys that specifically address the issue of child disability or include measures specifically designed to evaluate disability in children have produced more accurate results than household surveys or censuses that ask about disability in general. 126 Such surveys tend to report higher prevalence rates because they usually include more numerous and detailed questions. Questionnaire design Even well-designed surveys can misreport disability if a single set of questions is applied to children across the age spectrum. The choice of questions must be tailored to a child’s age in order to reflect the developmental stages and evolving capacities of children. 127 Some domains, such as self-care (e.g., washing and dressing), will not be appropriate for very young children. Given the complexity of developmental processes that take place over the first two years of life, it can be difficult to distinguish disability from variations in normal development without specialized tools or assessment. 128 Questions designed to assess disability in the adult population are not always applicable to children, yet many survey instruments use a FOUR CASE STUDIES (Continued) uCambodia 3 questions asked: Does (name) have any disability? If yes, what type? What was the cause? 2 questions asked: Is there a person who usually lives in your household who has any type of physical impairment? 2 questions asked: Does (name) have any disability? What was the cause? One question asked: If the person is physically/mentally disabled, give appropriate code from the list 1: in seeing; 2: in speech; 3: in hearing; 4: in movement; 5: mental One question asked: Does (name) have any of the following: Difficulty seeing, difficulty hearing, difficulty speaking, difficulty moving, difficulties in feeling or sensing, psychological or behavioural difficulties, learning difficulties, fits, other (specify)? Impaired since birth or due to an accident? 2% 2% 4% 1% 5% Socio-Economic Survey 1999 Demographic and Health Survey 2000 Socio-Economic Survey 2003–2004 Census 2008 Socio-Economic Survey 2010 66 THE STATE OF THE WORLD’S CHILDREN 2013: Children with Disabilities
single set of questions for both groups. Examples of questions with limited relevance to children include those about falling down or memory loss, as well as questions about tasks children may be too young to accomplish independently. Questions that link disability with an elderly population are not only irrelevant to child assessment but may also introduce a bias in the respondent’s mind as to which should be considered disability and thus affect the nature and quality of the response. 129 In order to accurately assess disability in children, care must be taken to use questionnaires specifically designed for the purpose. Many data collection instruments, including household surveys and censuses, are based on parental responses only, with caregivers normally expected to assess and report the disability status of children under their care. While parents and other caregivers are often very well placed to identify difficulties that their children uTurkey 3 questions asked: Do you have a visible physical disability, mental disorder or psychological defect? What is its nature? What was the cause? 1% Census 1985 2 questions asked: Do you have any physical or mental disability? What kind? 2% Census 2000 12% Turkey Disability Survey 2002 5 questions asked, including: Do you have any disfigurement; restriction of movement; bone disease; muscular weakness; lack, shortness or excess of your hands, arms, feet, legs, fingers or backbone? Are you able to speak, do you have a speech impediment, do you speak with a stammer? may experience in performing specific tasks, their responses alone are not sufficient to diagnose disabilities or establish a prevalence of disability. Accurate assessment of disability in a child requires a thorough understanding of age-appropriate behaviours. Survey respondents may have limited knowledge of specific benchmarks used for evaluating children at each stage of development and may not be in a position to adequately detect manifestations of particular types of disability. Certain temporary conditions, such as an ear infection, may cause acute difficulties in performing certain tasks and be reported as a form of disability. At the same time, parents may overlook certain signs, or hesitate to report them, because of a lack of acceptance or stigma surrounding disability in their culture. The choice of terminology used in questionnaires can either reinforce or correct such statistically distorting and socially discriminatory phenomena. Purpose and consequences Efforts to measure child disability represent an opportunity to link assessment with intervention strategies. Often an assessment provides the first chance for a child with a disability to be identified and referred to or receive some form of immediate care. Unfortunately, capacity and resources for follow-up assessment and support for those children who screen positive for disability are often scarce. 130 Recognizing the critical role of early intervention, the possibility of linking screening and assessment with simple interventions should be explored, especially in low- and middle-income settings. Data that capture the type and severity of children’s disabilities as well as the barriers to the functioning and community participation of children with disabilities, when combined with relevant socio-economic indicators, help to inform decisions about how to allocate resources, eliminate barriers, design and provide services and meaningfully evaluate such interventions. For instance, data can be used to map whether income, gender or minority status affects access MEASURING CHILD DISABILITY 67
