Course: Handicapped Person in the Community (673)

Semester: Autumn, 2021

ASSIGNMENT No. 1
Q.1 Handicapped persons has sub-normal pattern of life. Why? Suggest some ways to overcome the
difficulties of VHC in their life?
The meaning of “disability” has shifted with changes in public policy. Half a century ago, Congress was
convinced that narrow determinations of disability are easy for physicians to make. But with the advent of
universal civil rights protection against disability discrimination in the US, deciding whether particular
individuals are disabled became increasingly contentious, until Congress intervened. What should now be
addressed in each case is not whether the functionally compromised person is severely disabled enough to
exercise a right, but whether mitigating interventions and reasonable accommodations can together achieve
equitable access for that person.
“Disability” is a term of art with different specialized meanings, each developed for the particular policy or
program that uses it. How we conceptualize disability shifts relative to the methodologies used to learn about it
and the contexts in which it is addressed. The criteria for judging people to be disabled likewise fluctuate over
time and across different social and cultural contexts.
The history of the concept of disability illuminates its evolution. Before the nineteenth century, being disabled
meant being disadvantaged by laws preventing participation in some areas of a community’s social, political, or
economic life. For example, according to legal theory of that day, successful domestic arrangements required
husband and wife to be as one person, permitting only one decision-maker—the male. So married women were
explicitly disabled by law from the management or disposition of property [1].
While legal disability’s imposition of disadvantage was a result of a social arrangement, by the late nineteenth
century, another kind of disabling disadvantage—associated with compromised health rather than legislative
mandate—came to be portrayed as a natural fact. During this era, healthy and pathological states of organisms
began to be distinguished through statistical investigation, with species typical functioning being conceived as a
“norm” conducive to individual and species success [2]. As the nineteenth century turned to the twentieth,
anomalous biological functioning began to be equated as a general matter with disabling defectiveness that not
only disadvantages the individual but also, unless ameliorated or eliminated, detracts from social stability and
species survival [3, 4]. We examine social welfare and disability rights legislation in the US to consider
additional shifts in views of disability during the twentieth century.
A generalized characterization of persons with disabilities as functionally abnormal enabled them to be
addressed collectively for purposes of policy formulation. On the one hand, persons with such anomalies could
be discriminated against by policies denying them access to common services or by segregating them into
institutions [5, 6]. On the other hand, aggregation of various kinds of biological dysfunction enabled a more
positive policy effect: income-related benefits to individuals with impairments who, due to their past or
potential social contribution, were judged deserving. For example, after the Civil War, Congress gave veterans
with a variety of injuries and illnesses preference as a group for government employment [7]. Later, assistance

