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Current status of difficulties and needs of disabled children through research in Quang Ngai Province

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HNUE JOURNAL OF SCIENCE
Social Sciences, 2020, Volume 64, Issue 4D, pp. 105-114
This paper is available online at

CURRENT STATUS OF DIFFICULTIES AND NEEDS OF DISABLED CHILDREN
THROUGH RESEARCH IN QUANG NGAI PROVINCE

Nguyen Minh Phuong and Hoang Thi Nho
Faculty of Special Education, Hanoi National University of Education
Abstract. This article show some screening results of children with disabilities in Quang
Ngai province done byHanoi National University of Education with the technical and
financial assistance of Christoffel-Blindenmission Christian Blind Mission (CBM) in
Vietnam under the project: “Strengthening the capacity of inclusive education network for
children with disabilities in Quang Ngai province, Vietnam”. From statistical data and
survey indicated that the resource for early intervention and inclusive education in Quang
Ngai need to be improved to meet the need of children with disabilities. The paper also
given the recommendation for families of children with disabilities and other relevant
agencies in Quang Ngai Province to solve difficulties and meet the needs of children with
disabilities in the locality.
Keywords: chillden withs disability, congenital causes, early intervention, inclusive
education, family circumstances.

1.

Introduction

In Vietnam, the prevalence of disability found in the 2009 Census is 7.8%, of which 4.7%
are children and adolescents from aged 5 to 18 years (Census 2009) [1]. However, there are
unreliable and outdated data on the number of children under 5 years old with disabilities and
information about the types of disabilities. The most recent robust analysis found the total
number of children aged 0-18 years with disabilities to be 662.000 (2.4% of the total child


population aged 0-18 years). In the 0-6 age group, 76 % of the disabilities is caused by
congenital birth defects and 21 % of the disabilities are caused by diseases [2].
The various causes of disabilities include congenital (35.8%), disease (32.34%), the
consequences of war (25.56%), occupational accidents - especially road accidents (3.49%) and
other causes (1.57%). Information from 2001 to the 2006 shows 125,000 people with
disabilities, on average each year about 25,000 people [3]. The reasons reflect human factors,
as well as the fact that early childcare and the levels of health services limited in controlling
diseases that lead to high disability rates. The consequences of war are also a major cause, not
only with the current generation, but also future generations, especially victims of dioxin
during the Vietnam-American War [3].
To fit the legal system and international practices to which Vietnam is committed, and
especially to meet the desire of persons with disabilities, the Law on People with Disabilities
established in 2010 [4]. This was the first step - a very important one – towards the recognition
of the responsibility by the Vietnamese Government to include people with disabilities in its
Received April 11, 2020. Revised April 24, 2020. Accepted May 15, 2020.
Contact Nguyen Minh Phuong, e-mail address:

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Nguyen Minh Phuong and Hoang Thi Nho

agenda. With the establishment of this law, the Vietnamese Government recognizes their existence,
guarantees their rights, and takes responsibility as the first agency to implement this law.
An Education Support Policy for people with disabilities has regulated in the law and under
law documents. The Law on People with Disability Vietnam 51/2010/QH12 has one chapter
regulating education for people with disabilities [4]. The Decree 49/2010/ND-CP regulates
school fee exemption and reduction for students with disabilities [5]. Decision 23/2006/QDBGD&DT regulates inclusive education for people with disabilities (PWD) [6]. Decree
28/2012/ND-CP regulates detailing and guidelines the implementation of several articles of The
National Law on Disability [7] and Circular 03/2018/ TT-BGDDT regulates inclusive education

