CHAPTER ONE

UNDERSTANDING STUDENTS WITH SPECIAL NEEDS (DISABILITIES AND

VULNERABILITIES)

1.1. DEFINITIONS OF BASIC TERMS (IMPAIRMENT, DISABILITY AND

HANDICAP)

1. Impairment

Impairment means a lack, loss/abnormality of an anatomic, physiological or psychological

structure or function or deviation on a person. It is also the absence of particular body part or
organ.

It could also a condition in which the body exists but does not function.

E.g. Some children, for instance, have impairments such as eyes that do not see well,
arms and legs that are deformed, or a brain not developing in a typical way etc.
2. Disability
It is any restriction or lack of ability to perform an activity in a manner or within the range
considered normal for human being.
It limits a person’s ability to perform certain tasks such as seeing, hearing, walking in the
same manner in which non-disabled people do.
It is a reduction in function. It usually results from impairment. It is a functional Construct.
The term disability is ambiguous as there is no single agreement on the concept.
It is not synonymous with AKAL-GUDATENGA (የአካል ጉዳተኛ) meaning impairment
The concept of disability is complex, dynamic, multidimensional, and contested.
The full inclusion of people with impairments in society can be inhibited by:
1. Attitudinal (societal barriers, such as stigma).
2. Physical barriers (environmental barriers, such as absence of stairs).
3. Policy barriers (systemic barriers).

Note: Societal, environmental, and systemic barriers are the most popular disabling factors. If
attitudinal, physical and policy barriers are addressed; impairment may not lead to disability.

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3. Handicap
A disadvantage for a given individual, resulting from an impairment or disability that limits/
prevents the fulfillment of a role that is considered as normal depending on age, sex, and
social and cultural factors.
Limitation of opportunities to take part in life of the community.
Handicappedness is a social construct that an individual with disability is not able to perform
what he/she is expected by society due to the impairment experienced.
The term handicap has more negative connotation than the terms impairment and disability.

In teaching children with disability with other children, the level of participation of children with
disability varies with different forms of educational placement.

1. Segregation

It is an educational placement where children with disabilities are educated in separate school
environment or in a special needs class.

Today it is discouraged for its social and academic discrimination among children with
disabilities and children without disabilities.

2. Integration

It refers to the placement of children with disability in educational programs that also serve
children without disability.

A similar term is mainstreaming but not necessarily the identical treatment condition for
both.

‘Integration’ in its widest usage entails a process of making whole, of combining different
elements into a unit.

It provides a ‘natural’ environment where these pupils are together with their peers, are free
from the isolation that is characteristics of much special school placement.

In terms of association there are three forms of integration:

A. Locational integration: exists where special units or classes are set up in ordinary schools
or where a special school and ordinary school share the same geographical site.
B. Social integration: is where children attending a special class or unit eat, play and consort

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 with other children and possibly share organized out-of-classroom activities with them.
C. Functional integration: is the fullest form of integration and is achieved when location
and social integration lead to participation in educational activities.
3. Mainstreaming
It refers to the return of children with disability previously educated exclusively in
segregated settings to regular classroom, for all or part of the school day.
Treatment of a child with special needs like non-disabled one place the child in the ‘least
restrictive environment’ to meet his/her educational and social needs.
This has resulted in increased emphasis on mainstreaming children with disabilities.
4. Inclusion
It is a practice of assuring that all students with disabilities participate with other students in
all aspects of school.
It is a process of providing education for all children regardless of their background and
ability differences in the same class.
The following terms are very important in preventing or improving the conditions of
people with variety of disabilities.
A. Intervention
It is an attempt to prevent, improve, or eliminate impairments, disabilities or handicaps.
It is a broad term that includes preventive measures taken before the occurrence of the
problem and/or to change the situation after the occurrence of the problem.
Early intervention plays a significant role in diverting the situation of the child and promoting
his/her educational and psychosocial development.
B. Rehabilitation

It is a goal-oriented activity aimed at enabling persons with disabilities to reach maximum

mental, physical, social, and level of functioning.

It includes educational, psychological, medical and vocational services.

It often refers to the situation which comes after the onset of the problem.

