Free AIOU Solved Assignment Code 673 Spring 2023
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Course: Handicapped Person in the Community (673)
Semester: Spring, 2023
ASSIGNMENT No. 1
Q.1 a) Discuss the general views of disability. Explain the current professional definitions and functional definitions of disability.
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 .
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 . 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 . Later, assistance programs such as the 1920 Civil Vocational Rehabilitation Act  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 , “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” . 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 . 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” .
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 . 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” . 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 . 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 . 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 .
- b) Describe the special educational needs and curriculum requirements.
All children and young people may experience learning difficulties at some point. This is not unusual. For most children the difficulties are temporary and are soon overcome with help and encouragement from home and school.
The term ‘Special Educational Needs’ is used to describe learning difficulties or disabilities that make it harder for children to learn than most children of the same age. Children with Special Educational Needs (SEN) are likely to need extra or different help from that given to other children their age. This help is known as special educational provision.
Children are not considered to have SEN just because their first language is not English, although some children for whom English is not a second language may also have learning difficulties.
Children may have difficulties in one or more areas. Here are some examples:
- Thinking, understanding and learning: these children may find all learning activities difficult, or have particular difficulties with some learning activities such as reading and spelling.
- Emotional and behavioural difficulties: these children may have very low self-esteem and lack confidence. They may find it difficult to follow rules or settle down and behave properly in school.
- Speech, language and communication: these children may have difficulty in expressing themselves or understanding what others are saying to them. They may find it hard to make friends or relate to others. They may find it difficult to make sense of the world around them or to organise themselves.
- Physical or sensory difficulties: these children may have a disability or a medical condition that has an impact upon their learning. They may have a visual or hearing impairment.
What happens if a child has SEN?
The first and most important thing to remember is that all children with SEN are entitled to receive a broad, balanced and suitable education which includes the Early Years Foundation Stage Curriculum (for children aged 3 to 5) or the National Curriculum (for children aged 5 to 16).
Most children with SEN have their needs met in a mainstream school or early settings, although some children with more complex needs benefit from the more specialist help offered in a ‘special’ school.
You should be told if the school thinks your child has or may have SEN and how the school will be helping your child. Your views are very important and so are your child’s own views. The school should make sure that you are involved in all decisions that affect your child because you have a vital role in supporting your child’s education.
The Special Educational Needs and Disability Code of Practice: 0 to 25 years (2015; pages 97-98) outlines four ‘broad areas of need’ which should be planned for. These are:
- communication and interaction
- cognition and learning
- social, emotional and mental health difficulties
- sensory and / or physical needs.
The Code of Practice acknowledges that individual children or young people often have needs that cut across all these areas and that their needs may change over time.
- specific learning difficulty
- moderate learning difficulty
- severe learning difficulty
- profound and multiple learning difficulty
- social, emotional and mental health
- speech, language and communication needs
- hearing impairment
- visual impairment
- multi-sensory impairment
- physical disability
- autistic spectrum disorder
- other difficulty
- SEN support but no specialist assessment of type of need.
Schools may record pupils as having two areas of special need from this list, but must record one of the above needs as the pupil’s most significant, or primary, need.
The data on pupils’ SEN from the census is used to ensure accurate targeting of funding and in the monitoring and development of SEN policy.
As set out in Section 20 of the Children and Families Act 2014, a child or young person does not have a learning difficulty or disability solely because the language in which he or she is or will be taught is different from a language which they speak at home.
In early years settings, school and colleges, a member of staff is designated to oversee special educational needs (SEN) provision. This role is both strategic, in terms of developing SEN policy and provision, and operational, in terms of day-to-day coordination within a school / education setting.
In early years settings and schools, the role is usually known as the special educational needs coordinator (SENCO), but may also be known as the special educational needs and disabilities coordinator (SENDCO), or the Inclusion Coordinator. In further education colleges, the coordinator is known as the ‘named person’.
SENCOs in early childhood education and care
The role of the special educational needs coordinator (SENCO) in early childhood education and care involves:
- ensuring that all practitioners in the setting understand their responsibilities towards children with special educational needs (SEN), and the setting’s approach to identifying and meeting SEN;
- advising and supporting colleagues;
- ensuring parents are closely involved and that the setting takes their insights into consideration;
- liaising with professionals or agencies beyond the setting.
Under the Children and Families Act 2014, maintained nursery schools must ensure that there is a qualified teacher designated as the SENCO. Voluntary and private early years providers receiving government funding are also expected to have arrangements in place for meeting children’s SEN, which may involve identifying a SENCO.
For statutory guidance on the role of the SENCO in early years provision, see pages 88-9 of the 2015 Special Educational Needs and Disability Code of Practice: 0 to 25 years.
SENCOs in schools
The role of a special educational needs coordinator (SENCO) includes:
- determining the strategic development of special educational needs (SEN) policy and provision, alongside the headteacher and governing body of the school;
- day-to-day responsibility for the coordination and operation of SEN policy;
- providing professional guidance to colleagues;
- working closely with staff, parents and other agencies (including other educational institutions, health care professionals and voluntary bodies);
- tracking and recording the progress of all SEN pupils and ensuring that they are appropriately supported in class.
Designation of a SENCO in a maintained school or academy is a requirement under the Children and Families Act 2014. The member of staff appointed must be a headteacher (or acting headteacher), or a qualified teacher working at the school who has completed his / her induction period. This requirement is determined by The Special Educational Needs and Disability Regulations 2014, which also require a newly appointed SENCO to achieve a postgraduate National Award for Special Educational Needs Coordination within three years of appointment.
