Unit 1: Concept of developmental disabilities
1.1. Definition of developmental disabilities, developmental disorders, neurodevelopmental disorders, developmental delays - meaning and concept
1.2. Early symptoms of developmental disabilities and risk factors
1.3. Early identification and referral for intervention and support services
1.4. Advantages of early detection and intervention of children with developmental disabilities
1.5. Educational avenues for children with developmental disabilities
1.1 Definition of developmental disabilities, developmental disorders, neurodevelopmental disorders, developmental delays - meaning and concept
Disability is a natural part of the human experience. Differences in ability do not diminish the right of individuals to enjoy the opportunity for independence, productivity, integration and inclusion in the community. The law recognizes people with developmental disabilities require lifelong specialized services and assistance. To eliminate barriers and to meet the needs of people with disabilities, their families and caregivers, supports must be provided in a coordinated and culturally competent manner.
The International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY) regards disability as neither purely biological nor social but instead the interaction between health conditions and environmental and personal factors (8). Disability can occur at three levels:
· an impairment in body function or structure, such as a cataract which prevents the passage of light and sensing of form, shape, and size of visual stimuli;
· a limitation in activity, such as the inability to read or move around;
· a restriction in participation, such as exclusion from school.
The CRPD states that “persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others”
For the purposes of determining eligibility for services and supports the Developmental Disabilities Assistance and Civil Rights Act of 2000 defines the term "developmental disability" as a severe, chronic disability of an individual that is attributable to a mental or physical impairment or combination of mental and physical impairments that are manifested before the individual attains age 22 and are likely to continue indefinitely. Developmental disabilities result in substantial limitations in three or more of the following functional areas: self‐care, receptive and expressive language, learning, mobility, self‐direction, capacity for independent living and economic self‐sufficiency.
The term “developmental disability” is a social construct. The federal definition is based solely on function; however, many state definitions are based on specific diagnostic categories, such as cerebral palsy, autism, epilepsy, traumatic brain injury, and intellectual disability.
People with developmental disabilities have atypical neurological development which results in challenges in some or all of the following domains: 1) cognition, 2) sensory processing, 3) fine and gross motor skills, 4) seizure threshold and 5) behavior and mental health. Strengths and challenges in each of these areas need to be assessed for each individual. People with disabilities are at higher risk for secondary health conditions, such as obesity, falls, dental disease, and dysphagia. Many studies have documented high rates of health problems and hospitalizations among people with developmental disabilities. Studies that include health screenings demonstrate high rates of undetected medical problems that require action. People with developmental disabilities are medically underserved.
Developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person’s lifetime.
Developmental delay: A condition in which a child is behind schedule in reaching milestones of early childhood development. This term is often used as a euphemism for mental retardation, which can be less a delay than a permanent limitation of a child's ability to progress.
Fine and gross motor skill delay
Fine motor skills include small movements like holding a toy or using a crayon. Gross motor skills require larger movements, like jumping, climbing stairs, or throwing a ball. Children progress at different rates, but most children can lift their head by 3 months old, sit with some support by 6 months, and walk well before their second birthday. By age 5, most children can stand on one foot for 10 seconds or longer and can use a fork and spoon.
Exhibiting some of the following signs can mean that your child has delays in developing certain fine or gross motor functions:
Speech and language delay
The language learning process begins when an infant communicates hunger by crying. By 6 months old, most infants can recognize the sounds of basic language. At 12 to 15 months old, infants should be able to say two or three simple words, even if they aren’t clear. Most toddlers can say several words by the time they are 18 months old. When they reach the age of 3, most children can speak in brief sentences.
Speech and language delay aren’t the same. Speaking requires the muscle coordination of the vocal tract, tongue, lips, and jaw to make sounds. A speech delay occurs when children aren’t saying as many words as would be expected for their age. A language delay occurs when children have difficulty understanding what other people say or can’t express their own thoughts. Language includes speaking, gesturing, signing, and writing.
It can be hard to distinguish between speech and language delay in young children. A child who understands things and can express their needs (maybe by pointing or signing) but isn’t speaking as many words as they should may have an isolated speech delay.
Developmental disorders are better called neurodevelopmental disorders. Neurodevelopmental disorders are neurologically based conditions that can interfere with the acquisition, retention, or application of specific skills or sets of information. They may involve dysfunction in attention, memory, perception, language, problem-solving, or social interaction. These disorders may be mild and easily manageable with behavioral and educational interventions, or they may be more severe and affected children may require more support.
