A Study on the Psychosocial Behavior of the Disabled Children in Loni, Maharashtra

349

Indian Journal of Medical Sciences, Vol. 65, No. 8, August 2011

A STUDY ON THE PSYCHOSOCIAL BEHAVIOR OF THE DISABLED CHILDREN IN LONI, MAHARASHTRA

RAJAGOPAL RAO KODALI, SITARAMA P. CHARYULU

ABSTRACT

OBJECTIVES: To find out the changes in psychosocial behavior of the disabled children. MATERIALS AND METHODS: The study area comprises of villages under rural field practice area of Rural Medical College, Loni. 7300 children of the age group of 0‑14 years from the total population of 20,533 were studied by community based cross‑ sectional study. House to house survey was conducted to identify disabled children using a pre‑tested questionnaire by interview technique. Child behavior check list (CBCL) which was developed by T.M. Atenbach was the tool used to assess the comprehensive, multi informant evaluation of child’s behavior. RESULTS: The overall prevalence rate of disabilities in children was 2.25%. Psychosocial behavioral changes were observed more in children with multiple and miscellaneous disability which includes cerebral palsy and was followed by mental retardation, locomotor disability, visual impairment and least among the children with hearing and speech impairment. Psychosocial behavioral changes among the children with disabilities were statistically significant. CONCLUSION: The result of the study necessitates organizing counseling to disabled children and parents, community based rehabilitation program and integration of disabled into the main stream education to reduce the psychosocial behavioral changes.

Key words: Community based rehabilitation, child behavior check list measure, disabilities, psychosocial behavior

ORIGINAL ARTICLE

Department of Community Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinaoutpalli, Andhra Pradesh, India

Address for correspondence: Dr. Rajagopal Rao Kodali, Department of Community Medicine, Dr.Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinaoutpalli, Andhra Pradesh, India E‑mail: [email protected]

INTRODUCTION

Disability has been defined as “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being”.[1]

According to World Health Organization’s estimates, approximately 10% of given population suffer from disability of one kind or other. There were no comprehensive surveys to know the exact incidence of disability in India.

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Government of India Census 2001 has included disability, a separate question and revealed that 80% of the disabled children were in rural areas. The major preventable causes of disabil i t ies are malnutrit ion, communicable diseases, early‑childhood infections and accidents at home and work place. Early detection of impairment, combined with early and effective curative care can make a significant impact in minimizing or compensating for impairment and its consequences.[2]

Persons with disabilities who belong to poor families are marginalized and disadvantaged by variety of factors such as lack of access to productive resources and to opportunities, and lack of information and skills, which enable participation in the social, economic and political process. Some groups such as women and girls are more vulnerable to disabilities. It was estimated that only 2‑3% of disabled in the need of rehabilitation have access to the services.

Persons with disabilities frequently live in deplorable conditions, facing barriers that prevent their integration and meaningful participation in mainstream society. The basic human rights to freedom of movement, access to education and health care are often ignored. Because they suffer the additive difficulties of their disability, marginalization and invisibility, their health, especially their mental health may deteriorate even further.[3]

The persons with disabilities and their family members are socially, economically and emotionally affected. The negative attitudes of the abled persons in the family and in the

community are the greatest obstacles to full participation and equalization of opportunities.

Society’s understanding and the approach to the issues of the disabled has been fast changing for the past 30 years. Newer advances in technology, new civil rights movements, greater number of disabled people making their marks in different social, political, economic and other sectors have helped in mainstreaming of the disabled citizens.[4]

The establishment of Rehabilitation Council of India has been a major move for quality assurance in the education, training and management of persons with disabilities. Persons with disabilities (equal opportunities, protection of rights and full participation) Act, 1995 fixes the responsibilities on the central and state governments to provide services, create facilities and give up support to the people with disabilities in order to enable them to have an equal opportunity in participating as well as productive and contributing citizens of the country to their fullest extent.[5]

A new strategy termed CBR was evolved and found extremely useful to rehabilitate persons with disabilities in the community setting and with community participation.

Disability, whether inborn or later day affliction has an inevitable, devastating impact on the victims and care givers alike. This may lead to a strong and violent emotional upheavals—anger, frustration, depression and the feeling of self pity and worthlessness. Experiences turn from painful to rewarding, when the affected realize and start focusing on their

351A STUDY ON THE PSYCHOSOCIAL BEHAVIOR OF THE DISABLED CHILDREN IN LONI, MAHARASHTRA


abilities and potentialities. Apart from the nature and severity of a given child, his socio–economic circumstances have also to be taken into consideration. The psychosocial environment in the family of the child is of equal relevance.[6]

Prevention, early identification, intervention, rehabilitation, integration and inclusion of all persons with disabilities are the concept of today, where by such people also have rights to their family and to a natural environment.

