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This content is taken from the London School of Hygiene & Tropical Medicine, International Centre for Evidence in Disability & Fundação Oswaldo Cruz (Fiocruz)'s online course, Integrated Healthcare for Children with Developmental Disabilities. Join the course to learn more.

Skip to 0 minutes and 11 secondsISLAY MACTAGGART: So far this week, we have concentrated on learning more about common developmental conditions and the types of impairments that children with developmental conditions may experience. Now we will consider how developmental conditions and impairments contribute to a broader concept, developmental disability. We will begin by exploring common frameworks of disability in general and then consider developmental disability specifically. Historically, disability has meant different things to different people and can be a tricky term to clearly define. A common way that people have thought about disability in the past was to use a medical approach. With the medical model, a child is seen as being disabled because they have something, and I quote, "wrong with them" due to a health condition.

Skip to 0 minutes and 57 secondsAn example of this is describing all children with autism as disabled or all children with vision impairment as disabled. The primary concern with this approach is that children and adults with the same health condition may have very different experiences as to how this impacts on their lives. For example, consider two children with a severe hearing impairment. One child may receive speech and language therapy and assistive devices to support them, improving their ability to attend mainstream school, have friends, get a job, and so on. In contrast, another child with the same level of hearing impairment who hasn't received these supports may find it very challenging to learn in a mainstream school, and this will have lifelong impacts.

Skip to 1 minute and 37 secondsIn this way, the medical model doesn't recognise the role of the environment or external factors in excluding a child with a disability. In the next step, we will hear more about the social model, which was developed as a response to the medical model. The social model views disability as being due to society's failure to respond to the needs of children with an impairment. A child may have limited opportunities to attend and learn in school not because of his or her impairment but because the education system doesn't support his or her learning needs.

Skip to 2 minutes and 7 secondsThis can include physical inaccessibility, no ramps or accessible toilets in school for children with physical impairments, learning materials not being available in a way that supports children with visual, hearing, or intellectual impairments, or stigmatising attitudes of teachers or peers towards children with impairments. However, through a focus only on societal barriers, the model does not give enough attention to the role of the individual's impairment in their disability. For example, providing a ramp for a child in a wheelchair will not alleviate chronic pain that they might experience in their joints.

Skip to 2 minutes and 41 secondsPutting these different components together, a common way of viewing disability today, is the International Classification of Functioning, Disability, and Health, otherwise known as the ICF and launched by the World Health Organisation in 2001. Now this may look overwhelming, but let's go through it together. According to the ICF, a health condition can lead to an impairment. For instance, meningitis can lead to hearing impairment. This can lead to functional limitations, for instance, difficulty in hearing, speaking, and communicating. These functional limitations can then restrict full participation in aspects of society like having friends or being able to go to school and, therefore, result in exclusion and disability. This model, therefore, recognises three levels

Skip to 3 minutes and 28 secondsin which a child can experience a developmental disability: at the level of the body in terms of their health condition and impairments, at the level of the child in terms of functional limitations, and at the level of society in terms of the participation restrictions. The model also shows us that the impact of the impairment on disability is not inevitable but influenced by different factors, for example, environmental factors such as the access to assistive devices or rehabilitative therapies and personal factors such as wealth or social support. Here's another example. Autism spectrum disorder is a condition characterised by impairments in social functioning, communication, and behaviour.

Skip to 4 minutes and 11 secondsImpairments in attention and function can make it difficult for children to focus their attention and make decisions. This can present challenges when trying to learn the skills needed to live independently. However, other factors such as early intervention with an occupational therapist or personal factors such as the child's support network can improve skills in attention, function, and decision making minimising participation restrictions. The ICF, therefore, combines aspects of the medical and social models and is the prevailing model for disability used globally that we will use when discussing developmental disability throughout this course.

Disability: a framework

As we’ve heard previously, we can think of developmental disability as comprising three components: the condition, the impairment and the disability.

We’ve now learned a little more about conditions and impairment, so let’s consider how these contribute to the experience of disability.

Disability is a complex term that people describe in different ways. In this step, Dr. Islay Mactaggart explains disability in the context of children with developmental disabilities. Dr. Mactaggart provides an overview of past and prevailing frameworks for understanding and describing disability. This includes the medical model, the social model and the International Classification of Functioning, Disability and Health, otherwise known as the ICF.

Dr. Mactaggart is an Assistant Professor in Disability and Global Health at the International Centre for Evidence in Disability and the International Centre for Eye Health at LSHTM.

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Integrated Healthcare for Children with Developmental Disabilities

London School of Hygiene & Tropical Medicine