THE EXCEPTIONAL CHILD

An exceptional child is referred to as either a child who is a genius academically,

manually, physically etc. or it could be referred to as a child that is handicapped. The
type and extent of handicap varies from one child to another.

Classification:

There are two main classifications:

(a) The exceptionally good or exceptionally up to date physically, manually and

academically. These are referred to as "gifted children"
(b) The exceptionally poor child i.e. poor educationally, physically and manually.
These are referred to as handicapped children.

The handicapped children can also be sub-divided into 2 groups namely:

(i) Mentally handicapped Mongolism, imbecility, moron) educationally

subnormal.
(ii) Maladjusted children.

According to WHO, an impairment is defined as any loss of psychological,

physiological or anatomical structure or function.

A disability is defined as any restriction or lack of ability (resulting from impairment)

to perform an activity in the manner or within the range considered normal for a
human being

Handicap is defined as a disadvantage for a given individual, resulting impairment or

disability that limits or prevents the fulfillment of a role that’s normal

Impairment Disability Handicap

Etiology of Exceptional Child

 Congenital / Hereditary.
 Acquired i.e. secondary to other conditions such as infection, effect of drug…
1. CONGENITAL/ HEREDITY: These can also be divided into two.
 Pre-Natal Causes

Genetic / Heredity causes: This refers to abnormalities of the genes or chromosomes.

They can lead to the following genetic conditions:

(a) Down's syndrome,

(b) In-born error of metabolism, e.g. Phenylketonuria.
(c) Microcephaly.
(d) Muscular dystrophy.
(e) Sickle cell.
 Congenital Causes

These are those factors, which may affect the already formed child in the utero,
especially during the first trimester. They are referred to as environmental causes.
These includes:

(i) Drugs such as Thalidomide.

(ii) Infection such as, malaria, German measles etc.
(iii) Maternal antibodies.
(iv) Maternal toxemia.
(v) Dietary factors
(vi) Irradiation.
2. ACQUIRED AETIOLOGICAL FACTORS:

These is subdivided into 2.

(A) PERI-NATAL OR NATAL CAUSES: these are the defects due to

complications of delivery which can cause handicap, examples include
1. Trauma.
2. Fetal anoxia due to either maternal hemorrhage or cord prolapse.
3. Hypoglycemia.
4. Respiratory or metabolic acidosis.
5. Birth asphyxia.
(B) POST NATAL CAUSES: These are the causes of handicap after delivery
 1. Infection and measles
2. Trauma.
3. Poisoning.
4. Electrolyte imbalance.
5. Old age.
6. Malnutrition.
7. Irradiation e.t.c.

TYPES OF HANDICAPS

1. Locomotive Handicap: This refers to any individual's inability to move

normally due to disability. The restriction of movement may be partial or total
e.g. A person whose lower limb(s) is amputated suffers from locomotive
handicap
2. Communication Handicap: Any handicap that affects individuals hearing
ability, speech or ability to write is referred to as communication handicap.
3. Visual Handicap: This refers to disability affecting the eyes and its functional
ability. This can be partial or total
4. Intellectual Handicap: This includes impaired learning ability as in mental
retardation or loss of memory due to e.g. old age.
5. Emotional Handicap: This refers to problems of mental disorders such as
neurosis, drug addiction, and emotional immaturity e.t.c.
6. Social Handicap: This refers to a disadvantage in being able to perform
certain roles just because of one's social position such as: Poverty, Racial
discrimination, maternal deprivation e.t.c.
7. Visceral Handicap: This includes disorders of ingestion and excretion.
8. Invisible Handicap: This includes those handicap conditions, which are not
visible from outside e.g. Asthma, Diabetes, Epilepsy, Kidney diseases e.t.c.

Intelligent Test: Intelligent quotient test.

Example:

IQ = Mental age x 100/Real age.

A child of 10 years, whose mental age is that of 12 years old

1Q of this child = 12 x100/10 = 120%

A normal child should have an IQ of 100% while a gifted child could have more than
120%.

An IQ of between 120 to 125 is a very brilliant child

115 to 120 is a bright school child

90 to 1 15 is an average school child

80 to 90 is a retarded school child.

55 to 90 is an educationally sub-normal child (moderate).

Less than 50% is a severe educational sub-normal child.

PREVENTION OF HANDICAP

Primary prevention

1) Health education of community members on the causes and prevention of

handicap
2) Immunization of mothers and children against infectious diseases like tetanus,
rubella, poliomyelitis, meningitis etc
3) Adequate nutrition.
4) Marriage counselling on the problems of blood incompatibility, need for
family planning in terms of size, appropriate spacing so as to prevent
malnutrition
5) Fetal monitoring, screening of newborn and school children on conditions that
can cause disability
6) Avoidance of teratogenic substances like exposure to radiation consumption of
 alcohol and drugs
7) Measures aimed at preventing road traffic accidents e.g effective use of road
signs, campaigns against reckless driving etc

Secondary prevention

8. Early diagnosis and treatment of health conditions that can cause disability
9. Psychiatric treatment for emotional and behavioural difficulties

Tertiary prevention

10. Rehabilitation of physical, social status including vocational training

MANAGEMENT OF AN EXCEPTIONAL CHILD

The management of a gifted child differs from the handicap child.

Gifted children: To these groups of children, special preferences are given both
nationally and internationally. Scholarships are awarded to them this is to enable them
to face the right challenge that is commensurate to their IQ level.

All handicap children must be carefully assessed as regards their potentials i.e. to
know where they fix in either to refer them to special care centres for advice and
proper rehabilitation centres.