There are many causes of developmental disabilities, including:
The clinical features of developmental disabilities are variable in severity as well as in the specific areas of function that are limited. Brief descriptions of the clinical features of each of the broad categories of developmental disability are provided below. It may be noted that children with developmental disabilities are often affected in multiple domains of function because of the nature and extent of brain impairment or increased susceptibility to other causes of disability (e.g., malnutrition, trauma, infection) among children with a single disability.
Cognitive disabilities in children include mental retardation as well as specific learning disabilities in children of normal intelligence. Mental retardation is defined as subnormal intelligence (intelligence quotient [IQ] more than two standard deviations below that of the population mean), accompanied by deficits in adaptive behavior. Grades of mental retardation are typically defined in terms of IQ. Children with mild mental retardation, the most common form, are limited in academic performance and consequently have somewhat limited vocational opportunities. Adults with mild mental retardation typically lead independent lives. Children with more severe grades of mental retardation (moderate, severe, and profound) are more likely to have multiple disabilities (e.g., vision, hearing, motor, and/or seizure in addition to cognitive disability) and to be dependent on others for basic needs throughout their lives.
In contrast, specific learning disabilities result not from global intellectual deficit, but from impairments in one or more of the specific “processes of speech, language, reading, spelling, writing or arithmetic resulting from possible cerebral dysfunction.” Children with specific learning disabilities are usually identified as such only after entering school, where a significant discrepancy is noted between their achievements in specific domains and their overall abilities. With special educational accommodations, these children may learn to overcome their limitations and demonstrate normal or even superior levels of achievement.
Motor disabilities include limitations in walking and in use of the upper extremities (arms and/or hands). Some motor disabilities also affect speech and swallowing. Severity can range from mild to profound. Motor disabilities diagnosed in infancy or childhood include cerebral palsy, which results from damage to motor tracts of the developing brain; paralysis following conditions such as poliomyelitis and spinal cord injuries; congenital and acquired limb abnormalities; and progressive disorders, such as the muscular dystrophies and spinal muscular atrophies. Cerebral palsy results from a permanent, nonprogressive damage or insult to the developing brain. Affected children therefore may manifest a variety of motor dysfunctions, depending on the specific location of the damage. Involvement of the motor cortex produces spasticity, while involvement of the cerebellum results in hypotonia with or without ataxia. Involvement of the basal ganglia leads to dyskinesia and dystonia. Individuals with cerebral palsy often have other disabilities as a result of concomitant insults to various areas of the brain. Such disabilities include mental retardation, learning disabilities, epilepsy, language disorders, and behavioral problems. Similarly, some of the progressive motor disorders, such as muscular dystrophy, can be accompanied by cognitive disabilities. In contrast, in many forms of paralysis, such as that due to poliomyelitis or spinal cord injury, and congenital or acquired limb abnormalities, the disability is more likely to be restricted to motor skills or mobility.
HYPOTONIA Hypotonia is the most common symptom of motor dysfunction in newborns and infants. The child's developmental assessment should include the quality of the pregnancy, including the onset and vitality of fetal movements and problems during labor and delivery. The child's presentation in the neonatal period should be described, with special attention to the family history to document the potential for genetic disorder.
The key to diagnosing a hypotonic infant is a neurodevelopment examination. The challenge in correctly diagnosing a "floppy" child lies in distinguishing between central and neuromuscular hypotonia. A hypotonic infant who is not weak has low tone because of a central nervous disorder. Weakness strongly implies neuromuscular involvement. Normal or increased deep tendon reflexes suggest central hypotonia.
FINE-MOTOR ADAPTIVE DELAY If there is a delay in fine-motor adaptive development combined with delays in other developmental domains, the doctor will consider whether the child is visually impaired or mentally handicapped. It is important to assess the eyes and visual acuity of a child presenting with delayed fine-motor adaptive development.
If the delay occurs mainly in one developmental area, the child may have hemiplegia, a brachial plexus injury, such as Erb's or Klumple's palsy, or a broken clavicle. All symmetries of movement in the first two or three years should be watched.
