Diversity and Alberta Health Services

Diversity Resources

Health and Diverse Populations

Health and Persons with Disabilities in Canada

Overview
Defining Disability
Types of Disability
Statistics
Health Status and People with Disabilities
Common Debilitating Disorders with Associated Health Implications
Down Syndrome
Cerebral Palsy
Spina Bifida
Prader-Willi Syndrome
Intellectual Disabilities
Aging and Disability
Disability and Children and Youth
Violence/Abuse among People with Disabilities
References, Reports and Websites

Overview

The term disability is quite complex. It refers to limitations placed on daily activities and functioning. Disabilities exist in many different forms and severities and therefore can result in a wide range of health complications. In general, individuals with a disability tend to have reduced life expectancy, a higher prevalence of serious health conditions, and increased morbidity and mortality compared the general population (Kerr, 2004; Bittles, Petterson, Sullivan, Hussain, Glasson, Montgomery, 2002). Co-disability is common, meaning that disability typically coexists with another disease or condition. For example, individuals with Down Syndrome have a greater prevalence of heart defects, skin disorders, thyroid disease and intellectual impairment (Canadian Down Syndrome Society, 2006).

According to Statistics Canada (2002), an estimated one in eight Canadians are living with some type of disability. Although disability can affect anyone at any in their lives, the general trend indicates that the prevalence of disability increases as one ages. This may be of concern as the large baby boomer population ages.

Clinically treating an individual with a disability may be difficult for the health care provider, leading to poor communication between the health care provider and the patient. In turn, this can lead to the development of chronic conditions that may have been prevented if detected earlier. A greater number of individuals with disabilities have undetected hearing and vision problems partly because of their inability to communicate their health needs.

Mental health problems are common among individuals with any type of disability (National Advisory Council on Aging, 2004). Lack of the ability to express psychological symptoms by the patient, in combination with the lack of expertise in dual diagnosis of disability and mental illness by the clinician both contribute to the high prevalence of mental health problems among the disabled population.

Little is known about the prevalence and incidence of disability among different racial and ethnic groups. Although this Canadian data is somewhat outdated, the Health and Activity Limitations Survey of 1991 indicated that the overall prevalence of disability in the general population was 15.5%, and 31% in the Canadian Aboriginal population (Health and Activity Limitations Survey, 1991).

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Defining Disability

The word “disability” is a broad term and is difficult to define due to its multi-dimensional concepts, objective and subjective characteristics. Three major classification systems are used to help define disability in Canada (Government of Canada, 2003)

http://dsp-psd.communication.gc.ca/Collection/RH37-4-3-2003E.pdf

These include:

The Impairment Perspective that classifies based on the medical model which views disability in terms of disease, illness, and/or abnormality of the body or mind. The medical model does not consider the social and physical environment in the disabling process.

The Functional Limitations Perspective expands on the medical model and includes the social and physical environment in the disabling process. Therefore, limitations include activities that affect social roles, such as caring for a child, etc.

The Ecological Perspective goes beyond the impairment and functional limitations perspective and views disability as a result of interactions of impairment, activity limitation as well as restrictions in specific social and physical environments such as home, work, or school.

A general, yet broad definition of disability encompasses the interaction between impairment and activity limitations and restrictions. The World Health Organization defines disability as “an umbrella term for impairments, activity limitations and participation restrictions” (WHO, 2001, p.3). This definition encompasses disability with health, as well as limitations placed on functional activities and participation.

Types of Disability

Essentially, disability can be separated among four main categories; intellectual disability, psychiatric disability, physical disability and communication disability. It is very possible that an individual will have more than one type of disability.

An intellectual disability is “an impaired ability to learn” (Community Association for Community Living, 2006, p.1). Common terms have been used to refer to intellectual disability; these include cognitive impairment, mental retardation, and mentally challenged/handicap. An individual with an intellectual disability typically has difficulty taking in and processing information. Potential causes of intellectual disability include physical damage, head injury, or effects from a medical condition. An intellectual disability can have varying degrees of severity from a minor brain damage to severe mental retardation. Examples of conditions that can lead to intellectual disability include Down Syndrome, cerebral palsy, epilepsy and spina bifida.

According to the Learning Disability Association of Canada, Learning Disabilities “refer to a number of disorders which may affect the acquisition, organization, retention, understanding or use of verbal or nonverbal information. These disorders affect learning in individuals who otherwise demonstrate at least average abilities essential for thinking and/or reasoning. As such, learning disabilities are distinct from global intellectual deficiency.” (Learning Disability Association of Canada, 2005, p.1). Common types of learning disabilities include dyslexia, developmental articulation disorder, developmental expressive language disorder, attention deficit disorder, auditory processing disorder and visual processing disorder. With appropriate accommodations and modifications at home as well as in the classroom, individuals with a learning disability have the potential for academic success. A learning disability differs from an intellectual disability in that individuals with a learning disability usually have an IQ that is average or above, whereas individuals with an intellectual disability typically have IQ’s that are below average intelligence.

