Identification and Assessment

Timely identification of impairments, a secondary prevention, can reduce the impact of the impairment on the functional level of the individual and also in checking the impairments from becoming a disabling condition. Initially they need to be identified as soon as possible at home by the parents and outside (in the anganwadi centres/ schools/ sub - health centres/ through camps), and then they need to be assessed through a team of specialists to plan necessary interventions

Home

Parents can observe and identify the children with disabilities by using the following checklist for early identification of disabilities:

Hearing Impairment

Screening New Born

• Is there anyone in the family with deafness since childhood?
• Did the mother take an abortificient drug or any other medicine in large doses during the first three months of pregnancy?
• Is the birth weight below 1500 gms.
• Did the child have a delayed cry after birth?
• Did the child have significant jaundice (yellowness of eyes) during the first10 days after birth?
• Does the child have a cleft in the lip or palate, or a malformed pinna?

Screening Children in the age group of 6 months to 2 years:

• Does a child turn towards the source of sound which is located either at the back or towards one side of the body?
• Does he/she have discharge from the ear?

Screening Children above 2 years age

• Does he/she turn when called from behind?
• Uses gestures excessively
• The child does not speak or has a defective speech.
• The child does not understand the spoken language.
• The child has an ear discharge.

Visual Impairment

• The child does not follow an object moving before his eyes by 1 month’s age.
• The child does not reach for toys and things held in front of him by 3 months age.
• One eye moves differently from the other; including squint
• Eyes are either red or have a yellow discharge or the tears flow continuously.
• The child has tendency to bring pictures or books very near the eyes.

Mental Retardation

• Does the child respond to name/voice by 4^th Month?
• Does the child smiles at others by 6^th Month?
• Does the child hold the head steadily by 6^th Month?
• Does the child sit without support by 12^th Month?
• Can the child stand without support by 18^th Month?
• Can the child walk well by 20^th Month?
• Can the child talk 2 -3 word sentences by 3^rd Year?
• Can a child eat/drink by himself by 4^th year?
• Can he tell his name by 4^th year?
• Does he have toilet control by 4^th year?
• Does he avoid simple hazards?
• Does he get fits?

Locomotor Disability

• The child is not able to raise both the arms fully without any difficulties.
• The child is not able to grasp objects without any difficulty.
• The child has absence of any part of the limb.
• The child has a difficulty in walking.

Outside

In the rural and tribal areas as well as in the urban - slums, early identification is done through door - to door surveys, screening children at the anganwadis, schools, health centres, sub - health centres, rehabilitation centres or through camps usually organized by the voluntary workers, or else.

Anganwadi Centre – ICDS

The Department of Women and Child Development under the Ministry of Human Resource Development, has been implementing the programme of Integrated Child Development Scheme(ICDS) since 1975. An angandwadi Centre under the programme is located in each village and is run by an anganwadi worker. Some of the important objectives of the scheme include improvement of the nutritional status of the children in the age group of 0 - 6 years, providing nutrition and health education for every woman in the age group of 15 - 44 years and improving the capability of the mothers to loo k after the normal health and nutritional needs of their children. An anganwadi worker is required to do early detection of the disabilities in children present at their anganwadi centres

Sub - Health Centres - Primary Heatlh Centres

India has a well-established network of Primary Health Centres, each catering to a population of 30 to 40 thousand. These have sub - health centres at the field level. Each sub - health centre caters to a population of around 3000 persons and is managed by one female health worker. Under the programme of MCH (Mother & Child health) the worker takes care of the children by providing immunization, and vitamin A supplementation to children below 6 years of age. She also identifies the health problems which may lead to disability and takes further preventive action.

School

Teachers in all the primary, upper primary and secondary government schools have a responsibility to identify children with disabilities.

Check list for identification of children with special needs: (School teachers and parents should use this check list).

Visual

• Watering of eyes.
• Recurrent redness.
• Often irritation.
• Frequent blinking
• Squint.
• Inappropriate stumbling over objects or bump into other people
• Tilting of the head or closure of one eye.
• Headache while doing fine work.
• Difficulty in counting the fingers of an outstretched hand at a distance of one meter.
• Moving head side to side while reading
• Difficulty in recognizing distant objects
• Difficulty in doing other fine work requiring perfect vision.
• Holding books too close or too far from the eyes.
• Frequently ask other children when taking down notes from the black board
• Exhibit difficulty in reading from the blackboard.
• Hitting against the objects on the side.