for PWD [8].
In theory, the existing policies have mentioned and impacted on all related objects in many
areas, including education support systems for PWD. The significant policies include rights of
PWD to education, approaches and education establishments for PWD, preferential policies on
school fees, policies for those who work in education for PWD, and guidelines as to the
contents, approaches, methodologies and assessment of PWD’s education [9].
The Vietnamese Government invests a high proportion of its national budget towards
educational services for children. The Government is committed to improving its education
system to deliver inclusive education for children with disabilities. Ministry of Education and
Training MOET has showed leadership to operationalize the Government’s commitment to
provide education for children with disabilities. MOET set up a Committee on Education for
Children with Disabilities and Children under Special Circumstances, chaired by a Vice
Minister, with representatives from related departments to provide directions and to monitor the
MOET’s work.
Inclusive education for children with disabilities in Vietnam can be said to have officially
shifted from being understood as a “humanitarian” activity to showing responsibility by the
actions of individuals. In addition, the quality of education for children with disabilities is
improved, not only focussing on mobilizing numbers to integrate classes but also paying
attention to the quality of learning for children with disabilities [10], [11].
In order to achieve this goal, the screening and assessment of the difficulties and needs of
children with disabilities is an indispensable requirement, not only to help teachers plan care,
but also to help educators and other stakeholders to make decisions that help schools, families,
community members, and social organizations implement and coordinate care and education for
children with disabilities effectively.
Based on the findings of the screening program for children with disabilities in Quang Ngai
province in May 2017 conducted by the Faculty of Special Education, Hanoi National
University of Education, with the technical and financial assistance of CBM in Vietnam under
the project: “Strengthening the capacity of the inclusive education network for children with
disabilities in Quang Ngai province, Vietnam” [12], this study has been undertaken to analyzie
difficulties and needs of Children with Disabilities in the following: children with hearing

impairement, children with visual impairement, and children with motor disability.

2.

Content

2.1. General Introduction to Research
The study aimed at assessing the developmental areas, needs for the care and education of
children with disabilities under the age of 16 in three locations in Quang Ngai Province,
including: (1) developing the natural resources of Quang Ngai province; (2) assessing the
developmental areas and needs in 5 wards / communes (including 5 pilot schools and 5 primary
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Current status of difficulties and needs of disabled children through researeach in Quang Ngai province

schools) in Quang Ngai; (3) assessing the developmental areas and needs in 5 communes
(including 5 preschools and 5 primary schools) in Binh Son district.
The content focuses on two main issues: (1) Evaluating the developmental areas of the
child, including: physical, motor, sensory, language, communication/social interaction,
awareness, behavior, character; and emotional health; (2) Assessing the needs of children,
including: the need for medical care, early intervention/rehabilitation and education.
The evaluation tool is based on existing tools used around the world and updated and
adapted for the actual situation of children with disabilities, their families, communities and
schools in Vietnam. The toolkit for evaluating children with hearing impairment, visual
impairment and mobility impairment includes 5 elements (1 general evaluation form, 1 in-depth
evaluation form for hearing impaired children, 2 assessment cards for visual impairment and 1
evaluation form for children with mobility disabilities).
Specific assessment methods include: (1) Direct evaluation of the child: Using appropriate
assessment tools for each type of disability (pre-primary and primary); (2) Parents of children with

disabilities interview: Asking the parent or caregiver of children with disabilities at the time of the
child's visit for relevant information to further clarify the information from the direct evaluation of
the child; (3) Studying / examining children with disabilities records (medical, study, ...).
The number of children assessed with hearing impairment, visual impairment and motor
impairment was: 69 hearing impaired children, 10 visually impaired children and 28 children
with mobility impairment.

2.2. Findings
2.2.1. General Information on Groups of Children with Disabilities
Table 1. General information of children with disabilities
Group of
disabled
children

