Primary disabilities are characteristics or behaviours that reflect
differences in brain structure and function, such as mental retardation, attention
deficits and sensory integration dysfunction. Secondary disabilities are disabilities
that the individual is not born with. These disabilities and behaviours develop over
time because of a poor fit between the person and the environment.
A secondary condition is an additional condition that presupposes
the existence of a primary condition. It is distinguished from other health conditions
by the lapse in time from the acquisition of the primary condition to the occurrence
of the secondary condition. Examples include pressure ulcers, urinary tract infections,
and depression. Secondary conditions can reduce functioning, lower the quality of
life, increase health care costs, and lead to premature mortality. Many such conditions
are preventable and can be anticipated from primary health condition.
World Health Organisation, 2011
Although it is rarely possible to treat the primary cause of a
child's learning difficulty, it is often possible to prevent or at least minimize
the impact of secondary disabilities, such as epilepsy, sensory impairment, behavioural
or communication difficulties, and always possible to ensure that parents and carers
are informed about appropriate support.
Preventing secondary conditions related to existing disabilities
is an important priority... Timely referral can facilitate access and decrease...the
development of secondary conditions.
World Health Organisation, 2011
[For young people with cerebral palsy,] inactivity leads to muscle
weakness, stiffness, contractures, osteopenia/porosis, potential changes in motor
We need to anticipate and avoid secondary impairments, rather than treat them after they occur... [It requires a] paradigm shift emerging from the rehabilitation approach of acceptance of and compensation for injuries to strategies that promote neural recovery and restoration of function...
The identification of mental health difficulties in young people
with PMLD or ASD is often confused by the challenge of
interpreting behaviours which become associated with a 'condition' rather than a manifestation
of a mental health problem... Identification of potential mental health problems was
highlighted as a major challenge when working with these young people... whilst interventions
and strategies were identified by teachers and other professionals, these were often
reactionary and not always informed by an understanding of complex needs.
Fergusson et al, 2008
It is reported that many CYP
with FASD will have early entry into the criminal justice system – Kelly (2009)
reported that, above age 11 years, 60% of CYP
with FASD were in trouble with
the law, and 50% had experienced confinement... Streissguth and colleagues (1996)
found that 3% of 6-11-year-olds, 12% of 12–20-year-olds, and 23% of adults from
a cohort of 415 subjects diagnosed with FAS
or Foetal Alcohol Effects had attempted suicide (The adult figure is five times the
US national average).
Blackburn et al, 2012
Careful definition of secondary disabilities brings a real chance
to make a positive difference, as correct management can alleviate symptoms...secondary
disabilities can be significant and include the epilepsies, gastro-oesophageal reflux,
constipation, postural deformities, spasticity, dystonia, movement disorders, pain,
bladder problems, infections, osteopenia leading to fractures, drooling, behavioural
and sleep disorders, sensory impairments, growth and endocrine disorders.
Review key literature on the impact of secondary disabilities relating to the population of children in your school. Review the systems in place in your school to address secondary disabilities and to raise staff awareness.
Blackburn, C., Carpenter, B. and Egerton, J. (2012) Educating Children and Young People with FASD. London: Routledge.
Emerson, E. (2007) Challenging behaviour and psychiatric disorder in intellectual disability: common causal factors, Current Opinion in Psychiatry, 20 (5), 450-455.