People with Intellectual Disabilities and Complex Needs - Essay Example

Concept of Healthcare for Children and Adults with Intellectual Disabilities and Complex Needs Health of People with Intellectual disabilities and Complex Needs One of the basic aims of human survival is to enjoy good health. Health as a term implies an explicit meaning of maintaining a good physical health. But a deeper understanding of the word presents a concept which is holistic in nature. A person can be termed as to be in good health when he is physically, mentally and emotionally healthy. These three terms are interdependent. Good physical health of a person indicates the normal structure, development and physical functioning of all the organs in the human body with respect to his age. Even if he acquires any disease and if that can be cured fully, he restores his normal health. The state of illness was only temporary. But being physically healthy alone does not guarantee a person to have sound mental or emotional health. Mental health of an individual indicates the cognitive development appropriate to the age. The mental development of a child differs vastly with that of an adult. But the basically cognitive development includes five major intellectual functions. The ability to perceive things in their true context, comprehending skills (ability to understand what they see), analyze (think), decision making (judging) and capacity to remember. The degree of these skills may vary from person to person. But these should have developed to the extent that the individual is able to lead life on his own with acceptable social behaviours. Then he can said to be having a good mental health. Similarly emotional health of a person indicates acceptable or harmless emotional responses to different situations and an ability to express him clearly even in difficult situations. So it is important to have good physical, mental and to an extent emotional health to enjoy life. As mentioned earlier a person with good physical health may or may not have sound mental health whereas in vast majority of cases people who have problem in mental development also show physical disabilities. Mental disorders are found to cause other related physical discomforts making it difficult for them to lead a normal life. These people need early intervention, education, training and support to lead a normal life. People with reduced cognitive abilities are said to have intellectual disabilities. Intellectual disability (here in after referred to as ID) can be broadly defined as the inability or reduced ability to learn or understand any new skill (sub average intellectual functioning), Function independently (defects in adaptive behaviour) and is manifested during the initial development years. It generally has an adverse effect on the overall development of the individual. In majority of the cases, children are born with intellectual disabilities and in a few cases it is acquired at a later stage. For example elder people may develop some intellectual disorders due to accidents or ageing. For children born with intellectual disabilities, the causes may be either pre natal or post natal. In pre natal cases disability may happen due to genetic factors(e.g.-Down’s syndrome), abnormal development ( mental retardations) or infections (side effects of any medication, alcoholism) acquired by the mother during pregnancy. Complications during birth also result in intellectual disorders. Post natal causes are due to infections, side effects of medication or accidents. Generally children with Down’s syndrome, fragile X, cerebral palsy, mental retardation, autism etc. come under the intellectually disabled group .Due to the awareness of parents and health care workers and advancements in the medical field, those children who receive proper intervention, training and health care services at an early stage continue to grow as adults who can have a better quality of life than those who have not received any services at all. Even as adults they continuously need health care services like any normal people but the frequency and the regularity should be more. The concept of health care to these children with intellectual disabilities covers a wide range of services. It should aim at helping them to realize their full potential to lead a normal good quality of life to the extent possible. It includes educational, social and healthcare services. The most important and foremost is the early diagnosis and intervention. Children with severe and profound intellectual disorders can be easily identified due to the physical features. For example children having Down’s syndrome have distinct physical features- small mouth, thick eyelids with small slanting eyes, shorter hands with broader palms, space between first and second toe etc. Though these children can easily be identified, it requires a lot of efforts from the parents and the support staff to help them.Children with mild or very mild intellectual disability mostly does not show any abnormal physical features. Their problems come to the fore only when they go to school and their reduced ability to pay attention, grasp or retain information differentiate them from the normal children. These children should also be properly tested and diagnosed to asses the extent of the disability and to devise a correct rehabilitation program to help them realize their full potential. Not all intellectually disabled people exhibit same characteristics and the degree of disorder varies from individual to individual. Earlier, to find out the extent of intellectual function, intelligence quotient tests were used as a measure. But now based on the nature of disability, response shown by the person to training and treatment and the ability adapt, children with intellectual disorders are grouped in to mild, moderate, severe and profound. If the IQ of the child is found to be below 20, it is profound disability, IQ between 20 -35 as severe, IQ between 36-51 as moderate and IQ up to 70 as mild. A normal person possess IQ above 85 and the children whose IQ fall between 70 -85 are termed as slow learners. Many of the intellectual disorders also affect the normal physical development of children and result in any form of physical handicap ranging from immobility in severe cases to sensory impairments and also behavioral problems. Classification of persons