Protecting the health rights of children with special needs (the child of the autism spectrum as a model)

Children with special needs, including those on the autism spectrum, have the same fundamental right to health as any other child. However, they often face unique challenges in accessing quality healthcare and support services.

Protecting the health rights of children with autism is a critical issue that requires special attention from researchers, health practitioners and policymakers. Children with autism face unique health challenges that require specialized care and ongoing support. Despite progress in understanding autism and providing services to children with autism, there are significant gaps in the provision of universal health care for this group. Children with autism often face difficulties in obtaining an early and accurate diagnosis, delays in obtaining necessary therapeutic interventions, and a lack of awareness among health care providers of their specific needs. While human rights progress has been made, many children with autism do not have access to the comprehensive health care they need. Previous studies have highlighted the importance of early diagnosis and intervention, but they often lack the perspective of health practitioners working directly with this group.

This study aims to bridge this gap by exploring the experiences of children with autism and their families in accessing health and psychological care. Doctors and psychiatric workers were interviewed to identify the challenges they face in providing appropriate care for this group. The literature on the health rights of children with disabilities was also analyzed to identify relevant international standards.

This study is expected to contribute to a deeper understanding of the factors that affect children with autism's access to health care, and propose recommendations to improve the quality of care provided to them.

Problematic of the study:

Children with special needs and children on the autism spectrum constitute an important segment of society, and we must pay special attention to them to protect their rights, including their health rights.

After the international community realized the need to respect human beings and affirm their rights to live a decent life, especially after the technological and scientific progress that the world is witnessing today, and the resulting development in the methods and fields of health, social and psychological care... Human rights have become universal. As people with special needs are a vulnerable group in society that needs special care – especially children – we find that most countries and international conventions stipulate the protection of their rights and ensure nondiscrimination between them. The Convention on the Rights of the Child of 1989 is the first document that stipulated non-discrimination between children on the basis of disability, and then came many international conventions and declarations in this field, we find the Declaration on the Rights of the Mentally Handicapped of 1971, the Universal Declaration of the Rights of the Disabled of 1975, and the International Convention on the Rights of Persons with Disabilities of 2006 (Zogaa 2020).

The international declarations and covenants issued by the United Nations, represented in the Universal Declaration of Human Rights and the International Covenants, stipulate that children have the right to special care and assistance provided for in the legislation of the State and guaranteed by the State, society and the family, and in light of that the Convention on the Rights of the Child sets out the content of the special care and assistance enjoyed by the child, and article 23 of it stipulates the rights of the mentally or physically handicapped child, and obliges States to recognize and protect the rights of children with disabilities. In line with international conventions and declarations, the Algerian Constitution guarantees in Article 72 thereof the protection of the family, society and the State for the rights of the child, (Gharbi. 2020)

Not only that, but both the family and health centers play an important role in protecting the rights of children with special needs and children on the autism spectrum, as the family is a safe haven for children with special needs and children with autism, as it provides them with a supportive and loving environment that helps them grow and develop. The family should also recognize and defend the rights of children with special needs or children on the autism spectrum, and combat any discrimination they may be exposed to. In addition, the family has a role in enhancing the skills of a child with special needs or a child on the autism spectrum, and encouraging him to participate in various activities.

As for health centers, they provide specialized services for children with special needs and children with autism, including diagnosis, treatment and rehabilitation.

On this basis, our following questions were adopted: What are the measures to protect the health rights, whether physical or psychological health of a child on the autism spectrum?

Objectives of the study :

The objectives of this research paper are as follows:

• -    Highlighting the health rights of children with special needs in general and with autism spectrum disorder in particular

• -    Directing researchers' attention to the rights of children with special needs in general and those with autism spectrum disorder in particular

• -    Highlighting the right to health for a child on the autism spectrum

Importance of the study:

The importance of the current study lies in identifying measures to protect health rights, whether physical or psychological health for people with autism spectrum disorder. This is done by highlighting the role of each specialist separately in terms of initial evaluation, diagnosis and treatment, as well as followup.

Study terminology :

Right to health:

The right to health is a fundamental human right, which falls within the social, economic and cultural rights, and means: Everyone has the right to the enjoyment of the highest possible physical, psychological and mental health; Article 25 of the Universal Declaration of Human Rights of 1948 states: "Everyone has the right to a standard of living adequate to ensure the health and well-being of himself and his family, in particular in terms of food, clothing, housing, medical care and necessary social services.

