IDENTIFICATION AND ASSESSMENT OF THE DISABILITIES

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.
AT HOME:

Parents can observe and identify the children with disabilities by using the

following checklist for early identification of disabilities:

I. Hearing Impairment-

Screening New Born

  

1. Is there any one in the family with deafness since childhood.

2. Did the mother take an abortificient drug or any other medicine in large doses during

the first three months of pregnancy.

3. Is the birth weight below 1500 gms.

4. Did the child had a delayed cry after birth.

5. Did the child have significant jaundice (yellowness of eyes) during the first10 days

after birth.

6. 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:

1. Does a child turn towards the source of sound which is located either at the back or

towards one side of the body?

2. Does he/she have discharge from the ear?

Screening Children above 2 years age

  

1. Does he/she turn when called from behind?

2. Uses gestures excessively

3. The child does not speak or has a defective speech.

4. The child does not understand the spoken language.

5. The child has an ear discharge.

II. Visual Impairment

 

1. The child does not follow an object moving before his eyes by 1 month’s age.

2. The child does not reach for toys and things held in front of him by 3 months age.

3. One eye moves differently from the other; including squint

4. Eyes are either red or have a yellow discharge or the tears flow continuously.

5. The child has tendency to bring pictures or books very near the eyes.

III. Mental Retardation

 

1. Does the child respond to name/voice by 4th Month?

2. Does the child smiles at others by 6th Month?

3. Does the child hold the head steadily by 6th Month?

4. Does the child sit without support by 12th Month?

5. Can the child stand without support by 18th Month?

6. Can the child walk well by 20th Month?

7. Can the child talk 2-3 word sentences by 3rd Year?

8. Can a child eat/drink by himself by 4th year?

9. Can he tell his name by 4th year?

10. Does he have toilet control by 4th year?

11. Does he avoid simple hazards?

12. Does he get fits?

IV Locomotor Disability

 

1. The child is not able to raise both the arms fully without any difficulties.

2. The child is not able to grasp objects without any difficulty.

3. The child has absence of any part of the limb.

4. 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.

1. 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 look 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.

2. Sub- Health Centres-Primary Heatlh Centres :

India has a well established net work 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.

3. Rehabilitation Services are provided to all the eligible persons by the

Ministry of Social Justice and Empowerment through its various Programmes:

a) Camps under District Rehabilitation Centres (DRCs) in 11 districts :

 

Comprehensive Rehabilitation Services are provided to the rural disabled at their door

steps mainly through camps organized by voluntary organizations. Grassroot

functionaries like anganwadi workers, health workers, are also involved. These Centres

provide services for the prevention and early detection, medical intervention and surgical

correction, fitting of artificial aids and appliances, therapeutic services- such as

physiotherapy, occupational and speech therapy, provision of training for acquisition of

skills through vocational training, job placement in local industries, etc.

b) Composite Rehabilitation Services (District Centre) : Rehabilitation

Services in more than 107 districts in the country are being provided at the door steps of

persons with disabilities. These services include promotion of early detection and

prevention of disability, fitting, follow-up and repair of assistive devices, provide

vocational training and help in finding gainful-employment. At the field leve l, grass-root

level functionaries- anganwadi workers, health workers and PRIs are helping in

implementation of the programme(List of District Centres may be seen at annexure-III.C)

c) National Programme for Rehabilitation of Persons with Disabilities

 

(NPRPD): The programme of NPRPD has recently been launched as a State Sector

Scheme. Under the scheme there is a provision of 2 Community Based Rehabiliation

Workers at each Gram Panchayat and 2 Multi-purpose Rehabilitation Workers at Block

level. The focus at grass root level would be prevention, early detection and information

dissemination. Services at district level would be provided through various professionals

like Physiotherapists, Occupational therapists, Orthotic and Prosthetic Engineers, etc. At

the State Referral Centre, higher services would be provided.

4. 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).

 

1. (a) Visual: Watering of eyes.

(b) Recurrent redness.

(c) Often irritation.

(d) Frequent blinking

(e) Squint.

(f) Inappropriate stumbling over objects or bump into other people

(g) Tilting of the head or closure of one eye.

(h) Headache while doing fine work.

(i) Difficulty in counting the fingers of an outstretched hand at a distance of one meter.