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 Course: Handicapped Person in the Community (673)
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programs such as the 1920 Civil Vocational Rehabilitation Act [8] were devised to return citizens with the
potential to overcome their functional disabilities to the workforce, regardless of how the disability was
acquired.
Between 1954 and 1964, a series of amendments to the 1935 Social Security Act added payment of benefits to
persons with illness or injury too severe to work [9-11]. According to a US Social Security Advisory Board
report, The Social Security Definition of Disability [12], “When the Social Security Disability Insurance (DI)
program was enacted in 1956, it was intended for the ‘totally and permanently disabled,’ a population for whom
work was not an option” [13]. To the Social Security Administration (SSA), persons with disabilities were
people permanently unable to perform substantial gainful activity due to severe impairment. During
Congressional hearings on the Social Security Act amendments, controversies arose about the definition of
disability and its implementation through physicians’ testimony [14]. Despite testimony from American
Medical Association (AMA) leadership and many other physicians about their doubts that practitioners could
deliver objective judgments about disability, as the amendments to the 1935 Social Security Act apparently
presumed, federal legislators remained unshakably optimistic. As Georgia Senator Walter F. George declared,
“[M]any American doctors are afraid that they cannot determine when a man or a woman is disabled, when the
plain requirement is that the disability must be a medically determined physical or mental impairment. …. I
think more of the medical profession in this country than to believe that they cannot determine when a man or a
woman worker has a permanent and total disability” [15].
As the SSDI program functions today, to qualify for Social Security disability benefits, applicants’ conditions
must be severe enough to interfere with basic work-related activities. The SSA maintains a list of medical
conditions that are so severe they automatically mean that the person is disabled [16]. If the applicant’s
diagnosis is not on the list, there is a Social Security process that decides “if it is of equal severity to a medical
condition that is on the list” [16]. To receive benefits if the condition is not considered as severe as those on the
list, the applicant must demonstrate that the condition prevents executing both previous types of employment
and other types of employment in the relevant labor market [16]. Demonstrating such inability to work in the
relevant labor market is thus a critical aspect of disability determinations today for people whose conditions do
not fall within the SSA list.
As the AMA warned, however, diagnosing individuals’ inability to work has turned out to be much more
problematic than Congress initially supposed. Physicians’ assessments of the same patient’s disability can be
surprisingly varied, indicating that the theoretical foundation of this kind of diagnosis is far from robust [17].
Furthermore, clinical judgments of the impact of physiological or psychiatric medical conditions on ability to
work can be skewed by implicit bias [18, 19]. Finally, barriers to employment extend beyond actually executing
work. To illustrate, having to climb steep stairs to the workplace or restrooms can curtail employment for
persons with even modest impairments such as compromised respiration or tendonitis [20].
Q.2 How independence and self-concept could be faster in the handicapped?

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 Course: Handicapped Person in the Community (673)
Semester: Autumn, 2021
Inclusion is the response to the human rights movement that requested equal rights for all people, independent
of their gender, race, socio-economic background and/or disability in all areas of (public) life. The UN
Convention of the Rights of Persons with Disabilities (UN CRPD; United Nations, 2006) was one of the starting
points for implementing the idea of inclusion into all areas of society worldwide. The UN Convention also puts
emphasis on the education system: not only that access to all mainstream schools has to be ensured, but also the
promotion of learning and well-being within the classroom, independent of the kind of disability. Inclusive
schooling has become a shared policy in European countries, however its implementation varies widely
between different countries, and often also within the same country according to legislation, settings of
inclusion, financial support, access to inclusive schools and the pedagogical concepts (Schwab 2019;
Loreman 2017; UNESCO 2017; Watkins 2017).
In order to reach inclusion, an inclusive education system and inclusive methods of teaching and learning
should be established, however, what is defined as ‘inclusive’ has changed within the last decade. The UN
Convention rather focussed on students with disabilities, their needs and how to support them in order to
include them into mainstream schools. Later policy papers (e.g. the Sustainable Development Goals, see United
Nations 2015) encompass all learners (see also Schwab 2019). In this context, a paradigm shift took place,
emphasising the organisations, asking how they produce barriers of inclusion themselves and how schools can
ensure equality in education for all children (European Parliament 2017; Avramidis and Norwich 2002; Watkins
and Meijer 2016).
Inclusive education in Germany
This paper presents data from Germany. First approaches to inclusion, pushed forward mostly by parents,
emerged in Germany already in the 1970s when pilot experiments tried to integrate children with disabilities
into mainstream classes. However, Germany did not ratify the UN Convention before 2009 (Klemm 2015).
Whereas in the beginning some schools developed and experienced different practices voluntarily, after the
ratification of the UN Convention the whole educational system was under pressure to implement inclusion. As
the 16 Federal States of Germany have sovereignty in cultural and educational affairs, the UN Convention had
to be transferred into the domestic Federal State laws. As a result, legislation and understanding of inclusion
differ between the Federal States. This becomes evident concerning several dimensions: the settings for
inclusion, the financial support for schools and the access to schools including the options of parents to choose a
school for their child.
To support inclusion, schools often receive general funding for students with (an official diagnosis of having)
special educational needs (SEN) (‘throughput funding’, UNESCO 2017). The amount of these resources and the
way to request them differs according to the respective Federal State legislation. Additionally, schools are quite
autonomous in how they use the given resources (Klemm 2015).
Although children with SEN have the right to attend regular schools, the choices parents have are more or less
limited according to the options they have. Usually they can choose between special schools and regular schools

