Disability is the condition of being disadvantaged as a result of a physical or mental impairment that precludes a normal completion relatively to a particular (physic, psychic or sensorial) area. It follows a disadvantage that make difficult the normal daily life and the acquisition of a social role inside the belonging community.

When we consider the various relational and social implications related to the disability, we have firstly keep in our mind that if it is true that the disabled children, because of their impairment, have notable difficulties to develop some harmonious and integrated relationships with other people, it is true that also many people have remarkable difficulties to establish some harmonious and adequate relationships with the disabled individuals. This last is certainly a factor increasing the children’s psychic and interpersonal troubles.

We have to consider that, also in absence of any physical illnesses, some environmental and cultural influences can, sometimes, provoke alterations of the physical growth and the psychic development. About this, it is enough to mention the Hospitalism Syndrome, described in 1945 by Renè Spitz, concerning infants, for long time hospitalised or institutionalised, who, despite well-nursed by high-specialised personal, are suffering from early deprivation by reason of a prolonged separation from their mother. They, at times, showed a serious arrest of their growth and development, besides a high susceptibility to the infectious illnesses and consequently sometimes a high mortality.

Following these researches, today finally in the paediatric departments the mother is allowed to remain with her child during the whole hospitalisation.

Going back to the problems of interaction between a disabled individual and his entourage (we means above all his parents, educators and coetaneous, including brothers and sisters) we have to mention some dynamics well explained by recent research on the human communication, which can be synthetically summarized in these following formulations:

a) every behaviour is a communication provoking an answer that in turn is another behaviour-communication (action and retroaction);

b) the behaviour of a member, inside a family (or of a small group), influences inevitably the behaviours of all the other members with the result that the family (or group) ecosystem becomes stable through models of interrelation/communication that at last put everyone in role hardly changeable. All, for instance, know the figure of the scapegoat.

A child's birth, namely the entry of a new member into a family group, is an event loaded with many meanings, expectations and, at times, vicissitudes. Naturally the problems rise and intensify when the new member is a child who will have some disability.

In the past, before the development of the health services, the assistance net and the socio-cultural support for the disabled persons, one had frequently occasion to see wrong behaviours towards the these children. The reactions floated between the two extreme of the (more or less unconscious) rejection and the hyper-protection. When the prevailing feelings often was a mixture of anger, resentment and guilt in the parents, they seemed incapable to contain a more or less hidden refusal towards their child, he grew up sensing the dark feeling not to fully be desired and beloved. Contrarily it often happened, as it happens still today, that the parents succeeded to face their negative feelings replacing them with excessive worries and hyper-protection. In other words, many suffocating attentions took the place of the usual maternal cares as principal way to hold feelings of guilt. The sense of guilt can be denied only at the price of an incessant vigilance, but like this, a child can never develop his most possible autonomy.

Evidently, various subtle dynamics strongly impinge on the fortunes of the family group which has to devote itself to a disabled child. For instance, it is important the role the other children and the attitude that their parents pour onto them. At times, a strong mutual resentment arises between husband and wife. At times, various social worries can also influence the family and sometimes possible social prejudices; in these cases they don't are missing the love and the availability towards the disabled son but the surrounding environment doesn’t help the family to accept the disadvantageous condition of their child.

First objective to reach is to inform the parents about the objective reality about their child, the specificities of his disability and the features of his personality. It is necessary help them to find a correct equilibrium between the subjective reality (the parental feelings) and the objective reality (the true conditions of their child), which generally appear notably discrepant.

Often the principal obstacle to the realistic acceptance of their child’s disadvantage is the conviction by the parents that they have given life to something imperfect with consequent feeling of failure. This experience is certainly hard to bear and the parents try to overcome it acting various defence and compensation mechanisms. Sometimes the "guilt" for the child disability is projected on some external reality, other times the same disability is somehow denied. The support furnished by experienced family-relationship counsellors can generally favour in the parents of the disabled child the awareness of their defence and compensation mechanisms and all can be fundamental for a greater acceptance of their child’s impairment.