with ID in to mild, moderate and severe helps the healthcare personnel to devise the appropriate program to optimize their potential. Children who are classified as having mild intellectual disabilities but normal physical development can be put in to regular school. These children along with slow learners are capable of learning the regular academic curriculum but at a slower pace compared to the normal children. Teachers and parents should take care not pressurize these children to meet the expectations of a general class room. If allowed to learn at their own pace and with proper support these children grow in to normal individuals capable of leading their lives on their own. Children who are classified as moderate can not be sent to regular schools but to special schools meant for them. Here they should be taught basic day today living skills like bathing, eating, maintaining self hygiene, wearing dress, toilet training etc. With repeated practice they are able to take care of their own needs. These children can be taught to count, alphabets (to read and write simple words and sentences) and to sing. Some of these children can help their peers too. But more attention should be paid to increase their vocabulary and to teach them some vocational skills. As discussed later in this paper, these children may have some associated physical discomforts which should be taken care of. With supervision and a little support the quality of life of these children can be improved and as adults they don’t become a major burden. All children with profound and many with severe intellectual disabilities cannot perform their basic needs on their own. Still they should be trained to attend their basic needs. Many of them are on life support systems and need external help to take care of their day to day needs. The advancements in medical technology and the invention of new drugs have helped to lessen their physical pain or suffering and to improve their longevity. But the stress carried by the parents or caregivers of these persons is enormous. Generally children and adults having ID are found to have certain common symptoms and conditions like psychiatric disorders ( depression, mood swings, lack of self esteem etc), epilepsy ( which is a major cause of concern), sensory impairments ( hearing impairment, speech defects, vision problems) and dental diseases( due to poor oral hygiene). Children with ID are termed as normal children but with a reduced ability to learn and the rate of learning is also slow when compared to their age group peers. But having ID does not deny the person to lead a good quality life. The health care services to the children and adults with ID should keep this in mind. The health care services to them should be comprehensive in nature. Healthcare to a normal person consists of diagnosing illness, giving proper treatment and creating awareness about maintaining healthy habits. Though the same basic procedures apply to persons with ID, certain extra services and care should be provided to them to tackle the associated complaints. If the child is diagnosed with Down’s syndrome and if he also speech and hearing impairments, he should be given speech therapy and training in use of hearing aids. Similarly if the child is found to have difficulty with mobility he should be given physiotherapy in addition to the treatment and training he undergoes for his initial complaint. The parents and care givers should also be educated and be given training to take care of these persons. Health care in the following areas should be provided to the persons with Intellectual disabilities. Nutrition Proper nutrition is important for them to maintain good health and to increase their ability to cope up with the treatments. But many of these children have poor feeding habits. It may be due to lack of motor coordination or improper functioning of digestive systems. They also show complaints of severe constipation which maybe due to heavy medication and less food in take. It is very essential that children with ID are trained to have proper feeding habits. The health care personnel should periodically assess the general health condition, nutrition status, eating habits and devise a diet schedule with supplementary nutrients whenever required. This is very important in the case of children and old people. The parents and care takers should be educated about the necessity of giving proper nutrition to them and also should be taught to do the basic assessments regularly. Dental health Children and adults with ID have dental problems which is again due to their inability to maintain oral hygiene. Their regular health heck up should include the dental check up to prevent or treat any dental problems. The training program of persons with ID should include keeping up oral hygiene. However it is a primary duty of the care givers als9o to maintain the dental hygiene for these people. Vision, speech and hearing Children with severe ID are found to have either one or all of the above defects. Initial diagnosis should include the assessment of these abilities by the proper personnel namely an ophthalmologist and audiologist. For children with hearing and speech impairments, they should be trained to use hearing aids and should be given speech therapy regularly. This would enable them improve their ability in these fields and help them to move a step closer to leading a normal life. Also these children, even if they do not have major problems initially are more prone to develop eye and hearing defects as they grow in to adults. Hence periodic checking of vision and hearing are very essential for persons with ID. Epilepsy Many children and adults with ID are prone to have these seizures which may some times prove fatal to them. Because of this complaint they are more vulnerable to get injuries or fractures. Sometimes it may require hospitalization. Even people with not very severe ID are known to be epileptic. This also causes mental strain to them and also to the care givers. Both groups should be properly educated about the nature of the seizures and the ways to manage them and the awareness and confidence not to feel socially alienated. Caregivers should know the aid that should be given to the patient. Healthcare personnel should periodically check the epileptic history of the patient and assess the health condition and