In older preschool or elementary school children with fine-motor delays, developmental coordination disorder or a disorder of written expression may be causal. Developmental coordination disorder presents in about 6 percent of all children. It is often associated with attention deficit hyperactivity disorder or a learning disability.
PERSONAL AND SOCIAL DELAY When a child presents with personal and social delays, the doctor will consider whether the child has developmental cognitive disability, has autism, or is living in an environment of abuse, neglect, or deprivation.
Vision, Hearing and Speech Disabilities
The prevalence of low vision, blindness, and hearing loss increases with age, making these disabilities conditions that affect primarily adults. A number of important causes of vision as well as hearing disability have their onset early in life, however, and may be considered neurodevelopmental (as discussed further below). Refractive errors, the most common form of vision impairment, are especially problematic for children in low-income countries because eyeglasses and basic vision care services are unavailable to many. However, refractive errors are readily amenable to low-cost methods of diagnosis and intervention, which can become a component of primary care screening services.
Learning to speak depends on the ability to hear and repeat sounds. The optimal period for speech acquisition is the first 2 years of life; a child who does not speak by the age of 5–6 will have difficulty developing intelligible speech thereafter. It is therefore important to screen young children for hearing impairment and to evaluate the hearing of a child who is suspected of having mental retardation or delay in speech development.
In most of the developing world, resources for mental health care are far more limited than those for physical care. Therefore, the majority of children with psychological or behavioral disorders go undiagnosed or untreated. Although formal data are lacking, it is probable that behavioral problems are more common in low-income than in wealthier countries because of the excess prevalence of poverty, war, famine, and natural disasters in the developing world. Moreover, recent social transformations and rapid urbanization in many low-income countries have produced adverse effects, such as residential displacement and disruption of traditional family systems, that have in turn resulted in large numbers of homeless and displaced children. Behavioral disorders not necessarily linked to psychosocial precursors include autism and attention-deficit and hyperactivity disorders. These disorders can have profound effects on academic achievement and on families. Current research is seeking to identify structural and functional correlates in the brain for a range of behavioral disorders.
Developmental delay and developmental disability are two distinct concepts. Developmental delay is often defined as a deviation from normative milestones; this may be in terms of delayed cognitive, language, motor and/or socio-emotional development. The term developmental disabilities covers a range of childhood conditions and is used differently across different settings and cultures. In this article we define developmental disability as a heterogeneous group of conditions that can impact on the development of children's function (e.g. sensory, cognitive, physical), with a very wide range of effects. Developmental disability is the most common cause of childhood disability, with an estimated 53 million children <5 y of age living with developmental disabilities globally. This estimate is based on only six conditions (epilepsy, intellectual disability, vision loss, hearing loss, autism and attention deficit hyperactivity disorder) and on present reporting of these conditions. It is likely therefore that the true number of children with developmental disability is much higher than this estimate, particularly if a broader age range is considered.
1.2 Early symptoms of developmental disabilities and risk factors
Skills such as taking a first step, smiling for the first time, and waving “bye-bye” are called developmental milestones. Children reach milestones in how they play, learn, speak, behave, and move (for example, crawling and walking).
Children develop at their own pace, so it’s impossible to tell exactly when a child will learn a given skill. However, the developmental milestones give a general idea of the changes to expect as a child gets older.
As a parent, you know your child best. If your child is not meeting the milestones for his or her age, or if you think there could be a problem with the way your child plays, learns, speaks, acts, or moves, talk to your child’s doctor and share your concerns.
Developmental disabilities begin anytime during the developmental period and usually last throughout a person’s lifetime. Most developmental disabilities begin before a baby is born, but some can happen after birth because of injury, infection, or other factors.
Most developmental disabilities are thought to be caused by a complex mix of factors. These factors include genetics; parental health and behaviors (such as smoking and drinking) during pregnancy; complications during birth; infections the mother might have during pregnancy or the baby might have very early in life; and exposure of the mother or child to high levels of environmental toxins, such as lead. For some developmental disabilities, such as fetal alcohol syndrome, which is caused by drinking alcohol during pregnancy, we know the cause. But for most, we don’t.
Following are some examples of what we know about specific developmental disabilities:
1.3 Early identification and referral for intervention and support services
Early Identification refers to a parent, educator, health professional, or other adult’s ability to recognize developmental milestones in children and to understand the value of early intervention.
