Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
E
v
al
ua
ti
o
n
and
Rese
arch in
Education (I
JE
RE)
V
o
l.3
,
No
.3
, Sep
t
em
b
e
r
20
14, pp
. 175
~186
I
S
SN
: 225
2-8
8
2
2
1
75
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJERE
The Rol
e
of Governm
e
nt and
NGO in Promoting Wellness of
People with Down Syndrome
Yeo
Kee
Ji
ar
1
,
Lina
Hand
ayani
2
, Lu
X
i
1
1
Faculty
of Education
,
Un
iv
ersiti Teknologi
Malay
s
ia
, Johor
Bahr
u, Malay
s
ia
2
Faculty
of Public Health
, Univ
er
sitas Ahmad Dahlan, Yog
y
akar
ta, Indon
esia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
J
u
l 04, 2014
Rev
i
sed
Au
g
02
, 20
14
Accepted Aug 30, 2014
People with Down Sy
ndrom
e (PW
D
S) experienc
e
cognitiv
e dela
ys indic
a
te
d
b
y
dif
f
icu
lties with cognition,
long-
term memor
y
and non-ver
b
al problem
solving
skills
. PW
DS have specific sp
eech and l
a
nguage im
pair
m
e
nts which
affect all aspects
of development. So
me children develop
difficult behaviors
which c
a
us
e fa
m
i
l
y
s
t
r
e
s
s
and
affec
t
s
o
ci
al
and
educ
ation
a
l
incl
us
ion. Th
es
e
defic
its
are wors
ened b
y
a hig
h
er incid
e
nce o
f
certa
in m
e
dic
a
l problem
s
which were extensive from birth to old
age
.
Bei
ng intel
l
ec
tua
l
l
y
chall
e
nged
,
P
W
DS
face m
a
n
y
cha
lleng
es
and
barri
ers
to
car
e
for them
s
e
lves
, t
o
le
ad ri
c
h
and var
i
ed
lives
as well as to
get i
nvolv
e
d in
all aspects of
community
life.
Besides helping
them
to assum
e
respons
ibilit
y
fo
r their own well
being, i
t
i
s
upon dedication
s
from all parties to assist th
em to live a longer lif
e
expectancy
with
dignity
and
wellness intact.
This paper
aims to
understan
d
the scop
e of
welln
ess for PWDS and
the hindering f
a
ctors as well
as
identif
yi
ng con
t
ributions towa
rds wellness of PW
SD, its flaws an
d
suggestions for improvement. Th
e an
aly
s
is and
discussion is grounded in
th
e
contex
t
of
Malay
s
ia against the bac
kdrop of PWDS across nations. It found
that Peopl
e with
Disabiliti
es (PW
D
) in Mala
y
s
i
a
are prot
ect
ed b
y
diff
erent
laws and
ac
ts.
Keyword:
Go
ve
rnm
e
nt
Malaysia
N
GO
Peop
le w
ith dow
n synd
ro
m
e
(P
WDS
)
Welln
ess
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Yeo
Kee
Jiar,
Faculty of E
d
ucation,
Un
i
v
ersiti Tekn
o
l
o
g
i
Malaysia
Em
a
il: k
j
yeo
@
u
t
m
.
my
1.
INTRODUCTION
D
o
wn
s
ynd
rome (
D
S
)
is
a co
mm
o
n
ch
ro
mo
s
o
m
a
l d
i
sorde
r
due to a
n
ext
r
a chrom
o
som
e
num
ber 21
(triso
m
y
2
1
)
,
wh
ich
is ch
aracterized
b
y
reco
gn
izab
le
f
acial featu
r
es, im
p
a
ired
co
gn
itiv
e ab
ility, g
r
o
ss an
d fin
e
m
o
to
r sk
ills, la
n
g
u
a
g
e
, etc [1
]
-
[3
]. Th
e in
ciden
ce o
f
DS is ab
ou
t on
e in
ev
ery 73
3
b
i
rth
in
Un
ited
States [4
]
and
o
n
e
pe
r
95
0
bi
rt
hs
i
n
M
a
l
a
y
s
i
a
(USM
H
u
m
a
n Gen
o
m
e
C
e
nt
re a
n
d
Ge
net
i
c
,
20
1
3
)
[
5
]
,
[6]
.
T
h
e
b
r
ea
kd
o
w
n
of t
h
e n
u
m
b
er o
f
Pe
opl
e
wi
t
h
D
o
wn
S
y
nd
rom
e
(P
WDS) a
r
e I
n
do
nesi
a,
29
8,
0
6
6
, M
a
l
a
y
s
i
a
, 29
,4
0
3
,
Sin
g
a
po
re, 5
,
44
2,
Ph
illip
in
es,
10
7,802
, Th
ail
a
n
d
, 8
1
,
081
,
Vietn
a
m
,
1
03,328
,
Un
ited
States, 367
,0
69 [7
].
PWDS are cat
eg
orized
as peo
p
l
e with
In
tellectu
a
l Disab
ility
(ID). Down
synd
ro
m
e
a
cco
un
ts fo
r
al
m
o
st 4
0
%
o
f
cases o
f
m
o
d
e
rate to
sev
e
re learn
i
n
g
d
i
sab
ilities an
d
is a
li
felon
g
cond
ition
[8
]. A few of th
e
com
m
on phy
si
cal
t
r
ai
t
s
of D
o
w
n
sy
n
d
r
o
m
e
are lo
w m
u
scle to
n
e
, sm
all s
t
atu
r
e, an
upward sla
n
t to the
eyes,
and a si
ngle
de
ep crease ac
ros
s
the center
of the palm
. Ever
y
P
W
D
S
i
s
a u
n
i
q
ue i
n
di
vi
d
u
a
l
and m
a
y
possess
these c
h
aracteristics to differ
en
t d
e
grees
o
r
no
t at all.
PWDS
have a
n
incre
a
sed
risk for ce
rtain
m
e
dical
conditions suc
h
as
conge
n
ital heart defect
s
,
resp
i
r
ato
r
y
and h
e
aring
p
r
ob
le
m
s
, Alzh
eim
e
r’s d
i
sease,
ch
ild
ho
od
leuk
emia, and
tyro
id
co
nd
itio
ns. Man
y
of
these conditions are
now treatable,
so m
o
st PWDS lead healt
h
y lives
. Life e
xpect
ancy for
PWDS
ha
s
increase
d
dram
atically
in
recent deca
des
-
from
25 in 1983
to 60 t
oday.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
22
I
J
ERE
Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
75
–
18
6
17
6
Despite
ha
ving longer life e
x
pectancy
, at le
ast half
of all childre
n
a
n
d
a
dults with DS face
a
m
a
jor
men
t
al h
ealth
co
n
c
ern
d
u
ring th
eir life
sp
an
. Ch
ild
ren
and
ad
u
lts
with
m
u
ltip
le
m
e
d
i
cal p
r
ob
lem
s
ex
p
e
rien
ce
an e
v
en
higher rate
of m
e
ntal
hea
lth
p
r
ob
lems.
N
D
S
S
(
201
2)
r
e
po
r
t
t
h
e m
o
st co
mm
o
n
m
e
n
t
al h
ealth concer
ns
in
clu
d
e
g
e
n
e
ral an
x
i
ety, ob
sessiv
e
-co
m
p
u
l
siv
e
b
e
h
a
v
i
or
,
op
po
sition
a
l, imp
u
l
si
v
e
and
i
n
atten
tiv
e b
e
h
a
v
i
ors,
sleep
related
difficu
lties, an
d n
e
u
r
o
-
p
s
ych
o
l
o
g
i
cal
p
r
ob
le
m
s
ch
aracterized
b
y
progr
essiv
e
lo
ss of cog
n
itive
sk
ills [5
].
Mo
st you
ng an
d early scho
ol ag
e ch
ildren
h
a
v
e
limitat
i
o
n
s in
lang
u
a
g
e
an
d co
mm
u
n
i
c
a
tio
n
sk
ills,
co
gn
itio
n, an
d
n
on-v
e
rb
al
prob
lem
so
lv
in
g sk
ills. Ol
d
e
r
adu
lts showed increased vu
ln
erab
ility to
g
e
neralized
an
x
i
ety, depressio
n
, social with
drawal, loss o
f
i
n
tere
st,
an
d
d
i
m
i
n
i
sh
ed
self-care, d
e
clin
e in
cogn
itiv
e and
so
cial sk
ills and
d
e
m
e
n
tia.
In so
m
e
d
e
v
e
lo
p
e
d coun
tries, th
e
welfare
o
f
PWDS
are syste
m
atica
lly p
l
an
n
e
d to
en
su
re welln
ess i
n
th
eir liv
es. In
dev
e
lop
i
ng
co
un
tries su
ch as
Malaysia,
Acts and provisions are c
r
eat
ed t
o
pr
ot
ect
P
W
D
but
fo
r
th
e categ
ory of DS, m
u
ch
h
a
s to
b
e
d
o
n
e
fo
r th
is in
tellectu
a
lly ch
allen
g
ed
group
who
are m
a
rg
in
alized
in
m
a
ny
aspect
s of t
h
ei
r l
i
v
es
. In M
a
l
a
y
s
i
a
, t
h
e g
ove
r
n
m
e
nt and i
n
part
i
c
u
l
ar, t
h
e M
i
ni
st
ry
of E
ducat
i
o
n a
n
d
M
i
ni
st
ry
of
W
o
m
e
n, Fam
i
l
y
and C
o
m
m
uni
ty
Devel
o
pm
ent
,
as wel
l
as N
GO:
t
h
e M
a
l
a
y
s
i
a
n D
o
wn Sy
nd
r
o
m
e
Asso
ciatio
n (PSDM) at
n
a
tion
a
l an
d state lev
e
ls an
d Ki
wan
i
s
Down
Sy
n
d
ro
m
e
Fo
un
datio
n
are i
n
stitu
tio
ns
th
at prov
id assi
stan
ce to ch
ildren
with
DS.
Th
is p
a
per will
d
i
scu
s
s 4
m
a
in
p
a
rts related
to
th
e wellness of
PWDS:
(1
)
What is
welln
ess
for
P
W
DS
?
(
2
)
W
h
at
are t
h
e hi
n
d
eri
ng fact
ors t
o
achi
e
ve
wel
l
n
ess f
o
r
peo
p
l
e
wi
t
h
P
W
DS
?
(
3
) C
o
nt
ri
but
i
o
n fr
om
th
e Gov
e
rn
m
e
n
t
and
NG
O tow
a
rd
s
w
e
lln
ess of
PW
DS.
2.
WHAT
IS
WELLNESS FOR PWDS?
Welln
ess is an
activ
e p
r
o
cess o
f
b
e
co
m
i
n
g
aware and
m
a
k
i
n
g
ch
o
i
ces toward
a h
ealth
y an
d
fu
lfilli
ng
life. “It is a sta
t
e of com
p
lete
physical, m
e
ntal, and s
o
ci
al well-bei
ng a
n
d not m
e
rely
the absence
of
dis
ease or
in
firm
it
y”
(Th
e
Wo
ld
Health Org
a
n
i
zatio
n
)
.
Welln
ess is not j
u
st ab
sen
ce
fro
m
illn
ess b
u
t
en
co
m
p
asses
m
u
ch
m
o
re t
h
an
th
at.
Natio
n
a
l Down
Syn
d
ro
m
e
So
ciety, New York
(20
1
2
)
id
en
tified
welln
e
ss as com
b
ination of six
main areas of life: the
i
n
t
e
l
l
ect
ual
,
ph
y
s
i
cal
, em
ot
i
onal
,
soci
al
, psy
c
hol
ogi
cal
an
d
sp
iritu
al [5
]. Univ
eristy o
f
Californ
i
a (2
012
) l
i
sted
seve
n
di
m
e
nsions
t
o
co
nt
ri
but
e
t
o
wel
l
n
ess:
soci
al
,
e
m
oti
onal
,
s
p
i
r
i
t
u
al
, en
vi
r
o
n
m
ent
a
l
,
occ
u
p
a
t
i
onal
,
in
tellectu
a
l an
d ph
ysical wellness [9
].
From
the perspective of PWDS, t
h
eir
voic
e
s and wr
itings reflect their
hope to
be trul
y accepted
by
the society at large
and
value
d
.