Children with
hearing
impairment

Children with
visual
impairment

Children with
mobility disabilities

Total

Statistical
content


Number

%

Number

%

Number

%

Number

%

1. Gender
(Total)

69

100

10

100

28

100


107

100

Male

34

49.3

7

70

14

50

55

51.4

Female

35

50.7

3


30

14

50

52

48.6

2. School level
(Total)

69

100

10

100

28

100

107

100


Not yet
attending school

1

1.4

1

10

3

10.7

5

4.5

Preschool

6

8.7

2

20

3


21.4

11

10.3

Primary school

62

89.9

7

70

22

78.6

91

85.1

Youth

0

0


1

10

0

0

1

0.93

3. Term of
education
(Total)

68

100

9

100

25

100

102


100

Special
education

55

80.9

1

10

3

12

59

57.8

107


Nguyen Minh Phuong and Hoang Thi Nho
Inclusive
education

13


19.1

8

80

22

88

43

42.2

4. Early
Intervention
(Total)

69

100

10

100

28

100


107

100

Yes

3

4.3

2

20

5

17.9

10

9.3

No

66

95.7

8


80

23

82.1

97

90.7

5. Family
circumstances
(Total)

69

100

10

100

28

100

107

100


Poor

8

11.6

1

10

2

17.1

11

10.2

Near poor

11

15.9

1

10

12


42.9

24

24.8

Average

44

63.8

8

80

14

50

66

61.7

Wealthier

6

8.7


0

0

0

0

6

5.6

6. Confirmation
of disability
(Total)

69

100

10

100

28

100

107


100

Have been
granted
disability
certificates

51

73.9

1

10

6

21.4

58

54.2

Have not been
issued a
certificate of
disability

18


26.1

9

90

22

78.5

49

45.8

The Table 1 reflects that children with disabilities who are mobility disabilities, hearing
impaired, visually impaired and mobility disabilities at the point of screening show the
following statistical content:
Gender: The proportion of boys and girls surveyed was similar with 51.4% males and
48.6% females in total ( 49.3% males and 50.7% females of children with hearing impairement;
the number of boys who are visually impaired is twice that of girls who are visually impaired;
the proportion of boys and girls surveyed who are mobility disabilities was similar, with 50 %
males and 50% females).
At school level: Primary children were in the the majority with 85,1% in comparision with
children who are not yet attending school (4.5%), who are preschool children (10.3%), who are
youth (0.93%). Remaining with 89.9% children with hearing impaired, 70% children visually
impaired (7 children, accounting for), 78.6% who are mobility disabilities were children of
primary school age. This number indicated that’s in Quang Ngai province, the education
communicate and implemented mostly done with Primary school level based on compulsary
education law at primary level.

In terms of education: Special education (57.8%) and inclusive education (42.1%). There is
a deference in children with hearing impaired with very high rate of children attend in special
education (80.9%), inclusive education (19.1%). This number indicated that human recousre of
inclusive school should be improve to meet the need of children with hearing impaired because
most of them use sign languge to communicate in school.
Early Intervention: The rate of early intervention was very low (9.3% in total). This will greatly
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Current status of difficulties and needs of disabled children through researeach in Quang Ngai province

affect the development of the children, directly affecting the opportunity to integrate children.
About family circumstances: Mostly were average (61.7%), followed by near poor
(24.8%), less well off and poor. Some children came from poor and disadvantaged families
where the children had no parental care but were looked after by grandparents.
Confirmation of disability: A large number of children have been granted disability
certificates (54.2%). Most of the children who have not been issued a certificate of disability are
under-age (according to the commune regulations – they need to be over 6 years old).
2.2.2. Difficulties and Needs of Groups of Children with Disabilities
2.2.2.1. Difficulties and Needs of Children with Hearing Impairment
Of the 69 children evaluated, 68 children were found to be deaf from birth, 1 child with
cleft lip was not deaf.
Children with hearing impairment were evaluated for congenital deafness and late detection
of deafness. For most of the children there was no early intervention (only 3 children were in
early intervention programs). The children with hearing impairment have significant speechlanguage difficulties which affects their social and cognitive abilities.
At the time of the test, 100% of the children with hearing impairment were equipped with
hearing aids. Most of them had been wearing hearing aids since May 1, 2017, funded by the
Starkey Hearing Foundation. A hearing aid test showed that: 51.5% of hearing aids worked
well; 48.5% of hearing aids had little or no effect. Although there are hearing aids, only 27.9%
of the hearing impaired children were able to hear at a hearing level; 8.8% of children with

hearing impairment were at the stage of speech recognition; 52.9% of the hearing impaired
children could detect sounds while wearing hearing aids and 10.3% of hearing impaired children
did not hear any sound at all (chart 1). Most children with hearing impairment can hear midrange and lower frequency sounds better than high frequency ones. The percentage of children
under 3 who could hear the Ling six sound test was quite large (25.1%), 13.2% of the children
heard 4 sounds, 7.4% of the children heard 5 sounds and 44.1% of the children heard all 6
sounds in the Ling test.