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 MODELS / APPROACHES OF DISABILITY

1. Medical Approach

Disability is pathology (physiological, biological and intellectual). Disability means

functional limitations due to physical, intellectual or psychic impairment, health or psychic
disorders on a person.
The medical definition has given rise to the idea that people are individual objects to be
treated, changed" or improved" and made more normal. The medical definition views the
disabled person as needing to fit in rather than thinking about how society itself should
change. This medical definition does not adequately explain the interaction between
societal conditions or expectations and unique circumstances of an individual.

2. Social Approach

Disability is a highly varied and complex condition with a range of implications for social
identity and behavior.
Disability largely depends on the context and is a consequence of discrimination, prejudice
and exclusion.
Emphasizes the shortcomings in the environment and in many organized activities in
society, for example on information, communication and education, which prevent persons
with disabilities from participating on equal terms.

CAUSES OF DISABILITY

1. Genetic Causes

Abnormalities in genes and genetic inheritance can cause intellectual disability in children. In
some countries, down syndrome is the most common genetic condition. Sometimes,
diseases, illnesses, and over-exposure to x-rays can cause a genetic disorder.

2. Environmental
A . Poverty and malnutrition in pregnant mothers can cause a deficiency in vital minerals
and result in deformation issues in the unborn child. After birth, poverty and
malnutrition can also cause poor development of vital organs in the child, which can
eventually lead to disability.
B. The use of drugs, alcohol, tobacco, the exposure to certain toxic chemicals and

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 illnesses, toxoplasmosis, cytomegalovirus, rubella and syphilis by a pregnant mother
can cause intellectual disability to the child.
C . Childhood diseases such as a whooping cough, measles, and chicken pox may lead to
meningitis and encephalitis. This can cause damage to the brain of the child.
D. Toxic material such as lead and mercury can damage the brain too.
E. Unfortunate life events such as drowning, automobile accidents, falls and so on can
result in people losing their sight, hearing, limbs and other vital parts of their body
and cause disability.
3. Unknown Causes

The human body is a phenomenal thing. Scientists have still not figured out what and how
some things in the body, cells, brain, and genes come about. Humans have still not found all the
answers to all the defects in the human body.

4. Inaccessible environments

Sometimes society makes it difficult for people with some impairment to function freely.
When society develops infrastructure such as houses, roads, parks and other public places
without consideration to people with impairment, the basically make it impossible for them to
take care of themselves. For example, if a school is built with a ramp in addition to stairs, it
makes it easy for people with wheelchairs to move about freely. This way, their
impairment is not made worse. Lack of education, support services, health and opportunities for
people with impairment can cause additional disability to people with disabilities and even
people with no disability.

TYPE OF DISABILITIES

1. Visual impairment

Visual impairment in general designates two sub- classifications. These are blindness and
low vision.

A. Blindness: is total or partial inability to see because of disease or disorder of the eye,
optic nerve, or brain. The term blindness typically refers to vision loss that is not
correctable with eyeglasses or contact lenses. Blindness may not mean a total absence of
sight. However, some people who are considered blind may be able to perceive slowly

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 moving lights or colors.

B. Low vision: is used for moderately impaired vision. People with low vision may have a
visual impairment that affects only central vision the area directly in front of the eyes or
peripheral vision the area to either side of and slightly behind the eyes.

2. Hearing Impairment

It refers to a continuum of hearing loss from mild to profound which includes the sub-
classifications of the hard of hearing and deaf.

A. Hard of Hearing: "A hearing impairment, whether permanent of fluctuating, which

adversely affects a child's educational performance but which is not included under the
definition of 'deaf'. This term can also be used to describe persons with enough
(usually with hearing aids) as a primary modality of acquisition of language and in
communication with others.

B. Deaf: Those who have difficulty understanding speech, even with hearing aids but can
successfully communicate in sign language. Cultural definitions of deafness, on the
other hand, emphasize an individual‘s various abilities, use of sign language, and
connections with the culturally deaf community.

