Chính sách đối với trẻ tự kỷ ở việt nam hiện nay

Chinh sach doi voi tre ttf ky fr Viet Nam hien nay
Dgu Tuan Nam
v a Hai Vdn "
Tdm tdt: Trong khoang 15 nam Gd lai day, so lugng Ge d Vift Nam mic chiing t^r
ky gia tang dang kl va trd thanh mpt vdn dl xa hpi rat dang quan tam. Trong khi dd
nhan thiic cua cdc gia dinh, cpng dong, xa hpi ve hpi chiing nay cdn thilu diy du,
tham chi sai lfch; dilu do gay ra rdt nhieu kho khdn cho tre ty ky trong vifc tiep cjn,
thy hudng cdc djch vy y te, giao dye va cdc chinh sdch an sinh xa hpi. Bdi vilt de c^ip
nhihig khd khdn, bat cgp trong chinh sach dii vdi tre ty ky d Vift Nam, tG dd gpi ^
mpt so giai phap nhdm giup tre ty ky c6 ca hpi binh ddng trong tiep cgn, thy hudng
cac djch vy y te, giao dye vd cac chinh sach an sinh xd hfl cua Nha nudc.
Tit khda: Ty ky; roi lo^n phd ty ky; chinh sach doi vdi tre ty ky; tre ty ky.
1. IVld diu

Trung Qudc, van de ty ky cGng dd dugc cdc

Ty ky hay rdi logn p h i ty k^ Id mft dang

nhd khoa hpc ddc bift quan tam. Tuy

khuyet tat phdt t r i l n ' ' thudng xudt hifn vdo

nhidn, nhdn thGc cua cac cgng dong, nhdm

khodng 3 ndm dau ddi, nhung ton tgi lau dai

xd hpi v l hgi chung nay d nhieu quoc gia

vd gdy ndn nhGng khd khdn nhdt dinh, tham

cdn thieu day du, thfm ehi sai lfch gdy nen

chi nghiem Gpng tdi nhilu mdt Gong ddi
song gia dinh, xd hpi va bdn than trd mdc

**' Tien si, Hpc vifn Chinh trj khu vyc I, Hpc vi^
chinh trj quic gia Ho Chi Minh. DT: 0912539889.
Email:
tay Chdn dodn vd Thong ke cdc roi logn **'* Th?c sT, Hpc vifn An ninh nhSn ddn.
"* Theo CDC (Center for Disease Control and
tdm thdn - bdn Idn thii 5 (DSM-5) md ta la
Prevention - Trung tam kilm so4t vi phfing ngira
mft dgng khuyit tgt phdt triln vdi cdc d|ic djch bfnh thufc Bf Y tk \h. Dich vy NhSn sinh Hoa
Ky), khuyet t^it phdt tri6n 14 mft nh6m da bfnh man
trung CO bdn Id: khiem khuyit vd giao tilp tinh nghiem trpng do suy ylu tinh th^n v^o^c the
qua lgi vd tuong tdc xd hfi; hanh vi hgn hpp chSt. Khuyit ^t phdt triSn gdy ra nhieu khd khan
trong mft so Rnh vyc cua cufc sdng, d$c bi§t li
vd thudng l§p di ldp lgi*^\ Trdn thi gidi, sd Irong "ngdn ngO', V^ID dfng, hpc t ^ , tg Iyc vd sing
lugng cdc nghien ciiu v l hdi chung ty ky mft mltih", doi vdi nhihig ngudi dang phii s6ng
chung vdi chQng. />dugc thyc hifn ngdy cang nhilu, nhit la tai El%BA%BFt_t%E1%BA%ADtj)h%C3%Alt_tri%
cdc nudc phdt triln cd thu nhgp cao nhu El%BB%$3n.
*^' American Psychiatric Association (2013), Dia^ic
Anh, My, DGc, AusGalia... 6 eac nudc and Statistical Manual (f Mental Disorckrs, 5th Editkm.
Chdu A nhu Hdn Qudc, An Dp, Thdi Lan, Arlington, VA American Psychiatric AssociatitMi, Web.
[access date: 1 June 2013]. dsm.psychiatiyonline.org.
hpi chGng ndy. Rdi logi phd ty ky dugc SS

60


Chinh sdch ddi vdi tre tuky...

nhieu hf lyy trong ddi sdng xa hdi vd thye

sach y td ciia Tdng thdng Barack Obama, vd

thi cdc chinh sdch Gg giup. Trong thdng

dng ciing da keu ggi su ho trg nhieu han

difp "Ngay T h i gidi nhan thGc ve ty ky"

nGa cho tre ty ky va gia dinh cdc em, quyet

(ngdy 2 thang 4 ndm 2012), Tdng thu k^

dinh se chi hang ti dd la tG ngan sach lien

Lien Hgp Qudc, dng Ban Ki-moon cung da

bang cho cdc nguyen cGu ve nguydn nhan

tGng chi ra rdng: "Tre em va nhung ngudi

va phuang phdp tri lieu cho Ge ty ky.