According to General Comment No. 14 of 2000 of the Committee on Economic, Social and Cultural Rights, the right to health is a broad and comprehensive concept, not only limited to appropriate health care, the basic determinants of health, such as access to safe and potable water, but also includes adequate sanitation services, safe food and adequate housing, provision of healthy occupational and environmental conditions, and access to health-related education and information.

Children with special needs: It is that category of members of society that suffers from a defect or deficiency, which requires a special effort to reach them to the stage of accepting their cases as they are.

And help them to carry out their needs in the best possible way and protect them from the dangers that may be inflicted on them intentionally or unintentionally by others. It is the target segment of the service (Bousaid, 2020, 135, 136)

Autism spectrum disorder:

The National Autism Society in Britain (1962) has defined the autism spectrum as a developmental difficulty that affects the way of communication and the child's belonging to the people around him, and this difficulty is manifested in three areas:

• -    Social interaction.

• -    Social networking.

• -    The ability to imagine. ( Omar, 2012, 16)

And The National Society for Autistic Children New (NSAC) defines autism spectrum disorder as a disorder or syndrome that makes the child isolated from the world around him, and that the personal manifestations involved must appear before the child reaches the age of thirty months, and this includes a disorder in the speed or sequence of growth, a disorder in the sensory response to stimuli, a disorder in speech, language and cognitive abilities, and a disorder in attachment or belonging to people, events and subjects

Autism is also a neurodevelopmental disorder characterized by: a qualitative deficiency that appears in two developmental areas, namely interaction and social communication, and frequent and limited patterns of behavior, interests and activities, and these symptoms appear in an early period of growth, but the deficit may not be clarified until the requirements of social communication exceed limited capabilities or may be obscured by learnt responses later in life. (Kiroud, Mazouz, 2020)

Muhammad Ali Kamel says autism as: a disability in social development characterized by being chronic and severe and it appears in the first three years of life and is the result of a neurological disorder that negatively affects brain functions. (Mohamed Kamel, 2005: 20)

And also (ASD) : is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors. ( apa . 2013 )

Through all these different definitions, we can define autism spectrum disorder as a developmental disorder that appears on a child before the age of 3 years. It is evident through three basic manifestations:

• -    Poor ability to communicate socially.

• -    Poor ability to communicate verbally and nonverbally.

• -    Stereotypical movements.

Study Methodology :Temporal and spatial boundaries of the study:Spatial boundaries:

The study was conducted at the Child Psychotherapy Department of the Zaidi Abdelkader Hospital Mental Institution in Sidi Bel Abbes.

Time limits:

This study was determined in May 2024

Study Methodology:

In this study, we followed the descriptive approach due to its suitability to the nature of the study, which aims to identify the reality of protecting the health rights, whether physical or psychological, for children with special needs in general and children with autism spectrum disorder in particular.

Study Population:

Based on the objectives of the research, the population of the current study consists of all doctors, specialists and therapists for people with autism spectrum disorder who are present in the Department of Child Psychotherapy at the Hospital for Mental Diseases Sidi Bel Abbes.

Study sample:

The study sample was selected intentionally, where the number of sample members was 6 divided in the following table:

Table 01 Distribution of sample members

Specialization Name	Number of people	Percentage
Specialist Doctors 1		٪ 16.66
General Doctors 1		٪ 16.66
Psychologists 4		٪ 66.6
Total 6		٪ 100

Results of the study:

To answer the general question of the study, we conducted interviews with a group of specialists and we will analyze them in the following:

The right to physical health of children with autism spectrum disorder:

I n this type of protection of the health rights of these children, a group of doctors specialized in psychiatry as well as general practitioners with appropriate medical intervention in terms of the general assessment of the case, the beginning of developmental development, whether it is commensurate with the age of the child or has a delay, in addition to the work of medical examinations and analyzes, including electroencephalography EEG so that this test shows them the activity of the nerve impulse, any defect in the cerebral nerves appears in the form of a defect in the planning of test waves. In addition to requesting another examination, which is the assessment of the probability of auditory effort induced or auditory brainstem response (PEA), through which the type and severity of hearing loss is accurately detected and diagnosed.

