Number 19 n November 4, 2009

Functional Difficulties Among School-Aged Children:
 

United States, 2001–2007
 by Patricia N. Pastor, Ph.D.; Cynthia A. Reuben, M.A.; and Mitchell Loeb, M.S.,

Office of Analysis and Epidemiology

Abstract

Objective—This report presents estimates of basic actions difficulty, which

includes difficulties related to sensory, motor, cognitive, and emotional or

behavioral functioning, in U.S. children aged 5–17 years based on questions from

the National Health Interview Survey (NHIS). Selected estimates are shown for

the educational and health care service use of children with and without basic

actions difficulty.

Methods—Estimates of basic actions difficulty were derived from the Family

Core and the Sample Child Core questionnaires of the 2001–2007 NHIS.

Estimates were generated and compared using SUDAAN, a statistical package

that adjusts for the complex sample design of NHIS.

Results—Approximately 18% of children aged 5–17 had basic actions

difficulty in one or more of the following domains of functioning: sensory,

movement, cognitive, or emotional or behavioral. The percentage of children

with difficulty in specific domains varied: 3% had sensory difficulty, 2%

movement difficulty, 9% cognitive difficulty, and 10% emotional or behavioral

difficulty. From 2001 through 2007, the percentage of children aged 5–17 with

basic actions difficulty remained stable at about 18%. Children with and without

basic actions difficulty differed greatly in their use of both educational and health

care services. One-third of children with basic actions difficulty used special

education services compared with 2% of children without basic actions difficulty.

A substantially higher percentage of children with basic actions difficulty used

health care services, including mental health care, other types of therapy, and

prescription medication, than children without basic actions difficulty.

Keywords: basic actions difficulty c service utilization c child disability

Introduction

Functional difficulties in children

have major consequences for children

and the communities in which they live.

For children, early identification of

functional difficulties and timely

initiation of relevant health care,

therapies, and educational services can

lessen the impact on development (1).

For communities, data on the number of

children with functional difficulties can

help to guide equitable provision of

effective health care and educational

services (2). National health surveys

have a major role in these efforts by

providing nationally representative and

timely data about the characteristics and

service use of children with functional

difficulties (3).

Since its inception, the National

Health Interview Survey (NHIS) has

included questions that assess the impact

of health conditions and impairments on

a child’s functioning (4). Over the years,

several summary measures of functional

difficulties based on NHIS questions

have been proposed (3,5). The variation

in estimates based on these measures

reflects, in part, differences in the

particular survey questions used to

measure functional difficulties in

children. The basic actions difficulty

measure presented in this report is a

broad summary measure of functional

difficulties that uses the conceptual

framework of the International

Classification of Functioning, Disability

and Health—Version for Children &

Youth (ICF-CY) (6). Development of

this measure has also been influenced

by the concept of basic actions difficulty

developed by Altman and Bernstein

for a recent chartbook on adult

disability (7).

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 19 n November 4, 2009

The objectives of this report

include: 1) Description of a basic

actions difficulty measure for children

aged 5–17 years and examination of the

specific questions from the 2001–2007

NHIS used to create this measure; 2)

estimates of the prevalence of specific

functional difficulties in school-aged

children aged 5–17; 3) estimates of the

prevalence of activities of daily living

(ADL) limitations for children with

basic actions difficulty; and 4) estimates

of the educational and health care

services use of school-aged children

with basic actions difficulty. Differences

in the prevalence of basic actions

difficulty among children and the use of

selected services by these children are

shown by the children’s demographic

and socioeconomic characteristics. Two

characteristics—poverty status and

health insurance coverage—are

highlighted because of their association

with basic actions difficulty and their

relationship to the use of educational

and health care services by children

with basic actions difficulty.

Methods

Data source

The information presented in this

report is based on questions from the

Family Core and Sample Child Core

components of the 2001–2007 NHIS

(http://www.cdc.gov/nchs/nhis/

nhis_questionnaires.htm). NHIS is a

household survey conducted by the

Centers for Disease Control and

Prevention’s National Center for Health

Statistics and is fielded continuously

throughout the year. The survey involves

interviews of a nationally representative

sample of the civilian

noninstitutionalized population of the

United States. Some health and

demographic information is collected for

all household members. Additional,

detailed health-related information is

collected for one randomly selected

child (‘‘sample child’’) in each family

that includes children aged 0–17 years.

Information about children is collected

from an adult, usually a parent, who is

knowledgeable about the child’s health.

This report includes information only

about children aged 5–17. Information

about children under age 5 is not

included because of the different criteria

used to determine functional difficulty

in those children compared with

children aged 5–17 (8). In this report,

the term ‘‘school-aged’’ is used to refer

to children aged 5–17.

Measurement of basic

actions difficulty

Basic actions difficulty in children

is defined as difficulty in any of the

following core areas or domains of

functioning:

+ Sensory (seeing and hearing)

+ Movement (lower body movement)

+ Cognitive

+ Emotional or behavioral

Table 1 shows the exact wording of

the questions for each domain and, for

each question, the response categories

that indicate functional difficulty (shown

in bold-italic type). The location of each

question in the NHIS questionnaire is

also shown in the table’s last column.

Most questions measuring basic actions

difficulty are from the Sample Child

Core questionnaire and were asked only

for sample children. However, two

questions measuring basic actions

difficulty are from the Family Core

Questionnaire. These questions were

asked of all persons in the sample

households, including sample children.

Most of the questions used to

identify basic actions difficulty are

questions about the child’s functioning.

However, in the domains of cognitive

and emotional or behavioral functioning,

questions concerning the diagnosed

conditions of mental retardation, Down

syndrome, autism, learning disability,

and attention deficit hyperactivity

disorder (ADHD) are also used to

identify basic actions difficulty. Ideally,

a measure of basic actions difficulty

would be based only on questions

assessing a child’s functional abilities.

However, in the domains of cognitive

and emotional or behavioral functioning,

NHIS included only a few questions

directly measuring a child’s functional

abilities, and data for only one of these

questions (on overall serious emotional

or behavioral difficulty) were available

for all of the survey years (2001 through

2007). As a result, answers to questions

concerning diagnosed conditions are

used as indicators of cognitive and

emotional or behavioral difficulty.

Unlike physical disorders that are

diagnosed on the basis of a physical

examination or the results of a

laboratory test, the cognitive and

emotional or behavioral conditions used

to measure basic actions difficulty are

often diagnosed on the basis of parental

reports of the child’s observed

symptomatology (9).

Parental reports of functional

difficulty or diagnosed conditions were

not verified by information from the

child’s health or school records. As a

consequence, the criteria used by

individual parents to determine specific

types of functional difficulty are

unknown and likely to vary.

Furthermore, the measure of basic

actions difficulty does not include any

information about the duration or

severity of a child’s difficulties.

Measurement of other

variables

Other variables used in the

description of basic actions difficulty

include a child’s demographic and

socioeconomic characteristics, ADL

limitations (personal care needs such as

eating, bathing, or dressing), and use of

educational and health care services.

Definitions of these variables are

included in ‘‘Technical Notes.’’

Statistical analysis

The annual number of interviews

completed for all sample children aged

0–17 in NHIS varied from 13,579 in

2001 to 9,417 in 2007. The final annual

sample-child response rate also varied,

from 77%–81%; see ‘‘Technical Notes’’

for a description of the procedures used

in calculating final annual sample-child

response rates (http://www.cdc.gov/nchs/

nhis/quest_data_related_1997_forward

.htm). This report is based on data from

57,610 interviews for sample
National Health Statistics Reports n Number 19 n November 4, 2009	 Page 3

children aged 5–17 from 2001 through

2007 who had complete information for

all of the variables used to identify basic

actions difficulty. Among 58,679 sample

children aged 5–17 in the 2001–2007

NHIS, 1,069 children (2%) were

missing data for basic actions difficulty.

Average annual estimates of the

number of children with basic actions

difficulty and difficulty in specific

domains were calculated using data for

the 2001–2007 time period. The

population estimate used to calculate the

number of children with basic actions

difficulty is the total, average annual

number of children aged 5–17 in the

population and includes children who

have missing data on basic actions

difficulty.

All estimates and associated

standard errors shown in this report

were generated using SUDAAN, a

software package designed to account

for the complex design of the NHIS

sample (10). All estimates for children

were calculated using the sample child

record weight and are representative of

the U.S. noninstitutionalized population

of children aged 5–17. Estimates in this

report that have a relative standard error

of more than 30% and less than or equal

to 50% are identified with an asterisk

(*), indicating that they are statistically

unstable due to small sample size. The

difference between two percentages is

described as small if the absolute

difference is less than 1 percentage

point. Percentages in this report are

based on combined data for 2001–2007

and are described as average annual

estimates for 2001–2007.

Comparisons of estimates are based

on two-tailed significance tests at the

0.05 level. No adjustments were made

for multiple comparisons. Terms such as

‘‘greater than’’ and ‘‘less than’’ indicate

a statistically significant difference.

Terms such as ‘‘similar’’ or ‘‘no

difference’’ indicate that the estimates

being compared were not significantly

different. Lack of comment regarding

the difference between two estimates

does not mean that the difference was

tested and determined not to be

significant. Because of the crosssectional nature of the data collected in

NHIS, an association between variables

does not indicate a causal connection.

More information concerning the data

source and statistical analysis can be

found in ‘‘Technical Notes.’’

Results

Basic actions difficulty

prevalence and trend

(Figure 1, Table 2)

+	 From 2001 through 2007, the

percentage of children aged 5–17

years with basic actions difficulty

0 

10 

20 

30 

Percent 

Survey year 

2001 2002 2003 2004 2005 2006 2007 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

Figure 1. Prevalence of any basic actions difficulty among children aged 5–17 years, by

year: United States, average annual estimates for 2001–2007

remained relatively stable at about

18%.

+	 Approximately 9.4 million children

aged 5–17 (18%) had basic actions

difficulty in one or more of the

following domains: sensory,

movement, cognitive, or emotional or

behavioral functioning.