mdc chGng tu ky phai ddi mat vdi nhGng

O Vift Nam, tuy chua cd sd lifu cdng bd

thdch thGc Idn, Gong dd cd sy phdn bift

chinh thGc, nhung tG nam 2000 din nay sd

ddi xu cung nhu thidu khd nang tilp can

Ge dugc chdn dodn vd dilu tri chGng ty ky

djch vu ho Gg. Nhieu ngudi phai vat Ipn

tgi cdc CO sd y te cdng lap ngdy cdng tdng,

vdi cdc rdo cdn trong cudc sdng hang

ndm sau cao hon nam trudc. Theo sd lifu

ngdy"^ . Vi vdy, nghien cGu tim hidu

cua Khoa Phyc hdi chGc nang (Bfnh vifn

nhihig khd khan b i t cap Gong vifc thgc thi

Nhi Trung uong), ndm 2000 sd Ge ty ky

chinh sdch ddi vdi Ge tu ky Id vifc ldm hit

din khdm tdng 122% so vdi ndm trudc va

sGc can thidt, de tu do dua ra cdc khuyin

ndm 2007 sd Gd ty ky ddn khdm tang len

nghj v$n dgng chinh sdch nhdm giup ngudi

din 268%. Tgi Tp. Hd Chi Minh, ndm 2000

ty k^' ndi chung va Ge tu ky ndi ridng cd

chi ed 2 Gd din Bfnh vifn Nhi dong 1

CO hfi binh ddng Gong tilp cdn va thy

khdm vd dilu trj ehiing tu ky, thi ndm 2008

hudng cdc djch vu y t l , gido dye va an sinh

s l Ge den kham Id 324, tang hem 160 lin.

xd hpi cua Nhd nudc.

Trong nhOng ndm gdn day, s l lugt trd din

2. T i n g quan tinh hinh tre em mdc hfi
chGng ty- ky d Viet Nam
Theo thong kd ciia td chGe Autism
Speaks*''*, ty If Gd em dugc phdt hifn vd

khdm tai Khoa Tdm thin (Bfnh vifn Nhi
Trung uong) dugc chin dodn rdi logn p h i
ty ky hay cd diu hifu tg ky ngdy edng gia
tdng (Hinh 1).

chin dodn mdc hgi chung ty ky trdn thi gidi
gia tdng ddng k l , ndm 1975: 1/5000; ndm
1986: 1/2500; ndm 1995: 1/500; ndm 2001:
1/250; nam 2004: 1/166; ndm 2007: 1/150;
ndm 2009: 1/110; ndm 2012: 1/88*^' vd ndm
2014 Id 1/38**'. T^- Id Gd ty ky gia tdng
nhanh chdng dang dat ra nhung vin d l Idn
doi vdi nhilu quoc gia. Tgi My, tu ky dugc
x i p vdo danh muc 13 dgng khuyit t^t va
v i n d l trd ty ky dd dugc khdng djnh la mgt
Gong nhChig uu tidn hdng diu trong chmh

* * />*^' Autism Speaks \k mft t6 chiic tuyen truyin v§n
dfng ve ty 1P^ 6 My, hoat dfng chii yeu trfin c4c ITnh
vyc: tii trp cho nghiSn ctru \k ty kj \h tiln hinh cdc
ho^t dfng nhdm ndng cao nh^n thiic vd tilp c$n cfng
dSng.
*" />documents/media-center/as_prevalence_vs_costchartOl.jpg.
''" />autism%E2%80%99s-rising-prevalence-what-donumbers-mean.
61


Tgp chi Khoa hgc xa hgi Vift Nam, sd 11(96) - 2015
4000

- -

3500 j
3000

>K4J41

•

^~~~» 2468

2S00 ,

y\-)12

20OO
1500
1000

1 L„„»N5m 2008

Nam 2010

Nam 2012

Nim2014

Hinh 1: Sd lugng khdm rdi logn tu ky
Ngudn: Theo s6 lifu tfing hpp cua Khoa Tam than, Bfnh vifn Nhi Tmng uong.

