Attitudes, Attitudes, Attitudes Oct 13, 2011

BY H. BARRY WALDMAN, DDS, MPH, PHD; DOLORES CANNELLA, PHD; AND STEVEN P. PERLMAN, DDS, MSCD, DHL (HON)

American Academy of Developmental Medicine and Dentistry

When it comes to real estate, it’s always location, location, location. When it comes to individuals with developmental and acquired disabilities, it’s about attitudes, attitudes, attitudes—for both the individual with the special needs and the general public. When we “older folks” were growing up we were taught at an early age, “don’t stare,” “don’t make fun,” “just don’t …” when it came to individuals with special circumstances.

Actually, we had very few opportunities to “not stare.” Individuals with special needs usually were out of sight in some state facilities or secreted in family residences. They never appeared in the movies or television and definitely they never were in our school classes. There even was a “journalism conspiracy” so that the President of the United States was never seen or photographed in his wheelchair. That world has been replaced by deinstitutionalization and mainstreaming, by strategically placing individuals with “obvious disabilities” in photo-opportunities, and by prominently including the story line of individuals with special needs in movies and television (who by the end of the hour or so, overcame unbelievable hurdles which unfailingly is accompanied by a musical crescendo). Nevertheless, a critical factor that still needs to be updated is attitudes. In the past, as one individual reported:

“Being in the institution was bad…I didn’t have clothes of my own, and no privacy…but that wasn’t the worst. The real pain came from being a group. I was never a person. I was part of a group to eat, sleep and everything…it was sad.” 1

DEINSTITUTIONALIZATION HAS ITS PROBLEMS

“You face all of the attitudes people have about disability whenever you go out in the public. People hold doors for you, offer to carry your groceries, grab their children from your path, try to relate to you with stories of other disabled people they know, or speak to your companions on your behalf rather than directly to you.”2

CHANGING ATTITUDES

The day-to-day lives of people with a disability and their family have always been affected by the way they are viewed and treated by the communities in which they live. They want others to see them not just as “a disability.” They want others to know that they are not just “needy, incapable and tragic objects.”

The teen and early adult years can be very difficult for people disabled since birth or with a disability acquired during childhood. While youngsters may have been very well protected and supported by their families, as they reach beyond their high school years their childhood friends may move on to activities beyond those available to persons with disabling conditions.

The unfortunate truth is that there are many deeply held attitudes in most cultures about individuals with disabilities. “People will usually be uncomfortable unless they have already  had direct experience with a disabled person.”2 These feelings are transmitted readily to youngsters. For example, many children
will innocently ask why someone is in a wheelchair. “They don’t yet know that it is ‘rude’ to ask. The child’s interest makes the parents very uncomfortable, and that gets communicated (to the youngster)…The more severe or visible the disability, the larger the attitudinal obstacle.”2

SOME HARD FACTS

Many have believed that individuals with intellectual disabilities have been barred from inclusion in mainstream society because of misconceptions, ignorance and fear. A Special Olympics multinational study (conducted in ten countries across the world, with 8,000 persons responding) on attitudes toward individuals with intellectual disabilities (ID) confirms this view.

• More than half believe that the negative attitudes of their neighbors pose a major obstacle toward inclusion in society.

• 79 percent of the respondents believe that children with ID should be educated in a segregated setting, either in home or a special school.

• 81 percent believe that people with ID could not handle an emergency.

• 64 percent believe that those with ID could not perform more complex tasks, such as understanding a news event.

• 54 percent believed that persons with ID are not capable of playing on a team with others with ID.

“A curious finding is that most respondents believe that it’s other’s attitudes about persons with ID—and not necessarily their own—that affect how persons with ID are included in general society.”3

In a national study in Ireland, over 60 percent of respondents commented that it is “…society which disables people by creating barriers… Eighty percent of respondents believe there were occasions or circumstances when it was right to treat people with disabilities more favorably than others.”4 Three-quarters of respondents believed that children with physical disabilities should attend the same schools as youngsters without disabilities.

 By contrast  only 36 percent agreed that children with mental health difficulties should be in the same school as children with disabilities. Mental health difficulty was also the only disability category that had a relatively high level of objection to having children with that disability in the same class as children without disabilities.

