Categories/ Classification of Special

Children and their Characteristics

By
Abdul Qudoos Awan
According to The International Classification of
Impairments, Disability and Handicaps (ICIDH)
The ICIDH-2 from 1997 represents a further step in this process.
It defines disability as: “.an umbrella term covering three
dimensions:
 (i) Body structures and function;
 (ii) Personal activities;
 (iii) Participation in society.
These dimensions of health-related experience are termed
“impairments of function and impairments of structure”,
“activities” [i.e. nature and extent of individual functioning due
to impairments], and “participation” [the nature and extent of
a person’s involvement with life situations] respectively”.
The ICIDH-2 Framework for Understanding
Disability
Health Condition
(disorder / disease)

Impairment Activity Participation

Contextual Factors
A. Environmental
B. Personal
C. Institutional
 
 National Policy for the Persons with
Disabilities, 2002
In Pakistan, the National Policy for the Persons with Disabilities, 2002 defines
disability as lack of ability to perform an activity in a manner considered to be
normal.
 The Disabled Persons (Employment and Rehabilitation) Ordinance, 1981
The Disabled Persons (Employment and Rehabilitation) Ordinance, 1981
defines the disabled person as someone who on account of injury, disease or
congenital deformity, is handicapped for undertaking any gainful profession or
employment in order to earn a livelihood, and includes persons who are blind,
deaf, physically handicapped or mentally retarded. The disease is a physical or
mental condition arising from the imperfect development of an organ.
 These definitions by and large are close enough to the international standards
but certainly need to be further reviewed and modified to bring them into
conformity with the changing needs of the time and international conventions.
 
 WHO’s International Classification of
Diseases
 (ICD) especially in many of its subcategories; the
overall structure, however, is informed by a theory of
“planes of experience” in the development of illness
and disability. This gives rise to four main categories:
1-Disease/disorder,
2-Impairment
3-Disability
4- Handicap.
 
 Hearing impairment
Hearing impairment refers to deafness that varies
according to the extent of hearing loss that can easily
be assessed through a procedure of audiometry.
 Types of Hearing Loss
1. Conductive Hearing Loss
It is when hearing loss is due to problems with the ear canal, ear
drum, or middle ear and its little bones (the malleus, incus, and
stapes).
2. Sensorineural hearing loss (SNHL)
It is when hearing loss is due to problems of the inner ear, also
known as nerve-related hearing loss.
Types of Hearing Loss
3. Mixed Hearing Loss
It refers to a combination of conductive and sensorineural hearing loss. This
means that there may be damage in the outer or middle ear and in the inner ear
(cochlea) or auditory nerve.
Causes of Hearing Loss
 Malformation of outer ear,
ear canal, or middle ear
structures
 Fluid in the middle ear from
colds
 Ear infection
 Allergies
 Poor Eustachian tube function
 Perforated eardrum
 Benign tumors
 Impacted earwax
 Infection in the ear canal
 Foreign body in the ear
Hearing Loss
Mild Hearing Loss
What is mild hearing loss? On average, the most quiet sounds that people can hear
with their better ear are between 25 and 40 dB. People who suffer from mild hearing
loss have some difficulties keeping up with conversations, especially in noisy
surroundings.
Hearing Loss
Moderate Hearing Loss
What is moderate hearing loss? On average, the most quiet sounds heard by people
with their better ear are between 40 and 70 dB. People who suffer from moderate
hearing loss have difficulty keeping up with conversations when not using a hearing
aid.
Hearing Loss
Severe Hearing Loss
What is severe hearing loss? On average, the most quiet sounds heard by people with
their better ear are between 70 and 95 dB. People who suffer from severe hearing loss
will benefit from powerful hearing aids, but often they rely heavily on lip-reading even
when they are using hearing aids. Some also use sign language.
Hearing Loss
Profound Hearing Loss
What is profound hearing loss? On average, the most quiet sounds heard by people
with their better ear are from 95 dB or more. People who suffer from profound hearing
loss are very hard of hearing and rely mostly on lip-reading, and/or sign language.
Characteristics of Hearing Loss
 Hearing loss
 Mute
 Inability to understand verbal cues
 The disabilities in Pakistan are generally
categorized as
(i) Physical handicap
(ii) Hearing impairment
(iii) Visual impairment
(iv) Mentally Challenging
These are again classified as
(i) Mild
(ii) Moderate
(iii) Severe
(iv) profound
(depending upon the extent of loss or functional deformity.)
 
