National Population Residency Trends: A Concern For Children With Disabilities?

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AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY BY H. BARRY WALDMAN DDS, MPH, PHD, STEVEN P. PERLMAN DDS, MSCD, DHL (HON) AND MATTHEW COOKE, DDS, MD, MPH

CHANGING CHILD POPULATION NUMBERS
On the last day of 2013, the Census Bureau released figures from July 2012 to July 2013 which indicated that the population grew at “…lowest rate in more than seven decades… (in the oncoming year) one birth is expected every eight seconds in the United States, and a death every 12 seconds.” 1

Nationwide: The number of children (less than 18 years) in the United States (74.2 million) is at an all-time high, but the share of the national population who are children is at an all-time low. The number of children grew by only 1.9 million between 2000 and 2010—from 72.3 million to 74.2 million. This increase contrasts sharply with the 1990s when the child population grew by almost 9 million. “Over the past decade, the number of adults (age 18+) grew by over 25 million, which led to children being a smaller share of the overall population in 2010 than in 2000. The share of the population made up of children fell from 26 percent in 2000 to 24 percent in 2010.” 2

All of the growth in the child population since 2000 has been among groups other than Non-Hispanic whites.
• Children of mixed race grew at a faster rate than any other group over the past decade, from 1.9 million in 2000 to 2.8 million in 2010 (↑ 46 percent).
• The number of Hispanic children grew by 4.8 million (↑39 percent) between 2000 and 2010.
• The number of non-Hispanic Asian and Pacific Islander children grew by nearly 800,000 (↑ 31 percent) between 2000 and 2010.
Three major groups experienced decreases between 2000 and 2010:
• The number of non-Hispanic white children fell by 4.3 million (or nearly 10 percent).
• The number of non-Hispanic black children fell by about 250,000 (↓ 2 percent).
• The number of non-Hispanic American Indian and Alaskan Native children fell by about 39,000 (↓ 6 percent). 2

State level: During the 1990s the child population declined in only six states. But over the past decade, the child population declined in 23 states and Washington, DC. The biggest percentage increases in the number of children between 2000 and 2010 were concentrated in the Rocky Mountain states as well as in Texas, Georgia, and North Carolina. Nevada, Utah, and Arizona were the three states with the largest percentage increase in children between 2000 and 2010. The three states with the largest percentage decrease were Vermont, Michigan, and Rhode Island (Washington, DC also lost a high percentage of children). Losses were mostly in the Midwest and New England states. 2 (see Map)
In terms of numbers:
• Texas gained the largest number of children (↑ 979,065) while New York lost the most (↓ 365,178).
• Nine states added at least 100,000 children and six states lost more than 100,000 children. (see Table 1)

In several states, non-Hispanic white children are now less than half of all children. The 10 states (and Washington, DC) with a “minority majority” child population were: HI (87%), Dist. Of Columbia (83%), NM (74%), CA (73%), TX (66%), NV (61%), AZ (58%) FL (54%), MD (54%), GA (53%) and MS (51%).

“The recent demographic changes in the child population hold many implications for the country’s future. One of the foremost lessons is the need to educate today’s diverse cohort of children so they can be successful workers in tomorrow’s economy, in part, so they can support the growing retired population.” 2

City level: Between 2000 and 2010, Fort Worth, TX had the greatest increase in the number of children (↑66,576) and New York City had the greatest loss in the number of children (↓172,158) Three other large cities (Chicago, Los Angeles, and Detroit) lost more than 100,000 children. The 10 cities that lost the most children were primarily in the Northeast and Midwest, but they also included New Orleans, Los Angeles, and Long Beach. The top 10 cities in terms of an increase in the number of children were all in the Sunbelt. (see Table 2)

CONCERN FOR CHILDREN WITH DISABILITIES?
“Approximately 56.7 million people living in the United States had some kind of disability in 2010. This accounted for 18.7 percent of the 303.9 million people in the civilian non-institutionalized population that year. About 12.6 percent or 38.3 million people had a severe disability.”3 The Census Bureau reported for 2011 that 0.8 percent of children less than five years and 5.1 percent of children 5-15 years had one or more severe disabilities. 4

While there are no direct quantitative reports on the interstate movement of children with disabilities, given the significant overall changes in numbers of children in many of the states, it would seem reasonable to suggest that children with disabilities are a component of this migration of our population. If this assumption is correct, what potentially could be the impact on individual children and the general population of children with disabilities, as well as the health, education and social systems that provide needed care?