Grace (2005), a
hi
gh f
uncti
oni
ng adult wit
h
DS c
h
ose t
h
e
title “I Am
Human,
Not
Al
i
e
n”
on
her b
o
o
k
w
h
i
c
h co
ul
d t
r
an
sl
at
e i
n
t
o
her dr
eam
s
t
o
be gi
ven fai
r
t
r
eat
m
e
nt
. Her
wri
t
i
n
g
s
t
e
l
l
wh
at
welln
ess
mean
t to
her, as well as
o
t
h
e
r
PWDS
[10
]
:
“
W
e m
a
y
be di
ffe
rent
t
o
y
o
u
on
t
h
e
o
u
t
s
i
d
e,
but
we
feel
t
h
e
sam
e
on t
h
e
i
n
si
de.”
“I
feel that
not being acc
ept
e
d
by s
o
ci
ety is tearing m
e
apart
beca
use
we a
r
e
hum
an bei
n
g
s
t
o
o
w
h
o
do
n
’
t
d
e
serve
t
o
be t
r
e
a
t
e
d t
h
i
s
way
.
”
“I don
’t wan
t
to
waste m
y
e
n
tire life m
a
k
i
n
g
po
m
p
o
m
s
an
d
capp
ing
bo
ttles. I
want
t
o
l
e
a
r
n
s
o
m
e
t
h
i
ng a
n
d
m
a
ke use
o
f
m
y
brai
ns.”
D
o
wn
Syndr
ome A
sso
ciation
(D
SA
) acro
s
s th
e g
l
o
b
e is
w
o
r
k
i
n
g
r
e
len
tlessly to
ch
amp
i
on
th
e
r
i
gh
ts
o
f
PWDS. To
su
mm
arize th
e
i
r missio
n
stat
e
m
en
ts, it is ab
ou
t th
e wellness fo
r
PWDS wh
ich
co
vers ev
ery
aspect of t
h
eir lives to help e
n
sure
th
at th
ey
liv
e a
m
ean
in
g
f
u
l
life with
fu
ll in
clu
s
ion
rath
er th
an
ex
clusio
n.
Am
ong t
h
e
we
l
l
n
ess st
at
em
en
t
s
im
pl
i
cat
ed i
n
t
h
ei
r m
i
ssi
on st
at
em
ent
s
:
i.
DSA
o
f
Un
ited Kingd
o
m
: to
help
PWDS to liv
e
fu
ll an
d reward
i
n
g liv
es
ii.
Can
a
d
i
an
Down
Synd
ro
m
e
So
ciety, CDSS –
T
o
em
p
o
w
er Can
a
d
i
an
s
with
DS and
th
eir fam
ilies
b
y
r
a
isin
g awar
eness and
pr
ov
ide in
fo
r
m
atio
n
o
n
Dow
n
syndr
o
m
e th
ro
ugh
th
e pr
en
atal, ear
l
y ch
ildh
ood,
scho
o
l
years, ad
u
lthoo
d, an
d retir
e
m
en
t stag
es of
lif
e
iii.
DSA of
Qu
eenslan
d
- t
o
bu
ild
co
mm
u
n
ity a
w
aren
ess
of DS and to support, advocate for and em
powe
r
PWDS to ta
ke their rightful pl
ace as valuable a
nd c
ontributing m
e
mbers
of t
h
eir l
o
cal and gl
obal
co
mm
u
n
ity
iv
.
ISD
I
(I
kat
a
n
S
i
nd
rom
a
Do
w
n
I
n
do
nesi
a
or
In
d
one
si
an
D
o
w
n
sy
nd
r
o
m
e
Soci
et
y
)
- t
o
pre
p
are
chi
l
d
r
e
n
with DS
by giving them
various voca
tional trainings to suit
their abilities
and
gui
ding the
m
to reach their
max
i
m
u
m
p
o
t
en
tials. Th
is
way we hop
e th
ey will b
e
ab
le to
liv
e in
dep
e
nd
en
tly an
d
b
e
free
o
f
t
h
e
negat
i
v
e l
a
bel
t
h
ey
are carry
i
ng
no
w. S
o
l
i
f
e seem
s t
o
be beara
b
l
e
an
d t
h
e h
o
ri
z
on see
m
s t
o
open
up
t
o
gi
ve way
fo
r
a bri
ght
a
n
d
f
r
u
i
t
f
ul
fut
u
res
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
ERE
I
S
SN
:
225
2-8
8
2
2
Th
e Ro
le o
f
G
o
vernm
en
t an
d NG
O
i
n
Prom
otin
g
Welln
ess
of People with
Dow
n
Sy
ndr
ome .... (Yeo Kee Jiar)
17
7
v.
K
i
w
a
n
i
s Down
Syndro
m
e Fo
und
atio
n, Malaysia - co
mmitted
to
th
e welfare o
f
ch
ildren
w
ith
D
o
wn
Syn
d
ro
m
e
, its main
fo
cu
s
b
e
i
n
g th
e edu
cation
o
f
th
ese ch
ildren up
t
o
6
years
o
l
d
.
vi
.
DS
A
of
M
a
l
a
y
s
i
a
, Persat
ua
n Si
nd
r
o
m
Do
wn
M
a
l
a
y
s
i
a
(PDSM
)
- To
i
n
tegrate, co
llab
o
rate an
d
b
u
i
ld
part
ners
hi
ps
wi
t
h
t
h
e
go
v
e
rnm
e
nt
, co
r
p
orat
i
o
ns
an
d
gene
ral
pu
bl
i
c
t
o
ge
nerat
e
awa
r
ene
ss a
n
d
com
p
assion t
o
wards t
h
e
Do
w
n
Sy
nd
rom
e
co
m
m
uni
t
y
.
In
a nu
tsh
e
ll,
welln
ess
fo
r
PWDS tak
e
s a
few asp
ects, i
n
terrelated
and
i
n
teracts to contrib
u
t
e t
o
th
e
q
u
a
lity of th
ei
r life as
fo
llows:
i.
Ph
ysical wellness: to
m
a
in
tai
n
a
h
ealth
y
qu
ality o
f
life th
at
allo
ws t
h
em
to
k
e
ep
them
selv
es th
rou
g
h
d
a
il
y
activities without
undue fati
gue
or physical stress and
he
althy eating ha
bits. It also im
plies indi
vidua
l
s
tak
e
respo
n
s
i
b
ilit
y fo
r t
h
eir o
w
n
h
ealth
care su
ch
as
caring
fo
r m
i
n
o
r illn
ess and
kno
wi
ng
wh
en
pr
ofe
ssi
o
n
al
m
e
di
cal
at
t
e
nt
i
o
n
i
s
nee
d
e
d
ii.
Social wellnes
s: the ability
to interact with
people
around
them
. It invol
ves th
eir a
b
ility
to establish
a
nd
main
tain
m
ean
in
gfu
l
relatio
n
s
h
i
p
s
with fam
i
l
y
m
e
m
b
ers and
friend
s
throug
h goo
d co
mmu
n
i
cation
sk
ills,
respect
i
n
g t
h
e
m
sel
v
es an
d
ot
hers
.
iii.
Em
o
tio
n
a
l welln
ess: th
e ab
ility to
u
n
d
e
rstand
and
co
p
e
with
th
eir
o
w
n
tho
ugh
ts, feelings, and
b
e
h
a
v
i
ors,
wh
et
h
e
r po
sitiv
e
o
r
n
e
g
a
tiv
e
iv
.
Env
i
ron
m
en
tal welln
ess : ab
il
ity to
h
a
v
e
a m
ean
ing
f
ul
e
xpe
ri
ence i
n
sc
ho
o
l
s, fam
i
ly
, an
d
com
m
uni
t
y
v.
Occup
a
tion
a
l welln
ess: th
e ab
ility
to
g
e
t p
e
rson
al fu
l
f
ill
men
t
fro
m
j
o
b
s
wh
ile still
mai
n
tain
ing
b
a
lance
betwee
n work
and leisure ti
me, addressi
ng
workplace
stre
ss and
buildi
n
g positive relationships
with
co-
workers
and
con
t
ribu
te
p
o
s
itively to
th
e
o
r
g
a
n
i
zatio
n
t
h
at em
p
l
o
y
th
e
m
vi
.
Sen
s
e
o
f
accom
p
l
ish
m
en
t:
t
h
e ab
ility an
d
freed
o
m
to
re
jo
ice own
accom
p
l
i
sh
m
e
n
t
s, t
o
feel th
ei
r hard
wo
rk
a
n
d
de
di
cat
i
on
bei
n
g a
p
preci
at
ed
i
n
vi
s
i
bl
e way
s
a
n
d f
eel
s t
h
e
desi
re
t
o
co
nt
i
n
ue t
h
e
i
r ef
fo
rt
Sen
s
e of self-estee
m
:
ab
ility
t
o
see th
e d
i
fferen
ces
b
e
tween
th
em
selv
es a
n
d
th
eir
p
eers
with
ou
t DS,
main
tain
a sense of self-worth
an
d k
e
ep
ing
a po
sitiv
e self-i
m
a
g
e
3.
WHAT
ARE
THE HINDE
RING FACTORS
TO ACHIEVE WELLNESS
FOR PWDS?
To
liv
e
with
d
i
gn
ity is d
eemed
as a basi
c right for e
v
eryone.
Fo
r PWDS, it tak
e
s th
eir own
awaren
ess t
o
assu
m
e
resp
on
si
b
ility to
ach
ieve th
e so-ca
lled
righ
ts to
liv
e a
mean
in
gfu
l
life wh
ile
p
e
op
le who
are work
i
n
g with
th
em
to
advocate
for thei
r ri
ghts
.
T
h
ere
are m
a
ny
unc
o
n
t
r
ol
l
a
bl
e i
n
t
e
r
n
al
fact
ors
w
h
i
c
h a
r
e
in
tertwin
e
d
with
ex
tern
al fact
o
r
s, m
o
stly u
n
co
n
t
ro
lla
b
l
e t
h
at are inh
i
b
iting
welln
ess
of
PWDS. Am
o
n
g
th
ese
are th
e
d
e
v
e
lop
m
en
tal d
e
ficits in
co
gn
itiv
e
ab
ilities, lan
guag
e
, co
mm
u
n
i
catio
n
an
d sp
eech
; h
ealth con
d
ition
;
and their social
em
otional be
haviours
.
3.
1.
Physi
c
al
fi
t
n
es
s an
d he
al
t
h
s
t
atu
s
P
W
DS ha
ve c
e
rt
ai
n p
h
y
s
i
cal
defi
ci
t
s
whi
c
h m
a
y
ham
p
er t
h
ei
r
m
ovem
e
nt
s. They
de
vel
o
p m
o
t
o
r
sk
ills at a slo
w
er rate th
an
typically
d
e
v
e
lop
i
n
g
p
eers (V
icari, 2
006
)
wh
ich
is d
e
trim
en
ta
l to
th
e acq
u
i
sitio
n
of
o
t
h
e
r related
activ
ities in
ed
u
catio
n, vo
catio
n
a
l an
d
r
ecreatio
n
a
l (Jo
b
ling
,
1
998
) [11
]
,[12
]. Th
ei
r physical
d
e
v
e
l
o
p
m
en
t may b
e
affected
b
y
th
eir
h
ealth
statu
s
.
A
few h
ealth
profiles o
f
PWDS
as su
mmarized
b
y
Pitetti,
Bayn
ard and
Ag
iov
l
asitis (
201
3) are sho
w
n
in
Tab
l
e 1 and
Tab
l
e
2
[13
]
.
Tabl
e 1. Desc
ri
pt
i
o
n
,
dem
ogra
phi
cs
,
a
n
d
heal
t
h
p
r
ofi
l
e
s of p
e
rso
n
s wi
t
h
D
o
wn
sy
n
d
r
o
m
e
Characteristics
Description
Descr
i
ption and
dem
ogr
aphics
1.
Caused by
tr
iso
m
y 21
2.
11.
8 per
10,
000 bir
t
hs (
U
SA)
3. Mild/
m
odera
te i
n
tellectual disability
4. Li
m
ited adaptive skills
5. Lif
e
span near 6
0
years
Health profiles -
Childho
od
1.
Congenital hear
t disease (
s
eptal
and valvular
defects)
2. Respiratory illnesses (pne
u
m
onia
and chronic bronchitis)
Health profiles -
Adulthoo
d
1. Deterio
r
ation of functional capacities
due to de
m
e
ntia
of Alzhei
m
e
r’s t
ype
2.
Recur
r
e
nt pneum
onia
3.
Sensor
y
i
m
pairm
e
nts (
h
ear
i
ng and vision)
4. Musculoskeletal disorders (j
oint instability
and osteoporosis)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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SN
:
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252
-88
22
I
J
ERE
Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
75
–
18
6
17
8
Tab
l
e
2
.
