For asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), the objectives were to (1) describe the percent increases in prevalence and comorbidity and how these vary by poverty status, and (2) examine the extent to which poverty status is a predictor of higher than average comorbid conditions.
Secondary analyses of the National Survey of Children’s Health for years 2003, 2007, and 2011–2012 were conducted to identify trends in parent reported lifetime prevalence and comorbidity among children with asthma, ADHD, and ASD and examine variation by sociodemographic characteristics, poverty status, and insurance coverage. Using 2011–2012 data, multivariable regression was used to examine whether poverty status predicted higher than average comorbid conditions after adjusting for other sociodemographic characteristics.
Parent-reported lifetime prevalence of asthma and ADHD rose 18% and 44%, respectively, whereas the lifetime prevalence of ASD rose almost 400% (from 0.5% to 2%). For asthma, the rise was most prominent among the poor at 25.8%. For ADHD, the percent change by poverty status was similar (<100% federal poverty level [FPL]: 43.20%, 100% to 199% FPL: 52.38%, 200% to 399% FPL: 43.67%), although rise in ASD was associated with being nonpoor (200% to 399% FPL: 43.6%, ≥400% FPL: 36.0%). Publicly insured children with asthma, ADHD, and ASD also had significantly higher odds (1.9×, 1.6×, 3.0×, respectively) of having higher than average comorbidities.
Poverty status differentially influenced parent-reported lifetime prevalence and comorbidities of these target disorders. Future research is needed to examine parent and system-level characteristics that may further explain poverty’s variable impact.
Comments
Trends in Common Chronic Disorders With Regard to Poverty: What’s Missing?
As a future Physical Therapist, I strongly feel that I must elaborate on the conclusions detailed in the article, “Poverty and Trends in Three Common Chronic Disorders,” published in Pediatrics, Volume 139, Issue 3, March 2017. Authors Pulcini et al. propose that chronic disorders such as asthma, attention deficit/hyperactivity disorder, and autism spectrum disorder, along with comorbid disorders, are the result of poverty and public health insurance. Very common trends expressed in this article included the prevalence of these conditions due to poverty, as well as the high prevalence of comorbid conditions such as learning disability and speech/language disabilities in very poor children. While it can be agreed upon that “poverty is associated with increasing prevalence and more comorbidity 1,” correlation does not imply causation in this case, and the recognition of the importance of sensory integration is a major component missing from this conclusion.
A major foundation to the development of both common chronic disorders and their comorbidities is the lack of adequate sensory integration. Studies have shown that children diagnosed with autism have been confirmed to be commonly linked with having some type of sensory processing impairment 2. Children with neurodevelopmental disorders, especially autism spectrum disorder, respond to sensory input differently when compared to those without these chronic conditions. The major sensory systems associated with these systems are vestibular, proprioceptive, and tactile 2 . With regard to the vestibular system, children with autism spectrum disorder tend to highly exhibit auditory filtering problems. Additionally, children with Autism spectrum disorder have been proven to display dysfunction with regard to sensation and tactile sensitivity 2. Lack of proper sensory integration plays a major role in the development of many of the chronic disorders discussed in this article.
Lack of proper sensory integration does not only affect the development of common chronic disorders, however. Atypical sensory function has been linked to emotional problems in children with autism spectrum disorder, particularly conditions such as Alexithymia, and Intolerance of Uncertainty 3. Lack of sensory integration and functionality, along with emotional dysregulation have been proven to be major factors in the development of comorbidities with regard to autism spectrum disorder.
In conclusion, this article has displayed a clear correlation between poverty and the development of common chronic disorders and their comorbidities. The article demonstrates the human biological response to impoverished conditions, and describes the major influence of the environment on the development of these conditions. This research could however be vastly expanded to include the essential element of the development and growth of chronic and neurodevelopmental disorders that is poor sensory integration. Any person, wealthy or poor can possess a lack of proper sensory integration. Therefore, wealth has no significance with regard to sensory integration. We must include all of the possibilities when discussing the trends in common chronic disorders moving toward the future, and consider all aspects of these conditions, if we are to provide the community with remarkable advancements in medical research.
Karsten Barbagelata
Physical Therapy
Utica College
Utica, NY
References
Pulcini CD, Zima BT, Kelleher KJ, Houtrow AJ. Poverty and Trends in Three Common Chronic Disorders. Pediatrics. 2017;139(3). doi:10.1542/peds.2016-2539.
Tomchek SD, Dunn W. Sensory Processing in Children With and Without Autism: A Comparative Study Using the Short Sensory Profile. American Journal of Occupational Therapy. 2007;61(2):190-200. doi:10.5014/ajot.61.2.190.
