Developmental disabilities represent a large proportion of childhood illnesses and disorders. A disability is any restriction or inability to perform any activity in the manner or within the range considered normal for a human being, which has resulted from impairment (any loss or abnormality of psychological, physiological or anatomical structure or function).
Causes of Developmental Disabilities
Childhood disabilities are a cause of major concern as they cause significant handicap to affected children. According to UNICEF statistics, at least one in ten children is born with or acquires a physical, mental or sensory impairment. What is critical to understand is that as much as 50% of these can be prevented or postponed. The underlying causes may be environmental, genetic or multifactorial and make an exhaustive list. Acquired causes result from an injury to the developing brain, the timing of insult being prenatal, perinatal or post-natal. The common congenital causes include structural anomalies, genetic disorders, inborn errors of metabolism and various dysmorphology syndromes. In quite a large proportion of children, the cause may be unidentified. The conditions which are included in this very broad definition of childhood disabilities include the following, which may occur in isolation or in combination (multiple disabilities).
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Locomotor disabilities: Cerebral palsyOther neuromotor impairments
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Cognitive disabilities:
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Global developmental delay
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Intellectual disability
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Attention deficit hyperactivity disorder
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Learning disabilities
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Social, emotional and behavioral disabilities: Autistic spectrum disorder (ASD)
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Sensory disabilities:
- Hearing impairment (congenital/acquired)
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Visual impairment (congenital or acquired)
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Epilepsy
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Communication disabilities: Speech and language disorders.
What is common to all these disorders is the restriction or inability to perform an activity in the manner or within the range considered normal for a human being. This may lead to limitations or deficits in areas of developmental functioning, such as speech and/or language, motor planning (sequencing of actions or behaviors), social interactions and social relatedness and cognition and perceptual functioning (visual, auditory). As a result, the child fails to interact normally with peers and/or keeps him/her from learning skills or knowledge appropriate for the chronological age.
Classification Systems
Taking into consideration the heterogeneity of the entities which are included in childhood disabilities, it is not surprising that formulation of an optimal classification system is extremely challenging. The International Classification of Impairments, Disabilities and Handicaps (ICIDH), earlier in use used the following definitions:
Impairment—Any loss or abnormality of psychological, physiological or anatomical structure or function.
Disability—Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.
Handicap—A disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual.
In 2001, the WHO introduced ‘The International Classification of Functioning, Disability and Health’ (ICF). This is a universal, multipurpose classification with shift of focus from impairment and disability to health and function. The ICF is a universal, multipurpose classification system of disability and health that defines changes in body function and structure, the level of capacity or what a person with a health condition can do in a standard environment and the level of performance or what they can actually do in their usual environment (Fig. 1.1).
The following definitions are used:
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Functioning: All body functions, activities and participation.
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Body functions: Physiological and psychological functions of the body systems.
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Body structures: The anatomical parts of the body such as organs, limbs and their components.
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Activity: The execution of a task or action by an individual.
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Participation: The involvement in a life situation.
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Disability: An umbrella term for impairments, activity limitations and participation restrictions.
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Impairments: Problems in body function or structure such as a significant deviation or loss.
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Activity limitations: Difficulties an individual may have in executing activities.
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Participation restrictions: Problems an individual may experience in involvement in life situations.
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Environmental factors: The physical, social and attitudinal environment in which people live and conduct their lives.
This workshop will be focusing on developing the ability to differentiate between a specific cognitive disability ‘Attention deficit hyperactivity disorder’ from a specific social, emotional and behavioral disability ‘Autistic spectrum disorder (ASD)’, which often appear similar to the inexperienced pediatrician to whom these children present with one or more of the following delayed development, delayed speech, scholastic underachievement and maladaptive behavior leading to misdiagnosis, delay in establishing an accurate diagnosis and initiation of appropriate intervention.