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Disability evaluation in intellectual disability and in specific


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Disability evaluation in intellectual disability and in specific

  2. 2. INTELLECTUAL DISABILITY Adaptive function Intellectual function
  3. 3.  Age of onset before maturity (<18 years) is reached.  Estimated prevalence 2.5%-5%, males are more affected.
  4. 4. ADAPTIVE FUNCTION  Skills that are required for daily functioning.  Deficit in any 2 of the following . 1. Conceptual skills 2. Social skills 3. Practical skills
  5. 5. INTELLECTUAL FUNCTION  Performing an individually administered test measuring IQ .  Cut off <70 1. Mild = 55-69 2. Moderate = 40-54 3. Severe = 25-39 4. Profound = <20
  6. 6. COMMON PRESENTATIONS AGE AREA OF CONCERN Newborn Dysmorphism, organ dysfunction Early infancy (2-4 month) Poor interaction, vision & hearing impairment Later infancy (6- 18 months) Gross motor delay Toddler (2-3 years ) Language delays Preschool (3-5 years) Language delay, behavior difficulties School age (> 5 years) Poor academic performance
  7. 7. SCREENING  Patients with developmental delay.  Parents, School teacher labeled poor / slow learner.
  8. 8. MEDICAL DIAGNOSTIC  Neuroimaging  EEG  Karyotyping  Tandem mass spectrometry  Thyroid function test
  9. 9. DIAGNOSIS Child/ clinical psychologists for Adaptive functioning and IQ test. 1. Testing. The tools that can be used for the same include: (i) Adaptive functioning: VSMS(Vineland Social Maturity Scale) (ii) IQ testing: BKT (Binet Kamat intelligence test/ MISIC (Malin’s intelligence scale for Indian children.  Based on the above the diagnosis of ID will be confirmed. Based on adaptive functioning assessment, severity scoring will be done and disability for ID charted
  10. 10. Vinland Social Maturity Score Eight social areas:  Self-help General (SHG)  Self-help Eating (SHE)  Self-help Dressing (SHD)  Self direction (SD)  Occupation (OCC)  Communication (COM)  Locomotion (LOM)  Socialization (SOC)
  11. 11. Test Items 0- 1 Year 1. “Crows”, Laugh 2. Balance head 3. Grasps objects within reach 4. Reaches for familiar persons 5. Rolls over, (unassisted) 6. Reaches for nearby objects 7. Occupies self-upright 8. Sits unsupported 9. Pulls self upright 10. “Talks”, imitates sounds 11. Drinks from cup or glass assisted 12. Moves about on floor (creeping, crawling) 13. Grasps with thumb and finger 14. Demands personal attention 15. Stands alone 16. Does not drool 17. Follows simple instructions 1- 2 Year 18. Walks about room unattended 19. Marks with pencil or crayon or chalk 20. Masticates (chews) solid or semi- solid food 21. Pulls off clothes 22. Transfers objects 23. Overcomes simple obstacles 24. Fetches or carries familiar objects 25. Drinks from cup or glass 26. Walks without support 27. Plays with other children 28. Eats with own hands (biscuits, bread, etc.) 29. Goes about hours or yard 30. Discriminates edible substances from non-edibles 31. Uses names of familiar objects 32. Walks upstairs unassisted 33. Unwraps sweets, chocolates 34. Talks in short sentences
  12. 12. 2- 3 Years 35. Signals to go to toilet 36. Initiates own play activities 37. Removes shirt to or frock if unbuttoned 38. Eats with spoon/hands (food) 39. Gets drink (water) unassisted 40. Dries own hands 41. Avoids simple hazards 42. Puts on short or frock unassisted (need not button) 43. Can do paper folding 44. Relates experience 3- 4 Years 45. Walks downstairs, one step at a time 46. Plays co-operatively at kindergarten level. 47. Buttons shirt or frock 48. Helps at little household tasks 49. “Performs” for others 50. Washes hands unaided 4- 5 Years 51. Cares for self at toilet 52. Washes face unassisted 53. Goes about neighborhood Unattended 54. Dresses self expect for trying 55. Uses pencil or crayon or chalk for drawing 56. Plays competitive exercise games 5- 6 Years 57. Uses hoops, flies kites, or uses knife 58. Prints (writes) simple words 59. Plays simple games which require talking turns 60. Is trusted with money 61. Goes to school unattended 6- 7 Years 62. Mixed rice “properly unassisted 63. Use pencil or chalk for waiting 64. Bathes self assisted 65. Goes to bed unassisted
  13. 13. 7- 8 Years 66. Can differentiate between AM & PM 67. Helps himself during meals 68. Understands and keeps family secrets 69. Participants in pre-adolescent 70. Combs or burses hair 8- 9 Year 71. Uses tools or utensils 72. Does routine household tasks 73. Reads on own initiative 74. Bathes self unaided 9- 10 Years 75. Cares for self at meals 76. Makes minor purchase 77. Goes about home town freely 10- 11 Years 78. Distinguishes between friends any play mates 79. Makes independent choice of shops 80. Does small remunerative work 81. Follows local current events 11- 12 Years 82. Does simple creative work 83. Is left to care for self or others 84. Enjoys reading books, newspapers and magazines 12- 15 Years 85. Plays difficult games 86. Exercises complete care of dress 87. Buys own clothing accessories 88. Engages of adolescent group activities 89. Performs responsible routine chores
  14. 14. DISABILITY CALCULATION  The disability calculation will be done based on VSMS score. (i) VSMS score 0-20: Profound Disability-100% (ii) VSMS score 21-35: Severe Disability-90% (iii) VSMS score 36-54: Moderate Disability-75% (iv) VSMS score 55-69: Mild Disability-50% (v) VSMS score 70-84: Borderline Disability-25%
  15. 15. CERTIFICATION  The minimum age for certification will be one (01) completed year. Children above one year and up to the age of 5 years shall be given a diagnosis as Global Developmental Delay (GDD).  Children above the age of 5 years shall be given a diagnosis and certificate as Intellectual Disability.
