Special Needs and Mental Disorders

.: CHAPTERS
GİRİŞ
INTRODUCTION
Şaziye Senem BAŞGÜLa
aHasan Kalyoncu Üniversitesi İktisadi İdari ve Sosyal Bilimler Fakültesi, Psikoloji Bölümü, Gaziantep, TÜRKİYE
Başgül ŞS. Giriş. Başgül ŞS, editör. Özel Gereksinim ve Ruhsal Bozukluklar. 1. Baskı. Ankara: Türkiye Klinikleri; 2021. p.1-4.
Article Language: TR
ÖZET
Gelişimsel olarak normal sınırlardaki çocukların büyüme ve gelişmeleri için özel bir destek gerekmez. Çocuklar kazandıkları becerileri üst üste koyarak zamanı geldiğinde gelişir ve büyürler. Öyle ki birçok ebeveyn, normal gelişim gösteren çocuklarının büyüdüğünü çoğu kez çevreden gelen 'Ne kadar da büyümüş maşallah' yorumlarıyla karşılaştıklarında fark ederler. Normal gelişim gösteren çocuklara uygun bir çevre sağladıktan sonra onların büyüyüp serpilmelerini izlemek yeterlidir. Ancak, bazı çocukları, gelişim basamaklarında desteklemek gerekebilir.

Mental ve motor becerilerinde gelişiminin gerisinde olması nedeniyle, yaşının gerektirdiği becerileri yapmakta zorlanan her çocuğun özel gereksinimi vardır. Bu geniş bir tanımdır ve bilişsel gelişim, motor beceriler, dil becerisi, işitme yetisi, görme yetisi ve sosyal becerileri içerir. Bunun yanında ruh sağlığı açısından da özel gereksinim söz konusu olabilir. Bu tanımdan hareketle, işitme engelli bir çocuğun veya zihinsel engelli bir çocuğun özel gereksinimi olduğu gibi; dikkat eksikliği olan bir çocuğun, üstün zekâlı bir çocuğun veya kaygı bozukluğu olan bir çocuğun da özel gereksinimi olabilir. Bu çocukların özel gereksinimleri karşılandığında gelişimleri ilerleyecektir

Çocuk ve ergen psikiyatristlerinin çocuğu değerlendirmesi sonrasında gelişimsel ve ruhsal açıdan özel gereksinimi olduğu tespit edilen ve desteğe ihtiyaç duyulan çocuklara bireysel eğitim ve tedavi önerilir. Bireysel eğitim desteği planlanırken çocuğun yaşı ve içerisinde bulunduğu gelişim basamağı çok önemlidir. Okul öncesi dönemde, özellikle de ilk üç yaşlarındaki çocuklar için, eğitime mümkün olan en erken zamanda başlamak gerekir. Özellikle devlet hastanesinde çalışan çocuk ve ergen psikiyatristi meslektaşlarıma bu noktada çok iş düşmektedir. Öncelikli olarak, tanılara takılmadan çocuğun ihtiyacını belirlemek ve bunu ailesiyle paylaşmak gerekir. Devlet desteği alabilmek adına raporlama prosedürü, yoğunluk nedeni ile bazen uzun sürebilir ve geçen zaman çocuğun aleyhine olur. Bu nedenle, aileye çocuğun durumu çok iyi anlatılmalı ve eğitsel desteğe hemen başlanması gerekliliği salık verilmelidir. Bazı aileler rapor almak istemeyebilirler. Bu ailelere de anlayış göstermek ve çocuk için neler yapılması gerektiğini anlatmak yine biz hekimlerin görevidir. Her ailenin ve her çocuğun süreci farklıdır. Okul çağındaki özel gereksinimli çocuklar için, çocuğun ihtiyacına göre eğitsel tedbir yeterli olabileceği gibi, bazı durumlarda özel eğitim desteği de gerekebilir. Sadece eğitsel tedbir gereken çocuklarda tek hekim raporu yeterli iken, özel eğitim desteği gereken çocuklarda tıbbi rapora ihtiyaç vardır. Hastaneden alınan Çocuklar İçin Özel Gereksinim Raporu (ÇÖZGER) sonrasında, Rehberlik Araştırma Merkezlerinde (RAM) uzmanlar tarafından eğitsel değerlendirme yapılır ve her çocuğa özel bi reysel eğitim programı hazırlanır. Bu çocukların bir kısmı örgün eğitim içerisinde kaynaştırma öğrencisi olurken bir kısmı da özel eğitim sınıflarında veya özel eğitim okullarında eğitim öğrenim görürler.