 Types of Physical Disability
Neurological
Cerebral palsy
Muscular dystrophy
Spina bifida
convulsive disorder,
Spinal muscular a trophy etc
Orthopedics
Limb absence (mono plegia, di plegia, Tri Plegia, hemi plegia, & quarter plegia)
amputation
Health Impairments
 cystic fibrosis,
 heart disease
 sickle cell disease,
 haemophilia,
 asthma,
 rheumatic fever,
 cancer,
 AIDS or any other chronic or acute health condition that limits strength vitality and alertness that adversely
affect the educational performance.
Characteristics of Physical Disability
In the early years, children may have some difficulties in learning
to move skillfully. This is not unusual. However, for some children,
the muscles and nerves that control body movements may not be
properly formed or may become damaged causing a physical
disability. There are organizations and services that can help you
and your child if your child has a physical disability.
 Types of Physical Disability
1. Muscular dystrophies
When a child has muscular dystrophy, this means that the muscle
fibres in the body gradually weaken over time. Children can have different
types of muscular dystrophy. The most common type is Duchenne
Muscular Dystrophy which occurs only in boys. All types of muscular
dystrophy are genetic even though other family members may not have
the condition.
Types of Physical Disability
2. Acquired Brain & Spinal Injuries
Physical disabilities may result from permanent injuries to the brain,
spinal cord or limbs that prevent proper movement in parts of the body.
 Types of Physical Disability
3. Spina Bifida
Sometimes, a baby's spinal cord (the nerves that run down the spine)
do not develop normally during pregnancy. When this happens, the child
can have a physical disability called spina bifida. The type and amount of
disability caused by spina bifida will depend upon the level of the
abnormality of the spinal cord.
 Types of Physical Disability
3. Spina Bifida
Children with spina bifida may have:
 partial or full paralysis of the legs
 difficulties with bowel and bladder control.

 hydrocephalus (high pressure on the brain because of fluid

not being drained away as normal)

 bone and joint deformities (they may not grow normally)
 curvature (bending) of the spine.
 Types of Physical Disability
4. Cerebral Palsy
Cerebral palsy is caused by damage to the parts of the brain which
control movement during the early stages of development. In most
cases, this damage occurs during pregnancy. However, damage can
sometimes occur during birth and from brain injuries in early infancy
(such as lack of oxygen from near drowning, meningitis, head injury or
being shaken).
Types of Physical Disability
4. Cerebral Palsy
Children with cerebral palsy may have difficulties with:
 posture (the ability to put the body in a chosen position and keep
it there)
 movement of body parts or the whole body
 muscle weakness or tightness
 involuntary muscle movements (spasms)
 balance and coordination
 talking and eating
Types of Physical Disability
4. Cerebral Palsy
Children can have different types of cerebral palsy:
 Hemiplegia (involves muscle movements and weakness on one
side of the body)
 Diplegia (involves muscle movements and weakness in the lower
part of the body)
 Quadriplegia (involves muscle movements and weakness in both
arms and both legs)
 Ataxia (involves problems with balance and coordination).
Types of Physical Disability
5. Multiple disabilities
Some children with physical disabilities will have other disabilities,
such as intellectual, visual or hearing impairments. They may also have
communication difficulties or other medical conditions such as epilepsy
or asthma. When a child has several different types of disability,
professionals talk about multiple disabilities rather than listing separate
conditions.
Causes of PHC
 Inherited or genetic disorders, such as muscular dystrophy
 Conditions present at birth (congenital), such as spina
bifida
 Serious illness affecting the brain, nerves or muscles, such
as meningitis
 Spinal cord injury
 Brain injury
Severe & Multiple Disability
People with severe disabilities are those who traditionally have been labelled as
having severe to profound mental retardation.

These people require ongoing, extensive support in more than one major life
activity in order to participate in integrated community settings and enjoy the
quality of life available to people with fewer or no disabilities.