Note: If any of the above 4 responses are yes, then the child should be properly examined by a qualified ophthalmologist to see if the existing condition can be improved by medical treatment or by using spectacles.

Hearing

• Malformation of the ear
• Discharge from ear
• Pain in ear
• Irritation in ear
• Trying to listen from a closer distance
• Ask for the instructions repeatedly.
• Not able to write properly.
• Trying to listen to the echo reflection rather than from the speaker
• Make errors while copying from black board.
• Frequently ask a colleague to show his workbook.
• Problems in paying attention in the class
• Favour one ear for listening purposes.
• Problems when anyone speaks from behind.
• Child speaks loudly or too softly.
• Exhibit voice problem and mispronunciation
• Tune the TV/Radio too loud.
• Irrelevant answers.
• The child keeps away from his age mates.
• The child is unable to respond when you call from the other room.
• The child understands only after few repetitions.

Note: If any of the above 3-4 questions elicits response that indicates some kind of hearing/speech loss, then the child should be carefully examined by a qualified ENT specialist, an audiologist, and also by a speech therapist for complete evaluation. In case the child is below 4 - 5 years, a psychologist should also be consulted to address and identify any associated psychological problems which may not be overtly evident.

Speech

• Inappropriate sound in speech
• Stammering
• Baby speech
• Inability to learn correct sound and use incorrect speech
• Incomprehensible speech

Physical Disabilities

• Deformity in neck, hand, finger, waist, legs
• Difficulty in sitting, standing, walking
• Difficulty in lifting, holding, keeping things on floor
• Difficulty in moving or using any part of the body
• Difficulty in holding pen
• Using a stick to walk
• Jerks in walking
• Lack bodily coordination
• Epileptic behaviour/have tremors
• Joint pains
• Any part of the body is amputated.

Note: If answer to any of the above written statements is positive, the child should be carefully examined by a qualified orthopaedic surgeon and referred to a physiotherapist &/or prosthetic/orthotic technician as needed.

Mental Retardation

• If the child does not sit unassisted even much after 12 - 15 months
• Or starts to walke ven much after 2 ½ years.
• Or starts to talk even much after 2 ½ years.
• If a child has undue problems in doing independently any of the following activities by the age of 6 years
  • Eating
  • Dressing or
  • Toilet activity
• Problems in holding a pencil/ or using a scissors
• Unable to play with a ball; or play ‘guilli -danda’ with his peers.
• Frequent tantrums, while playing with the peers
• Usual inattentiveness to the spoken speech or addressal
• Requires too many repetitions to remember simple things
• Problems in naming even 5 fruits, vegetables or plants
• Problems in naming the days of the week
• Exhibit problems in expressing the needs in a clear language unlike the other peers
• Unable to concentrate on tasks even for a short period of time
• Inappropriate oral responses
• Difficulty in performing daily routine work
• Poor comprehension of lessons taught in the school class
• Difficulty in learning new things
• Difficulty in conceptualization
• Does not get well along with the children of same age group
• More efforts are required in learning or practicing as compared to the peers.
• Takes an unreasonable amount of time in perfecting any work
• Poor academic achievements
• Show an undue dependency on visual clues or material for learning.

Note: If the responses to any of the above 4 indicators is positive when compared to the average school going peers of same age group & class then the child should be properly assessed by a qualified psychologist or a teacher who is specially trained to take care of the mentally challenged children.

Learning Disabilities

• Difficulty in counting
• Lack of concentration or easily distraction by the surroundings, either at home or school
• Difficulty in sitting quietly in the classroom
• Does not write down the spoken words correctly
• In appropriate additions to the right word; e.g. ‘ischool’ in place of school
• Always confused between Right & Left
• Unreasonable difficulty in remembering the verbal instructions
• General difficulty in memorizing the things
• Extreme restlessness in a child which significantly interferes with the timely completion of various tasks
• Reverses letters or symbols too frequently while reading for example b as d, saw as was, etc.
• Reverses numbers too frequently while reading or writing for example 31 as 13, 6 as 9,etc.
• Excessive errors during reading like looses place or repeat / insert/ substitute/omit words.
• Poor in mathematical calculations
• Problems in accurate copying from the common sources like a book or a blackboard, even though the vision is normal.
• Write letters or words either too close or too far (spacing problems).
• The child appears to comprehend satisfactorily but is not able to answer the questions.

