 AFRICAMEDICAL COLLEGE

2015 ACADAMIC YEAR

INCLUAIVE EDUCATION
COURSE

FOR 2ND YEAR FARMACY

DEPARTMENT
Inclusiveness
2015
 What is inclusive education
 Goals of inclusive education
 Basic concepts of inclusiveness
 Causes of disability and vulnerability
 Types of disability
Inclusive education is a service refers to ―an
ongoing process aimed at offering quality
education/services for all while respecting
diversity and the different needs and abilities,
characteristics and learning expectations of the
students and communities and eliminating all
forms of discrimination‖ (UNESCO, 2008,
P.3, as cited in EADSNE, 2010, p.11).
 Inclusive services at any level are quality

provisions without discrimination or partiality

and meeting the diverse needs of people.
 Inclusion is seen as a process of
addressing and responding to the
diversity of needs of all persons through
increasing participation in learning,
employment, services, cultures and
communities, and reducing exclusion at all
social contexts.
 Or it is a wide range of strategies,

activities and processes that seek to

make a reality of the universal right to
quality, relevant and appropriate education
and services.
Definitions of Basic Terms
A/ Impairment,
B/ Disability and
C/ Handicap)
1. Impairment means a lack/abnormality of an
anatomic, physiological or psychological
structure or function or deviation on a person.
 It refers to any loss or abnormality of

physiological, psychological or anatomical

structure or function.
 It is the absence of particular body part or

organ.
 It could also a condition in which the body

exists but doesn‘t function.

2. Disability
 The term disability is ambiguous as there is no
single agreement on the concept (Mitra, 2006)
 It is not synonymous with AKAL-GUDATENGA

(የአካል ጉዳተኛ)
 The concept of disability is complex, dynamic,

multidimensional, and contested (WHO and

World Bank, 2011).
 The full inclusion of people with impairments in

society can be inhibited by:

1. Attitudinal (societal barriers, such as stigma)
2. Physical barriers (environmental barriers,
such as absence of stairs), and
3. Policy barriers (systemic barriers),
What is disability?
1. Medical Approach
 Disability is pathology (physiological,

biological and intellectual).

 Disability means functional limitations due

to physical, intellectual or psychic

impairment, health or psychic disorders on
a person (WHO,1996).
 The medical definition has given rise to the
idea that people are individual objects to
be ―treated‖, ―changed" or ―improved"
and made more ―normal‖.
 The medical definition views the disabled

person as needing to ―fit in ‖rather than

thinking about how society itself should
change.
The social definition of disability:
 Disability is a highly varied and complex

condition with a range of implications for

social identity and behavior.
 Disability largely depends on the context and

is a consequence of discrimination,
prejudice and exclusion.
 Emphasizes the shortcomings in the

environment and in many organized activities

in society, for example on information,
communication and education, which
prevent persons with disabilities from
participating on equal terms.
3. Handicap – it is any disadvantage on
a given individual as result of impairment and
disability
- The disadvantage may be physical, social,
political, economical and academicals
Causes of disability
1. Genetic Causes
Abnormalities in genes and genetic
inheritance can cause intellectual disability
in children.
In some countries, Down syndrome is the
most common genetic condition.
 Sometimes, diseases, illnesses, and over-

exposure to x-rays can cause a genetic

disorder.
2. Environmental
 Poverty and malnutrition in pregnant

mothers can cause a deficiency in vital

minerals and result in deformation issues in
the unborn child.
 After birth, poverty and malnutrition can

also cause poor development of vital organs

in the child, which can eventually lead to
disability.
 The use of drugs, alcohol, tobacco, the
exposure to certain.
 toxic chemicals and
 illnesses,
 toxoplasmosis,
 cytomegalovirus,
 rubella and syphilis by a pregnant mother

can
 cause intellectual disability to the child.
 Childhood diseases such as a
 whooping cough,
 measles, and
 chicken pox may lead to meningitis and encephalitis.
 Toxic material such as lead and mercury can damage

the brain too.