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 Course: Handicapped Person in the Community (673)
Semester: Autumn, 2021
which usually offer regular classes (without any children with disabilities) as well as inclusive classes (with at
least one child with SEN) as children with SEN are bundled into just a few classes, due to organisational
reasons. Additionally, the rights of parents are limited by the number of places schools offer for children with
SEN. Parents have the right to receive a place for their child in an inclusive school, but they cannot choose the
school itself. This can be a problem for parents with children with SEN as some schools do not offer places for
affected children (Klemm 2015).
Keeping these aspects in mind, the data for all Federal States show that Germany has about 524,000 students
with SEN (7.1 percent of all students, Klemm 2018). Within the last decade, the inclusion rate (proportion of
students with SEN which attended inclusive classes compared with all students with SEN) has increased from
18.4 percent (2008) to 39.3 percent (2016) (Klemm 2018, using data from the KMK/Kultusministerkonferenz,
The Standing Conference of the Ministers of Education and Cultural Affairs of the Federal States in the Federal
Republic of Germany, 2018). In 2016, 205.811 students with SEN attended inclusive classes (77,215 in primary
schools and 102,928 in various forms of secondary schools)1. When reviewing the inclusion rates between pre-
primary, primary and secondary schools, there is a reduction from 67.0 percent (kindergarten) to 46.9 percent
(primary schools) and 29.9 percent (secondary schools) (data for school year 2013/14, Klemm 2015)2.
However, that means: about 60 percent of students with SEN still attend special schools. An international
comparison makes evident that Germany’s inclusion rate is considered quite moderate compared with many
other European countries (average: 52.7 percent) (European Agency Statistics on Inclusive Education 2014).
Within Germany, the rate differs between 82.8 percent in the city-state Bremen and 26.3 percent in Bavaria
(Klemm 2018).
Q.3 Describe features and etiology of mental retardation. What is the role of preventive measures in
decreasing the incidence and severity of mental retardation?
Mental retardation (MR) refers to substantial limitations in present functioning. Mental retardation: The
condition of having an IQ measured as below 70 to 75 and significant delays or lacks in at least two areas of
adaptive skills. Mental retardation is present from childhood. Between 2 and 3 percent of the general population
meet the criteria for mental retardation. Causes of mental retardation include fetal alcohol syndrome and
fetal alcohol effect; brain damage caused by the use of prescription or illegal drugs during pregnancy; brain
injury and disease; and genetic disorders, such as Down syndrome and fragile X syndrome. Treatment of
mental retardation depends on the underlying cause. In some cases, such as phenylketonuria and
congenital hypothyroidism, special diets or medical treatments can help. In all cases, special education starting
as early in infancy as possible can help people with mental retardation maximize their abilities.
Intellectual disability (ID) becomes apparent during childhood and involves deficits in mental abilities, social
skills, and core activities of daily living (ADLs) when compared to same-aged peers.[10] There often are no
physical signs of mild forms of ID, although there may be characteristic physical traits when it is associated
with a genetic disorder (e.g., Down syndrome).[11]

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 Course: Handicapped Person in the Community (673)
Semester: Autumn, 2021
The level of impairment ranges in severity for each person. Some of the early signs can include:[11]

Delays in reaching, or failure to achieve milestones in motor skills development (sitting, crawling,
walking)

Slowness learning to talk, or continued difficulties with speech and language skills after starting to talk

Difficulty with self-help and self-care skills (e.g., getting dressed, washing, and feeding themselves)

Poor planning or problem-solving abilities

Behavioral and social problems[12]

