INTRODUCTION “The children of today will make the India of tomorrow

INTRODUCTION
“The children of today will make the India of tomorrow. The way we bring them up will determine the future of the country.” By Jawahar Lal Nehru
“The greatest legacy one can pass on to one’s children and grandchildren is not money or other material things accumulated in one’s life, but rather a legacy of character and faith.”   — Billy Graham, Evangelist 
“Children are like wet cement whatever falls on them makes an impression.” “A child is a beam of sunlight from the Infinite and Eternal, with possibilities of virtue and vice, but as yet unstained.” “Children are the hands by which we take hold of heaven.” “The soul is healed by being with children.”
The children are the most beautiful creation of God for mankind. Children create the world of every family beautiful and merry. Life without child is like life without smile. Parents are the ones who build and create this creation of God to a beautiful architecture. Parents are the creators of future generation because they enhance moral and values to children so that they can be a better human.

A child is a human being between the stages of birth and puberty. The legal definition of child generally refers to a minor, otherwise known as a person younger than the age of majority. Every child goes through many stages of social development. An infant or very young child will play alone happily. If another child wanders onto the scene, he or she may be physically attacked or pushed out of the way by the other. Next, the child can play with another child, gradually learning to share and take turns. Eventually, the group grows larger, to three or four children. By the time a child enters kindergarten; he or she can usually join in and enjoy group experiences.

As a child is growing they are learning how to do some tasks in chronological order. They learn how to prioritize their goals and actions. Their behaviour is transcending as they learn new perspectives from other people. They learn how to represent certain things symbolically and learn new behaviour.

Child population encompasses that proportion of the total population of the country which lies in the age group of 0-6 years which is an important indicator since it overlooks a delicate segment of the population. India is the second most populous country in the world where 13.12 percent of her population lies in the tender age bracket of 0-6 years as per the provisional Census 2011 figures. The decline in total child population since Census 2001 stands at 5,030,327 where the decline in rural child population is 8,885 which is in contrast to the increase in urban child population reported as 3,855. The highest rural and urban child population have been reported from Uttar Pradesh whereas the lowest figures for both the mentioned categories are recorded from Lakshadweep.

“One of the greatest titles in the world is parent, and one of the biggest blessings in the world is to have parents to call mom and dad” by Jim DeMint
“To be a good father and mother requires that the parents defer many of their own needs and desires in favour of the needs of their children. As a consequence of this sacrifice, conscientious parents develop a nobility of character and learn to put into practice the selfless truths taught by the Saviour Himself.” James E. Faust
Parents are the care takers of the children. Parents are the value givers and moral developers of the children. Parents without children are like tree without the strong roots. They are the true developing agent. They have the power to build and construct their generations.
Parent is a caregiver of the offspring in their own species. In humans, a parent is the caretaker of a child (where “child” refers to offspring, not necessarily age).

Parents of every race, religion, culture and nationality in all parts of the world are the primary caregivers and teachers of their children, preparing them for a happy, fulfilling and productive life. Parents are the anchors of the family and the foundation of our communities and societies.

Traditionally in many societies, fathers have been moral teachers, disciplinarians and breadwinners. In many countries, there is now an increased emphasis on the father’s role as a co-parent, fully engaged in the emotional and practical day-to-day aspects of raising children. Recent research has affirmed the positive impact of active involvement by fathers in the development of their children. Yet challenges persist for fathers — and for society and social policy. As our understanding of fatherhood grows, there is an opportunity for men to re-envision imaginatively what it means to be a father and to see opportunities to make a difference in communities. Mothers play a critical role in the family, which is a powerful force for social cohesion and integration. The mother-child relationship is vital for the healthy development of children. Violence against women, many of whom are mothers, remains one of the most pervasive human rights violations of our time. The benefits of educating women and girls accrue not only to individual families, but to whole countries, unlocking the potential of women to contribute to broader development efforts. Statistics also show that educated mothers are much more likely to keep their children in school, meaning that the benefits of education transcend generations. In order to support mothers in their caregiving work, the international community needs to develop and expand family-friendly policies and services, such as childcare centres that would reduce some of the workload placed on women. Women and men, alike, need stronger public support to share equally in work and family responsibilities. Families built on the recognition of equality between women and men will contribute to more stable and productive societies.

DISABILITY
Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations.

Disability is thus not just a health problem. It is a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she lives. Overcoming the difficulties faced by people with disabilities requires interventions to remove environmental and social barriers.

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Disability is an impairment that may be cognitive, developmental, intellectual, mental, physical, sensory, or some combination of these. It substantially affects a person’s life activities and may be present from birth or occur during a person’s lifetime. Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. Impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Disability is thus not just a health problem. It is a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she lives. — World Health Organization.

COMMON DISABILITIES
•Vision Impairment
•Deaf or Hard of Hearing
•Mental Health Conditions
•Intellectual Disability
•Acquired Brain Injury
•Autism Spectrum Disorder
•Physical Disability
Vision impairment refers to people who are blind or who have partial vision. People who are deaf or hard of hearing impairments can range from mild to profound. People who are hard of hearing may use a range of strategies and equipment including speech, lip-reading, writing notes, hearing aids or sign language interpreters. A person with mental health conditions is a general term for a group of illnesses that affect the mind or brain. These illnesses, which include bipolar disorder, depression, schizophrenia, anxiety and personality disorders, affect the way a person thinks, feels and acts. People with intellectual disability may have significant limitations in the skills needed to live and work in the community, including difficulties with communication, self-care, social skills, safety and self-direction. People with acquired brain injury refer to any type of brain damage that occurs after birth. The injury may occur because of infection, disease, lack of oxygen or a trauma to the head. People with Autism Spectrum Disorder are an umbrella description which includes Autistic disorder, Asperger’s syndrome and atypical autism. Autism affects the way information is taken in and stored in the brain. People with autism typically have difficulties in verbal and non-verbal communication, social interactions and other activities. A person with physical disability is that some aspect of a person’s physical functioning, usually their mobility, dexterity, or stamina, is affected.

INTELLECTUAL DISABILITY
Intellectual disability (ID), also known as general learning disability, and mental retardation (MR), is a generalised neurodevelopment disorder characterized by significantly impaired intellectual and adaptive functioning. It is defined as IQ score under 70 in addition to deficient in two or more adaptive behaviours that affect every day , general living.

Once focused almost entirely on cognition, the definition now includes both a component relating to mental functioning and one relating to individuals’ functional skills in their environments. As a result of this focus on the person’s abilities in practice, a person with an unusually low IQ may not be considered to have intellectually disability.

Intellectual disability is subdivided into syndrome intellectual disability, in which intellectual deficits associated with other medical and behavioural signs and symptoms are present, and non-syndrome intellectual disability, in which intellectual deficits appear without other abnormalities. Down syndrome and fragile X syndrome are examples of syndrome intellectual disabilities.

Intellectual disability affects about 2–3% of the general population. Seventy-five to ninety percent of the affected people have mild intellectual disability. Non-syndrome or idiopathic cases account for 30–50% of cases. About a quarter of cases are caused by a genetic disorder, and about 5% of cases are inherited from a person’s parents. Cases of unknown cause affect about 95 million people as of 2013.

Someone with intellectual disability has limitations in two areas. These areas are:
1.Intellectual functioning: Also known as IQ, this refers to a person’s ability to learn reason, make decisions, and solve problems.

2.Adaptive behaviours: These are skills necessary for day-to-day life, such as being able to communicate effectively, interact with others, and take care of oneself.

IQ (intelligence quotient) is measured by an IQ test. The average IQ is 100, with the majority of people scoring between 85 and 115. A person is considered intellectually disabled if he or she has an IQ of less than 70 to 75.

To measure a child’s adaptive behaviours, a specialist will observe the child’s skills and compare them to other children of the same age. Things that may be observed include how well the child can feed or dress himself or herself; how well the child is able to communicate with and understand others; and how the child interacts with family, friends, and other children of the same age.

Intellectual disability is thought to affect about 1% of the population. Of those affected, 85% have mild intellectual disability. This means they are just a little slower than average to learn new information or skills. With the right support, most will be able to live independently as adults.

SPECIAL CHILDREN (MENTAL CHALLENGED)
Special children are the children who need more care and special watch while they grow as their developments are special and different from the children who are not special. Children with Special Healthcare Needs are defined by the maternal and Child Health Bureau (2018) as: “Those who have one or more chronic physical, developmental, behavioural, or emotional conditions and who. Also require health and related services of a type or amount beyond that required by children generally”.

