17 - Assessing Disability Representation in Pediatric Clinical Research

Publication Number: 4016.17

Nehal Harish, Case Western Reserve University School of Medicine, Canton, MI, United States; Sarah D. Ronis, University Hospitals Rainbow Babies and Childrens Hospital, Cleveland Hts, OH, United States

Background: Extracurricular activities promote belonging, resilience, and mental health during childhood and adolescence. Yet children with special health care needs (CSHCN) and functional difficulties may face barriers that limit access, and the extent of these disparities is not well described.

Objective: To describe (1) overall rates of extracurricular participation among U.S. children, (2) sociodemographic and health-related differences in participation, and (3) the independent associations of CSHCN status and functional difficulties with participation.

Design/Methods: This was a retrospective, cross-sectional study of the 2023 National Survey of Children’s Health, limited to children ages 5–17. Children were categorized into four groups: no CSHCN or difficulties, no CSHCN with ≥1 functional difficulty, CSHCN without functional difficulties, and CSHCN with ≥1 functional difficulty. Covariates included age, sex, race/ethnicity, and poverty level. The dependent variable was extracurricular participation (≥1 activity vs. none). Weighted descriptive statistics, chi-square tests, and logistic regression models were used.

Results: Among a representative sample of U.S. children, 75.9% participated in ≥1 extracurricular activity and 24.1% did not. Participation varied significantly by race/ethnicity and poverty level (p < 0.001). Compared with children without CSHCN or functional difficulties, those with CSHCN but no difficulties had 33% reduced odds of participation (aOR 0.67, 95% CI 0.56–0.80), and those with both CSHCN and functional difficulties had 44% reduced odds (aOR 0.56, 95% CI 0.49–0.64). Children without CSHCN but with ≥1 functional difficulty did not differ significantly in adjusted models (aOR 0.89, 95% CI 0.73–1.10). Higher household income strongly predicted participation (aOR 6.36, 95% CI 5.36–7.56 for ≥400% FPL).

Conclusion(s): Children with CSHCN, especially those with functional difficulties, were significantly less likely to participate in extracurricular activities even after adjusting for demographics and income. These disparities highlight the need for inclusive programming and policies that ensure equitable access to extracurricular opportunities for children with health-related challenges.

Descriptive Statistics
NSCH Extracurricular Participation Abstract Table 1.pdfTable 1. Weighted sample characteristics of children ages 6–17 years in the 2023 National Survey of Children’s Health, including distributions by age, sex, race/ethnicity, poverty level, and special health care needs/functional difficulty status (n = 49,962,558).

Overall Differences in Extracurricular Participation by Demographics and Health Characteristics
NSCH Extracurricular Participation Abstract Table 2.pdfTable 2. Weighted bivariate associations between extracurricular participation and demographic, socioeconomic, and health-related characteristics among U.S. children ages 6–17 years, 2023 National Survey of Children’s Health.