3. Specific learning disability

Learning Disability means a disorder in one or more of the basic psychological processes
involved in understanding or in using language, spoken or written, that may manifest itself in
the imperfect ability to listen, think, speak, read, write, spell, or to do mathematical
calculations.
The term includes such conditions as perceptual disabilities, brain injury, minimal brain
dysfunction, dyslexia, and developmental aphasia. The term does not include learning
problems that are primarily the result of visual, hearing, or motor disabilities; of intellectual
disability; of emotional disturbance; or of environmental, cultural, or economic disadvantage.
Learning disabilities should not be confused with learning problems which are primarily the
result of visual, hearing, or motor handicaps; of intellectual disability; of emotional
disturbance; or of environmental, cultural or economic disadvantages.
Generally speaking, people with learning disabilities are of average or above average

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 intelligence. There often appears to be a gap between the individual‘s potential and actual
achievement. This is why learning disabilities are referred to as hidden disabilities: the
person looks perfectly normal‖ and seems to be a very bright and intelligent person, yet may
be unable to demonstrate the skill level expected from someone of a similar age. A learning
disability cannot be cured or fixed; it is a lifelong challenge. However, with appropriate
support and intervention, people with learning disabilities can achieve success in school, at
work, in relationships, and in the community.

Types of Specific Learning Disabilities

I. Auditory Processing Disorder (APD)

Also known as Central Auditory Processing Disorder, this is a condition that

adversely affects how sound that travels unimpeded through the ear is processed or
interpreted by the brain. Individuals with APD do not recognize subtle differences
between sounds in words, even when the sounds are loud and clear enough to be heard.
They can also find it difficult to tell where sounds are coming from, to make sense of the
order of sounds, or to block out competing background noises.

II. Dyscalculia

Dyscalculia is a specific learning disability that affects a person‘s ability to understand

numbers and learn math. Individuals with this type of LD may also have poor
comprehension of math symbols, may struggle with memorizing and organizing numbers,
have difficulty telling time, or have trouble with counting.

III. Dysgraphia

Dysgraphia is a specific learning disability that affects a person‘s handwriting ability and
fine motor skills. Problems may include illegible handwriting, inconsistent spacing, poor
spatial planning on paper, poor spelling, and difficulty composing writing as well as
thinking and writing at the same time.

IV. Dyslexia

Dyslexia is a specific learning disability that affects reading and related language-based
processing skills. The severity can differ in each individual but can affect reading fluency;
decoding, reading comprehension, recall, writing, spelling, and sometimes speech and can

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 exist along with other related disorders. Dyslexia is sometimes referred to as a Language-
Based Learning Disability.

V. Language Processing Disorder

Language Processing Disorder is a specific type of Auditory Processing Disorder (APD) in

which there is difficulty attaching meaning to sound groups that form words, sentences and
stories. While an APD affects the interpretation of all sounds coming into the brain, a
Language Processing Disorder (LPD) relates only to the processing of language. LPD can
affect expressive language and/or receptive language.

VI. Non-Verbal Learning Disabilities

Non-Verbal Learning Disabilities is a disorder which is usually characterized by a

significant discrepancy between higher verbal skills and weaker motor, visual-spatial and
social skills.

Typically, an individual with NLD (or NVLD) has trouble interpreting nonverbal cues like
facial expressions or body language, and may have poor coordination.

VII. Visual Perceptual/Visual Motor Deficit

Visual Perceptual/Visual Motor Deficit is a disorder that affects the understanding of

information that a person sees, or the ability to draw or copy. A characteristic seen in people
with learning disabilities such as Dysgraphia or Non-verbal LD, it can result in missing
subtle differences in shapes or printed letters, losing place frequently, struggles with cutting,
holding pencil too tightly, or poor eye/hand coordination.

4. Speech and Language Impairments

Speech and language impairment means a communication disorder such as stuttering,

impaired articulation, language impairment, or a voice impairment that adversely affects a
child‘s educational performance. It is disorder that adversely affects the child's ability to
talk, understand, read, and write. This disability category can be divided into two groups:
speech impairments and language impairments.

1. Speech Impairments

There are three basic types of speech impairments: articulation disorders, fluency disorders,

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 and voice disorders.

A. Articulation disorders are errors in the production of speech sounds that may be related to
anatomical or physiological limitations in the skeletal, muscular, or neuromuscular support
for speech production. These disorders include:

Omissions: (bo for boat)

Substitutions: (wabbit for rabbit)

Distortions: (shlip for sip)

B. Fluency disorders are difficulties with the rhythm and timing of speech characterized by
hesitations, repetitions, or prolongations of sounds, syllables, words, or phrases. Common
fluency disorders include:
Stuttering: rapid-fire repetitions of consonant or vowel sounds especially at the beginning
of words, prolongations, hesitations, interjections, and complete verbal blocks
Cluttering: excessively fast and jerky speech

C. Voice disorders are problems with the quality or use of one's voice resulting from disorders
in the larynx. Voice disorders are characterized by abnormal production and/or absences of
vocal quality, pitch, loudness, resonance, and/or duration.