First, whether it is related to particular population demographics (e.g. age, racial/ethnicity, economics), investments in educational, health and social programmatic efforts or any number of unknown specifics, it is essential to recognize the marked differences in the proportion of individuals with disabilities in the various states. Among the individuals with disabilities:
• Total population – ranges from 8.8 percent in Utah to 18.1 percent in West Virginia.
• Less than 5 years of age – ranges from 0.4 percent in five states to 2.0 percent in Wyoming.
• 5 to 15 years of age – ranges from 3.0 percent in North Dakota to 10.0 percent in Maine. (see Table 3)

Second, it may have taken an individual child with a disability (or disabilities) an extended period to feel secure and able to function during a critical period with teachers, therapists and other health and social providers. The child must now undergo a transition to both new settings and providers.

Third, the numbers of trained and experienced educators and health and social providers, as well as supportative agencies, will need to undergo review to assure adequate support for incoming numbers of children with disabilities. As to those communities with fewer youngsters (including those with disabilities), community residents’ reluctance to continue to maintain tax support for programs may impact on the agendas needed for those who remain.

Fourth, tens of thousands or even hundreds of thousands of new residents will require dramatic increases in community infrastructures, untold numbers of added physical facilities, education, health and social personnel and the inevitable taxes. During this extended period of fiscal turmoil, will there be adequate support for the needs of youngsters with disabilities, particularly in the sun-belt states where the geriatric populations will be demanding increased attention and support for their needs? Note: almost three-quarters (73.6%) of the 80 years and over population are reported to have one or more disabilities. 6

In essence, eventually, the turmoil of this transitional period will smooth out. But in the interim, the nation, individual states and cities (and rural areas) must also come to terms with the residency trends of children with disabilities. •

ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD – Distinguished Teaching Professor, Department of General Dentistry at Stony Brook University, NY; E-mail: h.waldman@stonybrook.edu
Steven P. Perlman, DDS, MScD, DHL (Hon) is Global Clinical Director, Special Olympics, Special Smiles and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine, Private pediatric dentistry practice – Lynn MA.
Matthew Cooke, DDS, MD, MPH is Associate Professor, Departments of Anesthesiology & Pediatric Dentistry University of Pittsburgh School of Dental Medicine Pittsburgh PA; Assistant Clinical Professor, Departments of Oral & Maxillofacial Surgery and Pediatric Dentistry Virginia Commonwealth University School of Dentistry, Richmond, VA.


AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE AND DENTISTRY
2The American Academy of Developmental Medicine and Dentistry (AADMD) was organized in 2002 to provide a forum for healthcare professionals who provide clinical care to people with neurodevelopmental disorders and intellectual disabilities (ND/ID). The mission of the organization is to improve the quality and assure the parity of healthcare for individuals with neurodevelopmental disorders and intellectual disabilities throughout the lifespan.


References
1. Lewin T. U.S. population up just 0.7%, census finds. NY Times, Dec 31, 2013, pA17.
2. Anne E. Casey Foundation. The changing child population of the United Stated: analysis of data from the 2010 census. Web site: http://www.aecf.org Accessed December 31, 2013.
3. Brault MW. Americans with Disabilities: 2010. Current Population Reports Household Economic Studies P70-131. Issued July 2012. Web site: http://www.census.gov/prod/2012pubs/p70-131.pdf Accessed December 6, 2013.
4. Cornell University. Disability statistics. Web site: http://www.disabilitystatistics.org Accessed December 31, 2013.
5. Census Bureau. American Community Survey. Web site: http://factfinder2.census.gov Accessed December 31, 2013.
6. Department of Health and Human Services. Office on Disability. Web site: http://www.hhs.gov/od/about/fact_sheets/whatisdisability.html Accessed January 2, 2014.