Ph
ysi
cal f
itn
ess i
n
y
o
u
t
h
w
ith
D
o
wn
syndr
o
m
e (
D
S)
Characteristics
Description
Car
d
iovascular
fitness
1. Low peak
aero
b
ic capacity/ti
m
e
t
o
exhaustion
2.
L
o
w peak hear
t r
a
te
3.
Peak aer
obic capacity
does not cha
nge signif
i
cantly with age af
ter
w16 yea
r
s
4.
Autono
m
i
c dy
s
f
unctio
n a pr
im
ar
y factor
r
e
lated to low fitness
5.
Field tests lar
g
ely
suppor
t labor
ator
y
findings
6.
Responsive to aer
obic endur
ance tr
aining,
par
ticular
ly
with i
m
pr
ovem
e
nts in wor
k
capacity
M
u
scular
str
e
ngth
1. Lowe
r strength
co
m
p
a
r
ed to individuals without disa
bilities
2. Resistance t
r
aining appears saf
e
and beneficial fo
r
im
pr
oving str
e
ngth
3.
I
m
p
r
oved leg str
e
ngth does not ap
pear
im
p
r
ove aer
o
b
ic capacity
Body
co
m
position
1.
Youth with DS
in Nor
t
h Am
er
ica
a
nd E
u
r
ope ar
e
m
o
r
e
obese/over
w
eig
h
t vs.
counterparts wi
thout disabilities
2. Cause of high rate of overweight/obes
ity is
m
u
ltifact
orial (physiological, societal,
envir
o
n
m
ental,
psy
c
hological,
etc.)
3. Studies show no i
m
p
r
ove
m
e
nt in
body
co
m
position
fr
o
m
exercise
train
i
ng alone, likely
d
u
e to lack of
dietary control.
In
di
vi
dual
s
wh
o are
w
o
r
k
i
n
g
t
o
p
r
om
ot
e t
h
e phy
si
cal
fi
t
n
ess o
f
P
W
D
S
have t
o
pl
an a
p
p
r
op
ri
at
e
p
h
y
sical activ
ities b
y
co
n
s
id
erin
g
th
e ch
aract
eristics o
f
ph
ysical h
ealth
, co
gn
itiv
e an
d
p
s
ych
o
s
o
c
ial wh
ich are
li
mitin
g
th
eir ph
ysical fitn
ess an
d
p
h
y
sical activ
ity. Desp
ite th
e p
r
ed
ispo
si
tio
n
attrib
u
t
es, Pitetti, et
al., (2
013
)
reco
mm
en
d
e
d p
h
y
sical activ
ities to
i
m
p
r
ov
e th
e card
i
o
v
a
scu
l
ar, metab
o
lic,
mu
scu
l
o
-
sk
eletal, and
p
s
ycho
so
cial health
pr
o
fi
les of
all
youths [13]. W
e
ll
desi
gne
d
progra
m
s
shoul
d take
int
o
account t
h
e
physical,
co
gn
itiv
e, and
p
s
ycho
so
cial
health
pr
ofiles of PWDS as wel
l
as th
eir
n
e
ed
for en
jo
ym
en
t an
d p
a
rticip
atio
n.
3.
2.
Co
gni
t
i
v
e fac
t
or
All PWDS exp
e
rien
ce co
gn
i
tiv
e d
e
lays
which
are
va
ri
ed
am
ong
i
n
di
vi
d
u
al
s. P
W
DS
a
ccou
n
t
s
fo
r
al
m
o
st 4
0
%
o
f
cases
o
f
m
o
d
e
rate to
sev
e
re learn
i
n
g
d
i
sab
ilities an
d
is
a life lon
g
con
d
ition
[8
]. Delay in
co
gn
itiv
e d
e
v
e
lo
p
m
en
t (e.g.
sp
eech
,
langu
ag
e, au
d
itory
sh
ort-term
m
e
m
o
ry) DS is an
o
t
h
e
r con
cern
[1
4
]
.
Sho
r
t-term
m
e
m
o
ry was foun
d as t
h
e sign
ifican
t
factor in
fl
u
e
n
c
i
n
g lan
g
u
a
g
e
an
d
co
m
p
reh
e
n
s
ion sk
ills
acq
u
i
sition
(Laws
et al.,
2004) and the core
problem
s
identified am
ong individuals with
DS we
re im
pa
ired
wo
rki
n
g m
e
m
o
ry
a
n
d e
x
ec
u
t
i
v
e f
unct
i
o
ni
n
g
(La
n
f
r
anc
h
i
et al.,
201
0)
[1
5
]
,[
16
]. Sho
r
t
-
ter
m
m
e
m
o
r
y
sp
an
pre
d
i
c
t
s
t
h
ei
r s
ubs
eq
ue
nt
v
o
c
a
bul
a
r
y
de
vel
o
pm
ent
and t
h
e
ver
b
al
sh
o
r
t
-
t
e
rm
m
e
m
o
ry
has been
rel
a
t
e
d
t
o
t
h
e
ab
ility o
f
an
ind
i
v
i
du
al to learn
th
e m
ean
in
g
o
f
unk
no
wn wo
rd
s
[17
]
.
P
W
DS ha
ve s
p
eci
fi
c di
f
f
i
c
ul
t
i
e
s i
n
l
earni
ng l
a
ng
ua
ge. D
e
l
a
y
s
i
n
l
a
ngu
age, com
m
uni
cat
i
on an
d
sp
eech
are
p
r
ofoun
d
i
n
ch
ildren
and
adu
lts with
Down’s
syn
d
ro
m
e
[1
8
]
.
Sp
eech
an
d
lang
u
a
g
e
sk
ills are
m
o
re
d
e
layed
th
an
th
e ch
ildren
'
s no
n-v
e
rb
al un
d
e
rstand
ing
and
reason
ing
ab
ilities [1
9
]
. M
o
st ch
ild
ren
with
Down
syndrom
e
understand m
o
re la
ngua
ge than t
h
ey can use as
a result of
spe
c
ific speech pr
oduction and hearing
d
i
fficu
lties. For th
is reaso
n
, learn
i
n
g
to
si
g
n
will h
e
lp
th
e
maj
o
rity o
f
ch
i
l
d
r
en
to
co
mmu
n
i
cate, to
show th
eir
un
de
rst
a
n
d
i
n
g
and
red
u
ce t
h
e
i
r fr
ust
r
at
i
o
n.
For m
o
st
chi
l
d
ren
wi
t
h
D
o
w
n
sy
n
d
r
o
m
e
, the m
o
st
seri
ou
s del
a
y
th
at th
ey exp
e
rien
ce is in
learn
i
ng
to
talk. Th
is is no
t on
ly fru
s
trating
bu
t
it h
a
s seriou
s co
n
s
equ
e
n
ces fo
r all
o
t
h
e
r asp
ects
of th
eir so
cial an
d cogn
itiv
e
dev
e
lop
m
en
t.
In s
p
eec
h, t
h
e
r
e i
s
consi
d
e
r
a
b
l
e
di
ffi
cul
t
y
at
al
l
l
e
vel
s
from
pl
an
ni
n
g
t
o
ar
t
i
c
ul
at
i
on an
d
ph
o
nol
ogy
.
Mo
st teen
ag
ers still h
a
v
e
sign
ifican
t in
tellig
ib
ility p
r
ob
le
m
s
[2
0
]
. Ex
pressiv
e
lang
u
a
g
e
is g
e
n
e
rally fo
und
to
be m
u
ch m
o
re
im
pai
r
ed i
n
i
ndi
vi
d
u
al
s
wi
t
h
DS t
h
an
rec
e
pt
i
v
e l
a
ng
ua
g
e
o
r
c
o
m
p
rehe
nsi
o
n a
n
d
no
n
-
ve
rbal
co
gn
itiv
e sk
ills [2
1
]
,[22
].
Deficits in
me
m
o
ry, p
r
o
c
essin
g
sk
ills, and
ex
pressiv
e
lang
u
a
g
e
affect t
h
e co
mm
u
n
i
cativ
e
co
m
p
eten
ce o
f
ch
ild
ren
and
i
n
teraction
s
wit
h
fam
ilies,
p
eers and
co
mm
u
n
ity
m
e
m
b
ers. Th
ese sh
ortcomin
g
s
are
bar
r
i
e
rs
fo
r
t
h
em
t
o
com
m
uni
cat
e t
h
ei
r t
h
ou
g
h
t
s
a
n
d
fee
l
i
ngs
of
sa
dnes
s
, a
nge
r, l
onel
i
ness a
n
d t
h
ei
r
need
s
effectively to others, and t
h
ere
f
ore
ham
p
erin
g th
eir con
n
ecti
v
ity with
o
t
h
e
rs.
3.
3.
Social
e
m
otional fac
t
or
So
cial d
e
v
e
lopmen
t in
clu
d
es
so
cial in
teracti
v
e sk
ills with
ch
ild
ren
and
ad
u
lts, so
cial
un
d
e
rstand
ing
an
d
em
p
a
th
y, friend
sh
i
p
s,
p
l
ay an
d
leisu
r
e sk
ills, p
e
rs
on
al an
d
so
cial in
d
e
p
e
nd
en
ce and
so
cially ap
p
r
op
riat
e
beha
vi
o
r
[
2
3]
.
Soci
al
f
u
nct
i
o
ni
n
g
i
s
re
gar
d
ed as st
re
n
g
t
h
fo
r i
n
di
vi
d
u
a
l
s wi
t
h
D
S
.
M
o
st
chi
l
d
ren
and
t
eenage
r
s
wi
t
h
DS
ha
ve a
g
e-
app
r
op
ri
at
e be
havi
or
, b
u
t
s
o
m
e
chi
l
d
re
n
do
de
vel
o
p c
h
al
l
e
ngi
ng
be
ha
vi
ors
wi
t
h
man
y
b
e
in
g
r
e
f
e
rr
ed
as ‘
s
t
u
bb
orn
’
or
‘o
b
s
ti
n
a
te [
1
8
]
. A
s
su
mmar
i
zed
b
y
Reyn
o
l
d
s
(
2010
), th
ese ch
allen
g
i
n
g
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
ERE
I
S
SN
:
225
2-8
8
2
2
Th
e Ro
le o
f
G
o
vernm
en
t an
d NG
O
i
n
Prom
otin
g
Welln
ess
of People with
Dow
n
Sy
ndr
ome .... (Yeo Kee Jiar)
17
9
b
e
h
a
v
i
or
s ar
e asso
ciated
with
so
m
e
n
e
gativ
e b
e
h
a
v
i
o
r
s su
ch
as sel
f
-
i
nju
r
y,
d
a
m
a
g
e
to
th
e
physica
l
en
v
i
ron
m
en
t, prev
en
t learn
i
ng of
n
e
w sk
ills an
d socially iso
l
ate th
e learn
e
r
[24
]
.
Ch
ild
ren
an
d teen
s
with
DS
wou
l
d wan
t
to h
a
v
e
th
ei
r own
circle of friends just
like
their peers
with
ou
t
DS.
So
cial in
teraction
invo
lv
es ab
i
lity to
co
mm
u
n
icate, to
un
d
e
rstand
th
e b
e
hav
i
or, em
o
tio
ns and
feelings
of
others. T
h
ese suc
cess factors in social
i
n
t
e
ract
i
on are
o
bvi
ou
sl
y
l
acki
ng am
on
g P
W
D
S
.
M
a
ny
in
d
i
v
i
d
u
a
ls
with
DS m
a
y
h
a
v
e
add
ition
a
l d
i
fficu
lties to
estab
lish
friend
s
h
i
p
s
d
u
e
to
th
ei
r so
cial
in
co
m
p
eten
cies as
well as sp
eech
an
d lang
uag
e
an
d cogn
itiv
e
d
e
lay.
3.
4.
F
a
m
ily
en
v
i
ron
m
e
n
t
From
bi
rt
h,
pa
rent
s are t
h
e c
l
osest
o
n
es t
o
chi
l
d
ren
with
DS.