So trd den kham mufn vd dugc chdn
dodn mde chGng ty ky tgi Bfnh vifn Nhi
Trung uong cdn chiem ty If rat cao
(43,86% Gdn 36 thdng tu6if\ Tuy mdi

dugc thdnh lap ndm 2012, nhung den nay
Don vj chdm cGu dieu tri va ehdm sdc d$e
bift cho ty ky, bgi ndo (Bfnh vifn Cham
ciiu Trung uang) cung dd thu nhgn 1.926
trd den dieu tri chGng ty ky bdng phuong
phdp cham cGu, cdy chi**'... Sd lifu thong
ke ciia Khoa Tdm thin (Bfnh vifn Nhi
Trung uong) eung cho thiy, cd sy khdc bift
ddng ke giGa ty If tre em trai mdc chGng ty
ky so vdi Ge em gai (sd be trai nhilu hon tG
4 - 6 lin so vdi be gdi) vd d thanh thi mdc
nhilu ban so vdi ndng thdn. Theo udc tinh
ciia mgt sl td chuc nudc ngoai, Vift Nam
hifn cd 165.325 ngudi ty ky*". Cd le ddy la
mgt con sl thieu chinh xdc, tren thyc tl sd
tre mde hpi chGng ndy cao ban rat nhilu. Vi
chi rieng thing ke sa bg cua Sd Gido due
va Ddo tgo Ha Ngi, tren dia ban thdnh phd
hifn cd khoang 200.000 Ge ly ky dang theo
hpc tgi cdc trudng tilu hpc*'**'.
Tuy chua diy du, nhung nhihig sl lifu
thong ke tren day cung dd cho thiy, sd Gd
62

em mic rdi loan phd ty ky dugc phdt hifn
ngdy cdng nhilu vd dieu nay dd, dang la
thach thuc khdng nhd vdi tit cd cdc quic
gia (ke ca nhiing nudc phat trien nhu Anh,
My, DGc, Phdp,... hay nudc dang phdt triln
nhu Viet Nam). Tren the gidi, hpi chiing ty

ky dd dugc bilt din tu ndm 1943 bdi bdc si
tdm than ngudi M^ Leo Kaimer (1894 1981). Nhung den nay, cac nha khoa hpc
tren the gidi van chua xdc djnh dugc mft
each ehinh xdc nguyen nhan gdy ra hpi
chGng ty ky. Va do dd, cac nha chuydn
mdn (bao gdm ed vl y khoa, trj lifu tdm ly,
<" Nguyen Thj Huong Giang, Tran Thj Thu H4
(2008), "Nghidn cuu xu the mdc vd mft s6 djc dilm
djch tl hgc ciia tre ty ky dieu trj tai Bfnh vifn Nhi
nung irong giai do?n 2000 din 2007", T?p chi YHQC
thyc hanh, s6 4, tr.l04 - 107.
*' Theo s6 lipu t6ng hpp ttr h6 sa dieu trj ciia Don vj
Chdm cihi dieu trj vd Chdm s6c ddc bift cho Ty ky,
b^i ndo (Bfnh vifn Cham cihi Trung uong), ndm
2012 c6 390 tr6 den dilu trj chtoig ty ky vd ndm
2013 Id 764 tre, ndm 2014 id 600 tre.
*'* http;//www.rightdiagnosis.com/a/autism/statscountry.htm.
'"" Sd Gido dye vd Ddo t^o Hd NOi (2011), K^yS'u
Hgi thao Hda nh$p c0Bg ddng cho tri ipk^, tS chiic
tgi Hd Nfi ngayl5/l 2/2011.


Chinh sdch ddi vdt treiuky...
gido dye.) ciing chua the dua ra dugc mgt
phuang phap chiia tri ndo hifu qua nhat
vdi chGng tu k^'. Cd the ndi, vifc tim kilm
giai phdp dd dieu tri/can thifp hgi chung ty
ky hifn dang Id mdi quan tam khdng chi
cua cdc nha chuyen mdn, ma can cd sy
tham gia cua ca cac nhd hogch dinh vd

thyc thi chinh sdch.
3. Chinh sach doi vdi tre t^ ky va
nhung van de ddt ra
Trudc hdt, phdi ndi ring, d Vift Nam tuy
da cd khung chinh sdch rit tiln bg nhdm
cung cdp cac dich vg cho ngudi khuyit tdt
ndi chung, nhung kl tG khi thuc hidn ddi
mdi, Chinh phu da cat gidm ho Gg ddnh cho
he thing giao dye vd y te. Vi vdy, sy chenh
lfch trong vide tilp can vd sG dyng cdc dich
vy sue khde vd gido dye tgi Vift Nam dd
gia tdng*"'. Theo thing ke cua Bd Y tl, chi
cd 66,8% dan sd cd bdo hidm y te trong
nam 2012. Ngan sach nha nudc danh cho y
td chi chidm 26% tdng chi tieu ve y te trong
ndm 2010 va so tidn ngudi dan phdi tu chi
tra danh cho cdc dich vu sue khde chiem
hon 50%*'^'. Trong bdi cdnh cua xd hfi Vift
Nam, do chua cd nhieu thdng tin ve hdi
chung ty ky vd cdc dich vy ddnh cho ngudi
tu ky, nen cd nhieu tre mdc chung ty ky
Gong mgt thdi gian rat dai, nhung khdng
duge phat hifn va can thidp sdm. Trong khi
dd, phin Idn cdn bd cdc nganh y tl, giao
dye ho$c cha mp tre cdn thieu nhGng kiln
thuc chuyen mdn de cd the phat hifn sdm
va chdm sdc trd mgt each tdt nhat. Cung vdi
dd la nhgn thuc cua cgng ddng, xd hgi trong
cdng tac chdm sdc, bao vf vd ddm bdo
quydn cho cdc em cdn g$p rat nhieu hgn