2. Language Impairments

There are five basic areas of language impairments: phonological disorders, morphological
disorders, semantic disorders, syntactical deficits, and pragmatic difficulties.

A. Phonological disorders are defined as the abnormal organization of the phonological

system, or a significant deficit in speech production or perception. A child with a
phonological disorder may be described as hard to understand or as not saying the sounds
correctly. Apraxia of speech is a specific phonological disorder where the student may want
to speak but has difficulty planning what to say and the motor movements to use.
B. Morphological disorders are defined as difficulties with morphological inflections
(inflections on nouns, verbs, and adjectives that signal different kinds of meanings).
C. Semantic disorders are characterized by poor vocabulary development, inappropriate use
of word meanings, and/or inability to comprehend word meanings. These students
will demonstrate restrictions in word meanings, difficulty with multiple word

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 meanings, excessive use of nonspecific terms (e.g., thing and stuff), and indefinite
references (e.g., that and there).

D. Syntactic deficits are characterized by difficulty in acquiring the rules that govern word
order and others aspects of grammar such as subject-verb agreement. Typically, these
students produce shorter and less elaborate sentences with fewer cohesive conjunctions
than their peers.

E. Pragmatic difficulties are characterized as problems in understanding and using language

in different social contexts. These students may lack an understanding of the rules for
making eye contact, respecting personal space, requesting information, and introducing
topics.

5. Autism
Autism means a developmental disability significantly affecting verbal and nonverbal
communication and social interaction. General characteristics of autism

Before age 3 adversely affects a child ‘s educational performance

Engaging in repetitive activities and stereotyped movements,

Resistance to environmental change or change in daily routines, and

Unusual responses to sensory experiences.

Autism is a neurodevelopment disorder defined by impairments in social and

communication development, accompanied by stereotyped patterns of behavior and interest.
Autism is pervasive developmental disorder characterized by lack of normal sociability,
impaired communication and repetitive obsessive behavior such as politeness, turn-taking.
Linked to Profound Learning Disability (PLDs) are further impairments in the production of
speech. Among these are

i . Personal pronouns reversal for instance the use of I instead of you and vice-versa,

ii. The misuse of such prepositions as in, on, under, next to (...), and

iii. The prevalence, in speech, of echolalia formal repetition of other ‘s utterances

Children with autism vary literally in their use of words. Communication deficiencies may
leave a lasting mark of social retardation on the child. The link, between social skills and

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language are made evident by the often- spontaneous appearance of affectionate and
dependent behavior in these children after they have been trained to speak.

6. Emotional and Behavioral Disorders

According to Individuals with Disabilities Education Act (IDEA), the term Emotional and
Behavioral Disorders means a condition exhibiting one or more of the following
characteristics over a long period of time and to a marked degree that adversely affects
educational performance.

1. An inability to learn that cannot be explained by intellectual, sensory, or health factors;

2. An inability to build or maintain satisfactory interpersonal relationships with peers and
teachers;
3. Inappropriate types of behavior or feelings under normal circumstances;
4. A general pervasive mood of unhappiness or depression; or
5. A tendency to develop physical symptoms or fears associated with personal or school
problems.

Classification of behavioral and emotional disorders

An individual having behavioral or emotional disorders can exhibit widely varied types of
behavior. Therefore, different classification systems of behavioral and emotional disorders can
be used for special education. Different professionals have developed a classification system,
which shows some promise for educational practice. These include:

1. Conduct disorder: individuals may seek attention, are disruptive and act out. The
disorder is classified by type: overt (with violence or tantrums) versus covert (with lying,
stealing, and/or drug use).
2. Socialized aggression: individuals join subculture group of peers who are openly
disrespectful to their peers, teachers, and parents. Common are delinquency and
dropping out of school. Early symptoms include stealing, running away from home,
habitual lying, cruelty to animals, and fire setting.
3. Attention problems- These individuals may have attention deficit, are easily destructible
and have poor concentration. They are frequently impulsive and may not think the
consequence of their actions.

