Tran Thi Lé Thu DAI CUONG CAN THIEP SOM CHO TRE KHUYET TAT TRi TUE Cuédn sch nay dugc xuat ban voi su hd tre tai chinh cla T8 chirc Down Ha Lan; va sy hé tr chuyén mén cla Thac si Marja Hodes, Chi tich T8 chirc Down Ha Lan, nguyén cé van chuyén mén Chung trinh can thigp som che tré khuyét tat tri tué tai Viet Nam. Nha xuat ban Dai hoc Quéc gia Ha NdiTran Thi Le Thu OVERVIEW ON EARLY INTERVENTION FOR INTELLECTUALLY DISABLED CHILDREN This book is published with the financial assistance from Dutch Down Syndrome Organization and the professional assistance from Ms. Marja Hodes MA., President of the Dutch Down ‘Syndrome Organization, former professional Consultant Program on Early Intervention for Intellectually Disabled Children in Vietnam Vietnam National University Publishing House, HanoiLéi gidi thiéu Cham séc, can thiép sém va gido duc tré khuyét tat a mét chi trugng, chinh sach giao duc Ién céia Dang va Nha nut ta. Trong diéu kién chung cla d&t nuéc con nhiéu khé kh&n, linh vuc can thiép sém va giao duc tré khuyét tat cling d4 duge quan tam xay dung va phat trign. Nhiéu cd sd can thiép s6m va gido duc tré khuyét tat 44 duoc thanh lap 6 trung ugng cing nhu cac dia phutng. Viée nghién citu, dao tao, giang day can thiép s6m va giao duc tré khuyét tat d& dude thuc hién tai cdc truéng su pham va cdc ¢d sd nghién ctfu cia nganh gido duc. é phat trign linh vuc can thiép sém va gido duc tré khuyét tat, viée xy dung cae co sé khoa hoc va thyc tién cho chuyén nganh nay [a rat can thiét va quan trong. Téi dd nh&n duge ban thao cuén “Dai cuong can thiép sém cho tré khuyét tat tri tué” cia TS. Tr&n Thi Lé Thu, gidng vién khoa Tam ly Gido duc, truéng Dai hoc Su pham Ha Néi. ‘Sch dugc bién soan vai su tu van vé chuyén mén cila chuyén gia can thiép sém Marja Hodes nguéi Ha Lan va sy hé trg tai chinh cia té chtte Down Ha Lan. Cuén séch dé cap dén hoat déng can thiép s6m va gido duc cho tré khuyét tat tri tué tit nhimg n&m thang dau tién trong cudc séng cla tré. Sach gém hai phan, 3 chuong dau ota phan | trinh bay nhiing van dé chung vé khuyét tat trf tué va can thiép sém; 9 chuong tiép theo trinh bay timg néi dung cu thé cia can thiép sdm cho tré khuyét tat tri tué tit 0 d8n 6 tudi, Phan Il bao gém 14 muc tai liéu hd tro can thiép sém cho tré khuyét tat tri tud. TS. Tam ly hoc Trén Thi L@ Thu da két hgp thanh tuu nghién ctu khoa hoc va kinh nghiém thuc tién trong finh vuc nay ctia quéc t& voi nhing nghién ctu cla minh tai Viét Nam 48 chuyén tai dén ban doc kién tht od ban vé céng téc can thiép sém va gido duc trusc tudi hoc cho tré khuyét tat tri tu8. V6i nhiing ndi dung due trinh bay, sdch 06 thé ding lam tai liéu gidng day, hoc tap, nghién ctu, thuc hanh cho sinh vién thuéc linh vue can thiép s6m va giao duc tré khuyét tat; cho cdc gido vién, phy huynh va chuyén gia dang truc tiép cham s6c, can thiép va gio duc tré khuyét tt. Bay ofing cé thé la tai ligu tham khdo tét cho t&t c& ban doc quan tam dén linh vue cham s6c va gido duc tré khuyét tat. Cham s6c va gido duc tré khuyét tat IA céng viéc hét sic khé khan va phic tap. Bé phat trién linh vue can thiép sém va giao duc tré khuyét tat rat cAn o6 sy tham gia dong gop, hé trd cd vé chuyén mén va tai chinh clla toan thé xa héi Viét Nam cing nhu ctia céng déng quéc té. Theo y nghia d6, tdi vui mimg gidi thiéu cuén s4ch “Dai cuong can thiép sém cho tré khuyét tat tri tué” cla TS. Trdn Thi Lé Thu voi déng 6&0 ban doc, Toi tin tuéng cuén sach sé la sit déng gép hitu [ch vao viée chm séc, gido duc tré khuyét tt tri tué ndi riéng va tré khuyét tat néi chung & nutc ta. Ha NGI, ngay 22 thang 12 ndm 2009 TS. Lé Minh Ha Vy truténg Vu Gido dyc Mém non B¢ Gido dyc & Bao tgo4 Introduction Care, early intervention and education of children with disabilities is a major educational direction and policy of the Party and the Govemment. Despite the socio- economic challenges of the country, early intervention and education of children with disabilities has always been given due attention and support. Many institutions for early intervention and education of children with disabilities have been established at national and sub-national levels. Studies, research and training in this field have been conducted in a variety of pedagogic and research institutes of the education sector. To further develop early intervention and education of children with disabilities, it is vital that a strong theoretical and practical foundation is built. | was therefore glad to receive the manuscript of "Overview on Early Intervention for Intellectually disabled Children” by Dr. Tran Thi Le Thu, lecturer of the Department of Psychology and Education of the Hanoi National University of Education. The book received professional input by Marja Hodes, a specialist in Early Intervention from the Netherlands, and the financial support by the Dutch Down Syndrome Organization. The book is about early intervention and education of children with intellectual disabilities from an early point in their lives and is divided in two sections. While the first three chapters of Section 1 provide a general outlook on intellectual disabilities and early intervention, the next nine chapters offer detailed information on the development of and support for children with intellectual disabilities aged 0-6. Section 2 follows up with 14 tools to support early intervention of these children. Dr. Tran Thi Le Thu has done an excellent job combining the theory and practice of international specialists with her own studies in Vietnam to provide readers with some solid knowledge on the subject. The book provides good material for teaching, training, studies, research, and practice for students pursuing this field and for teachers, trainers, specialists, parents and caretakers who work with children with disabilities. It is also a good reference