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Good Evening Ladies and Gentlemen, Today I shall be talking about Importance of early Detection and Identification For differently able. 2. For most of us Birth of the child is a joyous occasion. We all dream about how the child might be or how we would be as parents. For parents who are informed that their child is with some kind of disability or illness the fore most reaction is of Grief and Why ME? 3. Every human society expects its future children to be healthy and this depends on birth and rearing of healthy children. However that depends upon birth and rearing of healthy children. 4. Many times we hear people wishing that if only the children with intellectual impairment could have been recognized earlier something could have been done. 5. This recognition of condition is referred to as Identification. 6. The word early does not mean in terms of age of the child but early in the course of childs problems. 7. Few children have delayed development since birth but others are not born with defects or delay in development during infancy. 8. The causative factors leading to disability are heterogeneous and complex and their contributing in producing disability may differ in different populations. In one survey it was shown that 21.9 % cases of disability resulted from pre-natal damages while only 3% rose from peri-natal factors .Almost 20% were acquired during infancy and early childhood. 9. Nature and Nurture both play a very complex role in our development. Disability may be acquired with Genetics or can be influenced by the environment. Like Down Syndrome is a Genetic disorder while Heart problems may be congenital or environmentally induced. These are the few diseases with known causes in Genetics and Environment. 10. Let us see the Etiological factors influencing the disability at each stage of childs growth: Pre-natal damages-like genetic diseases, developmental malfunctions, maternal age, drugs, medicines, radiations and ethnic groups. Peri-natal factors like low birth weight, prematurity, trauma during labor etc. Post Natal causes may include poliomyelitis, tuberculosis, meningitis, encephalitis, malnutrition, environmental factors and psychosocial factors. All of these as you can see are detectable and preventable factors. While 47% had no known causes that also means that you cannot pin point at one individual factor to be the cause of developmental delays these figures are sufficient to show us how much critical role early detection and

intervention plays in the detection of disability in the early stages of a human life. From Conception till play years. 11. Human Growth and development follows a predictable pattern. 12. For the nine months of short but indeterminate post natal period brain growth is largely genetically determined however environmental factors are also involved from the beginning of embryonic life and will assume an increasingly important role. You can see the stages of brain development from conception till birth here. 13. See in this graph the motor movements are present even before birth, so are language skills. A British study has shown that the babys movement begins at the same time as sensory nerves begin to grow in to the spinal cord. In second month of pregnancy. In fact its the complex inter-relation of Genetics and Environmental factors which guarantees the uniqueness of each individual. 14. Here we see the developmental pattern after birth...the first social smile appears at first month, neck control at approx. 3 months while walking and talking begins at one year. `15. Development of brain and Skills continue even after birth. A child is most receptive of language till 5 to 6 years and His hearing has reached adult levels by 2years. 16. What are delays in development? 17. Developmental Delays refer to disability a child presently displays when his developmental abilities are compared with expected abilities for that age level. The vast majority of developmental delays of the so called cultural, familial symptoms are not generally detected until school Entry level. Since delay is mild and physical symptoms are usually absent. 18. The early Detection and Identification is done to reveal the areas of difficulty and the special ability of the child to learn and to identify the special help he needs. 19. Children with Special needs are identified in several ways. Sometimes incidentally and sometimes systematically. Informal or natural method -sometimes children are identified by parents themselves, relatives, doctors, teachers, social workers or other adults and referred for intervention While at times disability can be identified by distribution of specific questionnaire to the target population for obtaining first hand information about a particular condition. At times to provide the early Intervention to the needy mass screening is done. At first to identify the individuals who may have a problem and at the second stage Individual specific screening is done

20. Screening is a procedure to categorize Individuals as possibly handicapped or delayed or as not currently handicapped or delayed. 21. Screening assessment is done to measure overall level of Intellectual functioning, assessment of adaptive behavior and a detailed analysis of Individual. While screening following points should be kept in mind. What can child do or not do? What problems does the child have? How and when they begin In what way the childs body, mind and behavior affected? In order to find the answers of these questions we should do the following Observe the child carefully Take the medical history Assess the child using different developmental scales available. Like developmental schedules for infants, verbal Tests, Non Verbal performance tests. 22. Screening methods used should be Simple, specific, cost effective, simple to understand and repeatable. They must be acceptable to public and Professionals. 23. Process of screening can be visualized as this.outreach programs or case finding.screening of the cases to sort them.further individualized assessment and Early Intervention Program 24. At the School level four kinds of screening are doneNeurodevelopmental Screening, Visual Screening, Auditory Screening and Language Level Screening. Various Tests are done like Checking of squint, Hearing spoken words at 6 feet distance, General appearance, Speech Intelligibility, Tongue movement, Finger to nose pointing, Rapid turning movements of wrists, Pencil grasps, Gait, Heel to toe walk, Reflexes or tone, level of physical activity to note any unwanted movements General behavior during these tests. Various checklists are also used to test the child, as you must be aware of Basic MR, Functional checklists, Vineland Social maturity scale, and recently developed Automated Software Screener by Dr. Sam path Kumaran and Dr. Karthik Srinivasan of Maduram Narayan Institute for early Intervention, Chennai. 25. Early Identification and Detection is multidisciplinary that require services of professionals from all fields

