In 1974, a major shift in education for the child with disability was achieved with the launch of the comprehensive Integrated Education for the Disabled Child (IEDC) The aim was to provide children with moderate disabilities with both facilities and financial support. This was implemented in 15,000 schools in 26 states and union territories and reportedly covered 65,000 children with disabilities in mainstream schools. In a bid towards the implementation of this project, the Government launched Project Integrated Education Development (PIED), which provided teacher training, methodology for identification of children and school facilities as support services. . However a major criticism against this was that it covered only the mild and moderately disabled who were admitted in schools undetected as disabled and that it did not cover preschool children .It was also not specifically geared to children with intellectual disabilities. It was therefore withdrawn but it did provide learning experience in that it nudged policy makers closer to the concept of integration as a first step which led later to rethinking education services and to the formulation of inclusive practices.

Attitudes and concerns of pre-service teachers regarding implementation of inclusive education were examined. The participants consisted of 480 pre-service teachers enrolled in a one year Bachelor of Education (B.Ed) program at Pune University, in the state of Maharashtra. The results of the study showed that participants had somewhat negative attitudes and a moderate degree of concern regarding the inclusion of students with disabilities in their classes. Participants with higher level of education (i.e. postgraduate degrees) were found to have significantly more positive attitudes compared to their counterparts. Perceived level of confidence in teaching students with disabilities was also associated with lower degree of concerns amongst participants. The results are discussed with possible implications for university educators and policy makers (Sharma U, 1995).

Early years education and special needs education have been the focus of UK government interest in recent years, with a strong emphasis on 'joined up thinking' across professional boundaries in order to plan and provide cohesive and increasingly inclusive programmes of education and care. This article considers the potential for joined up thinking and action across the early years and special needs education domains with the argument that there is often neglected common ground between the two, such as the shared need for a holistic perspective, partnership with parents, multidisciplinary collaboration and developmentally appropriate practice. Examples are provided from the UK context but the debates are relevant more widely. The article ends with an exploration of why this potential has often not been realised, arguing that separate histories and vulnerabilities and a desire to avoid parallel stigma are partly responsible (Melanie N, 2002).

The purpose of this qualitative study was to describe regular education early childhood teachers' perceptions of those factors that contributed to or hindered their success in inclusive classrooms. From among the K-3 teachers in one pro-inclusion school district, six teachers (three self-described as successful with inclusion and three as unsuccessful) were randomly selected to participate in a series of four semi-structured interviews about their current experiences with inclusion. Analysis of the interview data indicated a strong shared belief in the fundamental value of inclusion, as well as revealing four themes that affected their perceptions about inclusion. The themes indicated a need for: more adequate and focused training (for both regular and special education personnel), better consideration of classroom load factors (including class size, ratios, and type and severity of special needs), more reliable support (in-class, collaborative, and administrative), and help to find more time to meet the increased planning and collaborative demands of inclusive classrooms. These themes were examined in relation to the participants' perceptions of their classroom success with inclusion. Implications and recommendations for professional development are discussed (Mary K, 2000).

This article provides a personal viewpoint on and outline of the author's contribution to learning disability in India. It refers to her doctoral research on policy and the status of people with disability in India. It puts forth the view that although India addresses diversity in many ways it tends to exclude people with disability from national programmes. It argues that inclusive education should be context- and culture-specific and that inclusive programmes can develop, albeit incrementally, despite the fact that systemic change has not taken place. The article ends with the suggestion that moral and ethical considerations demand that people engaged with inclusion need to work towards inclusion of all children wherever necessary and that each individual first of all needs to internalize the change within them (Alur M, 2001).

Teacher attitude is one of the most important variables in the education of children with disabilities. Attitudes of general educators in the city of Mumbai, India, toward disabilities and inclusion of students with disabilities into regular schools were studied through the usage of two attitude scales. The study investigated whether variable background characteristics such as age, gender, income level, education levels, years of teaching experience, acquaintance with a person with a disability, having a family member with a disability, frequency of contact and closeness to a person with disability affect the attitudes of teachers towards people with disabilities and towards inclusion of students with disabilities into regular schools. The analyses revealed that while some of the variables of interest did affect teachers' attitudes towards disabilities, the only variable that affected teachers' attitudes towards inclusion was prior acquaintance with a person with a disability (Parasuram K, 2006).