material for anyone interested in care and education of children with disabilities. Care and education of children with disabilities is a challenging job, for which every contribution and support from the intemational and local communities is highly appreciated. It is therefore my great pleasure to introduce “Overview on Early Intervention for intellectually disabled Children" by Dr. Tran Thi Le Thu, with the sincere belief that the book ‘will make a meaningful contribution to the cause of care and education of children with disabilities in general, and children with intellectual disabilities in particular, in Vietnam, Hanoi, 22 December 2009 Dr. Le Minh Ha Head of the Department of Pre-school Education Ministry of Education and TrainingLoi tya Quyén dude phat trién 1a mét trong bén diéu cét Idi ca céng uc Lién hiép Quéc vé quyén tré em. Day ciing chinh Ia quyén co ban danh cho tré khuyét tat. Can thiép sém déng vai trd quyét dinh d6i véi su phat trién cla tré khuyét tat, diéu nay 4 dude chinh phi Viét Nam céng nhan. Chuong trinh can thiép s6m cho tré khuyét tat 4a dude thuc hién tis nm 1998 dén nam 2001 véi su hé tro ctla BS Gido duc va Dao tao Viét Nam. 6 Ha Noi chuong trinh can thiép sém da dude the hién tai phong gido duc quan Hoan Kiém va cdc truding m&u giao trong quan; véi su céng téc chat ché cla trudng Dai hoc Su pham Ha Néi. SG thanh phé Hé Chi Minh, mét chuong trinh dao tao dai han da duge thuc hién tai Trung tam nghién ctu giao duc tré khuyét tat. Ciing thdi gian nay mét loat bai giang cling 4a dugc cung cép tai Sé gido duc va dao tao thanh phd Hé Chi Minh. Tir nam 2003 dén nam 2008 cac khéa dao tao vé can thiép sém cho tré khuyét tat tri tué d& due thuc hién tai truéng Dai hoc Su pham thanh phé Hé Chi Minh va cdc trudng cao ding su pham 6 Ha Néi, thanh phd Hé Chi Minh, Nha Trang. Chuong trinh a0 tao nay da dude chinh phd Viét Nam chinh thie cong nhan, dy Ban 2 Ha Lan- t8 chite phi chinh phi cia Ha lan da hé tr¢ tai chinh cho cc chuang trinh dao tao nay. 8 théng tin cla cac khéa dao tao dén dsc véi nhiéu nha chuyén mn han, néi dung cia tat c& cdc khéa dao tao da dugc viét lai, cép nhat héa, bd sung va diéu chinh cho phi hgp véi tinh hinh cla Viét Nam. Toan b6 ndi dung nay dude téng hgp trong cuén sach “Dai cudng can thiép sém cho tré khuyét tat tr tue”. Cing véi cu6n séch nay, véi sy cho phép cla Ba Robin Treleor, mét trong nhiing tac gia cla chyong trinh can thiép sém tai Uc, bd s4ch “Ting buéc nhé” cing sé duce chuyén dich va diéu chinh cho phi hgp véi tinh hinh cia Viet Nam. Cuén sch “Dai cutng can thiép s6m cho tré khuyét tat tri tu” 1a mét cudn sach giao khoa co ban danh cho cae sinh vién thuéc [inh vue can thiép sém va gio duc dac biét cla c4c trudng nhu Dai hoc su pham, cao dang su pham, trung hoc su pham & trung udng va dia phugng, cac giao vién va nhiing nha chuyén mén trong trong finh vuc giéo duc héa nhap va trong cdc trutng chuyén biét 6 Viét Nam. Té chife Down Ha Lan nhan trach nhiém hé tro tai chinh va tro gidp chuyén mén cho viée xudt ban cuén sach nay. T6 chife Down Ha Lan hy vong cuén sach va chuong trinh sé dong gdp hon nifa vao qua trinh phat trién can thiép sém cho tré khuyét tat tri tué va gia dinh cila tré tai Viét Nam. ThS. Marja Hodes Chi tich té chute Down Ha Lan Nguyén cé van chuyén mén chuong trinh CTS cho tré KTTT tai Viet Nam6 Foreword ‘One of the four core principles of the UN Convention of the Rights of the Child is the Tight of development. This is also a fundamental right for children with intellectual disabilities. Early Intervention is crucial for the development of children with intellectual disabilities. This has been very well recognized by the Vietnamese government. From 1998 until 2001 a programme was run on Early Intervention for disabled children supported by the Ministry of Education and Training (MOET). tn Ha Noi the programme was executed at the Education and Trainings chamber of Hoan Kiem district and the Kindergartens of this district. There was a close collaboration with the Ha Noi University of Education In Ho Chi Minh City a long term training programme was run at the Research and Education Center. Additional, lectures were provided at the Department of Education and Training (DOET) of Ho Chi Minh City. During the period of 2003 till 2008 training courses on Early intervention for children with intellectual disabilities at the Kindergarten age were provided at the National Colleges of Ha Noi, Ho Chi Minh City and Nha Trang and at the Pedagogic University of Ho Chi Minh City. The training programmes were officially recognized by the Vietnamese government. All programmes were financially supported by the Dutch NGO Komitee Twee In order to make all the information provided during the courses available for a wider range of professionals, the content of the courses has been rewritten, updated and adapted to the Vietnamese situation. This has resulted in a useful and accessible handbook on Early Intervention for intellectually disabled children and their families in Vietnam. Apart from the handbook - with the approval of Mrs. Robin Treleor, one of the authors of the programme- the Australian Early Intervention Programme ‘Small Steps’ will be transtated and adapted to the Vietnamese situation. This handbook aims to be a core textbook for students on Early Intervention and Special Education at National Pedagogic Universities, National and Provincial Teacher Training Colleges, Teacher Training high schools, Teachers and professionals involved in inclusive education and special schools in Vietnam The Dutch Down Syndrome Organisation (SDS) took the responsibility for the funding of the publication of this handbook and offered professional assistance for the content. The SDS hopes that the handbook and programme will contribute to the further development