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 4. Anxiety/Withdrawn- These individuals are self-conscious, reserved, and unsure of
themselves. They typically have low self-esteem and withdraw from immediate activities.
They are also anxious and frequently depressed.
5. Psychotic behavior: These individuals show more bizarre behavior. They
may hallucinate, deal in a fantasy world and may even talk in gibberish.
6. Motor excess: These students are hyperactive. They cannot sit nor listen to others
nor keep their attention focused.
Kauffman (1993) conclude that emotion or behavioral disorders fall into two broads
classifications:

1. Externalizing Behavior: also called under controlled disorder, include such problems
disobedience, disruptiveness, fighting, tempers tantrums, irresponsibility, jealous, anger,
attention seeking etc.…

2. Internalizing Behavior: also known as over controlled disorders, include such problems
anxiety, immaturity, shyness, social withdrawal, feeling of inadequacy (inferiority), guilt,
depression and worries a great deal.

Causes of behavioral and emotional disorders

Behavioral and emotion disorders result from many causes; these include the following.
A. Biological- includes genetic disorders, brain damage, and malnutrition, allergies,
temperament and damage to the central nervous system.
B. Family factors- include family interactions, family influence, child abuse, neglect, and
poor disciplinary practices at home.
C. Cultural factors- include some traditional and cultural negative practices, for example
watching violence and sexually oriented movies and TV programs.
D. Environmental factors- include peer pressure, living in impoverished areas, and schooling
practices that are unresponsive to individual needs.

7. Intellectual Disability

Intellectual disability is a disability characterized by significant limitations in both intellectual

functioning and in adaptive behavior, which covers many everyday social and practical skills.
This disability originates before the age of 18. An individual is considered to have an

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intellectual disability based on the following three criteria:

1. Sub average intellectual functioning: It refers to general mental capacity, such as

learning, reasoning, problem solving, and so on. One way to measure intellectual
functioning is an IQ test. Generally, an IQ test score of around 70 or as high as 75
indicates a limitation in intellectual functioning.
2. Significant limitations exist in two or more adaptive skill areas: It is the collection of
conceptual, social, and practical skills that are learned and performed by people in their
everyday lives.
Conceptual skills—language and literacy; money, time, and number concepts; and
self-direction.
Social skills—interpersonal skills, social responsibility, self-esteem, gullibility,
innocence (i.e., suspicion), social problem solving, and the ability to follow rules/obey
laws and to avoid being victimized.
Practical skills—activities of daily living (personal care), occupational skills,
healthcare, travel/transportation, schedules/routines, safety, use of money, use of the
telephone.

People with intellectual disabilities academic learning can be affected, as well as their ability to
adapt to home, school, and community environments are presented under the following sub-
headings:

General Cognition: People with intellectual disabilities vary physically and emotionally,
as well as by personality, disposition, and beliefs. Their apparent slowness in learning may
be related to the delayed rate of intellectual development.
Learning and Memory: The learning and memory capabilities of people with intellectual
disabilities are significantly below average in comparison to peers without disabilities.
Children with intellectual disabilities may not spontaneously use appropriate learning or
memory retention strategies and may have difficulty in realizing the conditions or actions
that aid learning and memory. However, these strategies can be taught.
Attention: To acquire information, children must attend to the learning task for the
required length of time and control distractions. Children with intellectual disabilities may
have difficulty distinguishing and attending to relevant questions in both learning and

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 social situations. The problem is not that the student will not pay attention, but rather that
the student does not understand or does not filter the information to get to the salient
features.
Adaptive Skills: The adaptive skills of people with intellectual disabilities are often not
comparable to those of their peers without disabilities. A child with intellectual disabilities
may have difficulty in both learning and applying skills for a number of reasons, including
a higher level of distractibility, inattentiveness, failure to read social cues, and impulsive
behavior. The lack or underdevelopment of these skills notably affects 18 memories,
rehearsal skills, organizational ability, and being in control of the process of learning.
Speech and Language: People with intellectual disabilities may have delayed speech,
language comprehension and formulation difficulties. Language problems are generally
associated with delays in language development rather than with a bizarre use of language.
People with intellectual disabilities may show delayed functioning on pragmatic aspects of
language, such as turn taking, selecting acceptable topics for conversation, knowing when
to speak knowing when to be silent, and similar contextual skills.
Motivation: People with intellectual disabilities are often described as lacking motivation,
or outer-directed behavior. Past experiences of failure and the anxiety generated by those
failures may make them appear to be fewer goals directed and lacking in motivation. The
result of failure is often learned helplessness. The history of failure is likely to lead to
dependence on external sources of reinforcement or reward rather than on internal sources
of reward. They are less likely to self-starters motivated by self-approval.
Academic Achievement: The cognitive difficulties of children with mild to moderate
intellectual disabilities lead to persistent problems in academic achievement, unless
intensive and extensive supports are provided.
Physical characteristics: Children with intellectual disabilities with differing biological
etiologies, may exhibit coexisting problems, such as physical, motor, orthopedic, visual and
auditory impairments, and health problems. A relationship exists between the severity of
the intellectual disabilities and the extent of physical differences for the individual. The
majority of children with severe and profound intellectual disabilities have multiple
disabilities that affect nearly every aspect of intellectual and physical development.

