UNIT 7 CHILDREN WITH MENTAL

. RETARDATION
Structure

7.1 Introduction
7.2 What is Mental Retardation ?
7.3 Degrees of Mental Retardation
7.3.1 Characteristicsof Children with Mental Retardation
7.4 Mental Retardation is not Mental Illness
7.5 Identifying a Mentally Disabled Child
7.5.1 Child's Appearance
7.5.2 Child's Behaviour
7.5.3 Milestones of Development
7.6 Causes of Mental Retardation
7.6.1 Genetic Factors
7.6.2 Environmental Factors
7.7 Working with a Mentally Disabled Child
7.7.1 Some Principles
7.7.2 Beginning Training at Home
7.7.3 Working with the Child in the Centre
7.8 The Parents' Perspective
7.9 Let Us Sum Up
7.10 Answers to Check Your Progress Exercises

7.1 INTRODUCTION
In Unit 4 of this Course, titled 'Understanding Special Children', you would remember
reading about body functions crucial for the nonnal working of human beings. Among
them, intellectual functioning was mentioned asone. In this Unit, we shall read in detail
about lowered intellectual functioning that makes a childperson have certain special needs.

Think of a girl who is 14 years old. Let us say her name is Mamta. She lives with her
parents and two brothers, both younger to her. Mamta goes to school, but she is in class
III and not class IX,like many other children of her age. She could notjoin school till she
was 7years old. After that, it took her six years to reach class III. Mamta could not walk
till she was 2%years of age and she did not speak much till she was 5 years old. Her
mother says that for simple things like eating, washing hands, dressing and putting on
shoes. Mamta had to be helped till she became 12 years old. Only in the last two years,
Mamta had learnt t6 be a little independent.

Marnta, at 14 years of age, can do most things that most children do by 6 or 7years of age.
She understands those school lessons which 8 years ol& study. l t is quite clear that
Mamta 's mental abilities are not in keeping with her age. Intellectually, she performs at a
much lower level than other children of her age. Mamta is mentally disabled-or slowed
down in intellectual functioning-in comparison with other children of her age. This
condition is commonly referred to as mental retardation.

Objectives
After studying this Unit, you should be able to
explain the term 'mental disabilitylmental retardation'
realize that there are degrees of mental retardation
identify a mentally disabled child
Chlldren with Special a help the parents understand the causes of mental disability and how it can be
-
Needs 2 prevented
a explain to the parents how to begin training the child at home
a make adjustments in your method of working at the centre, so as to be able to
accommodate the needs ofthe mentally disabled child.

7.2 WHAT IS MENTAL RETARDATION ?

Wben then is a l o w e d capacity for mental work of a permanat nature, it is called
mental retardation or mental disability. Mental disability is a condition that slows
down mental and physical growth. It is not an illness or a disease, but a condition due to
inadequate deve1opmnt of the brain. Children who have this condition are called dull or
mentally retarded. A child can be born mentally disabled, or become mentally disabled
during or a€ter birth.

Just as the child's body grows and develops in a manner appropriate to her age, the mental
abilities also expand in accordance with age. The rate of development of the mental
abilities of the child is known as her 'mental age'. In normal children, the age in years
(also r e f d to as chronological age) and mental age go together. If a child is described
as having normal mental development, it means that she has the same level of m d
abilities as the majority of normal children of that age. But in a mentally retarded child,
then ir a slowing down in the developmenfof the mental abilities, and the mental age
is loner than chronological age. For example, a child who is 6 years old may have the
mind ofa 3 year old. A mentally disabled child is slower than a normal child to walk,
cat, talk lad to reach other mikBtOnes of development. A mentally disabled child who is
five years old may act, talk and behave like a three year old, a two year old or wen younger.
Some mentally disabled children grow faster as compared to others like them. But
development of all mentally disabled children is slow as compared to normal children of
their age.

OM way of knowing that a child is rPtarded is that development in many areas of

functioning would be affected. Development in many areas would proceed slower than
what is expected of a child of that age. Some of the areas that are usually affected are :-

i) Communication
The mentally disabled child has diffculty in communicating with others, both through
speech and action In fhd, a m d e d child learns to speak later than other children. The
child has poor vocabuhy and has articulation problems. The speech may be unclear and,
thenfore, may be incomprehensible to the listener.

ii) Motor Development

There is lack of coordination in gross and fine motor movements. The milestones of motor
development are delayed.

iii) Self Care

The child with mental retardation takes longer to learn to look after her own daily needs,
such as eating, bathing, dressrng and going to the toilet.

iv) Social Skills

The mentally disabled child finds it diiTicult to deal with other people. She develops the
skills of interacting with other children and adults through training and conscious effort.

v) Self-direction
?Rere is a lack of direction in retarded children's actions. They may ho something without
purpose, such as rock themselves whilesitting or carry on doing something for no reason.
 vi) Health and Safety Children with Mental
Retardation
Many of these children require help from others to look after their health and safety even
a e r they are grown up. Some people with mental discrbility/retardationcannot be left
alone in a place which is not safe, even when they are adults.

vii) Academic Work

Generally, when children do not learn to read and write at the expected age, we consider
that their mental development is slow for their age. Some may never be able to attend
formal school due to their mental limitations, while others may take longer compared to
their agemates, to complete primary level education. There is a wide range of abilities even
among children we call 'retarded'. We shall come back to this aspect in a short while.

viii) Leisure and Work

Mentally retarded children are often unable to use recreational facilities and other
opportunities for enjoyment. They may also lack the initiative to,take up work
independently. They are easily distractable and, therefore, tend to be careless. Therefore,
they q u i r e the assistance of family members, n e i g h h or social workers.

Reading through the above description of areas of limitation may give one the impression
that mentally disabled children cannot do anything. This is not true at all. They are capable
in many ways. Besides, all children with mental r e t a r d a h will not have a difficulty in
all these areas. Also, the extent to which development will be aEected in these areas varies
from child to child. This will depend on the child's degree of retardation. The level of
retardation may vary from high to low. It is this fact that determines, to a large extent, the
level of functioning ofthe child. This is what is meant in the above sentence that 'there is a
wide range of abilities even among children we call retarded'.

7.3 DEGREES OF MENTAL RETARDATION

I! Broadly, mental n&udation is divided into four categories based on the level of intellectual
and social functioning of the child. A child may have mild, moderate, severe or profound
degree of mental retardation.

l a) Mild Retardation
When the mental ability of the child is more than half but less than three-fourths of that
expected of her age, she is mildly retarded. For example, a girl of 10 years having mental
abilities and behaviours of a 6-7 year old.

b) Moderate Retardation
When mental development is more than one-fourth but less than half of what is expected for
that particular age; the child is said to be moderately retarded. For example, a child of 12
years having mental &ilities of 4-5 years.

c) Severe and Profound Retardation

When the men& growth is a little less than one-fourth of that e-ed 'for a particular age,
the retardation is severe. Beyond that, it is called profound retardation.

In the table given below, let us see what the main charakteristics of children Ath different
degrees of mental retardation are that can help us differentiate them from normal children.
Children wltb Special 7.3.1 Characteristics of Children with Mental Retardation
-
Needs 2
Tlbk 7 (a) : Characteristics of Children With Mental Retardation

-Of During Preschool Age During School Age

~ e n t r~o
l (0-5 ~ k ) . (618 YM)
tardation

Mild ' Often not setn as diffetent from
nonnal until later agdwhen they
enter school; slight &lay in language
development but can develop ways
of communicating; should attend a
preschool as this will help
development of all fiscutties.
Moderate Much slower in learning and
understanding as compared to
normal children and, therefore,
are seen as different from an
early age. Child can talk or learn
to communicate; motor development
is slow but enables child to
become independent; it is possible
to train the child to look after her
day to day needs;child manageable
with some supe~sion;can attend
a pfeschool.
Severe Poor motor development; poor
speech development; dependent
for selfcare such as
washing, eating; little or
no comndcation skills;
will mad help all the time.
Profound Totally dependent for
for mobility, selfcare
and daily &, requires
nursing care at home.
Can learn academic skills upto
6th grade by adolescence; can
pick up ways of interacting
with people: can travel upto
limited areas independently.
Can look after their own day
to dayneeds. Can be expected
to be economically independent
as an adult.
Training in social and
occupational areas possible;
may not learn academic
skills beyond 2nd grade; may
learn to travel alone in known
places. As an adult, can do
routine work under supelvision.
Can learn to talk and
communicate, can be trained
to develop basic health habits
such as bathing: can benefit
from systematic training in
habit formation; can be sent
to a training centre for
special children.
Some progress in motor
development; simple selfcare
habits may be taught; would
benefit from care at a special
centre for disabled children.

C o n ~ d l ythe , intelligence or the level of intellectual hrnctioning of a person has

banmeasured on the basis of standardized intelligence tests, which yield the
Intelligence Quotient (IQ) of a person. On the basis of the IQ, a person is stated as one who
comes in the category of 'genius', 'nonnal intelligence', 'mild', 'moderate', 'severe' or
'profound' level of retardation. How well a person performs on these intelligence tests has
been used to assess the degree of mental retardation. Those tests have mainly been
developed in western countries. For use in India, some Indian scholars have mbdified the
questions and items of these tests so that they are more relevant to the Indian situation.

However, the& ir considerable controversy surrounding the use of these tests. There
are experts in the field who believe that testing of intelligence is not the right way of
assessing a petson's intellectual functioning. They say that many of these tests have
questions that are more appropriate for and, therefore, more easily answered, by people
from an urban background who have had schooling. Thus a person from a rural area who
is equally intelligent as his or her urban peer, is likely to get a lower score on the
intelligence test because ofthe type of specific questions asked.
8
 Therefore, this group,of people argues that since intelligence refers to the 'extent to which a Children witb Mental
person adapts himselfherself to hidher surroundings, it whdd ?kmore apgnbpirtc to htardation
infer the intelligence of a childfpemn from hidher day to day Fuaetioniag, bclraviour,
ability to relate to others, communication skills and whether the milestones of
development have been rerched'at the appropriate ages.

This latter approach has been adopted in this Unit while discussing mental disability and
identifjmg children with mental retardation. You shall read about iden-g the mentally
disabled a little later in this Unit.

7.4 MENTAL RETARDATION IS NOT MENTAL

C ILLNESS
Before we proceed any further, it is important to understand that mental retardation is quite
different fkom mental illness. It is common for a retarded person to be seen as mentally ill
andcbe referred to as 'mad', since some of the behaviom may seem similar. But you must
be cautious about this, and be alert to others around you, who may attach a wrong label to
the child.

A mentally ill child or an adult, unlike the mentally retarded, may have normal or high
intelligence. However, she develops certain behavious because of stressful experiences or
an illness affecting the brain. Mental illness is a disease that can occur at any age to
anyone. Due to mental illness, children may show rocking behavim (where they rock their
bodies to and fro for long periods of time), head banging and other selfdamaging
behaviours. There are some kinds of mental illness in which the child imagines that she
can hear stiange sounds or see visions. No matter how much you may convince her
otherwise, she will not believe you. In other cases, the child withdn~wsfrom her immdbte
circle, preferring to be alone and quiet.

A mentally retarded child, particularly if severely and profoundly retarded, may show
rocking behaviour or head banging, but they certainly do not imagine strange noises or see
visions and they are rarely withdrawn. When the mentally disabled child ' x hin an
abnormal way, which seems like the behaviour of a mentally ill child, it is usually because
she has not learnt the correct way to behave. She can be helped to reduce, and in many
cases eliminate, such behaviows with appropriate training in the horn and school.
A mentally ill person needs medical treatment which can reduce the illness or even cure it
completely. A mentally retarded person, on the other hand, primarily needs education and
training to improve her abilities. Some children may need a little nk@ximn. Mental
retardation, in this sense,cannot be cured. Mentally disabled children will not become
normal like other children as they grow older. But they can be stimulated and trained to
learn.
You can understand that if a mentally retarded child is labelled as mntally ill, then the
parents are not likely to make &om to train or educate the child, as they may have no
confidence in education. If this happens, precious time in the early years will be lost.
Therefore, both correct diagnosis and early interventionare extremelyimportant in the case
of mentally disabled children.
>

Check Your Progress Exercise 1

Answer the following questions in the space below.

1) What do you understand by the term 'mental disabilitylmental retardation'?

1 Children with Special
-
2) State whether you agree or disagree with the following statements.

1 Needs 2
a) A child with a mental disability functions at a level higher than
other children of her age.

b) The extent to which mentally disabled children's development is

affected in different areas will vary from child to child.
(

(
)

c) Mildly mentally disabled children are often not seen as different

from other children until later age. ( )

d) Profoundly retarded children will benefit from academic instruction

in a regular school. ( )

e) MildlTand moderately retarded children can be trained to become

economically independent. ( 1
f) M e n d illness is the same as mental retardation.

7.5 IDENTIFYING A MENTALLY DISABLED CHILD

Many mentally retarded children look like other children, particularly those who are mildly
retarded. Hence, to know whether a child is retarded, many factors have to be taken into
consideration.

7.5.1 Child's Appearance

The child's head may look too small or too large for her size. Some children will have
slanting eyes, a narrow forehead and a protruding tongue. Other children may have a dull
expression in their eyes or even appear to be hard of hearing on many occasions. Severely
and profoundly retarded children stand out from the rest, due to their appearance.
,

7.5.2 Child's Behaviour

Observation of the child's behaviour is a good way of knowing whether she is slower than
other children. Generally, a preschool age child with mental retardation will have '
some of following characteristics. (Again, you must remember that the extent to which
these are shown in a particular child, will depend on the level of her retydation.)
---
 a) The child has very little speech. Even if it is present, she will speak rarely, using only Children with Mental
II a few words or short sentences such as 'Radha doll' instead of saying:.'Radha give me Retardation
the doll'. The speech sound would not be very clear.
i
1 The child does not understand instructions easily; these have to be repeated to make
b)
her understand.

F c) Poor ability to pay attention to a task at hand is one of the characteristics. The child
may be fidgety, irritable and restless She will also tend to forget something just
it recently learnt.
d) The child may not have acquired complete bladder and bowel control.
. J

e) Children with mental retardation do not play actively with other children, unless
helped to do so. Some of them may avoid company. They do not show initiative and
imagination when playing. Their play is likely to be repetitive.

f) If you observe their body movements, these are odd or clumsy. Their use of hands is
not efficient. Manipulating small objects such as a toy or a pencil is generally
difficult. Poor motor development and coordination is evident in some of the
following signs :
Jerky and uncoordinated movements.
Difficulty in moving both arms at the same time.
Difficulty in crossing the mid-line of the body. For example, the child will have
difficulty in using her right hand to pick up a toy placed to the left of her body.
Poor balance, which is seen as the child frequently trips, bumps into people or
drops things.
Difficulty in skills or movements involving fingers and wrists. For example,
the child cannot button, hold a pencil properly or use scissors.
Difficulty in eye hand coordination, which is shown when the child tries to do
activities like pasting, catching a ball etc. and in jerky eye movements when she
'watches a moving object.

g) There may be problems of management of behaviour. Children may show behaviours

such as unprovoked aggression, temper tantrums, stubbornness, withdrawn behaviour
or resistance to new situations.

h) The child will have difficulty in learning.

7.5.3 Milestones of Development

You have read about milestones of development in DECE-1. Let us recapitulate what we
mean by this teml.

There are certain stages in development that all children go through, such as sitting,
standing and walking. These stages are reached approximately at the same age by most
children and are called milestones. These serve the important function of indicating
whether the child is growing normally. While over the entire period of childhood there are
several milestones, there are five during early development that are important. These are
listed in the table below.

Table 7@): Some Milestones of ~ e v e l o ~ m e n t

Milestones Age

Holding neck erect 3-5 months

Sitting with support 6-7 months
Standing with support 9-10 months
Walking 10-16 months
Using a few words 12-18 months
' Children with Special It would help you to list all the milsestones of development, from birth till six yean of age, ,
Needs 2- that you have read about in DECE-1. '1n this way, you will have a table for ready reference.

Milestones are delayed in a mentally disabled children. In other words, these children
do not grow at the same pace as other children.
If the child did not reach these milestones at approximately the same time as mentioned
here, then it may indicate mental retardation.
If you suspect that a child's behaviour in your centre reflects lowered intellectual
functioning, check with the parents. Find out through some probing questions as to when
the child had reached the above milestones. In a moderately retarded child, most of the
milestones would have been reached late. In fact, at three years, the child may not yet have
started speaking. She would be mainly using gestures to communicate. In case of a child
with a mild level of retardation, most other milestones would be only slightly delayed, but
language development would be noticeably slow. That is, even at three years of age the
child would use only a few words, such as 'Ma', 'did?.

7.6 CAUSES OF MENTAL RETARDATION

A question may arise whether children are born with retardation or whetlfer they become
retarded as they grow. In this section, we shall read about some factors that lead to mental
disability. The discussion will also help in understanding how retardation can be prevented
or controlled.
Broadly speaking, there are two types of reasons for mental retardation. There are those
that are inherited from parents and are referred to as genetic causes. Others are due to
factors in the environment. You have read about the influence of environmental and
genetic factors on development in DECE- 1.

7.6.1 Genetic Factors

In Block 1 of DECE-1, you have read that at the time of conception, genes are transmitted
from the parents to the child. The genes contain the codes of development which enable an
individual to develop from the single fertilized ow& in the mother's womb.
It is possible &t certain defects are also transmitted by the parentlparents to the new child
I
through genes. This means that one or both the parents have a defective gene that causes
retardation. Hence, if the defective genes of the mother or the father or of both parents,
that are known to result in damage to the brain, have come into the new baby, very
little can be done to change this condition. Fortunately, the chances of a couple having
defective genes that result in mentally retarded children are rare. In fact, with scientific
research it has been possible to identify conditions under which such defects occur. Hence,
mental retardation due to such factors can be prevented. If there is a history of mental
retardation on either side (the husband's or wife's), then the family should go in for genetic
counselling before having a child. This will enable the couple to know what the chances
are of their conceiving a healthy baby.
-
Another possibility is that the process of cell division or multiplication at conception
I becomes defective and the child thus conceived has a defect, even though the parents
\
did not have it. An example of this condition is Down's Syndrome. The child has a
defect of chromosomes which results in qpecific physical features as well as mental
. retardation. The child has slanting eyes and a short flat nose, a round head and face, short
broad fingers, rough skin on the palm.

7.6.2 Environmental Factors

As yo11know, the child's environment consists of everything that surrounds her from the
moment she starts living inside the mother's womb. Thts means that the state of the
mother duyng pregnancy affects the child who is developing inside the uterus. Once born,
the physical, social and cultural world constitutes the child's environment. Thus, factors in
the prenatal (before birth), perinatal (during birth) and postnatal (after birth)
environment can cause mental disability.
12
a) Factors Before Birth Children with Mental
Retardation
In Block 2 DECE-1, you have read that a pregnant woman must eat nutritious food, remain
healthy and avoid emotional stress. She must take adequate rest. The reason is that the
development of the baby that is growing in her womb is influenced by her diet, activities
and health.

While some things may harm both the mother and the foetus, some other elements may not
affect the mother but only the foetus. The effects may be severe enough to cause damage to
the developing child's brain and, thus, result in mental retardation. Brain damage may be
caused due to poor nutrition of the mother, use of medicines without the doctor's
advice, consumption of alcohol or smoking by the mother, exposure to X-rays
particularly during the first three months, if the mother suffers from a shock or has an
accident.

If the mother develops certain infectious diseases, such as german measles or syphilis,
these can affect the cbld's brain and cause damage. If the mother has diabetes or a
disorder of hormones, that can also lead to mental disability in the child.

Preventive Measures

i It is best if the mother, who has to bear a healthy child, is between 20 and 35 years of
age. At this stage of life, her reproductive system is mature and receptive to the growth of a
new being in the womb.

ii) You may have wondered sometimes why a pregnant woman is protected by family
members from hearing about shocking events or bad news, and why the older people in the
house advise others to keep her calm and in good humour. There is again a scientific
reason for this. Since many substances can pass through the mother's blood into the
growing baby's blood, the mother's hormones can reach the foetus. The mother's
emotional states (happiness or anxiety) produce changes in her hormonal levels. If she is
happy, the level changes for the better; but if she is angry or worried, the effect may be
harmful. Highly anxious mothers are more likely to have premature babies, complicated
deliveries or post-delivery problems, all of which are of high risk to the infant. In some
cases, they may result in brain damage to the newborn.

b) Factors During Birth

Most women tend to have normal childbirth, wnether it takes place at home or at a hospital.
However, there are many women who have difficult childbirth and this can lead to
mental retardation. If the pregnant woman is in pain for 24 hours without the baby being
born, if the child's head has been pressed excessively during labour, if the size of the child's
head is too big, if the umbilical cord is twined around the baby's neck, if medicines have
been used to hurry labour, if the baby had to be delivered by using instruments and these
have caused damage to the brain; if the baby did not cry soon after birth, if the baby was
premature (i.e., born before 36th week of pregnancy) - these conditions can cause brain
damage to the baby's brain. In such conditions, if great care is not observed, brain damage
is possible, thus resulting in the baby's retardation as one of the consequences.

Therefore, it is important that a trained person conduct the delivery of the child,
whether at home or in a hospital, so that situations of emergency can be handled.

c) Factors After Birth

Even when a child is born normal, it is possible for environmental factors to cause
mental retardation in the years of childhood. Malnutrition in the first few years, where
the child suffers from severe protein-calorie deficiencies, and lack of essential vitamins in
the diet, is known to have several serious consequences, including retardation. Infections
that cause brain fever such as meningitis or encephalitis have damaging effects on the
brain, if at all the child survives them. Injury to the head due to a fall or physical "
punishment cqn be equally risky and must be avoided. Higb fever with fits, severe
diarrhoea and dehydration can also cause mental retardation.
Children with Special Preventive Measures
-
Needs 2
i) See to it that small children do not roll over and fall off the bed or cot. Do not leave
them alone near staircases etc.
ii) From birth onwards, infants must receive a nourishing diet according to the needs of
their age. The diet should include nutrientssuch as proteins, vitamins and minerals.
Breast feed the child as long as possible. However, introduce supplementary foods fiom
four months onwards.

I
iii) Children must be immunized against infectious diseases at the recommended ages. If
the child still gets infected, medical help must be sought as soon as possible to prevent the
condition from becoming worse.
iv) Observing general health and hygiene rules helps in the prevention of most infections.
v) If the child develops high fever or has fits, consult a health worker. Cool the baby's
hands, feet and forehead with wet cloth.

- -

Check Your Progress Exercise 2

Answer the following questions in the space below.

1) What are some of the factors you will consider while i d e n w n g a mentally disabled
child ?

2) What are some of the factors during the postnatal period that can cause mental
disability? How can this be prevented?

7.7 WORKING WITH A MENTALLY DISABLED CHILD

-
We shall discuss managing a mentally disabled child in two situations at home,
when the parents know that the child has a disability and at the early childhood
education centre, when the chid starts attending it. In both cases, you have an
important role to play. You would need to guide the parents as to how to stimulate the
child at home, before she is mature enough to join the centre. At the centre, you as an
educator can help the child to develop her abilities to the maximum.

7.5.1 Some Principles

We shall first describe some aspects that one must keep in mind when working with mentally
disabled child. These methods are applicable in home setting as well as in the centre.
 Tablc 7{c) : Some Principles
METHOD
I) Begin to provide stimulation,
training and education to thc
cl~ildas early as possiblelas
soon as the child is identified
to have a mental disability.
2) Praise the child, hug her
o r give her a prize when
she does something correctly.
Evcn the slightest attempt n u t
be praised. Avoid giving sweets
as rewards.
3) Make learning fun. Try to make
learning experiences enjoyable. Play
is the best way to combine fun
and learning. Keep doing an activiiy
as long as the child is enjoying it.
When she looks disinterested, change
it or stop it for a while.
4) Help the child only as much as is needed.
Do not do all of child's work.
E\/en if she takes long, let her
try lo do as much as she can. This
will challenge her to do things even
when no help is around.
5) Be rcgular in teaching/
stimulating the child.
6) Repeat thc activity often.
7) Break an activity in many
steps and teach one step
at a time. This is true of any
activity in any area of develop-
nicnt. Teach the second step
only when the first step has been
lcarnt wcll. When the second step
is learnt. repeat the first and the
second step so that the child perceives
tlle~nas continuous and it becomes a habit
Then go 011to the tliird step.
8) Bc patient when working with the
cbild. Do ilot force the child to learn.
Do not laugh at or puilish the child.
Put the act~vityaside for some lime
and then go back to it again. Do
not expect results overnight. Do not
gibe up, even if progress is slow.
9. Most imporkantly, make the cbild feel
loved, sccurc and wanted.
Children with Mental
Retardation
EXPLANATION
During the early years, the
child makes rapid strides i11 all
areas of development and is
receptive to positive (;ISwell as neg-
ative espcrienccs). Time lost now is
difficult to make up later on.
Praise makes the child happy
and she works much better
thau wlleii we scold her for
failure. lf she fails, ellcourage
rage her to try again or
ignore it for a while.
Children learn best and are
co-operative when they enjoy
the activity they are doing.
Providiiig full encouragenlent
and partial assistance would
be a good rule to follow to
make the child self-reliant
gradually.
A mentally disabled child is
slower in learning and understanding.
She also has a shorter memory span
and may forget what has been taught
the previous day. If training/
stimulation is not rcg~lar,thc child
will forget what has bceu taught
carlier and you would need lo begln
all over again.
This is the way learning takes
place with most children.
However, we do not perceive
it in so many steps, because
it happens quickly. Since
~llentallydisabled cllildren
are slower in undcrstanding,
uiore time will havc to be
spent on each step of learning.
Forcing the child even when
she is not able to do soinething
frustrates her. She loses coilfidence
in herself and may hesitate to try
again. Laughing or ridiculing the
child will lower her selfconcept.
Ally child develops best in
an emotionally fulfilli~~ga~viroiuncnl
 -
Children with Special ,?t us now see what are the areas in which a mentally disabled child requires help and what
Needs -2 eel. bedone to help her improvc her functioning - at the home and at the centre. Sub-
section 7.7.2 describes how the parents can begin training the child at home. Sub-section
7.7.3 while it states aspects to be kept in mind while working with the child in the centre, is
applicable to the home situation as well.

How much dfl~cultya child experiences in each of these areas depends on the degree
of mental disability. A mildly disabled child is likely to have only a l~ttledifficulty. In the
same way, the amobt of time you need to spend with the child to help her learn will be
influenced by the degree of retardation. A child with moderate mental disability will be
able to acquire these skills much faster than a severely retarded cbld.

7.7.2 Beginning Training at Home

a) Movement/Motor Coordination
All children begin to use their bodies to move and look around themselves as they grow. A
mentally disabled child will have difficulty in one or more of the following areas involving
movement.
m Looking at diierent things
a Holding the head straight
a Sitting with or without support
Standing with or yithout support
a Walking using a support
a Standing and wallung independently
a Using the hands to hold objects.

Due to these, the child may find it diff~cultto function without the help of others.

The following are some activities that you can carry out to help the child with the above.

a Looking Around
Lay the child on her back so that she is looking at you. Swing a colourful object in front of
the child, such as a coloufil ribbon or a toy. Move the ribbon up and down, or in a circular
motion. The child's eyes will follow the movement.

Take the child along with you, wherever possible. Do not leave her alone in a room. Point
out the various objects in the roodstreet. These will create an interest in her and motivate
her to look around.