chi, dan den nhilu tre du da Idn nhung
khdng ndi dugc, khdng hda nhgp dugc vdi
mdi trudng xd hgi xung quanh vd phai sdng

phu thugc vdo su cham sdc ciia ngudi than
trong gia ^nh. Day Id mgt van de xa hgi
fit dang phdi luu tam, bdi khdng chi rieng
tre em ma ca nhung ngudi ty ky trudng
thdnh, cho den nay van chua the hda nhgp
cgng ddng do nhGng rdo can/dinh kien xd
hgi. Nai thdm kham va dieu tri chung ty ky
hidn chi cd d cdc thdnh phd Idn vdi lich
kham va dieu tri day ddc. Gong khi d nhung
khu vuc ndng thdn, ddc bift Id d khu vyc
midn nui tgi cdc vung sau, vung xa hodn
todn chua cd ca sd khdm chOa bfnh ddc thu
ndy. Cdng tdc gido due, ehdm sdc phyc hdi
chuc ndng ddi vdi tre ty ky ciing cdn rat
nhidu h^n che, ca chd chinh sdch Gg giup
xa hdi ddi vdi cdc em vd gia dinh cdn nhidu
bat cdp, chua phG hgp vdi sy phdt trien cua
xd hdi hidn nay. Vdi phdn Idn nhGng ngudi
tu ky, hp khdng the sdng ddc lap khi khdng
cd ngudi than ben cgnh trg giup, nhung d
nudc ta hidn nay lai chua cd noi ndo nhdn
cham sdc va nudi duong ngudi ty ky. Ben
cgnh dd, Nhd nudc cung chua ban hdnh mpt
van ban phap lugt ndo cdng nhdn ty ky la
mdt dgng khuyet tat ridng bift. Cac chinh
sach ddi vdi tre ty ky va gia dinh ed Gd ty

ky mdi chi dugc quy dinh ldng ghep trong
hf thdng van bdn, chuang trinh ehung vl
bao Gg xa hgi, hf thdng chuong trinh chinh
sdch ddi vdi tre em; he thdng cac chucmg
trinh, chinh sach ddi vdi ngudi khuyit tat
vd tre em khuydt tdt ndi chung; hf thing
cdc chuang trinh, chinh sdch chdm sdc ddi
' ' BJom Ekman, Nguyen Thanh Liem, Ha Anh Due
and Henrik Axelson (2008), Health insurance rrform
in Vietnam: a review of recent develf^ments and
fiiture challenges, Health Policy and Planning, 23(4):
252-263.
' " ' Ministry of Health and Health Partnership Group
(2013), Joint annual health review 2013: Towards
Universal Health Coverage. Hanoi, Ministry of Health.

63


Tgp chiKhog hgc xa hgi Vift Nam. sd 11(96) - 2015
tu(?ng trong cac ca sa bao trg xa hgi...
Trong do, Luat Ngiroi khuydt tat co hieu
bfc tir ngay 01 thang 01 nam 2011 duoc coi
la mot bucrc tien quan trpng thi chi hoa diy
du va toan di^n cac quan diem, chu trurong,
chinh sach cua Dang, Nha nuoc ve nguoi
khuyet tat nhSm t^o moi tnrang phap Iy,
dieu ki^n, co hgi binh d^g, khong rao can
doi voi nguai khuyet tat tren co so tilp can
vk b^o dam quyen cua nguai khuyit t^t,

