DISABILTY AND MENTAL RETARDATION AMONG SCHOOL-AGED CHILDREN

EXECUTIVE SUMMARY

This study consisted of two parts: the secondary data review and the survey of 1411 “special” School students in Ulaanbaatar. The study gathered baseline data on disability and mental retardation among school-aged children of Ulaanbaatar and was fielded from December 2005 to March 2006. Here, disability is defined broadly to include any disabilities/presences of one or more restrictions, limitations or impairments which had lasted, or were likely to last, for a period of 6 months or more.

Below are the main findings of the survey.

Secondary data review

• In Ulaanbaatar, there are 186186 students in the 193 secondary schools.

• Of the 186186 students, 17223 were reported with a disability giving an overall

rate of 92.5 cases per 1000.

• The most prevalent disabilities were visual disability (54.3/1000), followed by

hearing/speech disability (17.6/1000), locomotor disability (6.1/1000), mental

disability (5.5/1000) and other disabilities (8.9/1000).

• When all cases of disability (17223 cases) were considered, visual disability

predominated (58.7%), followed by hearing/speech disability (19.1%), mental

disability (6.6%), locomotor disability (6.0%) and other disabilities (9.7%).

Survey of “special” school students in Ulaanbaatar

• Totally, out of 1850 students of the “special” schools 1411(76.3%) children were

enrolled in the survey.

• The most commonly detected type of disability among “special” school students

was mental disability (68.6%). The second largest prevalence was in speech

(27.3%), followed by multiple (25.7%) and hearing (25.3%) disabilities, with

rates almost same as speech disability. Few children were having visual (9.8%)

and locomotor disabilities (4.3%).

• The most common type of mental disability was the mild mental retardation

(99.5%).

• 9.8% of all “special” school students were having some form of visual impairment. Most visual impairment was partial loss of vision (90.6%).

• Hearing impairments are more common (25.3%) than visual impairments among

“special” school students. Most hearing disability was a deaf (83.5%).

• Most speech disability was a dumb (70.1%).

• 4.3% of all “special” school students were having some form of locomotor

disability. Most locomotor disability was paralysis total or partial (50.8%).

• Over two thirds (74.3%) of “special” school students with any disability had one disability, a fifth had two disabilities and about a twentieth had three disabilities.

The most commonly occurring combination of disabilities was hearing, speech and mental disability for both male and female.

• Genetic diseases were the main disabling condition accounting for 20.2% of all

Students  with a disability. Congenital/prenatal factors accounted for 17.1% of all

Students  with a disability. Disease/illness factors accounted for 12%. Infant birth trauma (4%) and injury/accidents accounted for 4% and 2.7% of all students with a disability, respectively. In 42% the disability was with unknown etiology.

• By far the most common co-morbidities were chronic diseases of ear, nose and throat (83.5%) and eyes (43.7%), followed by diseases of the cardiovascular system (1%), diseases of the endocrinology system (6.5%), diseases of the skin (1.8%) and of the kidney (1.5%).

• Out of the 1411 students, 7.3% came from rural area and 1.4% was orphan. Over half (50.3%) of the students lived in Mongolian traditional tents/gers, 3.0% in

Dormitories, 1.4% in a orphan child care house and 1.2% in support centers.

In conclusion, the prevalence of disabilities especially mental disability among school aged children is still high. This has major implications for health, rehabilitation, welfare and educational services. These implications must be addressed in order to develop appropriate rehabilitation services for children. In addition, the results from our study suggested that further need more specified study especially on etiology of disabilities.

Developmental disabilities are lifelong conditions that result in substantial emotional, psychological, and financial costs to affected persons, their families and society. Services and care provided to the disabled person in the advanced countries have developed greatly in term of quantity and quality. 1 In the developing countries such care is still well below the required level, in spite of the fact these countries contain 80 percent of the total number (over 500 million) of disabled persons in the world. 2 International efforts with of co-ordination and

collaboration of many countries in the field of care for disable persons are shown in numerous documents such as the Declaration of the Rights of Mentally Retardation Persons (1971) and Economic and Social Council resolution 1921 (VIII) that held for the prevention of disability and rehabilitation of disabled persons. In addition, there are some other resolutions and documents issued by specialized international agencies such as UNESCO and the United Nations Children Fund (UNICEF) to help disable persons too.