Ancak, tüm bu aşamaların öncesinde, çocuğun desteğe ihtiyacı olduğunun fark edilmesi önemlidir. Bu noktada, başta ailelerin fark etmeleri ve sonrasında çocuğun sıklıkla takibini yapan çocuk hekiminin gözlemi çok kıymetlidir. Aileler, çocuklarının gelişiminde bir aksaklık olduğunda bazen psikolog, psikolojik danışman, çocuk gelişim uzmanı, okul öncesi öğretmeni gibi kişilere de başvurabilirler. Bu kişilerin etik açıdan çok titiz davranması gerekir. Çocuğun bilişsel, sosyal, motor geriliğinden şüphelenirlerse veya ruhsal sorunu olduğunu düşünürlerse ayrıntılı değerlendirme, tanılama ve tedavinin planlanması için mutlaka bir çocuk ve ergen psikiyatristine yönlendirmeleri gerekir. Etiyoloji ve eş nörolojik tanılar açısından, çocuk nörologlarının değerlendirmeleri de çok kıymetlidir.

En ufak bir aksaklıkta, tablo tam oturmasa da, tanı tam konulmasa da çocuğun gelişimsel ve sosyal ihtiyacı 'özel gereksinim' kapsamında değerlendirilip desteklenmelidir. Çocuğun ihtiyacı olan bireysel destek verilmeli, çevresel önlem alınmalıdır. Sonrasında çok geç olabilir. Çocuklar kendi ihtiyaçlarını dillendiremezler. Bu gereksinimlerin tespiti ve çözümü için yönlendirilmesi görevi biz hekimlere, ebeveynlere, devlet büyüklerine, çocukla ilişkili her meslek alanından uzmanlara düşer ve bu oldukça önemli bir sorumluluktur.

Tam tanılanamamış gelişimsel geriliği olan çocukları takip etmek ve tanılama için zaman kazanmak adına hemen kreşe yönlendirmek, yapılan önemli yanlışlardan biridir. Tanılama için harcanan zaman, müdahale için gereken zamanı daraltır. Çocuğun akranları ile uyum içerisinde olabilmesi ve akran öğrenimi için, öncelikle, sorununun çözümü adına çocuğa gerekli destek başlamalıdır. Geri kaldığı tespit edilen alanlarda bir yandan desteklenirken, aynı süreçte çocukla çalışan uzmanın kreş öğretmeni ile iş birliği kurması ve kademeli olarak kreşe devamı sağlanmalıdır. Aksi durumda, akran iletişimi ve eğitimi için yeterince beceriye sahip olmayan çocuğun problemi daha da artabilir.

Bir diğer önemli konu ise çocuğun ihtiyaç düzeyidir. Çocukların becerilerinin gelişebilmesi için verilmesi gereken destek, beceri geliştirmelerine engel olacak derecede aşırılığa kaçtığı zaman yine bir yetersizlikten bahsetmiş oluruz. Bu çocukların ebeveynleri, kaygıları nedeniyle aşırı koruyucu ve kollayıcı davranabilirler. Çocuklarının zorlanmaması için, onların adına bir çok şeyi üstlenebilirler. Biz uzmanların bu konuda da aileyi desteklemesi önemli ve gereklidir. Özel gereksinimli çocukları desteklerken amaç, bu çocukları kendi başlarına becerebilecekleri en üst düzeye taşımak olmalıdır.

Özel gereksinimli çocuğa ayrılan zaman, emek ve bütçe nedeniyle bu çocuğun kardeşi de özel ilgiye gereksinim duyar. Gelişimi normal olan bu kardeşlerin duygusal ihtiyaçlarının aksamaması adına ailelerin farkındalığının arttırılması ve desteklenmesi gerekir.

Özel gereksinimli çocukları ötekileştirmeden sınıfına, okuluna ve topluma kaynaştırmalıyız. Bir diğer yandan, özel gereksinimli çocuğun sınıf arkadaşı olmak, farklılıklarla yaşamayı öğrenmek adına bu çocuklar için de oldukça önemli bir kazanımdır.