 Unfortunate life events such as drowning, automobile

accidents,
3. Unknown Causes
 The human body is a phenomenal thing. Scientists have

still not figured out what and how some things in the
body, cells, brain, and genes come about.
 Humans have still not found all the answers to all the

defects in the human body

Some type of disabilities:
Some nine major disabilities are listed and briefly discussed
in the coming pages below.
1.Visual impairment
 Visual impairment in general designates two sub-

classifications. These are blindness and low vision.

 Blindness, total or partial inability to see because of

disease or disorder of the eye, optic nerve, or brain.

 The term blindness typically refers to vision loss that is

not correctable with eyeglasses or contact lenses.

 Blindness may not mean a total absence of sight,

however. Some people who are considered blind may be
able to perceive slowly moving lights or colors.
2. Hearing impairment
 Different people define the term hearing impairment

differently. The definitions given to hearing impairment

convey different meaning to different people.
 Different definitions and terminologies may be used in

different countries for different purpose

 Pasonella and Carat from legal point of view, define

hearing impairment as a generic term indicating a
continuum of hearing loss from mild to profound,
which includes the sub-classifications of the
1. hard of hearing and
2. deaf.
 Hard of Hearing: "A hearing impairment, whether
permanent of fluctuating, which adversely affects a
child's educational performance
 This term can also be used to describe persons with

enough (usually with hearing aids) as a primary

modality of acquisition of language and in
communication with others.
 Deaf: Those who have difficulty understanding

speech, even with hearing aids but can successfully

communicate in sign language.
 Cultural definitions of deafness, on the other hand,

emphasize an individual‘s various abilities, use of sign

language, and connections with the culturally deaf
community.
3. Specific learning disability
 Specific Learning Disability means a disorder in one
or more of the basic psychological processes involved
in understanding or in using language, spoken or
written, that may manifest itself in the imperfect
ability to listen, think, speak, read, write, spell, or to
do mathematical calculations.
 the term includes such conditions as perceptual
disabilities, brain injury, minimal brain dysfunction,
dyslexia, and developmental aphasia.
 The term does not include learning problems that are
primarily the result of visual, hearing, or motor
disabilities; of intellectual disability; of emotional
disturbance; or of environmental, cultural, or
economic disadvantage.
Types of Specific Learning Disabilities
 Auditory Processing Disorder (APD/
 affects how sound that travels unimpeded

through the ear is processed or interpreted

by the brain.
 Individuals with APD do not recognize subtle

differences between sounds in words, even

when the sounds are loud and clear enough
to be heard.
A. Dyscalculia
 Dyscalculia is a specific learning disability that affects

a person‘s ability to understand numbers and learn

math.
 Individuals with this type of LD may also have

poor comprehension of math symbols,

 may struggle with memorizing and organizing

numbers,
 have difficulty telling time, or
 have trouble with counting.
B. Dysgraphia
 Dysgraphia is a specific learning disability that affects

a person‘s handwriting ability and fine motor skills.

Problems may include
 illegible handwriting,
 inconsistent spacing,
 poor spatial planning on paper,
 poor spelling, and
 difficulty composing writing as well as thinking and

writing at the same time.

C. Dyslexia
 Dyslexia is a specific learning disability that affects

reading and related language-based processing skills.

 can affect reading fluency; decoding,
 reading comprehension,
 recall, writing, spelling, and
 sometimes speech and can exist along with other

related disorders. Dyslexia is sometimes referred to as a

Language Based Learning Disability.
D. Language Processing Disorder
 Language Processing Disorder is a specific type of

Auditory Processing Disorder (APD) in which there is

difficulty attaching meaning to sound groups that
form words, sentences and stories.
 While an APD affects the interpretation of all sounds

coming into the brain, a Language Processing Disorder

(LPD) relates only to the processing of language.
 LPD can affect expressive language and/or receptive

language.
 E. Non-Verbal Learning Disabilities
 Non-Verbal Learning Disabilities is a disorder which is

usually characterized by a significant discrepancy

between higher verbal skills and weaker motor,
visual-spatial and social skills.
 Typically, an individual with NLD (or NVLD) has

trouble interpreting nonverbal cues like

 facial expressions or
 body language, and
 may have poor coordination.
F. Visual Perceptual/Visual Motor Deficit
 Visual Perceptual/Visual Motor Deficit is a disorder

that affects the understanding of information that a

person sees, or the ability to draw or copy.
 A characteristic seen in people with learning

disabilities such as Dysgraphia or Non-verbal LD, it

can result in missing subtle differences in shapes or
printed letters,
 losing place frequently,
 struggles with cutting,
 holding pencil too tightly, or
 poor eye/hand coordination
4.Speech and Language Impairments
 Speech and language impairment means a

communication disorder such as

 stuttering,
 impaired articulation,
 language impairment, or
 a voice impairment that adversely affects a

child‘s educational performance.