South M, Rodgers J. Sensory, Emotional and Cognitive Contributions to Anxiety in Autism Spectrum Disorders. Frontiers in Human Neuroscience. 2017;11. doi:10.3389/fnhum.2017.00020.
Acknowledgements
Pulcini CD, Zima BT, Kelleher KJ, Houtrow AJ, Tomchek SD, Dunn W, South M, Rodgers J
Trends in Common Chronic Disorders With Regard to Poverty: What’s Missing?
Trends in Common Chronic Disorders With Regard to Poverty: What’s Missing?
Karsten Barbagelata
Pediatrics. 2017;139(3). doi:10.1542/peds.2016-2539
As a future Physical Therapist, I strongly feel that I must elaborate on the conclusions detailed in the article, “Poverty and Trends in Three Common Chronic Disorders,” published in Pediatrics, Volume 139, Issue 3, March 2017. Authors Pulcini et al. propose that chronic disorders such as asthma, attention deficit/hyperactivity disorder, and autism spectrum disorder, along with comorbid disorders, are the result of poverty and public health insurance. Very common trends expressed in this article included the prevalence of these conditions due to poverty, as well as the high prevalence of comorbid conditions such as learning disability and speech/language disabilities in very poor children. While it can be agreed upon that “poverty is associated with increasing prevalence and more comorbidity 1,” correlation does not imply causation in this case, and the recognition of the importance of sensory integration is a major component missing from this conclusion.
A major foundation to the development of both common chronic disorders and their comorbidities is the lack of adequate sensory integration. Studies have shown that children diagnosed with autism have been confirmed to be commonly linked with having some type of sensory processing impairment 2. Children with neurodevelopmental disorders, especially autism spectrum disorder, respond to sensory input differently when compared to those without these chronic conditions. The major sensory systems associated with these systems are vestibular, proprioceptive, and tactile 2 . With regard to the vestibular system, children with autism spectrum disorder tend to highly exhibit auditory filtering problems. Additionally, children with Autism spectrum disorder have been proven to display dysfunction with regard to sensation and tactile sensitivity 2. Lack of proper sensory integration plays a major role in the development of many of the chronic disorders discussed in this article.
Lack of proper sensory integration does not only affect the development of common chronic disorders, however. Atypical sensory function has been linked to emotional problems in children with autism spectrum disorder, particularly conditions such as Alexithymia, and Intolerance of Uncertainty 3. Lack of sensory integration and functionality, along with emotional dysregulation have been proven to be major factors in the development of comorbidities with regard to autism spectrum disorder.
In conclusion, this article has displayed a clear correlation between poverty and the development of common chronic disorders and their comorbidities. The article demonstrates the human biological response to impoverished conditions, and describes the major influence of the environment on the development of these conditions. This research could however be vastly expanded to include the essential element of the development and growth of chronic and neurodevelopmental disorders that is poor sensory integration. Any person, wealthy or poor can possess a lack of proper sensory integration. Therefore, wealth has no significance with regard to sensory integration. We must include all of the possibilities when discussing the trends in common chronic disorders moving toward the future, and consider all aspects of these conditions, if we are to provide the community with remarkable advancements in medical research.
Karsten Barbagelata
Physical Therapy
Utica College
Utica, NY
References
Pulcini CD, Zima BT, Kelleher KJ, Houtrow AJ. Poverty and Trends in Three Common Chronic Disorders. Pediatrics. 2017;139(3). doi:10.1542/peds.2016-2539.
Tomchek SD, Dunn W. Sensory Processing in Children With and Without Autism: A Comparative Study Using the Short Sensory Profile. American Journal of Occupational Therapy. 2007;61(2):190-200. doi:10.5014/ajot.61.2.190.
South M, Rodgers J. Sensory, Emotional and Cognitive Contributions to Anxiety in Autism Spectrum Disorders. Frontiers in Human Neuroscience. 2017;11. doi:10.3389/fnhum.2017.00020.
Acknowledgements
Pulcini CD, Zima BT, Kelleher KJ, Houtrow AJ, Tomchek SD, Dunn W, South M, Rodgers J
Trends in Common Chronic Disorders With Regard to Poverty: What’s Missing?
Very common trends expressed in this article included the prevalence of these conditions due to poverty, as well as the high prevalence of comorbid conditions such as learning disability and speech/language disabilities in very poor children. While it can be agreed upon that “poverty is associated with increasing prevalence and more comorbidity 1,” correlation does not imply causation in this case, and the recognition of the importance of sensory integration is a major component missing from this conclusion.