Prevalence of basic actions

difficulty by domain

(Figure 2, Table 2)

+	 About 3% of children aged 5–17 (1.8

million) had a parental report of

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

10 9 

2 3 

18 

Domain of functioning 

Any Sensory Movement Cognitive Emotional or 

behavioral 

0 

10 

20 

30 

Percent 

Figure 2. Prevalence of basic actions difficulty among children aged 5–17 years, by

domain of functioning: United States, average annual estimates for 2001–2007
Both learning disability or difficulty 

remembering and conditions of mental 

retardation, autism, or Down syndrome 

86% 

11% 3% 

Only conditions of mental 

retardation, autism, or 

Down syndrome 

Only learning
 

disability or difficulty 

remembering 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

Only serious 

overall 

Both ADHD1

 and serious emotional 

24% 27% 

49%	 

overall emotional or or behavioral 

behavioral difficulties difficulties 

Only ADHD1 

1

Attention deficit hyperactivity disorder.
 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey.
 

Page 4	 National Health Statistics Reports n Number 19 n November 4, 2009

Both seeing and 

hearing difficulties Only hearing 1% 

difficulty

 11% 

Only seeing
 

difficulty

 88%
 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

Figure 3. Percentage of children aged 5–17 years with specific difficulties among children

with any sensory difficulty: United States, average annual estimates for 2001–2007

Figure 4. Percentage of children aged 5–17 years with specific difficulties among children

with any cognitive difficulty: United States, average annual estimates for 2001–2007

Figure 5. Percentage of children aged 5–17 years with specific difficulties among children

with any emotional or behavioral difficulty: United States, average annual estimates for

2001–2007

sensory difficulty and 2% (1.1

million) had movement difficulty.

+	 Compared with sensory or movement

difficulty, cognitive and emotional or

behavioral difficulty were reported for

many more children. About 9% of

children aged 5–17 (4.7 million) had

a report of cognitive difficulty, and

10% (5.5 million) had a report of

emotional or behavioral difficulty.

Measurement of basic

actions difficulty by domain

(Figures 3–5)

+	 Among children with sensory

difficulty, most children were

reported to have difficulty only in

seeing (88%). About 11% of children

with sensory difficulty had difficulty

only in hearing. Few children with

sensory difficulty (1%) had difficulty

involving both seeing and hearing.

+	 Among children with movement

difficulty, nearly all (99%) were

identified by answers to the question

about whether a child had an

impairment or health problem that

limited their ability to walk, run, or

play.

+ Most children with cognitive

difficulty (86%) were reported to

have only a learning disability or

difficulty remembering. Relatively

few children (3%) were identified

solely by a parental report of a

diagnosis of mental retardation, Down

syndrome, or autism. About 11% of

the children with cognitive difficulty

had both a) a learning disability or

difficulty remembering, and b) a

diagnosis of mental retardation, Down

syndrome, or autism.

+ Nearly one-half of children with

emotional or behavioral difficulty

(49%) were reported to have a

diagnosis of ADHD only. About

one-quarter lacked a diagnosis of

ADHD (24%), but were reported to

have serious difficulty with their

emotions, concentration, behavior, or

being able to get along with other

people. Slightly more than onequarter of children with emotional or

behavioral difficulty (27%) had both

a diagnosis of ADHD and serious

difficulty with their emotions,

concentration, behavior,
Difficulty in three 

or more domains 

Difficulty in
 

two domains
 

Difficulty in 

one domain 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

5% 

67% 

28% 

Percent

50 

40 

30
 

23
 

19 20 18 16 

10 

0 

All children Poor Near poor Not poor 

Poverty status 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

National Health Statistics Reports n Number 19 n November 4, 2009	 Page 5

Figure 6. Prevalence of basic actions difficulty among children aged 5–17 years, by

number of domains of difficulty: United States, average annual estimates for 2001–2007

or being able to get along with other

people.

Basic actions difficulty by

number of domains

(Figure 6)

+ Most children with basic actions

difficulty had difficulty in one

domain of functioning (66%).

Approximately 28% had difficulty in

two domains, and less than 6% had

difficulty in three or more domains.

Basic actions difficulty and

children’s characteristics

(Table 3)

+	 Children aged 12–17 (21%) were

more likely to have basic actions

difficulty than children aged 5–11

(15%).

+	 Males (22%) were more likely to

have basic actions difficulty than

females (14%).

+	 Both non-Hispanic white and

non-Hispanic black children (19%)

Figure 7. Prevalence of any basic actions difficulty among children aged 5–17 years, by

poverty status: United States, average annual estimates for 2001–2007

were more likely to have basic
 

actions difficulty than Hispanic
 

children (14%).
 

+	 Children in mother-only families

(24%) were more likely to have

difficulty than children in two-parent

families (15%).

+	 Poor children (23%) were more likely

to have basic actions difficulty than

children who were not poor (16%)

(Figure 7).

+	 Children with public health insurance

coverage (25%) were more likely to

have difficulty than either children

with private health insurance

coverage (16%) or uninsured children

(16%).

Sensory difficulty and

children’s characteristics

(Table 4)

+	 Poor children (5%) were more likely

to have sensory difficulty than

children who were not poor (3%).

+	 Children with public insurance

coverage (4%) and uninsured children

(4%) were more likely to have

sensory difficulty than children with

private insurance coverage (3%).

+	 Children in mother-only families

(4%) were more likely to have

sensory difficulty than children in

two-parent families (3%).

+	 The differences in the prevalence of

sensory difficulty by a child’s age,

sex, and race or ethnicity were either

small (a difference of less than

1 percentage point) or not statistically

significant.

Movement difficulty and

children’s characteristics

(Table 4)

+	 Poor children (3%) were more likely

to have movement difficulty than

children who were not poor (2%).

+	 Children with public insurance

coverage (3%) were more likely to

have movement difficulty than

children with private health insurance

coverage (2%) and uninsured children

(2%).

+	 Children in mother-only families

(3%) were more likely to have
Page 6	 National Health Statistics Reports n Number 19 n November 4, 2009

sensory difficulty than children in

two-parent families (2%).

+ Differences in the prevalence of

movement difficulty by a child’s age,

sex, and race or ethnicity were either

small (a difference of less than

1 percentage point) or not statistically

significant.

Cognitive difficulty and

children’s characteristics

(Table 4)

+ Poor children (12%) were more likely

to have cognitive difficulty than

children who were not poor (8%).

+ Children with public insurance

coverage (14%) were more likely to

have cognitive difficulty than children

with private health insurance

coverage (7%) and uninsured children

(7%).

+ Differences in the prevalence of

cognitive difficulty by a child’s age,

sex, race or ethnicity, and family

structure were similar to the

differences observed for any basic

actions difficulty.

Emotional or behavioral

difficulty and children’s

characteristics (Table 4)

+ Poor children (13%) were more likely

to have emotional or behavioral

difficulty than children who were not

poor (9%).

+ Children with public insurance

coverage (15%) were more likely to

have emotional or behavioral

difficulty than children with private

health insurance coverage (9%) and

uninsured children (8%).

+ Differences in the prevalence of

emotional or behavioral difficulty by

a child’s age, sex, race or ethnicity,

and family structure were similar to

the differences observed for any basic

actions difficulty.

Difficulty in more than one

domain and children’s

characteristics (Table 5)

+ Poor children (8%) were more likely

to have difficulty in more than one

domain than children who were not

poor (5%).

+	 Children with public insurance

coverage (9%) were more likely to

have difficulty in more than one

domain than children with private

health insurance coverage (5%) and

uninsured children (4%).

+	 Differences in the prevalence of

difficulty in more than one domain by

a child’s age, sex, race or ethnicity,

and family structure were similar to

the differences observed for any basic

actions difficulty.

Limitations in activities of

daily living (Table 6)

+	 The prevalence of ADL limitations

among all children aged 5–17 was

less than 1%. Among children with

basic actions difficulty, the prevalence

was higher at 3%. Nearly all of the

children with ADL limitations were

also reported to have basic actions

difficulty.

+	 Among children with basic actions

difficulty:

n ADL limitations were not

associated with poverty status.

n Children with public health

insurance coverage (4%) more

often had ADL limitations than

children with private health

insurance coverage (2%).

n	 Differences in ADL limitations by

a child’s age, sex, race or

ethnicity, and family structure

were either small (a difference of

less than 1 percentage point) or not

statistically significant.

pecial education use

Table 7, Figure 8)

	 Children with basic actions difficulty

were more likely to use special

education services (33%) than

children without basic actions

difficulty (2%).

+ Among children with basic actions

difficulty:

n	 Males (35%) were more likely to

use special education services than

females (30%).

n	 Children in mother-only families

(37%) were more likely to use

special education services than

children in two-parent families

(32%).

n	 Poor children (38%) were more

likely to use special education

services than children who were

not poor (31%).

n	 Children with public health

insurance coverage (41%) were

much more likely to use special

education services than children

with private health insurance

S

(

+

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

Poverty status 

0 

10 

20

Percent30 

40 

50 

All children Poor Near poor Not poor 

31 

35 

38 

33 

2 2 2 2

Basic actions difficulty No basic actions difficulty 

Figure 8. Use of special education services among children aged 5–17 years with and

without basic actions difficulty, by poverty status: United States, average annual

estimates for 2001–2007
50 Basic actions difficulty No basic actions difficulty 

40

Percent30 

22 

27 

24 

13 11 11 

8 

4 

10 

0 

All children Private Public Uninsured 

Health insurance coverage 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey.
 

20 

50 Basic actions difficulty No basic actions difficulty 

40 

30

Percent

19 20 17 17

9 10 

4 4 3 

0 

All children Private Public Uninsured 

Health insurance coverage 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

2 

National Health Statistics Reports n Number 19 n November 4, 2009	 Page 7

coverage (30%) and uninsured

children (26%).

n Differences in the use of special

education services by a child’s age
 

and race or ethnicity were not
 

statistically significant.

+ A separate analysis of children

without basic actions difficulty who

used special education services found

that about one-half of these children

(52%) used these services because of

speech problems.

Contact with a medical

specialist (Table 8)

+ Children with basic actions difficulty

were more likely to have had contact

with a medical specialist during the

past 12 months (24%) than children

without basic actions difficulty (11%).

