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Question 1

Sigafoos et al. (2003) note that an adequate awareness of medical problems (mental health issues included) is essential for proper understanding of challenging behaviour in order to provide effective support to people with developmental disabilities and challenging behaviours. Unlike people without developmental disabilities, persons with developmental disabilities tend to be more prone to a number of mental and medical problems hence the need to promote their health and well-being. This paper describes two factors that are considered in health and medical screening and their relevance in supporting people with disabilities. These are; mental health and medical care and screening.

  1. Mental health

Assessment of an individual’s mental health will give an indication as whether the person has a mental illness or if the mental health problem is a reaction to stress from the surrounding environment such as death of a close relative. In addition, a person’s mental health could be a pointer as to whether they receive the necessary psychiatric care when necessary and in the case where psychotropic medications are used whether they are justified and their use monitored on a monthly basis. In our line of work, we receive many children with mental health problems and it is our responsibility to evaluate them individually and understand what could be triggering or encouraging the conditions so that we can give them the appropriate care that can nurture them to make independent decisions without stigmatization and isolation.

Lunsky et al. (2008) emphasize on the role that medical ethics play in protecting the medical rights of people with intellectual disability. Caregivers, healthcare providers and patients with disability should work together with the ultimate goal of achieving good health while meeting their medical rights. Self-determination in healthcare should be encouraged to reduce disparities in health that people with intellectual disabilities undergo. Self-determination has the capacity to change issues that are known to be sources of health disparities for example patient-level factors, health system factors and communication issues from the patient or healthcare provider. Bé rube (2013) argues that democratic principles give prospective parents the right to choose what they desire.  He recognises how difficult it is to maintain the abortion rights of an individual in the face of a social stigma directed at people who are disabled shaping their prenatal choices.  Bé rubé visualizes a world where certain conditions are screened and disability is not equated with disease. He adds that disabled people must be allowed to participate in the democratic deliberation of the public policies that affect them.

  1. Medical care and screening

This helps in determining whether the medical problems identified have been resolved and referrals to specialists are made when necessary. It will also help in determining whether the person with disability and the care provider comply with the recommended medical treatments.  It also ensures that before or during the period that behavioural and educational assessments and interventions are done, the individual is examined to evaluate vision, hearing, allergies, reactions to medications and other medical conditions that might be contributing to challenging behaviour but have not been recognized. In their study, Raina and Lunsky (2010) established that inpatients and outpatients from the forensic group engaged more in substance abuse, had higher levels of IQ and considerably longer stay lengths compared to the non-forensic group. This did not however translate to high rates of personality disorders in the forensic group, where the clients also had equal gender distribution. This is a clear indication that these clients need to be served in such a manner that they are accorded the necessary mental health supports adequately as well as the legal supports to address forensic-related issues. Similarly, in my day-to-day experiences with students in my early childhood special needs class, I have to thoroughly understand an individual’s medical history to know the specific medical problems they are suffering from in order for me to tailor the necessary supports and interventions that can help them grow and achieve independence as an individual rather than as a group.

Question 2

Based on the video clip, the different components of Enhanced Milieu Teaching (EMT) used by the mother to encourage communication from the child are; setting up an interactive context whereby the child is allowed to initiate the communication, response of interaction by responding to the child’s communication to you and using verbal terms to teach them how to have a conversation, modelling and expanding play by linking words with engaging activities and letting the child take the child, modelling communication target to expand the child’s utterances, environmental arrangement strategies whereby non-verbal tasks are used to initiate communication and  milieu teaching procedures where an adult encourages the child to say something by giving them a signal. Sandberg and Liliedahl (2008) advocate that prelinguistic children are given an active role in play interactions and provided with opportunities to ask questions in order to reinforce language development.

I would recommend that the mother use parent coaching to improve interactive communication with their child. For instance, the mother can enrol the child in a group-based program to complement the EMT. Moore et al. (2013) note that group training tends to be more effective and promoted an environment where peer parents are able to support and guide each other thereby encouraging participation and engagement, especially when they involve parent education programs that aim at reducing children’s challenging behaviours. The authors add that small groups consisting of 5-6 families are more effective as parents get an opportunity to share progress, support each and discuss the way forward in implementing strategies.

Another Milieu teaching strategy I would recommend is naturalistic intervention through the use of play and routines. According to Curiel and Sainato (2016), the focus in this case is on training the parents or adults present in the environment of the child to recognise and respond to attempts at communication by the child. This is because most attempts at communication by the child often go unnoticed leading to missed opportunities at elaboration of language. Children’s daily routines such as bath time, dressing, mealtime, nappy time and reading before going to bed provide rich environments for learning language. This is also shown by Ogletree et al. (2011) who demonstrate the acquisition of communication skills by a child through perlocutionary, illocutionary and locutionary stages where peers and teachers serve as communication partners.