In terms of young children, inclusion refers to providing individually determined developmental, educational, and therapeutic services in regular child care centers and preschool classrooms. Children are based in regular settings, and whenever possible, individually determined goals, instruction, materials, and supports are brought to the children rather than having them receive these services elsewhere. In many cases, a preschool child with disabilities follows the same curricular content using similar materials and instruction as those without disabilities. On the other hand, some preschoolers with disabilities follow a significantly different curriculum requiring different materials and instruction. For example, a preschooler with cerebral palsy has several individual goals, including learning how to use various drawing/coloring instruments and to use a walker. At an art center during center time, the child can sit in an adapted chair and color and paint with peers without major modifications. However, during recess when other children are climbing on playground equipment, this student spends part of his time working on using his walker with the assistance of a child care teacher. Similarly, a kindergartener with spina bifida who uses a wheelchair might participate in a throwing activity in regular physical education by throwing from his chair. Peers can assist this student by placing balls on his lap. During traveling activities, this student can work on pushing and maneuvering his wheelchair while peers work...

Teachers may find the inclusion of preschool children with disabilities challenging, but with creative use of time, space, staffing, and materials, these children can be included meaningfully and successfully.

SCREENING INSTRUMENTS

Purpose of screening is to provide early identification of disability, intellectual impairments, behavioral problems, and those who might have special educational needs. It should be performed on all children and take into account ages at which children achieve skills i.e. milestones in development (Lingam S., 1992) The screening test should gain information on three areas:

1. Physical and sensory functioning.

2. Developmental assessment

3. Environmental influences like parental care and attention, socio- economic conditions.

Three important methods are suggested for obtaining screening information
(i) Parental reports: critical information should be obtained from parents through interviews/questionnaires.

(ii) Observational method: Observing child's behavior and abilities.

(iii) Screening test: Consists of carefully selected items, questions or tasks to obtain systematic information on the child's abilities

In developing countries, screening is mainly done at community level by grassroots level workers. Generally these are women who are taught some basic skills of screening and they go house to house to examine children for Developmental and physical growth. Intention is that if they suspect abnormality ( Arya, S., 1987). They would be able to refer for complete check by more experienced professional. It is important that whoever is doing the screening should have a clear idea of what is normal and abnormal and the results interpreted according to culture and environment (Lingam. S, 1992).

Minnesota becomes the first state in the U.S to offer free, comprehensive screening programme to all children. Most commonly used screening instruments were DIAL (Developmental Indictors for the assessment of learning), DDST (Denver Developmental Screening Test), and MPSI (Minnesotta.Pre-school screening inventory). The variety of tools used for diagnosis was much greater than those for screening (Ysseldyke J.E., 1986).

The Trivandrum Developmental Screening Chart (TDSC) was designed by selecting 17 test items from BSID (Baroda Norms). It was validated both at the hospital and community level against the standardized DDST. TDSC had a sensitivity of 66.7% and specificity of 78.8% (Nair, et al, 1991).

The utility of the WHO Ten Questions Screen (TQS) was studied in a rural community of North India. The study was done in three villages, in two phases. In phase 1, the TQS was administered to parents of children aged between 2 and 9 years, during a house-to-house survey. In phase 2, all children screened positive and a random sample of 110 screened negative were clinically evaluated in detail. The total population of the three villages was 5830 with 1763 children aged between 2 and 9 years. Seventy-six children were positive on the TQS, of these, 38 were found to have significant disability, 18 had protein energy malnutrition and 19 were found normal on clinical evaluation. All the 110 screen-negative children were normal. Significantly larger numbers of boys were positive on TQS as compared to girls [Odd Ratio (OR) 1.5]. The sensitivity of the TQS for significant disability was 100%; the positive predictive value was 50% and was higher for boys than for girls. Of the 50% children classified as false positive 23% had mild delays due to malnutrition. The estimated prevalence of disability was 16/1000. The TQS was found to be a sensitive tool for detection of significant disabilities among children 2–9 years of age. The low-positive predictive value would lead to over referrals but a large number of these children would benefit from medical attention (Pratibha, et al, 2007).

The study was done to evaluate the validity and potential value of the parent completed infant monitoring questionnaire as a screening measure for developmental delay in high risk infants.140 one term infants born with moderate or severe newborn encephalopathy (NE) and 374 randomly selected comparison infants were administered a Griffiths Mental Development Scales (GMDS) assessment. Use of the IMQ as an accurate screening measure in infants at risk of developmental delay is supported .The low sensitivity of the IMQ for the comparison of infants indicate a need for caution when considering its application for general population screening (Dixon G, 2008).