The growth and development of every child is directly linked with care and love what they receive from their parents. The holistic development of child is directly associated with the holistic development of the parents. If parents are mentally and emotionally sound then they can provide best form of care for their children. ‘Giving birth to a child with a disability is no different than giving birth to a child without a disability. Neither one comes with an owner’s manual. Parenting is not an innate skill. It’s complicated enough having a healthy child, but having a child with special needs means that our needs are special, too. As parents we just want to do the right thing for our children.’
“People with disabilities are vulnerable because of the many barriers we face: attitudinal, physical, and financial. Addressing these barriers is within our reach and we have a moral duty to do so. But most important, addressing these barriers will unlock the potential of so many people with so much to contribute to the world. Governments everywhere can no longer overlook the hundreds of millions of people with disabilities who are denied access to health, rehabilitation, support, education, and employment—and never get the chance to shine.”
Late Stephen Hawking.

Children are the blessing from God. Parents are the backbone and foundation value giver for children. For special children also, these points are equally needed as for any other child. Family is the place where a child learns values, morals and behavioural traits. Parents are also to been seen as important as the children of the special needs. There was a case in Bangalore few months back in which a mother killed her special child by throwing from the fourth floor of the building. Mother was a teacher. The point here to be seen is not what the society wants to tell about the incident but to take your heart and mind to the problem of ignoring the parents of the special children. Parents need education, encouragement and awareness regarding what they are for their children. It’s not easy to develop a child, so imagine how difficult it would be to develop a special child.

Internationally, the definition of mental retardation has moved away from a medical model to that of an educational model which is functional and support based and emphasizes the rights of the individual. According to the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995, enacted in India, mental retardation means a “condition of arrested or incomplete development of mind of a person which is specially characterized by sub-normality of intelligence”. Field workers, parents and professionals in India opine that this definition has scope for improvement. To this date, a systematic enumeration of the number of persons with disabilities in the country has not been made, the reason being the large geographical area. Data on educational and other needs of pre-school, school going children, youth, adults and senior citizens is not available.

Mental Retardation: Changing Concepts
The American Association on Mental Deficiency (AAMD) The American Association on Mental Deficiency (AAMD), now the American Association on Mental Retardation (AAMR), and also known as the American Association on Intellectual Disabilities (AAID), has made a formal Mental Retardation in India change between 1959 and 1983, to include both measured intelligence and adaptive behaviour. With the WHO definition, which is in use in Britain, and that of the Persons with Disabilities Act, 1995 in India, the American Association on Mental Deficiency definition (1983) is more prevalent among the service providers and the institutions, the usage being more of academic interest than for operational reasons. The American Association on Mental Deficiency (1983) definition reads “Mental retardation refers to a significantly sub-average general intellectual functioning resulting in or associated with concurrent impairments in adaptive behaviour and manifested during the developmental period” (Grossman, 1983). It is a more functional definition which stresses the interaction between the person’s capabilities, the environment in which the individual functions, and the need for support systems. The American Association on Mental Retardation (1992) definition of mental retardation, manifesting before age 18, refers to a substantial limitations in present functioning, characterized by significantly sub-average intellectual functioning which exists concurrently with related limitations in two or more of the following adaptive skill areas: communication, selfcare, home living, social skills, community use, selfdirection, health and safety, functional academics, leisure and work. In adopting this definition and the accompanying classification system, American Association on Mental Retardation (1992) suggests the mild, moderate, severe and profound. Classification in the previous definitions to be substituted with ‘levels’ of support needed by an individual: intermittent, limited, extensive, and
pervasive. These terms may be summarized as below:
• Intermittent: Support of high or low intensity is provided as and when needed. Characterized as episodic or short-term during life-span transitions.

• Limited: Supports are provided consistently over time, but may not be extensive at any one time. Supports may require fewer staff members and lower expense than more intense levels of support.

• Extensive: Supports characterized by regular involvement (daily) in at least some environments (work or home) and not limited (example: long term support and long term home living support).

• Pervasive: High intensity supports are provided constantly, across environments, and may be of life sustaining and intrusive nature. Pervasive supports typically involve a variety of staff members. This definition essentially restates the 1983AAMD definition except that it raises the American Association on Mental Deficiency developmental period to age 22, consistent with he federal definitions of developmental disabilities.

The Diagnostic and Statistical Manual-IV (DSM-IV) – 1994; International Classification of
Diseases (ICD-10) The American Psychiatric Association in its fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); 1994, also retains the essence of the 1983 AAMD definition of mental retardation as well as the levels of severity of mental retardation. Further, DSM-IV and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) have coordinated sections on mental and behavioral disorder sconcurring with a common definition and classification system for mental retardation. This coordination specifies four degrees of severity reflecting the level of intellectual impairment.The AAMR 2002 definition reads “Mental retardation is a disability characterized by significant limitations, both in intellectual functioning and in adaptive behaviour, as expressed in conceptual, social, and practical adaptive skills, the disability originating before the age of 18. A complete and accurate understanding of mental retardation implies that mental retardation refers to a particular state of functioning, which begins in childhood, having many dimensions, and affected positively by individualized supports. As a model of functioning, it includes the contexts and environment within which the person functions and interacts, requiring a multidimensional and ecological approach that reflects the interaction of the individual with the environment. The outcomes of that interaction are with regard to independence, relationships, societal contributions, participation in school and community and to personal well being.229
Classification of Persons with Mental Retardation
Based on the 1983 AAMR definition, the operational classification for persons with mentalretardation is as follows:
Level of Retardation IQ Range Approximate percentage Stanford-Binet Wechsler Scales of persons with mentaland Cattell Tests retardation
Mild 52 – 67 55 – 69 89
Moderate 36 – 51 40 – 54 7
Severe 20 – 35 25 – 39 3
Profound 0 – 19 0 – 24 1
Educational Classification
In the special education centres in India, the classroom classification in operation is as shown below:
I. Pre-Primary (A) level
– Chronological ages 3 – 6 years
– Mental ages Upto 5 years
II. Pre-Primary (B) level
– Chronological ages Over 6 years
– Mental ages Around 4½ years
III. Primary level
– Chronological ages 7 – 10 years
– Mental ages 5 – 7 years
IV. Secondary level
– Chronological ages 10 – 13 years
– Mental ages 7 – 9 years
V. Pre-Vocational level
– Chronological ages 14 – 16 years
– Mental ages 8 + years
Most of the classification systems define mental retardation with emphasis on significantly sub-average intellectual functioning of the individual (assessed by the standardized intelligence tests).

In India, where a majority live in rural areas, engaged mostly with traditional, semi-skilled vocations, the adapted Indian intelligence tests have limitations in assessing the exact levels of intelligence due to lack of standardization on such population. No standard test has been so far developed suited to the Indian cultural milieu.

Certification
A disability certificate is issued by a Medical Board duly constituted by the Central and the State Governments. The State Government will constitute a Medical Board consisting of at least three members out of which at least one may be a specialist in the concerned field. In need of correction in the certification process are: limited availability of the specialists in respective areas of disability, distance from theresidence to the assessment and certification place, lack of guidelines on the standard test and the person to be used for assessment. No indigenously established behavior normsare available.

Characteristics of Persons with Mental Retardation
Severity Mild Moderate Severe Profound
Pre-school Can develop social Can talk or learn to Poor motor Gross retardation, and communicative communicate, poor development, minimal capacity for skills, minimal social awareness, fine speech functioning in retardation in motor development. minimal, sensory motor areas sensory- motor Profits from training, generally needs running care. areas, often not self help can be unable to distinguished from managed. profit from those normal until training, self late age. help little, no communicative skills. School age Can learn academic Can profit from Can talk or Some motor 6–20 years skills up to training in social and learn to development approximately 6th occupational skills to communicate, present. Many grade level by late progress beyond 2nd can be trained respond to minimal teens. Can be grade level in in elementary to limited training in guided on social academic subjects, skills and can self help. skills. may learn to travel profit from alone in familiar systematic places. training. Adult 21 & Can usually achieve May achieve self May contribute Some motor and over. social and maintenance in partially to self speech development vocational skills unskilled, under maintenance may be achieved, adequate to sheltered conditions, under complete but very limited self minimum, self needs supervision supervision, care needs are support but may and guidance when can develop achieved. need guidance and under mild social or self protection assistance when economic stress. skills to a under social or minimal useful economic stress. levels in controlled environment.