+ Among children with basic actions

difficulty:

n	 Non-Hispanic white children

(27%) were more likely to have

had contact with a medical

specialist than non-Hispanic black

children (16%) and Hispanic

children (20%).
 

n Children who were not poor (27%)
 

were more likely to have had

contact with a medical specialist

than near-poor children (21%) or

poor children (20%).

n	 Children with private health

insurance coverage (27%) and

children with public health

insurance coverage (22%) were

more likely to have had contact

with a medical specialist than

uninsured children (11%)

(Figure 9).

n	 Children in mother-only families

(26%) were more likely to have

had contact with a medical

specialist than children in twoparent families (22%).

n	 Differences in contact with a

medical specialist by a child’s age

and sex were not statistically

significant.

Figure 9. Contact with a medical specialist for children aged 5–17 years with and without

basic actions difficulty, by health insurance coverage: United States, average annual

estimates for 2001–2007

Figure 10. Contact with a therapist for children aged 5–17 years with and without basic

actions difficulty, by health insurance coverage: United States, average annual estimates

for 2001–2007

Contact with a therapist

(Table 8)

+ Children with basic actions difficulty

(17%) were more likely to have had

contact with a therapist (physical,

speech, respiratory, or occupational

therapist or audiologist) during the

past 12 months than children without

basic actions difficulty (4%).

+ Among children with basic actions

difficulty:	 

n	 Children aged 5–11 (22%) were

more likely to have had contact

with a therapist than children aged

12–17 (12%).

n There was no difference in the

percentage of children having had

contact with a therapist by a

child’s poverty status.

n Children with health insurance

coverage, private (17%) or public

(19%), were more likely to have

had contact with a therapist than

uninsured children (9%)

(Figure 10).
 

n Differences in contact with a
 

therapist by a child’s sex, race or
Page 8	 National Health Statistics Reports n Number 19 n November 4, 2009

ethnicity, and family structure

were not statistically significant.

Contact with a mental health

professional (Table 8)

+ Children with basic actions difficulty

(27%) were more likely to have had

contact with a mental health

professional during the past 12

months than children without basic

actions difficulty (3%).

+ Among children with basic actions

difficulty:

n Males (28%) were more likely to

have had contact with a mental

health professional than females

(25%).

n Non-Hispanic white children

(29%) were more likely to have

had contact with a mental health

professional than non-Hispanic

black children (24%) or Hispanic

children (22%).

n Children in mother-only families

(31%) were more likely to have

had contact with a mental health

professional than children in

two-parent families (24%).

n There was no difference in the

percentage of children having

contact with a mental health

professional by a child’s poverty

status.

n Children with health insurance

coverage, private (26%) or public

(31%), were more likely to have

had contact with a mental health

professional than uninsured

children (18%) (Figure 11).

n	 Differences in contact with a

mental health professional by a

child’s age were not statistically

significant.

Prescription medication use

(Table 9)

+ Children with basic actions difficulty

were more likely to have used

prescription medication on a regular

basis during the past 3 months (39%)

than children without basic actions

difficulty (10%).

+ Among children with basic actions

difficulty:

0 

10 

20 

30 

40 

50 

All children Private Public 

Health insurance coverage 

Uninsured 

Basic actions difficulty No basic actions difficulty 

Percent 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

2 

31 

26 

18 

3 3

27 

3 

Figure 11. Contact with a mental health professional for children aged 5–17 years with

and without basic actions difficulty, by health insurance coverage: United States, average

annual estimates for 2001–2007

n	 Males (42%) were more likely to

have used medication than females

(35%).

n	 Non-Hispanic white children

(44%) were more likely to have

used medication than non-Hispanic

black children (33%) and Hispanic

children (28%).

n	 Children who were not poor (41%)

were more likely to have used

medication than poor children

(36%).

n	 Children with health insurance

coverage, private (41%) and public

(42%), were more likely to have

used medication than uninsured

children (22%) (Figure 12).

n	 Differences in medication use

by a child’s age and family

structure were not statistically

significant.

Frequent health care visits

(Table 9)

+	 Children with basic actions difficulty

were more likely to have had 10 or

more health care visits during the

past 12 months (15%) than children

without basic actions difficulty (4%).

0 

10 

20 

30 

40 

50 

All children Private Public 

Health insurance coverage 

Uninsured 

Basic actions difficulty No basic actions difficulty 

Percent 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

22 

42 41 39 

4 

10 10 10

Figure 12. Medication use among children aged 5–17 years with and without basic actions

difficulty, by health insurance coverage: United States, average annual esimates for

2001–2007
Percent 

50 No basic actions difficulty
 

40
 

30
 

20
 

Basic actions difficulty 

17 15 15
 

10
 8 

4 4 4 

1 

0 

All children Private Public Uninsured 

Health insurance coverage 

NOTE: Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. 

DATA SOURCE: CDC/NCHS, National Health Interview Survey. 

National Health Statistics Reports n Number 19 n November 4, 2009	 Page 9

Figure 13. Frequent health care visits among children aged 5–17 years with and without

basic actions difficulty, by health insurance coverage: United States, average annual

estimates for 2001–2007

+ Among children with basic actions

difficulty:

n Non-Hispanic white children

(17%) were more likely to have

had frequent health visits than

non-Hispanic black children (10%)

and Hispanic children (12%).

n	 There was no difference in the

percentage of children with

frequent health care visits by a

child’s poverty status.

n	 Children with health insurance

coverage, private (15%) and public

(17%), were more likely to have

had frequent health care visits than

uninsured children (8%)

(Figure 13).

n	 Differences in frequent health care

visits by a child’s age, sex, and

family structure were not

statistically significant.

Discussion

NHIS results indicate that a sizeable

group of U.S. children aged 5–17 years

have functional difficulties that place

them at greater risk of experiencing

restrictions in performing specific tasks

and participating in social activities (11).

From 2001 through 2007, approximately

18% of children aged 5–17 had basic

actions difficulty, that is, difficulties in

one or more of the following domains:

sensory, movement, cognitive, or

emotional or behavioral functioning.

Most children with any basic actions

difficulty had difficulties with either

cognitive or emotional or behavioral

functioning. In contrast, a small fraction

of children with basic actions difficulty

were reported to have sensory or

movement difficulties. Although

two-thirds of children with basic actions

difficulty had functional problems in

only one domain, more than one-quarter

had difficulties involving two domains

of functioning, and a small fraction had

difficulties in three or more domains.

Past national estimates of the

prevalence of disability among U.S.

school-aged children have varied widely,

with most estimates from 5%–20%

(3,12,13). The reported differences in

prevalence estimates are not surprising

given the disparate purposes of different

child disability measures. Recent

estimates of child disability based on

program participation vary greatly

depending upon the programs’ eligibility

criteria. For example, special education

programs mandated by the Individuals

with Disabilities Education Act (IDEA)

provide services to all children who

have specified impairments and who

need educational or related services due

to their impairment. This broad-based

program served approximately 6 million

children aged 6–17 in 2007 (14). In

contrast, the Supplemental Security

Income (SSI) program, which provides

income support to persons with

disability, serves a smaller number of

children—approximately 1 million

children under 18 years in 2006 (15).

Recent survey estimates also have

varied widely depending upon the

questions used to identify children with

impairments and functional difficulties.

The 2005 Survey of Income and

Program Participation (SIPP)—using

questions about functional difficulties

related to seeing, hearing, speaking,

movement, ADL, learning, or emotional

or mental conditions—estimated the

prevalence of disability among children

aged 6–14 to be 13% (12). In contrast,

the 2007 American Community Survey

(ACS), using four questions to identify

sensory, physical, mental, or self-care

disabilities, estimated the prevalence of

any disability in children aged 5–15 to

be 6% (13). Very likely both the number

and specific wording of questions

contributed to the difference in these

estimates. A previous analysis has

suggested that differences in question

content and wording may have

accounted for the differences observed

in estimates of child disability produced

by sets of questions from the disability

supplement of the 1994–1995 NHIS,

1997–2000 NHIS, and 1996 SIPP (3).

The higher prevalence of basic

actions difficulty compared with the

prevalence of child disability estimated

by other measures reflects differences in

the purpose of the measures and the

particular questions used to create the

measures. The measure of basic actions

difficulty was designed to identify a

group of children at greater risk of

experiencing participation restrictions.

Some children with basic actions

difficulty may not experience such

restrictions because they have

difficulties that are mild and

unrestrictive, or they have assistive

devices or supportive environments

which allow them to engage fully in

their activities. Another factor which

may contribute to the relatively high

prevalence of basic actions difficulty is

the inclusion of several questions on

cognitive and emotional or behavioral

difficulties. The questions in other

measures, such as the ACS measure of
Page 10 National Health Statistics Reports n Number 19 n November 4, 2009

child disability, cover a more restricted

set of functional difficulties and do not

include questions related to the

emotional and behavioral problems of

children.

The current results indicate that the

likelihood of having functional

difficulties is significantly, and, in many

instances, substantially greater for

particular subgroups of children. These

findings parallel many of the findings

about the chronic health conditions,

impairments, and special health care

needs reported for particular subgroups

of children (16–19). Older children

(aged 12–17) were more likely to have

reports of basic actions difficulty than

younger children (aged 5–11), possibly

reflecting the emotional or behavioral

difficulties of adolescence as well as the

longer exposure of adolescents to the

possibility of evaluation and diagnosis.

Boys were more likely to have reports

of basic actions difficulty than girls,

while Hispanic children were less likely

to have reports of basic actions

difficulty than non-Hispanic children. A

higher prevalence of basic actions

difficulty was observed for children in

mother-only families than for children in

two-parent families.

Poor and near-poor children were

more likely to have basic actions

difficulty than children in more affluent

families. Finally, the prevalence of basic

actions difficulty among children with

different types of health insurance

coverage shows that both access to

health care services and specifically

public insurance coverage are associated

with parental reports of functional

difficulties. The higher percentage of

children with basic actions difficulty

among children with public health

insurance, compared with children

covered by private health insurance and

uninsured children, may reflect the fact

that some functional difficulties make a

child eligible for public insurance

coverage (19).

A comparison of the current

findings about the demographic

characteristics of children with and

without basic actions difficulty shows

that the characteristics of children with

basic actions difficulty are similar to the

characteristics reported in other surveys

for children with disability. For

example, Wells and Hogan (3) described

a similar pattern in the demographic

characteristics of children who were

identified as having an activity

limitation in the 1994–1995 NHIS

disability supplement, 1997–2000 NHIS,

and 1996 SIPP. The percentage of

children with an activity limitation was

higher among boys compared with girls,

non-Hispanic children compared with

Hispanic children, and children in

low-income families compared with

children in more affluent families.