Like Physiotherapists, Special educators Psychologists and what is most important is that these professionals should share information among themselves keeping their focus on the betterment of the child. 26. Early Identification and Detection must be done keeping in mind the children who are developmentally disabled as well as who are at risk.like the siblings or in the cases of close relation marriages as well as the state of mind of the families. 27. Early Detection is foremost important factor for reducing the number of handicaps by timely treatment, training, counseling like Genetic counseling and preventive measures like Immunization, Neo Natal Screening and surgical interventions. Timely Intervention after the diagnosis not only helps the optimal development of childs mental function but also helps his parents and family members in preserving their own mental health and in achieving success in caring for the child. 28 Counseling can be done both pre-natal and after the disability is diagnosed. Genetic counseling can lead to prevention of occurrence of disability while Family counseling can lead to a positive attitude towards disability and reduce stress in the family. Aim of such counseling is to provide support to the child as well as to the family members and help them recognize capabilities and deficits of the child. 29. The term Early Intervention refers to services given to very young children with special needs, their families with the aim of providing the opportunity for maximum development of the child. 30. When should these Early Intervention services start, I will say as soon as problem is identified or detected. These services should be started as soon as problem is diagnosed and continued up to the age of 5 to 6 years or till the child starts school. Since an infants brain is more adaptable. You either use it or lose it. 31. As you can see and infants brain has twice the number of synapses than the adults and by the age of ten weakly formed synapses start regressing. Hence earlier the better. 32. The Early childhood years are windows of opportunity and children are vulnerable and adapt easily, with right stimulation damaged brain can be compensated with in by forming alternate pathways so we must ensure that we provide all sorts of sensory motor stimulation in the early years of childs life. 33. Right stimulation leads to more development of Synapses and strengthening of existing networks in the brain. 34. The hope behind early Intervention is that these services, provided early, will address any delays in development so that the child will not need services later on. The focus of these services is Individualized Education Program or Individualized Family Service programs. The basis of which is the concept that No two children are

same and must be given specific training as per need and family and environment must be kept in the mind while designing any Individualized program. The purpose of early intervention (EI) is to provide family members, caregivers and early education practitioners with supports and resources to enhance childrens learning and development. 35. These here are the focus areas of development which needs to be encouraged as the child grows up. Areas that can be helped through early stimulation are movement, body control, strength and balance, use of hands, and senses, communication Interaction with other people Basic activities of daily living, observing, thinking and doing. 36. Early Intervention produces positive effects in the child. Children learn from everyday interactions with familiar people, places, experiences, and routines. Early intervention can help families recognize how they do this. This means that: Young children learn best when they are taught everyday life skills like eating, playing, moving, and communicating. Secondary complications can be avoided, which develop dues to prolonged disability, behavior problems and immobilization can be prevented through early intervention. Child need not be kept in the hostels or institutions due to secondary handicaps like behavior problems. Child can attain maximum potential by maintaining a daily routine and program. For example, A routine can be established with the child by giving him or her a choice to choose his own clothes, These everyday routines provide many opportunities to label favorite (and a few not so favorite) actions, objects, and Emotions. Picture books with stories are a handy tool too. When using their words gets child more juice or a favorite book, or makes her laugh, child is learning how powerful talking can be. Teaching in everyday routines offers more opportunities for practice than traditional therapy. 37. Families are seen as a very critical part of the Early Intervention Processes and are involved in setting goals and making programmatic decisions for themselves and their children. Although the development of the service plan is made by a case worker and the parent but it is carried out by the family.