Failure to grow intellectually, or continued infant childlike behavior

Problems keeping up in school

Failure to adapt or adjust to new situations

Difficulty understanding and following social rules[10]
In early childhood, mild ID (IQ 50–69) may not be obvious or identified until children begin school. [7] Even
when poor academic performance is recognized, it may take expert assessment to distinguish mild intellectual
disability from specific learning disability or emotional/behavioral disorders. People with mild ID are capable
of learning reading and mathematics skills to approximately the level of a typical child aged nine to twelve.
They can learn self-care and practical skills, such as cooking or using the local mass transit system. As
individuals with intellectual disability reach adulthood, many learn to live independently and maintain gainful
employment.[7] About 85% of persons with ID are likely to have mild ID.
Moderate ID (IQ 35–49) is nearly always apparent within the first years of life. Speech delays are particularly
common signs of moderate ID. People with moderate intellectual disabilities need considerable supports in
school, at home, and in the community in order to fully participate. While their academic potential is limited,
they can learn simple health and safety skills and to participate in simple activities. People with moderate ID are
capable of learning reading and mathematics skills to approximately the level of a typical child aged six to nine.
As adults, they may live with their parents, in a supportive group home, or even semi-independently with
significant supportive services to help them, for example, manage their finances. As adults, they may work in
a sheltered workshop.[7] About 10% of persons with ID are likely to have moderate ID.
People with Severe (IQ 20–34). accounting for 3.5% of persons with ID or Profound ID (IQ 19 or below)
accounting for 1.5% of persons with ID need more intensive support and supervision for their entire lives. They
may learn some ADLs, but an intellectual disability is considered severe or profound when individuals are
unable to independently care for themselves without ongoing significant assistance from a caregiver throughout
adulthood.[7] Individuals with profound ID are completely dependent on others for all ADLs and to maintain
their physical health and safety. They may be able to learn to participate in some of these activities to a limited
degree.[11]
Among children, the cause of intellectual disability is unknown for one-third to one-half of cases. [7] About 5%
of cases are inherited from a person's parents.[8] Genetic defects that cause intellectual disability, but are not

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 Course: Handicapped Person in the Community (673)
Semester: Autumn, 2021
inherited, can be caused by accidents or mutations in genetic development. Examples of such accidents are
development of an extra chromosome 18 (trisomy 18) and Down syndrome, which is the most common genetic
cause.[8] Velocardiofacial syndrome and fetal alcohol spectrum disorders are the two next most common causes.
 However, there are many other causes. The most common are:
[7]


Genetic conditions. Sometimes disability is caused by abnormal genes inherited from parents, errors
when genes combine, or other reasons. The most prevalent genetic conditions include Down
syndrome, Klinefelter syndrome, Fragile X syndrome (common among
boys), neurofibromatosis, congenital hypothyroidism, Williams syndrome, phenylketonuria (PKU),
and Prader–Willi syndrome. Other genetic conditions include Phelan-McDermid syndrome
(22q13del), Mowat–Wilson syndrome, genetic ciliopathy,[17] and Siderius type X-linked intellectual
disability (OMIM: 300263) as caused by mutations in the PHF8 gene (OMIM: 300560).[18][19] In the
rarest of cases, abnormalities with the X or Y chromosome may also cause disability. Tetrasomy
X and pentasomy X syndrome affect a small number of girls worldwide, while boys may be affected by
49, XXXXY, or 49, XYYYY. 47, XYY is not associated with significantly lowered IQ though affected
individuals may have slightly lower IQs than non-affected siblings on average.[20][21]

Problems during pregnancy. Intellectual disability can result when the fetus does not develop properly.
For example, there may be a problem with the way the fetus's cells divide as it grows. A pregnant
woman who drinks alcohol (see fetal alcohol spectrum disorder) or gets an infection like rubella during
pregnancy may also have a baby with an intellectual disability.

Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen, he
or she may have a developmental disability due to brain damage.