Additionally, Fujiura and Kamaki (20),

using data from the 1996 NHIS,

reported a higher prevalence of

disability among poor children and

children living in single-parent families.

Using data from the 2002 wave of the

National Survey of America’s Families,

Parish et al. (21) updated the earlier

findings of Fujiura and Kamaki,

showing that a strong association

persists between child disability and

poverty. They also documented in more

detail the material hardships experienced

by children with disabilities.

Not unexpectedly, children with and

without basic actions difficulty differ

greatly in their use of educational

services. NHIS data show that 33% of

children with basic actions difficulty use

special education services compared

with 2% of children without basic

actions difficulty. Because special

education programs are mandated to

serve the needs of children with

disabilities, the large difference in the

use of these services was expected.

What is probably of greater interest is

the substantial fraction of children with

basic actions difficulty who did not

receive these services. Some of these

children may receive school

accommodations available from other

programs or use health care or other

services that support their participation

in school activities. Others may not

experience limitations in their ability to

participate in academic and other school

activities. Finally, some children with

basic actions difficulty may have unmet

needs for school-related services.

Among children with basic actions

difficulty, the use of special education

services is significantly, although in

most cases modestly, associated with a

child’s demographic and socioeconomic

characteristics. Male children, poor

children, and children with public health

insurance were more likely to use

special education services. These

differences may indicate the greater

severity of difficulties of these groups of

children. The greater use of these

services by poor children with basic

actions difficulty suggests that low

family income was not a barrier to the

use of these services.

Children with and without basic

actions difficulty differed greatly in their

use of health care services. Compared

with children without difficulties, a

larger percentage of children with basic

actions difficulty were reported to have

contact with a medical specialist,

therapist, or mental health professional.

A larger percentage of children with

basic actions difficulty were also

reported to regularly use prescription

medication and to have visited a health

care provider 10 or more times during

the past 12 months. Among children

with basic actions difficulty, each of

these measures of health care use was

significantly and strongly associated

with a child’s health insurance coverage.

Children with either public or private

health insurance coverage were more

likely to report use of these services

than children with no health insurance

coverage.

Several other studies of children

with disabilities have reported greater

use of educational and health care

services by children with disability

compared with children without

disability. Newacheck, et al. (22), using

data from the 1999–2000 Medical

Expenditure Panel Survey, demonstrated

that children who have limitations in

school activities or who receive special

education services used more health care

services than children who do not have

limitations or receive special education

services. Similarly, Boulet, et al. (23),

using data from the 1997–2005 NHIS,

showed that children with

developmental disabilities were more

likely to use a variety of health care

services, including prescription

medication, special equipment, frequent

health care visits, and recent visits to

medical specialists, mental health
National Health Statistics Reports n Number 19 n November 4, 2009	 Page 11

professionals, or therapists. A review of

the findings in past reports on the

positive association between child

disability and health care use suggests

that this relationship is quite robust and

is not greatly affected by the way child

disability is measured.

Strengths and limitations

The large, nationally representative

sample of children used to generate the

estimates of basic actions difficulty is a

major strength of this report. Combining

data from 7 years of NHIS makes it

possible to estimate not only the

prevalence of any basic actions

difficulty, but also the prevalence of

difficulties in particular domains of

functioning. However, a number of

important limitations stem from using

the existing NHIS questions for children

to construct a measure of basic actions

difficulty. Ideally, the questions used for

a measure of basic actions difficulty

would measure functional difficulties in

a wide range of domains. Because the

NHIS questions for children were not

specifically designed to measure basic

actions difficulty, only a few questions

about functioning are available. In the

domain of cognitive functioning, it was

necessary to use parental reports of

diagnosed conditions such as mental

retardation and learning disability as

proxy measures for functional

difficulties. An examination of NHIS

data also suggests that the current

operational definition of basic actions

difficulty in children has gaps. Because

NHIS does not include any questions

about the communication difficulties of

children, this domain of difficulties is

not captured in the current measure. The

importance of speech problems as the

major reason for receiving special

education services among children who

do not have any basic actions difficulty

is further evidence suggesting that a

question about communication

difficulties would improve the

measurement of basic actions difficulty

in children.

Other limitations of the current

report include the use of data reported

only by parents. Parents play an

important role in children’s lives, but

they may be unaware of some of the

functional difficulties that their children

experience. A parent’s assessment of a

child’s mental disorders may not provide

a complete report of the child’s

emotional or behavior difficulties (24).

Having reports from both children and

adults would most likely improve the

measurement of basic actions difficulty.

Additionally, having questions specially

tailored for children of different ages

would improve the accuracy of survey

reports about the functional difficulties

of school-aged children as they

transition through childhood into young

adulthood. Finally, the cross-sectional

nature of the data collected in NHIS

precludes determining causal links

between functional difficulties and a

number of risk factors. Because data are

not collected about changes in the

functional difficulties of individual

children over time, tracing the

development or resolution of functional

difficulties as children age is not

possible.

Conclusion

The basic actions difficulty measure

presented in this report identifies a brief

set of questions that describes the

current state of functional difficulties in

U.S. school-aged children. By showing

that functional difficulties are a problem

for a sizeable number of children, and

that important disparities exist in the

basic actions difficulty of children with

different demographic and

socioeconomic characteristics, this report

provides a broad context for examining

the current policies and programs

available for children with disabilities.

The findings of this report also suggest

a number of topics which could be

explored in future research: development

of questions about the functional

difficulties of children of different ages;

inclusion of additional domains, such as

communication; development of a

measure that gauges how functional

difficulties affect children’s ability to

perform complex activities and a range

of social roles; and development of a

measure that describes the extent to

which physical and social environments

either restrict or support the activities of

children with functional difficulties.

References

1.	 Anderson LM, Shinn C, Fullilove

MT, Scrimshaw SC, Fielding JE,

Norman J, et al. The effectiveness of

early childhood development

programs: A systematic review. Am J

Prev Med 24(3S):32–46. 2003.

2.	 Aron LY, Loprest PJ. Meeting the

needs of children with disabilities.

Washington, DC: Urban Institute

Press. 2007.

3.	 Wells T, Hogan D. Developing

concise measures of childhood

activity limitations. Matern Child

Health J 7(2):115–26. 2003.

4.	 National Center for Health Statistics.

National Health Interview Survey:

Questionnaires, datasets, and related

documentation. Available from:

http://www.cdc.gov/nchs/nhis/

nhis_questionnaires.htm. Accessed

June 16, 2009.

5.	 Federal Interagency Forum on Child

and Family Statistics. America’s

children: Key national indicators of

well-being, 2009. Washington, DC:

U.S. Government Printing Office.
 

2009.
 

6.	 World Health Organization.

International Classification of

Functioning, Disability and

Health—Children & Youth Version.

Geneva: World Health Organization.

2007. Available from: http://

apps.who.int/classifications/

icfbrowser. Accessed May 22, 2009.

7.	 Altman B, Bernstein A. Disability

and Health in the United States,

2001–2005. Hyattsville, MD:

National Center for Health Statistics.

2008. Available from: http://

www.cdc.gov/nchs/data/misc/

disability2001-2005.pdf. Accessed

May 22, 2009.

8.	 National Research Council. Early

childhood assessment: Why, what,

and how. Committee on

Developmental Outcomes and

Assessments for Young Children,

Snow CE, Van Hemel SB, Editors.

Board on Children, Youth, and

Families, Board on Testing and

Assessment, Division of Behavioral

and Social Sciences and Education.

Washington, DC: The National

Academies Press. 2008.

9.	 American Psychiatric Association.

Diagnostic and statistical manual of
Page 12 National Health Statistics Reports n Number 19 n November 4, 2009

mental disorders, fourth edition, text

revision. Washington, DC. 2000.

10. Research Triangle Institute.

SUDAAN 10.0 software for the

statistical analyses of correlated data.

Research Triangle Park, NC. 2008.

11. Van Naarden Braun K, YearginAllsopp M, Lollar D. Activity

limitations among young adults with

developmental disabilities: A

population-based follow-up study.

Res Dev Disabil 30:179–91. 2009.

12. Brault M. Americans with

Disabilities: 2005. Current Population

Reports, P70–117. Washington, DC:

U.S. Census Bureau. 2008. Available

from: http://www.census.gov/prod/

2008pubs/p70-117.pdf. Accessed

May 22, 2009.

13. Erickson W, Lee C. 2007 Disability

Status Report: United States. Ithaca,

NY: Cornell University

Rehabilitation Research and Training

Center on Disability Demographics

and Statistics. 2008.

14. U.S. Department of Education, Data

Accountability Center. Individuals

with Disability Act (IDEA) Data.

Table B2A. Available from: https://

www.ideadata.org/PartBTrendData

Files.asp. Accessed July 15, 2009.

15. Social Security Administration.

Children Receiving SSI, 2006

(released July 2007). Available from:

http://www.socialsecurity.gov/policy/

docs/statcomps/ssi_children/2006/.

Accessed June 16, 2009.

16. Van Dyck PC, Kogan MD,

McPherson MG, Weissman GR,

Newacheck PW. Prevalence and

characteristics of children with

special health care needs. Arch

Pediatr Adolesc Med 158:884–90.

2004.

17. Newacheck PW, Halfon N.

Prevalence and impact of disabling

chronic conditions in childhood. Am

J Public Health 88:610–7. 1998.

18. Hogan DP, Rogers ML, Msall ME.

Functional limitations and key

indicators of well-being in children

with disability. Arch Pediatr Adolesc

Med 154:1042–8. 2000.

19. Davidoff AJ. Insurance for children

with special health care needs:

Patterns of coverage and burden on

families to provide adequate

insurance. Pediatrics 114:394–403.

2004.

20. Fujiura GT, Yamaki K. Trends in

demography of childhood poverty

and disability. Exceptional Children

66:187–99. 2000.

21. Parish SL, Rose RA, Andrews ME,

Grinstein-Weiss M, Richman EL.

Material hardship among U.S.

families raising children with

disabilities. Exceptional Children

75(1):71–92. 2008.

22. Newacheck PW, Inkelas M, Kim SE.

Health services use and health care

expenditures for children with

disabilities. Pediatrics 114:79–85.