Psychiatric Disabilities involve limitations to activities due to the presence of an emotional, psychological or behavioural condition (Statistics Canada, 2002). There are many types of psychiatric disabilities including mood disorders, anxiety disorders and schizophrenia. Limitations as a result of a psychiatric condition vary from mild to severe. Individuals with a psychiatric disability may have decreased mental alertness, difficulties concentrating and organizing and have trouble dealing with stress and anxiety (Public Service Commission of Canada, 2006).

A physical disability involves difficulties with mobility and completion of daily tasks due to problems with physical mobility, muscle coordination, pain, and/or limited tolerance and fatigue. Physical disabilities occur at various levels of severity and include, but are not limited to spinal cord injuries, muscular dystrophy, spina bifida, hearing and vision problems, arthritis, and physical injury (Public Service Commission of Canada, 2006).

Communication disabilities involve the inability to understand or use speech and language to communicate with others. Causes of communication disabilities include hearing and/or vision impairment, physical disability and developmental delay. A communication disability can be permanent or temporary and occur at various degrees of severity. Communication disabilities can occur as a result of speech and language problems, hearing impairment, physical disability (cleft palate, deformation) and Tourettes Syndrome (Public Service Commission of Canada, 2006).

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Statistics

According to the World Health Organization (WHO), approximately 600 million people around the world are currently living with a disability. A significant proportion of this global disability is a result of injury such as automobile accidents, burns, falls, violence/abuse and war (WHO, 2006).

Recent Canadian data indicates that approximately 3.6 million Canadians reported having activity limitations. This works out to a disability rate of 12.4% of the total Canadian population or approximately 1 in 8 Canadians are living with a disability (Statistics Canada, 2002).

The types of disability experienced across Canada are diverse. The following list below outlines the types and prevalence of each disability among Canadians 15 years of age and older (Statistics Canada, 2002).

Hearing 4.4%
Vision 2.5%
Speech 1.5%
Mobility 10.5%
Agility 9.7%
Pain 10.1%
Learning 1.9%
Memory 1.8%
Developmental 0.5%
Psychological 2.2%
Unknown 0.4%

Disability also varies depending on four levels of severity; mild, moderate, severe and very severe. The criteria for each level of severity is characterized in the severity scale (refer to Profile of Disability in Canada, 2001). Among the total Canadian population 15 years of age and older, 5% had a mild disability, 3.6% had a moderate disability, 3.9% had a severe disability and 2.0% had a very severe disability.

The majority of adults with disability (aged 15 and older) have more than one disability. According to PALS, 18.2% have one disability, 17.4 % have two disabilities, 29% have three, 27.7% have four or five and 7.8% have six or more disabilities.

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Health Status and People with Disabilities

Numerous studies have reported that the health status of people with disabilities is significantly worse than the general Canadian population (McColl, Bickenback, Boyce, Miller, Ogilvie, Shortt, & Sturtevant, 2003). Disabled Canadians encounter more difficulties with their health and generally score a lower rating on their self-reported well-being indicators (Statistics Canada National Population Health Survey, 1999). Moreover, individuals with a disability are more likely to report difficulties in accessing health care services compared to the non-disabled (CCSD, 2003). An increased chronic disease prevalence and lower life expectancy has been reported among Canadian disabled compared to the general population (Lubitz, Cai, Kramarow, Lentzner, 2003; Batavia, & Delong, 2001). In addition, people with disabilities have been reported to utilize more health care services, take more prescriptions and spend more days in hospital compared to the non-disabled Canadian population (McColl, Bickenback, Boyce, Miller, Ogilvie, Shortt, & Sturtevant, 2003; Dejong, 1997; Clarke, 1999)

One particular study by McColl, Bickenback, Boyce, Miller, Ogilvie, Shortt, & Sturtevant, (2003) investigated the health status and health care utilization patterns among Canada’s disabled population using the data of the 1998/1999 National Population Health Survey. Results of the study were interesting. Significantly more disabled individuals had less than a high school education compared to the general population. In addition, significantly less disabled individuals reported having a college or university degree. Disabled individuals were more likely to report having an income below $19,000. These findings indicated that disabled individuals are disadvantaged in terms of socioeconomic indicators compared to the general population. A number of chronic conditions including back problems, allergies, high blood pressure, heart disease, diabetes, urinary incontinence, and cancer were of greater prevalence among the disabled compared to the general population. The use of prescription and non-prescription drugs was significantly higher among the disabled study participants. In regards to health services utilization, disabled individuals made an average of three times more visits to their family doctor compared to the non-disabled population. The disabled in this study reported a greater number of unmet needs compared to the general population; the main barriers being costs, transportation and long wait times associated with such services (McColl, Bickenback, Boyce, Miller, Ogilvie, Shortt, & Sturtevant, 2003).