In some cases, other tests such as magnetic resonance imaging (IRM) are also requested in order to detect any other problems or brain injuries that may affect the behaviors and development of a child with autism spectrum disorder. On the other hand, doctors detect any other symptoms associated with the symptoms of autism spectrum disorder, such as aggression towards self and the other, excessive movement, epilepsy or others, and they treat them with special medications, for example: Respal / Depakine / strattera. Cases are also followed up through renewed appointments for each case in order to assess whether some of those associated symptoms have improved and eased and the stability of the child, in order to reduce the dose of medication or perhaps get rid of the drug completely and remain only in psychological, emotional and educational follow-up.

Protecting the right to mental health for children with autism spectrum disorder:

Supervises the protection of the psychological right of a child with special needs in general and people with autism spectrum describes in particular a specialized group of clinical psychologists who carry out their work with the case of the autism spectrum child in coordination with their team in their various specialties First they exclude any other organic problem that is an obstacle to improving the care of the case with the intervention of a specialist doctor, and then they make a preliminary assessment of the case after they conduct an in-depth and comprehensive case study of the case and identify the strengths and weaknesses of the case and those who have been diagnosed using the criteria Statistical and diagnostic guide to mental illness DSM and also using psychological tests and measures, including:

• 1-    Autism list for children under two years Checklist for Autism in Toddlers (CHAT)

• 2-    Childhood Autism Rating Scale (CARS)

• 3-    Gilliam Autism Rating Scales (GARS)

After the diagnosis and identification of the strengths and weaknesses of each case, they also identify language problems and are taken care of by an Speech Specialists and sensory problems taken care of by the functional specialist. After all this work, therapeutic intervention is based in most cases on behavioral intervention and begins to analyze behavior in terms of its causes and results, and a set of tools and means are used, for example, educational tools and intelligence games, and then work to teach him behaviors familiar to society and develop his skills of independence and self-reliance and others, as well as modifying some abnormal behaviors such as stereotypical behavior, aggressiveness, hyperactivity movement, lack of social interaction and others. This is in addition to the family treatment that is provided to parents by directing and guiding parents on how to deal with their son and urging them to participate in providing and implementing the program with him and with regard to follow-up, the case always remains in contact with the center to provide appropriate care even after integrating it into the school or going to other care centers.

Discussion of results

Through what was discussed in the presentation of the results of this study, which aims to know the reality of protecting the health rights of children with special needs and children on the autism spectrum, we concluded that the Department of Child Psychotherapy of the Hospital for Mental Diseases Zaidi Abdelkader in Sidi Bel Abbes. It provides health protection in terms of physical and is ensured by doctors, whether specialists and even general practitioners, in addition to protecting the mental health rights of this category, through the work of psychological care teams, which are supervised by psychologists, so that the child is provided with integrated and comprehensive care, whether the psychiatric medical aspect in every step you take, either in the initial evaluation or in providing diagnosis or in treatment and even follow-up.

Hoping from the multidisciplinary work team to reach children with autism spectrum disorder to safety, and this is what is to a microcosm of what health offers in Algeria with its legal charters or the supervision of the medical and psychological team on this category, and this does not guarantee the ideal image to protect the health rights of this category, but the competent and responsible team in the field seeks to permanent development and work to increase the effectiveness of the sector responsible for this category, whether in terms of medical or psychological, and that is behind the countries Advanced, which preceded its steps in this field, taking into account what it has reached and delving into the midst of the experience

Conclusion

Through this study, we reached children with needs in Algeria and children of the autism spectrum enjoy the protection of health rights, whether physical or psychological, like the rest of the ordinary Algerian children, except for their own case, which they receive a focus on this aspect, each case and according to its specificity and what it needs from medical or psychological care, and we also do not deny that these children and their families suffer from some difficulties such as the lack of specialized services and the scarcity of health centers dedicated to the treatment and care of children with special needs and children Autism spectrum, which constitutes an obstacle to their access to appropriate treatment, in addition to the small number of doctors who have the experience and skills necessary to diagnose and treat cases of children with special needs and children with autism spectrum. all over the country, and also provide training programs for doctors to enhance their skills In the diagnosis and treatment of cases of children with special needs and children on the autism spectrum. This is in addition to providing free or discounted transportation services to families of children with special needs and children with autism.

Recommendations:

In light of the research results, the researchers present a set of recommendations, which are as follows :

• -    Encouraging medical students to choose the specialty of child psychiatry due to the shortage we observe at the level of hospitals in Algeria

• -    Focusing on equal opportunities for children with special needs in health care at all levels, whether physical or psychological health

• -    Providing facilities for the provision of health services by health care providers for these children

• -    Conducting courses for health education for the families of this group

• -    Redoubling efforts, especially in providing digital health services for this category