Respondents thought employers were most willing to employ people with physical disabilities (32%), followed by hearing disabilities (27%). By far the lowest level of willingness to employ people was for those that had mental health difficulties, with only 7% of respondents thinking employers would be willing to hire people with this disability.4

Attitudes regarding individuals with disabilities not only vary among different populations, but also in terms of particular disabling conditions. Taking into account of variations in individual and community attitudes would be crucial to the success of any effort to provide services for community residents with disabilities.5

HOW DO YOU MODIFY ATTITUDES?

Contact, contact, and more contact with youngsters and the not so young with special needs is decisive. It would seem reasonable to assume that attitudes, even stigma, associated with various disabilities could be modified and abated with increased knowledge. The reality is that “just” information in itself may be insufficient to dispel attitudes related to individuals with particular disabilities. 6 It’s like learning to swim by just standing at the edge of a pool and practicing, but never getting wet in the water.

In our classroom exercises we have attempted any number of efforts to simulate the circumstances faced by individuals with disabilities. Whether it is using a wheelchair for a period of time, or having students close their eyes to simulate blindness, the reality is that the students can not appreciate the impact of the permanency of the disabling condition.

It has been the actual contact with, and the provision of care for, individuals with a wide range of special needs which has been the single most important factor in dispelling long held attitudes and concerns. Dental schools in Canada and United States have adopted accreditation requirements that ensure student contact with, and treatment for, individual with special needs.7,8

Yes, it is important to emphasize the fact that there are more than 50 million individuals with disabilities in this country. And yes, this number will increase dramatically as increasing numbers of:

• individuals with developmental and acquired disabilities survive to older ages, and

• “baby boomers” (reaching 70 million in the next fifteen to twenty years, or one-in-five residents) will be in their golden years (actually they’re the “rusting years”) with a high prevalence
of disabilities.9

But these are “just” meaningless numbers which may (will?) affect adversely attitudes relating to these individuals; particularly when the consequences of the numbers are equated with the financial impact on the economy of the general public. Overcoming these eventualities must include knowledge, but so too must it include contact, contact and yes, more contact.•

References

1. Changing attitudes. Web site: http://www.mencap.org.uk/page.asp?id=1895 Accessed August 25, 2010.\

2. Public attitude toward disability. Web site: http://booksonhealth.com/wheels/news/public.thml Accessed August 26, 2010.

3. Special Olympics Multinational study of attitudes toward individuals with intellectual disabilities: 2003. Web site: http://www.somena.org/Uploads/multinational_study_initatives.pdf Accessed August 26, 2010.

4. Public attitudes to disability in Ireland: report of findings February 2007. Web site: http://issda.ucd.ie/documentation/nda/nda06-surveyreport.pdf Accessed August 27, 2010.

5. Repper J, Brooker C. Public attitudes towards mental health facilities in the community. Health & Social Care in the Community 1996;4:290-299.
6. Surgeon General’s Report on Mental Health. Public attitudes about mental illness: 1950s to 1990s. Web site:
http://www.surgeongeneral.gov/library/mentalhealth/chapter1/sec1.html
Accessed August 23, 2010.

7. Commission on Dental Accreditation of Canada. Accreditation Requirements for Doctor of  Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) Programs. Updated November 30 2006. Web site: http://www.cda-adc.ca/cdacweb/en/ Accessed June 25, 2010.

8. Commission on Dental Accreditation. Accreditation Standards for Dental Education Program; Modified February 1, 2008. Standard 2-26. Web site: http://www.ada.org/prof/ed/accred/standards/ predoc.pdf Accessed June 24, 2010.

9. Census Bureau. The next four decades: the population in the United States: 2010 to 2050. Web site: http://www.census.gov/prod/2010pubs/p25-1138.pdf Accessed July 28, 2010.

H. Barry Waldman, DDS, MPH, PhD, Distinguished Teaching Professor Department of General Dentistry Stony Brook University, NY, e-mail: hwaldman@ notes.cc.sunysb.edu

Dolores Cannella, PhD Director, Behavioral Sciences Assistant Professor Department of General Dentistry, Stony Brook University Steven P. Perlman, DDS, MScD, DHL (Hon), Global Clinical Director, Special Olympics, Special Smiles, Clinical Professor of Pediatric Dentistry, The Boston University Goldman  School of Dental Medicine, Private pediatric dentistry practice - Lynn MA

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