Direct and Indirect Costs of Disabilities in Children (BUDGET)

• Wondemu, Michael Yisfashewa; Hermansen, Åsmund; Joranger, Pål & Brekke, Idunn (2026). Mothers’ return to work after a first-born child with a disability: evidence from Norway. Scandinavian Journal of Public Health. p. 1–10. doi: 10.1177/14034948261441935. Full text in Research Archive Show summary

  Aims: Previous research has documented the adverse economic consequences associated with caring for a child with a disability. However, less is known about the mechanisms responsible for these negative employment probabilities. To address this knowledge gap, this study examined differences in return to work following childbirth between mothers of a child with and without a disability, as well as the associated sociodemographic and job-related characteristics. Method: We analysed registry data from Statistics Norway. Our study included all first-born children in Norway between 2007 and 2015 and their respective mothers ( n =107,298). Linear probability regression models were used to examine differences in mothers’ return to work after childbirth and its associated factors. Results: After adjustment for sociodemographic and job-related characteristics, mothers of a child with a disability had lower probability of returning to work compared with other mothers. The factors having the strongest association with mothers’ return to work were psychosocial job exposures and educational level. Mechanical job exposures, immigrant background, and divorce status had a moderate correlation with mothers’ return to work. Factors that had a weaker influence on mothers’ return to work were mothers’ age at childbirth, and number of younger siblings. Moreover, educational level, divorce status and mechanical job exposures had differential effects on mothers of a child with and without a disability. Conclusions: Our results suggest that mothers of a child with a disability may experience a more pronounced employment disadvantage than other mothers, even in Norway, where the welfare support for this group of mothers is relatively robust and extensive.

• Austgulen, Marthe Hårvik; Alecu, Andreea Ioana & Roos, Gun (2025). Economic Costs of Raising a Child with ADHD in Norway: A Needs-Based Approach. Scandinavian Journal of Disability Research. 27(1), p. 476–489. doi: 10.16993/sjdr.1283. Full text in Research Archive Show summary

  This article presents an analysis of the everyday costs of caring for a child with a disability guided by the budget standard approach and the theoretical frameworks of human need and capability. The analysis is based on 30 in-depth digital interviews with 15 families raising children with ADHD in Norway. We find that all families interviewed have needs leading to increased economic costs at the household level. However, the estimated cost increase and the associated cost drivers vary substantially between the families, ranging between an approximate 16–67% increase in monthly costs compared to the Norwegian Reference Budget.

• Brekke, Idunn; Alecu, Andreea I.; Ohrazda, Celestia & Lee, Jiwon (2024). Implications of Childhood Autism Spectrum Disorder for Maternal Employment: United States vs. Norway. Maternal and Child Health Journal. 28, p. 1707–1715. doi: 10.1007/s10995-024-03961-z. Full text in Research Archive Show summary

  Objectives A country’s social welfare system may play an important role in maternal employment. This study compared the labor market participation of mothers of children within the United States (U.S.) and Norway to examine whether the child’s age and severity of the ASD affected mothers’ employment differently between the two countries. Methods The 2019 National Survey of Children’s Health was used for the U.S. analysis, and the 2019 administrative register data were used for the Norwegian analysis. A logit model was used to analyze the impact of a child’s age and ASD severity on maternal employment in the U.S. and Norway. We presented the results as average marginal effects obtained from the logistic regression analyses. Results After adjusting for mothers’ sociodemographic variables and the child’s age, U.S. mothers of children with mild ASD and moderate/severe ASD had respectively 12 and 25% points lower probability of being employed than U.S. mothers of children without special health care needs. In Norway, mothers of children with moderate/severe ASD had a 13% points lower probability of employment than mothers without special health care needs. The probability of being employed for mothers caring for a child with ASD was significantly greater as the child got older in both countries. Conclusions for Practice The employment gap was more substantial in the U.S. than in Norway. A general high employment participation rate among women and an elaborated welfare state and policy package seem to benefit employment among mothers of children with ASD in Norway.