Incidence and Magnitude of Mental Retardation in India
Estimates in India
Most available data on the prevalence of mental retardation in the country is derived from the psychiatric morbidity surveys conducted by the mental health professionals in specific or circumscribed geographical areas or on target populations, such as rural-urban, industrial population and educational institutions. The prevalence rates of mental retardation, some from the school population, some from the general population, is reported from 1951 to 1994, in the range of 0.07 to 40 per 1000. The prevalence rates for mental retardation in the school population and the general population, rural and urban, based on psychiatric morbidity survey ranges from 0.1 to 140. The sample selected hasbeen a skewed one. The variation in these figures does not give a clear picture of the situation.

The National Sample Survey Organisation (NSSO)
The National Sample Survey Organisation (NSSO) under the Department of Statistics, Government of India conducts large scale survey for socio-economic planning and policy formulation. The first large scale attempt to collect information on the prevalence of developmental delays was made in the 47th round of survey by NSSO. Data obtained from various sources indicate that the prevalence rate of mental retardation is about 20 per 1000 general population while the prevalence of developmental delays is about 30 per 1000 in the 14 year-old population.

In rural areas, the incidence of mental retardation is 3.1% and in urban, it is 0.9%. The NIMH mentions that 2% of the general population is MR. Three quarters of them are with mild retardation and one-fourth are with severe retardation (Panda, 1999). A door-to-door survey conducted in Tamil Nadu in the districts of Kancheepuram (RajaramDist. Collector), Ramanathapuram (Vijay KumarDist. Collector), in 2001 and earlier in 1984 in Tiruchirapalli in a population of 50,000, (Jeyachandran) indicates a prevalence of 1 per 1000.

Difficulties in Collecting Accurate Prevalence Rates
A large, population which is diverse in psychosocial, educational, economical and cultural background, limited number of specialists and lackof standard tools for assessment are the main difficulties. Those with mild mental retardation remain unidentified as they could be involved in a semiskilled vocation and in a structured and restricted environment.

Government of Tamil Nadu Initiative
The Government of Tamil Nadu has initiated creation of a data base on disabilities (2007) on the population with a door-to-door survey in all its districts.

Standard formats have been developed to identify disabilities as listed in Persons with Disabilities Act and the National Trust Act. The survey is based on the etiology of each of the listed disabilities. All the District Disability Rehabilitation Officers, village health workers, Anganwadi workers, the CBR workers, NGOs, working in the field of disability, members of the National Cadet Corps and retired veterans from the armed forces received the required training for the survey.
In India, the incidence and magnitude of mental retardation needs to be looked into.Theoretically, the horizon of special education is often restricted only up to the age of 18 years for persons with disabilities. “Schooling” or attendance in a class room alone is often considered ‘education’ even among the literate population of the nation. NSSO Survey, 1991 The National Sample Survey Organisation (NSSO) under the Department of Statistics, Government of India conducts large scale studies and surveys for socio-economic planning and policy formulation. The first large scale attempt to collect such information on the prevalence of developmental delays was made in the 47th round of survey by NSSO carried out between JulyDecember, 1991, on children age group 0-14 years, coming from 4,373 villages and 2,503 urban blocks.

Data obtained from various sources indicate that the prevalence rate of mental retardation is about 20 per 1000 general population, while the prevalence of developmental delays is about 30 per 1000 in the population of children up to the age of
It is difficult to collect the accurate prevalence rate of mental retardation in a country like India reasons for which have been given above. In the Census of India, 2001, an attempt has been made to assess the disability population in the country belonging to different categories. Unfortunately, no reliable information could be obtained from such data as regards mental retardation since it has been clubbed with mental illness, a term alien to mental retardation in its current conceptualization.

HISTORY OF MENTAL RETARDATION IN INDIA
Identification of persons with mental retardation and affording them care and management for their disabilities is not a new concept in India. The concept had been translated into practice over several centuries as a community participative culture. The status of disability in India, particularly in the provision of education and employment for persons with mental retardation, as a matter of need and above all, as a matter of right, has had its recognition only in recent times, almost after the enactment of the Persons with Disabilities Act (PWD), 1995.

Pre-Colonial India
Historically, over different periods of time and almost till the advent of the colonial rule in India, including the reigns of Muslim kings, the rulers exemplified as protectors, establishing charity homes to feed, clothe and care for the destitute persons with disabilities. The community with its governance through local elected bodies, the Panchayati system of those times, collected sufficient data on persons with disabilities for provision of services, though based on the philosophy of charity. With the establishment of the colonial rule in India, changes became noticeable on the type of care and management received by the persons with the influence from the West.

Pre-Independence–Changing Life Styles in India
Changes in attitudes towards persons with disabilities also came to about with city life. The administrative authorities began showing interest in providing a formal education system for persons with disabilities, particularly for families which had taken up residences in the cities. Changes in the lifestyle of the persons with mental retardation were also noticed with their shifting from ‘community inclusive settings’ in which families rendered services to that of services provided in ‘asylums’, run by governmental or non-governmental agencies (Chennai, then Madras, Lunatic Asylum, 1841). It was at the Madras Lunatic Asylum, renamed the Institute of Mental Health, that persons with mental illness and those with mental retardation were segregated and given appropriate treatment. Special schools were started for those who could not meet the demands of the mainstream schools (Kurseong, 1918; Travancore, 1931; Chennai, 1938). The first residential home for persons with mental retardation was established in Mumbai, then Bombay (Children Aid Society, Mankhurd, 1941) followed by the establishment of a special school in 1944. Subsequently, 11 more centres were established in other parts of India.

Post-Independent India–Current Scenario
Establishment of Special Schools
Article 41of the Constitution of India (1950) embodied in its clause the “Right to Free and Compulsory Education for All Children up to Age 14 years”. Many more schools for persons with mental retardation were established including an integrated school in Mumbai (Sushila Ben, 1955). Notwithstanding this obligatory clause on children’s mainstream education, more and more special schools were also being set up by nongovernmental organizations (NGOs) in an attempt to meet the parents’ demands.

Special Schools
Establishment of special schools in the country since independence is shown below:Year Number of Special Schoolsfor Children withMental Retardation1950 101960 391970 1201980 2901990 11002007 More than 3000Indian Education Commission, 1964-66The Indian Education Commission, 1964-66 made a clear mention of the presence of only 27 schools for persons with mental retardation in the entire country at that time.In 1953, training teachers to teach persons with mental retardation was initiated in Mumbai by Mrs. Vakil. In 1971, special education to train persons with mental retardation was introduced in Chennai at the Bala Vihar Training School by Mrs. M.Clubwala Jadhav. In the same year, the Dilkush Special School was established in Mumbai initiating special teachers’ training programs. The various Acts passed and the policies touching the lives of the disabled are dealt with in. This introductory chapter is intended to dispel the myth that very few services were available in India until the period of the Colonial rule. With the rights approach established through several legislations, the quality, accessibility, affordability and availability of an array of serviceshave been strengthened.

SIGNS OF SPECIAL CHILDREN
There are many different signs of being a special child. Signs may appear during infancy, or they may not be noticeable until a child reaches school age. It often depends on the severity of the disability. Some of the most common signs are:
1.Rolling over, sitting up, crawling, or walking late
2.Talking late or having trouble with talking
3.Slow to master things like potty training, dressing, and feeding himself or herself
4.Difficulty remembering things
5.Inability to connect actions with consequences
6.Behaviour problems such as explosive tantrums
7.Difficulty with problem-solving or logical thinking
8.In children with severe forms, there may be other health problems as well. These problems may include seizures, mood disorders (anxiety, autism etc.), motor skills impairment, vision problems, or hearing problems.

CAUSES
Anytime something interferes with normal brain development, intellectual disability can result. However, a specific cause for intellectual disability can only be pinpointed about a third of the time.

The most common causes of intellectual disability are:
i.Genetic conditions: These include things like Down syndrome and fragile X syndrome.

ii.Problems during pregnancy: Things that can interfere with fetal brain development include alcohol or drug use, malnutrition, certain infections, or preeclampsia.

iii.Problems during childbirth: Intellectual disability may result if a baby is deprived of oxygen during childbirth or born extremely premature.

iv.Illness or injury: Infections like meningitis, whooping cough, or the measles can lead to intellectual disability. Severe head injury, near-drowning, extreme malnutrition, infections in the brain, exposure to toxic substances such as lead, and severe neglect or abuse can also cause it.

v.None of the above: In two-thirds of all children who have intellectual disability, the cause is unknown.

