One way of classifying children’s functional status is to group their functional difficulties into categories based on the type of activity that is affected. Overall, the parents of 68.9 percent of CSHCN report that their child has difficulty with at least one bodily function (such as eating, dressing, or bathing), and the parents of 60.5 percent report that their child has difficulty with participation in activities (such as walking or running). Finally, the parents of 58.8 percent of CSHCN aged 18 months through 17 years report emotional or behavioral difficulties. A child can have difficulties in more than one area.

A higher percentage of boys with special health care needs are reported to have difficulties with participation in activities and with emotions and behavior, while girls are slightly more likely than boys to report difficulties with bodily functions.

There is some variation in the types of functional difficulties that are evident by racial and ethnic group. Non-Hispanic White children are less likely to have difficulties with bodily functions (65.2 percent) than non-Hispanic Black and Hispanic children, and Hispanic children are the most likely to have difficulty participating in activities (64.9 percent). Emotional and behavioral difficulties are the most prevalent among Hispanic (63.3 percent) and non- Hispanic Black (61.5 percent) children.

In each functional area, children in low-income families are more likely to report having difficulties than children with higher family incomes. The greatest disparity is seen for difficulty with participation in activities and emotional and behavioral difficulties, which are reported by 70.0 percent of CSHCN with family incomes below the Federal Poverty Level (FPL), and less than half of CSHCN with family incomes of 400 percent of the FPL or more.

Another way of looking at these functional difficulties is to create mutually exclusive categories, in which each child falls into only one group, based on the child’s combination of difficulties. Of these categories, the largest is children who are reported to have difficulties in all three areas: this category represents nearly one-third of CSCHN (32.7 percent). The next largest group is those who have difficulty only with their bodily functions (19.4 percent), followed by those who have difficulty with both participation in activities and emotional or behavioral difficulties. Only 2.7 percent of CSHCN have emotional or behavioral difficulties without any additional functional problems.

These three categories of functional difficulties—bodily functions, emotions or behavior, and participation in activities—comprise 14 specific difficulties that children may experience as a result of their conditions. For children of all ages, these may include difficulties with vision (even when wearing glasses or contacts); hearing (even when using hearing aids); breathing or respiration; swallowing, digestion, or metabolism; blood circulation; chronic physical pain, including headaches; coordination or movement; and use of hands. For children aged 1 to 17 years, other potential areas of difficulty include learning, understanding, or paying attention, and speaking, communicating, or being understood. For children aged 18 months to 17 years, additional potential problem areas include anxiety or depression and behavior problems. For children aged 3 through 17 years, other difficulties might include difficulty with self-care activities, such as bathing and dressing, and difficulty making and keeping friends. Overall, 45.6 percent of CSHCN were reported to have difficulties in four or more of these areas. An additional 12.3 percent had problems in 3 areas, and 14.1 percent reported two areas of difficulty. Only one area of difficulty was reported for 19.2 percent of CSHCN, and only 8.8 percent were reported to have no functional difficulties.

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