of Early Intervention for intellectually disabled children and their families in Vietnam. Mrs. M.W. (Marja) Hodes, Ma President of the Dutch Down Syndrome Organization Former Professional Consultant Program on Early Intervention for InteHectually Disabled Children in Viet NamLéi cam on Téi xin chan thanh cam on Té chite Down Ha Lan; Uy Ban II Ha Lan; Phong Gido duc Quan Hoan Kiém; Trung Dai hoc Su pham Ha Ndi; Céng ty Van Viét; Ts. Lé Minh Ha, Vu trudng Vu Gido duc Mam non, Bé Gido duc & Dao tao; ThS. Marja Hodes, chi tich t8 chife Down Ha Lan, Thanh vién Hiép héi Down quéc té, nguyén c6 van chuyén mén chuting trinh can thiép s6m cho tré khuyét tat tri tué tai Vit nam; ThS. Han Van Esch, chuyén gia giao duc dac biét tai Ha Lan, nguyén cé van chuyén mén Chuang trinh gido duc tré khuyét tat tri tué tai Viet Nam; chuyén gia gido duc dac biét Huynh Thi Thanh Binh, nguyén Gidm déc Trung tam nghién cifu giao duc tré khuyét tat TP.HCM; ThS. Nguyén Thi Quyén, Phd van phéng TW Héi bao vé quyén tré em Viét Nam; chuyén gia giao duc d&c biét Nguyén Ngoc Mai Huong, hiéu trudng truding Khuyét tat tri tué tu thuc Mai Linh; TS. Dung Thi Thanh Huyén, Trudng Phong Giao duc & Bao tao Quan Hoan Kiém; can bé gido duc Nguyén Thi Thanh Xuan, 16 trvdng té Mam non, Phong Gido duc Quan Hoan Kiém; chuyén gia gido duc dac biét V6 Thi Khoai, Hiéu tru’ng trudng Chuyén biét Gia Dinh TP.HCM; giao vién gido duc daic bit Nguyén Thi Nha Trang, Truéng Cao dang Su pham M4u giao TW; giao vién giao duc dac biét Nguyén Thi To Anh, Trung tam Sao Mai; c4c giao vién gido duc dac biét thuéc truéng Khuyét tat tr tué tu thue Mai Linh; TS. Tran Bao, Hoa si Nguyén Tuan Cudng; cing tat cA nhing ngudi than va ban bé 64 gop y va dong vién tdi hoan thanh cuén sach. Xin chan thanh cam on. Ha N6i, ngay 20 thang 09 ném 2009 Tr&n Thj Lé Thu Théng tin lién hé: Email: lethu_73@yahoo.com in thoai: 04 224660868 Acknowledgement | would like to express my sincere gratitude to the Dutch Down Syndrome Organization; the Dutch NGO Komitee Twee; Department of Education and Training of Hoan Kiem District; Hanoi Pedagogic University; Van Viet Company; Dr. Le Minn Ha, Head of the Department of Pre-school Education, Ministry of Education and Training; Ms. Marja Hodes (MA), President of the Dutch Down Syndrome Organization and member of the International Down Syndrome Organization, former technical adviser of Early Intervention of Children with Intellectual Disabilities in Vietnam, Mr. Han van Esch (MA), specialist in Special Education in the Netherlands, former technical adviser of Special Education of Children with Intellectual Disabilities in Vietnam; Ms. Huynh Thi Thanh Binh, Special Education specialist, former Director of the Research and Education Center for Children with Disabilities - Ho Chi Minh City, Ms. Nguyen Thi Quyen (MA), Deputy Chief of Office of Central Association of Child Right Protection of Vietnam, Ms. Nguyen Ngoc Mai Huong, Special Education specialist, Principal of Mai Linh Private School for Children with Intellectual Disabilities; Dr. Duong Thi Thanh Huyen, Director of Department of Education and Training of Hoan Kiem District; Ms. Nguyen Thi Thanh Xuan, education official, Head of Pre-school Education Section of Department of Education and Training of Hoan Kiem District; Ms. Vo Thi Khoai, Special Education specialist, Principal of Gia Dinh School for Special Education, Ho Chi Minh City; Ms. Nguyen Thi Nha Trang, Special Education teacher, National Pedagogic College for Pre-school Education; Ms. Nguyen Thi Tu Anh, Special Education teacher, Sao Mai Center; Special Education teachers of Mai Linh Private School for Children with Intellectual Disabilities; Dr. Tran Bao; Mr. Nguyen Tuan Cuong (MA), artist; and friends, who have been my constant source of encouragement and support in the writing of this book! With appreciation. Hanoi, 20 September 2009 Tran Thi Le ThuMyc LUC Li gidi thigu Lai tya Léi cam on PHAN I. CAN THIEP SOM CHO TRE KHUYET TAT TRI TUE. Chuong 1. Nhimg van dé chung vé khuyét tat tri tu@ 1.1, Tén goi va thuat ngit “khuyét tat tr! tue” 1.2. Khai niém khuyét tat tri tué 1.2.1. Khai niém khuyét tat trign tri tué duta trén két qua trac nghiém tri tué 4.2.2. Khai niém khuyét tat tri tué trén o0 sé khiém khuyét vé kha nang diéu chinh xd hdi 1.2.3. Khai niém khuyét tat tr tué theo nguyén nhan khuyét tat tri tug 1.2.4. Khai niém khuyét tat tri tué theo Sé tay chdn doan va théng ké nhiing réi nhigu tam than IV 1.2.5, Khai niém khuy6t tét tr tué theo Hip hoi Khuyét tat ti tué My (AMR) nam 1992 1.2.6, Khai niém khuyét tt ii tué theo Hip hoi khuyét tat tf tué My (AAMR) nm 2002 1.2.7. Khai niém khuyét tat trf tué dude sé dung hién nay é Viét Nam 1.3. Phan loai mic 46 khuyét tat tri tué 1.4. Tiéu chi chén dodn khuyét tat tri tué 4.4.4. Tri tue 1.4.2. Hanh vi thich tng 1.4.3. Thdi diém xuat hign 1.5. Nhing nguyén nhan gay khuyét tat tri tué 1.8.1. Nguyén nhan trudc khi sinh 1.5.2. Nguyén nhan trong khi sinh Nguyén nhan sau khi sinh 1.5.4. Céc héi ching thudng xuat hién va cé lién quan dén khuyét tat tri tué 1.6. Mét s6 quan niém, tinh cm va théi 6 d6i véi tré khuyét t8t tr tud Trang 24 24 28 26 27 27 27 28 28 29 3210 1.7. Tilé phé bién cla khuyét tat tri tu trén thé gidi va & Viét Nam 1.7.1. Tan 86 xuat hién khuyét tat tri tué ndi chung trén thé giéi 1.7.2. Ti16 tr khuyét tat tri tué & Viet nam Chuong 2. Lich sirean thigp sém cho tré khuyét tat tri tug trén thé gidi va d Vidt Nam 2.1. Lich str can thiép sm cho tré khuyét tat tr tué trén thé giéi 2.1.1. Giao duc mam non 2.1.2. Cac dich vu y té cho ba me va tré em 2.1.3. Gido duc dac biét 2.1.4, Nghién citu vé sy phat trién cla tré 2.1.5. Can thiép sém tai Ha Lan va Hoa Ky 2.2. Lich sit can thiép sém cho tré khuyét tat tr tué & Viet Nam Chung 3. Can thiép s6m cho tré khuyét tat tri tue 3.1. Khai