Children are our future. Promoting their development and wellbeing is widely accepted as an essential investment as well as a responsibility because of their vulnerability. The special concern is necessary for one group of children, those with disabilities, who are potentially a particularly vulnerable group, both in childhood and later in their adult lives. Children with severe disabilities may be in good health, but may have long-term activity limitations and participation restrictions, which they and their parents must cope with. 3

Childhood disability can create serious financial hardship for parents; they can have difficulty taking up employment that enables them to care for the child, which in turn reduces their ability to afford the additional care needed for their child. Therefore a disability affects not only the child but also the overall wellbeing of the families. 4-6

An estimated 625 million children and adolescents under 18 years of age, have disabilities in worldwide. In USA, among school-age children (5–17), 5.5 percent have school-related disabilities (including 3.2 percent who attend special schools or classes) and an additional 2.0 percent are limited in non-school activities.7

In 1980 the World Health Organization (WHO) proposed a classification system for impairments, disabilities and handicaps (ICIDH). These three concepts capture the consequences of disease and have been defined as follows: impairments are concerned with

the abnormalities of body structure and appearance and with organ or system function, resulting from any cause; disabilities reflect the consequences of impairment in terms of functional performance or inability to undertake activities considered normal; and handicap refers to the disadvantage experienced by an individual as a result of impairments or disabilities. In short, impairments represent disorder at the organ level; disabilities at the level of the person; and handicap the interaction between the individual and their environment. The ICIDH framework has gone through a number of revisions and recently a new classification - the International Classification of Functioning, Disability and Health

(ICF) - has been approved. The new classification allows for a dynamic rather than static or linear assessment of the interaction between functioning and disability, on the one hand, and individual contextual factors (environment and personal) on the other. It is applicable to all people, whatever their health condition. The ICF complements the new ICD-10 classification of diseases. 8-9

Disability groups, such as ‘intellectual disability’ and ‘physical disability’, provide a broad categorization of disabilities based not only on underlying health conditions and impairments, but also on activity limitations and participation restrictions. Disability groups are not an attempt to classify people but rather to categorize the experience of people across various domains of functioning and disability. 8-9

Intellectual/learning disability is associated with impairment of intellectual functions with limitations in a range of daily activities and with restriction in participation in various life areas. Supports may be needed throughout life, the level of support tending to be consistent over a period of time but may change in association with changes in life circumstances.

Psychiatric disability is associated with clinically recognizable symptoms and behavior patterns frequently associated with distress that may impair personal functioning in normal social activity. Impairments of global or specific mental functions may be experienced, with associated activity limitations and participation restrictions in various areas. Supports needed may vary in range, and may be required with intermittent intensity during the course of the condition. Changes in level of support tend to be related to changes in the extent of impairment, or in the environment.

Sensory/speech disability is associated with impairment of the eye, ear and related structures and of speech, structures and functions. Extent of impairment and activity limitation may remain consistent for long periods. Activity limitations may occur in various areas, for instance communication and mobility. Availability of a specific range of environmental factors will affect the level of disability experienced by people in this grouping. Once in place, the level of support tends to be relatively consistent.

Physical/diverse disability is associated with the presence of an impairment, which may have diverse effects within and among individuals, including effects on physical activities such as mobility. The range and extent of activity limitation and participation restriction will vary with the extent of impairment as well as with environmental factors. Environmental adjustments and support needs are related to areas of activity limitation and participation restriction, and may be required for long periods. Levels of support may vary with both life changes and extent of impairment.

Acquired brain injury is the term used to describe multiple disabilities arising from damage to the brain acquired after birth. It can occur as a result of accidents, stroke, brain tumors, infection, poisoning, lack of oxygen, degenerative neurological disease, etc. Effects include deterioration in cognitive, physical, emotional or independent functioning. For national and international data comparison purposes, acquired brain injury is often included as a

subcategory in the broad category of physical/diverse disability. The cognitive defect associated with PCB exposure is relatively specific.10 There is one study on “The disorders induced by iodine deficiency” and found: the main cause of epidemic goiter and cretinism is an insufficient dietary supply of  iodine.