PREVENTION
Certain causes are preventable. The most common of these are fetal alcohol syndrome. Pregnant women shouldn’t drink alcohol. Getting proper prenatal care, taking a prenatal vitamin, and getting vaccinated against certain infectious diseases can also lower the risk that your child will be born special.

In families with a history of genetic disorders, genetic testing may be recommended before conception.
Certain tests, such like ultrasounds and antenatal tests can also be performed during pregnancy to look for problems. Although these tests may identify problems before birth, they cannot correct them.

DIAGNOSIS
A child is special can be suspected for many different reasons. If a baby has physical abnormalities, a variety of tests may be done to confirm the diagnosis. These include blood tests, urine tests, imaging tests to look for structural problems in the brain, or electroencephalogram to look for evidence of seizures.

In children with developmental delays, the doctor will perform tests to rule out other problems, including hearing problems and certain neurological disorders. If no other cause can be found for the delays, the child will be referred for formal testing.

Three major factors for the diagnosis of intellectual disability are:
i.Interviews with the parents
ii.Observation of the child
iii.Testing of intelligence and adaptive behaviours.
A child is considered intellectually disabled if he or she has deficits in both IQ and adaptive behaviours. If only one or the other is present, the child is not considered intellectually disabled.

After a diagnosis of intellectual disability is made, a team of professionals will assess the child’s particular strengths and weaknesses. This helps them determine how much and what kind of support the child will need to succeed at home, in school, and in the community.

REMEDIES
Learn everything you can about your Childs special needs. The more you know the better advocate you can be for your child. Encourage your child’s independence. Let your child try new things and encourage your child to do things by him or herself. Provide guidance when it’s needed and give positive feedback when your child does something well or masters something new. Get your child involved in group activities. Taking an art class or participating in Scouts will help your child build social skills. Stay involved. By keeping in touch with your child’s teachers, you’ll be able to follow his or her progress and reinforce what your child is learning at school through practice at home. Get to know other parents facing the same challenges. They can be a great source of advice and emotional support. (Child line reports, 2016)
SPECIAL CHILDREN IN INDIA
Children with Disabilities are the children who need special assistance for their life. According to UN Enable, around 10% of the world’s populations, 650 million people, live with disabilities. Women and girls with disabilities are particularly at a risk of abuse. According to a UNICEF survey, 30% of street youth are disabled. Some countries where IMR rates are high, mortality rates for children with disabilities is as high as 80%. Some suspect that children with disabilities are being purposely weeded out. 90% of children with disabilities worldwide do not attend school. Conflict areas find that for every one child that is killed, three are injured and permanently disabled. Children with disabilities are at a 1.7 times greater risk of being subjected to some form of violence.

According to Child Rights over 150 million children worldwide have a disability. 50% of children with a hearing impairment and 60% of those with an intellectual impairment are sexually abused. There are many medical professionals who kill children with disabilities and right them of as mercy killings. 90% of the children with disabilities will not survive pass twenty years of age. Children with disabilities face discrimination not only in services but also in the justice system as they are often not considered credible witnesses.

In India children with disabilities mainly comes under the purview of the Ministry of Social Justice & Empowerment. Some of the issues are dealt with by the health ministry. But no single ministry has been assigned the protection of these children, which leads to varying data about occurrence of disability amongst children. In India 1.67% of the 0-19 population has a disability. 35.29% of all people living with disabilities are children. Other estimates say that India has 12 million children living with disabilities. Only 1% of children with disabilities have access to school and one third of most disabilities are preventable. Under-nutrition is a severe problem with children who suffer from cerebral palsy. In India 80% of children with disabilities will not survive past age forty.

Disability in India is still functioning in the realm of social welfare instead of a rights perspective. Teachers are not trained and schools don’t have the infrastructure to deal with children with disabilities. Neither are paediatric wards of hospitals equipped to deal with them. There is not enough data on the number of children living with disabilities to allow the government to provide the necessary services. Mental health disorders account for one sixth of all health disorders yet India spends 0.83% of its health budget on mental health.

Census 2001 has revealed that over 21 million people in India as suffering from one or the other kind of disability. This is equivalent to 2.1% of the population. Among the total disabled in the country, 12.6 million are males and 9.3 million are females. The number of disabled is more in rural compared to urban areas. Such proportion has been reported between 57-58 percent for males and 42-43 percent females. The disability rate (number of disabled per 100,000 populations) for the country as whole works out to 2130. This is 2,369in the case of males and 1,874 in the case of females.

Among the five types of disabilities on which data has been collected, disability In seeing at 48.5% emerges as the top category. Others in sequence are: In movement (27.9%), Mental (10.3%), In speech (7.5%), and In hearing (5.8%). The disabled by sex follow a similar pattern except for that the proportion of disabled females is higher in the category In seeing and In hearing.

Across the country, the highest number of disabled has been reported from the state of Uttar Pradesh (3.6 million). Significant numbers of disabled have also been reported from the state like Bihar (1.9 million), West Bengal (1.8million), Tamil Nadu and Maharashtra (1.6 million each). Tamil Nadu is the only state, which has a higher number of disabled females than males. Among the states, Arunachal Pradesh has the highest proportion of disabled males (66.6%) and lowest proportion of female disabled.

As per Census 2011, in India, out of the 121 Cr population, about 2.68 Cr persons are ‘disabled’ which is 2.21% of the total population. In an era where ‘inclusive development’ is being emphasised as the right path towards sustainable development, focussed initiatives for the welfare of disabled persons are essential. This emphasises the need for strengthening disability statistics in the Country.  Census 2001 has revealed that over 21 million people in India as suffering from one or the other kind of disability. This is equivalent to 2.1% of the population. Among the total disabled in the country, 12.6 million are males and 9.3 million are females. Although the number of disabled is more in rural and urban areas. Such proportion of the disabled by sex in rural and urban areas. Such proportion has been reported between 57-58 percent for males and 42-43 percent females. The disability rate (number of disabled per 100,000 populations) for the country as whole works out to 2130. This is 2,369in the case of males and 1,874 in the case of females.

   Among the five types of disabilities on which data has been collected, disability In seeing at 48.5% emerges as the top category. Others in sequence are: In movement (27.9%), Mental (10.3%), In speech (7.5%), and In hearing (5.8%). The disabled by sex follow a similar pattern except for that the proportion of disabled females is higher in the category In seeing and In hearing.

   Across the country, the highest number of disabled has been reported from the state of Uttar Pradesh (3.6 million). Significant numbers of disabled have also been reported from the state like Bihar (1.9 million), West Bengal (1.8million), Tamil Nadu and Maharashtra (1.6 million each). Tamil Nadu is the only state, which has a higher number of disabled females than males. Among the states, Arunachal Pradesh has the highest proportion of disabled males (66.6%) and lowest proportion of female disabled.

 
 
TABLE 20 : NUMBER OF DISABLED POPULATION AND TYPE OF DISABILITY
  Population Percentage (%)
Total population 1,028,610,328 100.0
Total disabled population 21,906,769 2.1
Disability rate ( per lakh population) 2,130 —
Type of Disability
(a) In seeing 10,634,881 1.0
(b) In speech 1,640,868 0.2
(c) In hearing 1,261,722 0.1
(d) In movement 6,105,477 0.6
(e) Mental 2,263,821 0.2
Source: Census of India 2001.

 
There are ample reasons for developing a sound national disability statistic. Information on their socio – demographic profile is essential for welfare of disabled persons. Information about their functional status is important to identify needs since two individuals with the same impairment may face different types of difficulties in undertaking certain activities, and so have different needs that require different kinds of interventions.

Functional status data is essential for determining the broader social needs of persons with disabilities, such as provision of assistive technology for use in employment or education or broader policy and laws.

Population disability data is essential for monitoring the quality and outcomes of policies for persons with disabilities. In particular, these data help to identify policy outcomes that maximize the participation of persons with disabilities in all areas of social life from transportation and communication, to participation in community life. Finally, with complete and reliable disability statistics, state agencies will have the tools for assessing the cost-effectiveness of policies for persons with disabilities, which in turn can provide the evidence to persuade governments of their ultimate benefit for all citizens.