8. Physical disability/Orthopedic and Health impairment

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Physical disability is a condition that interferes with the individual‘s ability to use his or her
body. Many but not all, physical disabilities are orthopedic impairments. (The term orthopedic
impairment generally refers to conditions of muscular or skeletal system and sometimes to
physical disabling conditions of the nervous system). Health impairment is a condition that
requires ongoing medical attention. It includes asthma, heart defects, cancer, diabetes,
hemophilia. HIV/AIDS, etc.

Classification and Characteristics

1. Physical disabilities: - based on the impact of physical disability on mobility and motor skills,
it is divided into three. These are: -

A. Mild physical disability: - these individuals are able to walk without aids and may make
normal developmental progress.

B. Moderate physical disability: - individuals can walk with braces and crutches and may
have difficulty with fine-motor skills and speech production.

C. Severe physical disability: -these are individuals who are wheel-chair dependent and may
need special help to achieve regular development.

The physical disability could be broadly classified in to two.

I. The neurological system (the brain, spinal cord & nerve) related problems.
II. Musculo skeletal system (the muscles, bones and joints) are deficient due to various causes.

I. Neurological system: -with a neurological condition like cerebral palsy or a traumatic brain
injury, the brain either sends the wrong instructions or interprets feedback incorrectly.

In both cases, the result is poorly coordinated movement. With the spinal cord injury or
deformity, the path ways between the brain and the muscles are interrupted, so messages are
transmitted but never received. The result is muscle paralysis and loss of sensation beyond the
point where the spinal cord or the nerve is damaged. These individuals may have motor skill
deficits that can range from mild in coordination to paralysis of the entire body. The most
severely affected children are totally dependent on other people or sophisticated equipment to
carry out academic and self-care task.

Additional problems that can be associated with cerebral palsy include learning disabilities,
mental retardation. Seizures, speech impairments, eating problems, sensory impairments, and

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joint and bone deformities such as spinal curvatures and contractures (permanently fixed, tight
muscles and joints). Approximately 40 percent of those with cerebral palsy have normal
intelligence; the remainders have from mild to severe retardation. This is an extremely
heterogeneous group having unique abilities and needs.

Epilepsy: -is disorder that occurs when the brain cells are not working properly and is often
called a seizure disorder.
Some children and youth will epilepsy have only a momentary loss of attention (petit mal
seizures); others fall to the floor and then move uncontrollably
Fortunately, once epilepsy is diagnosed, it can usually be controlled with medication and
does not interfere with performance in school. Most individuals with epilepsy have normal
intelligence.
Epilepsy is a condition that affects 1 to 2 percent of the population. It is characterized by
recurring seizures, which are spontaneous abnormal discharge of electrical impulses of the
brain.

Spinal bifida and spinal cord injury: - damage to the spinal cord leads to paralysis and loss of
sensation in the affected areas of the body. The spinal bifida is a birth defect of the backbone
(spinal column). The cause is unknown but it usually occurs in the first twenty-six days of
pregnancy.

II. Musculoskeletal system: - it includes the muscles and their supporting framework and the
skeleton.

1. Progressive muscle weakness (muscular dystrophy);

2. Inflammation of the joints (arthritis), or
3. Loss of various parts of the body (amputation).
The list of the impairment and associated with musculoskeletal malformation are the
following:

A. Muscular dystrophy: - is an inherited condition accruing mainly in males, in which the

muscles weaken and deteriorate. The weakness usually appears around 3 to 4 years of age and
worsens progressively. By age 11 most victims can to longer walk. Death usually comes between
the ages of 25 and 35 from respiratory failure or cardiac arrest.

