By: Chopra, G., Associate Professor, Dept of Human Development, Institute of Home Economics, University of Delhi.

Disability Screening Schedule is a broad based one time screening schedule for all the major disabilities, viz., locomotor, visual, hearing and intellectual in early childhood (0-6 years). DSS has a sensitivity of 0.89 and a specificity of 0.98. It has been successfully used by grassroot community workers to detect disabilities in children. In the first field trial 19 anganwadi workers screened 3560 children (0-6 years) from 9 slum clusters of south Delhi with the DSS and reported 3315 children screened as ‘normal’ and 245 as having an impairment/disability/ at risk conditions. The second field trial was inter-sectoral in nature and 53 workers in all were trained to use the DSS. These included 29 AWWs from a rural and urban ICDS project, 18 LHVs and ANMs and 6 workers from 3 NGOs of which one was a master trainer. The AWWs screened children from 6 slum pockets and 4 rural areas of Delhi, while the health workers screened children from 10 MCW centres of South Delhi. AWWs and health workers screened 4319 children and reported 268 ( 6.3%) cases of impairments and disabilities. The NGO workers screened 400 children and reported a whooping 85 ( 22.5%)children with disabilities. The AWWs did a house-to-house survey to screen children, the health workers screened children from homes as well as those coming to the centres and the workers of NGO used the key-informant approach to reach out to children with disabilities. In the third Field Trial 24 AWWs trained on the DSS, They screened 2248 children (0-6yr) from South Delhi slums of ICDS Khanpur project. In all, they detected 81 children with impairments and disabilities

The successful use of DSS by many categories of community workers to detect disabilities in early childhood, demystifies the notion of disability being a medical domain and also highlights the role trained community workers can play in early detection of disabilities. Also Chapter IV of the Persons With Disabilities act ( 1995), mandates that all children in the community be surveyed once every year for early detection of disabilities. The current study has demonstrated that the community workers can use the DSS to fulfill the mandate expressed in the said act. This could a very useful finding especially in the context of a developing country of the size of India.

INTRODUCTION to screening of children

The second most populous country in the world, India is home to over one billion people, or 16% of the world’s population. The first national level survey to enumerate the magnitude of disability was done only in 2001 in the census survey which is a decennial exercise. According to the 2001 Census findings, India’s disability population is 21.9 million, or 2.13% of the total population. (Census, 2001).

NSSO (July to December 2002) estimates the disabled population at 18.49 million, or 1.8% of the total population (NSSO, 2002). For the last two decades disability activists and NGOs in India have accepted a middle path, and pronounced the number of people with disabilities to be 5-6% of the total population (IDRM, 2005). According to World Bank (2007), it is estimated that people with disabilities comprise between 4 and 8 percent of the Indian population. When converted into numbers, India has 40-90 million individuals with disabilities, a vast sea of humanity asking for attention. With limited resources and services not reaching even 15% of the disabled population and those too being urban based, it makes sense to prevent disabilities and to screen them early in the course of development so that early intervention can be initiated.

Timely detection of a large number of childhood diseases could reduce significantly the number of children from getting disabled. A WHO study has indicated that 80 percent of the disabled children can be helped through the coordinated use of community resources ( WHO, 1980). This would require identification of simple methods, indicators and techniques for use at the community level. With early detection of disorder, one can arrest further deterioration of the impairment.

This paper presents a simple tool developed for broad based screening of all major disabilities in children under 6 years of age in poor communities by grass-root level community workers.

SCREENING TESTS

Screening tests sort out persons who have a disease from those probably who do not.

A screening test is not supposed to be diagnostic.

SCREENING is defined as identification among apparently healthy individuals of those who are sufficiently ‘at risk’ of a specific disorder to justify a subsequent diagnostic test or procedure, or in certain circumstances direct preventive action. WHO (1987) defines screening as application to all children, born of certain procedures which can be carried out in a short time by less specialized member of the staff, and which give an indication of the presence or absence of certain disability. If the result of the test is positive, the child is then referred to a specialist for investigation and care.

A screening test should detect latent or early symptomatic stages of a disease or disorder and should have high sensitivity and specificity. According to Beaglehole and Kjellstrom (1990), Sensitivity of a screening test is the proportion of truly ill persons who are screened as ill by the screening test, while Specificity is the proportion of truly healthy persons who are also screened as healthy by the screening test.

Earlier an exceptionality is recognized and intervention initiated, greater would be the chances of arresting the disability from deteriorating further and coming in the way of normal development of the child. With early detection of disabilities followed by effective intervention, one can arrest future deterioration of the impairment (Chopra, G. 1997). Early detection of Cerebral Palsy is essential for starting early therapy. The human nervous system when damaged, has the power to compensate, and as the body is still maturing (i) dormant abilities can be activated by early intervention, (ii) degree of motor disability can be minimized (iii) associated disability can be decreased (iv) deformities can be prevented (NIPCCD, 1989).

DEVELOPMENT OF Disability Screening Schedule (DSS)

While developing the DSS, many existing tests were studied, the major ones amongst those being:

1. NIMH development screening schedule

2. NIMH development assessment schedule

3. Trivandrum development screening chart

4. WHO ten question screen

5. WHO child disability questionnaire

6. David Werner’s record forms on physical, social and cognitive development

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