2004.

23. Boulet SL, Boyle CA, Schieve LA.

Health care use and health and

functional impact of developmental

disabilities among U.S. children,

1997–2005. Arch Pediatr Adolesc

Med 163(1):19–26. 2009.

24. Jensen PS, Rubio-Stipec M, Canino

G, Bird HR, Dulcan MK, SchwabStone ME, Lahey BB. Parent and

child contributions to diagnosis of

mental disorder: Are both informants

always necessary? J Am Acad Child

Adolesc Psychiatry 38(12):1569–79.

1999.

25. Schenker N, Raghunathan TE, Chiu

P, Makuc DM, Zhang G, Cohen AJ.

Multiple imputation of family income

and personal earnings in the National

Health Interview Survey: Methods

and examples. Available from:

http://www.cdc.gov/nchs/data/nhis/

tecdoc.pdf. August 28, 2008.
National Health Statistics Reports n Number 19 n November 4, 2009 Page 13

Table 1. Questions

2001–2007

measuring functional difficulties of children, by selected domain of functioning: National Health Interview Survey,

Domain and topic Question

Response

categories Questionnaire

Sensory
 

Hearing ...................

Seeing . . . . . . . . . . . . . . . . . . . .

Movement
 

Walking ...................

Walking, running, playing ........

Cognitive

Remembering ...............

Mental retardation,

Down syndrome, autism .........

Learning disability .............

Emotional or behavioral

Overall difficulties (definite, severe) . .

ADHD ....................


 


 


 


 


 


 

Which statement best describes {sample

child name}’s hearing without a hearing aid:

Does {sample child name} have any trouble

seeing even when wearing glasses or contact

lenses?

Because of a health problem, does {anyone

in the family} have difficulty walking without

using any special equipment?

Does {sample child name} have an

impairment or health problem that limits

{his/her} ability to (crawl), walk, run, or play?

Is {anyone in the family} limited in any way

because of difficulty remembering or because

{you/they} experience periods of confusion?

Has a doctor or health professional ever told

you that {sample child name} had:

. . . Mental retardation?

Looking at this list, has a doctor or other

health professional ever told you that {sample

child name} had any of these conditions?

. . . Down syndrome?

. . . Autism?

Has a representative from a school or a

health professional ever told you that {sample

child name} had a learning disability?

Overall, do you think that {sample child

name} has difficulties in any of the following

areas:

Emotions, concentration, behavior, or being

able to get along with other people?

Has a doctor or health professional ever told

you that {sample child name} had:

. . . Attention deficit hyperactivity disorder

(ADHD) or attention deficit disorder (ADD)?

Good, a little trouble, a lot of

trouble, or deaf?

Yes, no

Yes, no

Yes, no

Yes, no

Yes, no

Yes, no

Yes, no

Yes, no

No; yes, minor; yes, definite;

yes, severe

Yes, no

Sample Child

Sample Child

Family Core

Sample Child

Family Core

Sample Child

Sample Child

Sample Child

Sample Child

Sample Child

Core

Core

Core

Core

Core

Core

Core

Core

NOTES: Response categories that indicate functional difficulty are shown in

a sample of the civilian noninstitutionalized population.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2001–2007.

bold-italic type. Estimates are based on household interviews of
Page 14 National Health Statistics Reports n Number 19 n November 4, 2009

Table 2. Selected population and prevalence estimates of basic actions difficulty among

children aged 5–17 years, by selected functional domains and their components:

United States, average annual estimates for 2001–2007

Population Percent

estimate (standard

(millions) error)

Any basic actions difficulty ........................... 9.4 17.7 (0.2) 
 

Functional domains and components

Sensory ...................................... 1.8 3.3 (0.1)

Seeing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 2.9 (0.1) 
 

Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 0.4 (0.0) 
 

Movement ..................................... 1.1 2.1 (0.1) 
 

Walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... 0.3 (0.0) 
 

Walking, running, playing .......................... ... 2.1 (0.1) 
 

Cognitive ..................................... 4.7 8.8 (0.2) 
 

Remembering ................................. ... 0.4 (0.0) 
 

Mental retardation, Down syndrome, autism............... . . . 1.3 (0.1) 
 

Learning disability............................... ... 8.4 (0.2) 
 

Emotional or behavioral ............................ 5.5 10.3 (0.2) 
 

Serious overall emotional or behavioral difficulty ............ . . . 5.2 (0.1) 
 

ADHD1

. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . ... 7.8 (0.1) 
 

. . . Not applicable.
 1

Attention deficit hyperactivity disorder.
 

NOTES: The population estimate used to calculate the number of children with basic actions difficulty and difficulty in specific
 

domains is the total, average annual number of children aged 5–17 in the population during 2001–2007 and includes children
 

who have missing data on basic actions difficulty. Estimates are based on household interviews of a sample of the civilian
 

noninstitutionalized population.
 

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2001–2007.
 
National Health Statistics Reports n Number 19 n November 4, 2009 Page 15

Table 3. Prevalence estimates of basic actions difficulty among children aged 5–17 years,

by selected characteristics: United States, average annual estimates for 2001–2007

Percent

Characteristic (standard error) P value1

Total ............................... 17.7 (0.2) . . .

Age (years) .......................... . . . <0.01

5–11 ............................. 15.2 (0.3) . . .

12–17 ............................ 20.5 (0.3) . . .

Sex ............................... . . . <0.01

Male ............................. 21.6 (0.3) . . .

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.7 (0.3) . . .

Race and Hispanic origin2 ................. . . . <0.01

White only, not Hispanic ................. 18.9 (0.3) . . .

Black only, not Hispanic ................. 19.0 (0.5) . . .

Hispanic ........................... 14.2 (0.4) . . .

Family structure3 ....................... . . . <0.01

Mother only ......................... 23.5 (0.5) . . .

Two parent ......................... 15.4 (0.2) . . .

Poverty status4 ........................ . . . <0.01

Poor ............................. 22.5 (0.5) . . .

Near poor .......................... 19.4 (0.5) . . .

Not poor ........................... 15.7 (0.2) . . .

Heath insurance5 ....................... . . . <0.01

Private ........................... 15.6 (0.2) . . .

Public. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24.6 (0.5) . . .

Uninsured .......................... 16.0 (0.6) . . .

. . . Not applicable.
 1

Calculated for a Wald log-linear chi-square test.
 2

Children of Hispanic origin may be of any race. Data are not shown for non-Hispanic children of other races due to small
 

sample size. Non-Hispanic children of other races are included in ‘‘total’’ and the categories for other characteristics. Chi-square
 

test is based on the categories shown.
 3

Mother and father refer to biological, adoptive, step-, and foster parents. Data are not shown for children in other types of
 

families due to small sample size. Children living in other types of families are included in ‘‘total’’ and the categories for other
 

characteristics. Chi-square test is based on the categories shown.
 4

Based on income and family size using the U.S. Census Bureau’s poverty thresholds. ‘‘Poor’’ persons have incomes below the
 

poverty threshold. ‘‘Near poor’’ persons have incomes 100% to less than 200% of the poverty threshold. ‘‘Not poor’’ persons
 

have incomes 200% of the poverty threshold or greater.
 5

Classification of health insurance coverage is based on a hierarchy of mutually exclusive categories. Persons with more than
 

one type of health insurance were assigned to the first appropriate category in the hierarchy.
 

NOTES: The denominators for statistics shown exclude children with unknown information for basic actions difficulty. Percentage
 

for ‘‘total’’ includes children who have unknown values for any of the selected characteristics. Estimates are based on household
 

interviews of a sample of the civilian noninstitutionalized population.
 

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2001–2007.
 
Page 16 National Health Statistics Reports n Number 19 n November 4, 2009

Table 4. Prevalence estimates of basic actions difficulty in selected functional domains among children aged 5–17 years, by selected

characteristics: United States, average annual estimates for 2001–2007

Sensory Movement Cognitive Emotional or behavioral

Percent Percent Percent Percent

Characteristic (standard error) P value1 (standard error) P value1 (standard error) P value1 (standard error) P value1

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 (0.1) ... 2.1 (0.1) ... 8.8 (0.2) ... 10.3 (0.2) ... 
 

Age (years) .......................... ... <0.01 . . . <0.01 . . . <0.01 . . . <0.01
 

5–11 ............................. 2.8 (0.1) ... 1.7 (0.1) ... 7.4 (0.2) ... 8.5 (0.2) ... 
 

12–17 ............................ 3.7 (0.2) ... 2.6 (0.1) ... 10.3 (0.2) ... 12.2 (0.3) ... 
 

Sex ............................... ... 0.07 ... 0.97 ... <0.01 . . . <0.01
 

Male ............................. 3.4 (0.1) ... 2.1 (0.1) ... 11.0 (0.2) ... 13.6 (0.2) ... 
 

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1 (0.1) ... 2.1 (0.1) ... 6.4 (0.2) ... 6.7 (0.2) ... 
 

Race and Hispanic origin2 ................. ... 0.06 ... 0.03 ... <0.01 . . . <0.01
 

White only, not Hispanic ................. 3.1 (0.1) ... 2.2 (0.1) ... 9.3 (0.2) ... 11.4 (0.2) ... 
 

Black only, not Hispanic ................. 3.8 (0.3) ... 2.3 (0.2) ... 9.7 (0.4) ... 11.0 (0.4) ... 
 

Hispanic ........................... 3.4 (0.2) ... 1.8 (0.1) ... 7.3 (0.3) ... 6.7 (0.3) ... 
 

Family structure3 ....................... ... <0.01 . . . <0.01 . . . <0.01 . . . <0.01
 

Mother only . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 (0.2) ... 2.9 (0.2) ... 11.9 (0.4) ... 14.3 (0.4) ... 
 

Two parent ......................... 2.9 (0.1) ... 1.9 (0.1) ... 7.6 (0.2) ... 8.5 (0.2) ... 
 

Poverty status4 ........................ ... <0.01 . . . <0.01 . . . <0.01 . . . <0.01
 

Poor ............................. 4.7 (0.3) ... 3.3 (0.2) ... 12.2 (0.4) ... 12.7 (0.5) ... 
 

Near poor .......................... 3.9 (0.2) ... 2.5 (0.2) ... 9.4 (0.4) ... 11.1 (0.4) ... 
 

