Module

6 Children with
disabilities or
developmental
difficulties
 Module

6
Children with
disabilities or
developmental
difficulties
 Module 6 | Children with disabilities or developmental difficulties Children with disabilities or developmental difficulties | Module 6

KEY MESSAGES. Why is this topic important for you?

Disabilities and developmental difficulties are common everywhere around the globe. In
contents
Afghanistan, according to the Multiple Indicator Cluster Survey (MICS) 2022/23, 10.7 per cent
KEY MESSAGES: Why is this topic important for you? 5 of children aged three to four years have some form of functional difficulty. This means you
are likely to meet children with disabilities and/or developmental difficulties during your early
childhood development (ECD) sessions.
Learning outcomes 6
For newborns or young children with disabilities or developmental difficulties, the early days
and years are just as, or even more, critical for helping them achieve their full potential. As a
1. Introduction 7 Childhood Nutrition and Development Frontline Worker (CND-FLW), your role is key to support
the family and the child, listen to their concerns about the child’s development, refer them to
the appropriate services available in the area, assist them in using these services and promote
2. What are disabilities and developmental the full social inclusion of the child and the family in the community.
difficulties? 8 Sometimes, in your ECD sessions or visits, you will encounter parents who already know their
children have developmental difficulties or disabilities. At other times, you will be the first
to notice that a problem exists. Understanding the causes of disabilities or developmental
3. Inclusion of children with disabilities difficulties and the importance of early identification and intervention will help you support
and developmental difficulties 11 families and their children.

You play a very important role in helping parents accept reality and cope with feelings of guilt
4. The CND-FLW’s role in the prevention and inadequacy, and empowering them to enjoy the interactions with their child.
of disabilities and developmental delays 12

5. The CND-FLW’s role in developmental

monitoring 14

6. The CND-FLW’s role in supporting families

with children with disabilities
and developmental delays – common issues 15

Annex 21

References 22

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 Module 6 | Children with disabilities or developmental difficulties Children with disabilities or developmental difficulties | Module 6

Learning outcomes 1. Introduction

By the end of this module, you will be able to: All children have the right to the best possible start in life and throughout their childhood. Children
with disabilities, being first and foremost children, have the same rights as any other children.
Understand impairment and developmental difficulties. However, children with disabilities face multiple barriers to realizing these rights (physical, institutional
and social), often being excluded from different services and activities. The United Nations Convention
Understand the contribution you can make to prevention, early identification and intervention
on the Rights of the Child (CRC) and the Convention on the Rights of Persons with Disabilities (CRPD)
for young children with disabilities or developmental difficulties.
highlight how children with disabilities have the same rights as other children – for example to
healthcare, nutrition, education, social inclusion and protection from violence, abuse and neglect.
Have knowledge about common issues facing families with children who have disabilities or
Ensuring access to appropriate support, such as early childhood interventions and education, can
developmental difficulties.
fulfil the rights of children with disabilities, promoting rich and fulfilling childhoods and preparing
Learn about providing this group of families and children with the support they need. them for full and meaningful participation in adulthood.

Know how to utilize the resources available to you and the family and understand the importance Schools should not say no to children because they have a disability. Service providers and other
of working with other professionals to support children with disabilities and their families. groups (such as UNICEF) are working to include more children with disabilities in schools. For
example, work is being done to make schools accessible for children with physical disabilities,
Promote disability inclusion and the human rights-based model of understanding disability and to provide accommodations for children with disabilities so they can be included in schools.
inclusion. Unfortunately, most provisions in this regard are not yet being implemented.

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 Module 6 | Children with disabilities or developmental difficulties Children with disabilities or developmental difficulties | Module 6

2. What are disabilities and developmental

difficulties?

Definitions Example: Salma, as every child, should exercise her rights. Her intellectual impairment
should not be a reason for her exclusion from society, schools, healthcare, etc. Salma only
Disability has a disability when her impairment is met with physical, institutional and social barriers.

‘Disability is an evolving concept. Disability results from the interaction between persons with For example, Salma is currently not in mainstream school, not because she cannot learn but
impairments and attitudinal and environmental barriers that hinders their full and effective because there are institutional and social barriers hindering her as the curriculum is not adapted,
participation in society on an equal basis with others.’ Preamble, CRPD. the teachers aren’t equipped and there is stigma, and she does not receive the needed support.