Holding the head straight and rolling over

Let the child lie on the stomach. Sit in front of the child, so that the child can see you. Roll.
a coloured ball or any other colourfid object back and forth. Help the child to turn her head
to look at the ball. Putting a pillow under the chest will support the child's head. You can
add more pillows if you feel the child is not comfortable.

Do this activity two or three times a day. Carry out the activity each day. Talk to the child
during the activity. This will hold her interest and also give her encouragement.

Once the child can balance her head, encourage her to roll over on her side by putting an
attractive object some distance from her and encouraging her to reach for it.

Sitting
Hold the child's hands when she is lying down. Gently, pull the child to a sitting position,
supporting her back. You can put a pillow behind the child to give her support. Let the
child sit only for a short time. Do this activity many times each day.
 Gradually, over a period of days, help the child to use her arms to support herself while Children with Mental
sitting. Hold the child from the back gently as the child may move her hands to play and so Retardation
lose balance. Gradually, train the child to sit without your support.
Remember to talk to the chlld during these activities. This will make them enjoyable for her.

a Standing
When the child learns to sit by herself, teach her to stand. For this, hold the child's hahd
when she is sitting and lift her to standing position. Then let the child hold a stool or a
table. Leave the child, but stand behind her in case she loses her balance. If you do this
exercise in front of a mirror, where the child can see herself, she will get a feedback
regarding what she is doing and this will motivate her to try again.

Initially the child will not be able to stand for long. She will sit down quickly. But
gradually the duration of being able to stand will increase. When the child's balance
improves, remove the stool and encourage her to stand by herself.

Praise the child for the efforts.

a Walking
The activities described till now lay the foundation for the child to walk. All the above
steps have to be mastered before the child is able to walk. Before the child is able to walk,
encourage her to crawl. Hold an object that the child finds attractive in front of her. This
will motivate her to reach for it. Gradually, the child will be able to take a few steps. The ..
i d
*
child is bound to fall down as she practises walking. Reassure her and emurage her.

a Strengthening a m and hand movements

The child may have difficulty in coordinating the movements of her arms and hands.
Encourage the child to reach for objects and grasp them. To strengthen the muscles of the

Exercise to improve hand functions

Children with Special hand, give a piece of clay and ask the child to squeeze it. You may need to put the object in
-
Needs 2 the child's hand and curl her fingers around it, in order to explain to her how to hold it.

When helping the child to acquire these motor abilities, hold the child's body
whenever required. When teaching the child to use hand, arm or leg movements, do not
leave it to demonstration. Hold the child's hand, arm or waist etc. and help her perform the
movement. As in climbing a staircase, hold the child from behind and guide the leg
movements with your hand. Telling the child how to perform is not sufficient. She needs
actual phjsical experience of doing something before she can repeat the action.
Sometimes a child may have a difficulty with movement because the child has weakness or
stiffness of the muscles of the limbs. If this is so, then explain to the parents that they must
show the child to a health worker/doctor/PHC. They may prescribe some exercises to help
develop muscle tone. These exercises must be done regularly.

b) Self-help
The extent to which a child is able to take care of her routine and basic needs will
determine whether or not she is able to join a preschool centre or a school. For example, a
child who cannot go to the toilet by herself, will not be able to join a child care centre and
will miss out on many learning experiences. Therefore, it is important to explain to the
parents the need to train the child to look after herself and how it can be done.
A child may have difficulty in one or more of the following areas:
eating and drinking independently
going to the toilet
indicating when she is hungry, thirsty or uncomfortable
dressing and undressing
bathing.
It is important that the child is able to carry out at least the first three activities, if the
parents want her to join a centre for children. The extent to which the child has difficulty
in these areas and the time it takes for her to develop the requisite skills will depend on the
degree of retardation.

Feeding

Begin to train the child to feed herself when she is able to sit by herself, without support.
Sometimes, a child may have difficulty in eating or drinking because the saliva drools from
the mouth. If this is the case, then explain to the parents that they should consult a doctor/
health worker. It may be that the child needs to be given medication. The doctor may also
suggest some lip, tongue and chewing exercises that will help the child to control facial
muscles and tongue.
When training the child to feed herself, make her comfortable. Spread a cloth or a
newspaper to take care of spillage.
The process of feeding oneself in<olvesmany steps. Can you identrfy what these are ?

............................................................................................................................
Most of us perform all these steps in one fluid movement. Bui a nnentiilly disabled child may
face difficulty in any or all of these movements. She has to be helped to practise each
movement; learning will take place one step at a time. For example Children with Mental
Retardation
Give the child the food item to hold in her hand - this may be a biscuit, a piece of
chappati. Alternatively, it may be a spoon.
Take one of the same yourself and show the child how to hold it.
Bite a portion, chew it and swallow it.
Ask the child to chew and swallow it.
Begin by giving the child a few morsels to eat by herself.

Gradually, let her finish the entire meal herself

The child may take quite long in finishing each meal. You will need to be patient.
Rushing her during eating will make her nervous and the movements will become even
more uncoordinated. Explain to the parents that they will need to be patient.

To help a child to learn to drink from a cup or a glass, first train her to hold the glass with
both hands. Help her to bring the glass to her month and let her take a few sips. There is
bound to be spillage initially. The child may also try to chew on the water. These extra
motions will be given up subsequently.

Remember to talk to the child during all these activities. Explain to her what she is doing.

Dressing and Undressing

Undressing is easier for the child than dressing. First teach the child to remove simpler
garments like socks, pyjamas and garments which open from the front. Removing a
garment above the head, unbuttoning, tying the cord of pyjamas and tying shoe laces are
more difficult.

Show the child how to do these activities by doing them yourself. Encourage the child to
dress or undress a puppet or a toy. This will give her practice in coordinating hand
movements.

Once the child learns to remove some of her clothes, encourage her to learn to put on her
dress. When teaching the child undressing, begin with the simpler garments first. It will
help the child if she dresses and undresses in front of a mirror. It may take some time for
the child to recognize the front and back of a dress. You would need to show the child
again and again how to dress and undress. Assist the child in these activities, but gradually
let her do more and more of these on her own.

Toilet training

This involves that

* the child recognize that she needs to go to the toilet
* be due to able to undress and relieve herselfat the right place
* be able to wash herself and use the toilet appropriately
* be able to dress again.

In the beginning, observe the child's toilet habits and note the pattern.. Then start taking
the child to the toilet 10 to IS minutes before the time and encourage her to relieve herself
at the right place. Take the child to the toilet at regular intervals. Often the parent tends to'
clean the child herself or himself, thinking the child will not be able to do it or that she will
take longer. Explain to the parents that they may guide the child and show her how to wash
initially, but gradually let her do it herself. It will indeed take longer, but this is the only
way the child will learn.

If the child wets her clothes and later comes and tells you, take it as a positive sign. It
shows that the child is aware that she has not had control.

Explain to the parents that these are some areas where they should begin the training the
child at home. Once a child is able to look after her basic needs, she can attend the
preschool centre.

7.7.3 Working with the Child in the Centre

Let us now read about some aspects that you, as a child care worker, must keep in mind
when working with the child in the preschool centre. However, as we have said earlier, the
discussion in this sub-section is also relevant for parents. It will help them in training the Children with Mental
child at home, continuing the efforts initiated by the educator in the centre. Rehrdatlon

In a programme of early childhood c u e and education (ECCE),children who have

mild or moderate level8 of mental retardation can be taught dong witb normal
children witbout much M ~ d t y In . fact, children with special needs benefit greatly from
interactions with non-handicappedpeers and adults. N o d environments help them to
exercise their abitities to the full, and thus become integrated in society.

For example, we know that once a child begins to talk, she learns new words rapidly. This
is because she hears meaningfullanguage around her. But, if the same child grows up in
~ - ~ v i r o h u n e when
nt spoken language is hardly used, such as in a family where both
parents are deaf, and use only signs for communication, the same child will learn little
speech. Similarly, a child with mental retardation may -me slower than she actually is,
if she does not receive stimulation to use her mind. The company of mnod peers and
adults who art sensitive and accepting of a special child make up a stimulating
environment.

Once the child is among receptive, fiimdlyand professionally trained people, the learning
process becomes enjoyable for her. At this point, it is your responsibility as an ECLE
worker to see that the special child's needs are understood and care and education provided
accordingly. Even though the child will play and leam doag with other children, you
will need to spend extra time with her to help her leam.

Severely and profoundly mentally disabled children would benefh more by attending a
special schsol rather than a regular preschsol centre.
Let us now read about the areas in which the special child requires help.

A mentally disabled child's memory is not as e&cient as that of a nonnal child. This
means that the child requires several repetitions of an experience before s8e can
remember what was dbne. For example, when you teach a song of four lines to your
group of children, most of them would know the lines after it is sung a few times. The
retarded child may recoguize the words when you sing, but may not be able to repeat any of
the words immediately. However, gradually this child would also begin to repeat a k v
words, mostly the first and the last words in the line. It is only after several weeks or
months that the child will 'learn' all the four lines of the song.

This woul* true of any activity you cany out - whether it is recognizing colours,
claqs@ing objW or a discussion on animals.

If there are one or two mentally retarded children in the group that you har;dle7you will
find that there is a gap in their ability and that of others in understanding things. Include
them in all the activities, but also pay them extra attention individually. Let them sit near
you, repeat once again to them what you have said to the group. For example, if you have
said 'Show me your nose', look at the special child, repeat the instruction again and help
her to point to her nose.

One rRason why most of us can learn new tasks is that we give serious attention to them. In
thispy the child with mental retardation is weak. She has difTiculty in paying attention
to/task$'at hand, esgceially those that require sitting down and concentrating. When
the child does not attend to tasks,she is not doing so deliberately, as some of us may tend to
think; rather she has a disability that interferes in the natural development ofauending
Children with Special
Needs - 2

Spending extra time and devising meaningful activities

helps the special child to lea'rn

skills. So you must not get impatient with her or scold her. The following example will
help you to understand.

Babu is a six year old moderately retarded child, attending an ECCE centre. He is among
3-4 years'old children f i r all activrties. When the educator gives pebbles to all the
children to arrange along a crrcular path, Babu does not understand what he has to do.
The educator goes to him, shows what has to be done, watches him place two pebbles on
the line as she had done. When she moves on to see whot other children are doing, Babu
stops the activity, starts looking around and throwing away the pebbles. The educator has
to keep coming back to him to help hinrJinish the task. Babu has a low attention span. But
he can be helped to improve it.
22
 Children with Mental
Retardation

Such activities help to increase the child's attention span as well

as help in developing concepts

c) Language
Children with mental retardation begin to use speech much later in their childhood as
compared to other children. It is possible that even by three years of age, the disabled
child does not speak or is able to say only a few words. She may use only gestures and
sounds to communicate. While the milestones of language development may be delayed,
the sequence in which language develops is the same as in normal development.

Once again, it has been observed that children with language deficits, who grow up in an
environment that is rich in language, learn to use speech much better than those who grow
up in an environment where language is not rich and varied. In your centre, it is
important that a child with mental retardation should not be left to herself. She should
be a part of all language activities such as singing, story telling, conversation and play,
even if it appears that she does not understand or does not participate.
A child who lack? the ability to speak tends to use her body and gestures to conlrnunicate.
Other childrm and adults learn to accept such a mode of communication and sometimes,
they themselves use gestures with the child. However, this would be a hindrance to the
child's language development. Parents uld teachers have to be conscious that they have to
encourage the child to speak simple words and phrases to express her needs. This is more
likely to happen if the child hears conversation frequently, especially addressed to her.

Talk a lot to the child

Speak clearly using simple sentences while looking at the child. Verbalise the actions you
perform such as: "Here is my hand, here is yours. Lets join them together." Before a child
speaks she learns to listen and understand. So even if she does not speak, spealung to her
about things will enhance language and cognitive development. Thus if the child points
towards a carrot, do not simply give it to her. Rather, ask her: "Do you want the carrot?'
and then give it to her. Initially, the child may not respond or may not speak clearly, but do
not worry about this. Continue with your efforts.
Here is an example of how an educator works with a child at the centre.
Unia, ajve-year-old mildly retarded child, tugs at the educator's sari and points to a doll
lying on the sheK The worker says to Uma: "Uma, you want that doll? Do yoa want to
piny wlth it?" She picks up the doll and glves it to Uma who smiles and stares at it.
1 Children with Specid
-
Needs 2
Teacher: "Uma say 'doll: Say it like me: 'Doll '." (waitsfor the child to respond and then
continues) "Let us see the doll's eves, nose, hair and teeth. "
-

While doing this, the teacher touches these prTs on the doll's face. Uma is not be able to
say albthese wordr. but the educator encouragesher to point to them. When this activity is
.

repeated over several da-V.V.rImn will also learn the words.

Aman was a h i t f e d to the balwadi at the age of5 years by his parents because it became
too digcult for them to manage him at home. They said that he did not sit still, did not
obey them and did not have speech. He tended to beat his older sister. Aman was not only
meatalfy retarded but aim had behaviour problems.
Many mentally W d e d children sbow behavioucs that are maladaptive, i.e. wwmptable.
Why does the child show urnrceptable behaviouc? Is she born with it?Do mentally disabled
children develop more behavim problems than ~wnnalchildren? By it&, low
d a a not cause iarppmpriatc kbavitntr. B e b h r proMea~s=cur in nonnll c W r m
as weH. These develop in the child - w M k r disabled or not- mostly in mpst to
the attitude of the camgivers towards her. Consider the following situations.
Raj has a low span of attention'and, therefore, does not stay with an activityjbr long
enough and becomes restless. This keeps the parents on their toes, who lose their patience
with him andpunish him when he creates 'trouble ' 2i.e., when he does not do as he is
told.
Sita does not have bladder and bowel control. This causesfiustration to the parents and
they are harsh towar& her while teaching toilet skills. Their harshness worsens the
situation as Sita gets tense and her control over her movements gets worse.
When a child does not get love and affection fiom the family members,she feels neglected.
To get their attention she throws temper tantrums, bangs her hcad or beats herself, throws
things around or behaves badly in front of visitors. The child is then labelled as one with
'behaviour problems'. W h the parents are very strict with the child and scold her often,
then too the child develops behaviour problems.
Helping the Child develop Acceptable Behaviours
It is possible to help the child develop acceptable behaviours and give up the unacceptable
ones. The guiding principles to bring about modif"ation of behaviour are a follows :
The child should experience love and acceptance and not rejection from caregivers Children with Mental
and peers. Give attention to the child. Retardation

Giving individual attention to the special chlld

 Expectationsfrom the child should--- be realistic. Do not expect her to perform at the
same level as ordinary children.
It is not enough to tell the child what not to do. Explain and show to her what should
be done. In other words, the child should be given positive guidance in simple steps.
It is bater to deal with one problem behaviour at a time. For example, while
controlling her aggressive behaviour, do not start on toilet training at the same time.
Be consistent and firm in your rules for the child. If you have said 'no' to something,
do not change it to 'yes'. The child may cry or throw a tantrum for some time, but
will soon understand that you mean what you say.
Explain to the child that if she behaves badly, what the consequence may be. For
example, she will not get her favourite dish or be allowed to play with her toy. Do not
verbally abuse or hit the child
If the child still behaves badly, be consistent.
If the child stops bad behaviour/shows positive behaviour, reward her.

The above then were some areas where you would need to help the child. In general, a
stimulating classroom for preschool children is good enough for mentally disadvantaged
children too. There should be play material available to the child that she can manipulate,
there should be picture bodrs, picture charts at eye level on the walls, there should be music
and dance, puppetry and clay activity etc., in which the mentally disabled should be
included.

7.8 THE PARENTS' PERSPECTIVE

Shri and Shrimati Govind Ram had a 4 year-old daughter Meera when their son Atul was
born. The whole family was delighted to,have a son as the second child in the family. The
first few religious ceremonies were peqonned with gaiety. But soon the parents started
getting worried as Atul was quiet most of the time. Seven months passed and he could not
sit. When he became one year old, he could sit but could not stand. Atul did everything
much later than his sister. The mother was very disappointed. She was talking to an ECCE
worker at the time of his admission to the bahvadi when he tumedfour.
"It has been a painful experience bringing up Atul as compared to my daughter, Meera. I
cannot do housework at peace when he is awake. He wants me to be with him aN the time.
I f I leave him alone just to gojbr a bath, he screams, bangs his head or throws things.
Ever since he was born, I have not sleptproperly, nor have I gone outfbr a social
ficnction. " At this point she started crying.
Yes, the parents of a mentally retarded child have to go through a lot of physical and
psychological stress in bringing her up. The knowledge that the child may neverhe like
other children brings disappointment and a sense of failure. Above all, the care of the child
is strenuous and it tends to exhaust the parents. Hence, parents themselves need sympathy,
care and support from all concerned people.
If their child shows progress in any way, the parents' own confidence about the future
receives strength. You can contribute in this effort by meeting the parents regularly,
listening to what they have to say and guiding them wherever necessary. The parents,
gmndpuents and siblings have an important role in supporting the programme at the
centre, as they can continue those activities at home that the educator introduces at the centre.
Check Your,ProgressExercise 3 Children with Mental
1 Retardation
Answer the following questions in the space below.

1) Imagine that you are working as an educator in a child care centre. A mother of a
severely retarded six year old child comes to you for help. She has totally given up
hope in her child. She is depressed and does not think her child can do anything.
What advice would you give to the mother ?

2) A parent of a moderately retarad child comes to you and says that though he wants
to teach his child as much as is possible, he is not able to make much progress
because the c u d becomes restless very soon. Also, the child does not remember
much of what he has been taught the previous day.
How can you help the parent ?
....................................................................................................................................
...................................
4 ...............................................................................................

....................................................................................................................................
....................................................................................................................................
.....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
.....................................................................................................................................
3) State whether you agree or disagree with the followingstatements.

a) Mentally retarded children show more behaviour problems as

compared to other chirdren. ( )

b) Mentally disabled children need greater practice before they can

learn anything. ( )

c) Talking to a mentally disabled child who does not have much speech
is a waste of time. ( )
--.-- .~
-
7.9 LET US SUM UP , - ,

In this Unit you have read about cPildren who have mental disability. Children who have a
lowered capacity for intellectual fihctioning as compared to others of their age are mentally
retarded. Mental disability is a condition that affects mental and physical growth.
Development,in many areas is afkected- language, motor, social, cognitive, self care. 27
Children with Special This influences the extent to which the child will benefit from academic instruction in
-
Needs 2 school and the type of work she can take on as an adult.

The extent to which development is affected in these areas would depend on the extent of
retardation. A child may be mildly, moderately, severely or profoundly retarded. Mental
retardation must be differentiated from mental illness.

The child's behaviour, appearanke and the age at which she reaches the various milestones
of development would help in identifying whether the child has a mental disability or not.

Genetic and environmental factors can cause mental disability. Factors during the prenatal,
perinatal and postnatal period can lead to mental disability. Most of these are preventable,
if proper care is taken.

When managing mentally disabled children, some aspects need to be kept in mind. The.=
children learn in the same way as other children, but the learning takes place slowly. .
Therefore, instruction and training take longer. Begin training/stimulation as early as
possible. Be regular in trainingheaching the child and repeat the activity often. Make the
learning fun and help the child only as much as needed. Break an activity into steps and
teach one step at a time. Be patient when working with the child.

Once the parents come to know that their child has a disability, explain to them how to help
the child develop motor coordination and take care of basic needs: This is essential to
enable the child attend the centre.

In an ECEE centre, children who have mild and moderate degree of retardation can
taught along with other children without much difficulty. Severely and profoundly retarded
children will benefit more from instruction in a special school. In the preschool, help the
child to develop her memory, concentration, language and to improve her behaviour.

7.10 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
Check Your Progress Exercise 1

1) When a child's intellectual functioning is slower compared to others of her age, it

shows that the child has a mental disability. Mental dsability slows down physical
and mental growth and the development in many areas - motor, language and
communication, cognitive, social, self care, and academic skills. Whether the child's
development is slowed, down in one or more areas and the extent to which it is
slowed, will depend on the extent of retardation.
2) a) Disagree. he child functions at a lower level.
' b) Agree
C) Agree
d) Disagree. The child will find it difficult to keep pace with academic instruction
in a regular school.
e) - Agree
f) Disagree. Mental illness is a disease but mental retardation is not a disease or
illness.

Check Your Progress Exercise 2

1) a) The child's appearance may be different from others - the head may be too
large or too small, eyes may be slanting, the forehead narrow; the child may
have a dull expression on the face.
b) The child's behavio,ur - the childmay have little sp&h, have difficulty in
understanding instructions, may not be able to attend to tasks for long, may not
 have completebladder control, may not play actively with other children, body children with Mental
movements may be clumsy. Retardation
c) The milestones of development may be delayed.

2) a) Protein calorie deficiencies, lack of essential vitamins. These can be prevented

by taking an adequate nutritibus diet.
b) Infectious diseases. Some of these can be prevented by immunization and
maintaining hygiene.
c) Injury to head.

Check Your Progress Exercise 3

1) You could explain to her the following aspects :
a) Her child can improve his level of functioning if proper training and
stimulation is provided. .
b) You may give example of a similar child, if you know any.
c) Explain to her how she can begin tfaining the child at home and the principles
involved in training.
d) Visit her at her house at intervals to keep her morale high.
e) Ask her to show her child to a health workerldoctor.
f) If her depression does not get treated after quite some time, refer her to a
counsellor.

2) You can help the parent in the following way.

a) Explain to him the characteristics of mentally disabled children -that they
have a shorter memory and attention span and so become restless easily and
forget things.
b) Explain to him the principles in training the child at home
c) Help him to realize the achievements of his child.
d) Visit the family regularly to help them.

3) a) Disagree
UNIT 8 CHILDRENWITH PHYSICAL
DISABILITY

Structure
8.1 htroduction
8.2 Defining Physical Disability
8.3 Causes of Physical Disabilities
8.4 Managing Children with Neurological Disorders
8.4.1 Cerebral Palsy
8.4.2 Poliomyelitis
8.4.3 Convulsions or Fits
8.5 Musculo-skeletal Conditions
8.5.1 Muscular Dystrophy
8.5.2 Arthritis
8.5.3 Club Foot and Other Conditions
8.5.4 Managing the Child with Musculo-skeletal Disorders
in the Centre

8.6 Physical Disability due to Other Conditions

8.6.1 Accidents
8.L.2 Asthma
8.7 Rehabilitation of Children with Physical Disabilities
8.7.1 Social Environment
8.7.2 Physical Environment
8.7.3 Educational Implications
8.8 Let Us Sum Up
8.9 Answers to Check Your Progress Exercises

8.1 INTRODUCTION
As you have read in the previous Block, physical impairments are a major cause of
disability among children in our country. It is important to know how physical
impairments can be prevented and how one can help the child if she becomes disabled. If
the physical disability is detected early, much of its negative effects can be lessened through
timely surgery, exercises and use of mechanical supports. In most cases, physical disability
does not lead to mental retardation.

In this Unit, you will read how you, as an educator in an early childhood care and education
centre, can help the child with a physical disability, and her parents.

Objectives

After studying this Unit, you should be able to

explain what 'physical disability' means
state the causes of physical disability
explain to the parents how they can prevent their child from being physically
disabled
 a manage children with cerebral palsy, those affected by polio, fits, certain musculo- Children with Physical
skeletal conditions and those disabled due to accidents and certain diseases, at your Disability
centre
decide whether a particular child will benefit from instruction in your centre or needs
to go to a special school
a explain to the parents the efforts they need to make to help the child overcome the
handicap.
I
. -

8.2 DEFINING PHYSICAL DISABILITY

When we talk about individuals with physical disability, we reker to all those who have
non-se@hry physical limitations i.e., limitations not because of sense organs like
eyes or ears, but because of other organs iike limbs, bones, joints or muscles.
health problems which limit the individual's ability to lead a normal, healthy
life. For example, convulsions or fits, heart problems present from birth.

The physical disability, as you know, may be present since birth or it may come about later
in a person's life, However, a physical disability may or may not be a handicap to a person,
as the following real life situations show.

Paralysis of the legs is physical disabilily for Javed. Th'ishappened due to an attack of
polio at the age of$ve. However, Javed can move around by himselfon a wheelchair and
has worked hard at establishing his stationery shop, which he is managing alone. His
disability has not come in the way of his being a self-suflcient adult. Thus, it has not
handicapped him in this respect.

The well-known Bharatanatyam dancer Sudha Chandran, alter losing one leg in an,
accident, was able to continue with her passion for dancing with the help of an artificial
leg, the so-called llaipur Foot ', implanted on her. The llaipur Foot' is the artificial limb
suitable for Indian s y l e of living and has been developed and constructed individually
for each patient by Dr. P.K.Sethi, a famous orthopaedic surgeon.

Aids and appliances have helped both these persons to lessen the severity of the physical
disability, so that it is no longer a handicap for them. Apart from this, their own spirit to

. fight and overcome their limitations and move ahead was a major factor in making them
what they are presently.

The following are some aspects that one must bear in mind while discussing physical
disability:

1) Medical and surgical treatment is possbile for many defects of bones, joints and
muscles, and other health problems. The treatment can reduce, to a large extent, the
severity of the disability. The treatment may be required continuously or at intervals.

2) The age at which the disability arises is an important factor in shaping the course of
treatment. When the disability is present from birth, for example, congenital (by birth)
malformation of limbs, or appears shortly after birth, treatment can be started early and
training of the child can be directed towards helping her live within the limitations imposed
by the disability.

When the disability arises later in childhood, for example, due to an accident or diseases,
problems in training can be greater because the individual, who has already got
accustomed to one way of living, has to adapt again to an entirely different set of
circumstances.

3) Many physical disabilities, like cancer and A D S , may become more severe with time,
leading to complete invalidism and death. Goals then may change from emphasis on
preparing the person for an independent life, to helping her to live life with dignity.
 Children with Special
Needs - 2

I -\1

A moving frame with wheels gives the child much needed independence
i 4) As has been said time and again in this and the previous Block, more than the Children with Physical
disability, it is the social acceptance or rejection of the child with the disability by the Disability
family, peers, and the sxiety which determines how self-fulfilling and productive a life she
t will lead, and the kind of relationships she will develop.

5) A person with physical disability may also have one or more of the following
-
conditions mental retardation, visual impairment, hearing impairment, emotional
problems or speech problems. Treatment and training then has to be'directed towards
overcoming all the limitations and progress can be slow and difficult.

6) Treatment and training of the person with physical disability is a combined effort of
different people - medical professionals, para-medical professionals like speech therapists
and.physio-therapists, teachers, parents, other family members, community and, over all,
the individual herself.

8.3 CAUSES OF PHYSICAL DISABILITIES

Physical disabilities can be caused by :
damage to the brain or spinal cord.
damage to the muscles or bones.
effects of diseases and illnesses on general health.

Based on these causes, physical disabilities have been categorised into

Neurological disorders caused due to damage to the brain or the spinal cord
Musculo-skeletal disorders caused due to damage to muscles or bones
Others that are caused due to illness and disease and have an effect on the
general health. +

Table 8(a) : Categories of Physical Disability

Musculo-skeletal Others

Muscular dystrophy Asthma

Poliomyelitis Arthritis Accident
Corrvulsions/Fits Club Foot
Cleft
Palate

What are some of the factors that can cause damage to the brain, spinal cord, muscles or
bones and lead to illness and disease, which can result in physical disabilities? You have
read about these factors in the previous Block of this Course? as well as in Course 1. Can
you recall and list them here?
..............................................................................................................................................
-1

.
............................................................................................................................................ 3.