All ch
ild
ren
are influ
e
nced
b
y
th
ei
r
ex
p
e
rien
ces wi
th
th
eir
p
a
ren
t
s, si
b
ling
s
, and
o
t
h
e
r
p
e
rsonalities wh
o
are clo
s
e to
t
h
em. Th
is i
n
terp
erso
nal
expe
ri
ence
va
r
i
es wi
t
h
i
n
fam
i
l
i
e
s. As a
basi
c nee
d
f
o
r e
v
er
y
i
ndi
vi
dual
,
c
h
i
l
d
re
n
wi
t
h
D
S
t
o
o
wo
ul
d
w
a
nt
t
o
fu
lfill th
eir b
a
sic n
eed
s fo
r
warm
th
, lo
v
e
, foo
d
an
d
care
. Fo
r fam
ilies wh
ich
are so
cially d
i
sad
v
a
n
t
ag
ed
su
ch
as un
em
p
l
o
y
ed
p
a
ren
t
(s), sin
g
l
e
p
a
ren
t
,
or poo
r fam
ilie
s, th
eir ch
ildren
will ten
d
t
o
h
a
v
e
m
o
re ri
sk
for
d
e
v
e
l
o
p
m
en
tal d
i
fficu
lties [2
3].
B
e
si
des di
sa
d
v
a
nt
age
d
fam
i
l
y
bac
k
g
r
o
u
n
d
,
som
e
parent
s
m
a
y
have
po
o
r
pa
re
nt
i
n
g
ski
l
l
s
or
ha
ve
d
i
fficu
lties to
ad
ap
t t
o
b
e
co
m
i
n
g
p
a
ren
t
s
of a ch
ild
with
d
i
sab
ility, th
u
s
influ
e
n
ce th
e
p
r
og
ress of th
e child
. If
pare
nt
s d
o
n
o
t
get
su
p
p
o
r
t
f
r
om
out
si
de
, t
h
e t
a
sk
o
f
b
r
i
ngi
ng
u
p
c
h
i
l
d
re
n
wi
t
h
D
S
m
a
y
be em
ot
i
onal
l
y
strain
ing
esp
e
cially fo
r th
e m
o
th
er. In
ad
d
ition
,
p
a
ren
t
s who
h
a
ve in
app
r
op
riat
e exp
ectatio
n
s
and
requ
irem
en
ts fo
r
go
od
b
e
h
a
v
i
o
u
r an
d
t
h
eir i
n
ab
ility to
m
a
n
a
g
e
b
e
h
a
v
i
ou
r
o
f
t
h
e ch
ild
wi
th
DS m
a
y in
flu
e
n
c
e
th
e
d
e
v
e
l
o
p
m
en
t of t
h
e ch
ild
.
W
ithou
t fam
i
l
y
sup
p
o
r
t
and
u
n
d
e
rstand
ing
,
th
e ch
ild with DS m
a
y fall b
e
h
i
nd
th
eir p
e
ers i
n
man
y
d
e
v
e
l
o
pmen
tal areas an
d resu
ltin
g
i
n
d
i
fficu
lties to
co
p
e
with
t
h
e
de
m
a
n
d
s
fro
m
s
c
h
o
o
l
s,
th
u
s
falling
furth
e
r in
acqu
i
ri
n
g
acad
e
m
i
c
a
n
d
n
o
n
-
acad
e
mic sk
ills. Fo
r so
m
e
ch
ild
ren
,
b
e
h
a
v
i
ou
r is no
t easy
to cha
nge a
nd
if a child is persiste
ntly difficult in school a
nd at hom
e
,
parents a
nd teachers will have t
o
work
t
oget
h
e
r
t
o
dev
e
l
op c
o
m
m
on s
t
rat
e
gi
es i
n
o
r
d
e
r t
o
cha
n
ge t
h
e be
havi
ou
r
[2
3]
.
4.
CONTRIB
U
T
I
ON FROM THE GOVERNMEN
T AND
NGO TOWARDS WELLNESS OF
PWDS
I
N
M
A
LA
YSI
A
Alth
oug
h m
a
n
y
ch
ild
ren
with DS are ab
le to b
e
co
m
e
an i
n
t
e
gral
part
of
fa
m
i
ly
, peer,
co
m
m
uni
t
y
and
work e
n
vironments, success
in suc
h
s
ituations is
ofte
n ha
m
p
ered by cha
llenging be
ha
viours (Fe
e
ley & Jone
s
,
2
008
) and
h
eal
th
co
nd
itio
ns. It is
th
erefo
r
e
of p
a
ram
o
un
t im
p
o
r
tan
ce to
hav
e
targ
eted
strateg
i
es to
h
e
l
p
th
e
m
to face
challenges i
n
their lives [18].
In M
a
l
a
y
s
i
a
, t
h
ere a
r
e a
g
enc
i
es, or
ga
ni
zat
i
ons
, c
o
r
p
o
r
at
e
sect
ors a
n
d i
ndi
vi
d
u
al
s w
h
o are
gi
vi
n
g
fi
na
nci
a
l
ai
ds a
nd
ser
v
i
ces t
o
i
m
prove t
h
e l
i
f
e
of
P
W
D.
The
r
e are f
o
ur m
a
i
n
go
ve
rnm
e
nt
agenci
es i
n
v
o
l
v
ed i
n
t
h
e ser
v
i
ces f
o
r
P
W
D [
25]
:
(
1
)
M
i
ni
st
ry
of H
eal
t
h
, (
2
) S
o
ci
a
l
W
e
l
f
are
Depa
rt
m
e
nt
under
M
i
ni
st
ry
of
W
o
m
e
n,
Fam
i
l
y
and C
o
m
m
uni
t
y
Devel
o
pm
ent
(M
WFC
D
),
(
3
)
M
i
ni
st
ry
of
E
ducat
i
o
n,
a
n
d
(4
) La
b
o
r
De
p
a
rt
m
e
nt.
Besides these a
g
encies
, there
are NGO
th
at
p
r
ov
id
e serv
ices for th
e PWD.
T
h
ere are
bi
g corporati
ons
that are
activ
ely in
vo
lved
i
n
Corp
orat
e So
cial Respo
n
s
i
b
ility (CSR) activ
ities.
Th
e
10
MP
(Ten
th Malaysian
Plan
)
encourages
the private sec
t
or t
o
im
ple
m
en
t CSR prog
ram
s
and also
exp
licit
ly id
en
ti
fi
es nat
i
ona
l
commitments towa
rds childre
n.
In the last decade, a few L
a
ws and Acts
were pa
ssed to protect the rights of
PWD in Malaysia.
4.
1.
Laws and
Acts
In
M
a
l
a
y
s
i
a
,
a num
ber of p
o
l
i
c
i
e
s
were ge
ne
rat
e
d
t
o
secure
th
e righ
ts
o
f
PWD. Th
e Nati
o
n
a
l
Welfare
Po
licy 1
990
is ai
m
e
d
at creatin
g
a stab
le an
d
secure
so
ci
ety, an
d
g
i
v
i
ng
equ
a
l opp
ort
u
n
ities to
PWD. Th
e
N
a
tio
n
a
l
So
cial Po
licy 20
03
fo
cused on
d
e
f
e
n
d
i
n
g
th
e eq
u
a
l righ
ts of PWD an
d fu
ll p
a
rticip
atio
n
i
n
society.
Th
e Nati
o
n
a
l
Po
licy for Perso
n
s
with
Disabilit
ies 2
0
0
7
fo
cu
sed
on
th
e
well-b
e
ing
of PWD. Th
e in
trod
uctio
n
o
f
Person
s wi
th
Disab
ilities
Act 20
0
8
was a sign
ifican
t
m
o
v
e
for p
e
o
p
l
e
with
d
i
sab
ilities. It co
ntain
s
co
m
p
reh
e
n
s
iv
e rig
h
t
s an
d
wellfare for PWD, in
cl
u
d
i
n
g
pr
o
m
o
tio
n
of qu
ality o
f
life an
d
wellb
eing
,
p
u
b
lic
facilities an
d
serv
ices,
em
p
l
o
y
m
en
t, h
o
u
s
ing
and
reh
a
b
ilitatio
n
.
Perso
n
s
with
Disab
iliti
es Act 200
8
cl
early
states th
at ‘p
erso
ns
with
d
i
sab
ilities sh
all no
t b
e
ex
cl
u
d
e
d fro
m
th
e g
e
n
e
ral edu
cation
syste
m
o
n
th
e basis of
d
i
sab
ilities, and
ch
ildren
with
d
i
sab
ilities s
h
all n
o
t
b
e
exclu
d
e
d
fro
m
p
r
e-scho
o
l
,
p
r
i
m
ary, seco
nd
ary an
d
h
i
gh
er edu
catio
n, on
eq
u
a
l
basis with
p
e
rson
s or ch
ild
ren
with
ou
t d
i
sab
ilities, in
clu
d
i
ng v
o
cation
a
l train
i
n
g
an
d
lifel
o
n
g
l
earn
i
n
g
’ (p
.24). Th
e
Natio
nal Plan
of Actio
n
for Perso
n
s
with
Disab
ilities (2
007
-2
012
)
e
m
p
h
a
sized
on
po
sitiv
e attitu
d
e
,
b
a
rrier-free en
v
i
ron
m
en
t, user-friend
l
y tran
sp
ortatio
n
,
h
ealth
serv
ice,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
22
I
J
ERE
Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
75
–
18
6
18
0
reh
a
b
ilitatio
n
,
ed
u
cation
,
emp
l
o
y
m
e
n
t
, ro
les of NGO.
It stated
th
e
1
%
po
licy o
n
em
p
l
o
y
m
e
n
t
o
p
portu
n
ities
for PWD in th
e pu
b
lic sect
o
r
.
4.
2.
Si
gni
f
i
c
ance
o
f
gui
d
el
i
n
e f
o
r
bet
t
er he
al
t
h
and
pers
on
al
grow
th
There
are
seve
ral m
e
dical concerns t
h
at are
specific to
Down syndrom
e
, or at t
h
e
very l
east, occ
u
r in
m
u
ch hi
ghe
r i
n
ci
de
nce t
h
a
n
i
n
pe
opl
e w
h
o
do
not
have t
h
e co
n
d
i
t
i
on.
Ho
we
ver
,
wi
t
h
pr
ope
r i
d
e
n
t
i
f
i
cat
i
on,
in
fo
r
m
atio
n
,
an
d tr
eatm
e
n
t
o
f
th
e m
e
d
i
cal issu
es
o
f
ch
ildr
e
n
w
ith
Do
wn
syndr
o
m
e, m
o
st p
e
o
p
l
e
with
the
co
nd
itio
n liv
e
a fairly lon
g
and
h
ealth
life.
Life expectanc
y
over a
g
e
55 e
x
ists
f
o
r
at least 5
0
%
an
d
b
e
y
o
nd
ag
e 68
for
1
4
% of
th
e DS p
opu
lation
[26]. Early acc
ess to services
and cli
n
ical in
terv
en
tion
,
as
well as in
clu
s
ion in
th
e co
mm
u
n
ity, h
a
ve in
creased
l
i
f
e expect
anc
y
from
12 y
e
ars i
n
19
4
0
t
o
60 y
ears i
n
2
0
06 [
2
7]
. R
o
i
zen an
d Pat
t
e
rso
n
(2
0
0
3
)
p
o
i
n
t
e
d t
h
at
i
ndi
vi
dual
s
wi
t
h
D
S
are
p
r
o
n
e t
o
at
t
acke
d
by
c
o
n
g
e
n
i
t
a
l
hea
r
t
de
fect
s,
di
abet
es
,
dep
r
essi
o
n
,
Al
z
h
e
i
m
e
r’s
d
i
sease, and
thyro
i
d d
i
sease [2
8
]
.
Th
eref
ore, in
d
i
v
i
du
al wit
h
DS are at th
e h
i
gh
risk of mo
rtality th
an
t
h
at of
th
eir
p
e
ers with
in
tellectu
a
l d
i
sab
ilities
and
n
o
rm
al
p
e
o
p
l
e
[2
7
]
. Altho
ugh
p
n
e
u
m
o
n
i
a, o
r
o
t
h
e
r
t
y
p
e
s
of
respi
r
atory infections,
was the
m
o
st comm
o
n
cause of
deat
h acr
oss t
h
e en
t
i
r
e l
i
f
espan
,
ra
ngi
ng
fr
om
23
% o
f
deaths in a
dult
h
ood to 40% in sene
sce
n
ce,
each life stage exhibited a pa
rticular profile of com
o
rbi
d
ities.
Co
ng
en
ital h
ear
t d
e
f
ects
w
e
r
e
f
o
u
n
d
as th
e seco
nd
co
mm
o
n
cau
se
o
f
d
eat
h
(1
3
%
o
f
d
eat
h
s
in
ch
il
d
hood
and
23
% i
n
ad
ul
t
)
[
27]
.