 child's ability to talk, understand, read, and

write
Speech Impairments
 There are three basic types of speech

impairments: articulation disorders,

fluency disorders, and voice disorders.
 Articulation disorders are errors in the

production of speech sounds that may be

related to anatomical or physiological
limitations in the skeletal, muscular, or
neuromuscular support for speech
production. These disorders include:
  Omissions: (bo for boat)
  Substitutions: (wabbit for rabbit)
  Distortions: (shlip for sip)
 Fluency disorders are difficulties with the
rhythm and timing of speech characterized
by
 hesitations, repetitions, or
 prolongations of sounds, syllables, words,

or phrases.
 Common fluency disorders include:
 Stuttering: rapid-fire repetitions of

consonant or vowel sounds especially at the

beginning of words, prolongations,
hesitations, interjections,
 and complete verbal blocks Cluttering:

excessively fast and jerky speech

 Language Impairments
 There are five basic areas of language impairments:

1.phonological disorders,
2. morphological disorders,
3. semantic disorders,
4. syntactical deficits, and
5. pragmatic difficulties.
1. Phonological disorders are defined as the abnormal
organization of the phonological system, or a significant
deficit in speech production or perception
 Apraxia of speech is a specific phonological
disorder where the student may want to
speak but has difficulty planning what to
say and the motor movements to use.
2. Morphological disorders are defined as
difficulties with morphological inflections
(inflections on nouns, verbs, and adjectives
that signal different kinds of meanings).
3. Semantic disorders are characterized by
poor vocabulary development,
inappropriate use of word meanings,
and/or inability to comprehend word meanings.
 These students will demonstrate restrictions

in word meanings, difficulty with multiple

word meanings, excessive use of nonspecific
terms (e.g., thing and stuff), and indefinite
references (e.g., that and there)
4. Syntactic deficits are characterized by difficulty in
acquiring the rules that govern word order and others
aspects of grammar such as subject-verb agreement.
Typically, these students produce shorter and less elaborate
sentences with fewer cohesive conjunctions than their
peers.
5. Pragmatic difficulties are characterized as problems in
understanding and using language in different social
contexts.
 These students may lack an understanding of the rules

for making
 eye contact, respecting personal space, requesting

information, and introducing topics.

5.Autism
 It means a developmental disability significantly

affecting verbal and nonverbal communication and social

interaction, generally evident before age three that
adversely affects a child‘s educational performance.
 Other characteristics of autism are engaging in
 repetitive activities and stereotyped movements,

resistance to environmental change or

 change in daily routines, and unusual responses to

sensory experiences
 Autism is pervasive developmental disorder
characterized by
 lack of normal sociability,
 impaired communication and
 repetitive obsessive behavior such as

politeness, turn-taking
6. Emotional and Behavioral
Disorders
 This means a condition exhibiting one or more
of the following characteristics over a long
period of time and to a marked degree that
adversely affects educational performance
1) An inability to learn that cannot be explained by
intellectual, sensory, or health factors;
2) An inability to build or maintain satisfactory
interpersonal relationships with peers and teachers;
3) Inappropriate types of behavior or feelings under
normal circumstances;
4) A general pervasive mood of unhappiness or
depression; or
5) A tendency to develop physical symptoms or
fears associated with personal or school problems.
Classification of behavioral and emotional disorders
1. Conduct disorder: individuals may seek attention, are
disruptive and act out. The disorder is classified by type:
 overt (with violence or tantrums)
 covert (with lying, stealing, and/or drug use).