• Wondemu, Michael Yisfashewa; Hermansen, Åsmund; Joranger, Pål & Brekke, Idunn (2024). Sickness absence among mothers caring for a child with disability: Examining the impact of mechanical and psychosocial occupational exposures. SSM - Population Health. 25. doi: 10.1016/j.ssmph.2024.101610. Full text in Research Archive Show summary

  Background: Sickness absence is more prevalent among mothers caring for children with disability compared to those caring for non-disabled children. Working in a poor working environment may worsen the impact of care burden on health outcomes among mothers of children with disabilities. Objective: The study investigated how sickness absences are associated with mechanical and psychosocial occupational exposures among mothers caring for children with and without disabilities. Methods: The study included children born between 2005 and 2013 and their respective mothers (N =147, 507). Using register data from Statistics Norway, a Zero-Inflated Negative Binominal Regression was fitted to estimate the relationship between mechanical and psychosocial occupational exposures and sickness absence among employed mothers. Results: Mothers caring for children with disability had higher levels of sickness absences, even after adjusting for psychosocial and mechanical occupational exposures, and other possible confounding factors. When the occupational exposures analysed separately, both mechanical and psychosocial indices had a significant positive main effect on the number of sick days. The main effect of psychosocial exposure was no more significant in a simultaneous analysis, but mechanical exposure maintained its significant positive effect. However, we found no statistically significant differences in the number of sick absence days between mothers of children with and without disability based on their levels of psychosocial or mechanical job exposures. Conclusions: The findings emphasize the need of providing support to mothers caring for children with disability that help them manage occupational health risks.

• Brekke, Idunn; Alecu, Andreea Ioana; Ugreninov, Elisabeth; Suren, Pål & Evensen, Miriam (2023). Educational achievement among children with a disability: do parental resources compensate for disadvantage? SSM - Population Health. 23. doi: 10.1016/j.ssmph.2023.101465. Full text in Research Archive Show summary

  We examined the impact of child disability on Grade Points Average (GPA) using all children aged 15–16 years who completed their lower secondary education and registered with a GPA score in the period from 2016 to 2020 in Norway (n = 247 120). We use registry data that contain information on the child's main diagnosis, such as physical-, neurological- and neurodevelopmental conditions, and the severity of the condition, additional to the child's family characteristics. First, we examined whether the impact of the child's disability on the GPA scores varied by diagnosis and the severity of the child's condition. Second, we examined whether higher parental socioeconomic status (SES) buffers against the negative impact of child disability on GPA scores. Using longitudinal register data with the school fixed-effect model, the results showed that children with neurological and neurodevelopmental disabilities obtained lower GPA scores than their typically developing peers without chronic conditions, however children with asthma and diabetes had comparable GPA scores. These associations were most evident for neurodevelopmental conditions, such as ADHD and autism but also notable for neurological conditions such as epilepsy. In general, a severe condition impacts GPA scores more negatively than a less severe condition. Moreover, our analysis revealed that children of highly educated parents obtained higher GPA scores than children who had parents with short education. This applied to both disabled and typically developing peers, except children with autism and epilepsy, among whom buffering due to the parent's education did not seem to apply.

• Brekke, Idunn & Alecu, Andreea Ioana (2023). The health of mothers caring for a child with a disability: a longitudinal study. BMC Women's Health. 23(1). doi: 10.1186/s12905-023-02798-y. Full text in Research Archive Show summary

  Background Raising a child with disabilities requires a significant parental investment that is greater than that required by typically developing children. Previous studies have shown that parents caring for a child with a disability experience a range of health problems, particularly the mothers. However, few of these studies have controlled for maternal health prior to birth. Methods This study used a sample from the Norwegian administrative register that comprised all children born between 2009 and 2015. We followed the mothers and their children for 11 years, between 2009 and 2019. The outcome variable was the mothers’ physical and mental health, which was assessed using specific ICD-10 diagnoses recorded in the Norwegian Patient Register (NPR). The data included information on the mothers’ health before and after the birth of their first child, enabling us to control for maternal health prior to birth in our analysis, in addition to socio-demographic characteristics. The analyses of maternal health were performed using multiple logistic regression, and the results are presented on both a relative scale (odds ratio [OR]) and an absolute scale (average marginal effect [AME]), both with 95% confidence intervals. Results Mothers caring for a child with a disability have higher odds of having a diagnosis of a musculoskeletal disorder, depression, anxiety, sleeping disorder or migraines than mothers of children without a disability. The differences between the two groups of mothers decrease after adjusting for the characteristics of the children, mothers and families, but remain significant for musculoskeletal disorder, depression, anxiety and sleeping disorder, although the absolute differences are modest. Conclusion The findings suggest that mothers caring for a child with a disability are more likely to have health problems than mothers of children without a disability after controlling for maternal health prior to birth. Providing more support for mothers of children with a disability might help to improve their health.