1999 National Population Health Survey Report

The National Population Health Survey Report provides a detailed statistical overview of the health of Canadians. It is separated into two parts, 1) Determinants of health and 2) Health status. Key findings in regards to disability were in the area of self-reported health status. When individuals with a disability were asked to rate their overall health status, they reported significantly lower health status compared to the general population. When asked to self-rate their health status as excellent, very good, good, fair or poor the results were as follows:

9.7% of males (all ages) with disabilities rated their health status as “excellent” compared to 38.6% of males (all ages) without a disability.
6.6% of females (all ages) with disability rated their health status as “excellent” compared to 34% of females (all ages) without disability.
23.2% of males with disability rated their health status as “fair” compared to only 2.6% of the males without disability
25.2% of females with disability rated their health status as “fair” compared to only 3.2% of the females without a disability.

For a more detailed report on the findings from the survey, please refer to the following document http://www.statcan.ca/english/freepub/82-570-XIE/82-570-XIE1997001.pdf

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2001 Participation and Activity Limitation Survey Results Summary

Source: Statistics Canada, Participation and Activity Limitation Survey 2001

The Participation and Activity Limitation Survey (PALS) is a national survey intended for identification of 11 different types of disabilities among adults. These disabilities include mobility, pain, seeing, hearing, speaking, memory, learning, developmental, and unknown. The sample of participants for the PALS survey were selected based on their response to the activity limitation question on the national census. A total of 43,000 individuals participated in the survey, 35,000 adults and 8,000 children. Individuals residing in Yukon, Northwest Territories, Nunavut and on-reserve First Nations communities were excluded from the survey.

For a detailed report of the findings from the PALS survey refer to the following report titled “A Profile of Disability in Canada, 2001”
http://www.statcan.ca/english/freepub/89-577-XIE/pdf/89-577-XIE01001.pdf

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Common Debilitating Disorders and Associated Health Implications

Certain groups of individuals with debilitating conditions have co-existing disabilities and/or specific health risks. For example, individuals with an intellectual disability are more likely to have mental health problems, physical disability, hearing and vision impairments, and communication disability compared to someone without an intellectual disability (Ouellette-Kuntz, Garcin, Lewis, Minnes, Martin, Holden, 2005). The combined limitations involved in their initial disability and associated adaptive behaviours may make the disabled individual more susceptible to various health conditions. Research has shown that individuals with Down syndrome, cerebral palsy, spina bifida and Prader-Willi syndrome have a greater prevalence for certain health conditions.

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Downs Syndrome

Down Syndrome, also known as trisomy 21 syndrome, is a genetic conditions caused from an error in cell division. Approximately one in every 800 live births results in the presence of Down Syndrome (Canadian Down Syndrome Society, 2006). Downs syndrome has not been shown to correlate with any one particular ethnicity, religion or socioeconomic status (Down Syndrome Association of Toronto, 2003). Down Syndrome is characterized by a number of physical characteristics such as large and round eyes, small ears, large tongue, flattened face, smaller limbs and body frame. It can result in physical and intellectual disabilities and developmental delays. In addition, individuals with Down Syndrome may encounter health implications beyond the scope of typical childhood illnesses. Between 40-50% of individuals with Down Syndrome have heart defects at birth (American Academy of Pediatrics, 2001; Canadian Down Syndrome Society, 2006). This can be compared to the 0.8% incidence of congenital heart disease in the general population. Individuals with Down Syndrome have a greater prevalence of skin disorders (Leshin, 2001), eye problems (American Academy of Pediatrics, 2001), Alzheimer’s disease (Alvarez, 2005), thyroid disease (Coleman, 1994), diabetes (Kapell, et al, 1998), epilepsy (National Advisory Council on Aging, 2004) and problems with the digestive system, such as constipation, or celiac disease (Pueschel, Romano, Failla, Barone, & Pettinato, 1999). In addition, Down Syndrome places an individual at higher risk of developing childhood leukemia (Leshin, 2000).

For more information on Down Syndrome and its associated health conditions, refer to the following websites.

Calgary Health Region – Down Syndrome information
http://www.healthlinkalberta.ca

Calgary Down Syndrome Association
http://upsdowns.org

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Cerebral Palsy

Cerebral Palsy is a neurological condition that results from brain damage during the prenatal, perinatal and postnatal periods, essentially anytime before the cerebral development is complete (Krigger, 2006). The majority of cerebral palsy cases happen prenatally, before the child is born. However, between 10-20% of cases develop postnatally as a result of brain damage from meningitis, viral encephalitis, hyperbilirubinemia, falls, car accidents, or child abuse (Taylor, 2001). Complications from cerebral palsy are dependent upon the severity. Common complications include abnormal neurologic control, impaired oral-motor function, seizures, muscle spasticity, urinary incontinence, and hearing and vision problems (Krigger, 2006).

Secondary conditions have been identified among individuals with cerebral palsy. Individuals with cerebral palsy are at increased risk of developing reduced bone mass, putting them at risk of osteoporosis and fractures (King, Levin, Schmidt, Oestreich, Heubi, 2003). They are at increased risk of experiencing gastroesophageal reflux, which can lead to problems with vomiting, pneumonia and malnutrition (Gajdosik, Cicirello, 2001). Mental illness is prevalent among individuals with cerebral palsy. The associated pain, isolation, peer rejection and loss of functionality and independence places a cerebral palsy patient at risk for mental health issues.