niém chung vé can thiép sém cho tré khuyét tat tri tu8 3.2. Nhéing nguyén tac co ban cia can thiép s6m cho tré khuyét tat tr tué 3.2.1, Tat ca tr em, ké cd tré khuyét tat déu c6 kha ning hoc tap 3.2.2. Tré khuyét tat ti tug cén hoc va sit dung cdc ky ning nhu tt cd tré binh thutng 3.2.3. Nhig néim dau tién cla cudc d6i Id thdi gian quan trong nhat cho viée hoc 3.2.4, Gido vién quan trong nhét clia tré [4 nhing thanh vign trong gia dinh alia cdc em 3.2.5, Méi tré va méi gia dinh déu khéc nhau 3.3. Qua trinh can thiép sém cho tré khuyét tat tri tu 3.3.1. Giai doan thdc mac 3.3.2, Qua trinh danh gid 3.3.3. Lap ké hoach 3.3.4. Giai doan can thiép 3.3.5. Giai doan luang gid 3.4. Cc loai dich vu can thiép sém 3.4.1. Can thiép sém tai nha hoac tai co sé céng déng 3.4.2. Can thiép sém tai noi cé phuong tién hodc tai trung tam 3.4.3. Can thiép s6m theo hinh thtfe nhém cha me-con 3.4.4, Can thiép sém theo hinh thife nhém hé trd gia dinh 3.4.5. Can thiép sém theo hinh thie can thiép dé phat trign nhém 3.5. Cac nhom tré thudc qua trinh can thiép sém Muc luc 59 61 61 62 62 63 64 65 66 67 67 69 69 70 70 70 71 72Mus luc M1 3.5.1. Giai doan 0-3 tuéi 72 3.5.2. Giai doan 3-6 tudi 72 3.5.3. Giai doan 6 tui tré lén 72 3.6. ¥ nghia ctia can thiép sém cho tré khuyét tat tri tué 73 3.6.1. ¥ nghia d6i voi tré khuyét tat tri tue 73 3.6.2. ¥ nghia déi véi cha me va gia dinh tré khuyét tat 73 3.6.3. ¥ nghia déi véi xa hdi 74 3.7. Hung dan phu huynh va gia dinh tham gia can thiép sém cho tré khuyét tat tri tué 75 3.7.1. Nhiing diéu edn Iuu y khi huéng dln phy huynh va gia dinh 75 3.7.2. Hung din phu huynh va gia dinh tham gia can thiép s6m cho tré khuyét tat bi tue 76 Chuung 4. Géng téc vdi gia dinh tré khuyét tat tri tug trong céng téc can thigp sém 81 4.4. Hiéu phu huynh va gia dinh cla tré truéc khifbat dau thuc hién can thigp sém 82 4.1.1. Hidu cc d&c diém ciia gia dinh 83 4.1.2. Hidu vé dién bién tam ly cia gia dinh 84 4.2. Céng tac véi phu huynh va gia dinh tré trong can thiép sém 87 4.2.1. Xay dung méi quan hé vi phu huynh va gia dinh tré 87 4.2.2. Phat hién va khuyén khich nhiing diém manh cla phu huynh va giadinhtré 88 4.2.3. Nhing lau y og ban khi cng tac va hé tro gia dinh tré trong can thiép s6m 88 4.3. Tham gia dinh tré khuyét tat tri tué trong can thiép s6m ot 4.3.1. Muc dich va ly do tham gia dinh tré 91 4.3.2. Thai 46 khi th&im gia dinh tré 92 4.3.3. XAy dung quan hé giao tiép t6t voi phy huynh va cdc thanh vién gia dinh tré 92 4.3.4. Té chic lan thm gia dinh tré dau tién 94 Chuong 5. Phat hign sém, chan doén va danh gia trong can thigp s6m cho tré khuyét tat tri tug 99 5.1. Phat hién s6m, chan dodn va chan dodn tré khuyét tat tri tué 100 5.4.1. Khai niém chan doan 100 §.1.2. Phat hién sém va chén doan tré khuyét tat tri tué 101 5.2. Banh gid va danh gid tr khuyét tat tri tué 103 5.2.1. Khai niém danh gia 103 $.2.2. CAc loai d4nh gid 103 5.2.3, Danh gia trong can thiép s6m cho tré khuyét tat tr tué 10612 Muc luc 5.3. Vai tra vay nghia clla c6ng téc ch&n don, dénh gid tré khuyét tat tri tue 5.3.1. Vai tr cla céng tac ch&n doan, danh gia tré khuyét tat trf tus 5.3.2. y nghia cilia chan doan danh gia tré khuyét tat 5.2.3, Nhiing diéu.can Iuu y (yéu cu) trong céng tae chan doan va danh gid tré khuyét tat tr tue 5.4, Nhém nhém lam viée da chute nang trong céng tac chén doan, danh gid, CTS va giao duc tré khuyét tat tri tué 5.4.1. Thanh vién cla nhém lam vide da chife nang 118 118 118 119 119 119 5.4.2. Nhitng finh vue ma céc thanh vién thuéc nhém lam vide da chite néing cn ndm duge 120 5.4.3, Vai tré va déng gép cla cdc thanh vién trong nhhom Chuong 6. Giéi thigu chung trinh can thigp sém “Timg bude nhd” 6.1. Lua chon chuong trinh can thiép sém 6.2. Chuong trinh can thiép sém “Tig bude nha” 6.3. Nhing khia canh cn luu y khi st dung chuang trinh “Tumg buéc nho” 6.4, Sit dung chuong trinh “Timg bute nhd" 4é danh gid tré Chwong 7. Xay dying ké hoach can thigp va giao dyc c& nhan trong can thigp sém cho tré khuyét tat tri tug 7.1. Ban chat olla “ké hoach can thiép va gido duc cé nhan” 7.2. Cac thanh phn ctia “ké hoach can thiép va giéo duc ca nhan” 7.2.1. Mic phat trién hién tai cla tré 7.2.2. Muc tigu dai han (muc tiéu nam) 7.2.3. Muc tiéu trung han (muc tiéu quy) 7.2.4, Muc tigu ng4n han (muc tiéu tudn/ngay) 7.2.8, Luu két qua thuc hién 7.2.6, Lugng gia Chung 8. Viét bao c4o va lap hé so trong can thip sém cho tré khuyét tat tr tug 8.1, Viét b4o c4o trong can thiép sém cho tré khuyét tat tr tué 8.1.1. Ban chat cia bao céo 8.1.2. CAch viét bao cao 8.1.3. Néi dung bao cao 8.1.4, Mat mau bdo cao tam ly 8.2. Lap hé so trong can thiép s6m cho tré khuyét tat tri tué 133 134 135, 135 137 138 140 141 143 144 144 444 146 148 155Myc luc 13 8.2.1. Hé so cé nhan cilia tré 155 8.2.3. Hé so cla gido vién 158 Chung 9. Sir dung video trong céng tac can thigp s6m cho tré khuyét tat tritug 159 9.1. Lai Ich clia viée sit dung video 160 9.2, Cach sit dung video trong can thiép s6m 161 9.2.1, X4c dinh myc dich quay/mye dich sit dung dif ligu trong video 161 9.2.2. Xdc dinh thdi diém quay video va hoat déng cn quay 161 9.2.3. Lam gi trong khi quay video 162 9.2.4, St dung dif liéu video 44 quay 163 Chuong 10. Hé trg giéo vién va cde can bd thy hign can thigp s6mchotré.. 169 10.1. Gido vién/cén bé thu hién can thiép sém can dude cung cdp két qua chan doan va danh gia tré 170 10.2. Gido vién/can bé tht hién can thiép sém can dude tao diéu kién vé khéng gian thuc hién can thiép som 470 10.3. Gido vién/cén bé thuc hién can thiép sém cén dude tao diéu kién vé thdi gian thyc hién can thiép sém 170 10.4, Gido vién/cdn bé thuc hign can thiép sém cén duge tao diéu kién 4172 vé dung cu hé tre thyc hién can thigp sém Chuong 11. Sit dung s4ch heat déng va bang hoat déng trong gido duc... 175 14.1, Sit dung s&ch hoat é6ng 176 11.1.1. Cach lam sach hoat d6ng 176 41.1.2. C4ch sif dung s4ch hoat déng 178 11.2. Sit dung bang hoat déng 179 11.2.1, Cach lam bang hoat déng 180 41.2.2. Cach sit dung bang hoat déng 181 Chuong 12. Day hoc cho tré khuyét tat tri tug va td chute gido duc cho tré Khuyét tat tri tug trong Iép mau gido hoi nhap 183 12.1. Day hoe cho tré khuyét tat tri tug 184. 