(j) Moving head side to side while reading

11

(k) Difficulty in recognizing distant objects

(l) Difficulty in doing other fine work requiring perfect vision.

(m) Holding books too close or too far from the eyes.

(n) Frequently ask other children when taking down notes from the blackboard

(o) Exhibit difficulty in reading from the blackboard.

(p) 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.

2. Hearing:

(a) Malformation of the ear

(b) Discharge from ear

(c) Pain in ear.

(d) Irritation in ear.

(e) Trying to listen from a closer distance.

(f) Ask for the instructions repeatedly.

(g) Not able to write properly.

(h) Trying to listen to the echo reflection rather than from the speaker.

(i) Make errors while copying from black board.

(j) Frequently ask a colleague to show his workbook.

(k) Proble ms in paying attention in the class

(l) Favour one ear for listening purposes.

(m) Problems when anyone speaks from behind.

(n) Child speaks loudly or too softly.

(o) Exhibit voice problem and mispronunciation

(p) Tune the TV/Radio too loud.

(q) Irrelevant answers.

(r) The child keeps away from his age mates.

(s) The child is unable to respond when you call from the other room.

(t) 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 associa ted psychological problems which

may not be overtly evident.

3. Speech:

(a) Inappropriate sound in speech.

(b) Stammering

(c) Baby speech

(d) Inability to learn correct sound and use incorrect speech

(e) Incomprehensible speech

12

4. Physical Disabilities

(a) Deformity in neck, hand, finger, waist, legs

(b) Difficulty in sitting, standing, walking

(c) Difficulty in lifting, holding, keeping things on floor.

(d) Difficulty in moving or using any part of the body.

(e) Difficulty in holding pen

(f) Using a stick to walk

(g) Jerks in walking

(h) Lack bodily coordination

(i) Epileptic behaviour/have tremors.

(j) Joint pains

(k) 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.

5. Mental Retardation

(a) If the child does not sit unassisted even much after 12-15 months

(b) Or starts to walke ven much after 2 ½ years.

© Or starts to talk even much after 2 ½ years.

(d) 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

(e) Problems in holding a pencil/ or using a scissors

(f) Unable to play with a ball; or play ‘guilli- danda’ with his peers.

(g) Frequent tantrums, while playing with the peers.

(h) Usual inattentiveness to the spoken speech or addressal.

(i) Requires too many repetitions to remember simple things.

(j) Problems in naming even 5 fruits, vegetables or plants.

(k) Problems in naming the days of the week.

(l) Exhibit problems in expressing the needs in a clear language unlike the other

peers.

(m) Unable to concentrate on tasks even for a short period of time.

(n) Inappropriate oral responses.

(o) Difficulty in performing daily routine work.

(p) Poor comprehension of lessons taught in the school class.

(q) Difficulty in learning new things.

(r) Difficulty in conceptualization.

(s) Does not get well along with the children of same age group.

(t) More efforts are required in learning or practicing as compared to the peers.

(u) Takes an unreasonable amount of time in perfecting any work.

(v) Poor academic achievements.

(w) Show an undue dependency on visual clues or material for learning.

13

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.

6. Learning Disabilities:

(a) Difficulty in counting

(b) Lack of concentration or easily distraction by the surroundings, either at home or

school.

(c) Difficulty in sitting quietly in the classroom.

(d) Does not write down the spoken words correctly.

(e) In appropriate additions to the right word; e.g. ‘ischool’ in place of school.

(f) Always confused between Right & Left.

(g) Unreasonable difficulty in remembering the verbal instructio ns.

(h) General difficulty in memorizing the things.

(j) Extreme restlessness in a child which significantly interferes with the timely

completion of various tasks.

(k) Reverses letters or symbols too frequently while reading for exa mple b as d, saw

as was, etc.

(l) Reverses numbers too frequently while reading or writing for example 31 as 13, 6

as 9,etc.

(m) Excessive errors during reading like looses place or repeat / insert/ substitute/omit

words.

(n) Poor in mathematical calculations.

(o) Problems in accurate copying from the common sources like a book or a

blackboard, even though the vision is normal.

(p) Write letters or words either too close or too far (spacing problems).

(q) The child appears to comprehend satisfactorily but is not able to answer the

questions.

Note: i. 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.

ii. 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 disability in detail.