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A Child with
disability
Dr: Awatif Abushhiwa
Tripoli-childrens hospital

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Objectives

To define the terms : impairment, disability and

handicapped.

To list common conditions.

To understand how the different problems tend to

present at different age.

To asses a child with disability.

To break news to parents about disability

To outline the management

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Definitions

Disorder: maledevelopment of a skill (a medically definable

condition or disease entity ).

Impairment: any loss or abnormality of psychological,

physiological, or anatomical structure or function.

Disability: any restriction or lack( resulting from an

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

delay: implies slow acquisition of all skills ( global delay) or

area of skill ( specific delay)

Learning difficulty: used in relation to children of school age

& may be cognitive, physical or both

Handicap : a disadvantage from a disability which limits

or prevents fulfillment of a normal role.

Difficulty & disability are often used

instead the term of Handicap

Child

with special needs

are often used instead
of child with disability

the Pattern of abnormal

development
Categories of ( global or specific delay ) :
Slow but steady

Plateau effect

Showing regression

categories according to severity :

Moderate

Mild

Sever
Profound

Figure 1.1 pattern of abnormal development, these may be slow

but steady, plateau or regression

Figure1.2 for children with abnormal development, the gap between

their abilities and what is normal widens with age

+ Table 1.1 Presentation of neurodevelopmental

concerns by age

Prenatal

Positive family history e.g

affected sibling or family
member , ethnicity ,
antenatal U\S ,
amniocentesis

Perinatal

Birth asphyxia, neonatal

encephalopathy, preterm with
IVH

Infancy

Global developmental delay,

neurocutaneous \dysmorphic
features

Preschool

Speech &language delay ,

abnormal gait , loss of skills

School age

Problems with balance &

coordination
Learning difficulties ( dyslexia,
dyspraxia ), attention ,
hyperactivity

+ conditions which cause developmental

delay & learning difficulties
Prenatal

cause :

1) Genetic :

chromosomal & DNA disorders e.g. Downs syndrome & fragile X

syndrome.

2) metabolic : hypothyroidism, phenylketonuria

3) teratogenic: alcohol & drug abuse

4) congenital infection: Rubella, cytomegalovirus, toxoplasmosis

5) neurocutaneous syndrome: Tuberous sclerosis,

neurofibromatosis

Perinatal

cause:

1) extreme prematurity:
IVH\ periventricular leucomalacia

2) birth asphyxia
hypoxic ischemic encephalopathy

3) metabolic symptomatic
hypoglycemia, hyperbilirubinaemia

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Postnatal

cause;

1) infection:
meningitis, encephalitis

2) anoxia
near drowning, seizures , suffocation

3) trauma
head injury (accidental or non accidental )

4) metabolic
hypoglycemia, inborn errors of metabolism
Other : unknown ( 25%)

Global

developmental delay usually

present in the 1st two years of life

causes Specific developmental delay

Abnormal motor development ( presents between

6 months & 2 years ) causes :

Cerebral palsy

Congenital myopathy/ primary muscle disease

Spinal cord lesions e.g. spina bifida

Figure 1.3 normal milestones & pattern of abnormal motor development

Cerebral palsy is the commonest cause of developmental problems
shown

+Abnormal speech & language

development

Delay may be due to :

Hearing loss

Global developmental delay

Difficult in speech production from anatomical deficit

e.g. cleft palate or oromotor incoordination e.g. CP

Environmental deprivation / lack of opportunity for

social interactions

Normal variant/ familial pattern

Hearing impairment

Sensorineural caused by a lesion in the cochlea or

auditory nerve its usually present at birth ( may be
profound > 95 dB hearing loss )

Conductive from abnormalities of the ear canal or

the middle ear e.g. otitis media with effusion
( maximum of 60dB hearing loss )

Any child with poor or delayed speech or

language must have their hearing assessed

Speech & language disorders

Language comprehension ( receptive dysphasia)

Language expression ( expressive dysphasia )

