THE ongoing controversy over Cebu Pacific's boarding policy for special children has become quite emotional, even irrational. Visit some of the discussions on the Internet and you will find people hurling the most foul of expletives at each other, and at Cebu Pacific.

The fireworks reflect the paradoxical situation that we face. On one hand, special children are all around us. The incidence of autism alone, for example, has been estimated to be about 1 in every 500 children. With about 30 million Filipinos below the age of 14, that means about 60,000 special children, and yet that statistic (1 in every 500) is a very low estimate.

The numbers I have given refer only to children. Many special children will live to adulthood, so we?re really talking about special people who may even reach old age.

Despite the large numbers of special children, our social structures, from family and schools to airlines?are not quite prepared to handle their many needs.

Note how we use the English words ?special child? and that such usage is fairly recent. It?s a good term, but people look at it mainly as a euphemism and will still use it alongside ?retarded? and ?abnormal,? reflecting continuing ignorance of what these conditions involve. The term also tends to lump together different conditions, which are so many that they constitute a bewildering alphabet soup of abbreviations. Even the names given to these conditions and the criteria used for diagnosis are constantly being debated. There are even debates on whether these conditions should be considered illnesses and disorders.

All I can do in two columns is to give an overview of the different conditions. My interest here is as a parent, trying to educate other parents. It is important that we know what these conditions to be able to identify them in our own or other children, so professional help can be extended as early as possible. At the same time, as a medical anthropologist, I want to bring out some cultural issues which are rarely discussed among medical people. These issues contribute to the dilemmas in public policies, such as what we are seeing with Cebu Pacific.

Delays

The first case that Cebu Pacific had to deal with involved a child with ?global developmental delay? or GDD. (Sometimes you?ll even find GDDD, the last D standing for disorder.) GDD is diagnosed when a child?s development is delayed in two or more of the following areas or domains: gross/fine motor (referring to physical movements and coordination), speech/language, cognition (being able to recognize and differentiate objects), social/personal and daily living activities. Sometimes the term ?DD? is used when the delay is found only in one or two of the domains.

The problem here is defining a delay. The diagnosis is based on norms that have been established based on studies that observed large numbers of children. For example, around the area of language development, you will find books that say a child should have a vocabulary of around 200 words by the age of 2. I can imagine some of my readers beginning to panic now, as I did when I first heard that standard. Imagine me in the middle of the night doing an inventory of my son?s vocabulary and not even reaching 50 despite including ?ai ya!? (a Chinese exclamatory expression) and ?ambot? (Cebuano for ?don?t know,? which he picked up from household helpers).

But the anthropologist in me protested that we don?t have studies in the Philippines that established the norm, and given that all our children are growing up in households with at least two, and often more, languages, there?s bound to be some ?delay.? As you might have guessed, my son, who is now 4, cannot stop jabbering, and in three languages at that.

Let?s get back to GDD. I want to emphasize that GDD is not interchangeable with MR or mental retardation, a label that is being very seriously debated. In language-conscious America, there is even a move to stop the conversational use of ?retarded? because it is seen as discriminatory.

But discrimination is something social. ?Retarded? in itself, just like ?ill? and ?sick,? should be neutral terms, used without judgment. To be ?sick? is to be in poor health, yet notice how sometimes, it can mean ?perverted? or ?insane.?

Likewise, ?retarded? and ?delayed? simply means not being at the same level of the statistical ?norm.? So if a majority of 2-year-old children have a vocabulary of 200 words, a child with less than that would be considered ?delayed?? even ?retarded??if we want to be statistical.

It?s society that reads additional meanings in ?delayed? or ?retarded.? MR sounds particularly offensive because the ?mental? is tied to intelligence, and indeed an MR diagnosis is mainly based on results of IQ tests. The problem though is that IQ test results are affected by cross-cultural differences. Then, too, there are many forms of intelligences that IQ tests do not capture.

Remember the film ?Rain Man? (Dustin Hoffman and the song ?Raindrops are Falling on My Head?)? The film was based on the life of Kim Peck, who died just recently at the age of 58. As a child, Peck was diagnosed as being seriously mentally retarded and his parents were advised to just put him away in an institution. They decided to care for him at home. Although all his life he needed help with many daily activities, he could read eight books a day (two pages simultaneously, one with each eye). At the time of his death, he had a 30-hour-a-week job.

Autistic children are also considered special, but there are so many variations here that medical people use the term autistic spectrum disorders (ASD). As the name implies, we?re talking about variations on what might be one condition of autism. Many Filipinos will remember the TV public service ads trying to raise public awareness of autism showing a child banging her head on the wall. Autism does involve repetitive forms of behavior, but it does not have to be head-banging.

There are also debates about what should be included in ASD. Right now, for example, the American Psychiatric Association lists Asperger?s disorder separately from ASD, since Asperger?s involves difficulties in reading other people?s emotions. There?s a proposal now to merge Asperger?s into ASD, a move opposed by some people with Asperger?s.

We see now how ?special child? can mean so many different conditions. To add to the confusion, there can be overlaps, for example, between GDD and MR. In addition, there are other conditions associated with GDD and MR. For example, a person with Down?s syndrome (as in the second Cebu Pacific controversy) may also be MR, but not all MR cases involve Down?s syndrome.

I will discuss all that on Friday, and then move on to looking at how we might handle the problems of cultural stigma and discrimination associated with these conditions.

(Read more about Kim Peck on: http://www.guardian.co.uk/world/2009/dec/22/kim-peek-rain-man-dies?CMP=AFCYAH)

Email to mtan@inquirer.com.ph