MATERIALS AND METHODS

Study areaThe study area comprises of eight villages under rural field practice area of Rural Medical College, Loni (Maharashtra).

Study population7,300 children in the age group of 0‑14 years from the total population of 20,533.

Study designThe data has been col lected through a w e l l ‑ d e s i g n e d c o m m u n i t y b a s e d cross‑ sectional study.

Sample size determinationThe prevalence of disability among children in rural area was considered as 5%(P) for computation of the sample size. Keeping the confidence level as 95% and the relative result of the survey results as 10% of P i.e., 0.5%,

the sample size was calculated by using the formula n = Z2

1‑α/2 (1‑P)∑2P where Z = 1.96 (C.L = 95%) P = 5% ∑ = 0.5% (10% of P = 5). The sample size has been arrived at 7229 rounded to 7300.

Selection of study population/sample survey methodsHouse to house survey was conducted to identify disabled children using a pre‑tested questionnaire. The data was collected through interview technique. Respondent was the head of the family or parent or close relative of the children in the house. Child behavior check list (CBCL) which was developed by T.M. Atenbach was the tool used to assess the comprehensive, multi informant evaluation of child’s behavior. It was intended to evaluate pathological behavior and social competence in children more than 2 years of age and was compared with the control group of normal children without disabilities.

Quality assurance of the dataDaily checking of 10% of the filled questionnaire by the senior colleague in the department. Results were discussed with senior colleagues and summarized.

Statistical analysis and interpretation of data

Data collected has been presented through frequency distribution tables, cross‑tables and graphs. Interpretation of the results was done using percentages, proportions and “t”‑test.

RESULTS AND DISCUSSION

The prevalence of disability in rural India is 2.25%. Major disability is hearing and speech impairment followed by locomotor disability, visual impairment, mental retardation and less is multiple disabilities as shown in Table 1 and Figure 1. The prevalence rate of disabilities was less than the estimated figure of 10% of world population by WHO, but was falling within



Table 2: Distribution of children with disabilities (>2 years) by psychosocial behaviorDisability Number (%) CBCL measure ‘t’ value P valueLocomotor 23 (14.29) 08.52 3.81 <0.01Mental retardation 13 (08.07) 18.57 6.14 <0.01Visual impairment 17 (10.56) 06.82 3.05 <0.01Hearing and speech impairment 98 (60.87) 06.23 6.60 <0.01Multiple and miscellaneous 10 (06.21) 18.90 2.48 <0.01Total 161 (100) 08.43 9.05 <0.01

Figure 1: Children with type of disability

Figure 2: Psychosocial behavior and disabilities

Table 1: Distribution of children with disabilities by the type and prevalence of disabilityType of disability Number

(%)Prevalence rate per 100

Locomotor 23 (14.02) 0.32Mental retardation 14 (08.54) 0.19Visual impairment 17 (10.36) 0.23Hearing and speech 98 (59.76) 1.34Multiple and miscellaneous 12 (07.32) 0.17Total 164 (100) 2.25

the range of 2‑5% of the Indian population as estimated by rehabilitation council of India.

Psychosocial behavioral changes were observed among the children with disabilities as measured by CBCL and compared with the control group of normal children of the same age and same sex. CBCL measure in the control group was 2.73 and in children with disabilities were 8.43.

Psychosocial behavioral changes were observed more in children with multiple and miscellaneous disabilities which include cerebral palsy and was followed by mental retardation, locomotor disabil ity, visual impairment and least among the children with hearing and speech impairment as shown in Table 2 and Figure 2. The same has been reported by Emerson[6] and it was found statistically highly significant.

