Valerie Leiter

The Consequences of Caring Effects of Mothering a Child with Special Needs

This article broadens our knowledge about family caregiving across the life course by examining caregiving and employment effects experienced by women with children with special needs, using data from a survey conducted in 1998-1999. Almost one fifth of the mothers provide at least 20 hours a week of home health care to these children. More than half of the mothers in the labor force report an employment effect in the form of reducing their hours, and more than half of the mothers at home full-time report ceasing paid employment due to their children’s needs. Experiencing these effects was most strongly associated with the child’s health characteristics. The caregiving provided by mothers of children with special needs occurs at a formative stage of their lives and may be intense and of long duration. These mothers’ experiences should be included in the current research and theories about family caregiving across the life course.

Challenges to Children's Independent Citizenship: Immigration, Family and the State.

This article explores how recent federal legislation has increased the extent to which US children’s citizenship is dependent upon their parents’ citizenship, by contrasting children who are adopted internationally by US citizens and second-generation US children. Two interconnected phenomena are examined: (1) the broader material and theoretical relationships between children’s membership in families and the state; and (2) the social, political and economic inequalities that exist between these two groups of child citizens. The article also discusses some practical and theoretical implications of these analyses, regarding the dependence of child citizenship and the multidimensionality of citizenship.

Mind the Gap: Gender Differences in Child Special Health Care Needs

The gendered nature of special health care needs in childhood is an important yet understudied area. Although gendered differences in the prevalence of special health care needs have been documented, there is less knowledge about the factors which contribute to those differences. Two research questions guide this inquiry. First, is the gender gap consistent across child special health care need indicators? Second, to what extent is the gender gap in special health care needs driven by behavioral conditions? We use multiple indicators from the U.S. National Survey of Children’s Health to expand our understanding about the dynamic relationship between gender and childhood health. There are clear gender differences in the prevalence of special health care needs. Boys are more likely than girls to have special health care needs overall and on the five separate components examined (medication, more care than typical, limitations, special therapies, and educational or behavioral problem). This gender gap is dynamic and varies by indicator; while behavioral conditions play a role, it remains even after controlling for behavioral conditions. The reasons for the gender differences appear to be both biological and social but much remains unknown about this pattern.

The Division of Labor Among Systems of Therapeutic Care for Children with Disabilities

This article demonstrates that there is a division of labor in therapeutic care for children with disabilities (i.e., physical, occupational, and speech/language therapy) between educational and medical systems, with educational systems providing the bulk of that care. Analyses of the 1994—1995 National Health Interview Survey Disability Follow-back show that the majority of children with disabilities who received therapeutic care (75%) received those therapies only through school, whereas the remaining children received therapies only through health insurance (14%) or through other or multiple systems (11%). The majority of children who received therapies through school received speech/ language therapy, whereas most who received therapies through health insurance received physical therapy. Children served through the schools were younger and were more likely to have communication and learning limitations, compared with those who received therapies through insurance. Policy implications regarding payment for pediatric therapies and coordination of care across multiple service systems are discussed.

Enmeshed in controversy: claims about the risks of vaginal mesh devices

Urinary incontinence is a hidden, private issue that affects over 40% of women. Its experience has been medicalised, mainly through urogynaecological surgery, more recently using implanted synthetic vaginal mesh. In this article, we analyse the power dynamics at play in the US Food and Drug Administration’s public hearings on the regulation of mesh. We use grounded theory to analyse verbatim transcripts of two days’ hearings in 2011 of a Food and Drug Administration medical devices advisory panel regarding the risks and benefits of the mesh. Applying the concept of language games to the transcripts, we found that mesh manufacturers and physicians expanded perceptions of the locations of risk, thereby diffusing responsibility for mesh-associated claims of adverse effects. This resulted in ‘organised irresponsibility’ where accountability for the risks reported by patients was deflected away from the mesh to other issues such as inadequacies of surgeons’ training. Patients in turn questioned the Food and Drug Administration’s regulation of mesh safety. In this article, we reflect on the ways in which medical device regulation may become more pressing and contested in the future.