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 childs 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: kodalirgrao@gmail.com
INTRODUCTION
Disability has been defned 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 Organizations
esti mates, approxi matel y 10% of gi ven
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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DOI:
10.4103/0019-5359.107773
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350 INDIAN JOURNAL OF MEDICAL SCIENCES
Indian Journal of Medical Sciences, Vol. 65, No. 8, August 2011
Government of Indi a 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 di sabi l i t i es are mal nut ri t i on,
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 si gni fi cant i mpact i n mi ni mi zi ng
or compensati ng for i mpai rment and i ts
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 diffculties 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.
Societys understanding and the approach
to the issues of the disabled has been fast
changi ng 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 fxes 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 affiction
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
351 A STUDY ON THE PSYCHOSOCIAL BEHAVIOR OF THE DISABLED CHILDREN IN LONI, MAHARASHTRA
Indian Journal of Medical Sciences, Vol. 65, No. 8, August 2011
abilities and potentialities. Apart from the
nature and severity of a given child, his
socioeconomic circumstances have also to
be taken into consideration. The psychosocial
environment in the family of the child is of
equal relevance.
[6]
Prevention, early identifcation, 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 area
The study area comprises of eight villages
under rural feld practice area of Rural Medical
College, Loni (Maharashtra).
Study population
7,300 children in the age group of 0-14 years
from the total population of 20,533.
Study design
The dat a has been col l ect ed t hrough
a wel l - des i gned c ommuni t y bas ed
cross- sectional study.
Sample size determination
The prevalence of disability among children
in rural area was considered as 5%(P) for
computation of the sample size. Keeping the
confdence 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 = Z
2
1-/2
(1-P)
2
P 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 methods
House 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
childs 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 data
Daily checking of 10% of the flled 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 ttest.
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 fgure of 10% of
world population by WHO, but was falling within
352 INDIAN JOURNAL OF MEDICAL SCIENCES
Indian Journal of Medical Sciences, Vol. 65, No. 8, August 2011
Table 2: Distribution of children with disabilities (>2 years) by psychosocial behavior
Disability Number (%) CBCL measure t value P value
Locomotor 23 (14.29) 08.52 3.81 <0.01
Mental retardation 13 (08.07) 18.57 6.14 <0.01
Visual impairment 17 (10.56) 06.82 3.05 <0.01
Hearing and speech impairment 98 (60.87) 06.23 6.60 <0.01
Multiple and miscellaneous 10 (06.21) 18.90 2.48 <0.01
Total 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 disability
Type of disability Number
(%)
Prevalence
rate per 100
Locomotor 23 (14.02) 0.32
Mental retardation 14 (08.54) 0.19
Visual impairment 17 (10.36) 0.23
Hearing and speech 98 (59.76) 1.34
Multiple and miscellaneous 12 (07.32) 0.17
Total 164 (100) 2.25
the range of 2-5% of the Indian population as
estimated by rehabilitation council of India.
Psychosoci al behavi oral 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.
Psychosoci al behavi oral changes were
observed more in children with multiple and
mi scel l aneous di sabi l i ti es whi ch i ncl ude
cerebral palsy and was followed by mental
retardati on, l ocomotor di sabi l i ty, vi sual
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 signifcant.
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]
353 A STUDY ON THE PSYCHOSOCIAL BEHAVIOR OF THE DISABLED CHILDREN IN LONI, MAHARASHTRA
Indian Journal of Medical Sciences, Vol. 65, No. 8, August 2011
Figure 3: Psychosocial behavior in relation to dependency
Figure 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
value
P value
Mild (50-70) 06 (42.86) 09.83 3.39 <0.01
Moderate
(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 dependency
Dependency Number
(%)
CBCL
measure
t
value
P value
Complete
dependence
04 (17.39) 14.50 3.6 <0.01
Modifed
dependence
05 (21.74) 08.00 1.39 <0.05
Independent 14 (60.87) 07.00 2.58 <0.01
Total 23 (100) 08.52 3.8 <0.01
Normal 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.
354 INDIAN JOURNAL OF MEDICAL SCIENCES
Indian Journal of Medical Sciences, Vol. 65, No. 8, August 2011
CONCLUSION
The community must be made aware of
already existing social security measures
l i ke educati on faci l i ti es for the di sabl ed
children and other social security measures.
The govt. and private charitable agencies
must make avai l abl e prost het i cs, ai ds
and rehabilitation by CBR program. Non
Government Organizations 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 i nspi rati on, 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. Worl d Heal th Organi zati on. Internati onal
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 Peoples 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 OffcersNew 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. Confict of Interest: None declared.
Table 5: Distribution of psychosocial behavior of children with visual impairment by category
Category Number (%) CBCL measure t value P value
Blind (VA<3/60) 04 (23.53) 09.00 4.94 <0.01
Low vision (VA 3/60-6/18) 13 (76.47) 06.15 2.07 <0.05
Total 17 (100) 06.82 3.05 <0.01
Normal CBCL Measure in control group: 02.73
Table 6: Distribution of psychosocial behavior of children with hearing and speech disability by category
Category Number (%) CBCL measure t/Z* value P value
Hearing impairment 17 (17.35) 06.35 3.89 <0.01
Speech impairment 70 (71.43) 05.84 4.94* <0.01
Deafmutism 11 (11.22) 08.55 2.87 <0.01
Total 98 (100) 06.23 6.60* <0.01
*indicates Z value, Normal CBCL Measure in control group: 02.73
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