12.1.1, Mét 6 Gc diém dac biét vé kha nang hoc tap cla tré khuyét tat tritué 184 42.1.2, Nhimg nguyén tc co ban trong day hoc cho tré khuyét tat tri tu 186 42.1.3. Nhiing Iutu y vé fién trinh day tré khuyét tat tri tué 189 12.1.4. Chu&n bi chuong trinh day hoc tré khuyét tat tri tué 19014 Muse luc 12.1.5, Hinh thite t6 chic day hoc cho tré khuyét tat fri tué 191 12.1.6. Phuong php day hoc dic biét cho tré khuyét tat tr tué 194 12.2, Té chite giéo duc tr khuyét tat tri tué trong tép mau gido héi nhap 199 12.2.1. X4y dung va diéu chinh muc tiéu 199 12.2.2. Xay dung va digu chinh néi dung chuong trinh 199 12.2.3. Lua chon va diéu chinh phugng phap day hoc 199 12.2.4. Diéu chinh méi trudng l6p hoc 200 12.2.5. Giao tiép sur pham vai tré khuyét tat tr tué trong Ibp mau giéo hoi nhap 202 12.2.6, Quan ly hanh vi cia tré khuyét tat tri tué 203 12.2.7. T6 chic hoat déng chung cho lp mAu gido héi nhap of tS khuyét tatiitus «206 12.2.8. T6 chic tiét c& nh&n cho tré Khuyét tat tri tué 208 PHAN Il. TAI LIEU HO TRO CAN THIEP SOM CHO TRE KHUYET TAT TRI TUE A. Tai liéu hé tra thm gia dinh tré 212 B. Ké hoach danh gid tr 217 C. Bang mé td sd luge vé su phat trién cia tré 220 D. Bang kh4i quat cac giai doan phat trign ngén ngit dién dat 221 E. Bang cu héi sang loc nhan tré vao trudng mau giéo 225 F. Bang sang loc cac ky nang va hanh vi cla tré tai trudng mAu giao 226 G. Bang liét ké cac ky nang va hanh vi cén c6 cda tré khi 3 trong gia dinh 234 H. Bang dy tinh céc mye tiéu ng&n han cho ké hoach can thiép- giéo duccA nhan 235 t. K hoach can thiép- giao duc cé nhan 236 J. Bang heat déng 244 K. H6 80 cla rd 245 L. Bang li&t ké hoat dng- giao tiép 246 M. Danh myc 48 chai cfin ding cho tré khuyét tat tftué trong tru8ng mau gido 246 N. Tom tat cdc giai doan phat trign ky nang ctia tré tir 0 dn 6 tudi 252 Tai ligu tham khdo 270Nhiig tir va thuat ngif viét tat trong cudn s4ch AAMR: Hiép héi khuyét tat tri tué Hoa Ky AAIDD: Higp hoi khuyét tat tri tué va phat trién Hoa Ky KITT: Khuyét tat tri tué CTS: Can thiép s6m DSM-IV: 86 tay chdn doan, théng ké nhtng r6i nhiéu tam than IV DHSPHN: Bai hoc Su pham Ha N6i GD&DT: Giao duc va dao tao IASSID: Higp hoi nghién cctu khoa hoc que té vé khuyélt tat tr tué KHCN: Ké hoach can thiép - giao dyc ca nhan NST: Nhi&m sc thé TGLT: Trung gian lién tuéng TPHCM: Thanh phé Hé Chi Minh TTNCGDTKT: Trung tam nghién cttu giao duc tré Khuyét tat UNESCO: Té chitc Van hoa, Khoa hoc va Gido duc Lién hgp quéc WHO: Té chitc Y t6 thé giéiPHAN MOT CAN THIEP SOM CHO TRE KHUYET TAT TRi TUE Chung 4 Nhimg van dé chung vé khuyét tat tri tué48 Chuong 1 Chuong nay cung cap nhiing théng tin téng quan vé khuyét tat tri tué (K khai niém, nguyén nhan, cach phan toai va tiéu chi chan doan KTTT; quan diém, thai d6 cita ngudi binh thudng déi véi tré KTTT, sé ligu va ti 18 KTTT. 1.1. Thuat ngi “khuyét tat tri tué”” Cho dén nay trong hu hét cac tai liu lién quan & nuée ta déu chuyén dich thuat ngi “Mental Retardation” ho&e “Intellectual Disability” la “Cham phat trién tri tué”, Thuat ngi géc va lau dai nh&t dugc Hiép hdi thiéu hut tri tué Hoa Ky (the American Association on Mental Deficiency/AAMD) sit dung nam 1867 [a “Mental Deficiency”; nam 1987 Hiép hdi nay duge chinh thie dét tén thanh “Hiép héi cham phat trién trf tué Hoa Ky” (the American Association on Mental Retardation/AAMR) va thuat ngif ding fa “Mental Retardation”. Dén ngay 2 thang 11 n&m 2006 Hiép hdi nay lai duge 4éi tan mét lan nia thanh “Hiép hdi khuyét tat rf tué va phat trién Hoa Ky" (the American Association on Intellectual and Developmental Disabilities/AAIDD) va thuat ngif sit dung 1a “Intellectual Disability”. Hiép hdi khuyét tat tri tué va phat trigén Hoa Ky véi cai tén méi cla minh ngu y chi tam hoat dong rng hon, phuc vy ca déi tugng KTTT va cae déi tugng han ché vé phat trién, cé khuyét tat phat trién (Developmental Disabilities). Hién nay Hiép hdi nghién cttu khoa hoc quéc té v8 khuyét tat tri tué (The International Association for the Scientific Study of Intellectual Disabilities) cing dang sit dung thuat ngif “Intellectual Disability” thay: cho thuat ngit “Mental Deficiency” duge sit dung tir nim 1964. ° 6 Viét Nam, trong nganh gido duc dc biét dén nay vAn dang sit dung thuat . ngif “cham phat trién tri tué” (CPTTT) tuang itng véi thuat ngir tiéng Anh Ia "Mental Retardation” hodc “intellectual Disability". Tén goi CPTTT dugc chon ding trong H6i thao quéc gia dau tién vé CPTTT ngay 21 thang 1 n&m 1999 tai Truéng Dai ‘hoc Su pham Ha Ndi (BHSPHN). Sau dé trong quyét dinh sé 2592Q®/BGD&eT- DH ngay 22 thang 7 n&m 1999 clia BO Gido duc va Dao tao vé viée cho phép Trudng BHSPHN dao tao nhém nganh su pham dac biét, trinh dé clr nhan (ma sé 32.00) B6 GD&DT 4a sit dung thuat ngit CPTTT. Tif nam 1999 cho tdi nay trong tat cé cc sAch xuat ban, cdc bai gidng, gido trinh va cdc céng trinh nghién ctu déu ding thuat ngit CPTTT thay cho thuat ngir tiéng Anh la “Mental Retardation” hodc “Intellectual Disability”. é phir hgp véi quéc té va sy phat trién cia mét t6 chic [au ddi va uy tin nhat vé linh vuc nay - AAIDD (trude la AAMD, AAMR), trong cuén sach nay ching tdi 461 cach dich thuat ngit CPTTT thanh “Khuyét tat tri tug/KTTT” vi thuat ngir tiéng Anh tudng duong la “intellectual Disability”.Nhiing vn 48 chung vé khuyét tat tri tué 19 1.2. Khai niém khuyét tat tri tué 1.2.1. Khai niam khuyét tat tri tué dya trén két qua trac nghigm tri tug Hai tac gid ngudi Phap Alfred Binet va Theodore Simon la nhiing ngudi dau tién phat minh ra “tr&c nghiém