An interesting investigation into the cause of death among cerebral palsy patients in the United States resulted in some significant findings. Between 1986-1995, individuals with cerebral palsy had higher mortality from cerebrovascular disease, digestive disorders, and cardiovascular disease compared to the general population. There was an increase in the number of cancer cases among cerebral palsy patients compared to the general population. In addition, people with cerebral palsy suffered from significantly more preventable deaths such as drowning and car accidents compared to the general population (Strauss, Cable, & Shavelle, 1999).

For more information on Cerebral Palsy, visit the following websites.

Calgary Cerebral Palsy Association.
http://www.calgarycp.org

Calgary Health Region – Information on Cerebral Palsy
http://www.healthlinkalberta.ca

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Spina Bifida

Spina Bifida is a significant birth defect that develops when the tissue surrounding the spinal cord doesn’t close properly during fetal development. This in turn causes a defect in the fetal spinal cord and potentially serious long term effects. Spina Bifida varies in the associated disability and severity depending on the size and location of the defect along the spinal cord and whether skin or nerves are covering the effected area. Complications vary in severity from mild physical disability and normal intelligence to severe mental and physical disability. Common complications among individuals with spina bifida include paralysis, hydrocephalus and orthopedic problems such as scoliosis, club foot, and intellectual disability (Lenke, 2005). As children with spina bifida get older, additional complications typically arise. Interestingly, individuals with spina bifida have been reported to have an increased prevalence of latex allergies, urinary tract infections, gastrointestinal disorders, skin problems, seizure disorders, and depression, compared to the general population (Mayo Clinic, 2005).

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Prader-Willi Syndrome

Prader-Willi Syndrome is a rare genetic disease characterized by a short stature, intellectual impairment, learning disability, behavioural problems and obesity. The general prevalence of this rare condition is roughly 1 in 12,000 live births (Ontario Pradder-Willi Association, 2006)

The greatest risk of Prader-Willi Syndrome is obesity. Individuals with Prader-Willi Syndrome have difficulty managing food intake because of a defect in the part of the brain that controls hunger and fullness. This in turn, can cause excessive weight gain and morbid obesity, which places the individual at high risk of respiratory failure, diabetes, heart failure and other obesity-related complications (Wattendorf, & Muenke, 2005).

For more information on Prader-Willi Syndrome, visit http://www.aafp.org/afp/20050901/827.pdf for an article titled “Prader-Willi Syndrome” by D. Wattendorf and M. Muenke (2005)

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Intellectual Disabilities

Studies have shown that individuals with an intellectual disability suffer an increase in morbidity (Kerr, 2004), communication disorders, and an increased prevalence of serious health conditions such as epilepsy (Morgan, Scheepers, & Kerr, 2003), sensory deficit (National Advisory Council on Aging, 2004), obesity, oral disease (Waldman et al., 1998) and behaviour and psychological problems (Canadian Mental Health Association, 1998). In addition, individuals with an intellectual disability typically have a lower life expectancy compared to the general population (WHO, 1997). Life expectance was found to decrease as the severity of mental retardation increased (Janicki et al., 1999).

For more detailed information on the health of individuals with intellectual disability, refer to the document titled “Improving the General Health of People who have Learning Disabilities” available at the following link.

http://apt.rcpsych.org/cgi/content/full/10/3/200

A comprehensive literature review titled “The Health Status and Needs of Individuals with Mental Retardation” is available at the following link http://www.specialolympics.org

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Aging and Disability

Although disability can affect anyone at any point in their lives, generally, the common trend indicates the prevalence of disability increases as one ages. 2001 data indicates that 1.6 million seniors 65 years and older had at least one disability; this accounts for approximately 42% of the senior population (Government of Canada, 2005). Many Canadian seniors are active, healthy and living independently in their communities. However, it is natural that as individuals’ age, physical and intellectual functioning is reduced. As life expectancy is gradually increasing and older adults are living longer, an increasing number of individuals are living with some type of disability.

Seniors, in particular seniors with an underlying disability are prone to developing age-related diseases at a younger age (National Advisory Council on Aging, 2004). Individuals with a disability often lack the health education required to make healthy lifestyle choices, thereby increasing their susceptibility to certain illness.

Canadian seniors are faced with disabilities that 1) arose at birth, 2) disabilities that resulted after injury, trauma or illness, and 3) disabilities associated with age-related disease. Studies have demonstrated that in general, disability prevalence and severity increases with age (Hogan, Ebly, & Fung, 1999; Statistics Canada, 2001). According to Statistics Canada, 41% of Canadian seniors 65 years and over and 53.3% of seniors 75 years and older reported having some type of disability (Statistics Canada, 2001). This is significantly higher than the disability rate of the general population of 12.6%. Mobility problems are the most common type of disability among seniors; affecting eight in ten Canadian seniors with disability (Statistics Canada, 2001). Memory was another common disability affecting 4.3%, or one in ten of the Canadian senior population.