The earliest years of a child's life are critical. These years determine child's survival and thriving in life, and lay the foundations for her/ his learning and holistic development. It is during the early years that children develop the cognitive, physical, social and emotional skills that they need to succeed in life. The World Health Organization (WHO) states that early childhood is the most important phase for overall development. Factors like disability and malnutrition pose particularly difficult challenges. However, if these problems are solved at an early age, it minimizes developmental risks and enhances child development.
However as per guidelines of IDEA (Individuals with establishing the socio-demographic profiles & the Disabilities Education Act) of United States, "Early pattern of clinical features in children attending EIP. The intervention services are designed to meet the study also sought to assess the profile and expectations of developmental needs of children, from birth to three years people who attended the clinic with the long term of age, who have a delay in physical, cognitive, objective of modifying the program as per their needs. communicative, social, emotional or adaptive development or have a diagnosed condition that has a high probability of resulting in developmental delay"Individuals with (Disabilities EducationAct, 2001.
If children with developmental delays or disabilities and their families are not provided with timely and appropriate early intervention, support and protection, their difficulties can become more severe often leading to lifetime consequences, increased poverty and profound exclusion. Typical development is sometimes a struggle. Everyone likes to think that all babies will be okay, that parents will have nothing to worry about. But the reality is that not all babies will keep up, and some will continue to fall further and further behind. Science demonstrates that intellectual and cognitive potential is determined by how the brain develops during the first few years of life. The brain controls the biological effects of all the other organ systems and influences cognition, intelligence, learning, coping and adaptive skills, and behaviour. Because the brain controls these different aspects of human life, impaired brain function leads to impaired physical, mental, and emotional health and decreased functioning in society. Therefore, investments in early childhood to support healthy brain development help to reduce societal costs in remediation, health care, mental health services, and increased rates of incarceration.
There are a number of reasons for this early identification:
· Early Identification leads to early intervention, which is considered essential in remediation.
· The children have not yet faced academic failure therefore it becomes easier to work with them as they still retain their motivation to learn.
· At that young an age they have not developed the compensatory strategies, which will later form barriers in the remedial process.
Research has shown that children who received assessment and remedial services at a younger age were better able to cope with the disability and had a better prognosis than those who received help later.
“Screening (including developmental and health screening) includes activities to identify children who may need further evaluation in order to determine the existence of a delay in development or a particular disability. Evaluation is used to determine the existence of a delay or disability, to identify the child‘s strengths and needs in all areas of development. Assessment is used to determine the individual child‘s present level of performance and early intervention or educational needs”. [Boyle et al, 2011]
It is usually these teachers who do the screening through their informal measures including classroom tests. They are the ones that observe the students over a period time and can talk of a pattern of behavior, which is so important in the assessment process. Therefore it is appropriate to say that the assessment procedure requires input form both informal measures adopted by teachers for screening and tracking the progress of the student and the formal tests that firmly establish the diagnose and provide the standards for comparison.
Referral is the initial request to consider a student for a special education evaluation.
It is usual for classroom teachers or parents to make the initial request. This is a follow up of observations over a period of time and collection of initial impressions about the student‘s performance that causes concern. Once a student has been identified by the classroom teacher as showing signs of disabilities, the process of referral is begun. The stages through which the process is completed are as follows:
1.4 Advantages of early detection and intervention of children with developmental disabilities
Early identification of infants at risk for developmental delay is of the utmost importance to initiate appropriate intervention. Although early detection can be a challenge, the primary care practitioner is in the ideal position to recognize and refer these children. Early recognition requires an in-depth knowledge of the child's history, general physical examination, and developmental level and an understanding of the expected developmental precursors of a skill. Referral to appropriate interventional resources leads to a formalized developmental and neurologic evaluation. If necessary, the development of an interdisciplinary comprehensive plan of remediation can occur and a definitive diagnosis can be made. If no significant problem is found, a decision to provide expectant observation is warranted.
1. Early Intervention improves and enhances the development of a child with developmental delays, special needs, or other concerns.
2. Early Intervention provides assistance and support to empower families of children with developmental delays, special needs, or other concerns.