..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
..............................................................................................................................................
To help you recapitulate, we shall state the factorsthat can cause damage leading to
physical disabilities.
Children with Special
-
Needs 2
Prenatal Factors (Before Birth)
Damage to the developing foetus during pregnancy can lead to physical disabilities. This
I
can happen due to
poor health of the expecting mother
inadequate consumption of r~utritiousfood during pregnancy, particularly during the
first three months.
intake of medicines without the doctor's recommendation during pregnancy,
particularly during the first three months. Some drugs to control morning sickness
have been known to cause physical defects.
pregnancy before 20 years or after 35 years of age.

If the expectant mother takes care of these aspects, many of the physical disabilitiescan be
prevented. Particularly, as regards morning sickness, help the mother realize that this is
normal, and not an illness, and consuming medicines to control this should be avoided.
However, if the vomiting is severe, then the medicine should only be taken on the doctor's
recommendation.

Perinatal Factors (During Birth)

Complications during delivery can lead to physical disabilities in the child.
Expectant mothers who
are less than 4'10" in height
have a very narrow pelvis
have a history of prolonged labour in previous childbirths
have a big baby
have had bleeding before childbirth
have a poor nutritional and health status
have more chances of complications during delivery.

Physical disability in the child may also occur due to

lack of oxygen to the child's brain during delivery
use of instruments to help the child birth.

Therefore, it is important that the delivery be done by a trained person at home or in the
hospital.

postnatal Factors (After Birth)

Illness, disease, accidents, deficiency of adequate calories, proteins and vitamins in the
child's diet can lead to physical disabilities. You have read about nutrition and health care
I of children below six years in DECE-2. Keeping these aspects in mind will help to prevent
many childhood disabilities.

What istlear is that most the causes of physical disability are preventable.
 Children with Physlcal '

8.4 MANAGING CHILDREN WITH NEUROLOGICAL. Disability

DISORDERS
As you have read, neurological disorders are caused due to damage to, or a defect or
deterioration of the brain andlor the spinal cord.
A child with damage to the brain may have problems in many different areas of
functioning - learning ability; speech and language; physical movement or mental
functioning. The child may also have convulsions or fits (Epilepsy).
A child with damage to the spinal cord may have problems with sensation, movement and
may have paralysis of certain parts of the body.

Neurological disorders can be caused due to

congenital (i.e. present from birth) malformations
infectious diseases
accidents
deprivation of oxygen to the brain during delivery.
In the following sub-sections, we shall discuss some types of neurological disorders.

8.4.1 Cerebral Palsy

Anu is a nine year old, lively girl, eager to answer questions in class. She open comes
forward to help the teacher and classnrates in tasks like getting the attendance register
from the office, or helping a younger child to shut his bag properly. She speaks with a
slight slur. Her neck sonretimes bends a little to one side or tilts a little backwards. Her
fingers twitch - cr movement not under her control - so that she is not able to move her
jrencil in clear, definite strokes and her writing is not clear. Her walk is a little stifland
her arnrs and legs sometimes do not move in co-ordination. She can read simple Hindi
words and can solve simple problems in addition and subtraction. Anu is a child with
cerebral palsy.

Cerebral Palsy is a condition where due to damage to the brain, the individual may
have paralysis/weaknessin body parts and lack of coordination in gross and fine
motor movements, causing difficulty in walking and reaching for and holding objects. The
arm and leg movements may be jerky. Depending upon the extent 01 damage, the child
may be able to walk with a slight jerk which may not be perceptible, or may not be able to
walk at all. Between these two extremes are children with a variety of conditions.
Similarly, the arm and hand movements may be coordinated enough to enable the child to
write and handle objects. At the other extreme are children who have to make many
attempts to reach an object and hold it. The child may a l s have
~ difficulty in swallowing,
causing the saliva to drool from the mouth. She may find it difficult to close the lips. The
inability to coordinate the movement of the arms and legs may make it difficult for the child
to eat, drink, dress or use the toilet independently. She may need help wit11 the smallest
task that is routine for us. For some children, the movement of the facial muscles may not
be under control and there may be involuntary contortions or grimaces.
Besides difficulties in gross and fine motor movements, depending on the part of the
brain damaged and the extent of damage, cerepral palsied children may suffer from any
or all of the following problems.
Mental Retardation: About half the children with cerebral palsy have mental
retardation. However, there is no relationship between the extent of physical
handicap and intellectual functioning. That is, a child severely physically
handicapped may be above average in intellectual functioning and a child with a low
degree of physical handicap may be mentally retarded.
Visual Defects : A substantial number of these children suffer from vision problems.
Speech Defects : Defective speech is the most common problem associated with
cerebral palsy. About 70 per cent of cerebral palsied children will show speech
defects. They may have difficulty in articulation, delayed speech, disorders of the
voice, stuttering or aphasia.
Children with Special
Needs - 2

Two children with differing levels of cerebral palsy

Fits
PerceptuJ Disorders: Perception of sensory images especially auditory, vislual and
tactile, are also allkted.
Hearing Defecta : Defects of hearing may also he present but the incidence of these is
less than that of visual defects.
Thus, as is clear from the above description, the problem may be so mild that it is hardly
noticeable 05 so severe that the individual is physically almost completely
incapacitated. Treatment and training, if started early in life, helps the child to overcome
many of the limitations caused by cerebral palsy.

Causes .
Anything that can cause brain damage can cause cerebral palsy. The damage can happen
before birth
during birth
in the period immediatelyfollowingbirth or
during the e d . years of life.
You have read about the factors that can cause damage during these periods, in the
preceding section in this Unit. These are being repeated here to convey to you the
imporlance of reducing the risk of disability in the child, by taking care of the pregnant
woman and the child. ,

Damage before birth may be due to

viral inlb3ions of the mother during pregnancy, particularly rubella (German
\
Measles). -
 taking of certain drugs during pregnancy or excessive exposure of the unborn child to Children with Physitai
X-rays. Disability
a lack of oxygen to the developing foetus, for example, because of maternal
malnutrition.

You have read about care of the mother during pregnancy in Unit 6 of DECE 1 and Block 3
of DECE 2.

Damage during birth is probably the most common cause of brain damage leading to .
cerebral palsy. It can happen
a if the labour is unduly prolonged or unduly rapid
due to physical damage to the head through the use of instruments, like forceps,
during delivery.
due to anyUung that interferes with the oxygen supply to the child's brain during
labour, for example, when the umbilical cord winds around the child's neck.

Because of these reasons it is important that the delivery be done by a trained person, either
t in the house or the hospital. You have read about this aspect in Block 3 of DECE-2.
t1
t In early childhood i.e. in the first two or three years of life, cerebral palsy is sometimes
! caused due to:
i
Common infectious hseases such as gastro-enteritis, middle ear infection,
i encephalitis, complications arising due to measles and mumps, whooping cough
and scarlet fever.
Injuries to the head for example fracture of the skull.
Intake of poisonous substances, for example, lead or arsenic, by the child.
reduced supply of oxygen for a long time. This may happen in carbon monoxide
poisoning, strangulation, high attitudes/low pressures.

From your reading of the previous two Courses it would be clear to you that most of the
causes of cerebral palsy are preventable and that better w e of pregnant mothers, safety
measures during child birth and better control of the spread of infections can help to bring
about decrease in the incidences of brain damage and, therefore, cerebral palsy.

Managing a Child with Cerebral Palsy

The physical appearance of a child with cerebral palsy can lead the people to have a
negative image about her. She might be seen as a person capable of no independent action
and needing help with most of the activities of daily living. However, if the training and
treatment are begun early, the child can show tremendous improvement.

Anu 's parents, who themselves are well educated, had given up all hopes about her alfer
trying all kinds of treatments given by local healers. They had approached them even alfer
consultation with a doctor. It was alfer a closejFiend urged them to admit her in a school,
that they decided Po do so. Within one year the girl showed remarkable impmuement.
*

Depending upon the types and the extent of disabilities you would need to '
Help the child learn to move around independently or with some suitable mechanical
support.
Enable the child to look after herself - for example, be able to go to the toilet, wear
clothes, eat and drink.
Train her to communicate.
Help her to be as nonnal as possible in her appearance.
Assist the child in developing relationships with others.
Educate her, in keeping with the level of her intellectual functi.oning.
- , 37 ,
Children with Special Of course, you would not be able to manage all this by ~ourself.For example, to help the
-
Needs 2 child overcome the speech defects. you would need to associate with a speech therapist.
Difficulties in lpomotion would need to be handled by a physiotherapist. The child may
need to be fitted with appliances or may have to undergo surgery to enable her to walk.
Medicines would be needed to control fits. This means that you would need to refer the
child to a hospital where these services are available. Find out where these are available
nearest to the child's area.

b ~ a r lTraining
.~ and Stimulation of the Child at Home
While seeking the help of professionals for speech and mobility training is important, do
not forget the role of the parents. They are the ones who are with the child for most of the
day. Their attitude will have a crucial role in determining how far the child is able t s
overcome limitations of her disability.

Help the parents to understand cerebral palsy - they may not have seen a child with
this condition before. Explain to them how it affects mobility or intellectual functioning or
speech. They have to be trained in how to help the child become independent in her
activities. In fact, before the child is old enough to join preschool, it is the parents who
would have a major role in training her.
The early training and stimulation at home should concentrate on increasing muscle
strength and dexterity of different body parts. The idea is to make the child as self
sufficient as possible. Some of the areas in which the parents can train the child are
described below.

1) Teaching the child to swallow

Drooling saliva and having difficulty in swallowing are common problems that affect
children with cerebral palsy.
Explain to the parents to let the child feel the movements in the neck while they
themselves swallow. The child can be encouraged to swallow by stroking both sides
of her throat from the chin to the base of the neck or pressing the midbase of the
neck lightly with the index finger.
Encourage the child to close the lips by stretching the child's lips outwards towards
the ear. This will help to control the drooling of the saliva.

2) Helping the Child to Eat

When feeding, it is better to give the child slightly bland food as sweet foods tend to
increase saliva and drooling. Start with thicker liquids, such as soups and milk,
which are easier to swallow. Side by side give the child mashed foods. When she
can manage to eat these, teach her to bite off and chew solidlcrisp food. Help her to
keep the head straight during eating and use the tongue to control the food.
Encourage the the child to eat on her own. If the degree of physical handicap is
severe, the child will feel tremendous di£liculty in this. Explain to the parents that
they should not get impatient and begin feeding the child themselves. Explain to
them that trying is the only way the child will be able to overcome the handicap.
3) Using the ~ o i l e t
Due to poor control over their movements, children with cerebral palsy will find it
tlifticult to sit alone on the latrine or pot. In such cases, children need physical
supports, such as a base, which can be placed around the pot for the child to support
herself while sitting.
4) Coordinating Hand Movements
Ask the parents to give the child opportunities to grasp, hold, mould and squeeze
objects. This will help to develop the muscles of the wrist and fingers. In
working with the child, it is important to be patient and to take spilling, dropping
etc., in one's stride.
Help the child to pick up the things that have dropped, rather than scold her or do
these tasks for her, as the latter two actions will lead to greater dependency.
 Help the parents to understand that it will take quite some time for the child to manage Children with Phyrical I
Di~abilitY
these tasks on her own. Encouraging the child where she, shows any improvement is
important. Being able to coordinate the arm and leg movements for these activities, which
we take for granted, is no small achievement for a child with cerebral palsy.

Learning self-help skills with each other

While the above were some areas where you can explain to the parents how to train
the child, help them to understand that their child will benefit if they show her to a
person who is specifically trained to help the child improve her motor coordination.
Such a person is known as a 'physiotherapist'. Help the parents contact the Primary
Health Centre (PHC)/health worker/hospital to find out about physiotherapy.
Besides exercises to improve movements and coordination between different parts of
the body, the child may also need training in speech, if this is affected. For this, they
would need to get in touch with a speech therapist. If the parents are taking the
child to a speech therapist or physiotherapist, then they must carry out the
exercises with the child at home. Maintaining a regularity in the exercises is
. necessary - only then will the child benefit from them.
If the intellectual functioning of the child with cerebral palsy is below average, then
training the child to acquire basic skills would proceed differently. For not only will
the child have difficulty in physical movement, but may also find it a c u l t to
understand instructions, remember and pay attention. You have read about these
aspects in the preceding Unit on children with mental disability. In that case, you and
the parents would need to keep the principles eqlained in t h e l a l i e unit in mind as
well. Can you recall these principles and list them here ?
Children with Special
-
Needs 2

Working with the Child in the Centre

What about the education of child with cerebral palsy ? What sort of activities can you
organize for such a child in your early childhood care aod education centre ? While
planning for the child's activities at the preschool centre you would need to keep some
factors in mind.

As you have read, a child w l h cerebral palsy may have severe motor handicap, yet she
might be above average in intellectual functioning. Similarly, she may have mild physical
problems but moderate mental retardation. The intellectual functioning is not related to the
level of physical limitation. Therefore, the type of activities you plan for the child will
have to be in keeping with her levels of both intellectual and physical functioning. See
what the child is able to do and build upon that. The goals that you would keep for this
child would be different from what you would expect of the rest of the children at your
centre.

Some activities at a centre for spasHc children

If the child does not suffer from mental retardation, then she can participate in the same
activities as her peers - of course, within the limitation of the physical handicap. The
extent of the child's physical handicap would affect the type of activities you can plan for
her. A'child with severe physical problems will not be able to participate in outdoor
activities with other children. But remember that she would like ta see the others playing.
Do not isolate her just k a u s e she cannat herself move up to the swing. You can carry her
there and help her to enjoy the swinging motion of the swing. Be patient if the child takes
longer to complete her painting or is not able to sing the rhyme in hrne with others.

What we are saying is that it is important to realize that a child with cerebral pdry can
attend a regular school alongwith other children. The educator will have to be careful
in giving extra attention and help to the child, simplify the curriculum for her if required,
modify the activities so that she can also participate, and help her and the other children to
relate to each other. Sensitivity, patience and close obsentation of the child while working
with her in the centre would help you to understand the child better. Specialists in
physiotherapy and speech therapy would be able to give help in specific areas. A regular
health check up by a paediatrician would help to monitor her growth. Only if the child's
mental and physical handicap are such that she cannot M i t from attending a
mgular preschool, should she be put in a special school.

.-
Check Your Progrc~sExercise 1
Answer the following questions briefly in the space below.

I) What do you understand by the term 'physicaldisability'?

.....................................................................................................................................
....................................................................................................................................
........................................... ;..,....*.*..............................................................................

2)- What is the basis for categorizing 'physical disabilities?

.....................................................................................................................................

3) How wohd YOU &n&e o child with cerebral palsy?

.....................................................................................................................................
. .
1) Imagine that you are an educator working in a child care tee. During we dyoui
visits 10 the families in your area, you find that then is a three-& old child wite
. . Cerebral palsy in one of the families. On talking tcthe parents you find that thy do
 --

Children 4 t h Special not pay any special attention to the child because they do not think she can do
Needs 2- anythtng. The mother feeds and bathes her regularly. Since the child's speech is not
clear, the other children in the family do not speak much to her. For most part of the
day, the child is by herself.
What would you do in this situation 7

') State whether you agree or disagree with the following statements :

a) Medical and surgical treatment is possiblefor many physical disabilities. ( )

b) Most causes of physical disabilities are preventable ( )

c) Damage to the child's brain during birth is the most common cause
of cerebral palsy. ( 1
d) Early training, stimulation and physiotherapy can help to reduce many
of the physical limitations caused due to cerebral palsy. ( )
e) A child with cerebral palsy can attend a regular preschool. ( 1
- -
8.4.2 Poliomyelitis
-
Poliomyelitis, commonly known as polio, is of two types :
Spinal polio
Bulbar polio
Spinal polio, is an infection that affects the nerves in the spinal cord, so that the
muscl6s which are controlled by the cord are paralysed. The paralysis may affect the
entire body or just some parts. It usually affects the muscles of the limbs. The paralysis
results in difficulty in gross and fine motor movements and disables the child
physically. Depending upon the extent of the damage, the child's mobility would be
affected accordingly. The damage may be so little that the child walks with a slight limp.
In other cases, the person may need braces (support to legs), crutches or wheelchair to move
around: In extreme cases, the person may be letel^ el^ bedridden. Similarly, the arm and
hand m u l e s may be affected to a lesser or greater degree. Spinal polio does not affect
the intelligence of the child.

Bulbw poli:afkts the brain and damkes the throat, tongue and respiratory muscles.
Polio attacks the child in three stages
Stage 1 : The child develops mild fever and sore throat, feels weak and loses appetite.. This
lasts for two or three days. If the child's resistance is good, these mild symptoms disappear;
if not, they reappear. The reappearance of the symptoms signifies the second stage. If at
this time the child receives an injection for headache, cold, fever, sore throat or vomiting,
the polio will turn out to be very severe.
Stage 2: The fever reappears after a lapse of one or two days This time the fever is severe
, and child has headache, backache, pain in &e neck and loose motion. These lasts for three
to fout days. ,.
42 - -
Stage 3 : The child feels comfortable for one or two days. Then suddenly the child loses Children with Physical
movemcnt of the limbs that are affected. Paralysis of the limbs has occurred. At this stage, Disability
the child should not be allowed to exert herself. If she exerls, the loss of movement will be
very severe.

The first six weeks of the illness are the most crucial. At this time the child has a lot of
pain. The child must take complete rest as this is the only treatment at this stage.
During this period of illness :
8 Give complete bed rest to the child.
8 The child should lie down with her legs, hands and back flat and straight. Any other
way of lying down will defonn the limbs severely. Use a foot rest to help the child lie
straight. The health worker will know how to make a foot rest.
8 Do not make the child walk.
8 Do not take the child to nature healer for massage.
8 Do not give any injection once the illness has come about.
Do not lift or carry the child, even if she cries of pain.

Vai-ious deformities due to polio

Tmatmeat

After the acute stage (i.e., the first six weeks) the child begins to recover. This is the
recovery stage which takes two years. During this period the child must be taken for
regular check-ups to the health centre and she must do exercises. The exercises will be
taught by a physiotherapist at the health centre. There are different exercises for different
needs. Explain to the parents that they must learn the exercises and help the child do them
regularly at home. Exercises will prevent many deformities, help the child to gain strength
and laterenable her to walk. Along with this, the child should be given nutritious food to eat.

Pmveotiog Polio
8 Get the child immunized with the oral polio vaccine. You have read about this in
DECE-2.
if a child is affected by polio, keep her in a separate room and do not let young
children come near her.
L

L -

Children with Special Use separate vessels and clothes for the affected child.
Needs - 2
Bum or bury deep the stools of the child akected with polio-
@ Maintain hygiene.
Use boiled water for drinking.

Managing a Child with Polio ,

As you have read above, the child requires proper medic; help, orthopaedic (concerning
bQnes) care and physiotherapy to help overcome the difficulties because of the disease.
Some of the effects of polio can be corrected by surgery. Others can be overcome by use of
appliances such as artificial limbs or crutches. Regular physiotlierapyalso helps to tone up
. the muscles and improve their function& to a large extent. Thus, it is important that the
parents take the child to a medical centre. Besides, these visits must be made at regular
intervals so that the child's progress can be monitored. For example - if the child has
been fitted with braes (support to legs) or crutches, these have to be changed as the child
grows in height. If nqt altered, the child would face more diaculty in walking or could

,
develop other physical deformities, such as a curve in the spine.
,.

.,

Some aids that can help the child to walk or move around

Since polio does not affect the intellectual functioning of the child, she can participate in
the activitil organized for the rest of the children, in the preschool, of course within the
,limitation of the physical handicap. Subsequently, the child can pursue education in a
regular school and college. The centre and the school must provide for ti$ basic physical
facilities, so that the child is not taxed unduly. Ramps, instead of staircases, may be
I 44
 ' !.
provided so that it is easier for the child to walk or move the wheelchair; class rooms should Children with ~ h ~ s i e a f
be preferably be on the ground floor and special furniture may be needed to enable the child Disability
to sit in the wheel chair and work.

. 8.4.3 Convulsions or Fits

! The brain functions with flow of electrical activity in it. When the normal electrical activity
is disturbed, the person has a convulsion or fit. Why this happens is not known. When a
child has a fit she can become unconscious, may fall suddenly to the ground, become stiff or
begin to jerk, cry out or make other noises. The child may also lose control over bowel and
bladder for that period. She may not be conscious of urinating or passing stools. The
child's face can become contorted, the breathing heavy, and she may perspire and foam at
the mouth. She may injure herself by biting her lips or tongue or by hitting against objects
while falling, The more severe part of the fit may last from two to five minutes.

At-times, the fit is mild and only slightly visible. The child may only 'freeze' for 5 to 10
seconds, or perhaps flutter her eyelids.

Just before having the fit, the child might experience a peculiar sensation - she may hear
certain sbunds, see certain images, or perceive certain'odours.

The child might have a single fit or have repeated fits. Fits are more likely to occur
a one or two hours after the child falls asleep
a one to two hours before awakening
a due to some emotional disturbance and stress
a when the child has high fever.

While these are some likely causes, the fits are orten unpredictable and recurrent -which
can be frightening for observers.

Treatment -Drugs can help in preventing fits or reducing their,frequency. EQlain to the
parents that they need to take the child to a medical centre.

What to do when the Child has a Fit

There are certain things which the parents and you, as an educator in a chlld care centre, .
must keep in mind while managing children who have fits.
The child who is aware of the peculiar sensations that she has just before the fit starts,
can be trained to immediately communicate this to people around her or take
precautionary measures, like sitting on the ground against a safe rest, on her own.
Since the child can fall to the ground, the area around the child shduld be cleared of
furniture and other articles, so that she does not hurt herself.
The child should not be moved, restrained, or held during the fit.
The child's head should be protected b i cradling it in one's k d s . Do not restrain
head movement, butmove with the child.
When possible, move the child's head to one side so that the saliva drains out and
does not choke her. Turning the head would also prevent the child from getting
choked on her tongue, which could roll to the back of the throat.
Try to insert a soft object, for example, a folded handkerchief between the child's jaws
to prevent her from biting her tongue.
When the jerky movements subside a little, turn the child on her side so that she can
breathe easily.
Loosen her tight clothes when she is having the fit.
Sit down on the floor next to the child to reassure her.
Allow the child to remain lying down for a while after she has regained
Children with Special The child may not remember anything about the fit. She may also be tired. Talk to
Needs - 2 her in a calm voice. Explain to her that she had a fit, but do not make an issue of it.
When she is ready, help her to stand up.
There is no nced to call a doctor, unless you have been asked to do so by her parents.
, Inform the parents about the fit and for how loilg it happened.
Other children at the centre should be explained about the child's fits so that they are
not scared when it happens or make fun. Rather, involve them in taking care of the
child, for example, by moving furniture or staying with her.
Above all, remain
,
calm when the child has a fit.

Implicationsfor the Education of the Child

Having fits does not mean that the child cannot attend regular preschool or school. Fits are
not contagious. They do not cause mental retardation or physical disability. The cbld
who has fits is just like others in the various areas of functioning. Trw.t the child
normally. She can participate in all the activities that her peers are engaged in. The drugs
the child takes to control fits may have some side effects, like causing swelling of the gums.
You as an educator should be aware of this, so that you can help the child adjust to her
condition. Fits may interfere with the child's attention span. They may also cause her to be
irregular in attending the centre. You would need to deal with this situation by giving extra
attention to her when she comes to the centre.

A CHILD WHO BAS A FIT IS NOT MENTALLY RETARDED.

L I

8.5 MUSCULO-SKELETAL CONDITIONS

Some children are physically handicapped because of defects or diseases of the muscles or
bones. The muscular and skeletal problems may involve the child's legs, arms, joints, or
spine, making it difficult or impossible for the child to walk, stand, sit, or use the hands.

Children with musculo-skeletal problems are not mentally retarded.

The problems may be congenital or acquired after birth as a result of infectious diseases or
accidents.

In the following sub-sections, we shall read about a few of the common musculo-skeletal
conditions.

8.5.1 Muscular Dystrophy

Muscular dystrophy is a disease in which the muscles responsible for voluntary
movement of the body progressively weaken and degenerate, until they can no longer
function. It has been identified in infants one year old as also in people eighty years old
Before the onset of the disease, the child's growth and development is normal. Mostly male
children are affected and, generally, the disease is carried by the mother from one
generation to the next. (i.e., the mother has the defective gene responsible for muscular
dystrophy which. if passed on to her male child, will resulr in the disease. If the gene is
passed on to her female child, she becomes a carrier for muscular dystrophy and may pass it
on to her children. However, the disease will not show itself in the female child.)

Kamal was a normal, healthy infant belonging to a rich business class family. However, at
two years of age, he had dlflcul9 in walking. He walked unsteadily swaying from one side
to the other and also fell down frequently. While rising @om a sitting position, he would
rest his arms on the floor for support.

His family initially thought that he had contactedpolio. However, later tests showed he
had muscular dystroph-v. His mother wasfound to be a carrier, even though there were no
cases of muscular dystrophy previously in the fbmily. Kamal's sisters were also tested and
they were not found to be carriers of the disease.
 As Kamal grew older, he started using crutches and braces for walking. His abdomen Children with Physical
protruded out and the back turned inwards. Disability

Around thirteen years of age, Kamal could not walk independently. He had to use the
wheelchair-and had to be picked up and placed in it.

At twenty years of age, he has become veryfat which complicates the process oftaking
care of him.

Kamal had attended a regular school just like any other child, during childhood and
teenage years. He is now in hisJnalyear ofB.Com in a regular college.

Kamal has received tremendous support from his family. For one thing, the family has the,
resources to help him cope with his disability. To give you an example, the family stays in a
two storeyed house and they are now thinking of installing a IiJt,so that it is possible for
Kamal to move between the two floors.

Treatment
There is no treatment for muscular dystrophy. Regular exercises and physiotherapy
- would help to control the looseness or stiffness in limbs. The child and his family will
have to be counselled about the nature of the illness and poor chances for improvement.

-
-- -
8.5.2 Arthritis

Arthritis is a disorder that affects the joinqs. A person with arthritis feels pain in and
around the joints (elbow, knee, ankle, wrist etc). It can be so severe that the joints can be
permanently damaged, making it extremely difficult for the person to move around, lift
objects, or write, or it can be mild so that while there is some swelling, aching and stfiess
in joints, the person is able to cany ocwith routine activities. Sometimes, along with A 7
Children with Special arthritis, there are other complications like fever, respiratory problern, heart problems, or
-
Needs 2 eye infections.

Arthritis can affect people of any age, including young children. According to some recent
data, more girls'are affected than boys.

Treatment
Medicines can help to reduce pain. Exercises also help to keep the disease under control.
A child with arthritis must be taken to g medical centre. The exercises suggested must
be done regularly by the child at home for these to have an effect.

8.5.3 Club Foot and Other Conditions

The child with this disorder is born with one or both feel turned down and in. The heel and
the bottom of the foot look turned up to one side. This leads to an odd way of walking.

Treatment
Club Poet can be corrected with surgery, and with braces supporting the feet. The
child qan learn to walk in the normal fashion. Club foot is easy to correct when the muscles
are soft and the bones are tender. The treatment can be started d month after birth.
Explqn to the parents that they should take the child to the health centre where the doctor
i will tell them what to do. Improper massage and exercise can make the condition worse.