2. Socialized aggression: individuals join subculture group

of peers who are openly disrespectful to their peers,
teachers, and parents. Common are delinquency and
dropping out of school.
 Early symptoms include stealing, running away from

home, habitual lying, cruelty to animals, and fire setting

3. Attention problems- These individuals may
have attention deficit, are easily destructible and
have poor concentration. They are frequently
impulsive and may not think the consequence of
their actions.
4. Anxiety/Withdrawn- These individuals are
self-conscious, reserved, and unsure of
themselves. They typically have low self-esteem
and withdraw from immediate activities. They are
also anxious and frequently depressed.
4. Psychotic behavior: These individuals show
more bizarre behavior. They may hallucinate,
deal in a fantasy world and may even talk in
gibberish.
5. Motor excess: These students are hyperactive.
They cannot sit nor listen to others nor keep their
attention focused
 Kauffman (1993) conclude that emotion or behavioral
disorders fall into two broad classifications:
1) Externalizing Behavior: also called under controlled
disorder, include such problems disobedience,
disruptiveness, fighting, tempers tantrums,
irresponsibility, jealous, anger, attention seeking etc…
2) Internalizing Behavior: also known as over controlled
disorders, include such problems anxiety, immaturity,
shyness, social withdrawal, feeling of inadequacy
(inferiority), guilt, depression and worries a great deal
Causes of behavioral and emotional
disorders
Biological- includes genetic disorders, brain
damage, and malnutrition, allergies, temperament
and damage to the central nervous system.
2. Family factors- include family interactions,
family influence, child abuse, neglect, and poor
disciplinary practices at home.
3. Cultural factors- include some traditional and
cultural negative practices, for example watching
violence and sexually oriented movies and TV
programs.
4. Environmental factors- include peer pressure,
living in impoverished areas, and schooling
practices that are unresponsive to individual needs
7.Intellectual Disability
 Intellectual disability is a disability

characterized by significant limitations in

both intellectual functioning and in
adaptive behavior, which covers many
everyday social and practical skills
 1. Sub average intellectual functioning: It

refers to general mental capacity, such as

 learning,
 reasoning,
 problem solving, and so on
 One way to measure intellectual functioning

is an IQ test. Generally, an IQ test score of

around 70 or as high as 75 indicates a
limitation in intellectual functioning.
2. Significant limitations exist in two or more adaptive
skill areas: It is the collection of conceptual, social, and
practical skills that are learned and performed by people
in their everyday lives.
 Conceptual skills—language and literacy; money,

time, and number concepts; and self-direction.

 Social skills—interpersonal skills, social

responsibility, self-esteem, gullibility, innocence (i.e.,

suspicion), social problem solving, and the ability to
follow rules/obey laws and to avoid being victimized.
 Practical skills—activities of daily living (personal

care), occupational skills, healthcare,

travel/transportation, schedules/routines, safety, use of
money, use of the telephone.
 People with intellectual disabilities academic learning
can be affected, as well as their ability to adapt to
home, school, and community environments
 General Cognition: People with intellectual
disabilities vary physically and emotionally, as well as
by personality, disposition, and beliefs
 Learning and Memory: The learning and memory
capabilities of people with intellectual disabilities are
significantly below average in comparison to peers
without disabilities.
 Attention: To acquire information, children must
attend to the learning task for the required length of
time and control distractions
 A child with intellectual disabilities may
have difficulty in both learning and applying
skills for
 a number of reasons, including a
 higher level of distractibility,
 inattentiveness,
 failure to read social cues, and
 impulsive behavior
 Speech and Language: People with intellectual
disabilities may have delayed speech, language
comprehension and formulation difficulties
 Motivation: People with intellectual disabilities are
often described as lacking motivation, or outer-directed
behavior.
 Academic Achievement: The cognitive difficulties of
children with mild to moderate intellectual disabilities
lead to persistent problems in academic achievement
 Physical characteristics: Children with intellectual
disabilities with differing biological etiologies, may
exhibit coexisting problems, such as physical, motor,
orthopedic, visual and auditory impairments, and health
problems
8. Physical disability/Orthopedic
Impairment and Health impairment
 Physical disability is a condition that interferes with
the individual‘s ability to use his or her body.
 The term orthopedic impairment generally refers to
conditions of muscular or skeletal system and
sometimes to physical disabling conditions of the
nervous system
 Health impairment is a condition that requires
ongoing medical attention. It includes
 asthma, heart defects, cancer, diabetes, hemophilia.
HIV/AIDS, etc.
 Classification and Characteristics of physical
impairment
 Physical disabilities:- based on the impact of physical