quy djnh ro trdch nhifm ciia Nha nuoc, gia
dinh vd xa hpi trong viec x6a bo rao can va
ddm bdo cdc dieu ki?n d& nguoi khuyit tat
h6a nh^p xd hgi nhu ngu6i binh thu6ng
khac. Tjii Dilu 44 chirong VIII ciia Lujt
Nguoi khuyit tdt da quy dinh cu thi vl vin
de tro cdp xd hpi, ho try kinh phi chdm soc
hdng thdng. Tuy nhien, theo cdc quy djnh
ndy, chi nhihig tre tu ky dupe xip vdo
nhom khuyit t|t djc bift njng thi hp gia
dinh mdi thu^c di$n dupe ho trp kinh phi
chdm s6c nuoi duong. Con d6i vdi truong
hpp trd tu ky chua dupe xip losii, hojc da
dupe xdc dinh miic dp khuyit tjt nhe ho^c
n^ng thi hp gia dinh khong dupe ho tt» kinh
phi chdm soc.
Nhu vay, ngay cd trong Lu$t Nguin
khuyet tiit dupe coi Id vdn ban phdp ludt
tien bp nhit hi?n nay, thi tre tvt ky ciing
chua dupe dl c?p mpt cdch cu thi md chu
ylu long ghep voi cac ddi tupng khuyit t|lt
khdc. Mdc dd tvr ky dS dupe cong nhjn la
m0t khuyit t$t nhung do la d?mg khuyit tjit
nao, thi hi^n nay chua co mpt vdn ban phdp
lujt ndo n6i r6. Tien th\rc tl, Luiit Nguoi
khuyet t|t cOng chua co s\r tham chilu din
khdi ni$m tv ky. Theo quy djnh t?i Khodn
1, Bilu 3 Ludt Ngudi khuyit t?t cd phan
lo^i 6 nhdm khuyit tSX Id: khuyit t|t vjn
dpng; khuyit tjt nghe, ndi; khuyit tdt nhii);

64

khuyet tat thdn kinh, tam than; khuyit tat tri
tu$; khuyet tilt khac.
Nhu vjy, theo Luat Ngudi khuyit tjit
hien hdnh, tir ky khdng phdi la mpt dang
khuyet tat riSng bi?t, md se dupe quy ve
mpt trong 6 dang khuyit tdt tren. Thirc tl
nay d^t ra nhiing vdn de bit cdp nhu sau:
- T\i ky la mot phd r0ng vd Id djng
khuyit t jt cyc ky phiic tap, khdng gidi han
nhiing linh vuc dnh hirdng. Tu k^ cd thi la
toan bp cdc djng khuyit tdt tji Dilu 3 cua
Lusit Ngudi khuyit tjt. Nhilu ngudi tv k;^
khd khdn ngay trong cac hoat ddng sinh
hoat hang ngdy (nhu cai cue quin do, tdm
giat...); nhilu ngudi tir ky khdng bao gid cd
ngdn ngft vd trong so ngudi cd ngdn ngii thi
da phin cd ngdn ngii rit han chi; nhieu
ngudi tv ky bj rdi lo?m xir 1;? dm thanh,
thjim chi vice nghe mdt am thanh nhdt djnh
nao dd cOng khiin mpt sd ngudi tv ky cSm
thiy khd chiu, dau ddn vd sp hdi; rit nhilu
ngudi tv ky khdng thi nhin vao ngudi dii
di?n khi ndi chuyen, vi hp khdng thi xii ly
dupe thdng tin bilu cdm tren mjt ngudi dii
di$n... Nhu vay, vi^c xip tv ky vdo khuyit
tjt vdn ddng hay khuyit tat nghe ndi,
khuyit tat nhin ciing diu khdng chfah xdc.
- Xep tu ky vao "khuyit tjt than kinh,

tdm than" la khdng diing vdi ban chit ciia
khuyit t?it tu ky"". Tren thvc tl cd rit
nhilu tre tv ky diln hinh, rit khd khdn trong
Nguiri tir ky chi gap kh6 khan trong giao tilp, vl
khSng hiiu im/c cack^hi$ukhenglJrinhucGtchl,xllc
cdm, cac tir ngfl trim ni^ng, nSn cd nhihig I6i n6i hojc
hSnh vi bit thujmg. Doi khi vl khong biit each to
nguiri khac hiiu minh, ngn nguW tir ky c6 thi 16 ra gi^
do hoac tv c6 lap. Nhin bilu h i ^ bl n^oai, ngudi ta ai
the thiy giong mjt nguin c6 khuyjt Ut M n kii*.
nhung chua c6 nghiSn cflu ndo phSt hi?n dugc ri i*B
roi lo^n chlh; nSng nSo cua nguW tir k^, cilng khdng c4
lo?l lhu6c ndo dupe cho 14 hifu qud (S dilu trj tir kj.