As defined by the World Health Organization (WHO) and UNICEF (2012), disability can occur at This model states that exclusion happens because of physical, institutional and social
three levels: barriers. This is in line with the CRPD definition of disability stated earlier.

1. An impairment in body function or structure, such as a cataract that prevents the passage Children with disabilities are those up to the age of 18 years who have long-term physical, mental,
of light and sensing of form, shape and size of visual stimuli. intellectual or sensory impairments that, in interaction with various barriers, may hinder their full
and effective participation in society on an equal basis with others (CRPD, Article 1).
2. A limitation in activity, such as the inability to read or move around.
It is important to note that the impact of a disability on a child’s life may not be directly proportional
3. A restriction in participation, such as exclusion from school. to the severity of the impairment or the functional limitations at a basic activity level. For example,
consider a child whose vision is correctable with glasses. Her functional limitation is small – and
Historically, disability has been understood using three models. To best explain these models and
easily accommodated – but, if she does not have access to glasses, and as a result drops out of
how we have come to use the above definition of disability, let us walk through the three models
school, the impact on her life can still be substantial.
and apply each to a fictional character, Salma, born with an intellectual impairment.
The key factor in determining disability is not the underlying medical condition or its extent, but
1. The Charity Model: Persons with disabilities are seen as inferior, useless, dependent, a result
the interaction between the functional limitation and the environment of the child.
of divine punishment and a burden to society, and are not expected to contribute to society
in any way. Severity of disability ranges from mild (child is fully able to participate, with minimal support) to
severe (child needs a complex support system to participate and be fully included in society).
Example: It is very unfortunate that Salma was born abnormal. She is such a burden to her
Some children have single impairments while others may experience multiple impairments.
family and society is ashamed. She was sent by God as a punishment for the parents’ sins.
Just like typically developing children, children with disabilities or developmental difficulties
It is best to keep Salma hidden and limit her exposure. That is the best way to keep her and
can develop their full potential in the right environment. Consider, for example, a child with a
others away from harm. It is useless to invest in her.
hearing impairment, who is raised in a nurturing family that talks to her and uses sign language
for communication. This child may be on track with respect to all the developmental milestones.
2. The Medical Model: Disability is seen as a purely medical condition of an individual that should
be ‘fixed’. The focus is on ‘correcting’ the person, so they can be accepted and integrated
Another example may be a child with Down syndrome who is receiving support with comprehensive
into society. This approach sets low expectations for children with disabilities. It labels a child
development and who, despite some intellectual impairment, can participate actively in a regular
as ‘abnormal’.
preschool.
Example: Salma is an abnormal child. All efforts should go to treatment for Salma in special
The Five Developmental Areas are cognitive, communication/language, motor skills (fine and
care institutions. It is best to keep Salma secluded with specialists who know how to take
gross), socio-emotional development and self-help skills/adaptive skills.
care of her.
Developmental disorders or developmental disabilities are a group of conditions associated
These two models state that exclusion happens because the child has a disability.
with an impairment in physical, learning, language or behavioural areas. These conditions begin
during the developmental period, may impact day-to-day functioning and usually last throughout
3. The Social Model. Disability is seen as part of human diversity. This model shifts the focus
a person’s lifetime.
from the individual’s impairment to the relationship between the individual and society.
It is the interaction between impairment and existing barriers that hinder inclusion (e.g.,
Developmental delay has been defined as ‘a deviation of development from the normative
inaccessible environment, stigma, lack of access to assistive technologies).

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 Module 6 | Children with disabilities or developmental difficulties Children with disabilities or developmental difficulties | Module 6

3. Inclusion of children with disabilities

and developmental difficulties

milestones in the areas of cognitive, language, social, emotional and motor functioning’ (WHO There are many reasons to advocate for the full social inclusion of young children with disabilities
and UNICEF, 2012, p. 2). Children develop at different rates. Delays in development can owe to or developmental difficulties in society. Children with disabilities and/or developmental difficulties
disabilities, but also to a host of other conditions. Some developmental delays may improve with are children first, with needs and inalienable rights. As such, children with disabilities and/or
intervention and can even disappear. Delays can be general – that is, all developmental domains developmental difficulties have the same rights to grow up in their family and community,
are equally affected, and the child’s development is like the development of a younger child. participate fully and on an equal basis in society and receive all the necessary services to thrive.