disability on mobility and motor skills, it is divided

into three. These are:-
A. Mild physical disability:- these individuals are able to
walk without aids and may make normal developmental
progress.
B. Moderate physical disability:- individuals can walk
with braces and crutches and may have difficulty with
fine-motor skills and speech production.
C. Severe physical disability:-these are individuals who
are wheel-chair dependent and may need special help to
achieve regular development.
The physical disability could be broadly classified in to
two
 I. The neurological system (the brain ,spinal cord &

nerve) related problems.

 II. Musculo skeletal system ( the muscles, bones and

joints) are deficient due to various causes.

 Neurological system:-
 with a neurological condition like cerebral palsy or a

traumatic brain injury, the brain either sends the wrong

instructions or interprets feedback incorrectly.
 Additional problems that can be associated with
cerebral palsy include
 learning disabilities,
 mental retardation.
 Seizures,
 speech impairments,
 eating problems,
 sensory impairments, and
 joint and bone deformities such as spinal curvatures

and contractures
 Epilepsy:-is disorder that occurs when the brain cells are
not working properly and is often called a seizure
disorder.
 Some children and youth will epilepsy have only a
momentary loss of attention (petit mal seizures); others
fall to the floor and then move uncontrollably
 -Fortunately, once epilepsy is diagnosed, it can usually
be controlled with medication and does not interfere
with performance in school.
 Most individuals with epilepsy have normal intelligence.
 - Epilepsy is a condition that affects 1 to 2 percent of the
population.
 It is characterized by recurring seizures, which are
spontaneous abnormal discharge of electrical impulses
of the brain.
 Spinal bifida and spinal cord injury:- damage to the
spinal cord leads to paralysis and loss of sensation in
the affected areas of the body.
 The spinal blfida is a birth defect of the backbone

(spinal column). The cause is unknown but it usually

occurs in the first twenty-six days of pregnancy
II. Musculoskeletal system: - it includes the muscles and
their supporting framework and the skeleton.
2. Progressive muscle weakness (muscular dystrophy);
3. Inflammation of the joints (arthritis), or
4. Loss of various parts of the body (amputation)
 The list of the impairment and associated with
musculoskeletal malformation
Muscular dystrophy:- is an inherited condition accruing
mainly in males, in which the muscles weaken and
deteriorate.
 The weakness usually appears around 3 to 4 years of

age and worsens progressively. By age 11 most victims

can to longer walk.
 Death usually comes between the ages of 25 and 35

from respiratory failure or cardiac arrest

B. Arthritis:-is an inflammation of the joints.
 Symptoms include swollen and stiff joints, fever, and

pain in the joints during acute periods.

 Prolonged inflammation can lead joint deformities that

can eventually affect mobility.

C. Amputation:- a small number of children have
missing limbs because of congenital abnormalities or
injuiry or disease (malignant bone tumors in the limbs).
 These children can use customized prosthetic devices

(artificial hands, arms, or legs) to replace limp

functions and increase independence in daily activities.
 Other muscle-skeletal disorders are:-
D. Marfan syndrome is a genetic disorder in which the
muscles are poorly developed and the spine is curved.
 Individuals with marfan syndrome may have
 either long, thin limbs,
 prominent shoulder blades,
 spinal curvature,
 flat feet, or long fingers & thumbs.
 The heart and blood vessels are usually affected.
E. Achondroplasis:- is a genetic disorder that affects 1 in
10,000 births. Children with this disorder usually develop
a normal torso but have a straight upper back and a
curved lower back (sway back).
 Polio:- is viral disease that invade the brain and cause

severe paralysis of the total body system.