Seniors have an increased risk of developing a number of diseases and conditions that have been identified as risk factors for disability for the elderly (Fried, & Guralnick, 1997). Stroke, heart disease, diabetes, osteoporosis, dementia, glaucoma, and foot problems are all conditions associated with disability and they all have a greater prevalence among seniors 65 years and older (Public Health Agency of Canada, 2005). Moreover, seniors are at a higher risk of injuries, which depending on the severity, have the potential to result in functional, physical, cognitive or total disability.

A study by Hogan, Ebly and Fung (1999) examined whether diseases have similar impact on cognitively intact seniors 65-84 years of age and seniors 85 years plus. Their findings indicated that seniors aged 85 years plus, had almost twice as many functional disabilities compared to individuals in the 65-84 year age group. As well, disability increased with age in those individuals with and without disease risk factors. This result suggests that disability occurs in the elderly even in the absence of an explanatory disease.

Examples of Diseases that Cause Disability

As mentioned above, the elderly are at higher risk of developing diseases with associated disability. Stroke, foot problems, and arthritis and how temporary and/or permanent disability can result from the presence of disease in the elderly population is outlined below. As a note, seniors are at increased risk of developing a large number of disorders; they are not limited to these three disorders. These disorders are simply used to illustrate examples of how chronic illness can result in ongoing disability in the elderly.

Stroke

Seniors are at greater risk of stroke compared to the younger Canadian population. Strokes can occur at various degrees depending on the type of stroke, the area of the brain affected as well as the size of the damaged area. A stroke can result in various degrees of disability, some reversible, but some permanent. Disabilities associated with the result of a stroke include paralysis or weakness on one side of the body, depression, difficulties understanding language and recognizing objects, trouble learning and remembering new information, and changes in personality. Strokes can cause physical, cognitive, and emotional disability. Rehabilitation proceeding a stroke is essential in trying to recover lost ability (Public Health Agency of Canada [PHAC], 2005).

Foot Problems

Seniors have been reported to have a higher incidence of foot problems compared to the younger population (PHAC, 2005). Approximately three out of four people will develop foot problems as they age. This is of concern as healthy feet contribute to your overall health and safety; they allow individuals to stay active and provide balance. Health problems such as diabetes, arthritis, circulation problems, and nerve damage are a few health conditions that can impact the health of individual’s feet. Additionally, these health conditions and associated foot problems can contribute to infection and functional disability impacting ones walking, ability to prepare meals, and other daily functional activities (PHAC, 2005).

Arthritis

Arthritis is a major debilitating condition among Canadian seniors. Health Canada estimates that 85% of Canadians will be affected by osteoarthritis by the age of 70 years (PHAC, 2000). Arthritis results in pain, stiffness and swelling in the joints as a consequence of cartilage damage. Arthritis contributes significantly to activity limitations; individuals alter their daily functioning activities as a result of the immense amount of pain and stiffness associated with the disorder.

Statistics Canada (2001). A profile of Disability in Canada. http://www.statcan.ca/english/freepub/89-577-XIE/pdf/89-577-XIE01001.pdf

Persons with Disabilities Online. Service Canada. Available at
http://www.pwd-online.ca/pwdhome.jsp?lang=en

Aging with a Developmental Disability.
http://www.nia.nih.gov/AboutNIA/NACA/

Aboriginal Elders with Disabilities

Demographic trends from the 2001 Census indicate that the number of Aboriginal seniors are slowly rising along with the gradual rise in life expectancy. The 2001 Canadian census reported that 60.3% of First Nations, 63.7% of Métis and 54.4% of Inuit elders 65 years and older had at least one disability, this is compared to a 42% rate of disability for individuals 65 years and older in the general population (Statistic Canada, 2001). The overall rate of disability among Aboriginal women is higher than Aboriginal men (72% vs. 68%). Aboriginal elders with disability had self-reported health status significantly lower than their non-disabled peers. For example, 56% of Aboriginal elders with a disability reported their health as fair or poor, compared to 14% of their non-disabled peers.

Crowded living conditions and homes in need of major repair are realities for many Aboriginal elders; this creates additional barriers for elders with disability.

Aboriginal elders have an increased prevalence of diabetes (25%) compared to the non-Aboriginal population (10%) (Statistics Canada, 2003). This places them at increased risk of diabetes related disability and complications.

Many Aboriginal elders experience poor health and inadequate living conditions and community health services. These factors coupled with their disability may lead to relocation to a larger urban centre to attain sufficient care. The low income present among a significant number of elders, adds another barrier to accessing the services and supports they need.

Aboriginal elders are experiencing much of the same problems seen among the general Canadian senior population; poor health, low income and difficulties attaining housing supports. However, Aboriginal elders are also faced with the isolation factor, lack of culturally appropriate health care services and language barriers, all of which may be contributing to their significantly worse health status and reduced life expectancy compared to seniors in the general population.