Exposure to certain types of disease or toxins. Diseases like whooping cough, measles, or meningitis can
cause intellectual disability if medical care is delayed or inadequate. Exposure
to poisons like lead or mercury may also affect mental ability.

Iodine deficiency, affecting approximately 2 billion people worldwide, is the leading preventable cause
of intellectual disability in areas of the developing world where iodine deficiency is endemic. Iodine
deficiency also causes goiter, an enlargement of the thyroid gland. More common than full-
fledged cretinism, as intellectual disability caused by severe iodine deficiency is called, is mild
impairment of intelligence. Residents of certain areas of the world, due to natural deficiency and
governmental inaction, are severely affected by iodine deficiency. India has 500 million suffering from
deficiency, 54 million from goiter, and 2 million from cretinism. Among other nations affected by iodine
deficiency, China and Kazakhstan have instituted widespread salt iodization programs. But, as of
2006, Russia had not.
Q.4 Explain the behavior pattern of disabled children? Compare various techniques used for the
assessment of strengths and weaknesses.

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Cognitive disabilities in children include mental retardation as well as specific learning disabilities in children
of normal intelligence. Mental retardation is defined as subnormal intelligence (intelligence quotient [IQ] more
than two standard deviations below that of the population mean), accompanied by deficits in adaptive behavior.
Grades of mental retardation are typically defined in terms of IQ. Children with mild mental retardation, the
most common form, are limited in academic performance and consequently have somewhat limited vocational
opportunities. Adults with mild mental retardation typically lead independent lives. Children with more severe
grades of mental retardation (moderate, severe, and profound) are more likely to have multiple disabilities (e.g.,
vision, hearing, motor, and/or seizure in addition to cognitive disability) and to be dependent on others for basic
needs throughout their lives.
In contrast, specific learning disabilities result not from global intellectual deficit, but from impairments in one
or more of the specific “processes of speech, language, reading, spelling, writing or arithmetic resulting from
possible cerebral dysfunction.”[12] Children with specific learning disabilities are usually identified as such
only after entering school, where a significant discrepancy is noted between their achievements in specific
domains and their overall abilities. With special educational accommodations, these children may learn to
overcome their limitations and demonstrate normal or even superior levels of achievement.
Motor disabilities include limitations in walking and in use of the upper extremities (arms and/or hands). Some
motor disabilities also affect speech and swallowing. Severity can range from mild to profound. Motor
disabilities diagnosed in infancy or childhood include cerebral palsy, which results from damage to motor tracts
of the developing brain; paralysis following conditions such as poliomyelitis and spinal cord injuries; congenital
and acquired limb abnormalities; and progressive disorders, such as the muscular dystrophies and spinal
muscular atrophies. Cerebral palsy results from a permanent, nonprogressive damage or insult to the developing
brain. Affected children therefore may manifest a variety of motor dysfunctions, depending on the specific
location of the damage. Involvement of the motor cortex produces spasticity, while involvement of the
cerebellum results in hypotonia with or without ataxia. Involvement of the basal ganglia leads to dyskinesia and
dystonia. Individuals with cerebral palsy often have other disabilities as a result of concomitant insults to
various areas of the brain. Such disabilities include mental retardation, learning disabilities, epilepsy, language
disorders, and behavioral problems. Similarly, some of the progressive motor disorders, such as muscular
dystrophy, can be accompanied by cognitive disabilities. In contrast, in many forms of paralysis, such as that
due to poliomyelitis or spinal cord injury, and congenital or acquired limb abnormalities, the disability is more
likely to be restricted to motor skills or mobility.
Developmental disabilities impose enormous personal, social, and economic costs because of their early onset
and the lifetime of dependence that often ensues. Children with disabilities often have limited educational
opportunities, and as they grow older, limited employment options, productivity, and quality of life. Yet the
costs of developmental disabilities are difficult to quantify in settings where relevant data and services are
lacking. As a result, in low-income countries today, where more than 80 percent of the world's children are