Club foot
I
Childrfm born with other malformations like extra toe, two fingers attached, arms or legs
missing since birth, cleft-palate (cut in the upper lip and palate) can be helped through .
medicdl intervention such as plastic surgery, use of artificial devices and limbs. Proper
medic@care can helpthem to overcorn! the impairment and help in leading a normal life.
I

8.5.4 Managing the Child with Musculo-Skeletal Disorders

Musculo-skeletal disorders puts physical limitations on the child, but do not affect her
iatelktual functioning. Sa the child can participate in all the activities that you have
organized for children in your centre, to the extent her physical condition permits.
~ e e p j t h child
e as physically active as possible. This might become di&icult because of the
limited physical movements. Therefore, the physical games and activities you organize at
the centre would have to be modified in such a way that the child can participate.

If you have planned a relay race for the children at your centre, can you think df ways to
modifyit so that the child with braces can also participate without feeling 'different' and
'less able' amongst other children?
.............................................................................................................................................Chf dren Physical
..
.............................................................................................................................................
Disability

REGULAR EXERCISES HELP TO CQW-DZ Ma%d%#w

SKELETAL CONDITIONS.

Exerdsing to music is fun and helps the physically disabled to improve motor coordination

8.6 PHYSICAL DISABILITY DUE TO OTHER

CONDITIONS

Accidents and diseases can also cause physical disability. The parents and the educator
would need to make extra efforts to help the child adjust to her disability.

8.6.1 Accidents
Falling, burning, poisoning and accidents with vehicles might lead to physical handicaps
like amputation or disfigurement. Sometimes when the brain and spinal cord are affected,
it may lead to neurological conditions like paralysis or lack of control over movement of
limbs. When a child-is involved in an accident, the disabilitycan lead to emotional stress
and.depression. People close to the child have to take care that the child receives hve,
comfort and reassurance to get over these feelings and also prepare for the life ahrad with
positive feelings and confidence.

8.6.2 Asthma
Asthma is a chronic condition in which the individual experiences repeatcd episodes of
difficulty in breathing, especially in exbaling air. This is usually due to an allergic
Children with Special reaction to certain foods, diet or w c l e s in the air such as pollens. The individual's air
-
Needs 2 passages decrease in size because of which breathing becomes di&cult. Asthma affects
people of all age groups, even infants a few weeks old. Asthma tends to run in families.

Treatment
Try and keep the child in an allergy-free environment. This, however, is usually difficult to
control.
The child may be given drugs to increase resistance to allergic reactions.
Breathing exercises done on a regular basis, even when the child does not have an
attack, will help to reduce the intensity of the attack.
During an attack, the child must be given medicines to relax the air passage. This
must be done after consulting the doctor.
If the attack of asthma becomes severe and the wheeze is pronounced, the child may
need to be hospitalized. If the child starts turning blue, treat it as an emergency. You
have red about mana&ment of asthma in Block 7 of DECE-2.

Managing the Child in the Centre

Ask the pare&s whether any precautions n d t o be taken at school to avoid allergies, and
whetkr the cMd needs some other special attention when ahe gets an attack. Apart from
this, the asthxnatic child should be treated like any other qhild She can participate in all the
activities pu organize at the centre.

Exploring the outdoors : A group of physically disabled children with their educator
I

8.7 REHABILITATION OF CHILDREN WITH

PHYSICAL DISABILITIES
- Very often, children with physical disabilities may be seen as helpless or unable to learn,
because they are not able to do some of the things which most children can do. It is
forgourn that many children with physical disabilities can do most of the things, tRough
they may do it differently. For example, a child who does not have the use of her hands
- may do things with her feet or mouth. Just thinking about the limitations imposed because
of the physical disability, without trying to see how much the chld can learn, is
shortsighted; we must develop a human way of responding to people with a physical
50 difference.
 One of the major gods while working with children with physical disability is to bring Children with Pbyrical
, that tbe negative effects of their disability are
changes in their e n v i r o n ~ p tso Disability
minimized and they can lead a life as normal as possible. We have talked of this aspect
off and on in the Unit. Let us recapitulate and summarize it here.

8.7.1 Social Environment

How the children adapt to phykical limitations and how they relate with others, depends on
'
how their parents, siblings, teachers, peers and public react to them and assist them.

The society's reaction of fear, rejection or discrimination would lead to the child hiding or .
feeling guilty about her disability. If the reaction is of pity, the child loses confidence in
herself and would become dependent on others. Lack of friendships, which in the younger
age is quite dependent on the physical activities the children can participate in, can lead to
a feeling of loneliness and lowered selfesteem.

Can you think of ways in which the children could be sensitized towards those with a
physical disability? One educator planned the following activity to help the children become
aware of the difficultiesfaced by a child who used crutches to walk. The children were
asked to do tasks like jumping over a certain distance, climbing on a chair, putting a book
on the last shelf, which was very high. Thus without giving a 'lecture' on sensitivity
towards their classmate, the children were helped to realize the diaculties faced by the
child with the disability.

Besides such specific activities, your own attitude and behaviour whld communicate a lot
to the children. If you verbally express concern for the child with a physical disability, but
your behaviour with the child does not reflect that concern, then the other children are not
likely to show sensitivity towards the child, no matter what you may say.

The child's family would also need guidance and counselling to overcome their feelings of
shock, disappointment and depression, when their child is identified to have a disability.
Apart from the emotional stress, the family might face economic difliculties, as the
treatment can be expensive and long. Often, they may not have fidl information about the
options available for ueaunent. Other children in the family may feel neglected when the
child with disability is given extra care and attention, which she :requires. This might lead
to a feeling of anger towards the child with disabilit);.
..
You, as an ECCE worker, can help the family in overcoming many of these problems by
maintaining close contact with all the family members, talking to them and giving them an
objective view regarding the situation. You can help them to go to the right professionals
and agencies that can advidthem on their child's condition and the possible ways of
helping the child through:
Drugs or medication.
a
Surgery.
~pecikcexercises for physical growth. ,

Specific equipment - like braces, walker etc.

Specific exercises for improving speech.

8.4.2 Physical Environment

Staircases, high steps, narrow doors, things kept at a height, rooms crowded with too much
'furniture, are some of the things which would restrict the movement of children with
physical disability. This would restrict the opportunities for being independent and for a

learning. Can you think of ways in which a teacher could help to overcome these problems
in a sqhool -knowing that the authorities may not be able to or agree to spend on the
kpur of the building? '
...............
..,..........,.......,...............................................................................l

-
Children with Speclal ................................................................................................................................................
Needs - 2
........................................................................
........................................................................

A government school teacher was,for example, able to shift her classroom from the first
floor to the ground floor to enable one of her students with physical disability to attend
school regularly. The child used a walker.

. 8.7.3 Educational Implications

As you would have understood from reading the Unit, for children who have only physical
impairment, the curriculum and educational goals will be the same as for physically
normal children. They may, however, require special guidance to traio in skills like
using the toilet, dressing, feediig, and movement.

For children who have other handicaps in addition te physical limitations, for example,
mental retardation, you will have to modify the activities in keeping with their level of
intellectual functioning. Depending upon the extent of the handicap, the child q y b e d t
more from attending a special school rather than a regular preschool centre.

While it is necessary to lpok for appropriate people or agencies for specific advice for
children with physical disabilities, it is important to remember that if given ample
opportunity to develop sociarly, emotionally and educationally in as normal a fashion as
possible, many children with physical handicaps can make healthy adjustments to their
\
disabilities and becorne contributing members of the society.
I Answer the following questions in the space provided below.
Childkn with Physical
Disability

complete bed p t .

2) What parts of the body are aEected in

a) Polio
...........................................................................................................................

b) Muscular Dystrophy
...........................................................................................................................

I .

...........................................................................................................................

...........................................................................................................................

e) Asthma

........................................................................................................................... 53
 * .
8.8 LET US SUM UP
In this Unit you have read about some types of physical disabilities. All those individuals
who have non-sensory physical limitations, that is, limitations not due to sense organs but
due to organs like limbs, joints, bones or muscles, and those individuals who have health
problems that come in the'way of their leading a normal, healthy life are physically
disabled.

Physical disability can occur due to damage to the brain or spinal cord (neurological
disorders), due to damage to muscles or bones (musculo-skeletal conditions) or effects of
diseases on general health. Disability can occur during the prenatal period, delivery or after
birth.

Cerebral palsy is a neurological condition where, due to damage to the brain, the child has
paralysis or weakness in the body parts, which affects gross and fine movements. Besides
this, cerebral palsied children may have problems of vision, hearing, speech, perception or
mental retardation. Early training and stimulation for the child must begin at home.
Explain to the parents how they should train their child and emphasize the need to visit a
physiotherapist and speech therapist at a medical centre. If the child's mental ability is not
affected she kll be able to attend and benefit from the activities you would carry out in your
centre. Of course, while devising activities you would need to keep her physical limitations
in mind.

Children who are affected by polio or fits or mdo-skeletal problems have a physical
disability, but their mental abilities are just like those of other children. They can
participate in the activities you organize for the children in your preschool centre, within
the limitations of their handicap. Explain to the parents that a child affected by polio or
musculo-skeletal problems needs to visit a health centre or hospital and will benefit from
physiotherapy. .

It is important that the physical environment of the physically disabled child is conducive to
her functioning. This can help her to overcome many of the difficulties caused by her
disability. You would also need to deal sensitively with a child with disability and develop
such a concern and sensitivity in the children at your centre and other members of the
community.

8.9 ANSWERS TO CHECK YOUP PROGRESS

C

EXERCISES
Check Your Progress Exercise 1
1) Disability arising due to
/ limitations of non-sensory organs, i.e, limbs, bones, joints and muscles;
effects of disease on the general health of the body are physical disabilities.

2) Physical disabilities can be of three types :

those caused due to damage to brain or spinal cord (neurological disorders)
those caused due to damage to muscles and joints (mdo-skeletal conditions)
those caused due to illnessmd disease.

3) Theohild will have paralysis or weakness in body parts which will lead to lack of
coordination in gross and fine motor movements. Due to this, the child will have
- difticulty in walking, eating, reaching for objects and holding them. Arm and leg
movements would be jerky. She may have difhculty in swallowing, causing the saliva
to drool. There may be involuntaq contortions of the facial muscles. The severity of
the damage to the brain would determine how mild or severe these symptoms are.
Besides these, the child may be mentally retarded, have hearing or vision problems
-andspeech defects.
4) The following are some aspects you should help the parent to understand : Children with Physical
Dlrabillty
With training, the child can be helped to improve her level of functioning.
The child needs love, care and support of family members.
It is important to take the child to a health centre, where she can be given speech
therapy and physiotherapy. These exercises must be continued at home.
The child can participate in many household activities.
a The parents and the other children should talk to her even if they do not
understand completely what she says.

They should not neglect the child.

The child should join the preschool centre once she becomes a little mobile and
independent. The company of other children will help her to improve.
5) a) Agree
I

b) Agree
c) Agree
d) Agree
e) Agree
Check Your Progress Exercise 2
1) a) Agree
b) Agree
c) Disagree
d) Disagree
e) Disagree -
2) a) Spinal polio affects nerves in the spinal cord, so that the muscles controlled by
the cord are paralyzed. It usually aEects the muscles of the limbs, so that gross
and fine motor movements are affected.
. -,
B u l b i polio affects the brain and damages the throat, tongue and respiratory
muscles.
b) Meets the muscles responsible for voluntary movement, which progressively
weaken and degenerate.

c) M a t s the joints causing pain or difficulty in ann and leg movements. It can
completely immobilize the person.

d) The bone of the foot.

e) Mects the air passages, leading to difficulty in breathing.

I
UNIT 9 CHILDREN WITH,BEHAVIOUR
DIFFICULTIES
Structure
9.1 Introduction
9.2 Difficulties in Childhood
9.2:1 Who are the Children with Behaviour Difficulties?
9.3 General Causes of Behaviour Difficulties
9.3.1 Develqmental Changes as Causes
9.3.2 Environmental Factors as Causes
9.4 Qpes of Behaviour Difficulties
9.4.1 Temper Tantrums
9.4.2 Enuresis
9.4.3 Withdrawn Behaviour
9.4.4 Aggressive Behaviour
9.4.5 Stealing
9.4.6 Hyperactivity
9.4.7 Fears and Phobias
9.4.8 Autism
9.5 Parents?Perspective and Guictance to Parents of Children with DBculties
9.6- Let Us Sum Up
9.7 Answers to Check Your Progress Exercises

9.1 INTRODUCTION
Behaviour difficulties in a child are a cause of concern to the parents as well as to the
educator. A child with a behaviour difficulty may find it difficylt to be accepted and liked
by other children. The difficulty may come in the way of the child being able to form
relationships with others; it may cause her to develop a low self-concept and may even
hamper learning. Therefore, it is necessary that you help the child overcome it.
Sometimes it may become ditlicult to identify whether or not a child has a behaviour
difiiculty because different people may view and interpret the same behaviour differently.
To judge whether or not a child has a behaviour difficulty, one would need to observe the
child in different situations over a period of time.

In this Unit, you shall learn about some behaviour difficulties that children commonly show
and how you, as an educator, can help the child, and the parents, overcome it.

Objectives

After studying this Unit, you should be able to

identrfysome behaviour difEculties in children
deal with a child who shows a behaviour difficulty and modify her behaviour.
explain the parents how they can help their child overcome the difiiculty.

9.2 DIFFICULTIES IN CHILDHOOD

Childhood, we tend to believe, is a time when children are happy and carefree,free of all
those conflicts and anxieties that become a part of life later on. Yet, a child experiences
many difficult situations.
A child beginning to cry because the mother is too busy to pick her up is a common Children with Behrviour
experience that does not cause alarm to adults. Yet, it is a diflicult situation for the child at mmeulaea
that moment. She may cry as though it is the end of everything. But as soon as the mother
gets free and picks up the child, she beams a smile at her. The w~ulty is overcome.
Not all situations are as simple as the one mentioned above, nor are connections between
behaviours and their causes that direct. Many inborn and environmental factors can
adversely affect some children in a way that fiey experience difficulties in growing up and
these are reflected in their behaviour. These factors can be biological (inborn), i.e.,
physiological or hormonal problems of the body; or they can be environmental, i.e., due to
the family and society. Some may affect the child from the time of prenatal growth while
others may influence her during childhood years.

9.2.1 Who are the Children with Behaviour Difliculties?

Let us examine the case of a child who would be described as having a problem of
behaviour.
Manju is four years old and she attends a balwadi. The teacher has noticed that Manju
does not mix much with children. She does an activity only when ?he teacher asks her to,
otherwise she just watches other children. She smiles very rarely. She has a peculiar
habit. When she is sitting close to other children, she pinches them hard. She normally
does it when the teacher is not watching. On account of this, other children keep away
t near Manju. She will pinch you. " Quite open other children
fLom her saying: " D ~ n 'sit
hit her in return and complain to the teacher about her habit.
Many children do express their aggression through pinching when they are angry. But,
Manju's pinching behaviour is unusual because she seems to be doing it without any
apparent reason, as children whom she pinches have not teased her nor frustrated her in any
way. Therefore, this behaviour needs to be corrected. What also becomes obvious when
one looks at Manju is that she is not a happy child. Other children hesitate to be near her.
It appears that she does not like other children; but more than that, it seems she does not
like herself much. Manju needs help to become happy like other children. Her teacher can
play an important role in helping Manju overcome her problem. We shall deal with the
method of handling this a little later in the Unit.
The textbooks use terms such as 'behaviour disorders', 'behaviour problems', 'emotional
problems' or 'behaviour deviations' to refer to sociall~unaccqtablebehaviours. We will
use the term 'behaviour dBiculties', as it is a more child-iriendly term and, for our purpose,
refers to problems that a childcare worker can learn to handle at the ECCE Centre.
In order to decide as to which of the behaviours are unacceptable and require intervention,
we need to agree on the criteria that should be used to see a particular behaviour as
"difficult". There are two reasons why a child's behaviour would be seen as unacceptable
and we would say that the child has a behaviour di&culty. These are :
(a) It has a negative effect on the child's development and adjustment.
@) It interferes with other people's rights.

If we look at Manju's behaviour, it is clear that it affects her own adjustment with her peers,
and it interferes with other children's activity and produces discomfort.

Most children show unacceptable behaviours some of the time. However, this does not
mean that they are children with behaviour difficulties. It is when a child shows
undesirable behaviour most of the time over several months, or extremely negative
behaviour even over a short spau of time, that the child is said to be showing behaviour
difficulty. The examples of these behaviours are temper tantrums, head banging, extremely
f a reactions, bed-wetting, feeding and eating difficulties, and aggressiveness.

It is common knowledge that as children grow from one year to another, their behaviour
patterns change. Along with this, the types of challenges they face in &ping with life also 57
 '
Children with Special become difkrent. A moher can be found saying about her three year old son: "Till last
-
Needs 2 year he was ,no problem. This year he is makin difficult for me". Apparently, the
mother is referring to a change in the child's which seems to be causing some
difficulties for her.

For the purpose of our understanding, we can divide the difficulties or problems some
children experience during childhood into two types, based on their causes.
a) Those that arise as a consequence of the child's development.
b) Those tbat are caused by enviroluhentalfactors.
One may again state here that experiencing some problems some of the time is part of
normal growing for all children, and does not call for more than simple common s e m
handling by caregivers. It is when the child's unusual behaviour is coming in the way of
her own development andlor disturbing others' lives tha't we can call it problem behaviour.

9.3.1 Developmental Changes as Causes

It may sound strange, but it is true that the child's stage of development itself can be
behind the difficulties being shown by tbe child. This is because each stage in a child's
development has its own needs, tasks and hazards. At each stage of development, i.e.,
infancy, early childhood, middle childhood and adolescence, the levels of the child's
intellectual, social and emotional development influences her relationshipswith the people.
At each stage, the child has to adjust and cope with different situations and Merent
demands of growing up. Most children can cope with these situations. When children find
it difiicult tomeet these demands, their tension gets reflected in some difficulties in their
behaviour. Sometimes children can solve these themselves, while at other times they need
help.

At different stage8 of development, especially prenatal nad early childhood, if any

internal or erternal factors damage the brain, it generally affects behavioar. Brain
damage can be caused prenatally, if the mother is poorly nourished or if she conaunts
harmful medicines or suffers from infectious diseases. Constant stress in the mother can
also affect the brain of the foetus.

After birth, factors that can cause brain damage are malnutrition, accidents, falls and direct
blows, brain fevers, diseases like measles, mumps and bacterial and viral infections.
Objects and toys with lead-based paint can also be dangerous, as young children mouth
them and consume lead.
A child with brain damage may have problems such as mental retardation or cerebral palsy.
Even if she has normal intelligence she may show difficulties in learning, in sitting still and
diffiedties in controlling her own behaviour.

9.3.2 Environmental Facton as Causes

As you know, from reading of Course 1, the child's family has a tremendous influence on
her behaviour and personality. Child rearing practices in the family would determine
whether 01 not a child experiences a behaviour difficulty. Besides, the family, the
immediate neighbourhood, the larger community and the society are also an important part
ofthe child's environment. Factors and people within these can also be the causes of
behaviour difficulties in the child.

a) Tbe Family Setting : While most families contribute to the emot~onalwell-being of

their children, in some cases tbe family itself becomes a cause for the child's problems.
For example, if there is conflict among family members, especially between the mother and
the father, the atmosphere in the home can become disturbing and affect the child
negatively. If at a time when the child is expectingto receive love and experientx trust,
there is lack of trust and affection in the family, the child can sense it. Such situations can
cause tension to the child and she may develop symptoms such as speech defects,
withdrawal from people and poor concentration in work.

As you know, child rearing practices play a major role in determining the child's
personality. They can be tbe cause of behaviour diificdty in the child. The personality
 of the parents plays a significant role in their methods of child-rearing. A mother who is Children with Behaviorr
highly anxious, as she womes a lot about simple matters, is likely to convey this anxiety to Difficulties
the child in the way she handles her. She may get unduly upset when $e child wets her bed
or does not finish her feed. In her anxiety, she may punish the child in an inappropriate
manner. When such situations occur often, they are very likely to have a negative effect on
the child and this gets reflected in the child's behaviour. Similarly, a father who does not
'like crying children', may refuse to hold the baby when she is crying or scold her very
loudly. The child may become tense every time the father comes near her and a healthy
father-child relationship may not develop.

The family may J s o be responsible for behaviour problems in children through the
kind of values the members hold and practice. If the adults resort to lying and cheating
in their work, the children are bound to see q t as the acceptable way of work done.
Hence, if eight year old Amit lies to the teacher that he could not finish his school work at
home because he was unwell, he is doing what he saw his father do with somebody else.

b) Childcare and Education Centres : When a yomg child leaves home and comes to a
place like a childcare orland education centre, she is not prepared for unfamiliar people and
,I surroundings. Often, it looks and feels very different from home. Hence, it becomes very
important for the workers and teachers there to make the centre an inviting and attractive
I place through sensitive handling, and interesting activities. When this does not happen,
I i.e., the workers are uncaring and the method of working harsh, the child may begin to
I show unacceptable behaviours. She may become fearful of going to the centre, or stop
talking to people at there or become aggressive at home. Several other symptoms may

c) The Community : Almost every family in India identifies itself with a particular caste,
social class and region. Its members, in turn, see themselves as doing something because
others in their community sanction it. In this process, sometimes communities get
dominated by beliefs and practices that may harm the children. The practice of gender.

IF
discrimination is one such example. In general till today, most Indian societies express
preference for boys over girls. The reflection of this bias in the sex ratio is more prominent
in Northern India as compared to the Southern part. An effect of this practice of several
centuries is that some girls develop symptoms of maladjustment and show them through
behaviours like extreme submissiveness, lack of self-confidence or hostility towards parents
and others who practice discrimination.

The important thing is to understand that a given environmental problem does not
result in the same symptoms in d l the children exposed to it and a given symptom in
different children, such as hostile behaviour, can result due to different reasons. When
a child shows a behaviour difficulty, your role is to identify what is causing it and treat
the cause.

I b
Check Your Progress Exercise 1

1 Answer the following questions briefly in the space provided below.

I 1) What are the basis on which you would say that a certain child has a behaviour
diff~culty?

2) What may be some of the causes of behaviour difficulties shown by children 7 rn

Children with Special
-
Needs 2

....................................................................................................................................
3) State whether you agree or'disagree with the following statements.,
a) If a child shows some unacceptable behaviour some time,
we can say that the child is showing a behaviour difficulty. ( 1
b) Sometimes when a child is not able to meet with the demands 4
placed on her during different stages of development, it may get
reflected as a behaviour diff~culty. ( 1
c) Brain damage can result in some types of behaviour difticulties. ( )

d) Child rearing practices can be the cause of behaviour difticulties

in children. ( 1
e) If the child care worker is harsh and uncaring towards children,
\ the child may begin to show unacceptable behaviours. ( 1

Let us now discuss some of the dBculties that you, as a child care worker, are likely to
encounter among children at the centre. Whether or not a particular behaviour
difficulty can be termed serious would depend on three factors :
i) its frequency : does it occur very often 7
ii) its intensity : when it occurs, is it express forcefully?
iii) its duration : does it occur over several weeks or more?

i
High frequency, high intensity and long duration of a behaviour dficulty in the child
would render it serious. For example, ifa preschool child cries sometimes in response to
distress. h d becomes quiet when soothed, it is not a problem behaviour. But if she cries in
response to almost every situation of anxiety and continues to cry for a long time, despite
efforts to soothe he, it is a sign of an emotional problem in the child. *
We will now take up some behaviour di&culties one by one and read about their
descriptions as children experience them. We will also study the possible causes and
methods of helping the child overcome the di&culty.

9.4.1 Temper Tantrums

All children, like adults, experience anger. As we d l know, there are many ways in which
anger is expressed. When the child expresses this anger by screaming, throwing things
around and throwing herself on the floor, it is called a tantrum. Different children may
demonstrate different behaviwrs during a temper tantrum. Some may bite or hit
themselves; some may direct their anger towards others. The child seems to have a crying
and screamingfit, and may sometimes even hold her breath till she becomes blue. The
common feature in this behaviour is that the child cries loudly, becomes uncontrollable
and may harm people or damage things. She seems to lose control over herself.
A temper tantrum is triggered off by the child's need to do something that has been
forbidden. Such terrible behaviour initates and worries the parentlteacher who may give
in to the child's demand. However, if the parentsleducator give in to the child, it will
only increase this behaviour. Let us see example to understand this.
 Among a group ofchildren who are taking turns and coming down the slide, lsmail has a Children with Behaviol
temper tantrum because he wants his turnfirst. He starts rolling on the mudfloor and Difficulties
dirties his clothes, crying all the Ghile and saying : "lwant to be first." From her earlier
experience the teacher knows that ifshe lets him be thefirst to take a turn, he will become
quiet and allow the play to go on. So she says: "OK, OK, be quiet and 1' 11 give you a turn
first." Quite rightly, Ismail becomes quiet, gets up, runs to be first on the slide while other
children watch him do this.

I Do you know what has happened in this little scene? The teacher has actually helped
I Ismail learn that he can use a temper tantrum to get his way. We can say that the teacher
has reinforced his undesirable behaviour, or rewarded his behaviour. As you know from
I your reading of DECE-1, any behaviour that is rewarded is likely to continue rather than
discontinue.

It is possible that the teacher has earlier tried explaining to Ismail or even punished him for
his tantrums, but has failed. Now when she lets him have his way, he behaves well, at least
for some,time. But in the long run, it is not a good strategy.

Let us see how in Ismail's case we can suggest a different strategy to the teacher, which
she can also tell the parents to use.

i) When Ismail throws himself on the ground, the teacher should ignore him and let the
other children take turns at the slide.
\

ii) Possibly, Ismail's wailing will become louder and he may beat his arms and legs more
forcefully. She should avoid calling out to him or scolding him as by doing so, she
will give the attention that he is trying to seek. Other children who are actually
showing good behaviour will get less attention from the teacher.

activity level may reduce. If he gets up on his own and follows the other children in
taking turns, the teacher should reward him by patting him on his back, saying "good
boy" or even hugging him saying: "I like it when you listen to me".

iv) If Ismail stops his tantrum bufsits in a comer and sulks, then after spending some
time with the other children, the teacher should go to Ismail. She can gently but
finnly explain to him that he must observe the rules. She can pat him or even put
him in her lap for a while talking to him.

What the teacher can thus do is give attention to Ismail when he is not having a temper
tantrum, and explaining that controlling one's temper is a desirable behaviour. Most
diff~cultbehaviours can be managed if the teacherlparents can divide their approach

i) Observe carefully the circumstances of the child's unacceptable behaviour.

ii) Try to understand why the child behaves as he or she does.

ili) Set a reasonable goal for improvement based on the child's immediate needs and
developmental level.

iv) Plan to work towards the goal in small steps, always rewarding good behaviour and
making sure bad behaviour brings no pleasure.

v) After the child's behaviour has improved, gradually move towards a more natural
way of relating to her.
 ...
Children with Special The important point to remember when modifying the child's behaviour is that you
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Needs 2 must respond to it consistently in one manner, each time it occurs. This means that if
the teacher has once said 'no' to lsmail when he throws a tgntrum for his turn, she should
say 'no' each time. If she gives in to his tantrum in one instance and tries to mod@ it the
next time, her strategy will not work. In fact, the tantrum will become worse.