The delay can be variable, and some domains may be more delayed than others (e.g., language or Moreover, inclusion benefits everyone. It is in the country’s best interest to include children with
socio-emotional), or atypical, where the child develops differently in both the rate of development disabilities in every aspect of life. Inclusion benefits everyone:
of a domain and the quality (e.g., a child who can memorize a dialogue heard on television but
cannot ask for a food item). When children interact with their peers with disabilities, they are learning important social,
emotional and life skills.
Developmental difficulty. The term ‘children with developmental difficulties’ encompasses ‘all
children who have limitations in functioning and developing to their full potential’ (WHO, 2012, When teachers use inclusive teaching methods, everyone learns better.
p. 2). This may owe to disabilities, social deprivation or other conditions.
When an employee has a disability, the work culture is enriched.
Developmental milestones. Skills such as taking a first step, smiling for the first time and waving
The additional cost of inclusion is negligible compared to the impact of lifetime exclusion
‘bye bye’ are called developmental milestones. Children reach milestones in how they play, learn,
and underemployment and the opportunity costs of exclusion
speak, behave and move (e.g., crawling and walking) at approximately the same age.

Children with disabilities or developmental difficulties who receive support and early intervention
Children born with disabilities who live in poverty and are exposed to violence or neglect in the
are more likely to be able to function in their family and become productive and socially integrated
family are in the most difficult situation. We know that young children with disabilities are likely
adults, and may be able to contribute economically to their families.
to be more vulnerable and in need of adequate support in comparison to typically developing
children.
Over the past decade, the programmatic approach to disability has also changed gradually. While
children are still assessed and may receive a ‘diagnosis’ (e.g., ‘Autism Spectrum Disorder’, ‘Down
On the other hand, children with no obvious disabilities or no disabilities at all may be born into
syndrome’, ‘hearing impaired’, etc.), emphasis is now placed on how the condition affects the
situations of social disadvantage or go through adverse experiences during their early years and
child’s daily life and his/her ability to participate in society. Consequently, a ‘diagnosis’ now has
experience developmental difficulties. For example, we now know that the development of young
acquired a new meaning: it is not a label; it is a term that alerts us to the fact that the child needs
children can be seriously affected by being exposed to violence they experience themselves or
additional benefits and services that can be provided in their home and community.
observe against others. In addition, being cared for by a caregiver suffering from depression or
other mental illness may affect their development. Poverty can also contribute to developmental
difficulties; however, responsive and nurturing parenting and a stimulating home environment
can buffer against the effects of poverty and other adversities.

Your role in these cases can be crucial! You will want to promote the happiness and well-being
of all children, including those at risk and with disabilities. You can help families recognize risk
factors but also the developmental needs of the child and support them as they deal with these.
Observe the child’s development and make an informed decision as to whether you consider the
child to be at risk of a delay; refer the family to the necessary assessment services; support the
family in their work with intervention specialists (if available); and help them enjoy their children
and their developmental achievements. It is important for you to promote the idea that disability
is not a disease, rather that it is related to the environment and how inclusive it is. Promote a
rights-based approach to understanding disability.

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 Module 6 | Children with disabilities or developmental difficulties Children with disabilities or developmental difficulties | Module 6

4. The CND-FLW’s role in the prevention

of disabilities and developmental delays

There are many medical, congenital and environmental conditions that affect child development.
Condition Causal factors What you can do
in your role as CND-FLW

Self-assessment What you can do during the pregnancy:

The following table lists some common conditions. Think of how you in your role as CND-FLW Low birth weight Poor nutrition, maternal smoking Advise pregnant women on healthy lifestyles,
can contribute to prevention or to improving the quality of life of a child with a disability or at and very low birth including nutrition, smoking cessation, exposure
weight to smoking, insufficient rest, untreated medical
risk of a disability. Keep in mind that parents generally want to do what is best for their unborn, conditions, infections, etc.
newborn or young child, and this strong motivation can be maximized for the prevention of
disabilities and developmental difficulties. Anencephaly, Lack of folic acid before pregnancy and in Promote the use of folic acid among all women
hydrocephalus the early weeks planning a pregnancy, those with a history
of giving birth to a child with a neural tube
defect and all pregnant women, alongside iron
supplementation
Condition Causal factors What you can do
in your role as CND-FLW
What you can do after birth:

