National Human Resource Council (NHRC), in Disability Manual, 2005 outlines the definitions as given by the Rehabilitation Council of India Act, (RCI) 1992 and the People with Disability Act, (PWD) 1995. These are adopted by all current Indian Government regulations. The definitions given by the World Health Organization (WHO) in 1976 are also taken as guidelines by many Indian institutions.

India continues to use the medical model of defining disability. Nearly all definitions in the Indian context of government publications identify an individual as disabled based on medically determined physical or mental impairment that limits the person’s ability to perform an activity. It is important to note that the complementary possibility that the individual is limited by a barrier in society or the environment is never considered. Reliance upon defining disabilities in purely medical terms, or as a functional deficit is a major problem with Indian policy design and implementation.

RATIONALE OF EARLY DETECTION PROGRAMMES.

Many educators and social scientists believe that the earlier in life an exceptionality is recognized and programmes of education or treatment started, the better the outcome for the child.

While it is important to initiate action for preventing the occurrence of impairments in the first place, it is also equally important to detect an impairment after it has occurred and to prevent it from becoming complicated. Early detection is crucial for reducing the risk of further complication as also to help the affected child to develop to his full potential (NIPCCD, 1982).

Disability affects a child's developmental process, it is therefore necessary to prevent, detect and treat disabilities in order to encourage normal process of child development. Usually, when a child is born or acquires a disability, her early years go by with hardly any input in terms of schooling or medical treatment to correct or reduce her impaired function. Suddenly, the society wakes up when confronted with a handicapped adult, who has many limitations in living, has no education or skill and is also advanced in age and handicap (Patel, 1986).

The development of an effective early detection programme leads us to hope that we shall soon see dramatic decrease in the degree of disability , that results from being born with a specific condition or acquiring a disability in early childhood (Hallahan and Kauffman ,1991).

How effective is early intervention? Right up to 1980’s, it was felt that early detection and intervention was not very useful in case of brain damage, since neurons are not regenerable .However, recent animal studies in neurophysiology have shown that synapses if not neurons are regenerable .The concept of synapses culturing indicate that neurotransmission can be improved by selectively stabilizing one type of impulse at the expense of others. Both these processes are enhanced by training. This modifiability of the brain at molecular level forms the basis of early intervention in high risk infants (Pandit,Chaudhari,Bhanve,Kulkarni,1992). Available research (Murlidharan,1992) highlights the importance of early detection and intervention efforts by suggesting that:

   -About 50% of intellectual development takes place between conception and 4yrs and about 80% by 8yrs.    -50% of vocabulary attained by 18yrs takes place within first 8yrs and    -50% of child’s general educational attainments by 18yrs are attained by 9yrs. 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).

Few deny that timely diagnosis of a large number of childhood diseases could significantly reduce the number of children going disabled. However, one of the impediments in the early detection was believed to be the ignorance on the part of parents about seriousness of problem, or right action to be taken. It was in this context that the role of the community worker becomes very significant. A trained grass root level early child care/ health worker can easily detect disabilities in young children and can readily refer these children to health care facilities for further diagnosis and treatment.

According to a survey in Bombay, in the age group 5-9 years from various socio-economic groups revealed that as many as 20 per cent suffered from hearing loss, of whom 99 percent had conductive hearing loss, which is curable (Kaur, 1991). These studies underscore the importance of programmes for early detection and early intervention in disabilities.

Poverty, the root cause of the existence of slums or settlement colonies in urban areas has a great impact on almost all aspects of life of the urban poor, especially the all-round development of children. Examples from countries, across the globe provide evidence of improved early child development, made possible through integrated slum improvement programs, are few in numbers. The observed 2.5% prevalence of developmental delay in the less than 2 year olds of deprived urban settlements, the presence of risk factors for developmental delay like low birth weight, birth asphyxia, coupled with poor environment of home and alternate child care services, highlights the need for simple cost effective community model for promoting early child development. This review on early child development focuses on the developmental status of children in the deprived urban settlements, who are yet to be on the priority list of Governments and international agencies working for the welfare of children, the contributory nature-nurture factors and replicable working models like infant stimulation, early detection of developmental delay in infancy itself, developmental screening of toddlers, skill assessment for preschool children, school readiness programs, identification of mental sub-normality and primary education enhancement program for primary school children. Further, the review probes feasible intervention strategies through community owned early child care and development facilities, utilizing existing programs like ICDS, Urban Basic Services and by initiating services like Development Friendly Well Baby Clinics, Community Extension services, Child Development Referral Units at district hospitals and involving trained manpower like anganwadi/creche workers, public health nurses and developmental therapists. With the decentralization process the local self-government at municipalities and city corporations are financially equipped to be the prime movers to initiate, monitor and promote early child development programs, to emerge as a part and parcel of community owned sustainable development process ( Nair and Radhakrishnan, 2004).