By Ambika Sosale, M.Sc.
This article first appeared in the Nursing Digest (Jan-March 2016 Vol. 4 No. 1)
According to the World Health Organization (WHO), over 1 billion people around the world experience disabilities. The 2011 Census of India reported 2.21% of India’s population, i.e., over 26 million Indians as having a disability. With increased awareness, medical advancements and lifestyle changes the diagnosis of the number of persons with disabilities is steadily rising. Effective treatment of disabilities is the key to helping persons with disabilities to cope. When it comes to children with disabilities, early intervention is of utmost importance. This takes advantage of the plasticity of the brain.
Definition of Disability:
To understand the term “disability”, we must look at the meaning of development. Development is the pattern of change that begins at conception and continues through the life span. When there is a disruption to a largely common pattern of development, a disability occurs. The WHO defines disability as an umbrella term for impairments, activity limitations and participation restrictions.
“Disability refers to the interaction between individuals with a health condition (e.g. cerebral palsy, Down syndrome and depression) and personal and environmental factors (e.g. negative attitudes, inaccessible transportation and public buildings, and limited social supports).”
Classification of Disabilities:
Disabilities are classified based on which abilities of a person are most affected.
- Physical Disabilities: These are disabilities that affect a child’s movement and limb function. Physical functioning of the body is the major limitation. It can be present at birth (e.g., Cerebral Palsy, Spina Bifida) or occur later due to disease (e.g., Meningitis) or accident. Children with physical disabilities may require adaptations such as wheel chairs, custom shoes and ramps in buildings to perform daily functions.
- Intellectual Disability: The term Mental Retardation is no longer in use and has now been replaced with Intellectual Disability. Intellectual Disability or Intellectual Deficiency refers to below average functioning of a child’s mental and adaptive capacity based on standardized IQ tests. Intellectual Disabilities can be present from birth or appear later due to disease or brain injury. The causes of Intellectual Deficiency are varied and include genetic (in Down Syndrome) and environmental (in Fetal Alcohol Syndrome) factors. Diseases such as Measles, if not treated on time can also cause Intellectual Disability. Children with Intellectual Disability may have delayed milestones and take longer than usual to sit, crawl, stand, walk or speak. They show a reduced capacity to learn compared to neurotypical children. They also take time to process and learn information and require several repetitions to be able to do so. Depending on the extent of their deficiencies, some children with Intellectual Disability are able to complete their education with an adapted curriculum.
- Neuro-developmental Disabilities: These are a set of disorders present from birth which are caused due a different pattern of ‘wiring’ of the brain. They include Specific Learning Disabilities, Autism and ADHD. Sometimes Intellectual Disability is also incorporated under this classification. Children with Neurodevelopmental Disability have impaired learning, social and memory abilities. As the name suggests it affects the normal developmental trajectory of a child. The causes of these disorders are not clear yet and there is no known cure. However, researchers have discovered ways to help these children cope with their limitations at school, home and social situations. How far a child is able to integrate into mainstream activities depends on the severity of the disorder and the strength of the support system available.
- Speech-Language & Hearing Disabilities: Difficulties with producing speech, communication and understanding of language is identified as a Speech-Language Disorder (E.g., stammering, articulation difficulties). Partial or complete impairment to hearing (deafness) is a Hearing Disability. Often speech and hearing difficulties go hand-in-hand as the ability to speak and listen are closely related. Causes of speech-language and hearing impairments are many. It could be due to congenital factors, neurodevelopmental disorders, illness, accident or emotional trauma. Augmentative and alternative means of communication (E.g., sign language, hearing aids, symbols, pictures) all aid children with Speech-Language or Hearing Disabilities function in day-to-day situations.
- Visual Disability: Partial or complete impairment (blindness) to the ability of a child to see is called Visual Disability. Children with vision problems can see partially, have blurry vision or be completely blind. Just as in the case of most disabilities the cause of visual impairment can be due to illness, accident or congenital problems. In some cases, restoration of vision may be possible. If not, children with a Visual Disability use assistive aids that include but are not limited to a white stick, guide dogs, Braille transcribed or audio recordings of learning material. Many modified materials required for classroom learning are also available for children with visual difficulties. Some children with a Visual Disability attend mainstream schools if the school provides additional support.
- Chronic Illness: Children suffering from chronic illnesses, e.g., cancer, diabetes, epilepsy, heart disease etc., experience significant challenges in daily functioning caused by their illness. These difficulties may include difficulties with movement, energy levels, medication side effects, learning capacity, speech, hearing or language difficulties. When the problem caused by chronic illness is severe enough to cause impairment to a child’s ability to adjust to the environment it becomes a disability. Some chronic illnesses are life threatening. Coping with chronic disease can lead to emotional disturbances for the child and her family. Counseling and guidance must be provided to ease the challenges of living with a chronic illness.
- Brain Injury: Traumatic brain injury refers to damage to the brain that occurs after birth. It may happen as a result of a serious accident, near drowning or seizures. It can also occur due to physical abuse, falls and sports injuries. The symptoms of brain injury depend on the area of the brain affected. Brain injury can result in any of the disabilities mentioned above. Treatment options are chosen accordingly.
- Psychiatric Illness: A mental illness is often unseen but can cause as much, if not more, interference to a child’s functioning as a ‘visible’ disability. In fact, research shows that 50% of mental health issues have their origins before the age of 14 years. Psychiatric illnesses that occur in childhood may include schizophrenia, anxiety disorders, depression, eating disorders and bipolar disorder. There is no concrete cause but a combination of biological, environmental and psychological risk factors contributes to developing a mental illness. These mental health concerns cause significant challenges in social functioning, learning at school or ability to complete daily routines. Treatment often involves a combination of medication and psychotherapy.
Whatever the type of disability a human rights perspective necessitates equal opportunity for all. It is imperative for adults who come in contact with children to be aware and recognize signs and symptoms of disabilities. This will ensure early intervention and treatment. There are still no known causes or cures for many disabilities discussed in this article. However, awareness of disabilities coupled with a knowledge of intervention strategies go a long way in helping children with disabilities play a meaningful part in society. Disability only refers to functional impairment to a child’s ability to perform certain tasks. This should not deny them equal participation and inclusion.
Santrock, J. W. (2007). Child Development. New Delhi: Tata McGraw-Hill Publishing Company Limited.