Mental Health Challenges in Children with Special Needs

 

Words by Dr Rika Rijal

 

Children with special needs often face unique challenges that can affect their mental health, making it vital to adopt holistic approaches that embrace their individuality and strengths.

Do you remember the Bollywood movie Taare Zameen Par? It is a heartfelt portrayal of the challenges faced by children with special needs, particularly dyslexia. The movie delicately navigates the journey of Ishaan, a young boy who struggles with academics due to dyslexia, a learning disorder. It beautifully captures the frustration and isolation felt by children with learning difficulties, emphasizing the importance of understanding and support from both educators and parents. Through Ishaan’s story, the film underscores the significance of recognizing that every child is unique and may require a different approach to learning. It sheds light on the necessity of nurturing individual talents and offering an inclusive environment that celebrates diversity. Ultimately, “Taare Zameen Par” serves as a poignant reminder that with patience, empathy, and tailored support, children with special needs can shine and fulfill their potential. 

During my residency in PGIMER, India, I got a chance to work with many children with special needs. One of the cases that I came across was a 15-year-old boy with a genetic syndrome and mental retardation. He had problems in vision and hearing since his childhood. 

Addressing mental health in special needs children requires a comprehensive strategy, integrating education, therapy, family support, and community awareness to nurture their holistic well-being.

Since the patient was from a rural background and his family members were not much aware of his problems, they would often compare him with other children and send to the school attended by his siblings. In his school, due to his poor understanding, the students would often make fun of him and bully him. Teachers would not involve him in any activities that would mostly make him feel left out. Even in his class he would not be able understand the subject matter that would mostly result in failure or passing with grace marks which made him more stressed. Sometimes, he would also be seen to be making gestures and on one occasion he was seen to be touching his genitals in front of classmates. He would not share his problems with his family members as he felt that they didn’t understand his problems. So he would make reasons to avoid going to school and would mostly stay at home without interacting with his family members. Whenever his family members would force him to go to school he would easily become irritable and become aggressive. Over few months, he mostly remained in his room and remained sad, not showing interest in any activities. He would also be seen to be smiling and muttering to self on many occasions.

Seeing this one of the relatives became concerned and asked the family members to seek for help from a psychiatrist. They were reluctant at first but later became convinced after patient’s condition worsened. After detailed history taking, we made a diagnosis and discussed it with parents. At first, they were not ready to accept the diagnosis and reluctant to give medication for depressive disorder. So we had to do extensive psychoeducation to the family members regarding the nature of his illness and what all to expect. Patient was also given education regarding sex education and phases of sexual maturation using audio visual tools. After few weeks the family members started understanding the nature of their son’s illness. For his underlying depression, they started giving medication as recommended. They would mostly be concerned about patient’s education and work future. We provided them with the options that, there were special school for differently abled children where the patient can be enrolled and given education as per his mental age. Also, that if he plans to apply for a job/ plans a marriage than to be honest regarding patient’s condition so that both the parties are well known about his condition and no legal issue arises in the future. 

Finally, after months of close intervention, the patient’s condition improved and started going to school for differently abled children and maintained well.

This story is that of a differently abled child, who was seen as a regular child. The failure to identify the needs of the child led to such problems, this merely serves as an example of how easy is it for people to miss identifying such children at homes and even at regular schools. We may at times have seen such child in different set ups but dismissed the idea that the child is one with special needs simply by labelling him/her as a difficult child. 

 

Children with special needs

Children with special needs/ differently abled children is a term used to describe children who require additional support and accommodations due to their physical, developmental, behavioural, or learning challenges. These needs can be attributed to various conditions, such as intellectual disabilities, sensory impairments, neurodevelopmental disorders like autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), physical disabilities, and emotional or behavioural disorders. 

Creating inclusive environments and tailored interventions is crucial for empowering children with special needs, allowing them to thrive and achieve their full potential despite challenges they may face.