What you can do during the pregnancy: Prematurity, low Maternal risk factors, smoking, multiple Promote early and exclusive breastfeeding
birth weight pregnancies and others and skin-to-skin contact, support bonding
Low birth weight and very low Poor nutrition, maternal smoking and attachment processes, monitor the child’s
birth weight development, refer the family to additional
services as needed and early stimulation/
enrichment programmes
Anencephaly, hydrocephalus Lack of folic acid before pregnancy and in
the early weeks
Congenital Different causes during pregnancy or Promote breastfeeding and skin-to-skin contact,
conditions delivery support bonding and attachment processes,
What you can do after birth: monitor the child’s development, refer the family
to services as needed
Prematurity, low birth weight Maternal risk factors, smoking, multiple
pregnancies and others What you can do in the early years:

Congenital conditions Different causes during pregnancy or Failure to strive, Poor nutrition, lack of stimulation, perinatal Promote breastfeeding, age-appropriate
delivery stunting depression complementary feeding (quality and quantity),
responsive feeding and nurturing care, stimulating
What you can do in the early years: environment;

Failure to strive, stunting Poor nutrition, lack of stimulation Disabilities and Poor nutrition, lack of stimulation Propose age- and development-appropriate
developmental activities to stimulate the child’s development;
delays focus on daily routines and functioning needs of
Disabilities and developmental delays Maternal depression, parental mental the child; monitor the child’s milestones; always
illness, intra-family violence, disability, help the family enjoy the child and support
neglect, congenital conditions, prenatal parent–child attachment. Also: provide counselling
conditions, injuries, low birth weight, brain and listening support; if you observe or are told by
insult, other unknown causes the family about depression, disability, violence,
etc., refer and assist the family to enable access to
appropriate early intervention services; promote
Look at the following table and compare your answers with our suggestions. social inclusion; signpost the family to specialty
services, as needed.

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 Module 6 | Children with disabilities or developmental difficulties Children with disabilities or developmental difficulties | Module 6

6. The CND-FLW’s role in supporting families

5. The CND-FLW’s role in developmental with children with disabilities and
monitoring developmental delays – common issues

Programmes that address the child within the context of the family and everyday routines and As the CND-FLW, you provide both information and support. To provide good information on
engage family members – parents, siblings, grandparents – as partners in the early intervention the services that are available to families in the community, nationally or virtually on the internet,
approach are often the most successful in promoting development. it is good to map what is available to you and families and to know how you can help families
access the additional services they need. In addition to information, families will benefit from
In order to work well with families, it is important to be know related definitions and understand other types of support from you.
your role in each.
This section raises some of the common issues you may encounter when working with families
that have a child with disabilities or developmental difficulties.