  16. 16. GLOBAL DEVELOPMENT DELAY  Delay in acquiring milestones in two or more domains
  17. 17. MEDICAL BOARD  The Medical Superintendent or Chief Medical Officer or Civil Surgeon or any other equivalent authority as notified by the State Government  Pediatrician or Pediatric Neurologist (where available)/ Psychiatrist or Physician (if age >18years)  Clinical or Rehabilitation Psychologist  Psychiatrist
  18. 18. VALIDITY  Temporary certificate for children less than 5 years: The certificate will be valid for maximum 3 years/ 5 years age (whichever is earlier).  For children more than 5 years: The certificate will mention a renewal age. The certificate will have to be renewed at age of 5 years, 10 years and 18 years. The certificate issued at 18 years of age will be valid lifelong.
  19. 19. SPECIFIC LEARNING DISORDER  Deficit in scholastic skills (DSM5th edt)  Deficit in processing language, spoken or written reading and mathematics.
  20. 20. CLINICAL SPECTRUM  Dyslexia (reading disorder)  Dysgraphia (written language disorder)  Dyscalculia (mathematics disorder)  Dyspraxia (coordination disorder)  Developmental aphasia ( inability to formulate language)
  21. 21. ETIOLOGY Chromosomal disorder Turner syndrome, Digeorge syndrome Perinatal insults Very low birth weight, IUGR, HIE Environmental toxin Lead, cocaine drug abuse
  22. 22. SCREENING  The teachers of the public and private school shall carry out the screening in Class III or at eight years of age, whichever is earlier.  If in the screening shows test three or more answers are in “frequently” column, then the child should be referred for further assessment
  23. 23. DIAGNOSIS  Step 1- Assessment of paediatrician: The paediatrician will do the initial assessment. This will involve a detailed neurological examination including vision and hearing assessment. It has to be ensured that the child has normal visual acuity and hearing before proceeding to next step.  Step 2: IQ Assessment: Child/ clinical psychologist will do the IQ assessment using MISIC or WISCIII. If the IQ is determined to be >85, then step 3 will be applied.  Step 3- SLD Assessment: This would involve application of specific psychometric tests for diagnosing SLD and giving it a severity scale.
  24. 24. Diagnostic Tool  National Institute for Mental Health and Neurosciences (NIMHANS) test.
  25. 25. Medical Board  The Medical Superintendent or Chief Medical Officer or Civil Surgeon or any other equivalent authority as notified by the State Government  Pediatrician or Pediatric Neurologist (where available)  Clinical or Rehabilitation Psychologist  Occupational therapist or Special Educator or Teacher trained for assessment of SLD.
  26. 26. Validity of Certificate  The certification will be done for children aged eight years and above only. The child will have to undergo repeat certification at the age of 14 years and at the age of 18 years.  The certificate issued at 18 years will be valid life-long.
  27. 27. Teachers complain of poor understanding/drop in school grades Teachers applies screening test and refers the child with anomaly to school committee/principal Referred for SLD assessment with letter by principal and teacher’s screening Assessed by pediatrician with detailed neurological examination for comorbidities Chalk out the domains affected and involvement of visual/hearing abilities Assessment by psychologist with specific tests for IQ using MISIC/WISC-III If IQ> 85, do the specific test for SLD SLD confirmed Severity assessment Board assess and certifies Re-certification at 14 years and 18 yrs. age Include other disabilities if present