9.4.2 Enuresis
Commonly called bed-wetting, enuresis means that the child does not have bladder
control, even when she is old enough to have it. It is called bed-wetting because most
children who have this problem wet their bed at night. When a child is between five and
six years of age and becomes wet at least twice a month for about six months, we can say
that she has enuresis. For older children, wetting even once a month should be noticed for
treatment.

There may be children who neve'r learnt to become fully dry and have bed-wetting episodes
now and then. Others may have learnt to be dry, but start having problems of bladder
control once again. It is observed that wetting during day time is less common than night
time bed-wetting. To some extent, it is related to the child going of to sleep without going
to the toilet or being too tired and, hence, not being able to control bladder movement.

Enuresis is found more commonly among boys than girls, and is also,associated with some
other behaviour di&culties in these children.

Now, it is important to dserentiate between an accidental wetting during day time and
regular wetting called enuresis. As the infant becomes a toddler, the child's organs become
more mature. In the beginning, the infant passes urine without notice. Later, the mother
develops an idea of the gap between one episode and the next, and carries the baby to the
toilet for this purpose. Gradually the child gets an understanding about bladder movement
- while the mother learns to anticipate, the infant learns to control. Thus wetting
accidents reduce with age.

When the child starts walking, there is also increased use of speech and gestures. So she
learns to say or gtsture the need to urinate. A little while later, she can go to the toilet
herself. In the learning process, many toilet accidents take place; for some the child is
punished while others may just pass. Through this kind of growing and training, by the age
of four years, most children can control their bladder movement, especially during day time.
Yet, atcidents take place when the child is too anxious, or has had too much liquid to drink
or is very engrossed in play.

Enuresis, however, would be a state when it appears that the child is not able to control the
bladder movement. It may even seem that she does not want to control.

Many factors have been found to be related to enuresis. These are :

i) hereditary factors
ii) immaturity of the urinary system
iii) small bladder
iv) poor training.

Managing the child with enuresis requires a certain amount of alertness and
sensitivity. The first step would be to check if a particular child, who has reached the age
of five years has toilet accidents repeatedly.

A meeting with the parents would help in knowing if wetting takes place at home too, and
if there is night-time wetting too. Advise the parents to meet a doctor to see if the problem
can be tackled medically. There are drugs that can help in relaxing the muscles around the
bladder, thus increasing the capacity of the bladder.

At the child care centre, the child must receive support from the caregivers. It is uue that
she messes up her clothes and her surroundings. But she is not doing it deliberately and
needs help. Perhaps something is making her tense. If she looks like an anxious child who
cries easily or speaks very little, give her time, love and a£fection and things will begin to Children with Behaviour
change. ' Dimculties

But a happy looking child may also be enuretic. Take her to the toilet at regular intervals,
even is she does not wish to go. Gradually, teach her to remind herself through actions,
such as ringing of a bell. The day she has no wetting episode, give her a reward and praise
her.

Keep in touch with the child's parents and ensure that they do not resort to physical
punishment. There has to be a harmony between your methods and theirs. While
harshness is to be avoided, greater attention has to be paid to the training aspect.
Sometimes, day time dryness is achieved, but bed-wetting at night continues till the urinary
system matures around the age of 10 years. Thus, a combination of medical treatment,
sensitive handling and maturation of the concerned organs contribute to the child's success
in overcoming enuresis.

9.4.3 Withdrawn Behaviour

Kiran is a six year old girl who lives in a family of six members that include her parents,
grandparents and an older sister Jyoti. Kiran was born three years aJer Jyoti. Her
grandmother refused to celebrate her birth because "another girl was born". Even though
her mother wanted to distribute sweets, the fear of displeasing her mother-in-law stopped
herfrom doing so.

This is how Kiran began her lqe. Today she goes to a school in Class I. There are 35
other children in her class. For theflrstfav months, the teacher did not even take notice
of Kiran because Kiran did not talk or make noise like most other children. She sat
quietly, did her work and watched other children play, without running around like them.
The teacher then noticed that Kiran had nofiiends and she was on her own all the time.
She found it a bit unusual as all other children were always with theirfiiends duringfiee
time. The teacher felt that Kiran was lonely and she wanted to help her out. What can the
teacher do ?

If we reflect on how Kiran's birth was treated by her family, it would give us some clue
about Kiran's experiences of growing up. She may have been neglected, as she was the
second daughter in the family that was hoping to have a boy. Even as she was growing up,
she may have heard, time and again, the statement : "You should have been a boy".

Such messages must have made Kiran feel that she was not desired in the family and, thus,
given her a low concept of herself as a persgn. She preferred to remain indoors, not play
much with other children and not talk to others, behaving as though she did not exist. The
others in the family too did not interact much with her nor did they encourage her to be
with others. In fact, her father and grandmother would often say: "Kiran does not speak
much, she is a good girl". She learnt that others liked it when she remained subdued.

As we can see, in the family Kiran's behaviour of being 'invisible', was being rewarded;
hence she continued to be withdrawn. The family did not see it as a problem. But the
teacher felt she was not only too quiet, she was not like a normal healthy child - active
and curious.

Let us see how the teacher can help Kiran come out of her shell.
The first thing that the teacher must do is to call the parents to the school, or better still, go
over to their house, if it is not very far. During the visit, she can ask the following questions:
i) Do the parents notice thqt Kiran is withdrawn?
ii) What do they do when she acts shyly at home?
iii) Do family members compare her unfavourably with Jyoti, who is talkative?
Children witb Special She can also study the following a h:
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Needs 2
The attitude of the grandparents.
Parents' expectations of Kiran.

' If the teacher finds that the family members' behaviour is such that it reinforces withdrawn
behaviour, she should help the parents realize that if is harming Kiran's personality and
explain to them that they need to encourage her to mix with other children and adults. Of
course, all this cannot happen during one visit. The educator will have to develop a rapport
with the parents and explain the situation to them, over several visits.

At her own level, the educator can spend a f6w minutes with Kiran at school everyday,
communicating, giving her love and attention. She can play with her and encourage a few
children to play with her. Once Kiran knows the pleasure of playing with children who do
not tease her, she will seek their company on her own. She will change gradually, provided
her family members change their attitude towards her. While it is not necesSary for her to
become talkative, she must be relaxed and happy, instead of being subdued all the time.

Children vary in the amount of extrovert (outgoing) behaviour they show. Some are shy,
others are aggressive. Ifthe socialization in a specific culture has the objective of keeping
the female child subdued, girls at the preschool age may be less outspoken than boys. Yet,
withdrawn behaviour, whereby the child appears lonely, must be noticed and dealt
with. Helping such children overcome their fears and anxieties would go a long way in
making their lives happier and their families' too.

Check Your Progress Exercise 2

Answer the following questions brieily in the space provided below.

1) How would you determine whether a particular behaviour shown by a child is

problematic and serious ?

2) Imagine that you are an educator at a child care centre. One child at your centre
throws a tantrum whenever she wants to get his way. You have called his parents for
a discussion at the centre. When you ask them as to how they deal with the child's
behaviour, they reply : "Oh! when he does something like that, we do as he wants. It
is so much simpler to agree to him. At least there is peace after that!"
How would you respond to the parents' statements ?

3) A mother of an enuretic child responds to your query saying : "Oh ! I do not know
how to manage him any more. I have slapped him so many times for wetting his bed
but it makes no difference !"
64 1
 What wili be your response to the mother ? Children with Behaviour
Difficulties

) 'The behaviour and attitude of family members may be responsible for withdrawn
bt\aviour of a child'. Comment upon this statement.

9.4.4 Aggressive Behaviour

Aggressive behaviour is the opposite of withdrawn behaviour. The child is more
assertive and quarrelsome than is desirable. She might bully other children, fight with
them, provoke them, as well as adults, to react sharply. In fact, aggressive behaviour is
likely to be noticed much earlier than withdrawal because it causes hurt to others.

Some amount of aggression is present in all children, which they express when iingry or
unhappy. But they learn to control it or express it in ways that are tolerated. Those
children who either have difficulty in controlling their angry feelings or who want to
h a m others througb physical or verbal action would be E n as aggressive. Common
ways in which children express aggressive behaviour are hitting, kicking, pinching, spitting
at others, using bad language, teasing etc. Thus aggression may be expressed physically or
verbally. The child may show aggression towards other-children, adults and objects around
her.

We know that aggressive children are not easy to Ilke. They are often loud. hostile and
violent and, hence, are unpleasant to have around. Other children avoid them'or are a f b d
of them, while adults find it difficult to discipline them. But we cannot forget that the
child is not responsible for being aggressive.

A look into the histories of aggressive children has shown that their family conditions
contribute to this behaviour. It is true that temperamentallysome children have a
tendency to react with anger ever to small frustrations. But if, from the very beginning,
they are handled with patience rather than punishment, they can learn to divert their angry
feelings in non-aggressive ways.

Children learn to be aggressive early in their lives. It begins in the form of attracting
attention when the infant wants caregivers to feed her and play with her. Later, reaction to
frustrating situations could be expressed as temper tantrums, hitting others, or using
abusive language. But how did the childhow that she can resort to such behaviours? The
child behaves aggressively because it gets her what she wants. The child may want a
certain toy, or want her turn first or may want attention. Yes, surprising though it may
seem, many children behave aggressively just so that the people around may attend to them
- even if the attention they give is negative, i.e.,'it is in the form of a mlding or
punishment.

It is believed that the child learns aggression at home first and then outside the home.
Many characteristics of the family are related to aggressive behaviours in children. You
have read about this aspect in DECE-I, under the head 'Styles of Parenting' in Unit 20.
Children with Special Let us recapitulate the discussion here. When parents try to discipline their child using
-
Needs 2 punishment, they actually show the child how to be aggressive, as their own action is
aggressive. When they hit the child to stop her from doing something (i.e., when the
parents behave aggressively) they do not approve of, in a way they are communicating that
aggression helps one achieve one's goals.

Repeated physical punishment (shaming of the child for mistakes), and poor family -
management skills of parents are some of the factors that encourage aggressive behaviour in
children. Moreover, many parents are inconsistent-about disciplining aggressive behaviour.
They do not always discourage aggressive acts, especially if these are not directed towards
them. They sometimes ignore such acts, at other times show indifference and occasionally
discourage such behaviour. For example, if the child hits a dog with a stone, they may I

laugh or ignore it, rather than stop her from being cruel to the animal. The child thus
receives contradictory messages about desirable behaviour, and chooses the easier path, i.e.,
of being a bully.

An aggressive child is an unhappy child. Like a child witb tantrums, she seeks
attention tbrougb acts like bitting, pincbing or abusing. She needs to be understood
and belped to redise otber ways of communicating ber need.

When a child care worker comes across an aggressive child who does not listen to her usual
requests, she has to follow a systemic method to deal with her.

Tbe following are some hints that will belp you to deal witb aggressive behaviour. .
i) Avoid punishing the child for aggressive acts, as she is already used to punishment
and that has not proved to be helpful.

ii) Do not wait to give her attention till she shows the usual aggressive behaviour by
saying : 'Don't do it, or I will punish you'. Do something she likes during her
non-aggressive period. For example, tell her a story or sing a song to her.
iii) If she shows aggression during this period, ignore it. As soon as she shows 'good'
behaviour, pat her on the back or give her something she likes to play with.
However, if the child is likely to harm others or herself by hitting or kicking etc.,
immediately hold her from behind so that her arms and legs become immobile for
a while. When her anger subsides, reason with her or instruct her firmly,
depending upon what she might respond to.

iv) Use concrete rewards to reinforce non aggressive behaviour. For example, an
educator gave red and golden stars made of paper, for every ffieen minutes or half
an hour of non-aggressive behaviour. When the child collected 4-5 such stars, she
was allowed to do any one thing she wanted, such as playing with her favourite
toy, or the whole group clapping for her.

v) Finally, a talk with the family members on the lines discussed under 'Temper
Tantnlms' would help. If the child is repeatedly punished at home, or if other
members fight with each other, there is very little chance of the child changing.
Therefore, help the family understand that if they change their ways of interacting
with one another, the child's behaviour will also change.

Wbile managing aggressive behaviour, do not

i) Use physical beating to discipline the child.

ii) Shame the child in front of other children, as it will make her more angry.
iii) Lock her up in a room.

9.4.5 Stealing
There is probably nobody who has never stolen in his or her life. This is because stealing a
small thing that we like seems quite harmless, especially when the other person is not going
to find out. In children what we call stealing does not begin the ddYit appears later. Let us
6. look at an example.
I
I
Ram 's mother has made a lot ofsweets at home. Ram is 2 1/2 years old and likes eating
sweets. His mother leaves them in the kitchen to cool down. While she goes away to bathe,
Ram.cannot waitfor the sweets to cool. He goes to the kitchen, picks up a warm sweet and
starts eating it.

Strictly speaking we can say that Ram stole the sweet Since he did not take his mother's
permission to eat it. But his mother does not think so. When she comes out of her bath,
Children with Behaviour
Difficulties

she finds Ram finishing the last crumb of the sweet, his face all smeared with crumbs. She
bursts into a peal of laughter and says; "I should have known better and given you a hot
sweet before going for a bath. She does not scold him nor does she call him a thief. After
all, Ram did not mean to steal something, only to enjoy it.

Very young children take away something that is not theirs because they do not really see
the difference between their own possessions and those of others. They take something
because they want it. They do not yet have control over their wants. At slightly older ages,
say by 4-6 years, when they start visiting others, go to school and play with peers, the
knowledge of 'mine' and 'yours' does begin to come. But their conscience is not yet fully
developed to prevent them from picking up something that is not their own. However, if
during these stages of development the child's parents have made her aware of 'right acts'
and 'wrong acts' including 'stealing' the child is likely to refrain from lifting things that

Upto the age of 8 years, an act of stealing by the child has to be treated with understanding
because of her limited ability to understand its true meaning. In a classroom, it is common
for children to pick each otherslpencils, erasers, toys and sometimes even money. The
child who has stolen, derives a 1@of satisfaction from possessing the stolen object. But she
does not have the ability to imagine how painful its loss is to its owner. So the intention is
not to deprive the other person, but to own something because it looks so attractive.
It is not necessary that only children from poor families or who do not own many
things will steal. A lot depends on the child's early experiences and the parents' attitude
towards Stealing, In fact, a parent who uses an illegal electricity connection and does not
pay for it, is setting an example of stealing for his children. Quite often, parents do not
realize that their own behaviour is responsible for certain unacceptable behaviours in their

To deal with a child who steals at the child care centre, you need to remain calm and
observant. As in the case of other diffculties, do not shame the child for stealing. Talk to
her in private. If it seems that she is unable to control her habit, help her systematically.
Every morning, her own objects like pencil, eraser, coins can be affixed with a paper strip
of a certain colour. At the end of the day, before she leaves, her things can be checked.
Any other object without coloured strips can be taken out and she can be made aware that
those do not belong to her.
If the child steals food from others' lunch boxes, it may be because she does not get enough
to eat. That can be handled directly with the family.
Children who steal may be insecure, so make them feel secure through affection and
positive expenunces.

9.4.6 Hyperactivity
By this term most of us commonly understand that the child is overactive and is constantly
doing something. Children with hyperactivity are not simply overactive. They suffer from
a low attention span and they act without thinking. Such a child would be seen as clumsy,
immature, bossy and noisy. She would flit (move around) from one activity to another, pick
up fights with peers, ciy easily and become uncontrollably excited at small things. She
would be 'on the go' as though being driven by a motor.
Among the known causes of hyperactive behaviour are organic abnormalities. These may
be caused before birth or after birth, and may be either due to known factors such as
I jaundice at birth, or unknown conditions &ch as allergy to certain foods. In short, one
cannot be sure of why the child is showing this behaviour. Yet, it is very disturbing as the
child is unmanageable
Children with Special Medical treatment through drugs is possible to control hyperactivity. Therefore, explain to
Needs - 2 the parents that such a child needs to be taken a medical centre. However, even medicines
work best when the treatment is combined with some good behaviour management
techniques. As you can imagine, a d i c u l t child receives punishment and other negative
forms of responses at'home because she is a 'trouble maker'. Even at the child care centre,
other children would avoid her, tease her, fight with her and complain about her. Under
such circumstances, the child would have a poor selfconcept. Hence while helping her,
attempt has to be made to make her feel positive about herself.

The following are some suggestions tbat will belp you to deal witb tbe hyperactive
cbild:
i) Give her clear instructions that are simple to understand, whenever she is expected to
do something.
ii) Be with her when she is doing an activity and remind her to follow the steps one by
one.
iii) Reward her for every unit of good behaviour - e.g. loo- at a picture book for 5
minutes. The reward can be a toffee in the beginning, but later it should simply be
appreciation.
iv) For punishment, if at all necessary, separate her from others and let her sit facing a
blank wall for 2 to 5 minutes. Then call her back and explain why she was punished.
Do not ridicule her in front of other children.
v) Be consistent in your own behaviour towards her.
1
9.4.7 Fears and Phobias
Some of tbe commonest problems during childhood are fears. Children show fear of the
dark, of strangers, of unfamiliar places, of certain animals and loud noises. In general,
normal fears are towards tbe unexpected and most cbildren grow out of them as they
grow older. A child may just be afraid of something spontaneously, or she may learn this
response by observing the reactions of adults to it. For example, if the mother's reaction to
lightening is of fear, the child is likely to be afraid of it too.

However, it is not common fears that become difficult to deal with. Rather, it is tbe
pbobiw tbat create difficulties for cbildren and their caregivers. A phobia is an
extreme fear reaction towards an object or person that cannot be categorised as a
fearful stimulus. For instance, if a child shows fearful behaviour towards a chair in the
house, it would be phobia, as it has no fear producing association for others. Children are
known to have phobia of water, of high places, of travelling by lift, of lizards and
cockroaches.

Perhaps the child who has phobia of the chair, may have earlier fallen off it and hurt herself
badly. Here we can establish the relationship with the cause. But often, the cause cannot be
found, as in the case of water phobia. The child's phobia behaviour includes crying with
fear, trying to run away from the stimulus, clinging tb adults around, enuresis and a period
of anxiety following the phobic reaction. The child may tremble and become pale.

Dealing witb tbe cbild's pbobia

Since a phobia is an irrational fear, just telling the child that there is nothing to worry about
or getting upset with her do not help the child Immediately, the child needs physical
contact with a supportive adult, whom she can cling to. Forcing the child to be close to the
objeg feared may make things worse.
At the time the child is showing phobic reactions, the caregiver must remove stimulus or
take the child away from it. Afterwards, a conversation with the child about how she feels,
why she feels like that etc. can be helpful, as sometimes talking it out relieves tension. But
if the child would rather not talk about it, she should not be forced to talk. If adults or other
children make fun, tease, or punish the child, it would lead to more negative reactions in
the phobic child. If the child is reassured and gradually helped to understand why others
are not afraid of what she fears, the behaviour is likely to imprwe. Except in rare cases,
68 most children outgrow their phobias with age.
 Children with
Difficulties

Helping the chiid overcomehis fear of dogs

This cbild bad an immense fear of dogs. The educator is trylnp to help him overcome It. Using
puppets of a dog and a small.boy, she is narrating a story based upon the child's fear. Her
. strategy did help to lessen the child's f e a r b a considerable extent.
9.4.8 . Autism

Four year old Harpal's behaviour surprises everyone in the school. He does not talk to
anyone, he does not seem to understand when is said to him. He looks around blankly and
walks about aimlessly. Yet, suddenly he starts humming a song and laughs without reason.

It was found that Harpal has a very very rare condition called 'Infantile autism'. Due to
this, he does not feel the need to relate with others, likes to perform some actions again and
again, and repeats somewords or sentences out of context. His appearance is normal, but
he does not see eye to eye. One day, he started banging his head against the wall and tried
to bite the teacher.

Harpal was born with autism. It is believed that it results from damage to a certain part of
the brain and cannot be treated fully. But the child can be helped to learn some basic skills
such as bathing, wearing clothes, following simple routines and eating food.

In the schooh"Harpa1has got used to the eduptor, has started following her simple
instructions and likes listening to music. He can solve simple jigsaw puzzles. The educator
has worked out a programme for him so that he knows what he is expected to do. Even if
he does not seek children's company, other children are encouraged to involve him in ball
play, to hold his hand and make him run. If he attempts to hurt himself or others, he is
immediately prevented from doing so and is given his favourite activity (a jigsaw puzzle) to
work on.

Harpal does not do any of the* things deliberately. He is helpless because of his condition.
But if he did not come to school at all and remained at home, the condition would become
worse and his parents would find it very diacult to bring him up. He may not learn to read
or-write very much, but by coming to school his habits would improve and his behaviour
would become manageable, if guided with care.
Children with Special
-
Needs 2

\Helping the autistic child to develop eye

contact by encouraging her to look at herself in the mirror

9.5 PARENTS' PERSPECTIVE AND GUIDANCE TO

PARENTS OF CHILDREN WITH DIFFICULTIES ,

Well before the child care worker in the centre notices that a child is showing behavio~u
diaculties, her parents have been dealing with her problem. Any kind of improvement
work with the child would necessarily mean interaction with her parents. The family, as we
have bein saying all along in different Units, plays a crucial role in causing problems as
well as in solving them.

However, it does not mean that the parents know they are-responsiblefor their child's
behaviour or that they can be helpful in dealing with the difficult behaviour You, as a
child care worker, must realize that the family members get quite tired of a difficult child's
behaviour. Unknowingly, they may be causing the behaviour or reinforcing it, bht they
suffer when the child throws a tantrum or steals money. They often look to the educator to
help them in modifying the child's behaviour. And it is true that a sensitive worker can
influence the child more than the parents can in this regard. The following few
suggestions would come handy in helping the parents help the child.

i) Talk to the parents, but listen to them first to know what they think the problem is.

ii) Avoid telling them directly that they are responsible for the behaviour Wculties,
even if that seems to be happening.
iii) Find out what their methods of disciplining the chld are. If they are too strict or
too lax, discuss how such disciplining can influence the child's behaviour
negatively. If they areinconsistent, point out that being consistent would help the
child know the rules she must follow
iv) Ensure that the family members do not hold back love and affection from the child.
That is her food for emobonal strength.
v) Make the family members, including siblings and grand parents, aware of
practices such as discrimination between children, comparison with other children,
which they may be doing unknowingly or knowingly.

vi) Help the parents see thqt the child is not bad, but that she is having difficulties
which can she can overcome with the support of her caregivers and peers.
70 I
Check Your Progress Exercise 3
Answer the following questions briefly in the space provided below.

1) How do the family conditions contribute to aggressive behaviour in the child?

Children with Special
-
Needs 2
 Children wlth Behavlour
9.6 LET US SUM UP DiMculties

In this unit, you have read about some behaviour diaculties shown by children.

\ A child will be said to have a behaviour difficulty if that particular behaviour has a negative
effect on the child's development and adjustment and if it interferes with other people's
rights. In these cases, that behaviour of the child has to be changed.

To determine whether or not a child has a behaviour diBculty, you would need to observe
her in difficult situations over a period of time. The seriousness of a behaviour difficulty
would be judged by its intensity, frequency and duration. At all stages, when trying to judge
whether or not the child has a behaviour difficulty, you would need to keep the child's
developmental level in mind.

At all. times, it is important to remember that the child cannot be directly blamed for the
'
problem. There is usually some underlying factor that causes the problem behaviour and if
that factor is identified and treated, the problem behaviow can be controlled or minimized.
Sometimes, the family, community or the workers in the child care centre may be
responsible for the child's problem behaviour. Sometimes the child's own developmental
level may be causing the problem. Damage to the brain also affects the child's behaviour.

Temper tantrums, enuresis, withdrawn behaviour, phobia, autism, hyperactivity and

aggression are some difficulties seen in children. If you deal with the child sensitively and
with care, you can help her to overcome the difficulty. In the unit you have read about some
methods to deal with these problem behaviours. You will be more suasfbl in modifying a
child's behaviour, if you have developed a clow relationship with the child. When helping a
child overcome the diffculty, you would need to collaborate with the parents as well. .

-9.7 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
C h i Your Progress Exercise 1

1) There are two reasons why one would consider that a child has behaviour difficulty
I
a) the child shows behaviours that have a negative influence on her own
development
b) the child shows behaviows that interfere with other people's rights.

2) The causes may be

I
-the child's own developmental level
-damage to the child's brain
I

3)
-child rearing practices in the family
-the values held by the family

-the behaviour of the educator at

a)
the child care centre
I
-the attitude and values of the community
environm-
ental
factors .

Disagree. To judge whether a child has a behaviour difficulty, one has to guage
its intensity, duration and frequency.
b) Agree
c) Agree
d) Agree
e) Agree
Children with special
-
Needs 2 Chedk Your Progress Exercise 2

1) To guage whetlper a particular behaviour can termed as probl'ematic one.would

need to see its intensity, frequency and duration. One would also need to view it in
,. context of the child's developmental level.
.
2) The parents' way of responding to the child's tantrum is wrong. This will only
reinforce the behaviour and make the tantrum more forcefUl next time. They
should, in fact, ignore the child when he throws a tantrum. Once the child
quietens down because no one has paid attention to hi-he'rnay sit and sulk
because he was not attended to. In this case, talk firmly but gently to the child,
- '
explaining that what he did was wrong. If the child stops the tantrum and d m as
the parents wanted, then they should encourage and praise him.

3) The mother's method of tackling the situation is not likely to help the child. If
anything, the bed wetting may increase.

Explain to the mother that the child is not wetting the bed deliberately. Perhaps
something is making the child tense. If tliis is the case, then the tension causing
factor must be eliminated. But sometimd a happy child may also wet the bed.
2
The child needs to be toilet trainhi. Take the child to the toilet even when she
does not wish to go. Gradually teach htr to remind herself through actions. When
the child has no wetting episode, praise her and reward her.

It is possible that the child also needsl medical treatment.

In all cases, punishing the child'for wetting the bed must be avoided.

4) Agree. If the family andlor the community neglectdridiculu the child, she may
respond by withdrawing from interaction with people.

. Check Your Progress Exercise 3

The parents' child rearing practices and their own behaviour towards others can
cause the child to be aggressive. If the parents use punishment to discipline the
child, if they react aggressively towards others, the child also learns the same. If
parents are inconsistent in disciplining aggressive acts - i.e., sometimes
punishing the child, sometimes ignoring her - then that too leads to aggression in
the child.

Rashmi's way of handling the situation is incorrect. This will only strengthen the
child's aggressive behaviour. Repeated punishment and shaming the child in front
of others can also cause the child to have a low self concept, which may lead t ~ ,
other behaviour diaculties.

First of all, Rashmi must stop punishing the child. During the period when the
child is not behaving aggressively, she must praise and reward her for her non-
aggressive behaviour. When the child shows aggression, she should ignore it.
However;if if is hitting others or is harming himself, then that has to be
controlied. In this case, hold the child, so that he cannot hit out, till his anger
.subsides. After that, she shduld talk and reason with him. Along with this,
5 h m i will need to talk with the child's parents so that they also'follow her
method in controlling the child's aggression at home.

Disagree. For one thing, the Child does not really understand the meaning of
stealing. The chld takes way another person's things because it seen~sattractive
to her. Her 'conscience is not yet 'fully developed to underst.and what ,he .has done
Therefore, one has to be tolerant and sensitive in dealing with a child who has
stolen, instead of shamink and scolding her in front of others. In fact, this must
never be done.
4) A hyperaCtive child has a low attention span. This means that the child flits from ~ i ~ d r with
e n Behaviour
one activity to @e other. It seems as if she is acting without thinking. The child is Difficulties
overactive, and comes across as clumsy, bossy, noisy and immature. She may
become uncontrollably excited at small things. She appears 'on the go'.