Definitions

Developmental monitoring or surveillance. CND-FLWs and the family can participate in developmental Parenting a child with disabilities or developmental difficulties
monitoring, which observes how the child is growing and changing over time and whether the child
meets the typical developmental milestones in playing, learning, speaking, behaving and moving. Parents who raise children with disabilities go through their parenting under more difficult
Monitoring healthy development means not only paying attention to symptoms related to a child’s conditions than parents of typically developing children. These conditions are a result of the
condition but also to the child’s physical, mental, social and emotional well-being. additional care that is required for their child, such as frequent visits to specialists, more frequent
hospitalizations and medical examinations, and more demanding daily care. Also, parents have
You can use the developmental milestone as a monitoring tool to assess if the child is meeting the a greater need for information, and they are continuously dealing with the fact that the child is
age-appropriate milestones. You will be provided with the integrated ECD milestone cards that you different, and the future is less certain.
will use in your sessions and interaction with the child and caregiver. See Information Card 1 for an
excerpt. As the child is growing up, parenting is changing or growing up, too. Some have tried to describe
this journey as a path consisting of different stages of adaptation to a new life conditions. This
Developmental screening. Developmental screening takes a closer look at how the child is developing. may happen in four stages in a process of adaptation (Miller, 1997). These stages may follow each
A missed milestone could be a sign of a problem. If in your developmental monitoring of the child you other; they can also overlap, and parents may return to earlier stages. It is a dynamic process, and
notice a missed milestone, you can refer the child and family to the provincial or tertiary hospital, where a stage is never ‘completely conquered’. The support provided to these parents can contribute
the doctor, nurse or another specialist may assess the child’s development with a brief test to see if significantly to the psychosocial stability of family life, help them participate more actively in
the child is learning the age-appropriate basic skills, or if the child may have developmental delays. society and assist them to create a more stimulating environment for their child. As the CND-
FLW, it is important for you to be aware that parents will go through these stages and to give
Developmental assessment. Your role as the CND-FLW is not to conduct this assessment but to
them understanding and support.
refer the family to the specialists who can do so and provide the needed interventions to the child
and family. When delays are noted, a structured assessment may be conducted by a paediatrician The first stage begins when a parent realizes that a child’s developmental outcome is at risk
or developmental assessment specialist or, if possible, by a team of professionals tailored to the – i.e., that the child has a disability or a developmental difficulty. This stage is characterized by
child’s particular developmental difficulties (e.g., paediatrician, language specialist, audiologist, parents’ need to ‘survive’. This moment of realization is often etched deeply into the memory of
occupational therapist, child psychologist, physical therapist, infant mental health specialist and the parents. The entire first stage of adaptation is characterized by strong feelings of helplessness
others). The family should be a partner in this process. and loss of control over their own lives. Parents go through the process of ‘surviving’ in their own
individual way, so the duration of this period also determined individually. However, this process
is easier when parents have access to information that their feelings are a natural and healthy
reaction to what has happened. As a CND-FLW, remind parents gently that they also have to
Reflection and discussion
take care of themselves. There is a very strong tendency among parents to completely ignore
Here are some questions for reflection: themselves and their needs and those of other family members and to subordinate everything
to what they think might be the needs of their child.
In your role as the CND-FLW, where would you refer a child who needs a developmental assessment?
The second stage starts when a parent realizes and accepts that life will be different than planned.
Answer: First, refer the child to the nearest hospital (district/provincial/regional/tertiary), where there The focus of this stage is ‘searching’ in two main ways.
may be a paediatrician or other appropriate specialists.

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 Module 6 | Children with disabilities or developmental difficulties Children with disabilities or developmental difficulties | Module 6

‘Outer searching’ begins with looking for a diagnosis and interventions. In this phase, parents Some common responses of families are listed:
become very active in seeking help. If they are left to themselves, this period can be very
exhausting for them, both financially and mentally. As a CND-FLW, use your professional
The feelings of the parent/s:
experience and your knowledge of services available in your community, and help support grief, guilt and blaming
What you can do:
families during this phase to find an easier and shorter way to developmental screening,
assessment, services and support. When a child is stillborn or born with a genetic condition • Understand that parents may be grieving the loss of the
or very prematurely, parents and families may go ‘healthy child’ who was never born or born with special
‘Inner searching’ may be marked by such questions as: ‘What does the child’s disability mean through a grieving process. The anticipated, joyful needs and may need some time to adjust.
event of the birth of a healthy child has not happened.
for my life and my relationships with others?’ ‘What does it mean for my other children?’ In addition, the newborn or young child may require
• Be available to listen, acknowledge the family’s feelings
and show your support.
Thus begins the search for a new identity that will include parenting a child with a disability. extensive medical support and individualized attention
and strain the family’s physical energies to cope and their • Refer the families with resources, including other
This is a difficult period because, in their inner searching, parents ask themselves a number
financial resources. Self-blame or blaming the partner, families and parent support groups when available.
of questions that often they cannot answer immediately. They can become depressed and depression and loss of hope may make it difficult for • Help the family focus on the child’s strengths and
anxious, as well as feel a sense of incompetence in their parenting role. the parents and the family to meet the challenges of potentials, to find enjoyment in interacting and playing.
dealing with the child’s problems and forming a secure
attachment. • Help the family celebrate the successes and
The third stage reached in this process of adaptation is called ‘settling in’. Outer searching for achievements of their child’s development.
various forms of help has subsided, the pace of family life has stabilized and the child may be Some families may cope by focusing their efforts on • Provide accurate information.
the child; they may push and even force progress in
participating in a support programme, nursery or school. During this phase, parents learn that • Refer the family to services needed.
development, at the cost of other children in the family
they have gained new skills and new insights and that they understand many things in a new or the other parent. • Be a good role model in your own interactions with all
way. They feel more confident and assertive and know ways of addressing and solving problems. family members.
• Advocate for the services the family requires.
The fourth stage involves ‘separating’. Separation is a normal process that does not happen
at once. It begins at birth and occurs each day in small increments. In the case of children with
disabilities, this process can be altered and slowed down. Parents are exposed to special efforts to
The feelings of siblings What you can do:
help their children become independent and enable them to take care of themselves. Separating
is often filled with the same emotions that the parents experienced during the phase of dealing
Family life often centres around the needs of • Consider the well-being and involvement of the whole family
with the child’s disability. Making a decision about separation includes an enhanced inner and the child with disabilities or developmental (if possible) during your sessions or visits with parents.
outer search of what has been done or omitted. difficulties. The following issues are often
• Share with parents some of the common issues siblings may
experienced by siblings of children with
have with living with a brother or sister with developmental
developmental difficulties:
The CND-FLW plays an important role in supporting parents in relation to their coping with difficulties.
the fact that their child is different. Empowering parents helps them develop self-esteem and • Limited time and attention from the parent/s. • Share with parents what they can do to help the siblings of
• Participation in the day-to-day care of their children with disabilities.
problem-solving skills. However, empowerment is possible only if trust and a partnership have
sibling.
been established between parents and the CND-FLW. A partnership approach to parents means • Talk to them and problem-solve with them.
• Feeling of guilt (not having disabilities, anger
parents are involved in making decisions and their point of view is valued and appreciated, • Explain their sibling’s disability and its impact on the family.
with the sibling or jealous for attention
When the children understand their sibling’s disability, it can
because they are the experts who know their child the best. received, making it up to the parents by being
help them connect and build their relationship.
perfect).
• Worry about inviting friends to the home. • Help the siblings connect with people outside the family
through sport, extracurricular activities, time with friends and
• Stressful situations at home.
support groups.
• Restrictions on family activities at home and
Feelings of parents and family members in public. • Feeling embarrassed about the
• Ensure parents have individual time with all their children.
sibling in public. • Understand that the feelings of siblings are not constant but
The relationships among family members will make a tremendous difference in how the family • Being teased or bullied about the sibling. change over time and with each child’s development.
is able to cope with the additional demands of raising a child with disabilities or developmental • Feeling very protective of the sibling. • Role model positive and honest interactions with the siblings.
• Invite siblings to participate and speak during the sessions.
difficulties. These relationships are also likely to change over time. As a trusted professional, you • Worrying about the future and own long-term
responsibilities. • Include siblings in the family’s activities and events and
may be able to observe, or family members may share with you when extra support is needed.
respect their right to non-participation.
• Refer older siblings to resources when needed.