Chart 1. The level of hearing skills of children with hearing impairment
Among children with hearing impairment, only about 20% of the children have the ability
to understand and express themselves in a less restrictive way, including one who spoke well as
a child. These are children who have had early intervention and/or have been well-equipped
with hearing aids. These children have great potential to develop spoken language, to be able to
study in an inclusive education environment. Of the others, over 80% of children with hearing
impairment had significant difficulties in understanding and expressing words. Specifically,
children with hearing impairment are limited in verbal and written communication (with
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Nguyen Minh Phuong and Hoang Thi Nho

average scores of1.52 and 1.7). Over 60% of the children did not have verbal capacity.
Approximately 80% of the children with hearing impairment did not pronounce words well, lost
or omitted the first syllable or just made sounds. 17.6% of the children had hoarse voices. 38.2%
of the children with hearing impairment used voice. 8.8% of the hearing impaired children had
nasal sounds). Reading and writing ability was quite limited (children often found it difficult to
choose words, wrote words in the wrong grammatical order and their ability to read text was not
good) (Table 2).
Table 2. Levels of understanding and expression of children with hearing impairment
Ability


Understanding (%)

Expression (%)
Average
overall

Means of
communi
-cation

Not
yet

Limit

Limited

Good

Medium
score

Not
yet

Limit

Limited

Good


Medium
score

Speech

63.2

14,7

20,6

1,5

1,6

73,5

8,8

16,2

1,5

1,45

1,52

Sign


17,6

14,7

10,3

57,4

3,07

17,6

14,7

10,3

57,4

3,07

3,07

Writing

51,5

25

23,5


0,0

1,72

51,5

27,9

20,6

0,0

1,69

1,7

Visual
images
and
actions

0,0

0,0

0,0

100,0

4,0


0,0

0,0

0,0

100,0

4,0

4

Among 55 children currently enrolling in the Center for Inclusive Education Development in
Quang Ngai Province, most of them have not been provided with early intervention, have limited
speech and ability to communicate. Children are able to communicate fairly well in sign language.
The learning ferformancemost have been achieved according to the specific program that children
are studying. There is quite a high rate of children have significant difficulties in reading
comprehension and sentence writing. However, in this group there are some children who are able
to hear at a basic level and are well aware. These children could be transitioned to an inclusive
environment with the support of the Inclusive Education Development Assistance Center.
Among 13 children with hearing impairment screened in the community, 5 children had
early intervention and/or were fitted with appropriate hearing aids, had good hearing ability and
were intergrated in regular school. The remaining children, with hearing aids that are not
effective, are not able to hear and express speech. These children do not know sign language,
cannot read and write, so these children do not have the language with which to communicate
and to learn, which seriously affects their development of cognitive behavior. These children
should be screened and fitted with appropriate hearing aids. They will need assistance from the
Inclusive Development Support Center to learn sign language to access communication and the
synthesis of language.

2.2.2.2. Difficulties and Needs of Children with Visual Impairement
Among 10 children with visual impairment surveyed, the number of children who had
vision at the lowest level was the highest (60%). Most of the children’s impairements are due to
birth defects. The number of children with cataracts is high (40%). Of the four children with
cataracts, only two were examined at major hospitals (Da Nang Hospital and HCM City Eye
Hospital), and one was involved in cataract surgery at the age of 3. After the first surgery the
results were that his visual impairment was classified as severe. Assessment now shows that his
eyesight has progressively improved and he can wear glasses to read and write well.
Almost children with visual impairment have certain difficulties in mobility and
independence skills due to visual limitations. Only a small percentage (2 children—20%) had
visited to large hospitals for intervention and, periodic treatment. All 10 children had different
degrees of visual impairment with varying degrees of effect on their ability to learn, exercise
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Current status of difficulties and needs of disabled children through researeach in Quang Ngai province

and to be independant. In particular, one child was older but was not supported to learn to read
and write at a young age and this seriously affects that child’s ability to read and write today.
Two children with visual impairment had severe effects on learning ability and they had signs of
other disabilities.. Visual difficulties also have a profound effect on the children's ability to read
and write, and all the students surveyed had slower reading and writing skills. The survey also
showed that Quang Ngai Center for Inclusive Education and Development has not yet
implemented supportive activities for visually impaired children and is without professional
support staff. Learning in an integrative environment of underprivileged children is also
inadvisable and needs a great deal of support for the adjustment of teachers and facilities at
home and at school. Only two children used personal lights when studying.
There was a child with visual impairment who is currently studying in kindergarten. She
needs to develop tactile skills, directional movement and be prepared with pre-Braille reading
and writing skills so that she can prepare for primary school. Both school teachers and teachers