3. Early Intervention lays a foundation that will improve the life of the child and offer greater opportunities.
Early intervention is a set of services designed to help babies and toddlers who may be experiencing developmental delays or disabilities. Early Intervention provides eligible babies and toddlers with help in acquiring skills that typically develop during the first three years of life. These include:
· Physical skills like reaching, crawling, and walking
· Social skills such as playing and interacting with others
· Communication skills including listening, understanding, and talking
· Problem solving and cognitive skills, including learning
· Self help skills like eating and dressing without help
Developmental delays may occur in one or more areas, making a child eligible for services tailored to meet the individual needs and priorities of the child and their family.
Early identification of children with developmental disabilities, as well as early childhood intervention (ECI), improves children's opportunities to maximise their developmental potential and functioning as well as their quality of life and social participation. Early identification and intervention are two distinct complementary strands; timely identification of children with developmental disabilities is required for early intervention, which strengthens the cumulative process of development, helping children acquire new skills and behaviours to reinforce and strengthen learning. In addition, some ECIs may have wider benefits for caregivers, such as through establishing support, thus helping build their knowledge, confidence and coping strategies, with positive impacts for their mental health.
ECI for children with disabilities can comprise a range of coordinated multidisciplinary services and can take many forms, including hospital- or clinic-based care, school-based programmes, parenting and community support and home-based childhood therapies. In high-resource settings, we know that family-centred interventions are more likely to result in the greatest satisfaction with services and improve psychosocial well-being for the child and caregiver. With regards to impact, a systematic review of ECIs for children at risk of cerebral palsy demonstrated improved cognitive outcomes up to preschool age and improved motor outcomes during infancy, although variability in interventions limited the identification of which interventions are most effective.
While both inclusive and targeted efforts for children with disabilities at the level of early childhood centres have increased, weak country health systems and conflict settings are major impediments to delivering high-quality services. There remains a need for inclusive approaches for children with developmental disabilities in mainstream services, as well as within specialist ECIs. This means that the role of families can be particularly crucial to fill existing gaps in service availability.
1.5 Educational avenues for children with developmental disabilities
Historically international development and global health communities have focused on preventing health conditions associated with disability. Some health conditions that arise during pregnancy and childbirth can be avoided by good preconception, prenatal and perinatal care. Public health initiatives play a major role in preventive efforts. Such initiatives include: childhood vaccinations; child health, nutrition and education campaigns; and decreasing the exposure of young children to diseases that may lead to impairments such as malaria and trachoma, as well as to childhood injury.
The priority for children who have disabilities is to ensure that they remain as healthy as possible so they can grow, thrive and develop. While children with disabilities often have specialized health-care needs related to their disability, they are also at risk of the same childhood illnesses as other children such as influenza, diarrhoea, and pneumonia for which they require access to mainstream health-care services. Children with disabilities are also at an increased risk of secondary conditions related to their disability. Children who are wheelchair users, for example, are vulnerable to pressure ulcers. Many of these conditions can be addressed by mainstream health-care services.
Primary health care is a natural starting point for identifying and addressing the needs of children with disabilities, with appropriate referral for more specialized needs where required. Primary health-care workers can assist in the identification of children with disabilities, who are often hidden in their communities and denied access to health care, and support their inclusion in health-care activities such as immunizations. Where possible all centre-based health services should incorporate early identification, intervention and family support components as part of existing services. Food and nutrition programmes should also include children with disabilities and should be designed with consideration given to any specific digestive problems and nutritional requirements that may be associated with their disability.
Inclusive education is a process of strengthening the capacity of the education system to reach out to all learners—including those with disabilities—and can thus be understood as a key strategy to achieve EFA. As stated in Article 24 of the CRPD, children with disabilities should not be excluded from the general education system on the basis of disability and should have access to inclusive, quality and free primary and secondary education on an equal basis with others in the community in which they live.
Inclusive pre-school and early primary schooling offers children with disabilities a vital space in which to ensure optimal development by providing opportunities for child-focused learning, play, participation, peer interaction and the development of friendships. Children with disabilities are often denied early years of primary schooling, and when enrolled—due to a lack of inclusive approaches and rigid systems—they often fail, need to repeat and/or are encouraged to dropout during this critical developmental period.
The CRPD and EFA initiatives promote inclusive education for all children, including those with disabilities and call for the provision of assistance to ensure full and meaningful learning and participation. In many countries separate schools exist for children with certain types of impairments, for example schools for deaf or blind children. However, these schools usually accommodate a limited number of children, often lead to separation from the family at an early age, and fail to promote inclusion in the wider community. In some countries children with disabilities attend mainstream pre- and primary schools, however, they are segregated into special classrooms or resource centres which are staffed by teachers trained in special education.