Not poor ........................... 2.6 (0.1) ... 1.7 (0.1) ... 7.6 (0.2) ... 9.3 (0.2) ... 
 

Heath insurance5 ....................... ... <0.01 . . . <0.01 . . . <0.01 . . . <0.01
 

Private ........................... 2.8 (0.1) ... 1.8 (0.1) ... 7.4 (0.2) ... 9.0 (0.2) ... 
 

Public. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3 (0.2) ... 3.4 (0.2) ... 13.5 (0.4) ... 14.9 (0.4) ... 
 

Uninsured .......................... 4.0 (0.3) ... 1.6 (0.2) ... 7.1 (0.4) ... 8.3 (0.4) ... 
 

. . . Not applicable.
 1

Calculated for a Wald log-linear chi-square test.
 2

Children of Hispanic origin may be of any race. Data are not shown for non-Hispanic children of other races due to small sample size. Non-Hispanic children of other races are included in ‘‘total’’
 

and the categories for other characteristics. Chi-square test is based on the categories shown.
 3

Mother and father refer to biological, adoptive, step-, and foster parents. Data are not shown for children in other types of families due to small sample size. Children living in other types of
 

families are included in ‘‘total’’ and the categories for other characteristics. Chi-square test is based on the categories shown.
 4

Based on income and family size using the U.S. Census Bureau’s poverty thresholds. ‘‘Poor’’ persons have incomes below the poverty threshold. ‘‘Near poor’’ persons have incomes 100% to less
 

than 200% of the poverty threshold. ‘‘Not poor’’ persons have incomes 200% of the poverty threshold or greater.
 5

Classification of health insurance coverage is based on a hierarchy of mutually exclusive categories. Persons with more than one type of health insurance were assigned to the first appropriate
 

category in the hierarchy.
 

NOTES: The denominators for statistics shown exclude children with unknown information for basic actions difficulty. Percentage for ‘‘total’’ includes children who have unknown values for any of
 

the selected characteristics. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
 

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2001–2007.
 
National Health Statistics Reports n Number 19 n November 4, 2009 Page 17

Table 5. Prevalence estimates of basic actions difficulty in one domain and more than one domain among children aged 5–17 years, by

selected characteristics: United States, average annual estimates for 2001–2007

One domain More than one domain

Percent Percent

Characteristic (standard error) P value1 (standard error) P value1

Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.9 (0.2) . . . 5.8 (0.1) . . .

Age (years) ............................... . . . <0.01 . . . <0.01

5–11 .................................. 10.7 (0.2) . . . 4.5 (0.2) . . .

12–17 ................................. 13.3 (0.3) . . . 7.2 (0.2) . . .

Sex .................................... . . . <0.01 . . . <0.01

Male .................................. 14.1 (0.3) . . . 7.5 (0.2) . . .

Female ................................ 9.6 (0.2) . . . 4.0 (0.2) . . .

Race and Hispanic origin2 ...................... . . . <0.01 . . . <0.01

White only, not Hispanic ...................... 12.6 (0.2) . . . 6.3 (0.2) . . .

Black only, not Hispanic ...................... 12.4 (0.5) . . . 6.6 (0.3) . . .

Hispanic ................................ 10.2 (0.3) . . . 4.1 (0.2) . . .

Family structure3 ............................ . . . <0.01 . . . <0.01

Mother only .............................. 15.1 (0.4) . . . 8.4 (0.3) . . .

Two parent .............................. 10.7 (0.2) . . . 4.7 (0.1) . . .

Poverty status4 ............................. . . . <0.01 . . . <0.01

Poor .................................. 14.2 (0.4) . . . 8.4 (0.4) . . .

Near poor ............................... 13.1 (0.4) . . . 6.2 (0.3) . . .

Not poor................................ 10.9 (0.2) . . . 4.9 (0.1) . . .

Heath insurance5............................ . . . <0.01 . . . <0.01

Private ................................ 10.9 (0.2) . . . 4.7 (0.1) . . .

Public ................................. 15.2 (0.4) . . . 9.4 (0.3) . . .

Uninsured ............................... 11.5 (0.5) . . . 4.4 (0.3) . . .

. . . Not applicable.
 1

Calculated for a Wald log-linear chi-square test.
 2

Children of Hispanic origin may be of any race. Data are not shown for non-Hispanic children of other races due to small sample size. Non-Hispanic children of other races are included in ‘‘total’’
 

and the categories for other characteristics. Chi-square test is based on the categories shown.
 3

Mother and father refer to biological, adoptive, step-, and foster parents. Data are not shown for children in other types of families due to small sample size. Children living in other types of
 

families are included in ‘‘total’’ and the categories for other characteristics. Chi-square test is based on the categories shown.
 4

Based on income and family size using the U.S. Census Bureau’s poverty thresholds. ‘‘Poor’’ persons have incomes below the poverty threshold. ‘‘Near poor’’ persons have incomes 100% to less
 

than 200% of the poverty threshold. ‘‘Not poor’’ persons have incomes 200% of the poverty threshold or greater.
 5

Classification of health insurance coverage is based on a hierarchy of mutually exclusive categories. Persons with more than one type of health insurance were assigned to the first appropriate
 

category in the hierarchy.
 

NOTES: The denominators for statistics shown exclude children with unknown information for basic actions difficulty. Percentage for ‘‘total’’ includes children who have unknown values for any of
 

the selected characteristics. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
 

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2001–2007.
 
Page 18 National Health Statistics Reports n Number 19 n November 4, 2009

Table 6. Limitation in activities of daily living among U.S. children aged 5–17 years with

basic actions difficulty, by selected characteristics: United States, average annual

estimates for 2001–2007

Percent

Characteristic (standard error) p value1

Total ............................... 2.9 (0.2) . . .

Age (years) .......................... . . . <0.01

5–11 ............................. 3.8 (0.4) . . .

12–17 ............................ 2.1 (0.2) . . .

Sex ............................... . . . 0.73

Male ............................. 2.8 (0.3) . . .

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.0 (0.3) . . .

Race and Hispanic origin2 ................. . . . 0.04

White only, not Hispanic ................. 2.6 (0.3) . . .

Black only, not Hispanic ................. 2.4 (0.5) . . .

Hispanic ........................... 3.9 (0.5) . . .

Family structure3 ....................... . . . 0.55

Mother only ......................... 2.7 (0.3) . . .

Two parent ......................... 3.0 (0.3) . . .

Poverty status4 ........................ . . . 0.39

Poor ............................. 3.0 (0.5) . . .

Near poor .......................... 3.4 (0.5) . . .

Not poor ........................... 2.6 (0.3) . . .

Heath insurance5 ....................... . . . <0.01

Private ........................... 2.3 (0.2) . . .

Public. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 (0.5) . . .

Uninsured .......................... *1.3 (0.6) . . .

. . . Not applicable.

* Estimates have a relative standard error greater than 30% and do not meet standards of reliability or precision.
 1

Calculated for a Wald log-linear chi-square test.
 2

Children of Hispanic origin may be of any race. Data are not shown for non-Hispanic children of other races due to small
 

sample size. Non-Hispanic children of other races are included in ‘‘total’’ and the categories for other characteristics. Chi-square
 

test is based on the categories shown.
 3

Mother and father refer to biological, adoptive, step-, and foster parents. Data are not shown for children in other types of
 

families due to small sample size. Children living in other types of families are included in ‘‘total’’ and the categories for other
 

characteristics. Chi-square test is based on the categories shown.
 4

Based on income and family size using the U.S. Census Bureau’s poverty thresholds. ‘‘Poor’’ persons have incomes below the
 

poverty threshold. ‘‘Near poor’’ persons have incomes 100% to less than 200% of the poverty threshold. ‘‘Not poor’’ persons
 

have incomes 200% of the poverty threshold or greater.
 5

Classification of health insurance coverage is based on a hierarchy of mutually exclusive categories. Persons with more than
 

one type of health insurance were assigned to the first appropriate category in the hierarchy.
 

NOTES: The denominators for statistics shown exclude children with unknown information for basic actions difficulty. Percentage

for ‘‘total’’ includes children who have unknown values for any of the selected characteristics. Estimates are based on household

interviews of a sample of the civilian noninstitutionalized population.

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2001–2007.
National Health Statistics Reports n Number 19 n November 4, 2009 Page 19

Table 7. Current use of special education services among children aged 5–17 years with and without basic actions difficulty, by selected

characteristics: United States, average annual estimates for 2001–2007

Basic actions difficulty No basic actions difficulty

Characteristic

Percent

(standard error) p value1

Percent

(standard error) p value1

Total ................................. 33.4 (0.6) . . . 1.9 (0.1) . . .

Age (years) .............................

5–11 ................................

12–17 ...............................

. . .

34.6 (0.9)

32.4 (0.8)

0.06

. . .

. . .

. . .

2.4 (0.1)

1.2 (0.1)

<0.01

. . .

. . .

Sex ..................................

Male ...............................

Female ..............................

. . .

35.4 (0.7)

30.1 (0.9)

<0.01

. . .

. . .

. . .

2.4 (0.1)

1.3 (0.1)

<0.01

. . .

. . .

Race and Hispanic origin2 ....................

White only, not Hispanic....................

Black only, not Hispanic ....................

Hispanic .............................

. . .

33.1 (0.8)

36.4 (1.5)

32.5 (1.3)

0.08

. . .

. . .

. . .

. . .

2.1 (0.1)

1.5 (0.2)

1.4 (0.1)

<0.01

. . .

. . .

. . .

Family structure3 .........................

Mother only ...........................

Two parent ............................

. . .

36.9 (1.1)

31.8 (0.7)

<0.01

. . .

. . .

. . .

1.8 (0.2)

1.9 (0.1)

0.96

. . .

. . .

Poverty status4

...........................

Poor ...............................

Near poor ............................

Not poor .............................

. . .

38.0 (1.3)

34.8 (1.3)

30.9 (0.7)

<0.01

. . .

. . .

. . .

. . .

1.9 (0.2)

2.3 (0.2)

1.7 (0.1)

0.04

. . .

. . .

. . .

Heath insurance5 .........................

Private ..............................

Public ...............................

Uninsured ............................

. . .

30.4 (0.7)

41.0 (1.1)

26.4 (1.7)

<0.01

. . .