The general approach to care is educational and psychosocial. The family doctor and
pediatrician are mainly responsible for the early detection and assessment of mental
retardation. The team providing continuing healthcare also includes psychologists,
speech therapists, nurses, occupational therapists and physio-therapists.

A few mildly retarded children require fostering boarding school placements or

residential care, but usually specialist services are not required. Mildly retarded adults
may need help with housing. employment or with the special problems of old age.

In case of severely retarded children, some require special services throughout their
lives, which may include a sitting service, day respite during school holidays, or
overnight stays in a foster family or residential care. For adults, provisions are
required for work, occupation, housing, adult education, etc.

The main principle now guiding the provision of resources is that the retarded person
should be given sufficient help to be able to use the usual community services, rather
than to provide specialist segregated services.

Nursing Management Assessment

Assessment of early infant behaviours to indicate a cognitive disability among high-

risk children should be closely observed (e.g. children born to elderly primips, birth
trauma etc.); early infant behaviours that may indicate a cognitive disability include
non-responsiveness to contact, poor eye contact during feeding, slow feeding,
diminished spontaneous activity, decreased responsiveness to surroundings, decreased
alertness to voice or movement and irritability. Documentation of daily living skills.

Psychological assessment: This is directed at the interaction between them individual

and people who are clo sely involved in care and determining the correct needs and
wishes for the future. It should examine opportunities for learning new skills, making
relationships, and achieving maximum choice about the way of life.

Parents should be involved in establishing realistic goals for their mentally retarded
child. Some of these goals can be:

The child dresses himself

The child maintains continence of stool and urine.

The child demonstrates acceptable social behaviours.

The adolescent participates in a structured work program

Early intervention programs are essential to maximize the children's potential

development. This necessitates early recognition and referral. Nurses have an
opportunity to evaluate children in the nursery, in the clinic during well- child
healthcare, in schools and during acute management. The potential of each child will
vary according to the degree of mental retardation. Nurse can participate in programs
that teach infant stimulation, activities of daily living and independent self-care skills.
A successful technique in the treatment of the mentally retarded is operant
conditioning. It focuses on changing or modifying the individual's response to the
environment by reinforcing certain desirable patterns of behavior or eliminating
undesirable patterns.

In addition, learning social skills and adaptive behaviours assist the child in building a
positive self-image. For older children and adolescents assistance is needed to prepare
them for a productive work life.

In all instances, it is important for the nurse to maintain a non- threatening approach.

Cares and Rehabilitative Measures

Rehabilitation is the restoration of patients to their fullest physical, mental, social

capacity with the aim to enable the patient to gain independence instead of depending
on the society

Prompt Assessment: Prompt detailed assessment of the level of impairment,

disability and handicap by the team of health experts as mentioned above.

Corrective Measure: This is aimed at restoring the client's physical and emotional
impairments to the level that the he can be useful to himself and to the society.
Following corrective measures, client may be able to carry on with his former job or if
necessary, learn a new job depending on his residual ability.

Curative Measures: These measures can be medical or surgical and it is aimed at

correcting or limiting the deformity e.g. cosmetic surgery.

Educational Training: This is usually carried out in special schools for the
handicapped or unit for handicapped children within the normal school setting
(primary or secondary). In these types of schools special provision is usually made,
for the different categories of handicapped children such as the blind, the deaf, the
mentally retarded and the physically retarded respectively.
  The teachers usually receive special education, which enables them to handle
special problems of the children.
 Depending on their special needs and amount of resources available special
equipment are often available to facilitate teaching and learning process. For
example, toys, charts, Braille books for the blind children, hearing aids for the
deaf, walking sticks for the blind etc.
 The child's mental age or level of ability and not chronological age is usually
taken into consideration, especially for those having mental retardation.

Vocational Training: These are centres where disabled people can acquire some
skills, such as knitting, basket making, sewing, shoe repairing, poultry keeping etc
which can provide them with job opportunities especially self-employment. The skills
being acquired in vocational training centres do not often require mental ability.

Provision of Employment: In other to reduce the social problem of street begging

disabled people must be settled to a job after being discharged from the hospital or
rehabilitation center.

Designing and Producing of Special Gargets: In order to assist disabled people to

function independently, some public and private companies are specialized in the
production of special gadgets for the disabled. For example, wheel chairs, walking
sticks, special cars, lifts, prosthesis, beds, tricycles etc.

Centres for Guidance and Counselling: this type of centre should be made available
for the use of handicapped people and their families. A team that can handle the
different problems of handicapped people including physical, mental and social-
psychological problems should oversee the centre. The team must include public
health nurses, Midwives, Nurses, Doctors, Social workers, Clinical Psychologists,
Clergymen, Physiologists etc.

Hinderances

1. Lack of resources, such as specialist teachers, equipments, classrooms.

 residential accommodations, money etc.
2. Ignorance on the part of the parents and the community to bring their out their
children for training
3. Lack of commitment by the government

Role of the Health Workers in the Community in the Care of the Child

The mother is going to be profoundly depressed if her baby has some physical
handicap or deformity or mental sub normality

1. Give necessary information and explanations to the parents as they desired.

Provide emotional support and help to the mother to accept the situation.
2. The parents should be advised regarding available facilities for the child's care
and the need for training and educating the child.
3. Give mental assurance and comfort.
4. Parent needs guidance on day-to-day management of the child as their
attitudes and cooperation will affect the child's progress. The parent also needs
hope and encouragement to encourage them cope with continued trouble and
difficulties.
5. The gifted child should not be over protected or spoilt
6. Regular home visits and continuous checking of the child
7. Advice parents on the available rehabilitative facilities in the community and
the nation for the care of the child.
8. Encourage parents should show good relationship between the child and other
siblings in the family.