The National Policy for Persons with Disabilities (2006) recognizes that Persons with Disabilities are valuable human resource for the country and seeks to create an environment that provides equal opportunities, protection of their rights and full participation in society. To facilitate the national objective, there is a need for collection, compilation and analysis of data on disability.

The Sustainable Development Goals (2015) pledges for ‘leaving no one behind’. Recognizing that the dignity of the human being is fundamental, the SDGs wish to see the Goals and targets met for all nations and peoples and for all segments of society and to endeavour to reach the furthest behind first. The implementation and monitoring of these international commitments demand sound database of disabled persons.

In India children with disabilities mainly comes under the purview of the Ministry of Social Justice & Empowerment. Some of the issues are dealt with by the health ministry. But no single ministry has been assigned the protection of these children, which leads to varying data about occurrence of disability amongst children. In India 1.67% of the 0-19 population has a disability. 35.29% of all people living with disabilities are children. Other estimates say that India has 12 million children living with disabilities. Only 1% of children with disabilities have access to school and one third of most disabilities are preventable. Under-nutrition is a severe problem with children who suffer from cerebral palsy. In India 80% of children with disabilities will not survive past age forty.

Census 2001 has revealed that over 21 million people in India as suffering from one or the other kind of disability. This is equivalent to 2.1% of the population. Among the total disabled in the country, 12.6 million are males and 9.3 million are females. The number of disabled is more in rural compared urban areas. Such proportion has been reported between 57-58 percent for males and 42-43 percent females. The disability rate (number of disabled per 100,000 populations) for the country as whole works out to 2130. This is 2,369in the case of males and 1,874 in the case of females.

Among the five types of disabilities on which data has been collected, disability In seeing at 48.5% emerges as the top category. Others in sequence are: In movement (27.9%), Mental (10.3%), In speech (7.5%), and In hearing (5.8%). The disabled by sex follow a similar pattern except for that the proportion of disabled females is higher in the category In seeing and In hearing.

Viewing disability from a human rights perspective involves an evolution in thinking and acting by States and all sectors of society so that persons with disabilities are no longer considered to be recipients of charity or objects of others’ decisions but holders of rights. A rights-based approach seeks ways to respect, support and celebrate human diversity by creating the conditions that allow meaningful participation by a wide range of persons, including persons with disabilities. Protecting and promoting their rights is not only about providing disability-related services. It is about adopting measures to change attitudes and behaviours that stigmatize and marginalize. Understanding disability as human rights
SPECIAL CHILDREN IN TAMIL NADU

District wise population of the Differently Abled Persons in Tamil Nadu
as per the census 2011 of Government of India
S. No District VI HI LD MR MI MD OTHERS TOTAL
1. Chennai 10506 27273 14146 5495 2716 4780 25148 90064
2. Coimbatore 5985 15605 10452 4141 1385 3531 11353 52452
3. Cuddalore 5604 12202 9225 3625 825 3109 8042 42632
4. Dharmapuri 2903 5978 7381 1953 547 2366 4155 25283
5. Dindigul 3038 9973 7287 2769 837 2467 6582 32953
6. Erode 3930 8417 9793 2874 1185 3155 6007 35361
7. Kancheepuram 7242 17046 15082 5619 1739 4707 17626 69061
8. Kanyakumari 2820 7597 8720 3249 1660 2863 8443 35352
9. Karur 1601 3099 4475 1342 469 1365 1691 14042
10. Krishnagiri 3081 7324 7473 2232 528 2208 5845 28691
11. Madurai 5462 11339 11530 4384 1275 3271 9587 46848
12 Nagapattinam 3244 6024 7577 2974 1103 2726 4575 28223
13 Namakkal 3177 6322 8033 2231 596 1992 3994 26345
14 Nilgiris 1115 2161 2566 1016 317 860 1985 10020
15. Perambalore 1079 3203 2199 833 202 778 2092 10386
16. Pudukkottai 2614 5485 6128 2453 831 2524 4443 24478
17. Ramnad 2462 6359 5222 2230 692 1822 4645 23432
18. Salem 4822 9702 13639 4019 1140 3751 6595 43668
19. Sivakangai 2411 6227 5993 2235 692 2190 4374 24122
20. Thanjavur 3592 8048 9970 3981 1403 3350 5968 36312
21. Trichy 4460 8376 11139 4381 1283 3480 7157 40276
22. Theni 1857 5913 5140 1811 498 1607 4150 20976
23. Thiruvarur 3030 7562 6173 2041 778 2022 4670 26276
24. Thiruvannamalai 4524 9453 9790 3374 860 3333 6838 38172
25. Thiruvallur 7296 21857 13144 4961 1344 4969 20978 74549
26. Thirunelveli 5302 11840 14600 5195 1822 4183 8605 51547
27. Thoothukudi 3751 7366 8903 2988 1302 2472 4588 31370
28. Virudhunagar 2864 6604 8276 2927 839 2745 4559 28814
29. Villupuram 6324 14694 15994 4256 1175 4583 11507 58533
30. Vellore 6408 14645 15586 5535 1603 5362 12019 61158
31. Ariyalur 1790 4162 3733 1116 317 1294 2664 15076
32. Thiruppur 3111 8462 7872 2607 1001 2931 7507 33491
Total 127405 300318 287241 100847 32964 92796 238392 1179963

Importance of this research:
This is a unique subject as people are more focused on the disability of the children there are many efforts taken to bring the children with special needs to the mainstream. They have also been succeeded to include the special children to involve with the children in school and college setting. But from the being if we see there are very less research being conducted to include parents of the special children and also to understand the problems faced by them. When we talk abut the holistic development of any child the main important factor are the parents but in the past till mow there are very less measures take to develop parents of special children in our country or to include them also in the various development strategies of their children. the aim of this research is to know the psychosocial problems of the parents. This study will try to bring the various challenges faced by the parents of special children focusing of the parents of mentally challenged children and the various measures which can be taken to solve those challenges.

REVIEW OF LITRATURE
This chapter is the collection of all relevant studies related to the topic from various books and journals reviewed by the researcher and also this literature has helped the researcher to identify the critical psycho social problems of the parents and the state of managing the same.

The Review of the various study from the journals, articles and books are in an order from International to Regional studies.

A study on exploring the invisible issues in identification and assessment of students with learning disabilities in India; Fouzia Khursheed Ahmad; Transience 2015 Vol.6 Issue 1 Students with Learning Disabilities have special needs in academic, classroom, behavioural, physical, and social performance and hence require need-based adaptation of classroom procedures for effective academic instruction. To address the educational needs of learners having Learning Disability, it is essential to ensure timely identification, assessment and remediation to help minimize the effects of Learning Disability since it manifests itself in multiple forms. Children with disabilities in reading accompanied with the attention deficit disorder are found to be having reading deficits that are more severe and more resistant to intervention. Appropriate early intervention, phonological instruction, and continuous and intensive support to deal with other co-occurring disorders like CAPD (Central Auditory Processing Disorder) and ADHD is essential to address the issue and assist the children in efficient learning, since longer the children with disability in basic reading skills go unidentified and without intervention, the more difficult is the task of remediation, lesser the rate of success and more severe the accompanied social and behavioural deficits in the children as co-occurring disorders hampering their healthy learning and growth. It is therefore vital to identify and address the issues in identification and assessment of Learning Disabilities in the country to offer a fair platform to students, opening a window of opportunities by assisting them to learn at their own pace and helping them to study and perform at par with their non-disabled peers in schools. Policy recognition of Learning Disability, extension of equitable access to facilities and assistance in learning, effective and timely interventions, adequate research on the identification, treatment and remediation of Learning Disabilities to understand the gravity of the effects of this ‘invisible disability’ can help sought out a direction to address the problem. Besides, ensuring means of identification and assessment that are indigenous and easily adaptable in the country can help in addressing the differences in a just and need-based manner and making learning barrier-free, inclusive and accessible to all.

A study on problems faced by parents of mentally challenged children by J Lucy Boyd, Aug. 14,2017 in livestrong.com. It was concluded by the researcher that the parents of mentally challenged children need emotional strength and flexibility to take care of their children. As the child has special care needs with the daily needs of the children so sometimes it gets overwhelming for the parents emotionally and physically the care giving procedures. Weather the needs of the children are normal or complex it effects parents vitally. The various problems are emotional issues, physical exhaustion and stress, school related issues and financial problems. These are the issues on which the researcher threw light. It’s a conceptual study.