treatment taken. They try to reduce the occurrence of epileptic attacks and the severity of the attacks to the maximum level. Certain kinds of disabilities are associated with certain specific health problems which may not be readily recognizable to the caregiver or to the healthcare personnel. A normal person is alert to whatever changes happening in his body and is able to express himself. But people with ID lack this ability and it is the responsibility of the health care personnel should check them. They should be aware of the common and specific complaints associated with each type of disorder. Whether the patientshows any symptoms or not, they should be screened for these complaints regularly. Children or adults with Down’s syndrome develop thyroid disorders. Thyroid tests should be conducted periodically (depending on the severity of disability) to ascertain the proper function. People with severe intellectual disabilities suffer from gastro esophageal reflux disease with symptoms of vomiting, rumination etc. Children suffering from cerebral palsy also get this. Helicobacter pylori infection which may cause peptic ulcer and cancer are present in people with intellectual disabilities. All these may be due to the basic complaint or arise as a side effect of medication. Whatever is the case, children and adults with intellectual disabilities should be tested for these major complaints and should be given treatment accordingly. Osteoporosis is another condition which presents a risk to the people with intellectual disabilities. Down’s syndrome, under nutrition, lack of motor coordination and anticonvulsant drugs are some of the causes which make them to fall and fracture themselves easily. But this can be and should be prevented. These persons should be checked for bone density and based on the result further treatments or assessments should be conducted regularly. Mental health and behaviour problems Mental health of persons having intellectual disabilities is another area which should be monitored. Though they are capable of forming relationships, it is not always possible for a child with ID to have friendship with a normal child whom he likes. Their appearance and the visible activities don’t endear them to young normal children and this causes frustration in them. Also their reduced ability to express themselves or to understand others makes them feel irritated. People with very severe disabilities resign to their fate but those with mild problems always strive hard to match their normal peers. Failure to do that causes disappointment and it may lead to depression and severe mood swings or aggression. This would be one of the main reasons for the behaviour al problems exhibited by them. Other reasons may be due to complaints associated with their illness like poor sleep pattern, less food intake etc. The ignorance and insensitiveness of people dealing with them also may cause frustration in these people. They never need sympathy and they wish to be treated as any other normal individual. They wish to get accepted as they are without any social stigma. Persons with such intellectual disabilities should be helped to accept their limitations but at the same time taught to develop their self esteem which is very important. They should be assisted to face rejections and abuse which is common in the society. They should be made to understand their strengths. Any programs or services meant for children or adults with intellectual disabilities involve the parents or the care givers right from the diagnosis stage. When the condition of the child is assessed, parental history and parental behaviour towards the child is taken in to account. Parents are helped to accept the condition of the child, overcome grief and are prepared to work for the child as she is dependent on the parent or care giver to practice the services offered to her. Her progress of development in all spheres and his ability to optimally utilize the services depends on the people around her. Hence it becomes the responsibility of the healthcare personnel and the care givers to help the people with intellectual disabilities to achieve the aim of leading a better quality of life. Actually the percentage of people with profound and severe intellectual disabilities is around .3-.4% and the rest come under mild to very mild categories. In spite of all the advancements and awareness, still there are many children and adults who are not utilizing the services available and are leading a life of despair. In some cases parents are either unaware of the services or having practical difficulties (physical or financial). In some cases the primary health care person may not have identified the associated conditions which needed medical intervention. The health care personnel dealing with intellectually disabled persons must be aware of the entire spectrum of issues that may manifest in them. The assessment should be done by physical verification, information from the care givers and through diagnostic tests. Similarly when the primary complaint is assessed, manifestations of any co morbidities should be checked. Wherever required, help of specialist personnel should be sought. Based on these findings, a comprehensive package addressing all their issues should be devised and administered. It should be followed up with periodic check ups. With all these efforts of care givers and healthcare personnel the persons with intellectual disabilities are able to enjoy a better standard of life which otherwise would not have been possible to them. References Eric Matthews, (2003) ,Medical Technology and the Concept of Healthcare,University of Aberdeen[Online] Available from http://www.abdn.ac.uk/philosophy/endsandmeans/vol1no1/matthews.shtml [Cited 9 January 2007] Health Guidelines for Adults with an Intellectual Disability, 2002, Iassid Publication, [internet]. [Published 2002] Available from http://www.intellectualdisability.info/mental_phys_health/health_guide_adlt.htm [Cited 9 January 2007] Mary Lindsey, Overview of Learning [Intellectual] Disability in Children, [Online] Available from http://www.intellectualdisability.info/walking/newcomers/1_ldchildren_ml.htm [Cited 10 January 2007] Michael Kerr, Assessment in Primary Care, UK [online] Available from: http://www.intellectualdisability.info/values/assessment_mk.html [Cited 10th January 2007] Read More