The preferences for terminology may vary among individuals and communities. Some may prefer “differently abled,” while others may prefer term like “children with special needs”. The use of the term “differently abled” instead of “disabled” or “handicapped” reflects a shift in language to promote inclusivity, respect, and a positive perspective towards individuals with varying abilities. Some reasons for this change can be:

1. Positive Connotation: “Differently abled” emphasizes the unique abilities and talents of individuals, focusing on what they can do rather than what they cannot. This positive connotation aims to reduce stigma and challenge negative stereotypes associated with traditional terms like “disabled.”
2. Inclusivity: The term “differently abled” is inclusive and recognizes the diverse range of abilities that individuals may possess. It acknowledges that everyone has unique strengths and weaknesses and emphasizes the importance of creating an inclusive society that accommodates these differences.
3. Empowerment: The term “differently abled” is seen as empowering, allowing individuals to define themselves beyond any limitations imposed by societal perceptions. It encourages a focus on capabilities and encourages a more positive self-identity.
4. Evolution of Language: Language evolves over time to reflect societal attitudes and values. The shift towards terms like “differently abled” represents an evolving understanding of disability and a desire to promote more respectful and inclusive communication.

For a long time, and still today, children with special needs were overlooked, their emotional and their mental health struggles were often overshadowed. Studies have shown that such children are actually at an increased risk of mental health issues and are more susceptible to the risk factors for depression, anxiety and even suicide, due to increased traumatic experiences, bullying, social isolation discrimination, and an inability to regulate and express their feelings. This can further lead to feelings of frustration and loneliness and continue the cycle of emotional dysregulation. Data from different countries shows that students in special education are at high risk of developing mental illness compared to their peers, especially if they have an emotional disturbance. 

 

As we can see that such children often face unique challenges that can impact their mental health. Mental health problems in such children can be complex due to a combination of cognitive, social, and environmental factors. 

Addressing issues in Children with special needs

There are many issues related to children with special needs. Few issues were discussed in the case above like making them prone to develop mental illness like depression and anxiety.  Some of them might face communication difficulties, behavioural disorders making them prone to develop social isolation and loneliness. Addressing these issues in such children requires a holistic and individualized approach which many may include:

1. Behavioral Interventions

Functional Behavior Assessment (FBA): Conducting an FBA helps understand the function of challenging behaviors. This knowledge informs the development of targeted interventions.

Positive Behavior Support (PBS): Implementing PBS involves reinforcing positive behaviors, creating structured environments, and teaching alternative skills to replace challenging behaviors.

2. Communication Support

Augmentative and Alternative Communication (AAC): For children with difficulties in verbal communication, AAC systems such as picture communication boards or electronic devices can enhance expressive abilities.

Speech and Language Therapy: Collaborating with speech-language therapists can address speech and language challenges, facilitating improved communication.

3. Social Skills Training

Structured Social Skills Programs: Implementing evidence-based social skills programs tailored to the child’s needs can enhance their ability to navigate social interactions.

Peer-Mediated Interventions: Involving peers in intervention programs promotes social inclusion and provides natural opportunities for skill development.

4. Family and Caregiver Support

Psychoeducation: Providing families with information about their child’s condition, strategies for support, and available resources is crucial for effective intervention.

Psychotherapy and Support Groups: Offering therapy services and support groups creates a space for families to share experiences, seek advice, and foster a sense of community.

5. Individualized Education Plans

Tailored Educational Strategies: Collaborating with educators to develop such plan ensures that educational strategies are tailored to the child’s strengths and challenges.

Regular Progress Monitoring: Periodic assessments and adjustments to the IEP help track the child’s progress and adapt interventions accordingly.

6. Mental Health Professionals

Psychological Assessment: Conducting assessments by mental health professionals helps identify underlying mental health issues and informs appropriate interventions.

7. Sensory Integration Therapies

Occupational Therapy: Sensory integration therapies, often provided by occupational therapists, help children regulate sensory input, addressing sensory processing difficulties.

8. Challenges and Considerations

Diversity of Needs: Children with special needs encompass a broad spectrum of conditions, requiring diverse and flexible approaches.

Interdisciplinary Collaboration: Effective intervention often involves collaboration among educators, therapists, healthcare professionals, and families to address various aspects of a child’s well-being.

Advocacy: Advocacy for inclusive policies, accessible resources, and awareness is crucial for creating an environment that supports the mental health of children with special needs.

Conclusion

In conclusion, a comprehensive approach that integrates educational, behavioral, and emotional support is essential for addressing mental health challenges in children with special needs. Tailoring interventions to individual requirements, involving families, and fostering a supportive community contribute to the overall well-being of these children. Also, supporting and nurturing the well-being of children with special needs involves a collaborative and individualized approach, considering the unique strengths and challenges of each child. Educational, therapeutic, and familial interventions play a crucial role in fostering the holistic development of children with special needs, empowering them to reach their full potential. It is essential to promote inclusivity, understanding, and awareness in society to ensure that children with special needs receive the support and acceptance they deserve.