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B. Arthritis: -is an inflammation of the joints. Symptoms include swollen and stiff joints, fever,
and pain in the joints during acute periods. Prolonged inflammation can lead joint deformities
that can eventually affect mobility.

C. Amputation: - a small number of children have missing limbs because of congenital

abnormalities or injury or disease (malignant bone tumors in the limbs). These children can use
customized prosthetic devices (artificial hands, arms, or legs) to replace limp functions and
increase independence in daily activities.

Other muscle-skeletal disorders are: -

D. Marfan syndrome is a genetic disorder in which the muscles are poorly developed and the
spine is curved. Individuals with marfan syndrome may have either long, thin limbs, prominent
shoulder blades, spinal curvature, flat feet, or long fingers & thumbs. The heart and blood vessels
are usually affected. The greatest danger is damage to aorta, which can lead to heart failure.
Individuals with marfan syndrome need to avoid heavy exercise and lifting heavy objects.

E. Achondroplasias: - is a genetic disorder that affects 1 in 10,000 births. Children with this
disorder usually develop a normal torso but have a straight upper back and a curved lower back
(sway back). These children are at risk of sudden death during sleep from compression of the
spinal cord interfering with their breathing. The disability may be lessened through the use of the
back braces or by surgery.

F. Polio: - is viral disease that invade the brain and cause severe paralysis of the total body
system. In its mild form results in partial paralysis. Post-polio muscles that were previously
damaged weaken, and in some persons, other muscles that were not previously affected weaken
as well.

G. Club foot: - is a major orthopedic problem affecting about 9,000 infants each year. This term
is used to describe various ankle or foot deformities, i.e.

 Twisting inward (equino Varus), the most severe form.

 Sharply angled at the heel (calcanel vaigus), most common.

 The front part of the foot turned inward.

These conditions can be treated with physical therapy, and a cast on the foot can solve the

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problem in most instances. In more severe cases, surgery is necessary. With early treatment,
most children can wear regular shoes and take part in all school activities.

H. Cleft lip and cleft palate: - are openings in the lip or roof of the mouth, respectively, that fail
to close before birth, the cause is unknown. Most cleft problems can be repaired through surgery.

2. Health Impairments

Any disease that interferes with learning can make students eligible for special services. These
diseases caused problems are as follow.

1. Heart disease: - this is common among young people. It is caused by improper circulation
of blood by the heart some of the disorders are congenital) present at birth); others are the
product of inflammatory heart disease. Some students have heart value disorders; others
have disorders of the blood vessels. His time heart implantation helps children to get cured.
2. Cystic fibrosis: - is a hereditary disease that affects the lungs and pancreas. It leads to
recurrent respiratory and digestive problems including abnormal amounts of thick mucus,
sweet and saliva. The disease is so progressive and few who have it survive beyond age 20.
Children with such disease often spend significant timeout of school.
3. Acquired immune deficiency syndrome (AIDS): - is a very severe disease caused by
human immunodeficiency virus (HIV) infection and transmitted primarily through
exchange of bodily fluids in transfusions or unprotected sex, and by contaminated needles
in addictive drug use.
4. Hemophilia: - is a hereditary disease in which the blood clots very slowly or not all. The
disorder is transmitted by sex-linked recessive gene and nearly always occurs in males.
5. Asthma: is a chronic respiratory condition characterized by your airways narrow, swell
and may produce extra mucus. This can make breathing difficult and trigger coughing,
breathe out and shortness of breath.
6. Diabetes: Developmental or hereditary disorder characterized by inadequate secretion or
use of insulin.
7. Nephrosis & Nephritis: Kidney disorders or diseases caused by infections, poisoning,
burns, accidents or other diseases.
8. Sickle-cell anemia: Hereditary and chronic blood disease (occurring primarily in African
Americans) characterized by red blood cells that are distorted and that do not circulate

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 properly.
9. Leukemia: Disease characterized by excessive production of white blood Cells.
10. Lead poisoning: Disorder caused by ingesting lead-based paint chips or other substances
containing lead.
11. Rheumatic fever: Disease characterized by painful swelling and inflammation of the
joints that can spread to the heart and central nervous system.
12. Tuberculosis: Infectious disease that commonly affects the lungs and may affect other
tissues of the body.
13. Cancer: Abnormal growth of cells that can affect any organ system.

