Question

1. List and define 5 physical or developmental disabilities that might be found in children who are placed in an inclusion setting.

Answer 1

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

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.”[12] 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

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.

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.

Behavioral Disorders

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.[19,20] 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.

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