. . .

. . .

. . .

1.8 (0.1)

2.2 (0.2)

1.9 (0.3)

0.11

. . .

. . .

. . .

. . . Not applicable.
 1

Calculated for a Wald log-linear chi-square test.
 2

Children of Hispanic origin may be of any race. Data are not shown for non-Hispanic children of other races due to small sample size. Non-Hispanic children of other races are included in ‘‘total’’
 

and the categories for other characteristics. Chi-square test is based on the categories shown.
 3

Mother and father refer to biological, adoptive, step-, and foster parents. Data are not shown for children in other types of families due to small sample size. Children living in other types of
 

families are included in ‘‘total’’ and the categories for other characteristics. Chi-square test is based on the categories shown.
 4

Based on income and family size using the U.S. Census Bureau’s poverty thresholds. ‘‘Poor’’ persons have incomes below the poverty threshold. ‘‘Near poor’’ persons have incomes 100% to less
 

than 200% of the poverty threshold. ‘‘Not poor’’ persons have incomes 200% of the poverty threshold or greater.
 5

Classification of health insurance coverage is based on a hierarchy of mutually exclusive categories. Persons with more than one type of health insurance were assigned to the first appropriate
 

category in the hierarchy.
 

NOTES: The denominators for statistics shown exclude children with unknown information for basic actions difficulty. Percentage for ‘‘total’’ includes children who have unknown values for any of
 

the selected characteristics. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
 

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2001–2007.
 
Page 20 National Health Statistics Reports

n Number 19n November 4, 2009

dren aged 5–17 years with and without basic action difficulty, by selected characteristics: United States, average annual estimates for 2001–

Medical specialist1 Therapist1 Mental health professional1

Basic actions difficulty No basic actions difficulty Basic actions difficulty No basic actions difficulty Basic actions difficulty No basic actions difficulty

Percent Percent Percent Percent Percent Percent

standard error) p value2 (standard error) p value2 (standard error) p value2 (standard error) p value2 (standard error) p value2 (standard error) p value2

24.1 (0.5) . . . 11.0 (0.2) . . . 16.5 (0.5) . . . 3.6 (0.1) . . . 26.8 (0.6) . . . 3.2 (0.1) . . . 
 

... 0.82 . . . <0.01 . . . <0.01 . . . <0.01 . . . 0.84 . . . <0.01
 

23.9 (0.8) . . . 9.8 (0.2) . . . 22.2 (0.8) . . . 3.9 (0.2) . . . 26.9 (0.8) . . . 2.7 (0.1) . . . 
 24.2 (0.8) . . . 12.6 (0.3) . . . 11.7 (0.5) . . . 3.2 (0.1) . . . 26.7 (0.8) . . . 3.7 (0.2) . . . 
 

. . . 0.65 . . . 0.10 . . . 0.08 . . . <0.01 . . . <0.01 . . . <0.01
 

23.9 (0.6) . . . 11.3 (0.3) . . . 17.1 (0.6) . . . 4.2 (0.2) . . . 27.9 (0.7) . . . 2.9 (0.1) . . . 
 24.4 (0.9) . . . 10.7 (0.3) . . . 15.4 (0.8) . . . 3.0 (0.1) . . . 24.9 (0.9) . . . 3.4 (0.1) . . . 
 

... <0.01 . . . <0.01 . . . 0.12 . . . <0.01 . . . <0.01 . . . <0.01
 

26.9 (0.7) . . . 13.6 (0.3) . . . 17.0 (0.6) . . . 4.4 (0.2) . . . 28.5 (0.7) . . . 3.8 (0.1) . . . 
 

16.4 (1.2) . . . 7.1 (0.4) . . . 15.2 (1.1) . . . 2.5 (0.2) . . . 23.5 (1.3) . . . 2.1 (0.2) . . . 
 19.6 (1.1) . . . 6.7 (0.3) . . . 14.9 (1.0) . . . 2.3 (0.2) . . . 21.9 (1.2) . . . 2.0 (0.2) . . . 
 

... <0.01 . . . <0.01 . . . 0.63 . . . 0.04 . . . <0.01 . . . <0.01
 

21.8 (0.9) . . . 9.2 (0.3) . . . 16.6 (0.8) . . . 3.2 (0.2) . . . 30.9 (1.1) . . . 5.1 (0.3) . . . 
 

25.9 (0.7) . . . 11.8 (0.2) . . . 17.1 (0.6) . . . 3.7 (0.1) . . . 23.9 (0.7) . . . 2.4 (0.1) . . . 
 

... <0.01 . . . <0.01 . . . 0.74 . . . <0.01 . . . 0.92 . . . <0.01
 

20.1 (1.2) . . . 7.1 (0.4) . . . 17.2 (1.1) . . . 2.6 (0.2) . . . 26.9 (1.3) . . . 2.6 (0.2) . . . 
 

21.3 (1.1) . . . 7.9 (0.4) . . . 16.1 (1.1) . . . 3.1 (0.2) . . . 26.3 (1.2) . . . 2.9 (0.2) . . . 
 

26.9 (0.7) . . . 13.1 (0.3) . . . 16.4 (0.6) . . . 4.0 (0.1) . . . 26.9 (0.7) . . . 3.4 (0.1) . . . 
 

... <0.01 . . . <0.01 . . . <0.01 . . . <0.01 . . . <0.01 . . . <0.01
 

27.0 (0.7) . . . 13.0 (0.2) . . . 16.6 (0.6) . . . 4.0 (0.1) . . . 25.6 (0.7) . . . 3.3 (0.1) . . . 
 22.3 (0.9) . . . 8.0 (0.3) . . . 18.7 (0.9) . . . 3.1 (0.2) . . . 31.4 (1.1) . . . 3.4 (0.2) . . . 
 

11.0 (1.2) . . . 4.2 (0.3) . . . 8.7 (1.1) . . . 1.7 (0.2) . . . 18.1 (1.5) . . . 2.0 (0.2) . . . 
 

a are not shown for non-Hispanic children of other races due to small sample size. Non-Hispanic children of other races are included in ‘‘total’’ and the categories for other characteristics. Chi-square test
 

and foster parents. Data are not shown for children in other types of families due to small sample size. Children living in other types of families are included in ‘‘total’’ and the categories for other
 

ories shown.
 

nsus Bureau’s poverty thresholds. ‘‘Poor’’ persons have incomes below the poverty threshold. ‘‘Near poor’’ persons have incomes 100% to less than 200% of the poverty threshold. ‘‘Not poor’’ persons
 

er.
 

on a hierarchy of mutually exclusive categories. Persons with more than one type of health insurance were assigned to the first appropriate category in the hierarchy.
 

de children with unknown information for basic actions difficulty. Percentage for ‘‘total’’ includes children who have unknown values for any of the selected characteristics. Estimates are based on
 

nstitutionalized population.
 

ew Survey, 2001–2007.
 
National Health Statistics Reports n Number 19 n November 4, 2009 Page 21

Table 9. Use of prescription medication and frequent health care visits among children aged 5–17 years with and without basic action

difficulty, by selected characteristics: United States, average annual estimates for 2001–2007

Prescription medication1 Frequent health care visits1

Basic actions difficulty No basic actions difficulty Basic actions difficulty No basic actions difficulty

Characteristic

Percent

(standard error) p value2

Percent

(standard error) p value2

Percent

(standard error) p value2

Percent

(standard error) p value2

Total. . . . . . . . . . . . . . . . . . . . . . . . 39.4 (0.6) . . . 9.5 (0.2) . . . 15.0 (0.5) . . . 3.5 (0.1) . . .

Age (years) ...................

5–11 ......................

12–17 .....................

. . .

39.4 (0.9)

39.5 (0.8)

0.94

. . .

. . .

. . .

8.3 (0.2)

10.9 (0.3)

<0.01

. . .

. . .

. . .

15.7 (0.7)

14.5 (0.6)

0.19

. . .

. . .

. . .

3.2 (0.1)

3.9 (0.2)

<0.01

. . .

. . .

Sex ........................

Male ......................

Female ....................

. . .

41.9 (0.8)

35.3 (1.0)

<0.01

. . .

. . .

. . .

9.7 (0.2)

9.4 (0.2)

0.40

. . .

. . .

. . .

14.8 (0.6)

15.3 (0.8)

0.59

. . .

. . .

. . .

3.1 (0.1)

3.9 (0.2)

<0.01

. . .

. . .

Race and Hispanic origin3 ..........

White only, not Hispanic ..........

Black only, not Hispanic ..........

Hispanic ....................

. . .

43.8 (0.8)

32.7 (1.4)

28.1 (1.3)

<0.01

. . .

. . .

. . .

. . .

11.1 (0.3)

8.5 (0.4)

5.9 (0.3)

<0.01

. . .

. . .

. . .

. . .

17.1 (0.6)

9.6 (0.9)

12.0 (0.9)

<0.01

. . .

. . .

. . .

. . .

4.3 (0.2)

2.1 (0.2)

2.4 (0.2)

<0.01

. . .

. . .

. . .

Family structure4 ................

Mother only ..................

Two parent ..................

. . .

38.9 (1.1)

40.0 (0.8)

0.45

. . .

. . .

. . .

10.1 (0.4)

9.5 (0.2)

0.14

. . .

. . .

. . .

15.9 (0.8)

15.1 (0.6)

0.40

. . .

. . .

. . .

3.9 (0.2)

3.5 (0.1)

0.08

. . .

. . .

Poverty status5 .................

Poor ......................

Near poor ...................

Not poor....................

. . .

35.8 (1.3)

39.4 (1.3)

40.9 (0.8)

<0.01

. . .

. . .

. . .

. . .

8.0 (0.4)

8.0 (0.4)

10.4 (0.2)

<0.01

. . .

. . .

. . .

. . .

15.3 (1.1)

14.6 (1.0)

15.1 (0.6)

0.89

. . .

. . .

. . .

. . .

3.2 (0.3)

3.1 (0.2)

3.7 (0.1)

0.03

. . .

. . .

. . .

Heath insurance6................

Private ....................

Public .....................

Uninsured ...................

. . .

40.8 (0.8)

42.0 (1.2)

21.9 (1.7)

<0.01

. . .

. . .

. . .

. . .