They frequently have additional disabilities, including movement difficulties,

sensory losses, and behavior problems.
Characteristics of Severe & Multiple Disability
People with severe or multiple disabilities may exhibit a wide range of
characteristics, depending on the combination and severity of disabilities, and the
person's age. There are, however, some traits they may share, including:
 Limited speech or communication
 Difficulty in basic physical mobility
 Tendency to forget skills through disuse
 Trouble generalizing skills from one situation to another
 A need for support in major life activities (e.g., domestic, leisure,
community use, vocational)
 Visual impairment
Visual impairment refers to
Total blindness
 partial visual impairment or low vision.
It may be due to hereditary factors or because of any
infection, disease, head injury or pressure on optic nerve
or other retinal disease.
 
Blindness & Low Vision
A visual impairment is any visual condition that impacts an individual’s ability to
successfully complete the activities of everyday life.

Students with visual impairments are infants, toddlers, children and youths who
experience impairments of the visual system that impact their ability to learn.
Characteristics of Blindness & Low Vision
 Visual impairment is essentially an umbrella term used to describe the loss of
sight that can be a consequence of a number of different medical conditions.
 The onset, the severity, and the type of visual loss, as well as to any coexisting
disabilities that may be present in the child.
 Decreased visual acuity and visual field,
 Sensitivity to light or glare, blind spots in their visual fields, or problems with
contrast or certain colors.
Types of Blindness & Low Vision
According to the CDC and the World Health Organization the classification of visual
acuity and impairment includes (1, 2)
 Low visual acuity means vision between 20/70 and 20/400 with the best
possible correction, or a visual field of 20 degrees or less
 Blindness is defined as a visual acuity worse than 20/400 with the best possible
correction, or a visual field of 10 degrees or less
 Legal blindness in the US means visual acuity of 20/200 or worse with the best
possible correction, or a visual field of 20 degrees or less.
 Visual acuity of 20/70 to 20/400 (inclusive) is considered moderate visual
impairment or low vision.
 Causes of Blindness & Low Vision
 Presbyopia - difficulty focusing on objects that are close. This problem often
becomes noticeable in your early to mid 40s.
 Cataracts - cloudiness over the eye lens, causing poor nighttime vision,
halos around lights, and sensitivity to glare. Cataracts are common in the
elderly.
 Glaucoma - increased pressure in the eye, which is most often painless.
Vision will be normal at first, but over time you can develop poor night
vision, blind spots, and loss of vision to either side. Glaucoma can also
happen suddenly, which is a medical emergency.
Causes of Blindness & Low Vision
 Diabetic eye disease
 Macular degeneration - loss of central vision, blurred vision (especially
while reading), distorted vision (straight lines will appear to be wavy), and
colors that look faded. The most common cause of blindness in people over
age 60.
 Eye infection, inflammation, or injury
 Floaters - tiny particles drifting inside the eye, which may be confused with
retinal detachment.
 Night blindness
Causes of Blindness & Low Vision
 Retinal detachment - symptoms include floaters, sparks or flashes of light
in your vision, or a sensation of a shade or curtain hanging across part of
your visual field.
 Optic neuritis - inflammation of the optic nerve from infection or
multiple sclerosis. You may have pain when you move your eye or touch it
through the eyelid.
 Stroke or TIA
 Brain tumor
Causes of Blindness & Low Vision
 Bleeding into the eye
 Temporal arteritis - inflammation of an artery in the brain that supplies
blood to the optic nerve
 Migraine headaches - spots of light, halos, or zigzag patterns that appear
before the start of the headache
 Medications can also affect vision.
MCC
 Mentally Challenging
Mentally Challenging is different from mental sickness or
psychological functional disorders arising from worries, anxieties
and tensions that may lead to acute depression, neurosis,
psychosis or mental diseases like schizophrenia. Defining it as
what it is rather than what it is not would be preferable.
Mentally challenging (MC) is a condition diagnosed before
age 18, usually in infancy or prior to birth, that includes
below-average general intellectual function, and a lack of the
skills necessary for daily living.