ti tué”, trac nghiém nay duge cing bé nm 1905. Muc dich cla trac nghiém 1a dé phan biét cac tré em binh thudng hoc kém va cae tr em hoc kém do tri tué cham phat trién. Sau Kkhi ra dai trac nghiém nay da dugc cac nha tam ly hoc My cht y va né duge lay lam co sd 4€ phat trién nhiéu trac nghiém tri tué khac. Tu khi rc nghiém tri tué ra dai, qua nhiéu nm nghién citu, dai da sé cac chuyén gia da théng nh&t sif dung cac trac nghiém tri tug 48 xc dinh khuyét tat tri tué (K . Theo ho nhing ngudi c6 chi sé tri tué dubi 70 la KTTT. St dung tr&c nghiém tri tué dé chan doan KTTT 06 uu diém la khach quan va dang tin cay. Tuy nhién phuong phap nay cling cé nhiing han ché nhat dinh nhu: = Chi 6 tri tué khdng phai [a don vi do lung duy nhat vé tiém nang tri tué cla con ngudi; = Khéng phai lic nao két qué chan doan trén trac nghiém tri tué cing tile thuan véi kna nang thich ting cia tré. CO nhiéu trudng hop tré dat chi sé tri tué thSp nhung lai thich nghi dé dang véi méi trudng; - Nhuge diém [én nhét khi x4c dinh tré KTTT bang trac nghiém tri tué la trac nghiém nay té ra it hiéu qua d6i v6i tré em nghéo va tré cé nguén géc van hoa. khac (cdc trac nghiém’soan cho ngudi sinh truéng trong nhing diéu kién van hod - x héi nay khé thich hgp cho ngudi sinh truéng trong nhimg diéu kién van hoa-xa hdi khac). 1.2.2. Khai nigm khuyét tat tri tug tran co so khiém khuyét vé kha nang diéu chinh xa héi Nhiéu chuyén gia khdng str dung tr&c nghiém tri tug dé chan doan KTTT ma dya vao mife d6 thich (ng véi méi truéng va vain hoa cia mot ca han. Nam 1954, nha tam ly hoc ngudi My Benda 44 dua ra khai niém: "Ngudi KTTT la nguai khéng c6 kha nang diéu khién ban than va xit ly cac van 46 cia riéng minh, hoae phai duge day méi biét lam nhu vay; ho cé nhu céu vé sy gidm sat, kiém soat, chim s6c stfc khoé ban than va su cham séc cla cong déng™”. © Esch, Han van; Wright, Barry; Jong, Pieter de; Loo, Fred vd; Hodes, Marja; Hubbard, Ken; Mildenberg, Maryam; Samsom, Linda: Lectures on special education for intellectually disabled children. Training course for future lecturers and professionals in special education of intellectually disabled children. Training and Development Center for Special education, Hanoi Pedagogic University, 1999 - 2001.20 Chung 1 Khai niém nay cho rang ngudi KTTT la nguéi khéng dat d8n cudc séng déc lp trong qua trinh phat trién va trudng thanh cla ho, Nhuge diém cla cach tiép cn nay la: . - Mét cd nhan c6 thé bi coi 1a khuyét tat trong mdi truéng nay nhung lai khong g&p khé khan gi & méi trudng khac. Vi du: mot ngudi cam thdy hoc cac mén nhy tiéng Viét ho&c toan thi khé, nhung lai c6 thé dé thich nghi néu séng 6 néng thén hoac lam cae céng viée déng ang. Ho 66 thé bi coj la ngudi Khuyét tat néu séng trong diéu kién van hoa thanh thi hién dai, 6 d6 doi hdi ho phai biét lam ngay ca nhiing céng viée don gian nhat nhu dién vao mot ban cau hdi, doc dugc cac bién bao hoac chi din noi céng céng. - Nhuge diém thir hai cla cach tiép cn nay 1a khé xac dinh cu thé tré nao la tr khong thich nghi dufdc. Cac chuyén gia chua théng nhat thé nao la tré thich nghi duge. Hién nay nhiéu chuyén gia dang c8 gang thiét ké méi mét sé loai thang do chanh vi thich Ging nhu hing tréc nghiém tri tué. ~ Nhuge diém thit ba cia khai nigm KTTT dua theo kha nang thich Ung x4 di kém 1a c6 thé cé nhimg nguyén nhan khaéc ngoai KTTT gay nén suv thiéu hut cia hanh vi thich Ging. Vi du nhu c6 nhiéu ngudi do mét s6 truc trac vé tinh cam da anh hudng dén kha nang s6ng déc lap cia ho. 1.2.3. Khai niém khuyét tat tri tug theo nguyén nhan khuyét tat tri tug Céch xach dinh KTTT nay dya trén nhiing nguyén nhan hoae tinh chat co ban. cilia khuyét tat. Nam 1966 nha tam ly hoc ngudi Nga Luria dua ra khai niém KTTT nhu sau: "Tré KTTT [a nhitng tra mac bénh vé nao rat nang tit khi cdn trong bao thai hoac trong nhimg nam thang dau déi; bénh nay can trd su phat trign cila nao, do vay né gay ra sy phat trién khéng binh thudng vé tinh than. Tré KTTT dé dang due nhan ra do kha nang finh hdi y tudng va kha nang tiép nhan thuc t& bi han che”, Theo Luria, tén thudng ndo la nguyén nhan quan trong d&n dén cham phat trién. Han ché cla phuong phap chan doan nay [a cé nhiéu tré em va ngudi lon la KTTT nhung lai khéng phat hién dude nhiing khiém khuyét trong hé than kinh cua ho. © Esch, Han van; Wright, Barry; Jong, Pieter de; Loo, Fred vd; Hodes, Marja; Hubbard, Ken; Mildenberg, Maryam; Samsom, Linda: Lectures on special education for intellectually disabled children. Training course for future lecturers and professionals in special education of intellectually disabled children. Training and Development Center for Special education, Hanoi Pedagogic University, 1999 - 2001.Nhimg van dé chung vé khuyét tat trf tué 24 1.2.4. Khai nigm khuyét tat tri tué theo Sé tay chan doan va thong ké nhitng réi nhiéu tam than IV (DSM-IV). Theo DSM-IV, tiéu chi chain dodn KTTT bao gém: A. Chic nang tri tué duéi mic trung binh, tite 14 chi s6 tri tué dat gan 70 hoac thdp hon 70 trén mét lan the hién trac nghiém ca nhan (déi véi tré nhd ngudi ta dua vao cae danh gid 1am sang dé xac dinh). B. Bj thiéu hut ho&c khiém khuyét it nhat [a hai trong s6 nhiing finh vyc hanh vi thich Gng sau: giao tiép, tu cham séc, séng tai gia dinh, cdc kf nang x4 hdi/lién ca nhan, stt dung cac phuong tién trong céng déng, ty dinh hung, ky nang hoc duéng chife nang, lam viée, gidi tri, sic khoé va an toan. C. Hién tugng KTTT xuat hién truéc 18 tudi, Theo DMS-IV, dac diém ca ban ola khuyét tat la hoat déng tri tué duéi mite trung binh (Tiéu chi A), bi han ché dang ké vé it nhét la hai trong s6 nhimng finh vuc hanh vi thich img da dé cap (Tiéu chi B), khuyét tat xudt hién true 18 tudi (tiéu chi C), Chute n&ng tri tué téng quat la chi sé tri tué (c6 thé goi I IQ ho&c cdc thuat ngit tuong dugng vdi IQ) do dude qua danh gid bang mét