Chinh sdch ddi vdi tretvky...
tuong tdc xd hfi, nhung khdng cd day du
dau hidu ddc tnmg cua thdn kinh hay chgm
phdt trien. Do vay, nlu xip t^ ky vao chung
vdi mft trong hai nhdm ndy thi sd rat khd
khdn cho cdc hfi ding dia phuong xet cdng
nhgn khuyet tgt cung nhu phdn hang khuyet
tgt (cac muc n ^ g , tnmg binh, nh?). Ngoai
ra, vide phdn logi nay cd thi dan din nhihig
riii ro ve mdt hda nhgp cdng ding, vl phdn
bift ddi xd, djnh kien, kj' thi cho ngudi t^i ky.
- Xip tv ky vao nhdm "chgm phdt triln
tri tuf" la khdng phd hop vi theo nghien
cim cua cdc nha khoa hgc, cd 75% tre tu ky
cd kem theo cham phat trien, 25% tri tuf

binh thudng va td 3 - 5% rat thdng minh'"**.
Tv ky Id mft rii logn cd mdc dp rat khdc
nhau tir rat nh? den rdt ndng, nhung phan
Idn ngudi cd rii logn tv ky van cd khd ndng
hda nh^p cfng dong va cd the cd nhimg
dng hiln d miic dp khdc nhau cho xa hfi.
- Dua tu ky vdo dang "khuyit tgt khac"
cd thi dan din vifc tuy tifn cho rdng tu ky
Id mft dgng khuyit tat khdng nghiem trgng
vd do dd t^ If trd mdc tv k^ tren thvc tl sS
la mft con so nhidu.
Nhu v$y, dua tu ky vdo bit ky dgng ndo
trong 6 dgng khuyit tgt theo quy dinh hifn
hdnh cung sd khdng hodn toan hgrp ly. Vi
v$y, vifc phan tv k^ thanh nhdm rieng s6
giiap cho cdng ddng nhgn thdc r6 rang hon
vd tv ky, nhdn thdc dupe muc dp nghiem
trpng vd cd chinh sdch ro rdng han cho
nhdm khuyit t§t nay. Quan diem ndy hoan
todn ph^ hpp vdi xu hudng phan logi tv ky
hifn nay d cdc nudc cd trinh df khoa hpc
phdt triln. Ong Daniel Mont, nhdm chuyen
gia cao cdp cua Ngdn hang Thi gidi dang
ho tra xay dvng Thdng tu hudng dan thi
hdnh Lugt Ngudi khuyit tgt cho bilt: " 0
M>f, each phan dang khuyit tgt khac vdi

Viet Nam. Ddi nguac vdi khuyet tat the
chdt (vi du van ddng), la khuyit tdt than
kinh trong dd cd "khuyit tdt tri tuf",

"khuyet tat tam thdn" - va "khuyit tgt phdt
triln". Do phap iuat Viet Nam tach ridng
khuyet tat tri tue va thdn kinh tam thin, nen
so vdi lugt My, khdi nifm "khuydt tat phat
trien", trong do cd tu ky, da bj bien mat. Do
vay, trong ludt Vift Nam, khdng nen dd
khuydt tdt tv ky biln mdt ho^c lan trong cdc
dang tgt khac nhu tri tuf hay than kinh tam than, Ngan hang The gidi cimg mong
mudn tv ky dupe chii y mpt each thod dang
tu cac Bd - ngdnh lien quan"*'^*.
Vifc xdc djnh rdi logn phd tu ky la loai
khuyet tgt nao trong Lugt Ngudi khuyit tat
r^t quan trpng. Vi nd lien quan den chinh
sdch cua Nhd nudc danh cho trd tv ky sau
nay trdn cdc ITnh vvc nghien ciiu khoa hpc,
y tl, gido dvc... Ngodi ra, ddy cdn la co sd
phap ly de tre tu ky vd cac gia dinh cd tre tv
ky dupe thu hudng day du cac chinh sdch
uu vift eua Nha nudc ve y te, gido dye, bdo
trp xa hpi... Nhu vay, nhihig bit cap trong
vifc phdn logi khuyet tat hifn nay dd khien
cho tre tv ky vd cac gia dinh cd trd tu ky
g^p rdt nhidu khd khdn, d|c bift la trong
van de tidp cgn djch vu y te, gido due...
Do chinh sdch chua day du va khdng rd
rang, cung vdi sv thidu thdng nhit vd quan
dilm chi dao cda eac nganh, cdc cap vd
nhdng han chd ve nhdn thiic ciia can bp d
c ^ dia phuang trong vifc xdc nhgn khuyit
""* Nguyin TTij Kim QuJ, Nguyin Vfln Thdy (2009),

"Tflng quan c4c van dl vl tv ky vd cSc bifn p h ^ can
thifp cho tre tg ky trSn thi giiSi v i Irong nirdc". Chuyen
de khoa hpc phyc vy de tdi Xoy dtfng vd thCc nghi$m mo
hinh can thifp sdm tretukyd thdnh pho Hd Ngi, ma s6
DU04-2009-2,tr.4.
*"* httpy/pwAvn/diendan/threads/tu-ky-la-dang-khuyettat-nao229S.