5) Autism is a rare condition some children are born with. An autistic child does not
feel the need to relate to others, does not make eye contact, does repetitive actions
like thumping on the ground, can harm himself and others, knows some language
but uses the wprds and sentences out of context.

Autism affects dl areas of the child's development quite seriously.

.
 UNIT 10 CHILDREN WITH VISUAL
IMPAIRMENT

10.1 Introduction
10.2 Who is a Blind Person ?
10.3 Detecting Visual Impairment
10.4 Effect of Visual Impairment on the Child's Development
10.4.1 Language Development
10.4.2 Cognitive Development
10.4.3 Physical and Motor Development
10.4.4 Social Adjustment and Emotional Devetopment
10.5 Helping the Child Learn
10.5.1 Developing Relationships
10.5.2 Helping the Child to Speak
10.5.3 Helping the Child to Learn about the Surroundings
10.5.4 Helping the Child to be Mobile
10.5.5 Teaching the Child to Take Care of Herself

10.7 Answers to Check Your Progress Exercises

1 10.1 INTRODUCTION
Have you ever met a blind person -a child or an adult ? In what situation or circumstance
did you meet the person? What were your feelings and reactions? Write down briefly abopt
the encounter you had and the feelings it aroused in you, in the space below.

Many of us feel uncomfortable in the presence of a blind uerson and we are not sure about
how to react. Should we help her cross the road? should we guide her as she walks?
Should we give her a seat? Some of us end up talking very loudly to the person, as if we
expect being blind she may not be able to hear normally or understand as well! Nothing
could be less true. Research has also shown that most of us are f&ful of becoming blind,
though blindness is the least prevalent of all disabilities. One reason for feeling
uncomfortable could be that blindness is visible. On the other hand, unless one talks to a
deafpemn, one often does not realize that the person has a hearing impairment. Many
mentally retarded individuals cannot be distinguished from others on the basis of physical
a-nce. The visually disabled can be idei&ied immediately byaeir cane or of
dark glasses or their posture, the way'the look and their walking style.

But they, just like people with any other disability, would like others to be sensitive, yet
would want to be perceived as similar to, rather than dissimilar to, the majority.
 In this Unit, you will study about visual impairment - its signs and symptoms aM how to *Wsud
mildm
hpd-t
help a visually impaired child in the tasks of day to day living aad how to promote her all
I round development.

,Af€erstudying this Unit you should be able to

1.
identi@symptoms and signs that indicate visual impairment
explain to the parents how to prevent visual impaihent in their children

r @ adapt play activities for visually impaired children in your child care centre to
promote their development

P
help a visually impaired child to be able to do the tasks essential for day to day living.
I
, 10.2 WHO IS A BLIND PERSON ?
The question may seem trivial. Most of us would say, a blind person is one who cannot see.
But the fact is that the majority of blind people can actually see something. Most blind
people can make out shades of dark and light, though they may not be able to perceive the
exact colour, they can make out the intensity of sunlight; some can read if theprint is very
large and bold. This means that such persons have some partial vision which can help
them in the day-today e, they are not completely blind. Only a minority of visually
impaired people are completely blind. HOIN do we then define visual impairment? Who is a
person with visual impairment? One can answer this question from the legal or
dministrative point of view as well as from the educational point of view.

Legally, a blind person is mid to be one wbo has a visual acuity of 20/200or less in the
better eye, even with correction or wbose field of vision is so narrowed tbat its widest
diameter subtends m angular distance no greater than 20 degree& The fraction 201200
means that the person sees at 20 feet what a person with nonnal vision sees at 200 feet.
(Normal visual activity is 20/20). The term 'with correction' means that the person has
used glasses or lenses to improve the eyesight. 'Narrowed field of vision' means that the
person may have 20120 (that means,perfect eyesight) in the central field of vision, but may
have severely restricted peripheral vision.

A partidly dgbted person or a partially blind pe- is one whose visual reuity falls
between 20170 and 20/200 in the better eye, witb correction.

Many educators working with the visually impaired have found the abeve method of
classification inappropriate. They feel that this definition does not say anything about how
the person can use the remaining sight she has, what functions she can carry out and what
sort of educational experiences will help her. As said earlier, most people who are legally
blind do have some ariKHlnt of vision which they can use. In fact, a person classified as
legally blind may be able to read very large print. Therefore, educationists have evolved a
definition which will help to m e as a guideline to handle the child's various needs. For
ducational pu'm blind individuals are tbose who are so severely impaired tbat
.they must be taught to read Braille or use aural metbods (audio tapes and records).
Partially sighted individuals can read print, though tbey need to use magnifying
devices or books witb large print. These definitions, by though not as precise as the legal
definitions, by enabling educators to plan,how the child has to be taught, are more useful
filnctioualAy.
U

10.3 DETECTING VIS AL IMPAIRMENT '

Eye testing can help you to find out whether a person has some form of visual impairment
or not. But most of us do not go for an eyetesi unless we have been experiencing some
problem in the eye for a long time. Then by the time we do go to the doctor, a lot of
damage has been done. Also, we tend to ignore certain symptoms of illness, thinking that
minor problem will go away in time.
Children with Special However, it is not wise to ignore any problem of the eye, if it persists for more than a few
Needs - 2 days. The following are some symptoms which must not be neglected. They can lead to
visual impairment, if not treated in time.
The child rubs the eyes excessively.
The child shuts or covers one eye, tilts head or thrusts head forward in an altempt to
see better.
The child experiences Miculty in reading or in other work-requiring close use of the
eyes.
The child blinks more than usual.
I

The chld becomes'irritable when doing close work and complains of pain, dizziness
and nausea.
The child holds things close to the eye when examining them or when trying to have
a better look.
The child finds it difficult to see distant things clearly - cannot make out the colou'r,
shape, size or read what is written on distant objects clearly.
The child frowns or squints eyelids together when looking at something.
The child tends to confuse letters of a similar shape.
There is poor spacing in writing and difficulty in staying in the line.
The eyes appear red rimmed, swollen or there are crusts on lids.
There is a watery discharge from the eyes and they inflamed.
Styes frequently erupt on the eyelids.
The child complains that the eyes feel itchy, scratchy or that there is a burning
sensation.
The pupils are of uneven size
Crossed eyes or those that are not straight.

If any of the above signs are noticed, the child must be referred to an opthalmologist. The
presence of one or more of these signs does not always mean that the child has a visual
impairment; but the child has to be referred for further evaluation before one can say so.

10.4 EFFECT OF VISUAL IMPAIRMENT ON THE

CHILD'S DEVELOPMENT
Let us read what effect does partial sight or a total inability to see have on the child's
language, cognitive, physical, motor, social and emotional development.

10.4.1 Language Development

As you know, language has three components - verbal, non-verbal &d the written. Most
of us learn to use the first two modes of communication almost effortlessly during the
course of growing up. Learning to read and write requires some effort and exposure to
formal teaching. A child denied these-experiences may not be able to read and write.

If the blind child's hearing is not affected, the child's verbal language will develop like
that of any other child. Speech in most cases will be normal. Of course, you will need to
help the child to acquire speech. You will read about this in the next section.

What about the non-verbal behaviour ? Have you spoken to a blind person ? Did.$nything
strike you as different from others regarding their eye movements, gestures and p6sture ?
Most of us use gestures whdk speaking and the movement of our body, our facial Children with Visual
expressions add to what we are saying. Maintaining eye contact is also important for a Impairment
good conversation. But using appropriate gestures and expressions is something we have
learnt as we watch others. Children who are totally blind miss out on this experience
and, therefore, you may find that they make relatively few gestures, or that their
movements are jerky, or that they make repetitive movements of the head or the hand.
The child may have a specific mannerism which you may find distressing or irritating at
first. You can help the child to know the gestures that go with a particular speech - for
example, nodding one's head sideways when saying 'no' and top to down when saying
'yes'. When you speak, let the child touch your face d o d y to know your expressions
and body movements. Since appropriate expressions are such an important part of our
interaction with each other, the blind child with inappropriate mannerisms is likely to
become an object of ridicule.

A blind child can read and write through the use of Braille. Braille is a system of
communication developed by Louis Braille, after whom it has been named. It is a system
in which raised dots are 'printed' on paper. The blind person feels them with the finger
tips A particular configuration of dots stand for a particular alphabet. The Braille
alphabet consists of six dots which, when arranged in different ways, constitute the symbols
from A to Z.

In our country, not many books have been converted into Braille for use by children. Not
even all the text books have been so converted. The child misses out on the rich
experiences which sighted people can gain through books. To help the child combat this
handicap, take some time out dufing the day and read aloud some passages or stories to her
and discuss important events from the newspaper. The partially sighted individuals are at
an advantage when it comes to reading and writlng. They can read, provided the print is
very large. They can read books written in 18 point size

10.4.2 Cognitive Development

The visually impaired child's cognitive development will depend, to a very large
extent, on the type of experiences she has. One may say that this is true of the sighted
child as well. Read the following discussion to understand the difference.

If you think about it, you will find that we depend upon our vision, to a very large extent, to
understand the world around us and develop concepts. Think of a one year old child who
cannot see. The child may have, on one occasion, met a person who spoke to her very
affectionately and lovingly. On another occasion, the person is angry and speaks very
roughly to another person, so that the tone of voice and the manner of speaking are
changed. For the blind child, it may become difficult to make the connection that these
persons, who appear to be diferent, are actually the same person. For the child who has
vision, this connection is easy to make, as she can actually see the person producing two
different qualit~esof voice. Thus vision helps us to link different experiences and to
develop an integrated concept of a particular object, idea or person. If vision is impaired,
the task of acquiring the integrated concept is more difficult.

Of course, one may say that the blind child can use the sense of touch to develop an
integrated concept. In the above example, if the child has a chance to touch and feel the
person in both the instances, she would have been able to understand that the voice on the
two different occasions belonged to the same person. But there is a major difference
between using sight and touch, to form integrated concepts. Vision is agtive as long as
the eyes are open and one hears as long as there is nothing wrong with the internal organs.
This means that without making any particular effort, and sometimes without even
conscious effort, we are looking at things and forming an idea about them. However, if we
wish to learn about an object through touch, then we need to make a special effort -
learning through touch is not automatic, so to say. This means that we have to frequently
encourage blind children to use touch to explore.

There is another aspect that complicates this issue. In our society, there-is a restriction on
what or whom you can touch and these restrictions increase as the child grows older. While
it is permissible for a three year old to feel a stranger's face with her hands. a ten year old
doing so is likely to be looked upon with disapproval.
 Children with Special There is yet another difference between using touch and sight to form an idea of the world.
Needs - f Vision stimulates a child more. When a child sees something, her curiosity is aroused and
she wants to find out more about it. This leads to exploration (which you know is basic for
developing concepts). Through observing others, imitating them and by just looking, she
learns many things without any conscious effort on the part of her caregivers. ~ ufort a
blind child, since touching is not as spontaneous as vision, special efforts will have to be
made to stimulate her. The caregivers will need to give her things to touch and encourage
her when she touches objects. They will need to organize, explain and interpret the
world to the child, in a more deliberate and conscious way than'they would do with a

I child who has vision.

Then too, there is a difference between the types of touch. One is the synthetic touch -
this refers toa person's tactual exploration (by touch) of objects, small enough to be
enclosed by one or both hands. However, most things are too large for synthetic touch to be
useful. For these, analytic touch has to be used. Analytic touch involves touching of
various parts of an object and then mentally constructing these separate parts. For example,
to f o q a concept of a chair, a blind person will touch the seat of the chair, then the back of
the chair, then its arms and then the legs. She will form an idea about these separate parts
and then integrate these separate parts to form a concept of the chair as a whole. This .
means that the blind person comes to know about an object successively, i.e., one after the
other, whereas the sighted person perceives different parts of an object simultaneously. Try
this out with a child through the following activities.

Blindfold a child and place some objects whch are unfamiliar to her. Ask her to feel
them and tell you what they are. Ask her to describe them to you as well. Then
remove the blindfold and let her see what she felt. Ask her whether this was the
image she had formed in her mind.

You can try another activlty as well. Take any object and keep it with you, so that
the child cannot see it. Then describe the object to the child inclulng its colour,
shape, texture size,what it is used for. In other words, provide as many details about
the object as you can. Now ask the child to tell you what she thinks the object is. '

Such experiences will give you an understanding as to how a child who does not have sight
perceives the world, and the problems that she may face. They will also sensitize the child
with whom you tty out the activity, towards how a blind child feels. Ask this child to
express what she felt when he or she could not see. Ask her to Ue the blindfold for about an
hour and carry out her nonnal activities. Ask her what she felt.

But, of course, there are certain things that the child cannot even touch - the clouds, or the
mountains, the sun and the moon. And even though the child can touch the walls of each
room of the house, and measure the distance of the entire house, she does not have the same
understanding about the house as a person with vision has - one who sees the parts of the
house as well as the whole house all at once. So for certain things, the blind child's
understanding will be very different from that of people with vision. Once again it is
important to emphasize that it is nbt necessary nor desirable to use words like whose
understanding or concepts are better. Instead of being judgemental, what is important,is
that you help d e child to know about as many things as possible~helpher to build coricepts
of the world around her and realize her potential.

While you were carrying out the above mentioned activities, you may have noticed one
thing. The child drew upon her previous experiences when trying to formulate an idea
about what she was touching. This leads us to the next point. F

The age at which the child lost sight is very important. Ifa child's vision was intact for
some years after birth, then she will be at a distinct advantage in fonning concepts.
Children who have partial sight will also acquire concepts rapidly. Children who are blind
from birth itself, find it the most dficult to form concepts.

Thus the child's cognitive development will depend on the degree of visual impairment,
the age when loss of sight occurred, the motivation of the child and the experiences
provided by the caregivers.
80
 The'above were some aspects because dwhich a child with impaired vision may face a Children with Visual
handicap in developing concepts. But visually impaived children have some strengths h~aiment .
I
also. They have a better attention span and concentration. This is because they have to
rely to a great extent on other senses, and absorbing.informationfrom other sense
,modalities requires a great deal of attention. Agan you can try this out for yourself.
Blindfold yourself, sit for 15 minutes in a room where there are some people. Subsequently,
describe what went on in the room during those 15 minutes. You will find that to
understand what was going on, you had to concentrate more than you would have done
-
otherwise. You had to listen, attend and concentrate better, so that you could compensate
for what you could not see.
Here it is important to c l a m one point. It is not as if the visually impaired are born with a
better sense of hearing, touch; smell or taste as compared to people who have vision. What
happens is that the visually impaired make better use of these senses. Through
concentration and attention, they develop them further and are able to make fine
discriminations. A common misconception in this connection is that blind people are born
musicians. This is not so. Sinci: music predominantly requires a good sense of hearing and
blind people rely on this sense so much that they refine it. A l s ~music is a field through
which they can express themselves and achieve success, since many other avenues are
closed for them.

10.4.3 Physical and Motor Development

neighbourhood.

To move around, the child needs to develop a sense of space - to judge how much space
objects occupy so as not to bump into them. The sighted child develops this idea almost
effortlessly. The child who cannot see develops an idea of space by touching and feeling
objects and by judging the time it takes to walk various distances. In other words, the child
has to make a conscious effort to develop spatial sense. The caregivers have to help the
child develop this. Training the child to be mobile is a very important task of the
caregiver. You \till learn about how to do this in the next Section.

One may think that a partially sighted person will find it easier to be mobile than one who
is completely blind. But studies have shown that this is not actually the case. The crucial
factor is the motivation of the child. In fact, it has been seen that a child who is blind is
more motivated to be independent than one who is partially sighted. Partially sighted
children or adults have been found to have more attitude problems - since they can see a

they know they cannot rely on their vision at all.

children who lost sight a few years after birth, at least after they learnt to walk as infants,
have some advantage over children blind from birth. These children had developed a
certain understanding of space and objects, and how to move around. Though they will
have adjustment problems once they are suddenly deprived of sight, yet they can be trained
to move around more easily.

It is commonly believed that the blind have some sixth sense that enables them to 'sense' an
object in their path. This has also been referred to as 'obstacle sense'. But it is not as if
:they have some extra sense. Once again the explanation for this lies in the fact that since
thky are not able to depend on sight, they become proficient in using their other senses and
in,picking up information from the surroundings, In sensing obstacles, so to say, they rely
on their hearing. !pt us n~derstandhow they do so.

It is a common observation that as you approach a source of sound, its pitch rises. If you
have not noticed this before, be alert as you walk on the road the next time. One reason
why we may not have noticed this till now is because we are so distracted by what We can
1I Children with Special
-
Needs 2
see that we miss out on information from other senses. People with vision problems, on the
other hand, have learnt to concentratsand detect subtle changes in the pitch of objects as
they move towards them, which most of us would normally miss. So it is not as if they have
some extra sense, but that they have learnt to use their remaining senses fully.

10.4.4 Social Adjustment and Emotional Development

The social and emotional development of a visually impaired child depends, to a very
1

large extent, on the family's and society's reaction to her. You have read about social
development in DECE-I and are familiar with how experieyes shape one's views about
oneself and others. If a visually disabled child has had wa& loving and supportive
interactions and experiences with caregivers in the early years, the child will develop as a
well adjusted, confident and caring person. Later in life, she will be able to develop
meaningful relationships. A child who has been neglected or rejected by the caregivers is
likely to mistrust others, and to hesitate in developing relationship with people, doubt
herself and suffer from low self-esteem. This is what we would normally expect. But
. development, affected as it is by so many different factors, may proceed differently. Being
spumed and scorned at often, may motivate the child to try even harder to surmount the
difficulties she faces and prove herself, to the very people who laughed at her. Comments
like: "You are good for nothing" may leave one child dejected and another ready to take on
more, in a desire to show that she is at least as good as others.

-
- But the child's inner strength apart, it is important that the visually disabled child have
positive social experiences during the early years. The will 'inoculate' her, in a sense, from
unfriendly attitudes and behaviours she is likely to find because of her disability.
It is the sighted, the so-called normal people, who need to change their attitude towards
their 'disabled peers. If we consciously believe that there is nothing that prevents a visually
impaired child from developing like most others, and forming happy emotional
relationships, we are likely to behave in ways that will help her to develop herself.

One problem that the visually impaired may find during social interactions is that they find
it =cult to exhibit appropriate facial expressions. We usually learn facial expressions by
watching others and by getting a feedback. This aspect has been mentioned earlier in the
Unit.

.
- ,'--- - -
- ~

Check Your Progress Exercise 1

Answer the following questions briefly in the space below.
1) What system of classification has been adopted by the educationists for classrfying
people with visual impairment 7

....................................................................................................................................
.................................................................................................................................
....................................................................................................................................
...................................................................................................................................
....................................................................................................................................

2) . List at least ten.signs that indicate that the child may be expehencing some dmculty
in seeing.

....................................................................................................................................
.......................................................................................
..:.......................................
h.
82
,
...................................................................................................................................
--. -- - -- - -.
Comment upon the following statements, stating whether you agree or disagree with Children wlth Visual
them. Give reasons for your views. Impairment

a) Blind individuals will display appropriate gestures and expressions during

conversation.

b) The idea or the concept that a visually impaired person forms about certain
things and objects may be very different from those developed by the sighted
. individuals.

c) One's sense of touch enables one to form an idea about things as effectively
and spontaneously as one's sense of vision.

d) The caregiver will need to make conscious and deliberate efforts to help the
visually disabled child to learn, than she would with a sighted child.

e) The age at which the child lost sight will determine how much di&culty the
child faces in developing concepts.

f) The visually impaired are born with a better sense of hearing, touch, smell and
taste.
Children with Special g) The visually impaired child may not begin to crawl and walk at the same age
-
Needs 2 as the sighted child.
...........................................................................................................................
..........................................................................................................................

h) The visually impaired have some sixth sense, called 'obstacle sense', that
enables them to 'sense', objects in their path and so helps them to move
around.

4) What are the factors that will influence the cognitive development of the visually
' impaired child?

...................................................................................................................................

10.5 HELPING THE CHILD LEARN

1
The discussion in the previous section has primarily focussed on the difEculties the visually
impaired child will have in fonning concepts, using language and moving around. But this
should not be taken to mean that the child cannot learn as well as the sighted child. The
,'
i
caregivers must stimulate the child's other senses so that she is helped to understand
antbmake sense of her experiences.
Having studied the previous section, can you list the areas where the visually disabled child 1
would have difficulty in learning and you would have to make efforts to help the child
learn? Compare your list with the one given below.
I
.............................................................................................................................................
.......................................................................................................................................
......................................................................................................................................

.
.............................................................................................................................................
i
i

.............................................................................................................................................
a The child has difficulty in learning how to use the body. This is because the child
cannot see how people sit, use their fingers and hands to touch and hold objects, move
around, walk and run.
a The child has difficulty in taking care o f herself - - in eating, taking care of her
body, bathing and dressing.
a The child has difficulty in communicating because she cannot see how others
communicate by changing the expre'ssion on their faces and by gestures.
 Children with Visual

i The child cannot see things around her and, therefore, does not learn in the same way
as other children of her age. She does not know how other children play. She has
difficulty in forming concepts.
Impairment

1
I
t
I
All the above difficulties can come in the way of the child developing social
relations hips.

To help the child learn let her

I touchobjects

I listen to sounds

i smell things
taste food items

Let the child use all these ways to learn. Stop the child from exploring in this way, only if
she is doing something that can cause injury to her.

1 10.5.1 Developing Relationships

As the primary caregiver, tell the mother to talk to the baby frequently, to hold her
close to herself and to let the baby explore her face and body using her hands when she
begins doing so. The child has to form a mental idea about the mother (and other people
later on) - that means that she must integrate the sound of her voice, her approaching
steps, the feel and smell of her body, into one experience - the mother. The sighted child
is at an advantage - even if the mother does not talk much with the baby, she has a strong
visual image of what she looks like. But in this case, if the mother were not to converse, the
child has little information on what to build her idea about the mother.

Therefore, when bathing, feeding, and taking care of the child encourage the mother to talk
to her. Encourage others also to talk to child and hold her close, so that she is able to
identify each person as separate.
I
Sometimes, it may seem foolish to you to talk to the baby who does not reply. But even
though the newborn baby is too young to vocalize (that, as you know, starts around 1 112 to
2 months of age), you will be rewarded by a slight smile or the alert look on the baby's face
when she stops everything else to look at you, all her senses directed at you. And it is these
early experiences, as you know, that will lay the foundations for l a n w g e and other
developments later on.
I

10.5.2 Helping the Child to Speak

A child who has difficulty seeing may not learn to speak at the same age as other children
because she cannot see the way people move their lips when they speak.

I Encourage the child to feel your mouth and face as you speak 85
Children with Special To help the child learn to speak, begin by putting the child's hand on your mouth and
-
Needs 2 face as you speak. She will feel how your lips, cheeks and jaws move and how the air t
comes out of your nose and mouth as you speak. Then ask the child to put her hands on
her mouth and repeat the words you said, moving the lips, cheeks, and jaws and blowing
the air out of the nose and mouth as you did. In this way, ask her to repeat words after you.
Of course, in the first few months, the child will not speak the words - she will coo and
babble.
1

Since the child cannot see objects, she cannot learn their names without help or she may
know some words, but not what they mean. Therefore, to help the child understand the
meaning of words, say its name whenever the child touches something. Encourage her
to explore the object and repeat its name. If such experiences occur regularly, the child
will learn the names of objects.

Encourage the child to explore objects and say their names as she touches them

Use your voice in different ways to communicate various expressions and feelings - such
as when there is danger or when you are happy.

Always call out the child's name before you speak to her, so that she knows she is being
spoken to. Help the child to learn the appropriate gestures and expressions that go with a
particular speech by letting her feel your body and face as you speak.

By 8-9 months, the child begins to understand more of what you are saying (provided you
have been talking to child fairly regularly during the earlier period). Take the child out
with you when you go shopping or visiting relatives and describe to her what you
encounter on the way. NOW again here is where you have to be sensitive. Being sighted,
your descriptions are likely to be those which will be heavily dominated by visual words
(like the colour of objects, the dress somebody is wearing) and this may not be so
meanin01 for the blind child. When you describe, concentrate on what the child can hear,
touch or feel. You too must begin to sense the world with your ears and nose and so
describe it to the child.

10.5.3 Helping the Child to Learn about the Surroundings

Encourage the child to learn about things around her by touching them, listening to sounds
and by using her sense of smell. Begin by moving the child's hand over different objects
so that she can feel them as you describe them. When the child is able to hold objects,
encourage her to hold them. Explain to her what the objects are, what they look like and
how they are used. Talk in this manner cven to the infant, though she cannot yet use words Children with Visual
to speak. In this way, the child will learn to 'see' objects with her hands and fingers. Impairment

Encourage the child to explore objects

When the child begins to crawl, help her to explore the surroundings. Go with the child
from place to place and let her feel what is around her. Put your hand over the child's hand
and make her feel pet animals and birds as they move.

Learning about animals

The child spontaneously responds to sound. Help her to develop this ability -to know
where the sounds are coming from, their direction and how far the sound source is. Also
teach the child to distinguish between different types of sounds. You can carry out activities
like the following :

Go a few steps away from the child, and make some sound, like clapping your
hands or ringing a bell. Ask t m h i l d to point in your direction.. Repeat this
activity many times, over a period of days.
a When the child is older, around 3 to 4 years of age, ask her to guess how far away
the sound source is. She can tell you in terms of steps - i.e., it is 10 steps away, c
in terms of some landmark, i.e., near the tree.

Encourage the family members to talk to the child and hold her. In this way the child I
will be able to explore their faces and learn to associate the voice, smell and feel of each I
4
person. The larger the number of people who interact with the child, the better will be the
child's development in all areas.

I
Encourrgiag the chid to explore the faces of people

Carry the infant outdoors for some time. When the child is able to walk, encourage
her to explore the neighbourhood. Help her to identrfy the various sounds and smells.
Describe to the preschooler the people who live in the houses neahy, especially those of her
age. Take the child to meet them,

When you take the clhld out for a walk with you, encourage her to talk to the people she
meets on the way. Tell the child what is happening around her. Describe to the child the
things that come along in the way, even holes and big stones. Help the child to learn about
these by feeling them with her hands and feet. Describe to the child the animals that you
come across such as dogs, cats, cows or chickens. Let her touch'them, if possible, and help
her to distinguish the different sounds they make. Help her also to know the sounds and '
smells of things such as animals and rubbish, that should be avoided. Teach her also to .
recognize smells of flowers, cooking food, the river, the market place. Knowing these
sounds and smells will help her to find her way around the neighbourhood.

To develop the child's ability to listen, draw her attention to the different sounds in the
surroun&ngs. When people talk to her, mention to her which voice belongs to which
person. Ask the person to come close to the child, so that she can touch the person's faceas
you describe the person.
 Children with Visuai
Impairment

Exploring the outdoors

Explain to the child the sound of a bus moving, running water, wind blowing, the rustling
of wind and the chirping of birds. Make different sounds by clapping your hands, snapping
your fingers, clicking your tongue by blowing. Let her feel your movements as you make
these sounds and help her to make the same sounds. For example, to teach the child to
clap, put your hands over the child's hands and make her clap. Make these sounds fast and
slow, loud and soft, so that the child l e a k the difference.

Gradually help the child to learn the difference between all the sounds that are heard in a
noisy place - the sound of the traffic, the sound of people talking, the machine moving.

