Working With Disabled Children and Adults-It’s Easier Than You Think

I spent over half of my career as an occupational therapist working in pediatrics.  I first did school-based therapy for the Department of Defense Dependant Schools overseas.  I worked with kids with learning disabilities, autism, and some with mild physical disabilities.  After graduate school, courtesy of the Air Force, I was assigned to Wilford Hall, our largest hospital, which is in Texas.  There I worked with children with varying degrees of physical and cognitive disabilities, including severely impaired children. 

When people found out that I was a pediatric specialist, they would say “I could never do that!  It would be too hard working with handicapped kids.”  For the most part, those people were wrong.  Working with disabled children is pretty easy, because kids don’t feel sorry for themselves. 

Information from the Division of Services for Children with Special Health Care Needs, Maternal and Child Health Bureau, Rockville, MD, estimates 18% of children in the United States under 18 years old have some type of chronic developmental, physical, behavioral or emotional problem that requires health or related services.  Other statistics project as many as 150 to 250 million children with disabilities world-wide. 

But does a condition considered by experts to be “disabling” make a child “disabled”?  Sure a child may have a condition that puts them at a disadvantage, but does it prevent them from participating in, and being successful at normal childhood activities?  Does the condition prevent them from growing up to be an independent, self sufficient, productive adult?  For many the answer is yes, it does prevent them from having a “normal” life.  But other children with “disabilities” are very able, and are happy with their version of a normal life. 

Of the 43 million disabled people in the United States, only 15% were born with their disability. 

My dad was born with a disability.  He is completely deaf in his right ear.  We’re talking “flat line” on testing.  No one knew until he was five years old.  He had teenaged sisters who were dating.  The boyfriend of his oldest sister was playing with him, and was whispering in his ear.  My dad said “No, that’s the one I can’t hear out of.”  My grandmother about had a heart attack.  “What do you mean that’s the one you can’t hear out of?!”  Dad thought everyone had one ear that they couldn’t hear out of, because that was normal for him. 

My dad’s “disability” was so normal to him, it didn’t even occur to him that he would get deferred from military service.  So he didn’t serve in the peace-time Army.  He usually chooses his seat strategically when dining out with a group.  And don’t talk to him if he’s driving, because he has to turn his head to hear.  So I wouldn’t say my dad’s hearing impairment had no impact on his life, but he’s lived a happy productive life that is normal for him.  If you casually mentioned his disability, I’m certain he would look puzzled, and ask what the heck you were talking about. 

I recall early in my career working with a young lady, about nine years old, who had Erb’s palsy.  This is a birth trauma that causes nerve damage, usually to just one arm.  The arm will have a characteristic appearance, with internal rotation at the shoulder, and some amount of flexion at the elbow.  With the arm down at the side, the wrist will usually be flexed and the hand turned outward.  The degree of “disability” will depend on how severe the initial injury was. 

This young lady had the classic appearance of Erb’s Palsy in her left arm.  Her mother and grandmother wanted me to do serial (a series of) splinting to the wrist to achieve a more normal position.  When I talked to my patient, she was precocious and wise beyond her years.  She said the only thing she could think of that she absolutely could not do was cartwheels.  She stated she was perfectly okay with her inability to do cartwheels, and she was okay with how her arm looked.  In conclusion, she really had no interest in serial splinting. 

Some children are born with severe birth defects. Most of us would consider being born without arms or without legs to be a severe disability. But it doesn’t have to be.

Have you seen shows on The Discovery Channel of children who were born without arm? They learn to do amazing things with their feet. Actually, they learn to do everything with their feet. It’s hard to imagine, but they do.

Other children and adults overcome terrible injuries, what most of us would consider horrible, disabling injuries. Obviously not everyone does well. Some never truly re-engage in their lives. But some inspire us all. They don’t just re-engage, they excel.

What makes the difference?  Why do these children grow up to be independent, happy, productive adults?  Why do some people, children or adults bounce back after overwhelming odds and devastating injuries or illnesses? 

Many of them say their families did not treat them differently, meaning their families projected a “can do” expectation.  They never saw themselves as disabled, and set out to discover how they could be differently able.  For some people, maybe “disabled” is a state of mind.  One they have no concept of.  These brave, magnificent people don’t feel sorry for themselves.  They have a very able state of mind. 

Obviously some children and adults truly have insurmountable disabilities.  I don’t mean to minimize these conditions by any means.  That’s another topic.