• Wondemu, Michael Yisfashewa; Joranger, Pål; Hermansen, Åsmund & Brekke, Idunn (2022). Impact of child disability on parental employment and labour income: a quasi-experimental study of parents of children with disabilities in Norway. BMC Public Health. 22(1). doi: 10.1186/s12889-022-14195-5. Full text in Research Archive Show summary

  Background: Caring for children with disabilities has both immediate and long-term economic costs that affect the well-being of children, parents, and society. The purpose of this study was to investigate the impact of child disability on parental employment and labour income by examining differences by parental gender, disability severity, and child age. Methods: The study included children with disabilities born between 2004 to 2011 and their mothers (n = 139,189) and fathers (n = 134,457). Longitudinal data on employment, working hours and labour income was obtained from Statistics Norway, specifically the National Education Database, the Central Population Register and the Event History Database. A quasi-experimental difference-in-differences model was used to examine differences in employment, working hours and labour income. Results: The results showed that caring for children with disabilities has a negative effect on mothers’ labour market participation, working hours and labour income. The more severe a child’s condition is, the more likely the mother was to work and earn less, or to stop working entirely. Additionally, the differences in labour market participation and income between mothers of children with and without disabilities increased as their children reached school age. Labour market participation, working hours, and labour income for fathers of children with less severe disabilities is comparable to those of fathers of children without disabilities. Caring for children with more severe disabilities reduces fathers’ labour income but has no effect on their working hours or labour market participation. Conclusion: Policymakers and child welfare stakeholders should evaluate policy options and provide the necessary welfare support particularly to mothers caring for children with a more severe disability.

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• Dokken, Therese & Finnvold, Jon Erik (2024). Sysselsetting blant foreldre med funksjonshemmede barn. Full text in Research Archive
• Roos, Gun; Alecu, Andreea Ioana & Austgulen, Marthe Hårvik (2024). Economic costs to households raising a child with cerebral palsy. Full text in Research Archive
• Roos, Gun; Alecu, Andreea Ioana & Austgulen, Marthe Hårvik (2024). Everyday household costs of raising a child with cerebral palsy. Full text in Research Archive
• Brekke, Idunn; Alecu, Andreea Ioana; Celestia, Ohrazda & Lee, Jiwon (2023). Implications of Childhood Autism Spectrum Disorder for Maternal Employment: United States vs. Norway. Full text in Research Archive
• Brekke, Idunn & Alecu, Andreea Ioana (2023). The health of mothers caring for a child with a disability: a longitudinal study. Full text in Research Archive
• Alecu, Andreea Ioana; Austgulen, Marthe Hårvik & Roos, Gun (2022). Mind the gap – household costs and consequences associated with disability. Full text in Research Archive
• Brekke, Idunn & Alecu, Andreea Ioana (2022). Health of mothers caring for a child with a disability. Full text in Research Archive
• Finnvold, Jon Erik & Dokken, Therese (2022). Research on the welfare state and social inequality: What status do parents of children with disabilities have as an empirical source? Full text in Research Archive
• Brekke, Idunn; Alecu, Andreea Ioana; Evensen, Miriam; Ugreninov, Elisabeth & Suren, Pål (2022). Educational Attainment among children with a Disability: the impact of family characteristics. Full text in Research Archive
• Austgulen, Marthe Hårvik; Laitala, Kirsi & Alecu, Andreea Ioana (2020). WP 2: Direkte kostnader forbundet med å ha omsorg for barn med nedsatt funsjonsevne. Full text in Research Archive

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