A study by Brian O’Toole David Luterman (1991), regarding the involvement of volunteers, parents and community members with children with special needs. This was a study conducted by the UNESCO in the various developing nations to understand the various problems and challenges faced by that various care takers of special children. This study is done in among the population of Guinea. It is basically to understand the level of involvement of the various social care takers to develop the special children and their needs. The neighbour’s visit came mid-way through the ‘Decade of Disabled Persons’. It seemed, however, that much of the time had been spent highlighting the inadequacies of existing service models in the areas of special education and rehabilitation, rather than re searching and developing innovative alternatives. It was clear then, as it is now, that parents the world over were not receiving enough help with the care, education and training of their disabled children. In many of the poorer developing countries, the parents often find no help at all. There is an urgent need for a reappraisal of the concept of staffing, the models of training and the nature of services offered in the areas of rehabilitation and special education. A major reason for the lack of progress over the past decade is the adoption of inappropriate models of service delivery. The ‘modernisation mirage’ which fosters the illusion that Western skills, knowledge and attitudes need to be transmitted to people in developing countries, has yet to fade. In a blinkered desire to imitate a Western model of service provision, the developing countries have lost sight of the true magnitude of the problem. The official justification for this ‘policy’ is to ‘maintain standards’. However, for the 98% of families which are presently receiving no assistance, the argument concerning standards of service provision has no relevance.
An effective innovation needs a well-informed and well-prepared community, and time was therefore spent on developing community awareness. Coverage in the media at different times during the project has done much to enhance the status of the programme and has helped to give the volunteers and families the feeling that they are part of an important project. This has been augmented by the announcements concerning the project in places of worship, health centres and schools in the region.

A study by Tali Heiman (2002) regarding the parents of children with disabilities: resilience, coping, and future expectations. It’s a conceptual study to acquire the various Resilience, coping and future fears of parents of special children. This study is just a form of article not complete study. Definitions of the concept of resilience usually include the ability to withstand and rebound from crisis and distress. A systemic view of resilience within ecological and developmental contexts seeks to identify elements that enable families to cope more effectively and emerge hardier from crises or persistent stresses. A similar concept of hardiness grew out of another line of research on stress and coping. Although there are no exact terms or variables that define resilience, several different researches have examined diverse terms associated with it, such as a sense of mastery, optimism, and reliance on God, resilience as successful adjustment in terms of self-esteem, social support, various aspects of social life, problem-solving, and coping strategies notions of social integration, interdependence, and close relationships .Another study on resilience revealed three constitutional factors that include measures of self-efficacy, well-defined faith lives, and the ability to reframe barriers and obstacles. The study helps to make a note on the changes made in the daily routine of the child care creates a significance change in the development of the children. Various resilience and coping and future fears what parents of the special children go through what are the various coping skills and methods to be acquired by them to be an overcoming parent and also to develop their children in a better way to be self-dependent.

A study by MF Khan & Ma Alam (2016), about the coping trends of parents having children with developmental difficulties. Having to take care of children with developmental disabilities can affect parents not only in their psychological well-being but also affect physical well-being. Taking care of a child with special needs can be a growing experience or it can become stressful depending on how a parent perceives the event. Depending on the cognitive appraisal and the person environment interaction, parents can either engage in positive behaviours of dealing with the disability or indulge in poor coping behaviour which will have adverse impact physically as well as psychologically. The present article attempts to highlight the various ways of coping used by parents to deal with their children s disabilities. Review of research papers suggests some clear differences between affected parents and non-affected parents on use of different types of coping strategies along with various moderating factors like education, income, social support available, socio-economic conditions, and type of coping used. There were also findings on how mothers differ from the fathers in their coping behaviours when dealing with disabilities.It’s an article for the journal and it’s a conceptual study on the base of the review of Literature. Parenting is a tough exercise and having a child with disabilities can make things more difficult. Since children with disabilities have impairment in physio, psycho, social development, parents can find their roles very stressful when dealing with developmental issues resulting in social, economic/ financial problems, physical and psychological problems. The problems associated with developmental needs of children with disabilities create ambiguity which parents find unacceptable many at times, parents find it quite stressful to accept the disability of their child. And if a child had severe impairment leading to greater dependency on the caregiver, greater was the discomfort felt by the caregiver. Family also tend to perceive the child with special needs as less valuable as compared to the other non-affected children. The present paper thus will try to highlight the findings of various studies and see how parents of children with disabilities cope. Research has shown that caring for children with disabilities can create anxiety and stress for parents. Parenting children with special needs may affect well; putting parents at risk for stress, anxiety and depression; difficulties in marriage, and in extreme cases leading to separation; and adverse impact on physical health. In addition, if the disability of child is severe, the family tend to feel more socially isolated greater stigma. Such families are likely to experience greater stigma, loss of control, absence of support from spouse and also professional help. Results indicate that almost all the parents of children with disabilities tried to have belief in their child s capabilities, remaining optimistic, and being realistic and accepting of the disability to cope with their child s disability. Use of such as coping strategy is effective as it allows an individual to take proactive initiatives to accept or change stressful situations rather than to focus on negative feelings. The importance of family coping with the stress they experience in having a member with disability often relies on the parents. Hence, how the parents cope with the stressful situation will dictate how the child with disability will be provided services needed for his or her development.

A study by Louise Callan (2013), a case study examining the inclusion of children with special educational needs in a mainstream primary school. The study aims to find out how inclusive one primary school is with regard to students with special educational needs. To the study the school is called Rose Hill Primary School. There have been many changes in policy and legislation relating to the inclusion of children with special educational needs in mainstream schools. This study aims to examine the extent to which Rose Hill Primary School meets the criteria for an inclusive school. The study examines the inclusivity of Rose Hill School in relation to the ten themes of inclusion drawn up by the National Council for Special Education’s Consultative Forum. The objective of this study are the Provision of Information, Physical Features, Inclusive School Policies, An Individual Education Plan (IEP), Student Interactions, Staffing and Personnel, External Links, Assessment of Achievement, Curriculum and Teaching Strategies.
The aim of the qualitative researcher is to provide insights into the lives, experiences and understandings of the research participants. However, only partial understandings of such situations can be provided.These included issues relating to the school building, limited access to appropriate services provided by outside agencies and lack of specialist resources in the school. There was a significant degree of unanimity among respondents as to how these deficiencies might be overcome.

A study by Erjona Dervishaliaj (2013), regarding the parental stress in families of children with disabilities. A lot has been written about the stressors in the lives of parents of children with disabilities. This paper examines the existing research on stress in families of children with disabilities, highlighting different variables related to stress. Through a literature review and conceptual framework, the aim of this article is to help professionals to a better understanding of variables related to stress, and to create some basis and guidelines for further empirical research in Albania.
Research suggest that parents of children with developmental disabilities not only experience higher levels of stress compared to families of children with typical development, but their mental health in general might be complicated as well. Parents may experience depression, anxiety, higher levels of hopelessness, failure, guilt, they report less parental skills and less marital satisfaction.

This literature review points to different factors related to stress for professionals and researchers to bear in mind while working with families of children with developmental disabilities. There is a large variation in the experience of caring for a child with a disability. Professionals working with these families need to know care giving produces both positive and negative experiences. This review of literature points out that healthy family functioning is important for the wellbeing of the family, and that practitioners need to support the needs of the entire family and not just the needs of the child with a disability. Practitioners working with young children can play an important role in helping family members reframe their care giving experience in positive ways and assisting family members in feeling like they have the knowledge, skills, and ability to successfully advocate for what their children need.

A study by Wai Tong Chien (2013), an Exploratory Study of Parents’ Perceived Educational Needs for Parenting a Child with Learning Disabilities this exploratory, qualitative study was conducted to explore Chinese couples’ perceived educational needs for parenting a child with specific learning difficulties (SLD).We recruited a purposive sample of 25 couples who were caring for a child with specific learning difficulties at home from one regional child mental health center in Hong Kong. Data were collected from individual couples via audio-taped, semi-structured interviews between April and June 2011. Each interview lasted for about an hour. We analysed the interview data using qualitative content analysis, as suggested
Four identified categories of parents’ perceived educational needs were information needs for care giving, a variety of health concerns with themselves and their child, inadequate psychosocial support, and perceived stigma attached to help-seeking. These results reveal challenges and information for mental health professionals in providing effective educational and psychosocial support and culture-specific health care for these families and their children with learning disabilities.