The point that we are trying to make is that given a variety of experiences the child will
develop concepts and form an idea about the things around her.

' You have read about play activities for infants, toddlers and preschoolers in DECE-1. With
modifications, y w can carry out most of these play activities with children who have
difficulty in seeing.

10.5.4 Helping the Child to be Mobile

The child who has difficulty in seeing will have difficulty in moving the way the other
children do. She will not be able to reach for objects, and may not know how to move her
arms and legs. Therefore, when the child is small, carry the child close to you when you
move around so that the child identifies the sensation of movement.

Put the child in your lap and move y w r arms, legs and hands so that the child knows
how it feels. Move the child in different ways in your lap. Then help the child to move
her arms and legs.
Children with Special
Needs - 2

Helping the child to h o w the feeling of movement

When the child is about three to four months of age, you know that she begins to reach for
dbjects and explore them. Again, thisj s more spontaneous for the sighted child. The
colours and the very presence of the,bbjects is enough to create interest. But the child who
has difficulty seeing has to be made aware that there are objects. Therefore, place objects
within her reach and give them in her hand. The child's play material should be such
that it makes a sound when touched so that it arouses interest.
When you give different objects to the child, talk about them to her. Explain to her what
they are, describe how they look and what they do.
By 7 to 8 months babies starts crawling. If the child is born blind, then that may prevent
the child from beginning to crawl at the age at which she should, because not being able to
see, the child does not get attracted to things and, therefore, does not move towards them.
You will have to motivate the child to crawl. The child, however, will move towards

Encourage the child to crawl

sound. Therefore, when it is time for the child to be able to crawl, hold the child kneeling Children with Visual
on the hands and knees, as if crawling. Ask a family member to clap from a distance or Impairment
make a sound that will encourage the child to move towards the person. Sound some toy or
object away from the child, let it roll towards her a little and encourage her to come ahead
and pick it up. Give her a ball, a rattle that makes a sound. As she will play with the ball,
it will roll along and she will be motivated to crawl.

Once the child begins to crawl, encourage her to move around and explore the things in the
house. This will help her to develop an idea about them. It will also help her to learn to
use her arms and legs.

Around one year of age, children begin to walk. When the child cannot see, she may
hesitate to move around for fear of bumping into things. Initially, walk with the child so

When it is time for the child to walk, walk with her so as to guide her.

that she gets over this fear. First guide the child to move around the house. Talk to the
child as you walk together. Describe to the child the Merent rooms you are entering and
help her to feel (with the hands and feet) things there - the doors, the furniture, the mat.
Ask the child to repeat the arrangement after you. Next time you are in the room, ask the
child to feel the objects and recall what they are.

When the child is a little older and her vocabulary has increased you can play a game like
the following. Ask the child to tell you the names of the things placed in a room and their
positions. Use words like up and down, below, inside, lower, to the left of, to the right of,
-these words will help the child to understand the notion of space. Gradually, you will
find that the child has made a mental map of the house and can mwe around. Perhaps the
child needs to count the number of steps it takes her to reach a certain place but, gradually,
she will be able to estimate distances without actually having to count.

It is important to give the child a lot of experiences related to space, so that words that
signify space become really meaningful for her. Sometimes blind children tend to use
words which they hear being said around them, simply to gain social approval, without
understanding what they mean.

When the child is a little older, ask the child to hold one arm in front of the face while
walking to protect her head and face, if she bumps into things. The other arm should be
down across the body to protect her while walking, so that she can find things before she
Children witb Special
-
Needs 2

Teach the child to protect herself while walking

alone. Gradually encourage the child to walk by herself. Initially, the child is likely to
feel alone. To help the child get over the initial fear, stay close by her and talk to her, but
do not hold her. This will give confidence to the child and she will feel that you are
interested in her.

You can also teach the child to follow a wall or a table with the back of one hand.

Using a wall to guide oneself

Help the child to know the djrection she should take to reach a certain place. To do
this, start from a known place, for example, a doorway or a wall. Give directions to the
child to reach the place. Do this repeatedly. You may tell the child to count the number of
steps it takes to reach a certain place. Gradually, she will develop an idea about distance
and will not need to count the steps.

Do not leave the child alone in an unknown place without telling her where she is and when
you will be back. .
When the child starts to walk by herself, there are bound to be times when she will fall Children with Visual
down. Teach the child to put the arms straight out in frorit when she falls. This will lessen Impairment
the injury. When the child learns this, she will not be afraid of moving arouxl. The point
to remember is that the child should be trained to move around from as early an age as
possible.

When bending, teach the child to place one hand in front of the face. This will protect
the face from hitting objects such as tables and chairs.

Once the child is able to move around in the house, take her outside in the immediate
neighbourhood. Guide her to the trees, the fence, and buildings and encourage her to
touch these. When the child goes out repeatedly, she will form a mental map of the
surroundings.

Getting to know the neighbourhood

Describe to the child the kind of ground she is walking on. Help her to know the
dfferent kinds of ground with her feet. This will help her to understand whether the
ground is rough, smooth, sandy or grassy. If you have been teaching the child to listen to
different kinds of sounds, this training will help her when she begins to move out of the
house.

Initially, when the child begins to walk, remove stones from her path and fill in the holes.
Gradually, when the child learns how to walk with a stick, you can teach her to avoid the
stones and holes. You will also have to guide her along uneven ground. If there is a fence,
the child can follow the fence with one hand while walk in^
Children with Special When the child is around six years of age, teach her to use a cane or a stick for
-
Needs 2 walking. The stick can be made from the branch of a tree or a bamboo. The stick should
be straight a 4 not too heavy. The l e n p of the stick should be such that it reaches halfway
between the person's shoulder and wgst, from the ground. When the child holds the stick
to the ground, it should reach the ghund one full step ahead of her. When she holds the
stick, the elbow should be bent little, so that the hand is level with the centre of the body.
1

Teach the child to hold the stick just below its upper end and so that it touches the ground

lightly. She should use the wrist to move the stick from side to side in front of her, in an
arc. She should not move the arm or the hand. These should stay at the centre of the body. Children with Visual
The end of the stick should touch the ground on either side in front of the feet. The Impairment
distance between the two places, where the stick touches the ground, shoultl be a little wider

than the child's shoulder. In this way, the stick helps the child to find things that are in her
way and she can avoid them. As the stick touches different things, different sounds are
made. Help the child to identify things by the sound they make. Explain to the child to
keep the cane or stick close to the ground, so that it does not miss small objects in the path.

As the stick touches the ground on one side, she should move the leg ok the opposite side
forward. She can use the hand that is free to look t
h ,aller things, like drums or a lamp
post, that are in the way.
Children with Special First train the child to move the stick. When she can do this correctly, train her to walk
-
Yeeds 2 using the stick. At first, walk in front of her and talk to her about where she is going. Then

walk behind the child and let her find her way on her own. It will take quite some time for
the child to learn to walk thus. But she must not give up. If the child can see a little, then
train her to look straight ahead and use the stick to feel the ground. This will make it safer
for her to walk.

Teach the child to know when she is moving in an open space or is close to a wall or
building. The child can know this by listening to the sounds of the footsteps, which will be
 different in open and closed places and by attending to other sounds. If you clap your hands Children with Visual
in a large open space or close to a building the sound will be different in the two places. Impairment

When you take the child for a walk around your area, tell her what is happening around
, her. She will then understand how to move around more easily.
Keep the child away from dangerous places like fires, wells, busy roads, traffic and rivers.
When the child is old enough to know what danger is, take her to these places and explain
I
the dangers, so that she realizes she must not go near them alone.
If the child has to cross a small drain ot a small stream, then teach her to touch the opposite
side with thtstick to find out how wide it is. She can also touch the bottom of the drain to
find out its depth. If the child cannot touch the opposite end of the drain, she should not

I attempt to cross it.

To teach the child to climb steps, ask her to feel the height of the steps with the stick and
the feet. Help her to go up and down the steps, using a handrail, if there is one.

MAKE EFFORTS TO ENABLE THE CHILD TO BE MOBILE

" 1
Chlldren with Special 10.5.5 Teaching the Child to Take Care of Herself
-
Needs 2
It is good for the child as well as the parents if the child is able to feed, bathe, dress and go
to the toilet by herself. This will make the child happy as well as give the caregiver some
time for herself. Therefore, train the child to be independent in these activities. Even if
- the child does them slowly, let her do them without help, on her own.

When teaching the child any of the self-help activities, first observe how much of the
activity she is able to do done and the areas where she needs help. Encourage the child to
do independently whatever she can. It is possible that the child is not able to do the activity
at all.

When beginning to teach the child self-help skills, begin with an activity that you think the
child will learn easily. To teach the activity, the following procedures are recommended.
Think about how the child should do the activity and then explain it to her.
Show the child how to do the task by doing it with her. Describe to her what you are
doing and, where possible, let her touch what you are doing.

Then ask the child to do the activity herself. Let her do as much as possible without
your help. Step in to help out with what she cannot manage alone. To do so, put your
hands over the child's to her what you are doing.

Whenever the child does an activip well or does something independently, express
98 your pleasure and approval.
 Gradually, give less help and less instruction to the child. Being able to do an activity Children with Visual
independently may take several days or weeks. Impairment

How much difficulty a child has in doing an activity and how much you need to train her,
will depend on several factors including when the child lost her vision.

Eating
Help the child to learn to eat just like other family members do. Then neither the child nor
the other family members will feel she is different.

Begin to teach the child to learn to feed independently at the same time as you would begin
with a sighted child.

If the child was born blind, then you will need to help the child learn about different kinds
of food. Sit by the child's side during a meal and tell her what food she is eating. Help her
to recognize the different food by their flavour, taste, smell and touch.

Teach the child to wash her hands before beginning to eat. Always put the child's plate and
other things used for eating, like a spoon or a glass, at the same place for every meal. Put
difTerent kinds of food at the same place in the child's plate. This will enable her to find
them easily.

Drinking : To teach the child to drink from a cup or a glass, put your hand over the child's
hand and together hold the cup. Take the cup to the child's mouth, ask her to take a sip

and bring the cup down. Do this many times, giving less help each time. At mealtimes,
keep the cup in the same place each time.

Dressing : Dress the child in the same kind of clothes as other family members wear.
Teach her which IS the front and the back. If there is not much difference between the two,
then make the b a b ~different by stitching a small piece of cloth on it, on the inside.
Children with Special
-
Needs 2

Teach the child the colour of different clothes as well. If the child is able to see a little bit,
train her to disti'nguish between different colours visually. If the child cannot see, then sticl
small cloth pieces of diierent shapes to the clothes of different colour and teach the child
which shape represents which colow.

Using money : Teach the preschooler to identify different coins by feeling their size,
between the fingers. If notes are of the same size, fold notes of different values in different
ways and explain to the child how the different notes have been folded by feeling them with
her fingers.
>
Check Your Progress Exercise 2
\
......... ... ... space below :

1) Why is it important for the mother to talk often to her visually impaired child, hold
her close and allow the baby to explore the mother's face with her hands when the
baby does.so?

2) What are some ways through which you can help the visually disabled child to
acquire language?
3) What can the caregiverfeducatordo to help the visually impaired child learn about Children with Visual
the surroundings and develop concepts? Impairment
...............................................................................................................................
...............................................................................................................................

4) Briefly state how you can train the visually impand child to be mobile ?

5) "What is the point of taking her out with me on walks or when I go shopping? He
can't see anything. I don't tell him about things around him either because it is
going to be of no wk."

e what the mother of a blind child remarked to an educator. What in

~ h l a b o v is
your opinion, should the educator say to the mother ?

10.6 LET US SUM UP

In this Unit you have read about how to help children with visual impairment. While the
legal definition of visual impairment is based on measurement of visual acuity, the
educationists have included definitions that would help to serve as a guideline to handle the
child's various needs. For educational purposes, blind individuals are those who are so
severely impaired that they must be taught to read by aural methods. Partially sighted
.individuals can read print, though they need ma-ng devices or books with large print.

Any infection or problem in the eye must be immediately referred to an opthalmologist as it

could lead to visual impairment.

Visual impairment will sect the child's language and cognitive development and will
cause difficulty in moving around. How much difiiculty the child faces in leanring to be
mobile, acquiring concepts and language will depend on the age at which the impairment
occurred, the degree of impairment - whether the child is blind or can see something, the
motivation of the child to learn and the stimulation provided to the child by the caregivers.

It is important that the caregivers encourage the child to explore objects and her
surroundings, using the other senses. Help the child to learn to do the tasks essential for
every day living - eating, dressing, bathing, going to the toilet and using money.

The caregiver and the educator will need to be more alert and make much more of a
conscious effort in planning play activities for the child and helping her learn.
Children with Special
Needs - 2 10.7 ANSWERS TO CHECK YOUR PROGRESS
EXERCISES
Check Your Progress Exercise 1

1) Educationists have evolved a classification system that enables them to handle the
child's various needs. In this system of classification, blind individuals are those
who are so severely impaired that they must be taught to read by Braille or by use
of aural methods.

Partially sighted are those who can read print, though they need magnifying
devises or books with large print.

2) The following signs may be an indication that the person has some visual
impairment which is causing a di£ticulty in seeing.

a The child rubs the eyes excessively.

The child shuts or covers one eye, tilts head or thrusts head foward in an
attempt to see better.
a The child experiencesdifficulty in reading or in other work requiring close
use of the eyes.
a The child blinks more than usual.
The child becomes imtable when doing close work and complains of pain,
dizziness and nausea.
The child holds things close to the eye when examining them or when
trying to have a better look.
The child finds it difficult to see distant things clearly - cannot make out
the colour, shape, size or read what is written on distant bbjects clearly.
The child frowns or squints eyelids together when looking at something
The child tends to confuse letters of a similar shape.
a There is poor spacing in writing and difficulty in staying in the line.
a The eyes appear red rimmed, swollen or there are crusts on lids.
There is a watery discharge from the eyes and they inflamed.
a Styes frequently erupt on the eyelids.
The child complains that the eyes feel itchy, scratchy or that there is a
burning sensation.
The pupils are of uneven size
a Crossed eyes or those that are not straight.
3) a) Disagree. By and large, blind individuals will display relatively few gestures; the
gestures they do show may be jerky and they may make repetitive movements of
the head or hand; they may have some specific mannerisms whch may be
inappropriate. This is because since the child cannot see, she has not learnt how
people use expressions and body movements during speech.
b) Agree. Not being able to see, the person misses out on information from one sense
modality. The other senses may not be as effective in developing an idea about
certain things.
c) Disagree. One has to make a special effort if one wants to learn about an object
through touch, unlike vision which is active so long as one's eyes are open.
Secondly, since touch is not as spontaneous as vision, special efforts need to be
made to stimulate and arouse the interest of the child. Thirdly, most objects can be
explored only through analytic touch which, means that the blind person cannot
see an object as a whole all at once.
 Agree. Since the blind child pcmarily learns through touch and since learning by Children with Visual
touch is not so spontaneous as vision, the caregiver will need to make extra efforts Impairment
to arouse the child's interest, stimulate her and explain things to her.
Agree. If the child is blind from birth, the child relies primarily on touch to know
about things. But if the child lost sight some years after birth, then she had been
able to form some idea about the world around her, and can use this knowledge to
help her form more concepts later on.
Disagree. They learn to make better use of these senses and so it appears as if they
are born with better sense of hearing, touch and smell.
Agree. Not being able to see, the child is not spontaneously attracted to things and
so may not learn to crawl at the same age as others. Walking may also be delayed
as the child may be fearful of falling.
Disagree. They make better use of their sense of hearing to detect things in their
path as compared to the sighted people. They do not have a sixth sense.

The factors are

- the degree of visual impairment - whether the child is blind or can see
some thing.
- the age when loss of sight occurred.
- the motivation of the child.
- the stimulation provided to the child by the caregivers.

Check your Progress Exercise 2

1) It is important for the mother to do so, so that the child can form a mental'image
about her and integrate the sound of her voice, thesmell and feel of her body into
one experience. This becomes all the more important in case of the blind child
because the child does not see what the mother looks like and so if she were not to
talk to her or hold her close, the child would not have enough information on
which to build her idea about the mother.

Allow the child to feel your face and mouth as you speak. Then ask the child to
put her hand on her mouth and speak the same words.
Help the child to learn appropriate gestures and expressions that go with a
particular speech.
Whenever the c s l d touches something, say its name. Encourage her to explore
objects.
Use your voice in different ways to convey different expressions and feelings.
Encourage the child to explore objects and things by touching them, listening to
sounds and by using her sense of smell.

Describe the objects to the child as she holds them.

When the baby is able to crawl, encourage her to explore the surroundings. When
the child is able to walk, encourage her to explore the neighbourhood.
Play games and carry out activities that will help her to develop the ability of
listening.
Take the child to meet people. Take the child along when you go shopping and
describe to her the things and people that come across on the way and what is
happening around her.
Teach her to recognize different smells.
Help her to differentiate between different sounds in the surroundings.
Children with Special 3) The educator must explain to the mother that her thinking is totally wrong. If' the
Needs - 2 child can't see, he can learn through his other senses. The more the mother talks
to the child, gives him things to explore and takes him along to meet people, the
better will be the child's development in all areas.
4) a) When the child is an infant, wry the child around with you, so that the child
knows the meaning of movement. Move her in dierent ways in your lap;
encourage her to feel you as you move your arms and legs. Encourage the child to
move her body as well.
b) When it is time for the infant to crawl, encourage her to do so by putting the child
in the crawling position and sounding an object some distance away, so that the
, child is motivated to reach it.
c) Around one year, encourage the child to walk. Gradually, train her to walk
independently. First let her walk in the house and then take her around the
immediate neighbourhd. Help her to learn to avoid obstacles in the way and to
know whether she is in an open space or closed area, in the market place or near
the road. Gradually, teach her to walk on uneven ground and to climb steps.
d) Around six years of age, help the child to learn to use a cane while walking.
UNIT 11 CHILDREN WITH HEARING
IMPAIRMENT

Structure
11.1 Introduction
11.2 Some Facts About Hearing Impairment
1i .3 The Importance of Hearing
11.4 Structure and Function of the Ear
11.5 Degree of Hearing Loss
11.6 Causes of Hearing Impairment
11.6.1 Tips for Care of E m

11.7 Identifying Hearing Loss

11.8 Care, Early Stimulation and Education of the Auditory
Disabled
11.8.1 Effect of Hearing Loss on other Areas of
Development
11.8.2 Stimulat~onand Training
11.9 Some Principles for Working with Children with Hearing
Loss
11.10 Educational S@g for the Hearing Impaired
21.11 L e t u s s u m u p
11.12 Answers to Check Your Progress Exercises

11.1 INTRODUCTION
Human contacts and relationships depend mostly on communication by means of speech
and language. Hearing impairment aEects the ability of a person to communicatefreely
and effectively with hearing persons, share ideas and feelings, and express oneself.

The difficulties that the individual may face because of hearing impairment are .
compounded by the 'invisibility' of the handicap, so to say. Hearing loss is not visible,
unless the person wears a hearing aid, whereas disabilities like blindness, physical handicap
and moderate and severe mental retardation are quite apparent. This &en leads to
embarrassing and distressing situations. We may not know that an individual is hearing
impaired when we begin conversing, and when we do realize it, an awkward silence may
follow or there may be some mumbled apology which causes humiliation to the individual
with the impairment. If the hearing loss is considerable or it has not been corrected, then
the individual is likely to feel neglected and isolated.

It is important that through appropriate training and education, people with hearing loss are
helped to adjust with hearing people and the hearing people are taught how to live with
them.

Objectives
After studying this Unit, you should be able to
understand the difficulties faced by children with hearing loss
identify a child with hearing loss
judge the extent to which a child's hearing is impaired
explain to the parents the causes of hearing impairment and how they can be treated
. provide stimulation to the child with hearing impairment at your centre
teach parents how to develop communication skills in their child.
Children with Special
-
Needs 2 11.2 SOME FACTS ABOUT HEARING IMPAIRMENT
Hearing impairment does not automatically lead to inability to speak. It is a barrier to
normal development of language. However, people with hearing impairment can be
taught how to communicate effectively with others. In this regard, the earlier the
stimulation and training begin, the better it is for the child.

A person with hearing impairment is not necessarily retarded. Her intellectual

capacities may be equal to or even better than those of a normal person. Her
performance may be lower in those areas which are dependent on use of language, if
she has not been able to develop speech. For example, narrating a story may be
difficult for her; however she has the capacity to understand the story.

Hearing impairment has a wide range of gradation - from profound to a partial loss
of hearing.

It is believed that some amount of residual hearing is present in all people with
hearing impairment.

Hearing aid is helpful for all people with hearing problems.

Early detection of hearing loss and training is essential to help the child make use of
whatever hearing she has and to help her develop comnlunication skills. Parents,
pediatricians, ENT specialists, health workers, social workers and educators -all
have an important role in this. Helping the hearing impaired person to develop the
ability to communicate is to be done at various levels -by helping her develop
language; by teaching her a special language, that is, sign language; and by
strengthening her ability to pick up cues, for example, gestures, facial expressions and
lip movements of persons speaking to her, in order to understand what is being
communicated.

How well and to what extent the child with hearing loss is able to develop her
capacities and abilities will be influenced by the attitude of people towards her, their
support to her, availability of appropriate learning experiences and her own
motivation.

11.3 THE IMPORTANCE OF HEARING

Let us first try to understand how we use our hearing. This will help us to get an insight
into the difficultiesof a person with hearing impairment.

We use words to represent objects and concepts. Our sense of hearing helps us to
learn words, using which we communicate with others. You have read in DECE-1
how a chld learns to speak. Hearing language is basic to being able to speak it. The
informal conversation among family members, which the infant hcars, and the
specific attempts the family makes to help her learn language. enable the child to
learn to speak.

A child with hearing loss, depending upon the degree of impairment, will not be
able to experience these learning opportunities that most of us take for granted,
and would be deprived of a common means of communication with'the world
around her.

We rely heavily on our hearing to signal to us changes in our environment and to

warn us of approaching danger. For example, the whistle of the train, the loud
ringing of an alarm bell or the sound of approachng thunder caution us to take care.
We respond to sound - consciously or unconsciously. A loss of hearing would
hinder the person's ability to react suitably to changes in the environment. For
example, while walking on the road, the person will have to rely on her sight and,
therefore, may not be able to sense the bus approaching from behind.
106
 It is almost impossible for us not to be Bearing something. If you close your eyes Children with Hearing
you will hear a number of sounds : a clock ticking, shouting, the hum of a tube light, Impairment
the wind rustling through the trees, the rain hitting the window, the radio, the noise
of the traffic, people talking, and so on. Our environment is filled with sounds. We
are accustomed to them and through them keep in touch with the environment.
These sounds in the background help us to feel one with our surroundings.
People who have lost the ability to hear, particularly those who could hear in the
beginning but have lost it during the later years of childhood, often experience an
almost overwhelming feeling of isolation. These feelings, and the frustration that
accompanies, can have serious psychological effects. It can make the person anxious,
sometimes leading to depression.

11.4 STRUCTURE AND FUNCTION OF THE EAR

To understand the hearing disorder, it is necessary to understand the structure of the ear
and the processes involved in hearing.

The ear consists of three parts :

- the outer ear
- the middle ear
- the inner ear.

Table ll(a) : Lmportant parts of the ear and their functions

- -

PART FUNCTION

External ear Carries sound (waves) to the eardrum

Protects the sensitive inner parts of the ear
from damage and foreign objects
Earwax (in the canal lining) traps foreign
material and prevents the canal and eardrum
from drying out

Middle ear Eardrum vibrates when sound waves

strike it
Malleus, Incus, Stapes (bones in midge ear)
ampllfy the vihrations and transmit it to the
cochlea in the inner ear
The eustachian tub&relieves the feeling of
pressure or stoppage we feel when coming
down from height (mountains) or swimming
under water.

Inner ear Cochlea is filled with fluid. The vibrations in

stapes create waves in this fluid, which
stimulate the auditory nerve.

The auditory nerve carries the messages to the

brain.
The semi-circular canals help in the adjustmen1
of the body to maintain balance.
 Children with Special
-
Needs 2 11.5 DEGREE OF HEARING LOSS
The inability to hear or hearing loss may range in severity from mild to profound.

The hearing impairment can be at two levels -loudness of sound and pitch of sounds.
Let us take the example of a radio to understand this. If we turn the volume knob of a radio
clockwise, the volume increases. If we turn the knob anticlockwise, the volume decreases.
In both these cases, the sound is still clear and understandable. The volume can be
decreased further till we are unable to hear any sound. A person with hearing impairment
may not be able to hear a sound at the same volume (loudness) as a normal person -she
will hear the same sound when it is louder. The loudness at which she hears the sounds is
measured by professionals (audiologists) in decibels, i.e., dB levels.
a

A person with hearing disability may have another problem. When we are altering the
position of the station knob (which changes the frequency), we pick up sounds from
different stations. The sounds are clear at different frequencies- there are certain points
when sound from two stations, i.e., two frequencies, can be heard together, which makes it
very unclear. Such can be the problem faced by a person with hearing loss. The person
may find it difficult to discriminate different sounds -the chirping of birds and rustling of
leaves may not be distinguishably clear. Thus, for some persons with hearing disability,
the sounds are perhaps clear but not loud enough; for others, sound is present but is
distorted; for still others, both volume and clarity are problems.

The degree of hearing loss may be different in the two ears. While hearing may be
normal in one ear, the person may not be able to hear from the other.

Depending on the degree of loss, hearing disability is categorized into the following :-

a) Mild loss (20-40 dB) - The person hears in most settings. She would have
difliculty in hearing faint.or distant speech.

b) Moderate loss (40-60 dB) - The person may have a problem in hearing group
conversations or when there is background noise or have difficulty in hearing
conversational speech beyond 3-5 feet.

C) Severe loss (60-80 dB) - The person misses all but very loud speech; will not be
able to hear loud sounds beyond a distance of a foot.

d) Profound loss (80 dB or more) - The person is unable to hear speech except a
loud shout, cannot hear spoken language, All not be able to rely on hearing as a
primary channel of communication.

A different method of classification of hearing impairment is based on the time since the
person has had the hearing loss. Thus, the prelingually deaf are those who have been d&
at birth or have become deaf before they could develop speech. The post-linpally deaf are
those whose deafness occurs at an age after language and speech are developed.

This method of classification has implications for giving speech training ta the hearing
impaired. It has been found that it is difficult to develop speech in +*,Gchild who lost her
ability to hear before she could develop speech, i.e., the prelingually deaf. The more the
child's exposure to language and the more developed her speech before the hearing loss
occurred, the easier it is to help her develop speech later on, after the hearing loss.
-

t
Check Your Progress Exercise 1
Answer the following questions briefly in the space provided below.

I 1) State whether the following statements are correct or incorrect.

I a) All people whose hearing is impaired cannot learn to speak. ( 1

I b) Hearing impairment leads to mental retardation.
 c) Some amount of residual heMng is present in all people with heafing ' Children with Hearing
impairment. ( ) \ > Impairment
d) The degree of hearing loss may be different in the two years. ( I \
e) The more the child's exposure to language and the more developed
the speech before hearing loss occurred, the easier it is to help her
develop speech later on aher hearing loss. ( )

2) What are some of the difficulties that a person with hearing impairment will
encounter ?

