Handicapped Children,

Acts and Welfare measures

Dr. Meghana Narendran
Assistant Professor,
Dept. of Community Medicine,
SMCW, Pune
 Definition

"Handicap" may be defined as "reduction in a person's capacity to fulfil a

social role as a consequence of an impairment, inadequate training for the
role, or other circumstances.

Applied to children, the term usually refers to the presence of an impairment or

other circumstances that are likely to interfere with normal growth and
development or with the capacity to learn"
International Classification of Impairments,
Disabilities and Handicaps (ICIDH) :

• First published by WHO in 1980,

• this is an attempt to produce a systematic taxonomy of the consequences
of injury and disease.
• In the year 2001 , International Classification of Functioning, Disability
and Health (ICF, WHO 2001) was published.
 Impairment

An impairment is defined as "any loss or abnormality of psychological,

physiological, or anatomical structure or function". Impairments are

disturbances at the level of the organ and include defects, loss of limb,

organ or other body structure and defects or loss of mental function.

 Disability

A disability is defined as "any restriction or lack (resulting from an

impairment) of ability to perform an activity in a manner or within the
range considered normal for a human being".

The term disability reflects the consequences of impairment in terms of

functional performance and activity by the individual; disability thus represents
disturbances at the level of the person.
 Handicap

A handicap is defined as “a disadvantage for a given individual, resulting

from an impairment or a disability, that limits or prevents the fulfilment of a
role that is normal (depending on age, sex, and social and cultural practice) for
that individual”.

The term handicap thus reflects interaction with and adaptation to the
individual's surroundings.
Handicap may be intrinsic or extrinsic.

For example, blindness is an intrinsic handicap, and loss of parents is an

extrinsic handicap.

One handicap can give rise to further handicaps and the terms "primary"
and "secondary" are used to denote this relationship.

Blindness is a primary handicap; it can lead to poverty, which will be

secondary handicap.
Nearly 83 million of the world's population are estimated to be mentally
retarded, with 41 million having long-term or permanent disability.

It ranks fourth in the list of leading causes of disability. Hearing loss (41
decibels and above) over the age of 3 is estimated to affect 42 million
people, ranking 3rd in the list.

Disability resulting from poliomyelitis has affected about 10 million

people.
It is difficult to,

• state how many people are mentally retarded in India as the census
estimates do not cover mental handicap.

• About 16.15 million persons (1.9 per cent of the population) suffer from
some or the other physical disability in the country.

• About 3 per cent child population in 1-14 years age group is affected by
developmental delays.
 Classification

It is usual to classify handicapped children into the following groups :

1. Physically handicapped

2. Mentally handicapped

3 . Socially handicapped.
 Physically handicapped children
This category includes children who are blind, deaf and mute; those with
hare- lip, cleft palate, talipes; and the "crippled" - e.g., resulting from polio,
cerebral palsy, congenital heart disease, road accidents, burns, injuries, etc.
These conditions fall into three broad causative groups :
(a) birth defects (b) infections, and (c) accidents.
These are all preventable to a large extent through adequate prenatal, natal,
postnatal services, and genetic counselling.
 Mentally handicapped children

Mental handicap is the present term used for mental retardation.

It is a condition of sub-average intellectual function combined with deficits

in adaptive behavior.

Terms which were previously used such as idiot, moron and imbecile are
now discarded. At least 2 per cent of India's population is said to be suffering
from some kind of mental disability.
 Causes

Mental handicap has many causes. These may be genetic, or environmental

and include prenatal as well as postnatal causes.

The possible and earliest time to recognize the problem of mental retardation
is to look for any delayed milestones and development.
 The known causative factors include the
following :
(a) Genetic conditions : Down's syndrome, Klinefelter syndrome, PKU, Tay- Sach
disease, galactosaemia, microcephaly, congenital hypothyroidism involving
both single and multiple gene action and chromosomal abnormalities.

(b) Antenatal factors : These comprise neural tube defects, Rh incompatibility,

certain infections (e.g., rubella, cytomegalovirus, toxoplasmosis, syphilis).
Drugs and irradiation .
(c) Perinatal factors : These include birth injuries, hypoxia and cerebral palsy.