What is necessary to underline is that in every case, already before being and functioning as a person (baby person in evolution) and, therefore, (in relational terms) before communicating, behaving and acting, a child, from the moment he begins to manifest his disability, can undergo to various (both conscious and unconscious) messages, communications, behaviours and actions, by the encircling people, that are psychologically certainly itself troubling because full of inappropriate attitudes, such that they, rarely, except for parents psychically disturbed or particular conditions of life, are suffered by normal children.

The consequences of this first moulding concerning the disabled child, in addition to the difficulties regarding the development and maturation, are the arising of ways of answer and subsequently of interaction which are perfectly complementary or symmetrical to the received negative stimuli. That is the disabled child will have always the tendency to develop relationships and expect other’s attitudes analogous to those experienced in the earlier years of life.

Until now we have examined some among the principal external or psycho-social causes interfering on the disabled child’s potential development. Now it is necessary to examine another aspect that is related to the intra-psychic repercussions of the disability, both from neuro-psychological and psychic point of view. In relation to the first point it needs to consider that the development of the various neuro-psychological functions is interdependent; therefore, in relationship to the disability, hardly ever we will see simply a mental backwardness or a development-block partially regarding one or more functions and/or ability to performance, on the contrary a global maturative pathology including the various functions typical of a certain age (praxis-gnosis functions, motility, bodily scheme, language, affectivity, character, intelligence).

From the psychic point of view - considering that the subjective experience of the personal trouble, a certain uneasiness to compare himself with the normal peer group and some interpersonal failures constitute a chronic psychic traumatism which exalts in a closed circuit the adaptation – one will have to operate so that to prevent elevated states of insecurity and anxiety and consequent depressive episodes, states of aggressiveness, blocks inhibitors or negativism or real psychotic autism.

Speaking of psychotic autism we have to underline that, for the different implications both from the evolutionary and the therapeutic point of view, it needs to make a distinction between the organic psychic disabled children and functional psychic disabled children, the latter are better definable as psychotic children (also specifying that in the babyhood never the psychiatric alterations are separated by organic injuries). Generally, the organic psychic disabled children, namely the carriers of primitive encephalic organic injures, manifest almost always a marked tendency to practice theirs, even if limited, potential of ability and besides they display notable efforts of adaptation to the environmental requirements. Contrarily, the psychotic children, who have exclusively disorders of the mental operative functions in absentia of organic alterations, manifest almost a refusal to use their, at times notable, potential abilities also maintaining a possibility of remarkable recovery as result of careful and technically correct cares. Besides, it needs to keep in mind, that, in the evolutionary age relatively to the functional (not- deriving from a brain organic alteration) troubles, the following rule is true: the troubles are imitative, provoked or reactive and they disappear when the causes end. Now we can better understand, from the therapeutic point of view, as the treatments are different according to the nature of the alterations: predominantly rehabilitative with possible psychotherapeutic supports when the pathology is organic; mainly psychotherapeutic and eventually joined to rehabilitative supports when the psychic pathology is only functional.

Going again to the relational and social aspects, there is to consider that to the disabled child (and to the people surrounding him) the growing up costs several problems in relation to the achievement of the possible personal autonomy, the physical independence and psychological emancipation. Often the parents assume some wrong educational attitudes because they sometimes pose to the child too insufficient stimuli, other times some excessive solicitations. Often one makes confusion between the child’s “not to want” and his “not to be able”. In reality, it would be better thing to safeguard the child from excessive pressures finalized to get some performances that could be superior to his possibilities; they can subsequently be too frustrating and not only to provoke irritability and aggressiveness but also feelings of discouragement and failure. The opposite attitude, the hyper-protective, therefore too scarce requirements and solicitations, in comparison with how much the child could do, are equally frustrating and negative because this attitude deprives him of whatever should help him to seek and to acquire ability and compensatory gratifications relatively to fields in which the disability doesn't inflict. For instance, the physically disabled child can be helped to find realization in intellectual field, just as the intellectually insufficient child can be able to reach some results in the field of the physical activities [see “Psycho-pedagogic activities for disadvantaged school children”; in www.psicologia-dinamica.it , home pg., link: thematic area]. Besides, really the quantity and the quality of contact with the environment generally determine the rhythm of individual development; how much lesser are such opportunities, so much more serious it will be the disadvantage. Scarce (or centred on the dependence) social relationship deprive the children of the fundamental intellectual and social stimuli that only the contact with other people can assure. Similarly it is necessary that the minor can avail of people that continually organize and renew appropriate stimuli to develop his cognitive functions and the abilities to mental performance. Likewise, the development of adequate schemes of emotional behaviour needs the repeated experience of social events and situations as the interest, the praise, the approval and the affective reward in relation to desirable forms of behaviour; besides, the social support ahead of the adversities, and, finally, aftercares but so as they don't produce new problems in the emotive sphere. What matters is that the development of the disabled child is allowed to progress at the maximum of his personal possibilities.