Due
to t
h
e
de
velopm
ental and health di
ffi
culties of
indi
viduals
with
DS, it is necessary to
better
u
n
d
e
rstand
th
e life q
u
a
lity a
n
d
h
ealth
p
r
ob
lem
s
o
f
th
is p
opu
latio
n
.
C
o
h
e
n
(2
009
) su
mmarized
a h
ealth
screeni
ng a
n
d
con
s
ul
t
a
t
i
on
g
u
i
d
el
i
n
es
fr
om
US t
o
hel
p
fa
m
i
ly
and pa
ren
t
s havi
n
g
DS c
h
i
l
d
re
n ke
ep
o
p
t
i
m
a
l
well-b
e
i
n
g
of
t
h
is p
opu
latio
n
(Tab
le 3)
[29
]
.
Tabl
e 3. A hea
l
t
h
care g
u
i
d
el
i
n
es fo
r
i
ndi
vi
d
u
al
wi
t
h
D
S
fr
om
US
[
2
9]
Age
Health supervision reco
mm
e
ndations
0
Confirm
the diagn
o
sis by
Chr
o
m
o
so
m
a
l kary
oty
p
e evaluation;
Car
d
iac evaluation (
i
ncluding echocar
diogr
aphy
)
;
Objective hear
ing
evaluation (
a
uditor
y
br
ainste
m
res
ponse test or
evoked otoac
oustic em
ission testing)
;
Ophthalm
oscopic
exam
ination to de
tect dense congenital catar
Acts;
T
h
y
r
oid function testing (
c
heck
state-m
a
ndated screening)
;
Earl
y Inte
rvention consultation (“
Birt
h to Three” develo
p
m
ental services
)
Discussion about t
h
e available fam
i
ly suppor
t;
M
e
dical genetics
consultation (
d
iscus
s
ion of
futur
e
r
i
sk in subseque
nt pr
egnancies)
1 year
Repeat hear
ing evaluation by
9–12
m
ont
hs with behavio
r
al audio
m
etry
.
E
y
e exam
ination at 6
m
onths.
Repeat thy
r
oid function testing (
t
hy
r
o
id-
s
tim
u
lati
ng hor
m
one and fr
ee thyroxi
ne)
at 6 and 12 m
onths.
1-
12 y
ear
s
Hearing evaluations per 6
m
onths un
til pure-tone audiogra
m
s can be
obtained f
o
r each ear sepa
ratel
y
, then,
exa
m
ine hearing b
y
year
.
E
y
e e
x
am
i
n
a
t
i
ons
;
T
h
y
r
oid function testing ever
y
y
e
ar
Dental care every
6
m
onths,
beginning at 2 y
e
ar
s old.
Obtain later
a
l cer
v
i
cal spine r
a
diogr
aphs (
f
lexion,
neutr
a
l,
and extension)
,
m
e
asur
ing the atlanto-
dens inter
v
al
and the neural can
al width, between
3 and 5
y
ears old t
o
look for atlantoaxial instability
.
Scr
een for
celiac d
i
sease at 2
y
e
ar
s old with im
m
unoglobulin A tissue tr
ansglutam
i
nase
antibody
and total
im
m
unoglobulin A levels.
adolescence
T
h
y
r
oid function testing per
y
e
ar
.
Vision,
hear
ing assess
m
e
nts and dental car
e;
Adolescent m
e
dicine
consultation
ab
out sexual health concer
ns.
Educational program
m
i
ng should
foc
u
s on transition pla
nning.
As s
h
ow
n
i
n
T
a
bl
e
3,
besi
de
som
e
speci
fi
c
i
t
e
m
s
rel
a
t
e
d t
o
c
h
ec
k-
up
s a
n
d
di
sea
s
e sc
r
eeni
n
g,
earl
y
i
n
t
e
rve
n
t
i
o
n
fo
r i
n
di
vi
dual
wi
t
h
D
S
was
rec
o
m
m
e
nded
si
n
ce t
h
ey
were
b
o
r
n
.
It
us
ual
l
y
cove
rs
a
br
oad
ra
n
g
e
of de
vel
opm
ent
a
l
t
r
ai
ni
ng an
d
t
h
erapi
e
s suc
h
as phy
si
cal
t
h
erapy
f
o
cusi
n
g
on m
o
t
o
r deve
l
opm
ent
,
speec
h an
d
l
a
ng
uage
t
h
era
p
y
,
oc
cu
pat
i
o
n
a
l
t
h
erapy
,
an
d
sens
ory
i
n
t
e
g
r
atio
n
th
erap
y.
At th
e ag
e of
3
,
ch
ild
ren
with
DS
are elig
ib
le
for prescho
o
l
edu
catio
n and
t
h
ey n
eed ex
t
r
a
h
e
lp
i
n
scho
o
l
; wh
ile th
e con
tin
uou
s i
n
d
i
vid
u
a
l
interve
n
tion is
still suggeste
d
to ens
u
re m
a
ster the
ba
sic self-m
anagem
ent skills, social a
nd em
otional s
k
ills.
At
t
h
e age
of
7
,
chi
l
d
ren
wi
t
h
DS are e
x
pect
ed t
o
e
n
r
o
l
l
i
n
l
o
cal
m
a
i
n
st
ream
school
s
wi
t
h
i
n
cl
usi
v
e e
d
uc
at
i
o
n
or s
p
ecial education.
At the
age of
20 t
o
23, they m
a
y be eligible to a
ccept po
st-sec
onda
ry education
or
train
i
ng
for th
e fu
ture em
p
l
o
y
m
en
t. After th
e su
ccessfu
l
p
o
s
t
-seco
nda
ry
t
r
ai
ni
ng
, i
ndi
vi
d
u
a
l
s
wi
t
h
DS ar
e abl
e
to
g
e
t app
r
op
ri
ate j
o
b
and
fu
ll
y o
r
p
a
rtially su
ppo
rt t
h
eir life.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
ERE
I
S
SN
:
225
2-8
8
2
2
Th
e Ro
le o
f
G
o
vernm
en
t an
d NG
O
i
n
Prom
otin
g
Welln
ess
of People with
Dow
n
Sy
ndr
ome .... (Yeo Kee Jiar)
18
1
4.
3.
Governme
nt c
o
ntributi
o
n in
educ
ati
o
n
for
PW
DS
In
Malaysia, t
h
e sp
ecial n
e
ed
s st
u
d
e
n
t
s are categ
orized
in
to
three m
a
i
n
d
i
sab
ilities: th
e h
e
aring
i
m
p
a
ired
, th
e
v
i
su
al im
p
a
ired
and
th
e learn
i
ng
d
i
fficu
lties/d
i
sab
ilities stu
d
e
n
t
s. St
ud
ents with
DS
fall u
n
d
e
r
th
e categ
ory of learn
i
ng
d
i
sabilit
ies (LD). The b
a
sic edu
catio
n
for all stu
d
e
n
t
s in
Malaysia is 1
1
years
bu
t for
stu
d
e
n
t
s with
d
i
sab
ilities (in
Malaysia,
th
ey are k
n
o
wn
as learn
i
ng
d
i
sab
ilities/d
i
fficu
lties, LD o
r
St
u
d
e
n
t
s
with Educational Nee
d
s, SE
N), t
h
ey are given
13 year
s of
free e
ducati
on
– one year presc
h
ool, si
x years
p
r
im
ar
y, th
r
ee year
s o
f
l
o
w
e
r
secon
d
a
r
y
and
3
year
s of
upper
second
ar
y ed
u
cation
an
d
ex
tr
a 2
years eith
er
at
th
e prim
ary o
r
secon
d
a
ry lev
e
l. Th
e ex
tra two
years are
g
i
ven
to
h
e
lp
th
em acq
u
i
re m
o
re sk
ills to
m
e
e
t
th
eir
n
eeds in fu
ture.
Th
e go
v
e
rn
m
e
n
t
o
f
Malaysia is co
mmit
t
e
d
to
en
su
re the rig
h
t
s of SEN in
form
al
e
d
u
cation
as
em
bodi
e
d
i
n
t
h
e E
ducat
i
on
Act
1
9
96
w
h
i
c
h st
at
es t
h
at
“
a
l
l
pu
pi
l
s
wi
t
h
speci
al
nee
d
s
wh
o a
r
e e
duca
b
l
e
a
r
e
elig
ib
le to
atten
d
th
e sp
ecial
ed
u
cation
program
. A
r
ticle 28
o
f
t
h
e Person
s
w
ith
D
i
sab
i
lities A
c
t 2
008 states
th
at ‘Perso
ns with
d
i
sab
ilities sh
all n
o
t
be ex
clu
d
e
d
from th
e g
e
n
e
ral
ed
u
cation
syste
m
o
n
th
e b
a
sis o
f
d
i
sab
ilities, and
ch
ildren
with
d
i
sab
ilities s
h
all n
o
t
b
e
exclu
d
e
d
fro
m
p
r
e-scho
o
l
,
p
r
i
m
ary, seco
nd
ary an
d
h
i
gh
er edu
catio
n, on
eq
u
a
l
basis with
p
e
rson
s or ch
ild
ren
with
ou
t d
i
sab
ilities, in
clu
d
i
ng v
o
cation
a
l train
i
n
g
an
d lif
elon
g lear
n
i
n
g
[3
0
]
,[
31].
Ed
ucat
i
on fo
r SEN
c
o
nt
i
nue
s
t
o
i
m
prove un
de
r
va
ri
o
u
s Act
s
an
d pr
ov
i
s
i
ons. The Pe
rso
n
s wi
t
h
Disab
ilities Act 2
008
states t
h
at ‘p
erson
s
with
d
i
sab
ilities sh
all no
t
b
e
exclu
d
e
d
fro
m
th
e g
e
n
e
ral edu
c
atio
n
syste
m
o
n
th
e b
a
sis
o
f
d
i
sab
ilities, an
d
ch
ild
ren
with
disab
ilities sh
all n
o
t
b
e
ex
clud
ed
fro
m
p
r
e-scho
o
l
,
prim
ary, seconda
ry and
higher edu
cation, on equal bas
i
s with pers
on
s or children
without disabi
lities,
includi
ng voca
tional traini
ng and lif
elong
learni
ng.’ The r
ecently launc
h
ed, Malaysia Education Blueprint
2
013
-20
2
5
aims to
h
a
v
e
30
p
e
rcen
t
of st
u
d
e
nts with
SEN
will en
ro
l
in
i
n
clu
s
iv
e pro
g
ram
b
y
201
5.
Th
e
g
o
a
l
sho
w
s
h
o
w se
r
i
ous t
h
e m
i
ni
stry
i
s
i
n
im
pl
em
ent
i
ng i
n
cl
usi
v
e educat
i
o
n.
I
n
cl
usi
v
e e
ducat
i
on
pr
o
v
i
d
es t
h
e l
east
rest
ri
ct
i
v
e e
nvi
ro
nm
ent
whi
c
h
i
s
i
d
eal
f
o
r t
h
e
de
vel
o
pm
ent
and
p
r
o
g
r
ess
of
SEN s
u
c
h
as
st
ude
nt
s
wi
t
h
D
S
. A
s
expl
ai
ne
d
by
W
i
nt
er
(1
9
9
9
)
,
i
n
cl
usi
v
e e
d
uc
at
i
on en
vi
r
o
nm
ent
s
are
desi
g
n
e
d t
o
pr
ovi
de a
n
ed
ucat
i
o
nal
s
e
t
t
i
ng
i
n
w
h
i
c
h
al
l
st
u
d
ent
s
can
be
as
i
n
v
o
l
v
e
d
a
n
d i
nde
pe
nde
nt
as
pos
si
bl
e
[3
2]
.
For
t
h
ose m
o
r
e
‘a
bl
ed
SE
N’
, t
h
ey
c
o
ul
d
fu
rt
her
t
h
ei
r
ed
u
cat
i
on t
o
t
e
rt
i
a
ry
l
e
vel
or
t
a
k
i
ng
va
ri
o
u
s
cert
i
f
i
cat
i
on o
r
di
pl
om
a cours
e
s wi
t
h
f
u
l
l
sp
ons
o
r
shi
p
.
In
t
h
e case of students with
DS, t
h
ere a
r
en’t any
who
h
a
v
e
m
a
d
e
it to
d
i
p
l
o
m
a o
r
un
iv
ersity lev
e
ls. Op
po
rt
un
ities for h
i
gh
er edu
catio
n
rem
a
in
b
l
eak
for th
em d
u
e
to
th
eir cogn
itiv
e d
e
lays and
o
t
h
e
r con
f
ou
nd
ing
ph
ysical an
d
i
n
tellectu
a
l facto
r
s.