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 Course: Handicapped Person in the Community (673)
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born, the magnitude of the impacts of developmental disabilities on individuals, families, societies, and
economic development remains largely unrecognized and has yet to be addressed from a policy perspective.
While disability-adjusted life years have been computed for some of the specific causes of developmental
disability, such as meningitis and iodine deficiency, 1 these figures do not convey the full proportion of cases
within a given category of disorder that result in early and lifelong disability or death. Nor are DALY estimates
currently available for the broad categories of developmental disability listed in Table 5-1 or for developmental
disability as a whole. What is needed before useful DALY or other measures of impact can be calculated for
developmental disabilities is accurate and up-to-date information from low-income countries on the prevalence
and impacts of long-term functional limitations originating early in life as a result of both known and unknown
causes. These data would allow an assessment of the costs and impacts of developmental disabilities against the
costs of their prevention, which would in turn facilitate rational decision making and resource allocation with
respect to child health and development. Without this information, there is a tendency to conclude that in low-
income countries, more pressing issues preclude the allocation of resources for the prevention of developmental
disabilities.
While the focus of this report is on the public health dimensions of developmental disabilities in children,
including etiology, quantitative indicators, and strategies for prevention, we cannot neglect the fact that the
major impacts of developmental disabilities in all countries are borne by families and individuals as a result of
experiences that are difficult to quantify. These experiences include stigma, lost hopes and opportunities,
discrimination, increased stress and daily challenges brought on by lifelong impairment, handicap, and social
isolation. It is hoped that as countries and governments begin to take responsibility for the public health
dimensions of developmental disabilities, improved awareness and management of the human dimensions of
these disorders will follow.
As societies and economies become increasingly information-oriented and dependent on highly skilled and
literate workers, it is critical that children everywhere have an opportunity to attain their optimal levels of
cognitive and neurological development. The persistence of excess prevalence rates of developmental
disabilities observed in low-income countries today is both a consequence of poverty and poor resource
allocation and an impediment to future social and economic development.
Q.5 Write notes on the following:
a) Socio-Economic Pressure
Socioeconomics (also known as social economics) is the social science that studies how economic
activity affects and is shaped by social processes. In general it analyzes how
modern societies progress, stagnate, or regress because of their local or regional economy, or the global
economy. Societies are divided into three groups: social, cultural and economic. It also refers to the ways that
social and economic factors influence the economy.

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 Course: Handicapped Person in the Community (673)
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Socioeconomic system at the regional level refers to the way social and economic factors influence one another
in local communities and households. These systems have a significant impact on the environment through
deforestation, pollution, natural disasters, and energy production and use. Through telecoupled systems, these
interactions can lead to global impact. Local economies, food insecurity, and environmental hazards are all
negative effects that are a direct outcome of socioeconomic systems.
 Deforestation is a major cause of environmental change. Deforestation can be attributed to population
growth, change in household dynamics, and resource management. Forests are traditionally owned by the
state and control resource management which means their government is responsible for the development of
forested land. Between 1970 and 2011, the tree coverage decreased by 20.6%.[7] The decrease can be
attributed to community development and increased use of resources. The issue of deforestation is
contributing to climate change because the wood is frequently burned and used as timber fuel which emits
CO2 into the atmosphere. Deforestation is also happening due to population growth and the expansion of
farmland which creates feedback loops. When forests are cut down to begin agriculture practices, soil
degradation often takes place and leads to further issues like declining crop yields, which can contribute to
food insecurity and contraction in the economy.
 Due to deforestation, animals often lose their habitats and vegetation is significantly decreased. Habitat
loss is common when deforestation happens because not only are the trees being cut down, but the land
trees previously inhabited suffers extreme soil erosion due to lack of protection from the tree coverage.
Animals' struggle to survive is further hindered due to high temperatures in places where tree coverage is
lost.[8] Local community economies are affected by this because they depend on these resources to drive
their local markets and feed their families. Modern medicine is also affected by deforestation because
several medicines are derived from plants found in these areas. Loss of these resources means a loss of
income to local communities who depend on these natural resources for profit. This can have a global effect
by creating shortages of some medicines worldwide.
Natural disasters are becoming more severe as the environment is shifting. In the Western hemisphere,
landslides are becoming more prevalent and severe. As communities continue to expand and develop,
landscapes are disrupted by human interactions and unstable hillside areas begin to crumple under these
pressures.[10] These effects can be responsible for habitat loss for animals, home loss for humans, and complete
destruction of industrial establishments. This can affect local economies just as any other natural disaster
because it disrupts the entire flow of communities. They can be divided into private and public, for example, a
highway being demolished by a landslide would be considered a public cost. A local farm that lost all of its
crops due to a landslide would be considered a private cost. Urbanization and deforestation are primarily
responsible for the increasing number of landslides in small communities.
b) Role of Community Based Supportive Programmes