65


Tgp chi Khoa hgc xa hgi Vipt Nam, sd 11(96) - 2015
t^ cho trd tv k)- (khi cho rdng tv ky Id mdt
bfnh cd thi chiia khdi chii khdng phdi mpt
dang khuyit tat) nen mdt sd dia phuang da
tir chdi lam hi so cdng nhgn khuydt tat cho
tre tu ky. Nhilu cha me tre tu ky da thuc sv
gap khd khdn trong qud hinh xin xdc nhan
khuyit tat cho con, do vdy nhieu trd tu ky
vd gia dinh cua trd da khdng duoc thu
hudng cac uu dai ve gido due, y te, bao tra
xd hdi vd an sinh xa hpi nhu cdc ddi tupng
tre em khuyet tat khdc. Dieu dd dd ldm cho
nhung khd khan vdn cd ciia trd tv ky va gia
dinh tre ngdy cang trd nen tram trpng hon.
Nhieu tre tv ky da khdng the den tnrdng vi
hi ky th}, khdng nhdn dupe sv se chia tu cac
bgc phu huynh vd sv ho trp tir nhd trudng;
nhieu tre tu ky Idn len khdng cd khd nang
tv chdm sde ban than nhung lai khdng du
tieu chudn (theo quy djnh cua Ludt hidn

hdnh) dl dupe vdo cdc trung tdm nudi
dudng, bdo trp xd hpi; nhilu gia dinh roi
vao tinh cdnh nghdo ddi do phdi chi tra
nhilu khodn phi trong qua trinh hi lifu, can
thifp cho con cua minh; nhilu cha me cua
he tv ky phdi iing phd vupt siic vdi nhung
edng thdng ma khdng cd sv ho hp tir cdng
ddng, xd hfi...
4. Mft so khuyin nghj
Nhdm giiip trd tv k^ cd co hdi binh ddng
trong tilp can, thy hudng cac dich vy y tl vd
chmh sdch an sinh cua Nhd nudc, trudc mdt
can phdi thvc hifn tit mpt sl vdn dd sau:
Mpt Id, can tdng cudng truyin thdng vl
hpi chung tv ky nhdm nang cao nhan thirc
cua cpng ddng, xd hfi va cua chmh ban
than nhihig gia dinh cd trd tv ky vd hfi
chimg ndy vd sv cin thilt phai cd cdc chinh
sdch uu tien ddi vdi tre tu ky, ho trp gia
dinh cd tre tu ky.
Hai Id, can thiic diy nhanh vifc nghien
66

ciiu xay dung chinh sach ddc thu ddi vdi tre
tu ky vd ho trp gia dinh cd tre tv k^. Trong
dd, cdn de xuat dieu chinh cac chi dp chinh
sdch hifn khdng cdn phii hpp, nhu dilu
chinh muc trp cap xa hpi, miic ho trp chdm
sdc, chinh sdch ho trp gido due, ho trp y
te... ddi vdi tre tv ky vd gia dinh ciia tre.

Ba la, tren thvc te theo nhihig quy djnh
ciia Lugt Ngudi khuyet tgt, ciing nhu cdc
vdn bdn hudng ddn vd xdc dinh mtic do
khuyet tat thi tu ky hidn nay da dupe nhin
nhan Id dang khuyet tat khac; m^c dd chua
thvc sv thda dang nhung can thilt phdi
dupe thuc hifn day du cdc chinh sach dii
vdi tre tv ky, gia dinh tre tv ky. Tiiy timg
mdc df khuyet tgt se cd nhihig chinh sach
ev the de ho tra ddi tupng nay. Tuy nhien,
day Id nhdm dgc thii nen cung cin phai c6
nhihig bifn phdp, chinh sach ddc thO va uu
tien hon.
Bdn la, thuc diy nhanh vifc xdc dinh
muc dp khuyit tat va cip giiy xdc dinh
miic dp khuyit tgt doi vdi tre tv ky. Bk lam
dupe vifc ndy ngoai vifc ban hdnh cac vdn
ban hudng dan thvc hifn chinh sdch, cac co
quan chuc ndng can cd tdi lifu phi biln tac
dpng ciia hdi chiing tu ky; tap huin cho c^
bp ngdnh Lao dpng, Thuong binh, Xd hfi
vd cdn bp chinh quyen dja phuang triln
khai thvc hifn vifc xdc dinh miic dp khuyit
tgt ddi vdi tre em tu k^...
5. Ket lugn
Tu k:y la mpt dgng khuyit tgt phdt triln,
thudng xuit hifn nhimg ndm diu ddi nhung
tdn tgi Idu dai, thgm chi sudt ddi. Cho din
nay cdc nha chuyen mdn van chua xdc djnh
dupe chinh xac nguyen nhdn gdy ra hfi

chiing ndy. Trong bdi canh ciia xd hpi Vift
Nam, khi md djnh kiln xd hdi doi vdi ngudi
tv ky vd trd tv ky cdn kha ndng nl, cdc