(d) Postnatal factors : Head injuries, accidents, encephalitis, physical and

chemical agents such as lead and mercury poisoning may result in mental
retardation.

(e) Miscellaneous : Maternal malnutrition, protein-energy malnutrition, iodine

deficiency (endemic goitre). consanguineous marriages, pregnancy after the
age of 40 (late marriages) are all known to be associated with mental
retardation.
 Categories of mental retardation

• Psychologists have used the concept of IQ to classify the degree of mental

retardation. The IQ scores rest on the assumption that intelligence distribution in
the general public follow the normal or Gaussian curve, with a mean of 100.

• The half of the general population achieve scores above 100, and one half below.
• The lower 3 per cent or so of the population achieve scores of 70 or less. They
are usually considered to be mentally retarded.
 The WHO gave the following classification
of mental retardation :
• Mild mental retardation IQ 50- 70
• Moderate mental retardation IQ 35- 49
• Severe mental retardation IQ 20- 34
• Profound mental retardation IQ under 20
• Children scoring above 70 are no longer described as mentally handicapped.
• The number of mild cases far exceed the severe and profound cases.
• English statistics which have been widely quoted suggest that, among 100
mentally handicapped persons, the following proportion will be found : 70
mild, 20 moderate and 5 severe cases.

• In other words, a very great majority of cases of mental handicap are of

the mild type and potentially capable of being taught to make a fairly
adequate social adaptation in appropriate circumstances.
• Severe mental retardation is uncommon.
• The great majority of severely handicapped children remain more or less
dependent throughout life.

• Mental retardation often involves psychiatric disturbances.

• It has been stressed that the IQ range suggested must not be applied too
rigidly.

• IQ level is not necessarily constant during the individual's life span.

 Socially handicapped children

A "socially handicapped child" may be defined as “a child whose

opportunities for a healthy personality development and a full unfolding
of potentialities are hampered by certain elements in his social
environment such as parental inadequacy, environmental deprivation
(i.e. lack of stimulation of learning process) and emotional disturbances”.
Such children would include children who are orphaned either due to death

or loss of parents; neglected and destitute children; those who are

exploited or victimized; and, delinquent children.

It may be pointed out that a child who is physically or mentally handicapped

also meets with social handicaps to the extent to which he is subject to social

rejection or misunderstanding and cannot make use of the normal value of

social fulfilment.
International Classification of Functioning,
Disability and Health (ICF)
Like ICD-10, ICF is a core classification in the WHO-FIC, where ICD-10 provides
users an etiologic framework for classification of disease, disorder and other health
conditions, ICF classifies functioning and disability associated with health
conditions.

ICD-10 and ICF are complementary classifications and WHO encourages users to use
both systems together to create a broader and more meaningful picture of health of
individuals and populations.
• Developed by WHO, ICF represents a revision of the International
Classification of Impairment, Disability and Handicaps (ICIDH).

• The focus of ICIDH was consequences of disease whereas focus of ICF is

"components of health".

• ICF is a classification of health and health related domain that describe

body function and structure, activities and participation.

• Since an individual's functioning and disability occur in a context, ICF is a

tool for measuring functioning in society no matter what the reason for
one's impairment.
 The model of ICF

Two major model of disability have been proposed.

• The medical model views disability as a feature of the person, directly

caused by disease, trauma or other health conditions; which requires
medical care provided in the form of individual treatment by professionals.

• The social model of disability, on the other hand, sees disability as a

socially created problem and not at all an attribute of an individual.
On the social model, disability demands a political response, since the
problem created by an unaccommodating physical environment brought
about by attitude and other features of the social environment.
 Components of ICF

The ICF framework consists of two parts:

a. Functioning and disability

b. Contextual factors
a. Functioning and disability includes :

• - Body function and structure - describes actual anatomy and

physiology/psychology of human body.

• - Activity and participation - describes the person's functional status,

including communication, mobility, interpersonal interactions, self-care,
learning, applying knowledge, etc.
 b. Contextual factors includes :

• - Environmental factors - factors that are not within the person's control,
such as family, work, government agencies, laws, and cultural beliefs.