For more detailed information and statistics regarding the health status of Aboriginal Elders with Disabilities, visit the Advancing the Inclusion of People with Disabilities Report at the following link http://www.hrsdc.gc.ca

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Disability and Children and Youth

At times it is difficult and sometimes impossible to identify specific types of disabilities before the age of five years considering the rate of physical, emotional and intellectual development. The Participation and Activity Limitation Survey (PALS) survey identified five common types of disability in children: vision, hearing, chronic health condition, developmental delay, and unknown disability. The percentage of children affected by each disability varied with age group. For example, the common types of disability reported among children aged 0-4 years are hearing impairment (12.1%), vision impairment (8.0%), developmental delay (68.0%) and chronic disease/condition (62.6%). Common types of disability among children and youth aged 5-14 years of age include hearing impairment (13%), vision impairment (9.4%), speech problems (43.3%), mobility (13.7%), developmental delay (29.8%), learning problems (64.9%), psychological condition (31.8%), chronic condition (65.3%) and unknown (3.2%). The degree of severity of disability varied across the child and youth population. 57.4% of disability between the ages of 0-14 years was deemed mild to moderate and 42.6% was classified as severe to very severe depending on the level of limitation (Statistics Canada, 2002).

Chronic health conditions constitute the most widespread disability among disabled children aged 0 to 14 years, representing 65% of children with disabilities and approximately 118,000 Canadian children. Examples of chronic conditions include asthma, severe allergies, heart condition, kidney disease, cancer, epilepsy, cerebral palsy, cystic fibrosis, and Fetal Alcohol Spectrum Disorder. These chronic conditions are termed disability when children are limited in the amount or type of activities that one can do due to the presence of one or more chronic condition(s).

Developmental delay is the most common type of disability among children between the ages of 0 and 4 years. 68% of disabled children aged 0-4 years had a developmental delay. This represents 1.1% of all children aged 0-4 years, approximately 18,000 children. Again, it is sometimes difficult to identify specific disability before the age of 5 years.

Multiple disabilities

A large percentage of children identified as having some type of disability, have more than one disability. 50.9% of children aged 0-4 years have only one type of disability, 39.8% have two types and 9.3% have three of more disabilities. 28.1% of children aged 5-14 years have one disability, 36.5% have two or three disabilities, 24.8% have four or five and 10.5 % have six or more disabilities.

For more detailed findings from the 2001 Participation and Activity Limitation Survey (PALS), refer to A Profile of Disability in Canada, 2001 available at
http://www.statcan.ca/english/freepub/89-577-XIE/pdf/89-577-XIE01001.pdf

The Well-being of Canada’s Young Children: Government of Canada Report 2002. – Young Children with Disabilities in Canada. Available at
http://socialunion.gc.ca/ecd/2003/report2_e/index.html

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Violence/Abuse Among People with Disabilities

Any individual, regardless of age, gender, ethnicity, socioeconomic status, is at risk of becoming a victim of violence and abuse. However, intellectually and physically disabled individuals have been reported to be at increased risk because they are more likely to be dependent on caregivers compared to the general population (Public Health Agency of Canada, 2005; Sullivan, & Knutson, 2000). Limited Canadian research exists to demonstrate the relationship between violence and abuse among people with disabilities. Prevalence data is scarce, one of the reasons being that violence and abuse is typically a hidden problem. We know that it is happening, the exact prevalence of the problem is unknown.

Violence and abuse also have the potential to result in disability, but the degree of its role may be grossly underestimated due to difficulties with investigation and the time lapse often between the potential abuse and the onset of disability. One example of this involves Shaken Baby Syndrome. Child abuse through considerable shaking and physical abuse during critical developmental periods has the potential to result in long-term neurological disability that often arises years later.

Child

A study by Sullivan and Knutson (2000) revealed that children with intellectual disabilities are 3.8 times more likely to experience both physical and emotional abuse and 4 times more likely to experience sexual abuse (Sullivan, & Knutson, 2000).

The Law Commission of Canada investigated the abuse occurring toward the disabled living in institutions across Canada. The findings reported that physical and sexual abuse toward children was a common phenomena present among many Canadian institutions (Law Commission of Canada, 2000).

For more information on Abuse among children with disabilities, refer to the following document.

Children with Disabilities and the United Nations Study of violence against Children. http://www.arts.ualberta.ca/cms/sobsey.pdf

Abuse of Children with Disability.
http://www.phac-aspc.gc.ca/ncfv-cnivf/
familyviolence/html/nfntsdisabl_e.html

Sexual Abuse of Adolescents with Chronic conditions. (1997).
http://www.cps.ca/english/statements/AM/am96-01.htm

Women

Disabled women are at increased risk of all types of abuse compared to non-disabled women (Public Health Agency of Canada, 1993; Stimpson, & Best, 1991; Wilson, & Brewer, 1992). Typically, disabled women rely heavily on a number of individuals for family care, support and assistance in carrying out everyday activities. Therefore, because they are more likely to be dependent on a larger number of people and their disability may make it more difficult to escape the abuse, disabled women are at increased risk.