Un
less seriou
s ed
u
c
atio
n
a
l
measures are
planned a
n
d carried
ou
t for stu
d
e
n
t
s with
DS, th
ere won’t b
e
an
y on
e
to
ch
art th
e
g
r
ap
h
for
h
i
gh
er edu
catio
n in
Malaysia.
4.
4.
Financi
a
l as
sistance
and other ser
v
ices [33]
1)
Laun
chi
n
g G
r
ant
s
(Ger
an
P
e
l
a
nca
r
a
n
)
-
To
assist
p
e
rsons with
d
i
sab
ilit
ies who
h
a
v
e
t
h
e
k
nowledg
e
an
d
sk
ills b
u
t
who
do
no
t h
a
v
e
th
e fin
a
n
c
ial cap
ital
o
r
eq
u
i
p
m
en
t fo
r self-su
ppo
rting
/ s
m
all
b
u
s
in
ess /
agri
c
u
l
t
u
ral
pr
oject
s
.
M
a
xi
m
u
m
Launc
hi
n
g
Gra
n
t
-
R
M
2,
7
0
0
.
2)
Disabled Wor
k
er’s Allowance
(Ela
un Pekerja
Ca
ca
t EPC) –
Wo
rki
ng al
l
o
wance of R
M
30
0
per
m
ont
h
is p
r
ov
id
ed
to
en
courag
e p
e
rso
n
s
with
d
i
sab
ilities
to
con
tin
u
e
wo
rk
ing
an
d b
e
self-sup
portin
g withou
t
d
e
p
e
nd
ing
o
n
th
eir
fam
i
l
y
o
r
o
t
h
e
rs, and
to
o
b
t
ain su
pp
lemen
t
ary in
co
m
e
for th
ei
r
b
a
sic
n
ecessities.
3)
Assistance with Purch
a
sin
g
National Vehi
cles -
Person
s
with
d
i
sab
ilitie
s who
can
d
r
ive are g
i
v
e
n
up
to
1
0
% o
f
f th
e sales tax
o
f
Nati
o
n
a
l cars/m
o
torcycles. App
licatio
n
s
can
b
e
mad
e
d
i
rectly
with
th
e Min
i
stry
of
Fi
na
nce
(
K
em
ent
e
ri
an
Ke
wan
g
a
n
)
t
o
get
h
er
wi
t
h
t
h
e
f
o
l
l
o
wi
ng
d
o
c
u
m
e
nt
s:
M
e
di
cal
rep
o
rt
,
doct
o
r
certificatio
n
,
Id
en
tity Card fo
r
Person
s
with
Disab
ilitie
s, IC, a
v
a
lid
driv
ing
licen
se an
d v
e
h
i
cle details
(m
odel, engine
num
b
er, c
h
ass
i
s num
b
er etc.)
4)
Telekom Assistance -
Telek
o
m Mala
ysia p
r
o
v
i
d
e
s assistance to
th
e d
i
sabled
in
th
e form o
f
: ex
em
p
t
i
o
n
fr
om
m
ont
hl
y
ph
o
n
e
rent
al
r
a
t
e
s, f
r
ee-
of
-cha
rge
1
0
3
ope
rat
o
r
cal
l
s
, an
d c
a
l
l
wai
t
i
ng /
cal
l
di
ve
rt
se
rvi
ces
.
5)
Ta
x R
e
l
i
e
f an
d E
x
em
pt
i
o
n
s
-
Tax rel
i
e
f/
exem
pt
i
ons
are
pr
ovi
ded fo
r pare
nt
s
w
ho h
a
ve
chi
l
d
ren wi
t
h
d
i
sab
ilities b
e
lo
w t
h
e ag
e
o
f
1
8
years. Tax
d
e
du
ction
s
are
g
i
v
e
n
fo
r t
h
e pu
rch
a
se
o
f
sp
ecial eq
u
i
p
m
en
t for
p
e
rson
al u
s
e o
r
fo
r th
e
u
s
e o
f
ch
ildren
/
paren
t
s with
d
i
sab
ilities. Tax
d
e
du
ctio
n
s
are also
g
i
v
e
n
t
o
e
m
p
l
o
y
ers
o
f
th
e
d
i
sab
l
ed
.
Ad
d
ition
a
l tax ex
em
p
tio
n
s
are
g
i
v
e
n
to p
e
rson
an
d sp
ou
ses
with
d
i
sab
ilities.
6)
Public Tran
sport Assistance
-
Am
ong
st
ot
hers
, M
A
S gi
v
e
s up t
o
5
0
%
di
sco
u
n
t
s
on
d
o
m
e
st
i
c
ai
rfares,
KTM
pr
o
v
i
d
e
s
up t
o
50%
of
f al
l
cl
asses of rai
l
t
r
avel
,
TR
ANS
N
A
T
I
O
N
A
L
b
u
sse
s gi
ves u
p
5
0
%
di
sco
u
n
t
s
o
f
t
i
c
ket
p
r
i
ces, a
n
d
PUTR
A-LR
T
al
so
pr
ovi
des
d
i
scou
nt
s
fo
r t
h
e di
sa
bl
ed.
7)
Housin
g As
sistance
-
Kual
a
Lum
pur C
i
t
y
Hal
l
(
D
B
K
L
)
a
l
so
pr
ovi
des t
h
e di
sa
bl
ed
wi
t
h
re
nt
al
assi
st
an
ce
fo
r
lo
w
-
cost h
o
u
sin
g
a
n
d DBKL flats.
8)
Ex
emp
tio
n
fro
m
Med
i
ca
l Trea
tment Bills -
Perso
n
s
with
d
i
sab
ilities are ex
em
p
t
ed
fro
m
p
a
yin
g
fo
r
th
ird-class
ward
s,
sp
ecialist b
i
lls an
d m
e
d
i
cat
io
n
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
22
I
J
ERE
Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
75
–
18
6
18
2
9)
Ex
emp
tio
n from Tra
vel
Do
cument Bills -
The Im
m
i
grat
ion
de
part
m
e
nt
pr
o
v
i
d
es e
x
em
pt
i
o
n
s
fr
om
cost
s
of
p
r
epa
r
i
n
g a
n
d
pr
ocessi
ng
t
r
avel
d
o
c
u
m
e
nt
s (I
nt
er
nat
i
o
nal
pass
p
o
rt
s)
.
10
)
Derivative Pe
nsion -
T
h
e g
o
v
er
nm
ent
,
t
h
ro
ug
h t
h
e P
u
bl
i
c
Servi
ce
Depa
r
t
m
e
nt
’s Pensi
o
ns Di
vi
si
o
n
, h
a
s
app
r
ove
d a
de
r
i
vat
i
v
e p
e
nsi
o
n
f
o
r c
h
i
l
d
ren/
d
e
pen
d
a
n
t
s
of ci
vi
l
ser
v
ant
s
w
h
o
have
pa
ssed
away
.
11
)
School allowance –
Mon
t
h
l
y
allo
wan
ce of RM1
5
0
t
o
studen
t
s with
d
i
sabilit
ies
in
p
r
im
a
r
y
and
second
ary
schools
12
)
Reg
i
stra
tio
n
and
Id
entity Ca
rd -
Th
e
pu
rp
o
s
e of reg
i
stratio
n
is to
co
l
l
ect d
a
ta an
d
statistics fo
r t
h
e
p
l
ann
i
ng
of serv
ices, reh
a
b
ilitatio
n
prog
ram
s
, p
r
ev
en
tio
n, train
i
n
g
, edu
catio
n
an
d
early in
terv
en
tio
n. The
Id
en
tity Card
fo
r Perso
n
s
with
Disab
ilities (
K
ad
Ken
a
l Di
ri Orang
Ku
rang
Up
aya) are i
ssu
ed
to
th
ose
who
reg
i
ster the
m
selv
es to
m
a
k
e
co
mm
u
n
i
catio
n
with
t
h
e relev
a
n
t
au
tho
r
i
ties easier.
13
)
Assista
n
ce with Ortho
tic/Assistive Devi
ces (B
ant
u
an
A
l
at
Ti
rua
n
/
O
t
o
rt
i
k
)
-
Th
e
pu
rpose of th
is is to
h
e
lp
p
e
rson
s with
d
i
sab
ilities
p
u
rch
a
se o
r
thotic/assis
tiv
e d
e
v
i
ces su
ch
as
wh
eelch
airs, calip
ers, artificial
li
m
b
s an
d
o
t
her equ
i
p
m
en
t
th
ey can
no
t afford. Th
ese
dev
i
ces will all
o
w th
em
to
b
e
m
o
b
ile an
d
to
co
n
tinu
e
with th
e activ
ities of
d
a
ily liv
in
g.
14
)
Sheltered W
o
rksh
op (Be
n
gkel Terlindun
g
)
–
Th
e W
e
lfare Dep
a
rtmen
t
will
try to
ob
tain
jo
b
opport
unities for the disa
bled in th
e private/
public sector,
or placem
en
t i
n
Sheltere
d
Wo
rkshops such
as
B
e
ng
kel
Day
a
Kl
an
g, B
e
ng
k
e
l
Day
a
Sg.
P
e
t
a
ni
, o
r
any
of t
h
e 1
3
ot
he
r w
o
r
k
s
h
ops
r
un
by
v
o
l
u
nt
a
r
y
or
ga
ni
zat
i
ons
.
15
)
Vo
ca
tiona
l Skills Tra
i
ning
-
Bang
i Cen
t
re for Reh
a
b
ilitatio
n
and
I
ndu
strial Trai
n
i
ng
(Pu
s
at Latihan
Peri
n
d
u
st
ri
an
dan Pem
u
l
i
h
an
B
a
ngi
) -
Di
pl
om
a-l
e
vel
cou
r
ses an
d M
L
V
K
(M
ajl
i
s
Lat
i
h
an
Vo
kasi
ona
l
Keb
a
ng
saan
) Certificatio
n
are o
f
fered
for p
e
rson
s
with
p
h
y
sical d
i
sab
i
lities
ag
ed
b
e
tween
18
and 40
y
ears, w
ho
hav
e
passed at
l
east
a PM
R
or eq
ui
val
e
nt
l
e
vel
,
and a
r
e i
nde
pe
nde
nt
. C
o
ur
ses
offe
re
d i
n
cl
u
d
e
com
puters a
nd secretarial, tailoring a
n
d fa
s
h
ion
de
sign
,
man
u
f
act
u
r
i
n
g of
assistiv
e dev
i
ces, co
m
p
uter
support, electrical wiring, electronics
, baki
ng
,
p
h
o
t
o
gra
p
hy
and
d
r
i
v
i
n
g
.
16
)
Entry into
Rehab
ilita
tio
n Institutio
ns (Tama
n
Sina
r Hara
pa
n)
-
Reh
a
b
ilitatio
n
is g
i
ven
to p
e
rso
n
s
with
intellectual disabilities to acceptable levels
base
d on
individual ca
pabilities and de
sires. Shelter a
n
d ca
re
are also
p
r
ov
ided
fo
r
p
e
rson
s
with
sev
e
re
d
i
sab
ilities. Activ
ities in
clu
d
e
train
i
n
g
d
a
ily liv
ing
sk
ills,
p
r
e-
vocational e
d
ucation, i
n
form
al academ
ic classes, re
li
gious/m
oral lessons, sports/recrea
tion a
nd
outdoor
activ
ities.
17
)
Co
mmunity –Ba
s
ed Rehab
i
l
ita
tio
n CBR (P
emulihan Da
la
m Komunit
i
PDK)
-
CBR
is a co
mm
u
n
ity
d
e
v
e
l
o
p
m
en
t strateg
y
for p
e
rson
s
with
d
i
sab
ilities to
o
b
tain
reh
a
b
ilitat
i
o
n
with
i
n
th
eir fam
i
ly an
d
co
mm
u
n
ity wh
ereb
y th
ey are
g
i
v
e
n
th
e equ
a
l o
p
portun
ity fo
r reh
a
b
ilitatio
n
and
in
teractio
n
with
so
ciet
y.
Activ
ities in
clu
d
e
gro
s
s m
o
t
o
r sk
ills, fi
n
e
m
o
to
r sk
ills, lan
g
u
a
g
e
d
e
v
e
l
o
p
m
en
t, so
cial d
e
v
e
l
o
p
m
en
t, self-
care, p
r
e-Read
in
g
/
Writing
/
Math
sk
ills,
creativ
ity, spo
r
ts and recreati
o
n.