In this scenario its best to have family counseling sessions, either home bound training programs or combined model of centre cum home based training program. To help family gain a better understanding of the strengths and needs of the infant. Also providing genetic counseling, making parents aware of risks involved with future children and keeping families small. Also more the family involvement with the child is more language understanding and vocabulary of the child will be. 38. Once family is taken in to confidence and involved in the care of the child it minimizes the stress on the family for having a differently able child, establishes a positive interaction among family members. When possible siblings should be involved in the care of the child so that future guardian ship role is established. And also their self worth increases. Through family counseling child should be encouraged to venture out among other relatives, market areas etc so that the child becomes independent in his movement. Early Intervention is must for the benefit of society too. In f act, the society will reap maximum benefits. The child's increased developmental and educational gains and decreased dependence upon social institutions, the family's increased ability to cope with the presence of an exceptional child, and perhaps the child's increased eligibility for employment, all provide economic as well as social benefits. 39. Let us talk about challenges to Early Childhood Identification 40. Detection, Identification and Intervention is multidisciplinary. Although multidisciplinary team members may work together and share the same space and tools, they usually function quite separately. Interaction among team members in the multidisciplinary approach does not foster services that reflect the view of the child as an integrated and interactive whole This can lead to fragmented services for children and confusing or conflicting reports to parents. 41. The lack of communication between team members that places the burden of coordination and case management on the family. Once a child is Identified Child is quickly labeled and left at that. People start expecting less from him.

Change in Family dynamics like death of a parent, moving away of a sibling - no one bothers to explain to the child what has happened. Child is confused and at loss that often results in frustrations and manifestation of problem behaviors. Every Institution has its own protocols for sharing information, If the family shifts schools, the child has to adjust to new school with additional burden on family and child for re-assessments and new IEPs. So I will request you all to send along a file or a copy with detailed report on the child when the child avails the TC from your schools. To ease out the process of adjustment of the child. Many schools do not involve parents in assessment and planning. That leads to problems in implementation of the Intervention program. Not only parents but other family members who are important in the life of child should be given counseling and made to understand the childs problem. While drawing out IEP parents should be asked what skills they think their child should learn. They should be given opportunity to work with child in the school so that they learn the imparting of skill under supervision and practice it at home too. Any problems they face can be identified and solved in their next visit. Planning is not complete or half hearted at time. Either goals are not planned properly for this weekly meeting with teachers and therapists should be held in school and re-evaluation of goals can be done if the expectations were too high while identifying the goals. That will save a lot of time and effort. We generally focus on few skills and do not provide or try other activities in which child can do well. Often the administrators of school or the parents or teachers believe that these children can or cannot do certain things. That myth should be clarified. Key is to focus on what can child do and find a skill that suits him for example autistic children love to play with string or inanimate object like buttonsutilizing button to teach them colors, math etc will really enhance their interest in learning and make the activity enjoyable. For example, Birbal used to come only for physiotherapy and leave earlier, His mother was only interested in exercise program as she had been doing it for past ten years, in different Military hospitals. When she came to Asha School, after counseling the mother we encouraged him to sit in the class and learn alphabets and other reading and writing skills. The child made friends and started taking interest in more of the school activities; he started co-operating more in his physiotherapy and even participated in fancy dress competition in the school. He never allows his cerebral palsy to slow him down. Now the family believes Birbal can enhance his fine and gross motor skills while also gaining valuable social, communication, and play skills. He never complains about his therapy because it is fun and includes his family and friends. 42. What I wish to say is that family and the environment must be kept in mind while designing Intervention services for the child. I will now like to present a case study of early diagnosis and Intervention.

43. Aryan had come to us in July this year with spasticity with quadriplegia; he is three year old now. HE had balancing problems, scissor gait, and we started him on therapies to improve his balance and muscle strength. Mostly active passive exercises were given. He was also advised to continue few academic activities after three months in October we did a secondary evaluation, though the change in him was very visible. He could maintain his balance for a small time; he could sit with straight legs and can now stand with support though he is scared and apprehensive. Inverted tendency of his feet is reduced and can color not within lines but he can hold crayons and scribble. He identifies his family members and teachers. Can point to five pictures. We can say that timely diagnosis by Military Hospital Luck now and intervention of Asha School Manipur has helped the child immensely. One of the factors that has helped ayan is the fact that he is just three year old and the window of opportunity is still open Play way method. 44. After three months in October we did a secondary evaluation, though the change in him was very visible. He could maintain his balance for a small time; he could sit with straight legs and can now stand with support though he is scared and apprehensive. Inverted tendency of his feet is reduced and can color not within lines but he can hold crayons and scribble. He identifies his family members and teachers. Can point to five pictures. We can say that timely diagnosis by Military Hospital Lucknow and intervention of Asha School Danapur has helped the child immensely. One of the factors that has helped ayan is the fact that he is just three year old and the window of opportunity is still open 45. The purpose of Early Identification and Intervention is to ensure and enhance the development, strengthen the family, self competencies and promote their social inclusion. These services are provided in the childs natural setting preferably at local level with family oriented and multidimensional teamwork approach. By redirecting our focus we may enable the partnership to become a reality once more. Do we have the will the commitment for the sake of our families, to shift the focus?

46. Thank You