What is normal development and disability in children?
In order to understand disability in children and where the consequent needs differ significantly from those of a non disabled child, it is necessary to have an understanding of the normal development process. The sequence of development is normally the same for all children e.g. they sit before they can walk etc, but the rate of development varies. For example, up to 10% do not crawl before they walk but "bottom-shuffle", creep, roll or just stand and walk. This may occur in those children who have an inherited pattern of low muscle tone and there is usually a history of affected relatives. Most children walk (even if it’s only a few steps) by the age of 2 years. The median age (i.e. the most commonly encountered age in years) of walking in shufflers, creepers and rollers is several months later than for crawlers and a few are still not walking by the age of 2. Eventually however, they function normally with walking established by the age of 3 years in the majority of these children. Those who just stand and walk also have low muscle tone and a similar family history but walk a month or two earlier than the crawler.
Development may be divided into four broad categories -:
- Vision and manipulation
- Hearing and speech
- Gross motor skills
- Social behaviour
Disability or disease in a child has a great impact on parents and the immediate family. Chronic illness or disability in the infant or young child may produce considerable additional care needs - usually provided by the parents themselves. Increasing numbers of children receive high dependency care provided at home over long periods.
The attention which is given, particularly to infants and very young children with disabilities, may differ in kind from that given to healthy children of the same age; but this may not mean that the amount of attention given is in excess of that usually required by a healthy child of the same age. Many healthy children waken at night for a variety of reasons and require attention. Likewise young children who are not disabled require care in relation to bodily functions such as eating, washing, dressing, undressing, and using the toilet. Some children, however, may not be receiving the attention they need as a result of their disabilities.
Assessment of care needs is also influenced by the fact that children develop both physically and mentally. This may result in decreased care needs; on the other hand, some care needs may increase. Physical development of the upper limbs in a child with defective lower limbs may enable them to move independently with mechanical aids where these are used. Increasing maturity may lead some children with chronic illness or disabilities (e.g. the child with diabetes mellitus, cystic fibrosis or arthritis etc) to assume responsibility for the care of their condition and so require less supervision. Training received may also have an effect, notably with blind and deaf children. On the other hand, physical development may increase the burden of disablement: a child with a learning disability may require more rather than less supervision as they get older and become more mobile. Adolescents with disabilities will also have to cope with care and/or mobility needs against a background of changing patterns in body functions, social attitudes and sometimes non-conforming and "rebellious" behaviour commonly encountered at this time.