at the Center for Inclusive Education have not prepared enough to meet the needs of primary
school children. There was another 6-year-old-child with visual impairment who need to study
and be provided with support in many specialized and individual approaches.
Among the remaining cases, most of them are low-vision children who can study in
inclusive schools now, but they need support in adjusting the equipment and support facilities to
ensure better conditions for the development of the children's literacy. However, schools and the
families are not aware of the importance of this and they lack knowledge and skills in
supporting and adjusting the learning environment for these children.
2.2.2.3. Difficulties and Needs of children with Mobility Disabilities
Among 28 children with mobility impairments, the number of children with disabilities in
the lower limbs is high. Most childrens’ mobility impairment was due to congenital causes (25
children, 89.2%). Among of them, 3 children with mobility disability was due to accidents
(accounted for 11.8%). At the time of the survey, most children with mobility disabilities did
not have any means of support in their daily activities and travel
Results of the evaluation also indicate that among the children with mobility disabilities
who were screened, there was a high proportion of children with cerebral palsy (a total of 17
children, accounting for 60.9%). The mobility, pronunciation, independance skills and literacy
of children with mobility impairments are affected.
28 children assessed with mobility impairments had different degrees of motor impairment.
There were three children who did not clearly show a degree of movement impairment that
would have a strong influence on the development of the child. (One child had signs of health
problems that need to be followed up and two sisters had weak but difficult mobility but the
main disadvantage for these girls is their limited ability to learn.
In most cases, children with mobility disabilities have very difficult family circumstances
and very few children have wheelchair support. Of the children who received screening, three
children with disabilities were examined at the hospital and participated in a rehabilitation
program and an early intervention program. For one child, although the assessment was heavy,
the effects of motor disability on speech and learning are unknown. These children are given
appropriate and effective early intervention because parents are well aware of the importance of
rehabilitation and early childhood training.

Among children with learning dificulty who are currently studying at the Quang Ngai
Inclusive Education Development Center, most of them have language difficulties and cognitive
abilities are attained according to the specific program they are following. They have significant
language difficulties because of the impact of violence. Among the children who study here,
there is one child who, although the level of motor impairment is quite severe, has been well
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Nguyen Minh Phuong and Hoang Thi Nho

educated., There are many advances that can be considered so that the children can be
transferred gradually into an integrated environment with the support of the Inclusive Education
Development Center.
For children with mobility disabilities in Quang Ngai and Binh Son Districts, there are 3
children in kindergarten, 22 children in primary schools, and 3 children of preschool age
learning. Understanding the views of parents and the school shows that they often have a point
of view when the children are independent and are able to walk, parents can get them to school,
which limits their motivation. This has greatly reduced children's chances of early integration
Out of 3 children who have not attended school, 2 children were interviewed by pre-school
teachers, both of whom were able to communicate well but the severity of motor impairment
was very high and they needed wheelchairs to support mobility to be able to integrate. However,
they have not been able to attend school due to the difficult economic conditions of the family.
Only grandparents are the main caregivers.

3. Conclusions and recommendations
3.1. Some General Conclusions Drawn from the Research Results
The time of detection of disabilities is quite late. Most children with disabilities do not
receive treatment and intervention in time so that the quality of social skills and learning (both
specialized and inclusive) are very limited.
The current disability certificate is not suitable: children over 6 years old are eligible for a

disability certificate.
Teachers lack knowledge and skills in assessing, treating, intervening and supporting CWD
(young individuals and in classrooms and schools). There is a lack of skills and tools to
communicate with children with disabilities. This is show that most of children who are deaf are
attending in special school system. Similarly, parents have not been guided for adjustments to
support their children in living and studying at home.
There is a lack of equipment for teaching and learning in the school and in the family. Only
a small number of children with disabilities (hearing impaired, motivated) are provided with
supportive devices (hearing aids, wheelchairs) and teachers and parents have not been instructed
on how to use them.
Schools, social services, and the Quang Ngai Inclusive Education Development Assistance
Center are not yet ready to support children with disabilities and their families in assessing
developmental needs, intervention, counseling and organizing activities to ensure the
participation of children with disabilities in schools and communities.

