Participation Restrictions in Early Learning and Child Care Among Children With Long-Term Conditions or Disabilities.

Abstract

Background: Children with long-term conditions (LTC) or disabilities often face participation restrictions in early learning and child care (ELCC), but little is known about their specific challenges. This study used latent class analysis (LCA) to identify non-categorical profiles of children's disability-related difficulties, capturing the heterogeneity of conditions rather than condition-specific categories, and examined socio-demographic and child care participation characteristics informing common challenges and needs.

Methods: Data drawn from the 2023 Survey on ELCC Arrangements-Children with LTC and Disabilities included 1977 children aged 0-5 (98% of survey sample). LCA identified groups based on parent-reported difficulties, activity limitations, LTC and disabilities. Child care participation, difficulty finding child care, extra support needs and school participation were compared across the total sample and identified classes.

Results: A four-class model provided the most meaningful solution. Class 1 (Relatively Healthy, 48%) included children likely to have difficulty learning, remembering, or concentrating sometimes. Class 2 (Activity Limitations and LTC, 14%) included children likely to have activity limitations (90%) and LTC (80%). Class 3 (LTC, 28%) included children most likely to have LTC (95%) but no activity limitations. Class 4 (Children with Disabilities, 10%) included children most likely to have multiple difficulties and disabilities, activity limitations and LTC. Relatively healthy children were most often reported in excellent or very good health (88%), were least likely to require extra support (42%) or have difficulty finding child care (37%) and were less often enrolled in school (34%), whereas children with disabilities were least likely to be in excellent or very good health (50%), most likely to require extra support (94%) and often enrolled in school (50%).

Conclusion: Children with LTC or disabilities are a diverse group with varying extra support needs and patterns of participation in ELCC and school engagement. These differences highlight the importance of inclusive, responsive strategies to reduce access gaps and promote early educational engagement.