Diagnosis vs. Function: A Review of Eligibility Criteria for Supports and Services for Children and Youth with Neurodevelopmental Disorders/ Disabilities In Canada

Abstract

Abstract BACKGROUND: Neurodevelopmental disorders/disabilities are characterized by impairment in one or more of the classic developmental domains of motor functioning, speech language/communication, learning and cognition, and social-emotional relating. Children with NDD/D require a wide variety of supports and services over their lifetimes and diagnostic classification has traditionally been used to determine eligibility for these resources. However, diagnosis alone tends to under-describe the functional complexity of this population and functional difficulties within a given NDD/D diagnosis can vary and may change over time. The International Classification of Functioning, Disability and Health re-conceptualized the notion of disability focusing on how a given health condition interacts with factors intrinsic and extrinsic to the individual to impact their functioning. In Canada ongoing tension exists between limited services and a growing population of children with NDD/D. These factors have lead to an evolving discourse on the appropriate way to confer eligibility to supports and services in this population. OBJECTIVES: To summarize eligibility criteria for supports and services for Canadian youth with NDD/D in an effort to facilitate discussion and advocacy to help ensure that all children receive the supports and services they require regardless of diagnostic categorization. DESIGN/METHODS: A focused gray literature review was performed to obtain eligibility criteria for government funded supports and services (early intervention, speech therapy, occupational therapy, behavioral intervention, and special education services) for youth aged 0-18 in each Canadian Province. Information was included only if it was published in a government website or document and was available online. Eligibility criteria was coded according to whether it was based on diagnostic categorization, functional impairment, or both and descriptive statistical analysis was performed. RESULTS: Early intervention services and pre-school aged speech/occupational therapy relies on functional impairment in nearly every (90% and 100% respectively) Canadian province/territory for which the information was available. Conversely, access to behavioral intervention relies heavily on diagnostic classification (81%). Some diagnoses (e.g. ASD) confer eligibility to extra therapy or more funding compared to other children with NDD/D. When children enter school access to special education services and speech/occupational therapy is more likely to be tied to diagnosis (45%, 36%, and 43% respectively) than in their pre-school years. CONCLUSION: 1) Eligibility criterion for services and supports for children/youth with NDD/D in Canada vary depending on province/territory. 2) Eligibility criteria are more likely to be based on the presence of functional impairment in preschool than school aged children, with an increasing requirement for children to have a specific diagnostic classification to access services as they age. 3) Certain diagnostic classifications confer increased eligibility for supports and services, in some cases without regard for level of functional impairment. 4) Further research is needed to develop ways of accurately, meaningfully, and efficiently measuring the function of children with NDD/D both at the individual and population level in order to equitably deliver supports and services in a resource limited environment.