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 Module 6 | Children with disabilities or developmental difficulties Children with disabilities or developmental difficulties | Module 6

Key messages:
Getting the child assessed and diagnosed What you can do:
Developmental screening is an effective means of detecting childhood difficulties and
Early intervention should start before a diagnosis is • Help families that are searching for a diagnosis by referring them for further assessment and intervention.
made. Children and families need support right after referring them for formal assessments.
it has been determined that there is some risk to
developmental delay.
• Help families understand that a diagnosis may not Adequate nutrition of pregnant and lactating women helps mitigate the risk of developmental
predict how a child will develop, since development may
delays and disabilities.
depend on the interplay of the condition, the family and
Families may respond differently to being able to obtain
the support provided by the environment.
a definitive diagnosis. Some families spend time, energy
and resources in searching for the cause; other families
Adequate awareness about preconception/antenatal/perinatal risks, including smoking,
• Know your referral sites and the organizations
prefer to focus on dealing with the child’s immediate and professionals involved in assessment and early exposure to toxins, mental illness, anxiety and depression, helps mitigate the risk of
challenges. intervention. developmental delays and disabilities.
• Be aware of other sources of information that may be
useful to the family. Sensitive caregiving and stimulation can greatly foster your child’s development and help
• Remember that the family may also be vulnerable to them reach their full potential.
individuals who give false promises and hope.
• Provide sufficient time and space for listening to As a CND-FLW, you can refer to the below key messages when meeting with parents during the
families with empathy.
sessions at health facility.

Family isolation and loneliness What you can do: 1. ‘You can trust medical professionals to give your child the best possible health care.’