Chinh sdch ddi vdi tre t^r ky...
ngudn luc danh cho y td, gido due chua dupe
ddu tu diing muc, su tidp can vd su dvng cdc
dich vy siic khde, giao due cd xu hudng
t^dy cdng gia tdng thi vifc thvc thi chinh
sdch ddi vdi tre tv ky cd y nglua rat quan
trpng ddi vdi gia dinh vd ban than tre tv ky.
Nhung hifn nay, chinh sdch ddi vdi ngudi tu
ky ndi chung vd trd tv ky ndi rieng cd qua
nhidu van dd bat cap va tren thuc td khdng
dupe thvc thi do tu ky khdng phdi la mdt
dang khuyet t$t rieng bift. Vi vgy, d l tu ky
dupe cdc CO quan chuyen njdn vd hogch
dinh chinh sach xem xet, trudc hdt cdn phai
cd sv thing nhat tir nhan thiic den hanh
dfng trong qua trinh van dpng chinh sdch.
Cd nhu vgy, nhihig ngudi mdc chiing tv ky
ndi chung va tre tv ky ndi rieng mdi cd ca
hfi dupe hudng d i y du cdc chinh sach uu
tien vd c h i df h5 tro y te, giao dye, bdo trp
xd hpi tdt nhit, uu vift nhat cua Nhd nudc.
Tdi lifu t h a m k h a o
1. Bfnh vifn Nhi Dong 1 (2008), Tdi lipu
hdi thdo bpnh Tie ^ d Ire em, Sd Y te Tp. Ho
Chi Minh.

2. Bfnh vifn Nhi Trung uang (2006), Rdi
logn ldm than d tre em - Pkdt hipn vd dieu tri,
Tai lifu Hfi thao cgp nhat Kiln thdc Nhi khoa
lan thir VII.
3. Ngd Xuan Difp (2009), Nghien ciiu nhgn
thdc cua Ire lit ky lgi thdnh pho Hd Cki Afinh,
Lu§n dn Tiln sT, Vifn Tam ly hpc.
4. Nguyen Thj Huong Giang, Tran Thi Thu
Ha (2008), **Nghien cim xu thi mdc vd mft so
d^c diem dich te hpc ciia trd tu ky dilu trj tgi
Bfnh vifn Nhi trung uong giai do?n 2000 den
2007", Tgp eh( Yhpc thitc hdnk, sl 4.
5. Qudch Thdy Minh vd cfng sy (2008),
"Tim hieu mft so ylu t l gia dinh vd hdnh vi cua
tre tv ky tgi khoa Tdm than Bfnh vifn Nhi

Trung uong". Trong: Hpi thdo cgp nhgt kien
thiic Nhi khoa nam 2008, Ha Nfi.
6. Nguyen Thj Kim Quy, Nguyen Vdn Thuy
(2009), Tdng quan cdc vdn di vi lu k^ vd cdc
bi^nph^ can thipp cho tre tuky tren the gidi vd
trong nudc. Chuyen de thupc de tai "Xay dvng
vd thd nghifm md hinh can thifp sdm tre tir ky d
thanh phi Ha Ndi", ma so DL/04 -2009-2.
7. Sd Gido dgc vd Ddo t^o Ha Nfi (2012),
Kyyiu Hpi thdo Hda nhgp cgng ddng cho tre tv

;tv,HaNfi.
8. Bjom Ekman, Nguyen Thanh Liem, Ha
Anh Due and Henrik Axelson (2008), Heahh

insurance reform in Vietnam: a review of recent
developments and future challenges. Health
Policy and Planning, 23(4): 252 - 263.
9. Kaimet L. (1942), Autistic disturbances of
affective contact. Nervous child 2; 217-250 (the
pediatricians role In the diagnosis and mangement
of autistic spectrum disorders in children. Pediatrics
107,1221 - 1226).
10. KarenS\ffExkom{2006).AudsmSourcebook
Everything You Need to Know about Diagnosis.
Treatment. Coping, and Healing, Reagan.
11. Koegel LK, Lazebnik C (2004X Overcoming
autism. Viking Penguin, NewYork, USA.
12. Laura Schreibman (2005), Science and
Fiction of Autism, Harvard.
13. Minisby of Health and Health Paitnership
Group (2013), Joint annual health review 2013:
Towards Universal Health Coverage, Hanoi,
Ministry of Health.
14. Power MD (2000), Children with autism.
Woodbine House, USA.
15. />files/documents/media-center/as_prevalence_vs
_costchart-01.jpg.
16. AU
_Sltuation_Revised_2%5Bl%5D.pdf.
17. />
67