A child, as long as he attends the maternal school, spends his time in a protective and playful atmosphere; but as soon as he attends the elementary school, experiences a radical change since the new context means objective evaluation, judgment on the abilities, demand of performance, comparison and rivalry with the classmates; but above all he now have to do an unusual effort of adaptation and to be able to socialize: that is to be together with the other schoolfellows, sat and applied, practically in a work-position totally analogous to that many adults, doing a sedentary work, have to assume. Evidently, this system doesn't favour the disabled child’s scholastic adaptation, and all makes more difficult the schoolmates’ and, above all, teacher’s assignment to help him to be better school integrated; such difficulties are partly whetted by the most greater or lesser awareness that the child has of his own diversity. At times, because of all that, the disabled person manifests his own uneasiness by means of psycho-emotional blocks, restlessness or aggressive behaviours, above all when he is invaded from the anguish or from the fear.

Rarely, in comparison with the past, today there are difficulties to find classmates available towards the disabled child, similarly less frequently they are the complaints from parents of the other pupils for the fear that the school-insertion of the disabled child can somehow to slow the progress of the entire class.

It is often the lack of suitable institutional structures and not a teacher’s inappropriate preparation that negatively influences the disabled child’s process of socialization and scholastic integration. These problems can be overcame by teachers who know what way of gratification and disapproval can facilitate or inhibit the process of learning; they, besides, haven’t not to pretend that is the student to adapt himself to the programs and the mentality of the teaching staff but on the contrary; at last, they have to be able to manage an individualized teaching through the planning of precise objectives to reach and to periodically verify. Just for this it is necessary to avoid hasty placements and the lacking in a preliminary accurate neuro-psychological investigation finalised to verify the individual basic potentialities. Besides, it is necessary to develop an accurate preparatory work, so that the teachers have appropriate operative methods without everything ends simply with a generic humanitarian acceptance.

The multidisciplinary childish neuropsychiatry service has the assignment of supporting and counselling the educators. The multidisciplinary équipe has to deepen in analytical way (functional diagnosis) the psycho-physic development at that moment reached by the disabled child in the various areas (cognitive, affective-relational, expressive-linguistics, sensorial, praxis-motor and neuro-psychological [memory, attention, space-time orientation, etc.] and to verify the level of his reached autonomy. The childish neuropsychiatry service, as per the emerging potentialities and the possibilities of rehabilitation, traces - together with the teaching staff and the specialized auxiliary teachers, and with the collaboration of the child’s family - after a first period of school-inclusion, the short and medium term attainable child’s level of development (functional dynamic profile), planning an individualized program (educational individualized program) and a variety of interconnected (scholastic and extra-scholastic) didactic-educational and rehabilitative enabling the disabled child to reach as the best possible level of education, instruction and integration into society.

The teacher’s psychological formation is fundamental to avoid that they can be frustrated by the discrepancy between the anyway hoped results and those practically gotten. It is in the moment in which the attended results don't correspond to the dedication and to the employed efforts, that, just in the moment of the disappointment, can begin the wish of “releasing”, which could be interpreted also as "confused perplexity" to underline that the teacher or the social operator can, at the end, lose the way for continuing to manage a difficult situation because it is characterized by repeated failures. The solution is partly technique and partly formative.