Education for children with disabilities should focus on inclusion in mainstream settings. While inclusion is consistent with the rights of children with disabilities and is generally more cost effective than special or separate schools, it cannot happen without appropriate levels of support. While additional investments are required, such as progressive national and local policy, trained staff, accessible facilities, flexible curricula and teaching methods, and educational resources, these investments will benefit all children.
For all inclusive early childhood education and learning interventions, positive attitudes and responses from and interactions with peers, teachers, school administrators, other school staff, parents and community members are critical. Assessing and monitoring ECD and school environments for promoting inclusion is an important part of guaranteeing appropriate educational opportunities for children with disabilities. Multisectoral approaches with effective coordinating mechanisms between such sectors as education, health and social welfare are required to ensure early identification efforts, promote holistic responses and link school-based learning with home and community interventions.
Parents/caregivers of children with disabilities, particularly mothers, need to have an adequate degree of economic security, access to resources and to basic services including health, nutrition and education, and protection from violence in order to be able to act on behalf of themselves and their children.
Children with disabilities and their family members require access to social services such as: child protection systems; support and assistance services; and social welfare services and benefits. Inclusive social protection recognizes how the social dimensions of exclusion, including disability, can be barriers to security and essential social services. In this sense, social protection programmes may support families of children with disabilities allowing them to overcome financial and social barriers to access basic and essential services. Such programs include: the utilization of existing social transfers such as conditional cash transfers; anti-discriminatory legislation; and policy reform. It is important that conditional cash transfers do not exclude children with disabilities due to conditions that families cannot fulfil.
Guaranteeing the systematic support and protection for children with disabilities and their families requires on-going coordination between health, education, child protection, ECD and other social services. This should include the incorporation of specific early intervention actions as part of the regular delivery system as opposed to structuring separate or parallel services for children with disabilities.
Special school concept is an accepted model of education for persons with disabilities throughout the world. As on today, more than 3000 special schools and institutions for the disabled children are functioning in India. Among them, approximately 900 are institutions for hearing impaired children, 400 for children with visual impairment, 1000 for mentally retarded and there maining 700 for children with other physical disabilities (UNIISED Report 1999).
The population of children with disabilities in the school-going age group, as per the RCI’s Manpower document is as follows: Visually Impaired-0.12millionHearingImpaired-0.65 Million; Mentally Retarded-3.61million; loco motor Handicapped -3.39 million though the population is huge, the coverage of these children in special school setting is rather low. Therefore, alternative approaches are emerging. Integrated education is one such alternative strategy. Integrated education emerged out of compulsion rather than option.
In special school concept, special education component is APART from the general education system. Whereas in integrated school, special education is A PART of general education. Inclusive school goes one step further. In this approach, special education is an integral part of general education system. Therefore, inclusion is an ideology and not a programme. Inclusive education approach indicates that the general classroom teachers should be fully equipped to take care of the educational needs o disabled children.
A good method of teaching is based on multi sensory approach, whether teaching disabled or non-disabled children. While teaching the teacher should bear in mind that children with disabilities have reduction in the range and variety of some learning experiences due to their disabilities.
As inclusive education is one of the most viable options to increase educational opportunities for persons with disabilities, a through curricular adaptation is needed for creating better learning environment. As far as possible, the curriculum need not be changed for disabled children since it would work as a criterion for segregation. Adoptions in terms of methods of Presentation display, content, etc. may be necessary to enhance the learning experiences of these children. This approach not only helps children with disabilities, but also helps the teacher to assist children who have learning problems.
Concepts development is fundamental in education of children with disabilities, particularly for those who are cognitively impaired such as mentally retarded children and sincerely impaired such as visually and/or hearing impaired. Loss of one sense of the child adversely affects the concepts development of these children.
education for the Disabled be promoted:
First things first; parents of disabled children should be made aware that disabled children are educable. Hence parents should make concerted efforts to seek for information about education of their children. Notwithstanding the fact that DPOs should also be in the forefront in disseminating information on disability issues and rights. There should also be training institutions of specialist teachers for streamlined Special Schools and Mainstream classrooms. Teachers, especially specialist teachers are important if promotion of education and training for the disabled people is to be realized. Deliberate screening exercises countrywide in order to have a range of disabilities to be catered for.