For more detailed information and statistics on Violence against disabled women, visit http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/html/femdisab_e.html

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Reference, Reports and Websites:

1. World Health Organization. (2006). Injury-related disability and rehabilitation. Available at http://www.who.int/violence_injury_prevention/disability/en/

2. Statistics Canada. (2002). A Profile of Disability in Canada, 2001. Available at http://www.statcan.ca/english/freepub/89-577-XIE/

3. Canadian Council on Social Development. (2003). The Health and Well-being of Persons with Disabilities. Available at http://www.ccsd.ca/drip/research/dis9/

4. World Health Organization. (2001). International classification of functioning, disability and health. Geneva, WHO.

5. McColl, M., Bickenback, J., Boyce, W., Miller, J., Ogilvie, L., Shortt, S., & Sturtevant, D. (2003). Health Status and Health Care in the Disability Community in Canada. Available at http://www.equalopportunity.on.ca/eng_g/subject/index.asp?action=search_7&dir_id=1132&file_id=25267

6. Government of Canada. (2005). Advancing the inclusion of people with disabilities. Website link no longer available.

7. Leshin, L. (2001). Dermatotologic disorders in Down Syndrome. Available at http://www.ds-health.com/derm.htm

8. Leshin, L. (2000). Diseases of the Blood in Down Syndrome. Available at http://www.ds-health.com/hemat.htm

9. Canadian Down Syndrome Society. (2006). http://www.cdss.ca/

10. Alvarez, N. (2005). Alzheimer’s Disease in Individuals with Down Syndrome. http://www.emedicine.com/neuro/topic552.htm

11. Coleman, M. (1994). Thyroid dysfunction in Down Syndrome: A review. http://www.down-syndrome.org/research-practice/

12. Pueschel, S., Romano, C., Failla, P., Barone, C., & Pettinato, R. (1999). Celiac Disease in Down Syndrome in the U.S. Acta Paediatr, 88(9):953-6

13. Krigger, K. (2006). Cerebral Palsy: An Overview. American Family Physician, 73 (1): 91-100.

14. Gajdosik, C., Cicirello, N. (2001). Secondary conditions of the musculoskeletal system in adolescents and adults with cerebral palsy, Journal of physical and occupational therapy in Pediatrics, 21, 49-68.

15. King, W., Levin, R., Schmidt, R., Oestreich, A., Heubi, J. (2003). Prevalence of reduced bone mass in children and adults with spastic quadriplegia, Developmental Medicine and Child Neurology, 45, 12-16.

16. Strauss, D., Cable, W., Shavelle, R. (1999). Causes of excess mortality in cerebral palsy, Developmental medicine and child neurology, 41, 580-585.

17. Taylor, F. (2001). Cerebral Palsy: Hope Through research. Available at http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm

18. Janicki, M., Dalton, A., Henderson, C., Davidson, P., (1999). Mortality and morbidity among older adults with intellectual disability: Health service considerations. Disability Rehabilitation. 21:284-294.

19. Kapell D, Nightingale B, Rodriquez A, Lee J, Zigman W, Schupf N. (1998). Prevalence of chronic medical conditions in adults with MR: Comparison with the general population. Mental Retardation. 36:269-279.

20. Waldman, H., Perlman, S., Swerdloff, M. (1998). Dental care for children with mental retardation: Thoughts about the Americans with Disabilities Act. Journal of Dentistry for Children. 65:487-491.

21. Public Health Agency of Canada (1993). Violence against women with disabilities. Available at http://www.phac-aspc.gc.ca/ncfv-cnivf/familyviolence/html/femdisab_e.html

22. Learning Disability Association of Canada (2005). Official Learning Disability Definition. Available at http://www.ldac-taac.ca/Defined/defined_new-e.asp

23. Mayo Clinic. (2005). Spina Bifida. (link no longer available)

24. Lenke, L. (2005).Spina Bifida: Complications include scoliosis and Kyphosis. Available at (link unavailable)

25. DSM IV. (1994). Diagnostic Criteria for Mental Retardation. Available at
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26. Bradley, E., Thompson, A., Bryson, S. (2002). Mental Retardation in Teenagers: Prevalence data from the Niagara region, Ontario. Canadian Journal of Psychiatry, 47(7), 652-659.

27. Sullivan, P. Knutson, J. (2000). Maltreatment and disabilities: a population-based study. Child Abuse and Neglect, 24(10), 1257-1273.

28. Law Commission of Canada. (2000). Institutional child abuse – restoring dignity: responding to child abuse in Canadian institutions.

29. Stimpson, L.,& Best, M. (1991). Courage above all: Sexual Assault Against Women with Disabilities (DAWN: Toronto, 1991).

30. Wilson, C. & Brewer, N. (1992). The Incidence of Criminal Victimization of Individuals with an Intellectual Disability. Australian Psychologist 27,2: 114-117.