For technical solution we don't intend now refer to the traditional devolution to the “psy” operators, but on the contrary we make reference to the acquisition by the educator of competences that allows him the strengthening of the ability to take on himself the disadvantaged pupil, however to the light of one “constructive reason”, in the sense also of construction of relationship with the pupil, as a relationship that can develop on the way of a “situation structured through a structured approach", what only the school can probably offer in a natural ambience, that is to say not in laboratory, or rather where the laboratory can become natural environment allowing not-marginalizing grouping. On the other hand, it also needs to consider that every human being, therefore every child, apart from some individual constants, interacts in different way according to the person he has a relationship. Insofar, we will see him as docile and compliant with one, instead as restless and rebellious with another person. This depends a lot on the attitude of whom one has in front and on the context in which the meeting becomes. Naturally this is true also for the disabled child. It is not presumable that a child, who receives ambiguous messages and feels embarrassment by the facing person, for instance the teacher, doesn't have any consequent emotional and behavioural reaction, even if he is a child treated with psychotherapy or rehabilitation. On the other hand the rehabilitation therapist or childish psychotherapist cannot never replace the teacher in his specific assignments. That is to say only the teacher can carry on that part of the work that is the really his own!

In the cases of disabled children, alongside the systematic institution of many extra-educational moments, the construction of a technically correct relationship has to respect the following fundamental rule: considering that the child has some specific sectorial deficits which somehow delay his global maturation, the care and the applications attitudes have to respect the state of his reached maturation. So for example by a 8 year-old child, who however has a stadium of neuro-psychological maturation comparable to that of a 5 year-old child, we cannot expect performances, behaviours and attitudes different from those common to a 5 year-old child; what mattes is not to deprive him of suitable stimuli to the development. So, another example, it would be an error to require to a child, whose cognitive development is still in full phase pre-operational (see Jean Piaget), some psycho-intellective performances that can complete only a child who has already reached the stadium of the concrete-operations. Only after he will have been helped to consolidate all the abilities which are peculiar to a determined stadium of the psycho-cognitive development, the child can try, without excessive frustrations, some activities which are connected to the following phase. All the children need experiences appropriate to their level and rhythm of development and the disabled child doesn't make any exception; he goes through the same phases of development like the other children but his evolutionary rhythm it is different.

Before concluding, another aspect, connected to the teacher’s psychological formation, must be underlined. In general, we can sustain that the teacher is an operator technically equipped relatively to the specific assignment that he has to face. Naturally it is necessary that the technical preparation is accompanied by human dowries or, if one prefers, by specific sensibilities. We want to avoid, here, to face some matters as those tied up to the professional ethic which in most cases could compensate, when they are lacking, the human dowries or the sensibilities, while we think necessary to set the accent on the fact that, if the qualification or technical preparation it is easily obtainable by the teacher through the specific university instruction, instead none university course can teach the sensibility. In truth, there are methods like the psychoanalysis (finalized to restructure the personality) which allow a development of sensibility or human quality, but, they undoubtedly are expensive methods by the emotional, time and economic point of view; therefore only few people can grasp them. There are some possibilities of psychological formation that, also not offering a real restructuring of the personality, they allow a partial modification of the personality above all in relation to the aptitude to establish suitable professional relationships. It would undoubtedly be necessary that all the social operators were psychologically formed to the relationship to the professional relationship, but the same formation is insufficient if the social operator is lacking in goodwill. An operator very often feels the need to endow himself with a psychologically formation really because he has taken conscience of the deep psycho-emotive implications connected to the relationship with the user; therefore, we can affirm that the formation is fruit of a wish to acquire formative experiences. In the most serious cases the operator cannot be defined properly endowed because he is lacking in qualification, formation and sensibility. In that cases, in conclusion, a part of the teacher’s Self and a part of the child’s Self will end with being forced to live their meeting as something of absurdity and of incomprehensible, like a bad dream which will force them to find out of their relationship some more gratifying reality. In every institution also the “group mind”, namely the operative staff as an indistinguishable whole, can influence the entire context in a negative way. Sometimes some recurrent group dynamics end with overhanging the individual resources, the creativeness, the cooperation. So a few educators, the class-teachers, could be trapped in a sort of group mind that negatively influences the operative models and practices; but it is clear that the group mind, even if not consciously shared by the single one, anyway represents the result of the anonymous contribution of every one.

It needs reflect on all these things when one works with disabled children.