title: Trajectories and outcomes among children with special health care needs.
abstract: OBJECTIVE
  Outcomes for children with special health care needs (SHCN) can vary by their patterns and persistence over time. We aimed to empirically establish typical SHCN trajectories throughout childhood and their predictive relationships with child and parent outcomes.
  
  
  METHODS
  The 2 cohorts of the nationally representative Longitudinal Study of Australian Children were recruited in 2004 at ages 0 to 1 (n = 5107, B cohort) and 4 to 5 years (n = 4983, K cohort). The parent-reported Children With SHCN Screener (Short Form) was completed at each of 4 biennial waves. Wave 4 outcomes were parent-reported behavior and health-related quality of life, teacher-reported learning, and directly assessed cognition. Both parents self-reported mental distress. We derived intracohort trajectories by using latent class analysis in Mplus. We compared mean outcome scores across trajectories by using linear regression, adjusting for socioeconomic position.
  
  
  RESULTS
  Four distinct SHCN trajectories were replicated in both cohorts: persistent (B 6.8%, K 8.7%), emerging (B 4.1%, K 11.5%), transient (B 7.9%, K 4.2%), and none (B 81.3%, K 75.6%). Every outcome was adversely affected except fathers' mental health. From infancy to age 6 to 7 years, the persistent and emerging groups had similarly poor outcomes. From age 4 and 5 to 10 and 11 years, outcomes were incrementally poorer on moving from none to transient to emerging and to persistent SHCN. Effect sizes were largest for behavior, learning, and psychosocial outcomes.
  
  
  CONCLUSIONS
  Adverse outcomes are shaped more by cumulative burden than point prevalence of SHCNs. In addition to providing care according to a child's need at any given time, prioritizing care toward persistent SHCNs may have the biggest benefits for children and parents.
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Carlton, Victoria, Australia; jon.quach@mcri.edu.au.
authors.forename: Jon
authors.initials: J
authors.lastname: Quach
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Erasmus Medical Center, Rotterdam, Netherlands; Erasmus University, Rotterdam, Netherlands; and.
authors.forename: Pauline W
authors.initials: PW
authors.lastname: Jansen
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Carlton, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: Fiona K
authors.initials: FK
authors.lastname: Mensah
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Carlton, Victoria, Australia; The Royal Children's Hospital, Parkville, Victoria, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis / Q000523:psychology; D000367:Age Factors; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000523:psychology; D002675:Child, Preschool; D015331:Cohort Studies; D017281:Cost of Illness; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000523:psychology*; D019988:Children with Disabilities / Q000523:psychology*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007859:Learning Disabilities / Q000175:diagnosis / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D010290:Parents / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D014739:Victoria
keywords: child behavior; child learning; longitudinal; parent mental health; special health care needs