31. Health and Activities Limitation Survey. (1991). http://www.statcan.ca/english/Dli/Data/Ftp/hals.htm

32. Canadian Mental Health Association. (1998). Dual Diagnosis; People with Developmental disability and mental illness. Available at http://www.ontario.cmha.ca/

33. Statistics Canada. (2001). A profile of Disability in Canada. http://www.statcan.ca/english/freepub/89-577-XIE/pdf/89-577-XIE01001.pdf

34. Statistics Canada. 2003. Statistics Canada. "Aboriginal Peoples Survey: Well-being of the non-reserve Aboriginal Population". (The Daily, Sept. 24, 2003). Ottawa: Author. Available at www.statcan.ca/Daily/English/030924/d030924b.htm

35. Batavia, A. & Delong, G, (2001). Disability, Chronic illness and risk selection, Journal of Medical Rehabilitation, 82, 546-552.

36. Bockenek, W. (1997). Primary care for persons with disabilities. American Journal of medical Rehabilitation, 76, s43-s46.

37. Clarke, A., Levinton, C., Joseph, L., Penrod, J., Zowall, H., Sibley, J., Grover, S. (1999). Predicting the short term direct medical costs incurred by patients with rheumatoid arthritis, Journal of Rhematoidology, 26, 1068-1075.

38. Coyle, C., Santiago, M., Shank, J, Ma, G., Boyd, R. (2000). Secondary conditions and women with disabilities: a descriptive study. American Journal of Medical Rehabilitation, 81, 1380-1387.

39. Jones, K., Tamari, I. (1997). Making our offices universally accessible: Guidelines for physicians, Canadian Medical Association Journal, 156, 647-656.

40. Lubitz, L. Cai, L., Kramaroe, &Lentzner, H. (2003). Health, life expectancy, and health care spending among the elderly. Northern England Journal of Medicine, 349, 1048-1055.

41. McColl, M., James, A., Boyce, W., & Shortt, S. (2003). Evidence based policy making about disability: Evaluating the evidence.

42. Randall, W., Parrila, R., & Sobsey, D. (2001). Ethnicity, disability and risk for abuse, Developmental Disabilities Bulletin, 29(1), 60-80.

43. Sobsey, D. (2002). Exceptionality, education, & maltreatment, Exceptionality, 10(1), 29-46.

44. Randall, W., Parrila, R., & Sobsey, D. (2000). Gender, disability status and risk for sexual abuse in children. Journal on Developmental Disabilities, 7(1), 1-15.

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Websites and Reports

Alberta Association for Community Living
http://www.aacl.org

Alberta Association of Rehabilitation Centers
http://www.albertarehab.org

Alberta Committee of Citizens with Disabilities
http://accd.net

Community Rehabilitation Department, University of Calgary
http://www.crds.org

Alberta Centre on Entrepreneurship and Disabilities.
http://www.acs.ucalgary.ca

Integrated network of Disability Information and Education (INDIE)
http://www.indie.ca

Alberta Aids to Daily living program
http://www.health.gov.ab.ca/regions/aadl.html

Canadian Association of Community Living
http://www.cacl.ca

Public Service Commission of Canada. (2006).
http://www.psc-cfp.gc.ca/ppc/coverpg_e.htm

To find resources and services for individuals with disabilities in your region, visit Persons with Disability Online at http://www.pwd-online.ca/pwdhome.jsp?lang=en

Disability Research Information Page.
http://www.ccsd.ca/drip/research/

Students with Disabilities.
Link no longer available

Alberta Association for Community Living
http://www.aacl.org/

Autism Treatment Services of Canada.
http://www.autism.ca/

An Inventory of Alberta Disability Websites
http://www.vrri.org

International Journal of Disability, Community and Rehabilitation.
http://www.crds.org

Annual Report 2003/2004 : Persons with Developmental Disabilities. Alberta Provincial Board. http://www.pdd.org/docs/prov/PDD_AR_2003_2004.pdf

Cross-Cultural Views of Disability
http://www.vrri.org

Addressing Health Disparities through Promoting Equity for individuals with Intellectual Disabilities. (2004)http://www.igh.ualberta.ca/RHD/Synthesis/Disabilities.pdf

Canadian Health Network. Living with Disabilities.
http://www.canadian-health-network.ca/servlet/ContentServer?cid=1045848110489&pagename=CHN-RCS%2FPage%2FGTPageTemplate&c=Page&lang=En

Health Canada. People with Disabilities. 2006.
Link no longer available

Chrysalis
http://www.chrysalis.ab.ca/

Canadian Paraplegic Association
http://www.canparaplegic.org/

Developmental Disability Resource Centre of Alberta
http://www.ualberta.ca/~jpdasddc/INDEX.html

Calgary SCOPE Society
http://www.calgscope.org/home.html

Premier's Council on the Status of Persons with Disabilities
http://www.seniors.gov.ab.ca/CSS/premiers_council/

Progressive Alternatives Society of Calgary
http://www.pasc-calgary.org/

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