Phonation & speech production (e.g.

dysfluency,dysathria, dyspraxia)

Pragmatics ( difference between sentence meaning &

speakers meaning )

Social /communication skills( e.g. autistic spectrum

disorder)

Abnormalities of vision
Visual impairment may present in infancy with:

Loss of red reflex ( cataract)

A white reflex in the pupil e.g. ( cataract ,

retinoblastoma, retinopathy of prematurity )

Not smiling ( at age 6 weeks)

Lack of eye contact with parents

Visual inattention

Random eye movements

Nystagmus

Squint

Figure 1.4 normal red reflex & loss of red reflex

Figure 1.5: types of Squint

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Causes of visual impairment

e.g. Cataract, retinoblastoma, retinal dystrophy

Antenatal & perinatal

E.g. Congenital infection, retinopathy of prematurity,

optic nerve hypoplasia, HIE

Genetic :

Postnatal

e.g. trauma, infection, juvenile idiopathic arthritis

How to assess a child with disability

Investigations

Cytogenetic : *chromosome karyotype e.g. fragile X

syndrome, DNA fish analysis e.g. for chromosome

7,12,22 deletions

Metabolic:* Thyroid function test , LFT , U\E, bone

chemistry , plasma amino acids , creatine kinase , blood
lactate , VLCFA, ammonia, blood gases, lysosomal
enzymes, urine amino& organic acids , urine
mucopolysaccharides, urine reducing substances ,
maternal amino acid for raised phenylalanine

Infection: congenital infection screen

Investigations
Imaging : cranial ultrasound in newborn
CT& MRI brain scans
skeletal survey

Neurophysiology: EEG , NCS, EMG

Histopathology / histochemistry :

Other: *hearing , *vision , clinical genetics , cognitive

assessment , therapy assessment, child psychiatry , nursery &
school reports

nerve & muscle biopsy

Slow acquisition of cognitive skills

/general learning difficulty
is preferred to mental retardation

Learning difficulty
or mental handicap

Learning difficulties are classified as:

Moderate( IQ 50-70)

Mild ( IQ 70-90)

Severe (IQ 20-50)

Profound ( IQ less than 20)

Specific learning disorders:

Dyspraxia ( developmental coordination disorder ) e.g.

handwriting whichs typically awkward & messy ,
dressing , cutting up food , messy eating

Dyslexia is a disorder of reading skills

Dyscalculia & dysgraphia : are disorders in the

development of calculation or writing skills

Examples

Impairment( abnor
mal organ function)

Disability ( activity
limitations)

Handicap
( participation
&restriction )

Cataract

Inability to read or
move around

Exclusion from school

Delayed speech&
language
development

Inability to speak
clearly enough to be
understood

Defective
communication with
others

Motor deficit
imbalance or joints
stiffness

Inability to activities
of daily living such as
dressing , walking &
feeding

Dependence &
immobility

How to break news to parents

about disability

1.Initial approach to the parents (Introduces yourself)

2. Looks to parents comfort and privacy

3. determines what they already knows

4. Establishes their outlook on the situation

5. Warns them that bad news is coming

6. Breaks the bad news

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7. Gives them time to respond:

shock-psychological& feelings of grief
reaction-feelings of anger &denial
adaptation-parents seek out ways of helping the
child
Orientation-parents being actively to plan a head

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8. Encourages her to express her emotions

9. Empathises with their emotions

10. Seeks to address those concern

11. Ensures that there is someone with her when she

leaves

12.Thanks

Management

Multidisciplinary approach in child with special needs

Multidisciplinary approach
Respiratory
Gastrointestinal
Hearing

Vision
orthopedi
c
Special health
visitor

Neurologica
l
Behavio

r
Speech &language therapist
Occupational therapist
Physiotherapist

Dietician
Social worker/social service
Psychologist ( clinical & educational)

Pediatrician

Not all disable people are stupid the worlds smartest is disabled

Thank you