hodc hon mét trac nghiém trén ca nhan vé tri tué. 86 chénh léch cao nhét trong qua trinh xac dinh chi 86 tri tug 1a 5 diém, ké ca khi cdc loai céng cu do 6 nhitng diém khac biét nhat . dinh. Do vay, van o6 thé ch8n doan nhing ngudi cé nhiéu khiém khuyét vé hanh vi xa hdi va cé chi sé tri tué dao déng tir 70 dén 75 la ngudi KTTT. Ngugc lai, mot ngudi c6 chi sé tri tué thdp hon 70 nhung lai it bi khiém khuyét hodc thiéu hut lén vé kha nang thich (ing thi lai khéng bi coi [a KTTT. Ngoai chi s6 IQ thdp, kha nang thich tng kém thudng [a nhiing triéu ching cla cac ca nhan KTTT. Kha nang thich (mg 6 nghia la mic dé dap ting nhing dai héi chung cla cudc sng va mite dé 4p Gng nhiing tiéu chugn doc lap cd nhan, tigu chudn ma nhimg ngudi cling tudi dat dug trong cling hoan c&nh van hoa, x4 hi va méi truéng céng déng. Kha nang thich ting cé thé bi anh hudng bdi nhiéu yéu té khac nhau nhu giéo duc, déng co, dic diém nhan cach, co héi vé xa h6i va nghé nghiép, r6i loan tinh thén va nhimg van dé sic khoé; cdc yéu té nay 6 thé xuat hién cing v6i KTTT. ‘ DSM-IV: Diagnostic and Statistical Manual of Mental Disorders 4th edition. American Psychiatric Association Washington DC, 1997.22 Chuong 1 1.2.5. Khai niaém khuyét tat tri tué theo Hiép héi khuyét tat tri tué My (AAMR) ndm 1992") Theo AAMR nam 1992, KTTT la nhitng han ché I6n vé kha nang thuc hién chife nang. Dac diém cia KTTT la: + Hoat d6ng tri tué dudi mifc trung binh. + Han ché vé hai ho&c nhiéu han nhimg linh vuc k¥ nang thich ting: giao tiép, tu cham séc, séng tai gia dinh, cdc kf nang xa hdi, str dung cac phuong tién trong céng déng, ty dinh huéng, sic khoé va an toan, ky n&ng hoc duéng chute nang, gidi tri, am viéc. + Hién tugng KTTT xuat hién truéc 18 tudi. Theo AAMR, dac diém ca ban cilia KTTT dude bigu thi & hoat déng tri tué dudi md trung binh; diéu nay duge xe dinh khi chi sé tri tué ca nhan chi dat tit 70 dén 75 hoac thap hon, chi sé nay do duge théng qua mét hoc han mét trac nghiém tri tué; déng théi né phai dugc théng qua béi mét nhém chuyén gia va phai phd hop véi két qua cla cdc trac nghiém bé sung cing nhu phd hgp véi théng tin danh gid. Han ché vé tri tué xdy ra déng thdi véi su han ché vé ky nang thich Ging. Tim ra nhimg d&n ching vé thich img kém [a cn thiét béi vi néu chi co nhing dan ching vé hoat déng tri tué khéng théi thi chua di dé chan doan la KTTT. Phai tim i d&n chimg vé tac déng do nhing sy han ché nay gay ra it nhat la 461 véi hai linh vuc k¥ nang thich ing, trén co s6 dé ta biét duge han ché chung va gidm bét kha n&ng sai sé trong qua trinh chan doan. Mudi finn vuc ky nang thich tng (giao tiép, ty cham séc, s6ng tai gia dinh, x4 hi, sts dung cdc phudng tién trong céng déng, tu dinh huéng, stic khoé va an toan, hoc duténg chic nang, gidi tri, va lam viéc) quyét dinh kha nang s6ng va lién quan mat thiét véi nhu cu can hé trg cla nguéi KTTT. C6 su khac nhau 6 timg Ita tudi trong tifng linh vuc thich ting nén viéc danh gid phai xem xét ca yéu 6 dé tudi cla ngudi dude lam trac nghiém. Sinh nhat lan thir 18 la diém méc danh dau suf trudng thanh vé moi mat cia mét cA nhan trong xa héi, diéu nay cé su khdc biét & nhing xa hdi khac nhau. Theo AARM, KTTT khéng phai la c4i ma ban cé nhu mat, mii, hoc mét trai tim yéu dudi, né cing khéng phai la hinh thie nhu g4y hoc thap; KTTT ciing khéng phai la su rdi loan vé y hoc hoac rdi loan vé tinh thén; KTTT la mot tinh trang dac Luckasson, Re. lental Retardation: Definition, classification, and Systems of Supports American association on Mental Retardation. Washington DC, 1992.Nhiing van dé chung vé khuyét tat tri tué 23 biét vé chit nang bat d4u xuat hién tir khi tré con nhd va duge biéu hién béi sy han ché vé tri tué va kha nang thich ting. KTTT phan anh sy hoa hop giita kha nang ella cdc cd nhan v6i co cfu va ky vong cia méi trudng ma cé nhan dang séng trong d6, Khai niém KTTT theo AAMR cing két luan rang khi con ngudi va méi truding khéng hoa hgp véi nhau thi xuat hién nhu céu can duge phuc vu. AARM nh&n manh bon v&n dé phai can nhac truéc khi 4p dung khai niém nay: - Mét su danh gia higu qua phai tinh dén sy da dang vé van hoa va ngén ng, cling nhu su khac nhau vé cdc yéu t6 giao tiép va hanh vi; + Su han ché vé ky nang thich tmg xay ra trong hoan canh mdi truéng céng déng, dc trung cho tuéi déng trang lifa véi cé nhan va thé hién ré nhu cau can hd tra cla ngudi dé; - Nhémng han ché cu thé vé ky nang thich tng luén di kém véi nhiing ky nang ca nhan va hanh vi thich (mg tét/manh mé (nhiing han ché thuéng di cing véi cac diém manh); - Véi su hé trg thich hap trong khang thdi gian thich hgp, kha n&ng thy hién chic nang cudc s6ng clia mt ngudi KTTT nédi chung sé dude cai thién. Van 4 cudi cling duge nh&n manh trong khai niém nay 1a: xa hdi od trach nhiém hé trd dé ngudi khuyét tat cé kha n&ing hoa nhap hon. Hé théng hd tro co nghia la phai cé nhiéu loai hinh dich vu va diéu phéi phu hgp v4i nhu cau cla ngudi khuyét tat. Néu ngudi cang khuyét tat nang thi mutc d6 hd trd lai cang phai cao dé gitip nguéi dé hoa nhap vao x4 héi 6 mie dé téi da. 4.2.6. Khai nigm khuyét tat tri tué theo Higp hoi khuyét tat tri tué MY (AAMR) nam 2002" Trong tuyén tap this 10 “Cham phat trién tri tué: khai niém, phan loai va hé théng cdc hé tra”, xudt ban nam 2002, AAMR dua ra khai nigém KTTT nhu sau: “KTTT 1 loai khuyét tat duge xac dinh béi nhing han ché dang ké vé hoat dng tri tué va hanh vi thich mg thé hién & cdc ky nang nhan thie, x4 Ndi va ky nang thich (mg thuc té; khuyét tat xudt hign truée 18 tuéi”. Khai niém nay cing gidng nhu cac khai nigm K gan day cla AAMR 1a déu bao gém suf han ché dang ké 6 ba yéu t6: han ché trong hoat d6ng tri tué, xay ra “ Mental Retardation: Definition, classification, and Systems of Supports (10th edition) American association on Mental Retardation. Washington DC, 2002.24 . Chuong 1 déng