Note:

• If the answer to any of the above 3-5 statements is positive, the child should be carefully examined by a qualified psychologist/paeditrician/ or a special educator for initial screening & further consultations.
• One of the main characteristics children with learning disabilies is that their verbal skills are often much better than the writing skills. Therefore, they should be formally tested in order to elucidate their disabi lity in detail.

Learning disabilities what to look for some first signs of trouble keeping up with the flow of expectations

	LANGUAGE	MEMORY	ATTENTION	FINE MOTOR SKILL	OTHER FUNCTIONS
Preschool	Pronunciation problems  Slow vocabulary growth. Lack of interest in story telling	Trouble learning numbers, alphabet, days of week, etc. poor memory for routines.	Trouble sitting still, Extreme restlessness, in persistence at tasks	Trouble learning self-help skills (e.g. tying shoe laces), Clumsiness, Reluctance to draw or trace	Trouble learning left from right (Possible visual spatial confusion), Trouble interacting (Poor social skills)
Lower Grades	Delayed decoding abilities for reading, Trouble following directions, Poor spelling	Slow recall of facts, Organizational problems, slow acquisition of new skills, Poor spelling.	Impassivity, lack of planning, careless errors, Insatiability, Distractibility	Unstable pencil grip, Trouble with letter formation	Trouble learning about time (Temporal – sequential disorganization, Poor grasp of math concepts)
Middle Grades	Poor reading comprehension Lack of verbal participation in class, Trouble with word problems.	Poor intelligible writing, Slow or poor recall of math facts, Failure of automatic recall	Inconsistency, Poor self - monitoring, Great Knowledge of Trivia, Distaste for fine detail	First - like or tight pencil illegible, slow or inconsistent writing Reluctance to write.	Poor learning strategies Disorganisation in time or space, peer rejection
Upper Grades	Weak grasp of explanations, foreign language problems, Poor written expression, Trouble summarizing.	Trouble studying for tests, Weak cumulative memory, Slow work place.	Memory problems due to weak attention, Mental fatigue	(Lessening relevance of fine motor skills)	Poor grasp of abstract concepts. Failure to elaborate, Trouble taking tests, multiple choice (e.g. SAT’s)

Note: These are guideposts for parents, teachers and other involved. They should not be used in isolation, but may lead you to seek further assessment. Many children will, from time to time, have difficulty with one or more of these items. They should always be reviewed in a broader content of understanding about a child.

Categories of Locomotor Disabilities

• Permanent Physical impairment of Upper Limb
• Permanent Physical impairment of Lower Limb
• Permanent Physical impairment of Trunk (Spine)
• Permanent Physical impairment in case Short Stature/ Dwarfism
• Permanent Physical impairment in Amputees
• Longitudinal deficiencies
• Permanent Physical impairment in Neurological conditions
• Permanent Physical impairment due to cardiopulmonary Diseases

The estimation of permanent impairment depends upon the measurement of functional impairment.

• Impairment: Impairment in any loss or abnormality of psychological, physiological or anatomical structure or function in a human being.
• Functional Limitations: Impairment may cause functional limitations which are partial or total inability to perform these activities necessary for motor, sensory or mental function within the range or manner of which a human being is normally capable.

If the child has locomotor disability contact: Orthopaedic Surgeon or specialist in physic al medicine and rehabilitation – Available at block, district, State hospital for assessment,

Organizations for education - Formal schools, Open School – Non - Governmental Organisations working in the field of locomotor disabilities

Organisations for providing aids and appliances -  Field, Sub - health Centre, Primary Health Center, Gram Panchayat, Rehabilitation centre if available, NGOs working in the field of disability.

• Block: Block Welfare Officer
• District: District Welfare Officer
• Students: in schools

Source: A Handbook for Parents of Children with Disabilities