 Club foot:- is a major orthopedic problem affecting

about 9,000 infants each year. This term is used to

describe various ankle or foot deformities, i.e
 Twisting inward (equino varus), the most severe form
 Sharply angled at the heel (calcanel vaigus), most

common
 The front part of the foot turned inward
 Cleft lip and cleft palate:- are openings in the
lip or roof of the mouth, respectively, that fail to
close before birth, the cause is unknown
Health Impairments
 Heart disease:- this is common among young
people. It is caused by improper circulation of
blood by the heart some of the disorders are
congenital )present at birth);others are the product
of inflammatory heart disease
 Cystic fibrosis:- is a hereditary disease that
affects the lungs and pancreas. It leads to
recurrent respiratory and digestive problems
including abnormal amounts of thick mucus, sweet
and saliva.
 Acquired immune deficiency syndrome
(AIDS):- is a very severe disease caused by
human immunodeficiency virus (HIV) infection
4. Hemophilia:- is a hereditary disease in which the blood
clots very slowly or not all. The disorder is transmitted by
sex-linked recessive gene and nearly always occurs in males.
5. Asthma: is a chronic respiratory condition characterized
by repeared eplosde of breathing difficulties especially while
exhaling.
6. Diabetes: Developmental or hereditary disorder
characterized by inadequate secretion or use of insulin
7. Nephrosis & Nephritis Kidney disorders or diseases
caused by infections, poisoning, burns, accidents or other
disease
8. Sickle-cell anemia Hereditary and chronic blood disease
(occurring primarly in African Americans) characterized by
red blood cells that are distored and that do not circulate
properly
9. Leukemia: Disease characterized by excessive
production of white blood Cells
10. Lead poisoning Disorder caused by ingesting lead-
based paint chips or other substances containing lead
11. Rheumatic fever Disease characterized by painful
swelling and inflammation of the joints that can spread to
the hear and central nervous system.
12. Tuberculosis Infectious disease that commonly
affects the lungs and may affect other tissues of the body.
13. Cancer Abnormal growth of cells that can affect any
organ system
9. Vulnerability
 Vulnerable means being at risk of being harmed
 vulnerability can be generally defined as a

complex phenomenon that refers to the

following dimensions:
1. Economic difficulties/lack of financial
resources: poverty, low living standards, housing
problems (e.g. too damp, too expensive, too cold or
difficult to heat) etc.;
2. Social exclusion: limited access to facilities
such as transporatation, schools, libraries or medical
services;
3. Lack of social support from social networks: no
assistance from family members, friends, neighbors
or colleagues (referring to practical help as well as
emotional support) like highly gifted individuals;
4. Stigmatization: being a victim of stereotypes, being
devalued, confronted with disgraceful behavior because of
belonging to a particular social or ethnic group;
5. Health difficulties: disadvantages resulting from poor
mental health, physical health or disabilities;
6. Being a victim of crime: in family context especially
of violence
Causes of Vulnerability
 Vulnerability may be causes by
 rapid population growth,
 poverty and hunger, poor health,
 low levels of education, gender inequality,
 fragile and hazardous location, and lack of access to
resources and services,
 including knowledge and technological means,
 disintegration of social patterns (social vulnerability).
 lack of access to information and knowledge,
 lack of public awareness,
 limited access to political power and representation
(political vulnerability),
Characteristics of Vulnerable People
 characteristics of vulnerable people

1. Less physically or mentally capable (infants, older

adults, people with disabilities)
2. Fewer material and/or financial resources (low-
income households, homeless)
3. Less knowledge or experience (children, illiterate,
foreigners, tourists)
4. Restricted by society to grow and develop according
to their needs and potentials
 vulnerable people
A. Women: particularly women in developing nations and
those who are living in rural areas are vulnerable for
many backward traditional practices
B. Children: Significant number of children are
vulnerable and at risk for development. Children are
vulnerable for psychological and physical abuse
C. Minorities: some people are vulnerable due to their
minority background.
D. Poverty: People are vulnerable for many undesirable
phenomena due to poverty
E. Disabilities: People with disabilities very much
vulnerable for many kind of risks.
F. Age: Old people or very young children are
vulnerable for all kinds evils
g. Illiteracy and less education: People
with high rates of illiteracy and lack quality
educational opportunities are vulnerable
H. Sickness: Uncured health problems for
example people living with HIV/AIDS are much
vulnerable for psychosocial problems,
I. Gifted and Talentedness: Gifted and
talented children are vulnerable for socio
emotional developments