10.4 (0.2)

9.5 (0.4)

4.2 (0.3)

<0.01

. . .

. . .

. . .

. . .

14.9 (0.6)

17.1 (0.9)

8.4 (1.1)

<0.01

. . .

. . .

. . .

. . .

3.7 (0.1)

3.9 (0.2)

1.4 (0.2)

<0.01

. . .

. . .

. . .

. . . Not applicable.
 1

See health service terms in ‘‘Technical Notes.’’
 2

Calculated for a Wald log-linear chi-square test.
 3

Children of Hispanic origin may be of any race. Data are not shown for non-Hispanic children of other races due to small sample size. Non-Hispanic children of other races are included in ‘‘total’’
 

and the categories for other characteristics. Chi-square test is based on the categories shown.
 4

Mother and father refer to biological, adoptive, step-, and foster parents. Data are not shown for children in other types of families due to small sample size. Children living in other types of
 

families are included in ‘‘total’’ and the categories for other characteristics. Chi-square test is based on the categories shown.
 5

Based on income and family size using the U.S. Census Bureau’s poverty thresholds. ‘‘Poor’’ persons have incomes below the poverty threshold. ‘‘Near poor’’ persons have incomes 100% to less
 

than 200% of the poverty threshold. ‘‘Not poor’’ persons have incomes 200% of the poverty threshold or greater.
 6

Classification of health insurance coverage is based on a hierarchy of mutually exclusive categories. Persons with more than one type of health insurance were assigned to the first appropriate
 

category in the hierarchy.
 

NOTES: The denominators for statistics shown exclude children with unknown information for basic actions difficulty. Percentage for ‘‘total’’ includes children who have unknown values for any of
 

the selected characteristics. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
 

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 2001–2007.
 
Page 22 National Health Statistics Reports n Number 19 n November 4, 2009

Technical Notes

Sample design

The National Health Interview

Survey (NHIS) is a cross-sectional

household interview survey of the U.S.

civilian noninstitutionalized population.

Data are collected continuously

throughout the year in all 50 states and

the District of Columbia. NHIS uses a

multistage, clustered sample design to

produce national estimates for a variety

of health indicators. Information on

basic health topics is collected for all

household members. Additional

information is collected for one

randomly selected adult and, for families

with children under age 18, one

randomly selected child in each family.

A household adult knowledgeable about

the health of the sample child is the

respondent for the sample child.

Interviews are conducted in the home by

field staff from the U.S. Census Bureau

using a computer-assisted personal

interview, known as CAPI, with

telephone interviewing permitted for

follow-up if necessary.

Starting in 2006, the sample design

included Asian persons in the

oversampling of NHIS populations;

during 2001–2005, only households with

black and Hispanic persons were

oversampled.

Item nonresponse

From 2001 through 2007, item

nonresponse for each of the

demographic indicators for children

aged 5–17 years shown in this report

was generally less than 1%, with the

exception of poverty status, which is

based on detailed family income

ascertained from the family component

of the questionnaire. Because the item

nonresponse for the poverty status

variable for children aged 5–17 was

relatively high (22%–31% from 1997

through 2007), family income data were

imputed for families with missing values

(25). Item nonresponse related to

limitations in activities of daily living,

use of special education services, and

use of health care services was 0.5% or

less. The denominators for statistics

shown in the tables exclude persons

with unknown information about basic

actions difficulty for a given table.

Among 58,679 sample children aged

5–17 in the 2001–2007 NHIS, 1,069

children, or 2%, were missing data for

basic actions difficulty.

Tests of significance

Statistical tests performed to assess

the significance of differences in

estimates were two-tailed with no

adjustments for multiple comparisons.

The statistic used to determine statistical

significance in contingency tables was

the Wald log linear chi-square test at the

0.05 level of significance. The test

statistic used to determine statistical

significance of differences between two

percentages was

|Xa–Xb|

Z =

√S 2 + S 2 a b

where Xa and Xb are the two

percentages being compared, and Sa and

Sb are the standard errors of those

percentages. The critical value used for

two-sided tests at the 0.05 level of

significance was 1.96.

Relative standard error

Estimates with a relative standard

error (RSE) more than 30% but less

than or equal to 50% are identified with

an asterisk (*). The RSE of an estimate

is calculated as:

RSE (percent) = (Sest/Est) * 100

where Sest is the standard error of the

estimate and Est is the estimate.

Definition of terms

Demographic and socioeconomic

terms

Age—Recorded for each person as

of his or her last birthday.

Family structure—For each child in

the sample, respondents were asked

whether the mother was a household

member and whether the father was a

household member. Mother and father

can include biological, adoptive,

stepparent, and foster relationships. This

recode does not classify legal guardians

as parents. A mother-only family refers

to a family in which a mother, but not a

father, is a household member. A

two-parent family refers to a family in

which both the mother and father are

household members.

Health insurance coverage—NHIS

respondents at the time of the interview

reported whether they were covered by

private health insurance (obtained

through the employer or workplace,

purchased directly, or acquired through a

local or community program), Medicare,

Medigap (supplemental Medicare

coverage), Medicaid, Children’s Health

Insurance Program (CHIP), Indian

Health Service (IHS), military insurance

(including VA, TRICARE, or CHAMPVA), a state-sponsored health plan,

another government program, or any

single-service plans. This information

was used to form a health insurance

hierarchy that consisted of three

mutually exclusive categories. Persons

with more than one type of health

insurance were assigned to the first

appropriate category in the following

hierarchy: private coverage (includes

persons with military coverage and

those covered by another government

program), public coverage (includes

Medicaid, CHIP, and other related

state-sponsored health plans), and

uninsured (also includes persons who

are covered only by IHS or have only

single-service plans).

Hispanic or Latino origin—Includes

persons of Mexican, Puerto Rican,

Cuban, Central and South American, or

Spanish origins. Persons of Hispanic or

Latino origin may be of any race.

Poverty status—Based on family

income and family size using the U.S.

Census Bureau’s poverty thresholds.

‘‘Poor’’ persons are defined as those

with family incomes below the poverty

threshold. Persons who are ‘‘near poor’’

have family incomes of 100% to less

than 200% of the poverty threshold, and

persons who are ‘‘not poor’’ have family

incomes that are 200% of the poverty

threshold or greater.

Race and Hispanic origin—The

reporting of race conforms with the

1997 Office of Management and

Budget’s Race and Ethnic Standards for
National Health Statistics Reports n Number 19 n November 4, 2009 Page 23

Federal Statistics and Administrative

Reporting. In this report, three

categories are shown: non-Hispanic

white, non-Hispanic black, and Hispanic

of any race. Other racial categories,

including a multiple-race category, are

not shown due to the small number of

sample children in these categories.

Disability-related terms

Basic actions—The volitional

physical and mental operations at the

level of the whole person. Examples

include walking, climbing steps,

reading, and communicating. Basic

actions are distinct from body functions,

which are defined in the International

Classification of Functioning and Health

(ICF) as ‘‘physiological functions of

body systems’’ rather than functions of

the whole person. The level of basic

action functioning can be measured with

or without the use of assistive devices.

Complex activities—The execution

of specific tasks and organized activities

that make up the elements of a social

role, ranging from personal care

activities to going to school or

socializing with peers.

Condition—A health condition is a

departure from a state of physical or

mental well-being.

Difficulties or limitations—Bounds,

restraints, or restrictions that a person

experiences when attempting to perform

basic actions, tasks, or complex

activities in everyday life situations.

Disability—An umbrella term that

reflects the interaction of a person with

his or her environment resulting in some

form of limitation in actions or

participation.

Impairment—Any loss or

abnormality of psychological,

physiological, or anatomical structure or

function. It represents the exterior

manifestation of an abnormality in the

body and reflects ongoing or residual

disturbances at the organ level. An

impairment may be either temporary or

permanent.

Limitation in activities of daily

living (ADL)—Activities of daily living

include bathing, eating, dressing, getting

in or out of a bed or chair, using the

toilet, or getting around inside the home.

Persons are limited in ADL if they

require the help of other persons with

any of these activities due to a physical,

mental, or emotional problem.

Special education—Teaching that is

designed to meet the needs of a child

with special needs or disabilities. It is

funded by the public school system and

may take place at a regular school,

special school, private school, home, or

hospital. The respondent for children in

the NHIS is asked if the child currently

receives special education services.

Health service terms

Contact with a mental health

professional—Based on a question that

asked whether respondents, during the

past 12 months, had seen or talked to a

mental health care provider about the

sample child’s health. Providers

included psychiatrists, psychologists,

psychiatric nurses, or clinical social

workers.

Contact with a medical specialist—

Based on a question that asked whether

respondents, during the past 12 months,

had seen or talked to a medical

specialist about the sample child’s

health. Medical specialists included

medical doctors who specialize in a

particular medical disease or problem

(other than an obstetrician/gynecologist,

psychiatrist, or ophthalmologist).

Contact with a therapist—Based on

a question that asked whether

respondents, during the past 12 months,

had seen or talked to a therapist about

the sample child’s health. Therapists

included physical, speech, respiratory, or

occupational therapists, or audiologists.

Prescription medication—Based on

a question that asked the respondent

whether the sample child currently has a

problem for which he or she has

regularly taken prescription medication

for at least three months.

Frequent health care visits—

Constituting 10 or more visits during the

previous 12-month period. The

respondent for the sample child was

asked how many times, during the past

12 months, the child had been seen by a

doctor or other health care professional

about his or her health at a doctor’s

office, a clinic, or some other place.

Respondents were instructed not to

include overnight hospitalizations, visits

to the hospital emergency room, home

visits, telephone calls, or dental visits.
Page 24 National Health Statistics Reports n Number 19 n November 4, 2009

Suggested citation

Pastor PN, Reuben CA, Loeb M. Functional

difficulties among school-aged children:

United States, 2001–2007. National health

statistics reports; no 19. Hyattsville, MD:

National Center for Health Statistics. 2009.

Copyright information

All material appearing in this report is in the

public domain and may be reproduced or

copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Edward J. Sondik, Ph.D., Director
 

Jennifer H. Madans, Ph.D., Associate Director
 

for Science
 

Office of Analysis and Epidemiology

Linda T. Bilheimer, Ph.D., Director

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

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DHHS Publication No. (PHS) 2010-1250

CS206675

T35321 (11/2009)