Son söz olarak, 'özel gereksinim' dinamik bir tanımdır. Herkesin bir gün özel gereksinimi olabilir.
ABSTRACT
No special support is required for the growth and development of developmentally normal children. Children develop and grow by superimposing the skills they have acquired. Many parents realize their developmentally normal children's growth with the reactions coming from the environment. It is enough to create an ideal growth environment for parents who have developmentally normal children. However, it may be necessary to support some children through their developmental stages.

If a child is behind according to his or her peers in terms of mental and motor developmental skills, he or she has special needs. This is a broad definition and this definition includes cognitive development, motor skills, language skills, hearing ability, visual skills, and social skills. In addition, there may be special needs in terms of mental health. Based on this definition, as a hearing-impaired child or a mentally retarded child has a special need; A child with an attention deficit, a gifted child, or a child with an anxiety disorder may also have special needs. When the special needs of these children are met, their development will progress.

After the evaluation of the child by the child and adolescent psychiatrists, individual training and treatment are recommended for children who are found to have special needs in terms of developmental and mental aspects. When planning individual education support, the age of the child and the developmental stage he/she is in are very important. It is necessary to start education as early as possible in the pre-school period, especially for children in the first three years of age. Especially child and adolescent psychiatrists working in public hospitals have a lot of work at this point. First of all, it is necessary to determine the needs of the child and share this with the family without getting stuck in the diagnosis. In order to receive government support, the reporting procedure can sometimes take a long time due to the intensity and the time taken is against the development of the child. Therefore, the family should be well informed about the situation of the child, and it should be recommended that educational support should begin immediately. Some families may not want to receive reports. It is again the task of the doctors to show understanding to these families and to explain what needs to be done for the child. The process of every family and every child is different. For school-age children with special needs, educational measures may be sufficient according to the needs of the child, and in some cases, special education support may be required. While a single physician report is sufficient for children who need only educational measures, a medical report is needed for children who require special educational support. After the Special Needs Report for Children (ÇÖZGER) taken from the hospital, educational evaluation is made by experts in the Guidance Research Centers (RAM) and an individual education program is prepared for each child. While some of these children become inclusive students in formal education, some of them receive education in special education classes or special education schools.

However, before all these stages, it is important to realize that the child needs support. At this point, the awareness of the families and then the observation of the pediatrician who follows up the child is very valuable. Families can sometimes get help from people such as psychologists, psychological counselors, child development specialists, preschool teachers when there is a problem in the development of their children. These people must be very careful in terms of ethics. If they suspect the child's cognitive, social, motor retardation, or if they think that the child has a mental problem, they should definitely refer to a child and adolescent psychiatrist for detailed evaluation, diagnosis, and treatment planning. Pediatric neurologists' evaluations are also very valuable in terms of etiology and co-neurological diagnoses.

In the slightest disruption, the developmental and social needs of the child should be evaluated and supported within the scope of "special needs", even if the picture is not fully established and the diagnosis is not made fully. The individual needs of the child should be given and the environmental precautions should be taken. It may be too late afterward. Children cannot express their own needs. The determination of these needs and the guidance of the children to solve the situation is the responsibility of doctors, parents, statesmen, and experts from all professions related to the child. This is a very important responsibility.

It is one of the important mistakes to direct children with developmental retardation who are not fully diagnosed to the daycare center in order to gain time for diagnosis. The diagnostic process reduces the time required for intervention. In order for the child to be in harmony with his/her peers, the necessary support must begin first. While the child continues to receive support in the areas where he/she falls behind, it should be ensured that the specialist working with the child cooperates with the kindergarten teacher and the child gradually attends the kindergarten. Otherwise, the problem of not having enough skills for peer communication and education may increase.

Another important issue is the child's level of need for support. If the support given to children to develop their skills goes too far, it also prevents them from developing skills. Parents of these children can be overly protective and watchful because of their anxiety. They can take on many responsibilities on their behalf so that their children do not have difficulties. It is important and necessary for us experts to support the family in this regard. When supporting children with special needs, the aim should be to bring these children to the highest level they can handle on their own.

Due to the time, effort, and budget allocated to the child with special needs, this child's sibling also starts to need special attention. The awareness of families should be increased in order not to interrupt the emotional needs of these siblings whose development is normal.

We must integrate children with special needs into their class, school, and society without alienating them. On the other hand, being a classmate of a child with special needs is a very important achievement for these children in order to learn to live with differences.

As the last word, "special need" is a dynamic definition. Everyone may have special needs one day.

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30.03.2014

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