18
)
Tra
i
ning
a
n
d
Rehab
ilita
tio
n
Assista
n
ce
-
Th
e So
cial Welfare Dep
a
rt
men
t
p
r
ov
id
es
sk
ill
train
i
n
g
and
reh
a
b
ilitatio
n
p
r
og
ram
s
in
its in
stitu
tion
s
fo
r ch
ildren
with
d
i
sab
ilities.
At th
is tim
e, o
n
l
y ch
ildren with
in
tellectu
a
l (learn
i
n
g
) an
d physical d
i
sab
iliti
es are elig
i
b
le fo
r serv
ices.
19
)
Assistance with Pr
osthetic /
Assistive Devices -
The
g
o
v
e
r
nm
ent
pr
o
v
i
d
es exem
pt
i
on
f
r
om
im
port
dut
i
e
s
an
d sales tax fo
r equ
i
p
m
en
t desig
n
e
d
sp
ecifi
cally fo
r
u
s
e by p
e
rson
s
with
d
i
sab
ilities.
20
)
Jo
b O
p
port
u
n
i
t
y
A
ssi
st
ance -
Th
e gov
ernmen
t’s co
mmi
t
m
en
t to
p
r
o
v
id
e j
o
b
opp
ortu
n
ities for th
e
di
sabl
e
d
i
n
cl
u
d
es t
h
e al
l
o
cat
i
on
o
f
1%
of
al
l
pu
bl
i
c
sect
or
j
o
bs.
The
Depa
rt
m
e
nt
of
Lab
o
u
r
(Ja
b
at
an
Ten
a
g
a
Kerj
a) also
p
r
o
v
i
d
e
s reg
i
stratio
n
services
o
f
job
o
ppo
rt
u
n
ities
fo
r
t
h
e d
i
sab
l
ed
.
4.
5.
NGO
’
s c
o
n
t
ri
bution
NG
O t
h
at
are
pred
om
i
n
ant
l
y
pro
v
i
d
i
n
g r
e
so
urces
, cont
ri
b
u
t
i
on a
nd s
e
rvi
ces t
o
war
d
s P
W
D
S
as
fo
llows:
1)
Kiwa
nis Do
wn Synd
ro
me
Fo
und
a
t
i
o
n,
KDSF –
Th
e
K
i
w
ani
s D
o
w
n
Syn
d
r
o
me F
o
un
d
a
t
i
o
n
has ni
n
e
b
r
an
ch
es n
a
tion
w
i
d
e and
p
l
ayin
g
th
e ro
le as th
e
m
o
st sig
n
i
fican
t NGO fo
r ch
ild
ren with
DS. It is
co
mmitted
to
t
h
e welfare of ch
ild
ren
with
DS, its
m
a
in
fo
cu
s b
e
i
n
g
t
h
e edu
catio
n
o
f
t
h
ese ch
ild
ren
b
e
l
o
w
6
years
o
l
d
.
Each
cen
t
r
e prov
i
d
es th
e Early In
terv
en
tion
Pro
g
ram
co
v
e
rs
g
r
o
ss an
d
fin
e
m
o
to
r sk
ills, so
ial
devel
opm
ent, a
cadem
ic skills, cognitive
skills
, self-hel
p skills and speech thera
p
y.
2)
Kiwa
nis Disability Info
rma
t
i
o
n and
Sup
port Centre, KDISF –
It serve
s
as a one
-stop centre t
o
ass
i
st
p
e
op
le in
lookin
g
for d
i
sab
ility in
fo
rm
atio
n
an
d
reso
urces. It is a v
e
ry u
s
efu
l
w
e
b
s
ite to p
r
o
v
i
d
e
up-to-
date inform
ati
on
on any aspe
cts of
disability, easy acce
ss to disa
bility resources a
n
d services available
in
Malaysia, co
nn
ectin
g all org
a
n
i
zation
s
, gr
oup
s,
p
r
of
ess
i
onal
s
a
n
d se
r
v
i
ce p
r
ovi
ders
i
n
v
o
l
v
e
d
wi
t
h
disabilities in
Malaysia, to form
an
online
disability databa
se and c
o
mm
u
n
ity accessible
24
hours a
da
y,
to
pro
v
i
d
e
p
a
ren
t
s wit
h
d
i
sab
ility in
fo
rm
atio
n, etc.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
ERE
I
S
SN
:
225
2-8
8
2
2
Th
e Ro
le o
f
G
o
vernm
en
t an
d NG
O
i
n
Prom
otin
g
Welln
ess
of People with
Dow
n
Sy
ndr
ome .... (Yeo Kee Jiar)
18
3
3)
Do
wn
Synd
rome Asso
ci
a
tion o
f
M
a
la
ysi
a
–
M
i
ssi
on t
o
i
n
t
e
grat
e, c
o
l
l
a
b
o
rat
e
a
nd
bui
l
d
part
n
e
rs
hi
ps
w
i
th
t
h
e g
ove
r
n
m
e
nt
, co
r
p
o
r
at
i
o
n
s
an
d ge
ner
a
l
pu
bl
i
c
t
o
gene
rat
e
awar
enes
s
and c
o
m
p
assi
on t
o
wa
r
d
s t
h
e
Down
Synd
rome co
mm
u
n
i
t
y
; to
p
r
o
v
i
d
e
serv
ices, reso
urces and
assistan
ce to
all
state affiliate
d
asso
ciatio
ns; to
co
ord
i
n
a
te activ
ities with
DSAs at
state
lev
e
l; to
in
crease pub
lic awaren
ess
on
PWD
S
;
get
t
i
ng i
n
t
o
u
c
h wi
t
h
P
W
D
S
and t
h
ei
r p
a
rent
s acr
oss t
h
e nat
i
o
n;
or
g
a
ni
ze sem
i
nar,
wor
k
s
h
o
p
s a
n
d
d
i
scu
ssi
on
s wi
th
m
e
m
b
ers and
affiliated
DSAs; coo
r
d
i
n
a
te v
a
riou
s activ
i
ties lo
ally an
d
in
tern
ation
a
lly,
etc.
4)
DSA in othe
r states
– J
o
h
o
r
,
Keda
h,
Pena
n
g
,
Tere
ng
ga
nu
,
Nege
ri
Sem
b
i
l
an, a
nd
Sawa
r
a
k are
pr
o
v
i
d
i
n
g
services
to i
n
crease awa
r
ene
s
s
of the
pubic
towards
DS
an
d
t
o
p
r
ovi
de t
r
ai
ni
n
g
fo
r c
h
i
l
d
r
e
n
wi
t
h
DS,
an
d
their pare
nts.
5)
O
t
her NGO
– There
a
r
e ot
he
r
N
GO w
h
i
c
h r
e
nde
r
assi
st
anc
e
and services to
PWDS whe
n
eve
r
necessary
as part
o
f
t
h
ei
r com
m
i
tm
ent t
o
soci
al
serv
i
ce for P
W
D
.
Am
ong t
h
ese
are M
a
l
a
y
s
i
a
n C
a
re, C
h
es
hi
r
e
Hom
e
, CareHe
art,
Tam
a
n
S
i
na
r H
a
rapa
n
an
d m
a
ny
rel
i
g
i
o
us
or
ga
ni
zat
i
o
n
s
.
4.
6.
Gaps
be
tween policies
and implementati
on
Laws an
d
po
licies en
shrin
e
d
th
e righ
ts fo
r
PWD
bu
t th
ere are still
m
a
n
y
g
a
p
s
b
e
tween
p
o
licies and
real setting (M. Rezaul, 2015) which dra
w
criticis
m
s
from
PW
D and
people who
are concerne
d with the
wel
f
are of P
W
D [3
3]
.
T
h
e
r
e
ha
ve
bee
n
m
a
ny
m
eeti
n
g
s
and di
scu
ssi
ons wi
t
h
go
ve
rnm
e
nt
aut
h
o
r
i
t
i
e
s
but
o
p
i
n
i
on
s
o
f
PW
D or
t
h
eir
r
e
p
r
esen
tativ
es
on
issu
es af
f
ecti
n
g th
eir w
e
l
f
are and
liv
elihood
ar
e
o
f
ten
ex
clu
d
e
d
.
Fo
r t
h
e in
tellectu
a
lly ch
allen
g
e
d
lik
e
PWDS, th
ey do
n
o
t
h
a
v
e
t
h
e ab
ili
ty to
ex
ercise
th
eir civ
il, po
l
itical,
so
cial, econo
mic an
d
cu
ltural righ
ts on
eq
u
a
l b
a
sis with
ot
hers; t
h
ere
f
ore
they are s
o
cially exclude
d a
nd le
ft
out
of t
h
e de
ve
lopm
ent
m
a
in stream
. The advocacy a
n
d
cha
m
pions
on disability issu
e and ri
ghts
of
PWDS in
Malaysia
is
stil
l
n
o
t
strong
to p
u
s
h
fo
r b
e
tter treat
m
e
n
t
.
Besid
e
s th
e gov
ern
m
en
t actio
n
an
d suppo
r
t
, NG
O p
l
ay an ex
tr
em
ely i
m
p
o
r
t
an
t
r
o
le i
n
p
r
acticin
g
t
hose
p
o
l
i
c
i
e
s
[3
4]
.
In
M
a
l
a
y
s
i
a
, t
h
ere
i
s
no
o
r
ga
ni
zed
i
n
t
e
rve
n
t
i
o
n
or
t
r
a
i
ni
ng
sy
st
em
from
go
ver
n
m
e
nt
f
o
r
in
fan
t
and
todd
ler
with
DS.
Families o
r
p
a
ren
t
s
rely
m
o
re o
n
NGO and
priv
ate th
erap
ists. Ki
n
d
e
rgarten
s
av
ailab
l
e fo
r ch
ild
ren
with
DS are lim
i
t
ed
an
d
t
h
ey do
n
o
t
m
eet th
e requirem
e
n
t
, so
mo
st p
a
ren
t
s still sen
d
th
eir
D
S
ch
ild
ren
to
th
e NGO. For
th
e school ch
ild
r
e
n
(
6
-
1
9
year
s o
l
d
)
, t
h
er
e is or
g
a
n
i
zed
edu
cation
syste
m
by
go
ver
n
m
e
nt
i
n
M
a
l
a
y
s
i
a
.
M
o
st
i
ndi
vi
du
al
s wi
t
h
DS at
t
h
i
s
age coul
d be pl
ace
d at
go
ver
n
m
e
nt
scho
ol
s
whe
r
e teac
hers
are
require
d
t
o
write and im
ple
m
ent Indi
vi
dual
Education
Pl
an (IE
P) for ea
ch
st
ude
nt. Al
m
o
st
al
l
st
udent
s wi
t
h
DS i
n
M
a
l
a
y
s
i
a
do not
en
t
e
r t
h
e post
-
se
con
d
a
r
y
scho
o
l
aft
e
r 19 y
ear
s ol
d t
o
ex
peri
ence
vocat
i
o
nal
ski
l
l
s
t
r
ai
ni
ng as t
h
ey
are not
abl
e
t
o
si
t
for pu
b
l
i
c
exam
i
n
at
i
ons at
up
per sec
o
n
d
a
r
y
scho
ol
due t
o
th
e lack
of in
t
e
llectu
a
l ab
ilit
y. Cu
rren
tly th
e ad
u
lthoo
d
o
f
PWDS is a hu
g
e
ch
alleng
e
an
d
st
ressfu
l
fo
r th
is
po
p
u
l
a
t
i
on a
n
d
fam
i
ly
i
f
t
h
ey
coul
d
not
get
t
h
e
vocat
i
o
nal
t
r
ai
ni
n
g
fo
r
fut
u
re em
pl
oym
ent
.
Whe
n
t
h
ey
fa
ce t
h
e
diffic
u
lties in access to em
p
l
oym
ent and e
ducation, t
h
eir life quality a
nd
wellness will be j
e
opa
rdi
zed in
fut
u
re. T
h
e
gaps bet
w
een policies and
practi
ce re
m
a
in
a sign
ifican
t
p
r
ob
lem
fo
r PWDS.
The MOE is aiming to ac
hieve 30% enrolm
ent of st
ud
en
ts with
SEN in
t
h
e m
a
in
strea
m
classes b
y
20
1
5
.