) Match column A with column B

Column A Column B
1) Mild loss of hearing a) 80 dB or more; can hear only a loud shout;
does not understand spoken language
2) Moderate loss of hearing b) those born deaf or those who became deaf
before they could develop speech
3) Severe loss of hearing - c) 40-60 db. Has mculty in hearing
conversational speech beyond 3-5 feet
4) Profound loss of hearing d) those who became deaf after they developed
speech
5) Prelingually deaf e) 60-80 db. Hears only very loud speech.
Cannot hear socnds beyond a distance of a
foot.
6) Postlingually deaf f) 20-40 dB. Can hear in most settings. Has
difficulty in hearing faint or distant
speech.

11.6 CAUSES OF HEARING IMPAIRMENT

Hearing impairment can occur while the baby is in the mother's womb (i.e., before
birth), during the time when the baby Is being born (i.e., during birth) or after birth.
You have read about many of these causes in earlier Units. Therefore, we shall merely list
them here, as you have already read about their implications.

Before Birth
History of hearing impairment in the family.
Consanguinous maniages (marriage between close relatives).
Blood group complications or RH incompatibility between the parents.
Infectious diseases or illnesses contracted by the mother during pregnancy (for
example, syphillis, rashes with fever, mumps, German measles), particularly during
the first three months.
Poor health of the expectant mother
Excessive intake of alchohol or nicotine by the pregnant woman.
Intake of antibiotics or any other drugs by the mother when they are not prescribed by
a doctor.
Exposure to X-rays during pregnancy.
Children with Special During Birth
Needs - 2
Premature delivery
Lack of oxygen to the infant during delivery
Low birth weight of child.
Delivery using instruments that can cause damage to the part of the brain responsible
for hearing.

After Birth
Jaundice, high fever or convulsions immediately after birth.
Infectious diseases (e.g. whooping cough, mumps, measles, syphillis, brain fever,
viral fever, T.B.) contracted by the child during childhood.
Intake of antibiotics for a long duration.
Injury to the ear,such as due to blow on the head or putting objects in the ear.
Exposure to loud sounds
High blood pressure, diabetes
Tumours in the ear
Neglect of infectionof the ear, such as neglected ear discharge

Thus genetic or environmental factors can lead to hearing impairment.

Many of the environmental causes of hearing impairment are preventable. Proper care
of the mother during pregnancy, the presence of' +trained person during delivery. adequate
nutrition during childhood, maintaining hygiene of the ear and immunizing the child
against preventable diseases can prevent hearing impairment.

You have read about common infections of the ear, during childhood, their symptoms, and
how they can be prevented in DECE-2. It would be worthwhile to refer to that Unit at this
point. To help you recapitulate, we are stating some tips for care of the ear.

11.6.1 Tips for Care of Ears

1) Do not hit the child on the ear.
2) Protect the child from sudden loud noises like those of crackers and from continuous
loud noises like aeroplanes, factory machines.
3) Do not clear ears with pointed objects like hairpins, pencils etc.
4) Take care that the child does not put small objects inside the ears.
5) Do not clean ears with water or oil.
6) Bathing or swimming in dirty water can cause ear infections.
7) Do not use the pillow or towel of a person having ear infections
8) Breast feed the infant with care. Do not let her head tilt while sucking as the milk
can go to the ear causing infection.
9) Treat any swelling, pain or discharge from the ear immediately.

11.7 IDENTIFYING HEARING LOSS

The age at which the hearing loss occurs is very important because it would affect the
development of language and speech as well as influence educational achievement, which is
largely determined by the child's ability to hear and speak. Consequemly, hearing loss will
affect the social, personal and vocational adjustments in the later years of the child's life.
The first few years are extremely important for the child to acquire language. You know
>
that if the child is deprived of the ilormal experiences to hear and learn language in the Children with Hearing
early years, she will find it difficult to lcarn it later. It is important that any degree of Impairment
deafness be recognized as early as possible. so that stimulation and training can also
begin early.

However, it is generally seen that the parents' suspicions that a child may have a hearing
inlpainlient may not be aroused, even if the deafness is severe, until the latter part of the
first year. If the deafness is mild, nothing may be suspected until very much later -
perhaps not till the child starts attending school.

Here are certain checks for parents and educators which will help them to determine
whether the child is hearing properly or not.

Table ll(b) : CAN YOUR BABY HEAR YOU ?

AGE TICK IF RESPONSE IS PRESENT

I
Shortly after Birth

Your baby should be startled by a sudden

loud noise and she should blink or open
her eyes widely to such sounds

By One Month

She should show the additional response of

becoming still if you make a sudden
prolonged sound.

By Three Months

She sllould quieten or smile to the sound of

your voice even when she cannot see you.
She may also turn her head or eyes towards
you if you come up from behind and speak
to her from the side, i.e., she should search
for source of sound with eyes.

By Six Months
She should turn immediately to your voice
across the room or to very quiet noises
made on each side.

By Nine Months

She should listen attentively to familiar

everyday sounds and search for very quiet
sounds made out of sight. She should also
show pleasure in babbling loudly and
tunefully.

By Twelve Months
She should show some response to her own
nanie and to other familiar words. She may
also respond to 'no' and 'bye-bye'. The
child should be able to say a word or two.

By Two Years

The child should begin using meaningful

speech at 1 112 to 2 years. The vocabulary
sliould grow regularly.
Children with Special If you suspect that the child cannot hear normally, either because you cannot place a
-
Necds 2 definite tick against the items above or for some other reason, then contact the nearest
health clinic for advice.

The other signs when parent or the ECCE worker should become alert and seek
professional help are when
a The child has frequent colds and sore throats.
a Fluid runs from the ears.
a The child begins to babble at the right age, but gradually the frequency of babbling
decreases.
a The child does not follow simple directions like: 'come here'; 'take this', at 1 112
years.
a The child understands your speech only after few repetitions.
a The child does not respond to being called from the other room.
a The child does not speak meaningfully even at 1 112 or 2 years of age.
a The child uses only gestures to communicate.
a The child tunes the T.V./radio abnormally loud all the time.
Slowness in speech development or in progress in learning can be due to hearing
impairment.
a Wandering of the child's attention in class or at play. The child loses interest more
easily because she misses out on spoken informatibn.
a Turning of head by the child when she needs to hear the speaker. This may happen
because she is trying to hear with her better ear.
a A hearing impaired child shows fluctuations in her listening behaviour. This may be
because of blockage or discomfort in the ear which may be sometimes released when
she yawns or swallows. During blockage, she experiences difficulty in listening.
This behaviour that the child understands a spoken message at one time and not at
another may be wrongly considered as stubbornness.
Difficulty in following oral directions. In our ignorance we may label such a child as
lazy or shy. The child may not show difficulty in following written directions.
a The child looks at other people in the group before she starts work.
a The child does not seem to be performing as wdl as is expected of her.

If you as an educator have been the first to identify the hearing loss in the chlld, then
discuss the condition with the child's parents and gu'ide them for detailed testing of the
child. It is important to remember that the child can be helped - the impairment can be
corrected through surgery or medication. Even if it cannot be completely corrected, the
disability due to the impairment can be lessened through the use of hearing aids and early
stimulation. It may not be an easy task, but with proper guidance and support, the child can
be helped to overcome the handicap.
- 1

Check Your Progress Exercise 2

Answer the following questions briefly in the space provided below.

I) List three factors each that can cause hearing impairment during the prenatal,
perinatal and postnatal period.
....................................................................................................................................
.....................................................................................................................................
....................................................................................................................................
...............................................................................................................................
112
2) Why is it important to identify hearing loss at the earliest ? * Children with Hearing
Impairment

3) List 10 signs which may indicate that the child is having some problem in hearing.

11.8 CARE, EARLY STIMULATIOV AND EDUCATION

OF THE AUDITORY DISABL$D
It is possible that you are the one who has identified hearing loss in the child.
Alternatively, the parents of the child may approach you with this problem.
Whenever hearing loss has been identified, if is important that the parents take the child to
the medical centre. Here the child would be referred to an audiologist, who would help in
assessing the degree and type of hearing loss. Based on the reports of the audiologist, the
child would be referred to an ENT specialist, who would examine the ear. It is possible that
hearing loss is due to accumulation of wax, infection, obstruction or any other condition
that can be treated through medication or surgery. In such cases, it would be possible to
restore the child's hearing.
Many problems, however, cannot be medically corre~ted.The hearing impairment in these
cases would remain. In such cases the child can be helped at three levels :
Providing the child with hearing aids to irnp~ovethe existing hearing capacity.
Giving the child training to develop speech. This is usually done by a speech
therapist. However, you as an educator can learn some of the techniques and help the
child in the centre. Some of these havebeen described later in the Unit.
If the extent of hearing loss is moderate or severe, then the child's language may not
develop to an extent to enable her to communicate. In these cases, the child will have
to be taught lip reading, sign l a n w g e and/or finger spelling. These again should be
taught to the child by a specialist. However, you cail learn how to help the child to lip
read or use finger spelling or sign language, so that the work done by the
professionals can be carried out by you at the cenlre and you can further train the
parents to continue the training at home.
The point that is being made here is that early identification of hearing loss is extremely
important. Once that is done, the next step is to help the child develop the ability to
communicate with others. For this it is preferable that the child's hearing be improved
through the use of hearing aid, so that she develops speech. However, if needed, the child
should also be taught lip leading, sign language and finger spelling. The idea is to
encourage the child to use different means of communication, so that she can relate
effectively with people.
Children with Special 11.8.1 Effect of Hearing Loss on other Areas of Development
-
Needs 2
The primary area where the bearing impaired child will lag behind others is
development of speech and language. This may or may not interfere with the child's
academic performance at school, depending upon whether the child has received speech
t r a i ~ n and
g whether the residual hearing has been strengthened, through the use of hearing
aid. However, what we need to remember is that hearing impairment does not
automatically lead to slow intellectual development or mental retardation.

How successful the child is in developing social relationships would depend on the attitude
of the peers and the community. This will also be influenced by how well the child can
communicate and how much the others are able to understand her. Therefore, it is
important to help the child develop as many means of communication as possible, as well as
selfconfidence.

The physical and motor development of a hearing impaired child will be like those of other
children.

11.8.2 Stimulation and Training

The early training of the child has to begin at home and at the preschool centre. Let us now
see how you, as an educator, can help the child develop the means of communication.
Remember that you would need to explain these to the parents as well, because the training
of the child must be a regular and consistent process -to be followed at home as well as
the preschool centre. Ideally, there should be inputs of all concerned - speech therapist,
professionals in the area of hearing impairment, medical personnel, you as an educator and
the parents - in helping the child.

However, even in the absence of experts, you can help with attitudes to the disability, as
well a s with communication skills.

Strengthening the Child's Hearing and Developing Listening Skills

It is important to make use of wbatever bearing the child has and to build upon it.
This is referred to as auditoj training. There are two aspects to be considered while
budding upon her remaining (residual) hearing.
* ' The power to hear
* The use of the power to hear.

The Power to Hear : Hearing aid is invaluable in incteasing a person's power to hear.
Hearing aid is an electronic device that makes sounds louder. It does not restore the
hearing to normal, but greatly improves communication skills. Different kinds of hearing
aid are av$lable -while some can be worn next to the ear, others are worn on the body,
with cords leading to the ear. The aid is fitted in accordance with the degree of hearing
loss. Children with a lower degree of hearing loss will benefit more from the aid.

Care has to taken to keep the hearing aid in good working condition. It should be worn
continuously and checked for any alterations in size, depending on the physical changes
(size) in the ear with age.

Sunita is a 10 year old girl with hearing impairment. She started using a hearing aid when
she was 6 years of age. For thefirst two years she was not regular in wearing the aid -
she would wear it only to school and would remove it as soon as she reached home. There
used to be logg gaps (1-2 months) when she did not wear the aid because she had only one
pair, which had to be repaired. Her progress in speech and language learning was slow,
even though she comprehended most offhe tasks. She could even make purchases
independently.

The educator had workedhard at helping Sunita's parents understand the importance of
regular and continuous use ofthe hearing aid and the guidance and support they would
need to give her. She reminded Sunita daily to wear the aid at home so that she would
develop the 'habit '.' The parents were asked to speak to the audiologist, learn how fo take
care ofthe hearing aid and to teach Smita about this aspect as well. Sunita 's hearing aid Children with Hearing
was changed three times (to adjust its size to the size of her ears) and now she is wearing Impairment
'behind the ear ' ones.

For the past two years, Sunita has started wearing the aid all the time (she tdkes it oflonly
during bathing or sleeping),,and there has been a tremendous itnprovernent in her interest
in classroom activities. The educator gives her special attention to help her with her
language work and she now can converse in short sin~plesentences and can understand
most of the things said to her. Of course, to help her understand clearly the educator also
uses gestures, written words and pictures along with oral instructions. She is presently
preparing for her primary school examination through the Open Board. Her father plans
to teach her the family trade - making artificial jewellery -- and hopes that one day she
would take over his business.

HEARING AID IS USEFUL FOR ALL PEOPLE W I T H BEAWUYG

DISABILITY . .

The Use of the Power to Hear : If a child with hearing impairment does not receive
help early in life to make use of whatever hearing she has, this gets lessened even
further. This happens because either the child fails to acquire the habit of listening or
because she learns not to pay attention to what she hears, since it does not make any sense
to her.

It is very important that the child with a hearing disability must, from the moment at
which that disability is recognized, receive deliberate training to listen to sounds and
to associate sounds with meaning. The fact that she may not be able to hear all sounds or
distinguish between the finer details of different sounds or understand what they mean is
not important. At the early stage, if she realizes that sounds differ and have meaning is
enough. If because of lack of training, she fails to realize this and forms the habit of relying
on sight primarily and not paying attention to sound, it will be very difficult to develop
whatevcr hearing she has. ,

In this regard, the family has an important part to play. Onc may even say, a primaq
role to play. Help the parents understand that the child must get constant listening
practice.

The hearing aid must bc provided as soon as possible - as young as 8-10 months old
infants can bc given a hearing aid. It must be constantly worn.

Initially, the child may find it uncomfortable. The hearing aid may cause physical
discomfort and the sounds the child hears will be a new and strange experience, which may
not always be pleasant. However, the child will gradually learn to get used to them and will
start liking them, once shc starts attaching meaning to what she hears.

Explain to the parents that they should expose the child to lots of language -they
should speak to the child whether or not she responds. Ordinary home routine offers ample
scope and opportunities.to talk to the child and to hclp her acquire the knowledge of words
-whether at meal times, while taking bath or during other household activities like
washing clothes, cooking ctc. The mother may sing to the child while bathing her,
encouraging the baby to look at her face, concentrate on her facial expressions and
movement of lips. Explain to the parents that they must call the child by name before
speaking to her so that the child knows she is being spokcn to. It is important to make
sure that the child is looking at them when they are speaking to her.

It is important to use full sentences when speaking to the child. Do not think that the
child will not be able to understand them. Do not say: "Saurabh Milk; say the full
sentence: "Saurabh drink the milk." Encourage the child too, to use full sentences while
speaking.

The words the parent uses should be related to the experience of the child. For
example, during n?eallimes, thcy can associate the word 'chappati', with what the child is
eating. If words are spoken without showing the object to the child, it will not make much
Children with Special sense to her initially. Keep the sentences short so that the child can understand easily. The
-
Needs 2 child has to be encouraged to imitate the parent -initially the imitations may be very poor
but it is enough that the child is learning to listen and is trying to speak.

When we speak, we tend to use gestures to make our meaning clear to the listener. As you
know, these gestures and facial expressions are called 'body language'. Use body language
.along with speech so tbat the child understands the conversations and knows what tbe
expressions mean.

The parents may use songs, books. drawings, actual objects and anything else which they
feel will be able to assist them in communicating with the child.

The parents and you, as an educator, would need to be in touch with the speech therapist to
learn ways of training the child. It is important that the work done by the therapist with the
child be carried out rtt home and the preschool.

Lip reading ,
Lip reading involves understanding the spoken language by watching the mouth and
face movements of the speaker. Children with moderate to profound hearing loss, depend
a great deal on lip reading to understand the spoken word.

Lip reading can be taught to the child when she is over three years of age. Sit in front of
the child and shows her an object, for example a ball, and says the word "ball" making the
movements of the lips very clear by spealung slowly. Allow the child to feel the movements
of your lips, and watch the expression on your face. Repeat the word many times to help
the child to imitate.

Use short, simple but whole sentences. Avoid baby talk. If the child is only exposed to
broken sentences, she will only learn these, whereas the goal is to teach her normal
language.

Speak naturally using the normal voice at a moderate speed. Exaggerating words or
speaking more slowly than usual will only confuse the child.

Sign Language and Finger Spelling

Sign language involves the use of specific signs for different words in order to
communicate. Children whose hearing loss is high are taught to communicate with the use
of sign language. The disadvantage is that this language may not be understood by
everybody.

Another technique which the children with hearing impairment Can learn to communicate
is by spelling out each letter of the word by different formations of fingers. These
techniques can be taught to the child by people specially trained in this area.

11.9 SOME PRINCIPLES FOR WORKING WITH '

CHILDREN WITH HEARING LOSS
The following are a few points that the parents and the educator must bear in mind while
working with the child with hearing impairment.

1) Helping the Cbild Understand Your Speech

Use full sentences to speak to the child, so that the child can understand the content.
Also, the child will learn what she hears. If you speak incorrectly or use incomplete
 Repeat the word or sentence the child does not understand Simplify and rephrase the Cbildna with Her*
sentence. Imprimeat
Use objects, drawings, actions along with speech to make it clear to her.
It is not necessary to shout or u p exaggerated lip movements. This is likely to
confuse the child.
Make sure that the child is aware of the topic under discpssion. Alert her when the
topic is changed.
Write new words on the blackboard or on a notebook.
Keep in constant touch with the child's parents so that they can help the child
practice at home. For example, give the list of new words, you have taught to the
child, to the parents so that they can continue teaching at home.

Helping the Child Use Her Listening Skills More Effectively

Insist that the child wear the hearing aid
Check the working condition of the aid
Help her to notice all the sounds around her such as school bell knock on the door
etc.
Encourage her to respond to her name. Call out her name whenever you want to
catch her attention- do not pull her clothes or touch her
Familiarize her with the names of her classmates.
Encourage and reward her whenever she makes an attempt to listen and say
something. r

Encouraging the Child to Speak

Ask her questions and expect answers from her. Wait for -her response.
Involve herdn all oral activities like singing rhymes, narrating stories.
Provide words to her only when she does not seem to have them.
If she uses an incomplete phrase or a sentence, provide her with the proper sentence.
Whenever she attempts new words or phrases, praise and encourage her
Occasionally, remind her of her speech mistakes. However, do not interrupt her
communication with constant corrections.
Ask her to repeat, speak clearly or explain more, if you do not understand her. Do not
hesitate to tell her that you cannot understand her.
Make her participate in all games,drama, prayer and music activities

Helping the Child and-her Classmatea to adjust to each other

Be observant about the behaviour of the other children towards the child. They might
tease or ignore her.
Help the other children learn ways to understand the child's gestures, speech etc.
. Conduct activities to
help other children learn to communicate without using speech.
This will help them to develop a sensitivity towards the dil3iculties experienced by the
hearing impaired child.
Plan activities where the other children can interact closely with the child, for
example, decorating a bulletin board together.

Classmm Structure and Seating Arrangement

The child should sit in a front seat
The child should be able to watch the face of the educator whilst she is talking to the
class. The educator should try to face the child when important instructions are being
given.
Children w i t h i r i a l a The educator should not talk with her back to the class.
Needs-2 ,
.. a The child should be allowed to turn around to see the f a d s of other children
' - ' I participating in class discussions. Seating children in a semicircle is a good way of
doing this.
a More attention needs to be given to the child when on outings or on the road, as she
may not be able to sense the dangers.
a Focus on what the child can do, rather than on what she cannot. Discuss the special
abilities and interests of all the children, including her, in the class. Expect her to
meet the same standards of behaviour, promptness and cow?esy as her hearing
classmates. Do not let her use her hearing loss as an excuse for her misbehaviour.
a In the case of the hearing impaired child, there may be special emergencies. For
-
example, while playing she may fall on her ears which could cause the plastic ear
mould to injure her ears. Do not panic. Give her first aid. Inform her parents so that
they can take her to a doctor or assist them in doing so.
a If the hearing aid gets damaged, remove it, keep it safely and hand it over to the
child, along with a note'to her parents explaining them the problem.
a Keep in touchwith the speech therapist, whom the child may be visiting for training.
It will help you plan her education programme more effectively. .

11.10 EDUCATIONAL SETTING FOR THE HEARING

IMPAIRED
A rich and stimulating ECCE centre or a preschool, where the educator is sensitive towards
the needs of the child with hearing loss, will be adequate for the child. Of course, the
educator will need the support of the audiologist, speech therapist and other professionals to
'help her with the child. She would need to pay special attention and extra time to the child.

When it comes to joining a school, the parents will need to decide whether the child attends
a regular school or a special school for the hearing impaired. Again the answer depends on
how well the child has been able to develop the ability to communicate. If the degree of
hearing Loss is mild, then the child will be able to adjust in a regular school. Children with
severe and profound degree of hearing loss would beneft from education in the special
school, where there are trained educators who can meet their special needs. However,
special schools are not available everywhere, so being part of a regular school may be the
only solution.
I '
Check Your Progresa Exercise 3

Answer the following questions briefly in the space provided below.

I) Ifthe child's hearing loss cannot be treated medically or surgically, in what way can
.. you help the child to learn speech and thus communicate with others 7

L...... ..............................................................................................................................

2) 'If a child with hearing impairment daes not receive help early in life to make use of
whatever remnants of hearing she has, these get lessened even further.'
Do you agree with this statement? Give reasons for your answer.
 .................................................................................................................................... , Children with Haring
I Impairment

3) What are some of the aspects to be kept in mind when helping a child with hearing
impairment to develop speech? ,

1 4) State whether the following statements are correct or incorrect.

a) Hearing aid restores the person's hearing to normal.
C
b) It is important to speak to the child with hearing loss, whether she responds or
not.
c) It is important to make sure that the child with hearing loss looks at you when
you speak to him or her.

I1 5) What do you understand by the terms

a) Lip reading

...........................................................................................................................
............................................................................................................................
i
I b)' Sign Language

...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
...........................................................................................................................
c) Finger spelling
............................................................................................................................

6) State the incorrect alternative(s)

i) When speaking to a child with hearing loss

a) use full sentences
b) shout in order to help the child to hear and use exaggerated lip movements
c) use objects, drawings, actions along with the speech to make it clearer to the
child
d) write new words on the notebook or the blackboard
ii) In the classroom
a) make the child sit on the back seat
b) the educator should face the child
c) plan activities where the rest of the children can interact closely with the child
with hearing loss.
Cblldren with Special iii) To encourage the child to speak
-
Needs 2
a) ask her questions and wait for her to reply /'
/ or telling stones as that
exclude her from oral activities, like singing, rhymes
b)
i may slow down the rest of the children
I

11.11 LET US SUM UP

In this Unit you have read about iden@ing and helping children with hearing loss.
4

Being able to hear language is basic to being able to speak it. Children with hearing loss
find it dficult to learn to speak. How much difficulty they face will depend on the degree
of hearing loss as well as the age when heanng loss occurred. I
4
1
Because speech development may be atfected due to hearing loss, it can hamper the child in
developing social relationships and in educational achievement as both these are heavily i
dependent on language.

Hearing loss may be mild, moderate, severe or profound. Hearing loss may be different in
the two ears. Hearing loss does not automatically lead to inability to speak. Through
training, the person can be helped to develop language.

Hearing loss by itself does not lead to mental retardation. It may, however, influence the
child's performance in areas that are dependent on language.

Hearing impairment can occur due to damage to any part of the ear or to the area in the
brain concerned with hearing. This can occur during prenatal, postnatal or perinatal
period. The person with hearing impairment may have problems with loudness of sounds
or the pitch of sounds or both.

It is important that any degree of deafness be ident ed as early as possible, so that

stimulation and training can also begin early.

Sometimes it may be possible to restore a child's hearing through medication or surgery.

But if this is not possible, then the child has to be helped in other ways. The first thing to
do is to provide the child with hearing aid to improve the listening capacity. Along with
this, the child has to be given training to develop speech. This is usually done by the
speech therapist. However, you too can learn the techniques so that the parents as well as
you can cany on the training at the centre and at home.

If the child cannot be helped to develop speech then she has to be helped to learn lip
reading, finger spelling or sign language.

11.12 ANSWERS TO CHECK YOUR PROGRESS

EXERCISES
Check Your Progress Exercise 1

1) a) Incorrect. With training most can be taught to speak.

b) Incorrect. Hearing impairment may hinder the person's performance In those

areas which are heavily dependent on the use of language, if the person has not
been able to develop speech. But the intellectual capacities 01the person will be
the same or even better than those of a person who can hear.

c) Agree. Hearing aid can help a person to make use of this residual hearing.
d) Agree.
e) Agree.
: 2) a) Hearing loss wil~greventthe person from picking up cues h m the environment. Children with Hearing
Thus she may not be able to sense approaching danger. Impairment

b) The person may find it difficult to communicate with people and this may come in
the way of her being able to develop social relationships.

c) Being able to hear the background sounds in the environment helps us to feel one
with the surroundings. A person who became deaf some years aiter birth will
miss out on,thisbackground sounds and this can lead to an overwhelming feeling
of isolation and depression, sometimes leading to severe physiological effects.

Check Your Progress Exercise 2

1) Prenatal : (i) . Infectious diseases or illnesses contracted by the mother.
(ii) excessive intake of alcohol or nicotine
(iii) intake of antibiotics or other drugs without consulting the doctor.

Perinatal : (i) Premature delivery

(ii) Lack of oxygen to the infant during delivery
(iii) Low birth weight of the child

Postnatal : (i) Jaundice, high fever or convulsions after birth.

(ii) Infectious diseases contracted by the child
(iii) Injury to the ear.

In section 11.6 you have read about other causes of hearing impairment. You can mention
any of these as well.

2) The first few years are crucial for the development of language. A child deprived
of normal experiences to hear will find it difficult to acquire language later on.
Educational achievement, social relationships and vocational avenues, which are
largely dependent on the ability to hear and speak, will also be affected.

3) Many signs have been described in section 11.7. You may list any of them.

Check Your Progress Exercise 3

1) The child can be helped at three levels

provide the child with hearing aids to improve the existing hearing capacity

I
give training to the child to develop speech with the help of a speech therapist.
if the child cannot acquire language, help her to learn sign language, finger
spelling or lip reading.

2) Agree. This happens because the child does not find any meaning in the sounds and
learns not to attend to them.
3) a) Use full sentences while spealung.
121
Children with Special Give the child hearing aid
~ & d -s 2
Do not shout or use exaggerated lip movements
Look at her while spealung.
Make sure that the child is aware of the topic of conversation
Use objects and pictures to make your meaning clear.
Wait for the child to respond. Provide words only when she does not seem to have
them
Repeat the wordlsentences the child does not widerstand
Ask her questions
Involve her in all oral activities in the class
Ask her to repeat what inhat you do not understand
If she uses incomplete sentence, provide her with the proper one
Correct her speech mistakes occasionally. Do not interrupt her while speaking.
Incorrect
Correct
Correct
Lip reading - Understanding the spoken language by watching the mouth and
face movements of the speaker
Sign Language - Use of specific signs for different words in order to
commumicate.
Finger spelling - Spelling out each letter of the word by d&erent formations:of
the fingers
6 ) i) b
ii)
iii)