• - Personal factors - include race, gender, age, educational level, coping

styles. etc.
ICF is used by persons with disability and professionals alike to evaluate

health care settings that deal with chronic illness and disability, such as

rehabilitation centres, nursing homes, psychiatry institutions and

common services.
 Approaches to Prevention

One of the objectives of Mother and Child Health Services is the prevention

of handicapping conditions, and the early management of illness to prevent

crippling sequelae.
 Primary Prevention

• (a) Genetic counselling

• (b) At-risk approach
• (c) Immunization
• (d) Nutrition
• (e) Others
 Secondary Prevention

• (a) Early diagnosis of handicap

• (b) Treatment
• (c) Training and education – Vocational guidance
In India, there are over 150 schools and institutions for the
handicapped.
The following are some of the important ones :
(1) Occupational Therapy School, Mumbai;
(2) Physical Therapy School, Mumbai;
(3) Occupational Therapy School, Nagpur;
(4) All India Institute of Physical Medicine and Rehabilitation, Mumbai;
(5) Institute of Physical Medicine and Rehabilitation, Christian Medical College,
Vellore; and
(6) Occupational Therapy College, New Delhi. Beside these, there are schools
for the blind, deaf, and special hospitals and wards for crippled children.
Institutional care of the handicapped children is being replaced by

various social support measures and services, enabling families to

assume a larger share of rehabilitation within the family cycle.

The mentally handicapped children can be helped to reach their optimal

capacity through attention to the following :

(a) they should get love and warmth, patience and tolerance, besides

discipline.

(b) their natural potentials should be identified, and the child must be

helped to develop in that direction in all possible manner.

 The Rights of Persons with
Disabilities Bill - 2016

• Disability has been defined based on an evolving and dynamic concept.

• The types of disabilities have been increased from existing 7 to 21 and the

Central Government will have the power to add more types of disabilities.
 The 21 disabilities are given below:
• 1. Low-vision
• 2. Leprosy cured persons • 12. Chronic neurological conditions
• 3. Blindness • 13. Specific learning disabilities
• 4. Hearing impairment (deaf and hard of • 14. Multiple sclerosis
hearing)
• 15. Speech and language disability
• 5. Locomotors disability
• 16. Thalassemia
• 6. Dwarfism
• 17. Haemophilia
• 7. Intellectual disability
• 18. Sickle cell disease
• 8. Mental Illness
• 19. Multiple disabilities including deaf blindness
• 9. Autism spectrum disorder
• 20. Acid attack victim
• 10. Cerebral palsy
• 21 . Parkinson's disease
• 11. Muscular dystrophy
• Speech and language disability and specific learning disability have
been added for the first time. Acid attack victims have been included.
Dwarfism. muscular dystrophy have has been indicated as separate class
of specified disability.

• The new categories of disabilities also include three blood disorders,

thalassemia, hemophilia and sickle cell disease.

• In addition, the government has been authorized to notify any other

category of specified disability.
Responsibility has been cast upon the appropriate governments to take
effective measures to ensure that the persons with disabilities enjoy their
rights equally as others.
 Conclusion

• In considering the management of the socially handicapped child , we must

remember that such children are normal in their needs and development.

• Their needs should be identified and met.

• The children Act, 1960 provides for the "care, protection, maintenance,
welfare, training, education and rehabilitation of the socially
handicapped children.
• Lastly, we need to strengthen the family.
• There were times when the handicapped child was considered a liability to
the parents and to the society.

• The family is the most effective bulwark to prevent children from

becoming socially handicapped.

• All over the world, there is an awakening that handicapped children can
and must be helped to make their lives as happy and useful as possible.
 MCQ’s
1. Which is not the definition of disability as seen by the Human Rights and
Equal opportunity Commission (1994) ?
a) Loss of physical or mental function
b) Loss of a part of the body
c) Any condition which affects a persons thought processes
d) Emotional stress
2. The term mental retardation is replaced with which
term?

a) Intellectual disability
b) Mental weakness
c) Intellectual backwardness
d) Intellectual disadvantage
 Take home Questions (Saq’s)

1. What are the causes of mental handicap?

2. Primary prevention of disabilities in Handicaps.

Thank You