Table 3 and Figure 3 reveals that psychosocial behavioral changes in children with locomotor disability were more in children with complete dependency and less in children who are independent. Among the children with mental retardation, the psychosocial behavioral changes were more in profound followed by severe, moderate and less in mild mental retardation as shown in Table 4 and Figure 4. The same has been observed by Dykens.[7]

353A STUDY ON THE PSYCHOSOCIAL BEHAVIOR OF THE DISABLED CHILDREN IN LONI, MAHARASHTRA


Figure 3: Psychosocial behavior in relation to dependencyFigure 4: Psychosocial behavior in relation to mental retardation

Figure 5: Psychosocial behavior in relation to visual impairment

Figure 6: Psychosocial behavior in relation to hearing and speech impairments

Table 4: Distribution of psychosocial behavior of children with mental retardation by intelligent quotient (I.Q.)I.Q. Number

(%)CBCL

measure“t”

valueP value

Mild (50‑70) 06 (42.86) 09.83 3.39 <0.01Moderate (35‑49)

05 (35.71) 20.30 15.85 <0.01

Severe (20‑34)

02 (14.29) 30.00 9.64 <0.01

Profound (<20)

01 (07.14) 37.00 * *

Total 14 (100) 18.57 6.14 <0.01* ‘t’ test cannot be applied as the sample was only one.

Table 3: Distribution of psychosocial behavior of children with locomotor disability by dependencyDependency Number

(%)CBCL

measure“t”

valueP value

Complete dependence

04 (17.39) 14.50 3.6 <0.01

Modified dependence

05 (21.74) 08.00 1.39 <0.05

Independent 14 (60.87) 07.00 2.58 <0.01Total 23 (100) 08.52 3.8 <0.01Normal CBCL Measure in control group: 02.73

Table 5 and Figure 5 reveals that psychosocial behavioral changes were more among the blind children compared to children with low vision. The children with deaf mutism showed more behavioral changes and less change

were observed among the children with speech impairment as was observed in Table 6 and Figure 6.



CONCLUSION

The community must be made aware of already existing social security measures like education facilities for the disabled children and other social security measures. The govt. and private charitable agencies must make avai lable prosthetics, aids and rehabilitation by CBR program. Non Government Organization’s should be involved in organizing parents clubs, counseling to develop warm relationship with their disabled child. All these measures will further enhance the positive attitudes of the society towards the disabled children, thereby minimizing the psychosocial pathology.

ACKNOWLEDGMENTS

The authors are grateful to Dr.R.C. Goyal, Former

Professor and Head, Department of Community

Medicine, Rural Medical College, Loni for his

constant inspiration, encouragement, expert

guidance and total involvement in the study. The

teaching faculty of Community Medicine and the

respondents of the study are greatly acknowledged

for their cooperation.

REFERENCES

1. World Health Organization. International Classification of Impairments, Disabilities, Handicaps. Geneva: WHO; 1980. p. 26‑28.

2. Agarwal V. Disabled child, Disabil India J, April 2003. Available from: http://www.disabilityindia.org. [Last accessed on 08 Oct 2012].

3. Council for Advancement of People’s Action and Rural Technology – A strategy to Promote the Participation of People with disabilities in Programmes for Rural Development, New Delhi: CAPART; 2000.

4. Nampudakam M. Disabled or differently abled. Health Millions 2000;26;3.

5. Rehabilitation Council of India‑Manual for Training of PHC Medical Officers‑New Delhi: Ministry of Social Justice and Empowerment, Government of India; 2001.

6. Emerson E. Prevalence of psychiatric disorders in children and adolescent with and without intellectual disability. J Intellectual Disabil Res 2003;47:51‑8.

7. Dykens EM. Psychopathology in children with intellectual disability. J Child Psychol Psychiatry 2000;41:407‑17.

How to cite this article: Kodali RR, Charyulu SP. A study on the psychosocial behavior of the disabled children in Loni, Maharashtra. Indian J Med Sci 2011;65:349‑54.Source of Support: Nil. Conflict of Interest: None declared.

Table 5: Distribution of psychosocial behavior of children with visual impairment by categoryCategory Number (%) CBCL measure “t” value P value

Blind (VA<3/60) 04 (23.53) 09.00 4.94 <0.01Low vision (VA 3/60‑6/18) 13 (76.47) 06.15 2.07 <0.05Total 17 (100) 06.82 3.05 <0.01Normal CBCL Measure in control group: 02.73

Table 6: Distribution of psychosocial behavior of children with hearing and speech disability by categoryCategory Number (%) CBCL measure “t”/Z* value P valueHearing impairment 17 (17.35) 06.35 3.89 <0.01Speech impairment 70 (71.43) 05.84 4.94* <0.01Deafmutism 11 (11.22) 08.55 2.87 <0.01Total 98 (100) 06.23 6.60* <0.01*indicates Z value, Normal CBCL Measure in control group: 02.73

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A Study on the Psychosocial Behavior of the Disabled Children in Loni, Maharashtra