At
t
h
e m
o
m
e
nt
onl
y
l
e
ss t
h
an
1
0
%
o
f
st
ude
nt
s
wi
t
h
SEN are i
n
th
e in
clu
s
ive classes. Situ
ation
may b
e
i
m
p
r
ov
ed
should
stud
en
ts
w
ith
DS
w
e
r
e
either
m
a
in
str
e
a
m
ed
o
r
pu
t in
inclu
s
iv
e ed
ucatio
n or
at least hav
i
ng
effective learni
ng e
xpe
rience
with IEP ca
refully planne
d fo
r them
. Howe
ver, m
o
st of these actions are
either
ab
sen
t
o
r
n
o
t
i
m
p
l
e
m
en
ted
effectiv
ely. Th
e
b
a
sic prin
ci
p
l
es o
f
writing
IEP are no
t adh
e
red
to, m
a
n
y
p
a
ren
t
s’
voi
ces
were
n
o
t
hear
d o
r
t
h
ey
are n
o
t
bei
ng t
o
l
d
or e
x
pl
ai
ne
d ab
o
u
t
IEP
– i
t
s si
gni
fi
ca
nce
and
pa
rent
al
r
o
l
e
i
n
its im
ple
m
enta
tion.
The
r
e
wa
s a lack
of
proper or e
ffec
t
i
v
e
d
o
cum
e
nt
at
i
on
of
st
u
d
ent
s
l
e
arni
ng
o
r
asse
s
s
m
e
nt
.
Ev
en
th
oug
h
th
e h
a
rdware
prov
id
ed
b
y
MOE is su
fficien
t
an
d
o
f
qu
al
ity, b
u
t
th
ey a
r
e n
o
t
op
tim
iz
ed
for
teaching
bot
h academic and vocational skills. Teachers’
low expecta
tions and
ne
gative perce
p
tions
on
stu
d
e
n
t
s
with
DS ab
ilities in
acad
e
m
i
c
may in
h
i
b
it th
e
op
po
rt
u
n
ities in
learn
i
ng
.
In
ad
d
ition
,
teach
er’s
com
p
et
enci
es i
n
peda
g
ogy
se
em
t
o
be a
hi
n
d
eri
ng
fact
o
r
i
n
I
E
i
m
pl
em
en
t
a
t
i
on.
Acc
o
r
d
i
n
g t
o
B
o
si
(
2
0
1
0
)
,
m
o
st of the
M
a
laysia teachers we
re t
r
aine
d
only t
o
t
eac
h c
h
ildre
n
place
d
in tra
d
itional c
l
assroom
s
and
they
had no e
x
perie
n
ce in teachi
n
g children with
special nee
d
s
[35].
So
m
e
sch
o
o
l
au
tho
r
ities are
fo
und
to
b
e
no
t co
op
erativ
e and
dehu
m
a
n
i
zin
g
in
so
m
e
in
stan
ces.
Th
ere
was a
case
of
sch
ool
m
a
nage
m
e
nt
dep
r
i
v
e
d
t
h
e
op
p
o
rt
uni
t
y
of
a
hi
g
h
f
u
nct
i
oni
ng
st
u
d
e
nt
f
r
om
joi
n
i
n
g
t
h
e
m
a
i
n
st
ream
i
n
t
h
e pret
e
x
t
t
h
at
t
h
e st
ude
nt
wi
l
l
bri
ng
do
w
n
t
h
e pe
rf
orm
a
nce of t
h
e sc
ho
ol
[3
5]
. St
u
d
ent
s
wi
t
h
severe
physical and m
e
ntal disabilities are usually not
rec
o
mmended by
medical pe
rsonnel for
placement into
g
o
v
e
rn
m
e
n
t
-run
schoo
l b
u
t
are reco
mmen
d
ed
to
enro
l in
to
Co
mm
u
n
ity-Based
Reh
a
b
ilitatio
n
cen
tre
o
r
th
ey
may ch
o
o
se
o
t
h
e
r edu
cation
a
l in
stitu
tio
n
s
man
a
g
e
d
b
y
NGO.
Du
e to v
a
ri
o
u
s
co
n
s
t
r
ain
t
s, so
m
e
stu
d
e
n
t
s with
d
i
sab
ilities are k
e
p
t
at ho
m
e
an
d
t
h
ey
m
i
ss
o
u
t
th
e ed
u
c
atio
n
a
l ex
p
e
rien
ces in
scho
o
l
settin
g
.
Obv
i
ou
sly th
e
law do
es no
t
p
r
o
t
ect th
e
righ
ts to
ed
u
cati
o
n fo
r all PWDS.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
22
I
J
ERE
Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
75
–
18
6
18
4
Pre
d
icam
ents faced by PWDS m
a
yb
e the re
sult of lax e
n
forcem
ent
of Persons
with Di
sabilities Act
2
008
.
Disab
l
ed
p
e
op
le h
a
v
e
b
een
co
m
p
lain
ing
th
at th
e
PWD Act
2
008
is pu
rely an ad
m
i
n
i
strativ
e act as
th
ere are
no
pu
n
itiv
e m
easu
r
es fo
r non
-com
p
l
ian
ce or
acts o
f
d
i
scrim
i
n
a
tio
n. Th
is
Act ackn
o
wledges th
e
ri
g
h
t
s
of di
sa
b
l
ed peo
p
l
e
an
d
m
oves away
f
r
om
a wel
f
are-base
d concept
to the ri
ghts-based conce
p
t. There
is
no
p
r
o
v
isio
n
fo
r p
e
na
lties
because it is not the purpose
of this
Act
to punis
h
disa
bled people. Howe
ver,
the
p
e
n
a
lties for
parties no
t in com
p
l
i
an
ce to
t
h
is Act
will
b
e
st
ated
in
o
t
her
Acts, reg
u
l
ation
s
and
b
y
-laws.
Wh
en
law en
fo
rcem
en
t is lax
,
v
a
ri
o
u
s po
li
cies an
d in
itiativ
es are no
t pro
p
e
rly im
p
l
e
m
en
ted
.
Kho
o
et. al (2
012
)
p
o
i
n
t
ed
ou
t the 1
%
of civ
il
serv
ice
po
sition
s
t
o
PWD are m
e
rely p
o
licy state
m
en
t with
o
u
t
running its annual course [36]. Resear
c
h
has
also s
h
own tha
t
there are spec
ific issu
es en
cou
n
t
ered
b
y
PWD in
em
pl
oym
ent
causi
n
g
l
o
w em
pl
oy
m
e
nt
rat
e
am
ong t
h
i
s
po
pul
at
i
o
n. M
e
l
i
ssa and See
(2
0
1
1
)
re
po
rt
ed t
h
at
t
h
e
increasing
dem
a
nd for acade
m
ic and
job-re
lated skills m
a
y
m
a
ke it m
o
re difficult for PWD to
find
jobs
[37].
Facto
r
s
wh
ich fu
rt
h
e
r inh
i
b
i
t th
is situ
atio
n
in
clu
d
e
inacc
essible trans
portation, inacc
e
ssible buil
d
ings, and
n
e
g
a
tiv
e attitu
d
e
s
b
y
em
p
l
o
y
ees, low self-estee
m
an
d
ov
erpro
t
ectiv
e
famil
i
es. Research
b
y
Ti
u
n
and
Kho
o
(2013) showed that the highest perce
n
tage
am
ong th
e
unem
ployed we
re pe
ople
with learning disa
bilities
whi
c
h i
n
cl
u
d
e
P
W
DS, at
5
3
.
5
% [3
8]
. A hi
gh
perce
n
t
a
ge
of
th
em
h
a
v
e
lo
w ed
u
cation
a
l qu
alificatio
n
s
an
d
are
u
n
a
b
l
e to b
e
ind
e
p
e
nd
en
t, thus jo
b opp
ortunities fo
r t
h
is
g
r
o
u
p
are m
a
in
ly
with
NGO and
m
a
n
y
m
a
y n
o
t
b
e
ab
le to
find
any j
o
b
s
at all. Self-em
p
lo
y
m
en
t is an
op
tio
n
b
u
t
m
a
n
y
of the
m
are ju
st
h
e
l
p
ing
th
ei
r
p
a
ren
t
s to
r
u
n
sm
all scale bu
sin
e
ss
o
r
j
u
st stay at ho
m
e
w
ith
th
ei
r
sib
l
i
n
g
s
.
H
e
ro
n and Mur
r
a
y (
200
3)
f
ound
that
em
pl
oy
ers
oft
e
n e
x
cl
u
d
e P
W
D
fr
om
t
h
ei
r l
i
s
t
of em
ployees as t
h
ey are re
garded as
unsuita
ble for
em
pl
oym
ent
[3
9]
.
5.
R
E
C
O
MM
EN
DA
TION
AN
D
CONC
LUSION
P
W
DS c
oul
d
be co
nsi
d
ere
d
as o
n
e o
f
t
h
e
m
o
st
vul
nera
bl
e of t
h
e m
i
nori
t
y
gro
u
p
s i
n
t
h
e M
a
l
a
y
s
i
a
n
p
opu
latio
n
.
With
th
eir in
ad
eq
u
acies in
d
e
v
e
lop
m
en
tal a
s
p
ects and
learn
i
n
g
as well as u
n
s
tab
l
e h
ealth
co
nd
itio
ns, v
a
rio
u
s
effectiv
e
measu
r
es inv
o
lv
in
g
g
o
v
e
rn
m
e
n
t
ag
encies, p
u
b
lic secto
r
, NGO and
so
ciety in
gene
ral
,
s
h
o
u
l
d
be
pl
a
nne
d a
nd i
m
pl
em
ent
e
d o
r
t
o
u
pdat
e
and re
vi
se
t
h
ose
e
x
i
s
t
i
ng o
n
es. Or
ga
ni
zat
i
ons or
sch
ool
s w
h
i
c
h
pr
ovi
de ed
uc
at
i
onal
ser
v
i
ces sho
u
l
d
t
eac
h
P
W
D
S
i
n
aca
dem
i
c subject
s
for t
h
em
t
o
acqui
re
b
a
sic kno
wledg
e
an
d
co
mmu
n
i
cation
sk
ills. PWDS sh
ould
b
e
tau
g
h
t
vo
catio
n
a
l sk
ills to
prep
are t
h
e
m
fo
r
e
m
p
l
o
y
m
en
t an
d
t
o
b
e
self
relian
t
. Co
un
sellin
g, cogn
itiv
e an
d
b
e
h
a
v
i
ou
r t
h
erap
ies sh
ou
l
d
b
e
av
ailab
l
e t
o
h
e
l
p
P
W
DS m
a
nag
e
t
h
ei
r
beha
vi
o
u
r i
n
a
n
ap
p
r
o
p
ri
at
e m
a
nner.
Fam
i
l
i
e
s wi
t
h
P
W
DS s
h
oul
d
be s
u
pp
ort
e
d
so t
h
a
t
t
h
ey
coul
d p
r
ovi
de co
n
duci
v
e en
vi
r
onm
ent
fo
r P
W
D
S
. Society at la
rge s
h
oul
d rec
o
gnize the
value and
co
n
t
ribu
tio
n
of PWDS to
ou
r co
mm
u
n
itie
s. Qu
ality ed
ucatio
n
a
l p
r
og
ra
m
,
sti
m
u
l
a
tin
g
ho
m
e
en
v
i
ron
m
en
t,
g
ood
h
ealth
care an
d po
sitiv
e supp
ort fro
m
fam
i
ly, fri
end
s
and
t
h
e co
mm
u
n
ity are all im
p
o
r
tan
t
fact
o
r
s t
o
en
ab
le
PWDS
to
d
e
v
e
lop
fu
ll p
o
t
en
tial and
l
ead
fu
lfilling
liv
es.
R
e
search s
h
oul
d be ca
rri
e
d
ou
t
t
o
foc
u
s
on t
h
e i
ssue o
f
wel
l
n
ess am
ong
P
W
D
S
an
d t
h
ei
r
fam
i
l
i
e
s t
o
g
a
in
b
e
tter
un
der
s
tand
ing
o
f
help
in
g
and
h
i
nd
er
i
n
g
factors
fo
r PWDS to liv
e
a m
eaningful life.
In s
u
m
m
ary
,
a hol
i
s
t
i
c
app
r
oach t
h
at
i
n
v
o
l
ves va
ri
o
u
s s
t
akeh
ol
de
rs –
P
W
DS,
pare
nt
s, si
bl
i
n
gs,
gove
rnm
e
nt agencies, educat
ors
,
em
pl
oyers,
counsellors, NGO, job
coac
hes
and m
e
dia, is needed t
o
provide
ap
pro
p
riate and
effectiv
e m
e
asu
r
e to
enh
a
nce
kn
owledg
e,
sk
ills and
co
mp
eten
cies
o
f
PWDS.
REFERE
NC
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st
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