9 . Vulnerability

Vulnerable means being at risk of being harmed. Everyone can be harmed, so being vulnerable is
part of being human. In principle, everyone is vulnerable to some adverse event or circumstance,
but some people are more vulnerable than others. For instance, people with disabilities are more
likely as a group to experience greater vulnerability. They are also often more severely affected
by the vulnerability they experience. Based on the existing literature, vulnerability can be
generally defined as a complex phenomenon that refers to the following dimensions:

1. Economic difficulties/lack of financial resources: poverty, low living standards, housing

problems (e.g. too damp, too expensive, too cold or difficult to heat) etc.
2. Social exclusion: limited access to facilities such as transportations, schools, libraries or
medical services;
3. Lack of social support from social networks: no assistance from family members, friends,
neighbors or colleagues (referring to practical help as well as emotional support) like
highly gifted individuals;
4. Stigmatization: being a victim of stereotypes, being devalued, and confronted with
disgraceful behavior because of belonging to a particular social or ethnic group;
5. Health difficulties: disadvantages resulting from poor mental health, physical health or
disabilities;
6. Being a victim of crime: in family context especially of violence.

Causes of Vulnerability

Vulnerability may be causes by rapid population growth, poverty and hunger, poor health, low

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levels of education, gender inequality, fragile and hazardous location, and lack of access to
resources and services, including knowledge and technological means, disintegration of social
patterns (social vulnerability). Other causes include; lack of access to information and
knowledge, lack of public awareness, limited access to political power and representation
(political vulnerability). When people are socially disadvantaged or lack political voice, their
vulnerability is exacerbated further. The economic vulnerability is related to a number of
interacting elements, including its importance in the overall national economy, trade and foreign-
exchange earnings, aid and investments, international prices of commodities and inputs, and
production and consumption patterns. Environmental vulnerability concerns land degradation,
earthquake, flood, hurricane, drought, storms (Monsoon rain, El Niño), water scarcity,
deforestation, and the other threats to biodiversity.

Characteristics of Vulnerable People

1. Less physically or mentally capable (infants, older adults, people with disabilities).
2. Fewer material and/or financial resources (low-income households, homeless).
3. Less knowledge or experience (children, illiterate, foreigners, tourists).
4. Restricted by society to grow and develop according to their needs and potentials.

People who are helped by others (who are then restricted by commitments) are still vulnerable
people, which includes the following extracted from various researches.

A. Women: particularly women in developing nations and those who are living in rural areas are
vulnerable for many backward traditional practices. These women are oppressed by the culture
and do not get access to education and employment.

B. Children: Significant number of children are vulnerable and at risk for development.
Children are vulnerable for psychological and physical abuse. This include illegally working
children, children who are pregnant or become mothers, children born out of marriage, children
from a single-parent, delinquent children, homeless children, HIV-infected children, uneducated
children, institutionalized children, married children, mentally ill children, migrant children,
orphans, sexually exploited children, street children, war-affected children…etc.

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C. Minorities: some people are vulnerable due to their minority background. Particularly, ethnic
(cultural and linguistic minority) and religious minority. These people are political and socially
discriminated.

D. Poverty: People are vulnerable for many undesirable phenomena due to poverty. This may be
resulted in, poor households and large households, inequality, absences of access to health
services, important resources for life, lack of access to education, information, financial and
natural resources and lack of social networks.

E. Disabilities: People with disabilities very much vulnerable for many kind of risks. This
includes abuses, poverty, illiteracy, health problems, psychological and social problems.

F. Age: Old people or very young children are vulnerable for all kinds evils.

G. Illiteracy and less education: People with high rates of illiteracy and lack quality
educational opportunities are vulnerable for absence all kinds of developments.

H. Sickness: Uncured health problems for example people living with HIV/AIDS are much
vulnerable for psychosocial problems, poverty and health.

I. Gifted and Talentedness: Gifted and talented children are vulnerable for socioemotional
developments. Due to lack of psychological support they may feel isolation as they are pulled
from their regular classrooms and given instruction in separate settings and due to myths and
expectations of themselves and the public.

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