Key messages:
Families may become absorbed in their child’s problem • Know family support groups in the area and
and the challenges of making it from day to day. associations in your area (and country).
Caregivers need to take their children to regular medical follow-up.
• Exchange information with your colleagues on
Families often find it helpful to get in touch with other
families that are willing to reach out to others in similar
families facing similar problems and find that such
families more truly understand what they are going
situations. Medical professionals will give more accurate diagnoses and are sensitive when announcing
through and are good sources of support. In the very • Be aware of trusted parent and family support groups these to parents.
early phases, parents may not be ready to connect with that operate website support for certain disabilities or
others. Give them time. Do not assume that, because issues and assist families interested in making such Healthcare personnel receive disability-specific trainings.
they have refused once, they are unwilling to consider contacts.
this option later on.

2. ‘Celebrate your child’s uniqueness, acknowledge his/her strengths and enjoy your relationship
with him/her, it will become easier to support his/her progress.’
Inclusion in society
Key messages:
The perception of disability negatively affects inclusion, and it is likely that people with disabilities
Social workers and other health worker teams are here to support you.
and their parents have internalized and adopted this negative view of disability themselves.
Therefore, it is very important as a frontliner to tackle this in the visits by parents to health facilities The child–caregiver relationship is the key in promoting ECD.
or when you are visiting in the community. Discuss the importance of inclusion and its benefits for
Do not be afraid to talk about your child’s impairment.
everyone involved and the community as a whole. Below are some important aspects to discuss.
Listen to your child and talk to him/her.
When developmental delays are detected and addressed early, disabilities can be prevented or
mitigated.

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 Module 6 | Children with disabilities or developmental difficulties Children with disabilities or developmental difficulties | Module 6

Annex

3. ‘If you let your child interact with other children, it will help her/him build a social network Information Card 1. Excerpts from integrated
beneficial for her/his well-being and independence.’ early childhood development milestone cards
– one-year-old child
Key messages:

Interacting with other children can contribute to mitigating impairments.

The child at 12 months – what most babies do by this age:
Children well integrated within the community are empowered/prepared to face bullying
Social/emotional milestones
incidents.
Plays games with you, like pat-a-cake
Interacting with other children is essential for a child’s development.

Language/communication milestones
4. ‘An inclusive community is a stronger community.’
Waves ‘bye bye’
Key messages: Calls a parent ‘mama’ or ‘baba’ or another special name

Children with disabilities have the same rights as their peers without disabilities. Understands ‘No’ (pauses briefly or stops when you say it)

Children with and without disabilities enjoy the same things and have the same dreams.
Cognitive milestones (learning, thinking, problem-solving)
Disabilities are not wrong or a curse but the result of human diversity.
Puts something in a container, like a block in a cup
Children with disabilities can be independent in the right environment.
Looks for things s/he sees you hide, like a toy under a blanket

Using respectful and inclusive language: person-first terminology for disabilities

Movement/physical development milestones
There are many terms used to refer to people with disabilities, such as ‘disabled’, ‘people with Pulls up to stand
special needs’, ‘ ‘neurodivergent’, etc.
Walks, holding on to furniture
It is best to use the term ‘person with a disability’, per the guidance of those with disabilities
themselves and the United Nations. Drinks from a cup without a lid, as you hold it

Picks things up between thumb and pointer finger, like small bits of food
Using a person-first approach is the most important aspect. As such, make sure to say ‘person
with a disability’ and not ‘disabled person’.

If the child is not meeting one or more milestones or has lost skills s/he once had, or you have
other concerns, refer the child and the parent/s to the health facility with specialized care (e.g.,
provincial/regional or tertiary hospital).

Circle action taken:

Referred to specialized health facility

No action (meets milestones)

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 Module 6 | Children with disabilities or developmental difficulties

References

CDC Developmental Milestone Checklist by Age Group and what to do if a child misses a
milestone. [Link]/ncbddd/actearly/pdf/FULL-LIST-CDC_LTSAE-Checklists2021_Eng_
FNL2_508.pdf

Miller N. 1997 Nobody’s Perfect: Living & Growing with Children Who Have Special Needs. Paul
H. Brookes Publishing Company.

United Nations Convention on the Rights of the Child:

[Link]/child-rights-convention/convention-text

United Nations Convention on the Rights of Persons with Disabilities.

[Link]/development/desa/disabilities/convention-on-the-rights-of-persons-with-
[Link]

WHO and UNICEF. 2012. Early Childhood Development and Disability: A Discussion Paper.
[Link]/media/126501/file/[Link]

Afghanistan Country Office

[Link]/afghanistan

Unicef Afghanistan

@UNICEFAfg

unicefafghanistan

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