thdi va lién quan véi nhing han ché dang ké vé hanh vi thich img, béc 16 trong mét giai doan phat trién nh&t dinh cia cd thé, Khac v6i cac khai niém truéc day, trong khai niém KTTT nam 2002 AAMR dé cp dén ba loai hanh vi thich (mg dé la: nhiing ky nang nhan thic, nhimg ky nang x4 héi, va nhiing ky nang thyc hanh. Khai niém KTTT nam 1992 cla AAMR dua ra 40 finh vue hanh vi thich (ng [xem muc 1.2.4]. AAMR néu 4 van dé quan trong cAn iuu y khi st? dung khai niém KTTT nam 4992 [xem muc 1.2.4], con déi véi khai nigém KTTT nam 2002 ho dua ra nam van dé sau: = Nhimg han ché vé chifc nang hay hoat déng hién tai phai dugce xem xét trong hoan c&nh méi trudng céng déng tiéu biéu cho cac ban cing trang ita va cing van hoa véi cé nhén. + Mét danh gid hiéu qua phai dugc xem xét dén tinh da dang ciia van hoa va ngén ngif cling nhu suf khac biét vé giao tiép, cam gidc, van déng va cac yéu té mang tinh hanh vi. = Trong méi ca nhan, nhimg han ché thudng di cing véi cac diém manh. - Muc dich quan trong khi miéu t& c&c han ché la phai xay dung cdc hé so hd tro can thiét. - Trong pham vi nhitng hé tre ca nhan phi hgp tai mdt khoang thdi gian nhat dinh, hoat déng s6ng cia ca nhan KTTT néi chung dugc cai thién. 1.2.7, Khai niém khuyét tat tri tug duge str dung hign nay 6 Viet Nam Cho én nay, nhing khai niém KTTT duge sts dung réng rai nhat Viet Nam la theo DSM-IV va AAMR nam 1992. Nhitng khai niém nay str dung cac tiéu chi co ban giéng nhau nhu hoat déng tri tué dudi mic trung binh, han ché vé ky nang thich Ging va khuyét tat xudt hién truéc 18 tudi. Biém khdc nhau la: DSM-IV sif dung tiéu chudn tri tué dé xac dinh mite d6 KTTT, cén bang phan loai AAMR str dung tigu chun ja kha nang thich tng x4 héi. Tuy nhién ca hai bang phan loai nay déu chia lam bén mic dé KTTT [xem muc 1.3]. 1.3. Phan loai mife dé khuyét tat tri tué DSM-IV sit dung chi sé tri tué lam tiéu chi dé phan loai mite 46 KTTT. Cé bén mac dO KTTT™ la: ‘ DSM-IV: Diagnostic and Statistical Manual of Mental Disorders 4th edition, American Psychiatric Association Washington DC, 1997. tr.40.Nhiing van dé chung vé khuyét tat tri tue. 25 - KTTT nhe: chi sé tri tué tur 50-55 t6i xp xi 70; - KTTT trung binh: chi s6 tn tué tu 35-40 t6i 50-55; - KTTT nang: chi sé tri tué tir 20-25 tai 35-40; -KTTT r&t nang: chi sé tri tué dui 20 hoac 25. AAMR séf dung tiéu chi thich (ng dé phan loai mie KTTT, tuong cing véi bén mic hé tro: - H6 tro kh6ng thudng xuyén: La loai hé tig dua theo nhu cau, né dude xa¢ dinh trén co sé ban chat clia ting giai doan va cé nhan khéng phai Itic nao cling can duge hé tra, hoa chi c&n hé tro ngdn han trong nhing giai doan chuyén déi ctla cuéc séng. Loai hé trd nay 06 thé 4 mifc cao hoac thdp. . - Hé tre c6 gidi han: Mifc 46 hé tr¢ tuy theo thdi diém va han ché vé thi gian cht khéng phai la hinh thttc hé tra gian doan; hinh thife hé tra nay 6 thé dai hdi it nh4n vién hon va kinh phi cfing thdp hon cdc mic dé hé tre tap trung/chuyén su. - Hé tro mé rong: La loai hé trg dién ra déu dan, vi du nhu hé tro hang ngay & nhing méi truéng nh&t dinh nhu tai nai lam viéc hoc tai nha. Hinh thifc hé tro nay khéng han ché vé thdi gian. - Hé tro toan dién: la loai hé tro thuéng xuyén va 4 mic dé cao; hé tro trong nhiéu méi trudng va trong suét cuéc déi. Loai nay c&n su tham gia cila nhiéu ngudi, né 1a hinh thie hé tr¢ mang tinh x4m nhap nhiéu hon la hd tro md réng hay hé tro ¢6 gidi han vé thdi gian. Theo 6 Bac si Nguyén Khdc Vién, dling phyong phap do tri tué dé phan loai mite dé KTTT ta cé bén loait”: - Chi s6 tri tué 70-80 la KTTT nhe; - Chi s6 tri tué 50-70 la KTTT vita; - Chi sé tri tué 30-50 ia KTTT nang; - Chi sé tri tué duéi 30 la KTTT rat nang. Theo Kisler (1964) KTTT cling duc phan lam bén loai mite dé cu thé nhu sau®. - Mic nhe: chi sé tri tué la 53-69; - Md trung binh: chi s6 tri tué la 36-52; - Mic nang: chi sé tri tué la 20- 35; Trin Thi L8 Thu: Bai cuting gido duc dc bibt cho tré cham phat tin tr tu. NXB BHQG, 2003. ® Trin Trong Thuy: Khoa hoe ehdn doan tam ly. NXB GD, 1992.Chuong 1 - Mic r&t nang: chi sé tri tué duéi 20. Viée phan loai mic dé KTTT gitip chung ta c6 co s6 doan biét va ky vong vé mifc d6 hanh vi cla dita tré, biét duoc diéu kién thé chat va dac biét la biét mic 46, hinh thtfc cham séc cn thiét cho difa tré. 6 nuéc ta hién nay cdc chuyén gia, cc thdy c6 gido vA céc cén b6 nghién cit trong [inh vuc GD DB dang st dung cach phan loai mtic dé KTTT theo DSM-IV. 1.4. Tigu chi chan dodn khuyét tat tri tué 1.4.1. Tri tué DSM-IV va AAMR déu lay chi sé tr tué nhu la mét trong nhimg tiéu chi giup chan doan KTTT: + DSM-IV: Hoat déng tri tué chung dugc xac dinh bdi chi sé tri tué- chi sé nay dude do bang mét hodc hon mét trac nghiém tri tué da chun hoa déi vdi ca nha. Hoat déng tri tué duéi mite 46 trung binh la khi chi sé tri tué dat 70 hoc dudi 70. + AAMR: Hoat d6ng tri tué du6i mic dé trung binh cé nghia la khi chi sé tri tué dat tir 70 dén 75 ho’c thap hon, dya trén danh gia qua mét hoc hon mot trac nghiém tri tué dudc thuc hién trén c& nhan. 1.4.2. Hanh vi thich img Déi véi nhitng ngudi KTTT, kha nang tac déng vao xa hi va dat dugce su chap nhan trong x4 hi da bi giam dang ké béi nhiing han ché vé hanh vi thich img. Céng trinh nghién cttu cla chuyén gia nghién ctu KTTT ngudi MY Voisin (1843) nhan manh tam quan trong cla hanh vi thich ing va viée x4c dinh mifc do cla hanh vi thich dng. Viéc thu thap cac théng tin vé kha nang thich (mg tir cac nguén khdc nhau la rat c6 ich, vi dy nhu qua danh gia cia gido vién, qua qua trinh dude giao duc, qua trinh phat trién cGing nhu qua tién st site khoé cla déi tugng. Ngudi ta da xAy dung mdt sé thang do iuéng hanh vi thich Ung, vi du nhu thang do hanh vi thich (ng cla Vineland va thang do hanh vi thich tng cla AAMR. Nhiing thang nay c6 thé cung cp cho ta théng tin rat co ban vé mdt sé ky nang thich Gng nhét dinh.