The findings indicate a few important educational needs of parents in caring for a child with SLD that might be underestimated by mental health professionals and teachers, such as psychological support and information needs. To facilitate effective parenting, holistic and individualized needs assessment and education should be provided to address each parent’s biopsychosocial and cultural needs in relation to care giving.

A study on Parents of Children with Disabilities: Resilience, Coping, and Future Expectations, Tali Heiman, Journal of Developmental and Physical Disabilities, June 2002, Volume 14, Issue 2, On the basis of characteristics of family resilience, the study examined the perspectives of parents of children with an intellectual, physical, or learning disability. Thirty-two parents were interviewed as to past, present, and the modes of coping. The questions examined various aspects of family ecology domains: parents’ responses to the child’s diagnosis; patterns of adjustment; family support and services used by parents; and parents’ feelings and future expectations. Although, it was found that most parents had to make changes in their social life and expressed high levels of frustration and dissatisfaction, many try to maintain their routine life. The majority expressed the need for a strong belief in the child and in the child’s future, an optimistic outlook, and a realistic view and acceptance of the disability. The study highlighted the importance of social resources and support, and the need for effective programs of intervention.

A Qualitative Study of Psychosocial Problems among Parents of Children with Cerebral Palsy Attending Two Tertiary Care Hospitals in Western India, Somashekhar Nimbalkar,1,2 Shyamsundar Raithatha,Rutvij Shah, and Dhara Antani Panchal, Hindawi Publishing Corporation ISRN Family Medicine Volume 2014,Received 9 December 2013; Accepted 15 January 2014; Published 20 February 2014. A qualitative study using focus group discussions (FGDs) was done. Present study sheds light on the wide range of social, psychological, and health problems experienced by the parents of children with cerebral palsy. A wide range of these problems are experienced by the caretakers of these children. While planning a family-centred program for such children, these problems should be considered and addressed in order to make care of the child more e?ective. Cerebral palsy (CP), with a prevalence of 2.83 per 1000 children among the age group of 0 to 19 years, is one of the most common causes of disability in India. A child with CP su?ers from several problems such as spastic paralysis, cognitive impairment, chronic pain, speech and visual impairment, and gastrointestinal and feeding problems. They also have several limitations in self-care functions such as feeding, dressing, bathing, and mobility. These limitations can result in requirements for long-term care that far exceed the usual needs of normal children. The difficulties faced by children with cerebral palsy result in their parents experiencing a higher level of stress which has an adverse e?ect on their physical health and social well-being. Changes in healthcare systems and societal attitudes have resulted in most children staying at home in the care of family rather than in an institution. Moreover, in western countries, a greater emphasis is laid on family-centred care, wherein the focus of attention is the entire family, rather than just the child, and this has been found to be highly e?ective. The family, together with service providers, is able to make informed decisions about the services and supports the child and family shall receive. In order to develop a family-centered care practice, it is imperative to understand and address the psychosocial problems experienced by the caregivers of the a?ected children. Several studies of this kind have been undertaken in western countries but very few are reported in India. In a country like India there are significant di?erences between the environments of urban and rural areas. Our study seeks to explore the psychosocial problems experienced by the parents of children with cerebral palsy.

A study on “Stress ; Coping Strategies in Families of Mentally Retarded Children”. Journal of Evolution of Medical and Dental Sciences 2015; Vol. 4, Issue 52, June 29; Page: 8977-8985, DOI: 10.14260/jemds/2015/1303 by Mukesh Morya, Atul Agrawal, Suneet Kumar Upadhyaya, D. K. Sharma. Families with mentally retarded children experience a great physical and psychosocial stress which demands various psychosocial strategies for effective coping. This study was conducted in the department of Psychiatry, Government Medical College, Kota (Rajasthan) with the objectives of finding out the stress & coping strategies and the factors influencing these strategies in the families with mentally retarded children. Fifty mentally retarded children were divided into two groups. Parents of selected mentally retarded children were interviewed by using semi structured Performa containing– personnel identification data, Family Interview for Stress and Coping in Mental Retardation (FISC-MR), NIMH–Family Efficacy Scale (NIMH-FES), Problem Behaviour Check List. In various dimensions of perceived stress, families with mentally retarded children with less IQ experienced significantly higher daily care stress, emotional stress, social stress and total perceived stress than the families with mentally retarded children with IQ greater. Families in both groups used similar coping strategies (i.e., awareness about mental retardation, attitude and expectation, rearing practices and social support) except global support strategy which was used significantly higher by the families of children with IQ<5o. Having a female mentally retarded child and nuclear family were the factors associated with higher stress in families. This study shows various dimensions of perceived stress and coping strategies by the families of mentally retarded children which needs to be considered before planning effective policies and programmes.

A study on attitudes of family members towards mentally handicapped children and family burden by Rajdeep Kaur, Harish Arora Department of Psychiatry, Civil Hospital, Gurdaspur, Punjab, Delhi psychiatry journal vol. 13 no.1 April 2010 .The burden associated with rearing such mentally handicapped children usually affects whole of atmosphere of home including routine family life, emotional aspects and financial resources of family. The study has been undertaken with the aim of determining the attitudes of family members towards a mentally handicapped child in their family and it has been assessed whether such children are considered as burden to their families. The study was carried out in psychiatry outpatient department of the civil hospital, Gurdaspur in Punjab. Parents of children suffering from mental handicap who came for getting mental disability certificate for their children were included in the study. Total 200 families of mentally handicapped children were included in age group of up to 16 years of age. They were interviewed using a questionnaire based on ‘Questionnaire on Resources and stress ‘scale to measure burden in their families. During the interview, an attempt was made to have both the parents present. Basic psychometric properties of the questionnaire were sound. Findings revealed that mean burden was minimal to moderate in all the 200 families. The intelligence quotient was between 36 and 51 in 120 children, 70 children had IQ between 20 and 35, 10 children had IQ below 20. The education of parents was up to 5th standard in 100 children, up to 8th standard in 80 children, upto12th standard in 15 children and up to graduation in 5 children. 80% of families belonged to poor socioeconomic status. 10% of families belonged to middle class background. The findings support the fact that children suffering from mental handicap are considered as burden by their family members. Negative parental attitude leads to rejecting attitude towards mentally retarded children. This adversely affects the interaction within the family and also with outsiders. Such children should be offered support by family members to enable them to cope with stressful situations and in their rehabilitation. There is a need for implementation of family based schemes for such disabled children.

A study on children’s and parents’/carers’ perceptions of mental health and stigma; by Fiona Gale; Department of Child and Adolescent Psychiatry; Division of Psychiatry; School of Medicine; University of Leicester; March 2006. This study examined the perceptions of mental health and stigma in young children with emerging mental health problems, and those of their parents or carers. The study’s objective was to gain some understanding of the context and impact of stigma on children and their parents/carers, and to determine factors which could contribute to service improvement and policies to tackle stigma. A qualitative design, using Interpretative Phenomenological Analysis, was undertaken to explore children’s and their parents’/carers’ perceptions of mental health, children’s mental health services and the stigma attached. Semi-structured interviews, using a specifically designed storybook technique, were conducted with 20 children, aged 5 to 11 years, who had been referred to Child and Adolescent Mental Health Services for the first time. In addition, semi-structured interviews were undertaken with their parents or carers .The study found that young children and their parents/carers have sophisticated and complex perceptions of mental health and the stigma attached. However, the findings show that understanding of the definition of mental health is not salient, and that participants experience the discriminatory effects of the stigmatisation process. The effects of stigma are communicated within the parent/carer-child dyad, which serves to contribute to perceptions of shame, blame and being different held by children and parents/carers. Participants also have preconceived ideas about mental health and children’s mental health services, which contribute to the stigmatisation process. In turn, this affects help-seeking and can contribute to the severity of children’s mental health problems. The study highlights that collaborative approaches with young children and their parents/carers in education about mental health and stigma, development of non-stigmatising mental health services, and tackling stigma should be mainstreamed at a local and policy level, in order to effect positive change.
A case study examining the inclusion of children with special educational needs in a mainstream primary school by Callan, Louise ; Dublin Trinity College Dublin; 2013 ;Publisher Trinity College, Dublin ;29-Mar-2018. Creating an inclusive learning environment is a complex task. According to the participants in this research study, significant progress has been made but some obstacles remain to be overcome before Rose Hill School can be considered fully inclusive. This inclusiveness is evident from the school’s inclusive admissions policy, the use by teachers of differentiation to facilitate the needs of all children in their classes, and the willingness of all staff members to do what they can to ensure that the needs of all the children in the school are fully met. It can become even more inclusive. The respondents identified certain factors which they considered prevented the school from being fully inclusive. These include: an absence of appropriate continuing professional development; time constraints, which make it difficult for teachers to collaborate and co-ordinate to the extent required; inadequate physical resources; and lack of appropriate supports from external professionals such as speech therapists, occupational therapists and psychologists. The participants agree that a positive attitude on the part of teachers is critical to developing an inclusive learning environment. Positive, accepting attitudes by teachers towards children with special needs create the basis for inclusive practice. However, positive attitudes alone will not make a school inclusive. From the study it is clear that respondents feel that including children with special needs in the mainstream school requires adequate funding, proactive leadership, ongoing professional development and the development of collaborative relationships between schools, parents and support agencies.

