New approaches to categorising childhood disability: an international comparative analysis of the UNICEF/Washington Group child functioning module

Background: The Child Functioning Module (CFM) assesses children's functional difficulties in multiple domains (i.e., sensory, physical, communication, cognitive, psychosocial, and emotional functioning). Cut-off points are defined to identify children with disabilities, for use in international monitoring activities. While appropriate for many uses, the recommended cut-offs limit representation of the patterns of multiple co-occurring difficulties. Objective: This paper proposes a new analytical approach that expands the identification of multiple co-occurring difficulties and tests it, using data from the 6th round of UNICEF-supported MICS in seven African countries. Methods: In each country we implemented: a) Confirmatory Factor Analysis (CFA), to examine the possibility of identifying theoretical functional domains; b) Latent Profile Analysis (LPA) on the functional domains factorial scores to explore whether it was possible to identify groups characterised by specific disability profiles. Results: The posited 6-factor CFA model resulted in adequate goodness of fit across countries. The factorial correlations suggest the co-occurrence of difficulties across domains, except for the emotional functioning factor, which was found to be largely independent. The LPA identified six disability profiles - with a striking degree of replication, both in their nature and frequency - across countries. Conclusion: Findings highlights the value and potential of an alternative approach to analyse CFM data to examine and understand co-occurrences of difficulties which a) provides policymakers with key information to tailor interventions to the specific needs of children with disabilities; b) has important implications for models of developmental disabilities, global health planning and resource allocation.