3.2. Recommendations
Based on the above findings, we make some recommendations for families of children with
disabilities and their families in Quang Ngai Province as follows:

3.2.1. For Families with Children with Disabilities
Seek information and opportunities to acquire knowledge and skills to care for and provide
intervention. and support for children with disabilities online, in workshops, club activities and
other activities with people with disabilities, community activists and schools that welcome the
participation of children with disabilities.
Maintain regular contact with Quang Ngai Inclusive Education Center and local schools to
receive support and counseling on how to care for, provide intervention, and treat and educate
CWD in the community. At the same time, families should regularly exchange information
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Current status of difficulties and needs of disabled children through researeach in Quang Ngai province

about their children with disabilities with teachers, staff and managers of these specialized units.
Maintain regular follow-up of family therapy activities, intervention, and support to
children with disabilities on the basis of learning observation from the guidance of school
teachers and the Inclusive Education Center.
Select and decide on the educational environment or mode or to combine therapeutic,
intervention and educational modes appropriate to the abilities and needs of children with
disabilities.

3.2.2. For Quang Ngai Inclusive Education Center
Be active and cooperate with provincial agencies and organizations to organize awarenessraising activities for parents of children with disabilities and members of organizations and
stakeholders on disability issues and rights of children and on disability knowledge, skills in
care, treatment, intervention and support for children with disabilities.
Develop programs and organize evaluation, treatment, intervention, education, support for
children with disabilities, and counseling for family members in the Center to meet the integration
needs of children with disabilities (1 to 2 times per week, 1-2 hours per child at the Center).
Regularly coordinate with the education and training sections and local integration schools
to identify and plan for support for children with disabilities and provide professional support to
teachers who are teaching in inclusive education.
Develop a plan to support children with disabilities at Centers and kindergartens and
primary schools in the 2017-2018 school year, focusing on the schools in the project area.
Choose, plan, and train to improve the capacity of the staff to meet the above-mentioned
tasks and activities (audiology, children's evaluation, early intervention and treatment, use of
communication tools, etc.).
There should be a transition plan for children with disabilities who are able to integrate and
those who transfer to secondary school or to vocational training institutions in the area.

3.2.3. For the Two Education and Training Offices (Quang Ngai City and Binh Son
District) and Kindergartens

Take initiative and coordinate with units / organizations of the district / commune (Health,
Labor, and Social Affairs, Culture and Information, People with Disabilities) to organize
activities to raise awareness, provide information for parents of children with disabilities and
members of organizations and stakeholders on disability issues, rights of children with
disabilities, knowledge and skills in the care, treatment, intervention and support for children
with disabilities.
Regularly collaborate with the IE Development Support Center to assess, treat, intervene
and support the integration of children with disabilities and improve the knowledge and skills of
teachers. At the same time, ensure close coordination with the families of children with
disabilities in organizing the implementation of these activities.
Develop a plan to detect, receive, pay for classes, and support children with disabilities at
school in the school year 2017-2018 and strengthen the guiding role of the Department of
Education and Training for this work.
Select the core staff of the Department and each school and at the same time have
implementation plans to train and foster the capacity of this core team to meet the delivery of
focussed tasks and activities.
Proactively provide information and records to the commune / ward level disability
determination council to help streamline the process of granting disability certificates.
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Nguyen Minh Phuong and Hoang Thi Nho

3.2.4. For Quang Ngai Department of Education and Training
Strengthen the direction of the Education and Training Divisions and schools on statistics,
dossiers and plans for individual education for children with disabilities.
Direct Education and Training Offices, schools providing education, teaching and inclusive
support for children with disabilities who have not been issued with a disability certificate (but
have been provided with family, teacher and or for children who are not on the list of disabilities
under the Law on People with Disabilities (such as children with autism disorder, children with

learning disabilities, etc.).
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