Early childhood intervention (ECI) should be an integral part of existing health, education and social system actions for all children. The provision of intervention programmes as early as possible can result in positive outcomes for children with disabilities and their families and can address the multiple factors of exclusion. There is growing evidence that children who receive ECI and other services show gains in a wide range of skills, greatly enhancing their abilities to flourish when they begin formal education and thus justifying the greater costs that such targeted interventions might entail. In addition to enhancing children’s developmental competencies and minimizing secondary complications, ECI programmes can help to build effective support networks for parents, promoting confidence and competence. ECI programmes that coordinate services across different sectors, such as health, education, and social protection/support, are sustainable over time, and support children and families as they move from early childhood into successful primary school experiences are particularly desirable.
Therapy services aim to optimize a child’s development and ability to participate in family and community life by providing structured opportunities to practice skills appropriate to the child’s current developmental level. Service provision should include a combination of centre- and home-based interventions with the active involvement of parents and/or other family members. Where available, CBR programmes can assist in establishing a bridge between centre-based services and the home environment. Therapy interventions for young children include: therapeutic activities based around play and other activities; functional training to work on skills required for independence in everyday activities; education for parents to help them better understand their child’s disability and their role; prescription and provision of assistive devices including user training; and modifications to the home and school environments. Interventions that allow the acquisition of even basic skills, such as helping a child with a disability learn to feed or dress himself or herself, can lead to a growing sense of independence and competency and reduce the burden on other family members.
Families are critical to the development and protection of their children and a close child-caregiver bond is important for both children with and without disabilities. Inclusion begins in the home environment during the early years and later broadens to school and community settings. Family services should aim to provide families with the knowledge, skills and support to meet and advocate for the needs and rights of their child in all settings. Service providers must work closely with families to design and implement interventions that are culturally appropriate and meet their needs.
Following early identification and assessment, many parents/caregivers of children with disabilities will require information about their child’s disability and development progress, what steps they can and should take, and the resources available for support and treatment. Recognizing that formal assessment processes are often delayed or not available, the provision of information for parents is critical during the early stages of support and intervention. Information should be furnished in ways that educates parents and other family members and that promotes constructive dialogue within the family and community.
Fathers, siblings and other extended family members often play a significant role in caring for and supporting children with disabilities. Overlooking this potential support often places additional burdens on mothers. An approach which encourages father/male involvement and promotes competency building would significantly enhance families’ abilities to care for children with disabilities.
Group discussions, one-on-one listening, support groups for parents of children with similar disabilities and other potential interventions can provide opportunities to share experiences and encourage peer support and guidance. The use of stories that feature children with disabilities as protagonists is one way to demonstrate to all family members, including the child with a disability, that many capabilities are present and should be cultivated. Promoting appropriate activities that caregivers and children with disabilities can do together to improve developmental outcomes in children with disabilities is essential. Home visits by community workers combined with centre-based support can be an effective way to increase the confidence and competencies of parents and engage significant others in supporting the development of children with disabilities. Providing literacy and educational opportunities for adolescent girls and mothers can also have a direct impact on improving their care-giving competencies.
Organizations of and for families with children with disabilities can be an important resource for parents and other family members, allowing them to learn from others in similar situations and providing them with relevant information and support. Links with disabled people’s organizations (DPOs) can: provide a network of support; provide information, guidance and advice; expand collective advocacy and public demand efforts; and connect parents and children with other people with disabilities who may serve as role models.
 Inclusive social protection entails using instruments that explicitly promote social inclusion and equity, and ensuring that programme design and implementation are sensitive to the added vulnerabilities that stem from social exclusion. This implies moving away from targeting particular groups and looking at the underlying causes of exclusion and vulnerabilities these groups share: discrimination and stigma; traditional social norms preventing use of services; limited assets and visibility, etc (70).
Assistive devices that children with disabilities might require include mobility devices (e.g. crutches, wheelchairs, orthoses and prostheses); visual devices (e.g. white canes, eyeglasses, Braille systems and talking books); hearing devices (e.g. hearing aids); communication devices (e.g. communication boards and electronic speech output devices); cognitive devices (e.g. diaries, calendars and schedules); and daily living devices (e.g. adapted cutlery and cups, shower seats and commodes) (60).