 
 Types of Mental Retardation
1. Mild Retardation
 75% to 90% of all cases of retardation
 Function at one half to two thirds of CA (IQ: 50 to 70)
 Slow in all areas
 May have no unusual physical signs
 Can acquire practical skills
 Useful reading and math skills up to grades 3 to 6 level
 Can conform socially
 Can acquire vocational skills for self-maintenance
 Integrated into general society
Types of Mental Retardation
2. Moderate Retardation
 ~10% to 25% of all cases of retardation
 Function at one third to one half of CA (IQ: 35 to 49)
 Noticeable delays, especially in speech
 May have some unusual physical signs
 Can learn simple communication
 Can learn elementary health and safety habits
 Can participate in simple activities and self-care
 Can perform tasks in sheltered conditions
 Can travel alone to familiar places
 Types of Mental Retardation
3. Severe Retardation
 ~10% to 25% of all cases of retardation

 Function at one fifth to one third of CA (IQ: 20 to 34)

 Marked and obvious delays; may walk late

 Little or no communication skills but may have some understanding

of speech and show some response

 May be taught daily routines and repetitive activities
 May be trained in simple self-care

 Need direction and supervision

 Types of Mental Retardation
4. Profound Retardation
 ~10% to 25% of all cases of retardation

 Function at < one fifth of CA (IQ: < 20)

 Marked delays in all areas

 Congenital abnormalities often present

 Need close supervision

 Often need attendant care

 May respond to regular physical activity and social stimulation

 Not capable of self-care

Characteristics of Mental Retardation
 Motor Asymmetry
 Abnormal head size or shape
 Craniofacial malformation
 Loss or plateau of developmental skills
 Multiple somatic anomalies
 Neuro cutaneous findings
 Seizures
 IQ < 50
Causes of Mental Retardation
 Unexplained (the largest category)
 Trauma (prenatal and postnatal) such as oxygen deprivation before, during
or after birth
 Infection (congenital and postnatal)
 Chromosomal abnormalities
 Genetic abnormalities and inherited metabolic disorders
 Metabolic disorders
 Toxins such as lead or mercury poisoning
 Nutritional deficits such as severe malnutrition
 Environment
Characteristics of Mental Retardation
 Cytogenetic Studies
 Microcephaly
 Multiple (even minor) somatic anomalies
 Family history of mental retardation
 Family history of fetal loss
 IQ < 50
 Skin pigment anomalies (mosaicism)
Characteristics of Mental Retardation
 Metabolic studies
 Episodic vomiting or lethargy
 Poor growth
 Seizures
 Unusual body odors
 Somatic evidence of storage disease
 Loss or plateau of developmental skills
 Movement disorder (choreoathetosis, dystonia, ataxia)
 Sensory loss (especially retinal abnormality)
 Acquired cutaneous disorders
Models Of Disability
Medical model of disability

Charity model of disability

 Social model of disability

Rights-based model of disability

Medical model of disability

The medical model of disability relies on a purely medical

definition of disability. It thus equates the physical or mental
impairment from a disease or disorder with the disability
that the person experiences. From a policy viewpoint, the
person with disability is viewed as the “problem”, and in
need of cure and treatment. In terms of services, the general
approach within this model is towards special institutions
for people with disabilities, e.g. special schools, sheltered
workshops, special transport etc. The limitations of the pure
medical model are evident, though it underlies some current
analysis such as that based on disability-adjusted life years
(DALYs);
Charity model of disability

The charity model of disability also views the

person with disabilities as the problem and
dependent on the sympathy of others to provide
assistance in a charity or welfare mode;
 
Social model of disability
The social model of disability “places the emphasis
on promoting social change that empowers and
incorporates the experiences of PWD, asking society
itself to adapt”. Thesocial modelemphasizes
institutional, environmental and attitudinal
discriminations as the real basis for disability. Thus it
is the society at large which disables the person with
disabilities through discrimination, denial of rights,
and creation of economic dependency;
 
Rights-based Model Of Disability
The rights-based model of disability builds on the
insights of the social model to promote creation of
communities which accept diversities and differences,
and have a non-discriminating environment in terms
of inclusion in all aspects of the life of society.
 
THANKS