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THE STATE OF THE WORLD’S CHILDREN
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THE STATE OF THE WORLD’S CHILDREN
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FOREWORD Is there a child who does
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FOCUS Violence against children wit
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CHAPTER 1 INTRODUCTION Reports such
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Under the Convention on the Rights
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People with disabilities are becomi
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Education is the key to stopping th
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(continued from p. 3) the right to
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CHAPTER 2 FUNDAMENTALS OF INCLUSION
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hierarchy and traditional expectati
Page 23 and 24: to education and health-care servic
Page 25 and 26: An inclusive kindergarten in Nizhny
Page 27 and 28: Assistive technology products Categ
Page 29 and 30: We need to make media more accessib
Page 31 and 32: CHAPTER 3 A STRONG FOUNDATION Good
Page 33 and 34: Early childhood stunting, which is
Page 35 and 36: are particularly important. Develop
Page 37 and 38: the needs of all children. In an in
Page 39 and 40: Look at Hanif and you will see that
Page 41 and 42: terms for 20 schools at a time, wit
Page 43 and 44: epilepsy. The ketogenic diet is an
Page 45 and 46: Reading Braille at a school in Ugan
Page 47 and 48: Saja opened my eyes to my own abili
Page 49 and 50: CHAPTER 4 ESSENTIALS OF PROTECTION
Page 51 and 52: Independent States, institutionaliz
Page 53 and 54: Children with disabilities are at g
Page 55 and 56: It is much harder to protect childr
Page 57 and 58: CHAPTER 5 HUMANITARIAN RESPONSE Hum
Page 59 and 60: Explosive remnants of war (ERW) on
Page 61 and 62: esist, than children without disabi
Page 63 and 64: Since monitoring began in 1999, the
Page 65 and 66: FOCUS (continued) Child casualties
Page 67 and 68: Child casualties by type of explosi
Page 69 and 70: If people with disabilities can’t
Page 71 and 72: CHAPTER 6 MEASURING CHILD DISABILIT
Page 73: Mental Development Scale, 120 canno
Page 77 and 78: FOCUS Lessons learned Since 1995, U
Page 79 and 80: A strategy for intervention on beha
Page 81 and 82: Data can be hard to gather: Indigen
Page 83 and 84: CHAPTER 7 AN AGENDA FOR ACTION The
Page 85 and 86: discrimination is vital in reducing
Page 87 and 88: I would like to be confident that w
Page 89 and 90: Support families The CRC states tha
Page 91 and 92: Being visually challenged, I’ve h
Page 93 and 94: Six-year-old Nemanja (far left) sit
Page 95 and 96: We [in government] must understand
Page 97 and 98: 33 South African Disability Institu
Page 99 and 100: 106 Mental Disability Rights Intern
Page 101 and 102: Statistical Tables Economic and soc
Page 103 and 104: under-five mortality rate (per 1,00
Page 105 and 106: TABLE 10. THE RATE OF pROGRESS The
Page 107 and 108: under-five mortality rankings The f
Page 109 and 110: TABLE 1 BASIC INdICATORS Countries
Page 111 and 112: TABLE 1 BASIC INdICATORS Countries
Page 113 and 114: TABLE 2 NuTRITION Countries and are
Page 115 and 116: TABLE 2 NuTRITION Countries and are
Page 117 and 118: TABLE 3 HEALTH Countries Use of imp
Page 119 and 120: Countries Use of improved drinking
Page 121 and 122: TABLE 4 HIV/AIdS Prevention among y
Page 123 and 124: TABLE 4 HIV/AIdS Prevention among y
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TABLE 5 education Countries and are
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TABLE 5 EduCATION Countries and are
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TABLE 6 dEmOGRApHIC INdICATORS Coun
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TABLE 6 dEmOGRApHIC INdICATORS Coun
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TABLE 7 ECONOmIC INdICATORS Countri
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TABLE 7 ECONOmIC INdICATORS Countri
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TABLE 8 WOmEN Countries and areas L
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TABLE 8 WOmEN Countries and areas L
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TABLE 9 CHILd pROTECTION Countries
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TABLE 9 CHILd pROTECTION Countries
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TABLE 10 THE RATE OF pROGRESS Count
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TABLE 10 THE RATE OF pROGRESS Count
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TABLE 11 AdOLESCENTS Countries and
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TABLE 11 AdOLESCENTS Countries and
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TABLE 12 disparities by residence C
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TABLE 12 dISpARITIES By RESIdENCE C
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TABLE 13 dISpARITIES By HOuSEHOLd W
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TABLE 13 dISpARITIES By HOuSEHOLd W
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TABLE 14 EARLy CHILdHOOd dEVELOpmEN
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