AIOU Solved Assignment Code 673 Spring 2023
Q.2 Explain the attitudes and reactions of parents towards disability. How could a change in societal attitude be carried out?
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 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 (77,235 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).
AIOU Solved Assignment 1 Code 673 Spring 2023
Q.3 Describe parameters for classification 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. 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).
The level of impairment ranges in severity for each person. Some of the early signs can include:
- 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
- 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
In early childhood, mild ID (IQ 50–69) may not be obvious or identified until children begin school. 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. 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. 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. 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.
Among children, the cause of intellectual disability is unknown for one-third to one-half of cases. About 5% of cases are inherited from a person’s parents. Genetic defects that cause intellectual disability, but are not 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. Velocardiofacial syndrome and fetal alcohol spectrum disorders are the two next most common causes. However, there are many other causes. The most common are:
- 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 (23q13del), Mowat–Wilson syndrome, genetic ciliopathy, and Siderius type X-linked intellectual disability (OMIM: 300263) as caused by mutations in the PHF8 gene (OMIM: 300560). 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.
- 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.
AIOU Solved Assignment 2 Code 673 Spring 2023
Q.4 Discuss the developmental assessment in people with profound retardation and Multiple Impairment.
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.” 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 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.
AIOU Solved Assignment Code 673 Autumn 2023
Q.5 Write notes on the following:
- a) Behavioural testing of hearing
We may use a combination of behavioral and physiologic measures to assess the hearing/auditory status of infants and children.
- Behavioral hearing tests include behavioral observation, visual reinforcement, conditioned orientation response, conditioned play, and conventional audiometry, as well as speech audiometry.
- Physiologic auditory tests include acoustic immittance measures (for example, tympanometry, acoustic reflexes), Auditory Brainstem Response (ABR – including sedated and unsedated/infant ABR for hearing threshold assessment), and Otoacoustic emissions (OAE).
Please note: At this time, the Pediatric Audiology Program does not offer auditory processing evaluations. Please contact us to find a center that offers this specialized testing.
Behavioral hearing tests
During behavioral hearing tests, the child (and typically the parent) is seated in a sound booth. Sounds of varying intensity are presented to the child via calibrated speakers or earphones. The sounds may consist of speech or music as well as specific frequencies that are critical to access (hear) the different sounds of speech. The audiologist looks for and records the child’s responses to the softest sounds presented and plots them out on a graph called an audiogram.
|Behavioral Observation Audiometry (BOA) – The child’s responses may consist of quieting, eye widening, startle, etc.||0 to 5 months|
|Visual Reinforcement Audiometry (VRA) – The child turns to the sound stimulus and a puppet lights-up to reward (reinforce) the child’s listening behavior.||6 months to 2+ years|
|Conditioned Orientation Reflex (COR) Audiometry – This test is the same as VRA, but multiple sound sources and puppet reinforcers are used. Many parents describe it as a “sound finding game.”||6 months to 2+ years|
|Conditioned Play Audiometry (CPA) – A listening game that uses toys to maintain the child’s attention and focus to the listening task. For example, the child holds a block, waits and listens for the sound. When the child hears the sound, they drop the block in a bucket. This is no different than raising one’s hand in response to the sound, but the toys establish and maintains the child interested in the listening task for much longer than hand-raising alone. This “listening game” is demonstrated to the child by the audiologist, and once the child understands the game testing is underway.||2+ years|
|Conventional Audiometry – The child raises hand or provides verbal response (for example, “beep”, “I hear it”) in response to the sound stimulus.|
Physiologic auditory tests
Physiologic auditory tests are not direct measures of hearing. Instead, they measure auditory function. Some of these tests, however, are correlated with difference degrees of hearing or hearing loss.
- Tympanometry (tympanogram) – This type of acoustic immittance test assesses the health of the middle ear system and takes about three to five seconds. A small probe tip is placed in the ear canal. Sound is presented and recorded. A computer plots the movement of the eardrum by measuring the amount of sound reflected back. It is not painful, but does feel a little stuffy for a few seconds.
- Acoustic reflexes – Another type of acoustic immittance test, this test assesses the integrity of a neural loop from the inner ear to the brainstem and back to the middle ear system. The same probe tip assembly is used in this test as is used in tympanometry.
- Otoacoustic emission (OAE) – This test assesses the outer hair cell function in the inner ear (cochlea). It takes about three minutes per run. A probe tip is placed in the ear canal. Sounds are presented and an elicited response recorded. The response is very faint so the child must be extremely quiet during the test. Because the response is so faint, it may be obscured by the presence of ear wax, middle ear pathology (for example, fluid, pressure) or the presence of pressure equalization (PE) tubes.
- Auditory Brainstem Response (ABR) – This is an electrophysiological test. It is used in two ways: to assess auditory nerve function and to estimate hearing levels. Sounds are presented through an earphone while three small surface electrodes (one on or behind each ear and one usually placed on the forehead) pick up the response to sound from the inner ear (cochlea) and auditory nerve. A computer averages the auditory responses and the audiologist interprets the results. Usually, the results are shared with the family immediately following the test. The test is not uncomfortable to the patient.When this test is used to estimate hearing levels for children six months and older, sedation is required for ABR recording. Sedation is not used for infants from birth through age six months. Sedation is determined and monitored by the CHaD PainFree Program anesthesia team. On the day of the ABR test, the child is also seen by the otolaryngology (ear, nose, and throat) staff to determine if the ears are “clear” (for example, free of wax, middle ear fluid/infection) just prior to testing.
- b) Conceptual models of family influence
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 together . 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.