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There is no unique scientific method to guide the process of empirical enquiry. Likewise, there is no distinctive
conceptual model that can be applied in all research programmes of family studies. So, the aim of this chapter is
NOT to build up an all-embracing model in such a complex area as family environment. No one model would
be sufficiently comprehensive that it could guide all future research. However, without adopting some form of
CM no research could be done and so, adopting a CM is the first and indispensable part of research that no
researcher could avoid even if they never make explicit the CM that underpinned their study which in fact
frequently happens.
But how does a researcher choose among the competing CMs that are available and which are likely to prove
suitable for other cultures? Again, there is not a single and simple guideline to help the researcher’s choice. This
is a tricky and potentially fallible step and one that has to be informed by the chosen topic of the investigation,
the extant literature on it and the experiences gained personally by the researcher and in consultation with
practitioners and families who have the lived experience of the chosen phenomena. It is some consolation to
know that the CM initially chosen often is found to have shortcomings when it is put into practice. Abandoning
the chosen CM and adopting another one is not a good recommendation most of the time; especially when the
chosen CM has enabled us to deal with certain aspects of the problem. The better solution is to extend the CM
to encompass newly identified issues. By offering an example around parental empowerment that might be
useful to others, we aim to show how the formation of a more complete CM can be achieved. In so doing, we
hope to draw out the ways in which this case study could assist practitioners and also the future research
questions that can emanate from it.
ASD is predominantly conceived as a medical condition based on DSM or ICD definitions. The medical model
tends to believe that the curing or managing of disability generally or completely, revolves around identifying
the illness or disability from an ‘in-depth’ clinical perspective involving doctors, therapists and psychologists.
The irony is that ASD even in the medical sources is defined based on its behavioural manifestation rather than
clinical symptoms. Sole reliance on a medical condition sits outside modern conceptions of disability that
acknowledge environmental influences such as family and society on a child/person’s level of functioning.
These may be particularly crucial in developing countries with their poor service infrastructures at local and
national.
The International Classification of Functioning, Disability and Health (ICF, WHO, 2002) is an updated
framework for the description of health and health-related states. The classification is focused on health and
health-related domains based on what a person with a health condition can do in a standard environment
compared to what they actually do in their usual environment (comparing the level of capacity to the level of
performance). Thus social and environmental factors can have a major influence on a child’s level of
functioning in addition to any medical and disability condition.
The ICF also embodied the thinking in the bio-psycho-social frameworks which have been proposed in
disability and mental health in which different biological, psychological, and social influences are brought

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together [8]. As Engel argues there is a reciprocal rather than a linear relationship between all these three main
factors. According to this model, although a specific disability may require primary attention at the biological
level – such as hearing impairment-it will also have an impact on psychological factors and both factors in turn
may influence the social system of the person with disability and their parents. Thus ICF provides a
comprehensive view of factors involving health, illness and health care and explains and understands individual
behaviour in particular contexts.

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