A study on stress and coping in families of children with mental retardation; by Satish Chandra Girimaji, Shobha Srinath Shekhar Seshadri & D.K. Subba Krishna; Indian Journal of Psychiatry, 1999. Stress and coping in the families caring for their member with mental retardation has recently received worldwide research attention. There is no comprehensive instrument to study these issues in India. This study reports on development and standardization of a new instrument to fill this lacuna. Family Interview for Stress and Coping in Mental Retardation (FISC – MR), a semi-structured interview schedule, was developed as a part of two years prospective study of efficacy of brief family intervention for 157 children with mental retardation (funded by ICMR). The tool consists of 2 sections – one measuring stress (daily care, emotional, social and financial) and the other measuring mediators of stress or coping strategies (awareness, attitudes, expectations, rearing practices and social support). It indicates moderate to high reliability (internal consistency, inter-rater reliability and test-retest reliability) and validity (factorial, criterion and construct) of the instrument. It is concluded that FISC -MR is a useful, reliable and valid instrument for both clinical and research purposes.

A study on the family perceptions in caring for children and adolescents with mental disabilities: a qualitative study from Tanzania; by G.S.K. MBWILO, B. SMIDE and C. AARTS ;Muhimbili University of Health and Allied Sciences, Institute of Allied Health Sciences, School of Nurse ;Teachers, Dares Salaam, Tanzania; Tanzania Journal of Health Research Volume 12, Number 2, April 2010. This study has shown that the provision of services to children and adolescents with mental disability is not responding to the needs of this population. This community based study was carried out in Temeke Municipality in Tanzania and aimed to explore factors that influence family perspectives in the provision of care to these samples. This is a qualitative study of 52 respondents from 29 families involved in the daily care of them, chosen through convenient sampling. A semi?structured questionnaire was used in the interviews. The text was analysed using thematic content analysis. The results of the study revealed family characteristics; deficient knowledge about mental disability (MD); and lack of health care facilities and resources for caring them. The community and families of these respondents had poor knowledge on mental disability and appropriate care, and about availability of resources and quality care. Families were not supported in the care of their children. Some children in consequence did not receive adequate health care. Some suffered from physical problems due to inadequate care; others were being locked in their room during periods when no?one was able to look after them. These factors were related to socio?economic characteristics of the families as well as to lacking service facilities. “Patient” oriented, community/family?based health services to support management of chronic or life?long conditions such as mental disability is needed. The support of caregivers to children with mental disability has to be improved. A well worked?out strategy would improve health care of them through provision of guidance and supervision to the families. Community and family/home?based care in the study area would benefit families of these respondents.

A Study of Their Needs and Expectations: Parents of Intellectually Disabled Children; Dr. Amrita Sahay, Clinical Psychologist, National Institute for the Mentally Handicapped, New Delhi Jai Prakash, Psychologist, Vocational Rehabilitation Centre for Handicapped, Ludhiana, Punjab Dr Abdul Khalique, Reader, Psychology Department, Ranchi University, Ranchi Priti Kumar, Special Educator, New Delhi; International Journal of Humanities and Social Science Invention;ISSN (Online): 2319 – 7722, ISSN (Print): 2319 – 7714 www.ijhssi.org Volume 2 Issue 7 ;July. 2013. In this study the needs have been defined as the basic requirement expressed by an individual for survival. The needs expressed by families of children with intellectual disabilities are different from person to person and family to family. The present study examined a total of 45 parents of children with intellectual disabilities; children were under treatment at National Institute for the Mentally Handicapped, Regional Centre New Delhi. The Family Needs Survey Scale (Bailey and Simeonsson, 1988) was used to find out the needs of the parents of intellectual disabilities. Finding suggested that parents referred to strong needs about information of current and future service available in society and the community (88.7%) which is followed by basic expenses (82.7%), teaching strategies and therapy (80%), day care services (77.8%). Parents showed less expected needs towards the professional influences (Minister, 4.4%). This study helps to understand the implementation of Government Policies and services model in the community to provide financial support to family with intellectual disabilities.

A study on the stress perceived by families with mentally retarded children enrolled in special schools at Indore ; by Aesha Farheen, Sanjay Dixit, S.B.Bansal; JK-Practitioner volume 18 Nos (1-2)January-June 2013. In the presence of a mentally retarded child in the family may bring many stresses on the family members. This stress can affect the daily life of family members as well as have a negative impact on their psychosocial health. Describing the stress can help in identifying areas that need to be addressed, for planning of care for the affected children as well as their family members who are the primary caregivers. This study was undertaken to describe the stress perceived by families with presence of a mentally retarded child. A total of 100 families with 102 mentally retarded children enrolled in special schools in Indore city were questioned on a pretested self-administered questionnaire. Various areas in which stress was studied were; daily care stress, emotional stress, social stress and financial stress.81% families reported daily care stress, 65% reported emotional stress, 51.5% reported social stress, and 64% families reported financial stress. Severe or very high stress is reported by the families in sub areas of extra inputs for care and decreased leisure time. Moderate degree of stress is felt by maximum families in sub areas of personal distress and neglect of other family members. In various sub areas a large number of families do report no stress. Such sub areas are marital problems (44%), other interpersonal problems (45%), altered social life (48%) and social embarrassment (49%).

A study on parents of children with mental retardation: coping mechanisms and support needs; Samuel Bauman, doctor of philosophy, Dissertation submitted to the Faculty of the Graduate School of the University of Maryland, College Park in partial fulfilment of the requirements for the degree of Doctor of Philosophy ;2004. The purpose of this research was to explore the subjective experiences of families of children with mental retardation, specifically the sources of stress and coping for these families. Interviews were conducted with families to shed light on their subjective experiences of coping and stress. In an effort to increase understanding of the worldview of these families, issues in theory, practice, and future research are briefly discussed. Social support and empowerment oriented professional practice were found to have a mediating effect on family stress.

A study on understanding of mental health and mental illness by Gujarati young people and their parents;Nisha Dogra BM DCH MRCPsych MA PhD senior Lecturer and Honorary Consultant in Child and Adolescent Psychiatry; University of Leicester, Leicester, UK; Diversity in Health and Social Care; Radcliffe Publishing;2005. This paper presents an account of a project that explored Gujarati Hindu young people’s and their parents’ understanding of the terms ‘mental health’ and ‘mental illness’ through the use of semi-structured interviews. The sample of 15 parents and 15 young people was selected from an inner city community with a large minority ethnic population in which Gujaratis formed the largest social group in that setting. Thematic analysis identified three key themes understanding the terms mental health and mental illness; causes of mental health problems; and sociocultural factors and mental health. These themes showed that neither the young people nor their parents had a consistent understanding of the terms ‘mental health’ or ‘mental illness’. There was also confusion between these terms and that of ‘learning disability’. A range of views was presented so it is difficult to conclude that the Gujarati Hindus conceptualise mental health or mental illness in any specific way. It is highly possible that the findings of this study would have been similar for other ethnic groups with similar socio-economic backgrounds. The findings indicate that before patients and communities can be involved in child and adolescent service planning and development, there is considerable work that needs to be undertaken to establish a shared understanding of key terms such as ‘mental health’ and ‘mental illness’.