The International Pilot study of severe Childhood Disability was completed in 10 sites in nine developing countries: Bangladesh, Brazil, India, Malaysia, Nepal, Pakistan, Philippines, Sri Lanka and Zambia. The major focus of the Pilot study was to determine whether it would be possible, in developing countries, to identify children with severe mental retardation and other disabling conditions, by means of short questionnaires. This was accomplished in a house to house survey, which was followed by professional examination s of (a) children who screened positive on the questionnaire and (b) a small random sample of normal children who were screened negative on the questionnaire.

Ten Question screen has been extensively used to detect severe disabilities in the community. A survey of 2576 children aged two to nine years was carried out in Dhaka, Bangladesh, as part of a collaborative study to test the validity of a questionnaire (the Ten Questions) for screening severe childhood disabilities in community settings. Approximately 7% of the children were positive on the screen and this rate was slightly higher in boys than girls. The sensitivity, specificity and negative predictive value of the Ten Questions were perfect or nearly perfect for severe and moderate (serious) disabilities. The positive predictive value was only 22% for serious disabilities, but 70% of children classified as false positives were found to have mild disabilities or other conditions (such as ear infections) for which early detection and treatment could be beneficial ( Zaman, 1990). It screens the children who are severely disabled leaving out the mildly disabled and medical conditions which, when left untreated, could lead to possible disablement.

The Disability Screening Schedule was developed and validated in Delhi for screening children under six years for four major disabilities, viz. locomotor, visual, hearing, speech and intellectual. ( Chopra, 1997). 19 AWWs were trained to use the DSS. The trained workers screened 3560 children from 9 slum clusters of Delhi. They reported 3315 cases as normal and 245 as having an impairment or a disability. Of these children, the investigator reviewed 219 cases of impairment. Of these 209 ‘ true positives’ and 10 ‘false positives’ were found. 536 normal cases were reviewed. Of these 511 ‘true negatives’ and 25 ‘false negatives’ were found. The DSS was found as having very high Sensitivity(0.89) and very high Specificity (0.98).

Auditory screening is an attempt to identify persons who have significant hearing defect from a population predominantly made up of people with normal hearing. To conduct auditory screening using conventional methods would be extremely difficult, considering paucity of funds, the scarcity of trained professionals and predominantly rural based population. A successful attempt has been made to develop a mass screening test, which can be broadcast/ telecast over radio T.V. a single administration of this would be able to screen a very large population, which was hitherto not possible. (Kumar S., 1987)

One hundred and seven neonates were screened within 24 hours after birth by a tricolored mid arm circumference (MAC) measuring tape with a borderline Yellow-zone between 7.5 cm. and 8.5 cm. and two peripheral zones, red and green beyond 7.5 cm. and 8.5 cm. respectively. All the neonates identified by red zone have birth weights less than 1500 gms. Majority 89.7% of the neonates identified by the yellow zone had birth weight between 1500 - 2000 gms. But only a small number (10.3%) of neonates had birth weight more than 2000 gms. The sensitivity and specificity of MAC for identifying neonates below 2000 gms. were 93.7% and 98.2% respectively. This simple MAC measuring tape can be used by field workers to assess low birth weight neonates. (Barman, 1994).

A survey of 2576 children aged two to nine years was carried out in Dhaka, Bangladesh, as part of a collaborative study to test the validity of a questionnaire (the Ten Questions) for screening severe childhood disabilities in community settings. Approximately 7% of the children were positive on the screen and this rate was slightly higher in boys than girls. The sensitivity, specificity and negative predictive value of the Ten Questions were perfect or nearly perfect for severe and moderate (serious) disabilities. The positive predictive value was only 22% for serious disabilities, but 70% of children classified as false positives were found to have mild disabilities or other conditions (such as ear infections) for which early detection and treatment could be beneficial. No major age or gender differences in the validity of the questionnaire were apparent, but this finding needs additional study and confirmation with studies based on larger samples. In general, the results indicate that the Ten Questions is a valid tool for screening serious disabilities in children and can potentially improve the efficiency of health services by reducing the number of children requiring attention from professionals. Future studies using the Ten Questions should foster greater attention to the dimensions of childhood disability as a public health problem in the less developed world. (Zaman et al.1990) The purpose of this study was to examine the feasibility and effectiveness of implementation of validated developmental screening by using the Parents' Evaluation of Developmental Status in 2 urban pediatric practices. The author implemented the Parents' Evaluation of Developmental Status at Boston Children's Hospital Primary Care Center and at Joseph Smith Community Health Center as quality improvement initiatives. Each practice offered screening to all of the patients attending well-child care visits between 6 months and 8 years of age. The implementation process was investigated by using reimplementation and post implementation surveys and a focus group of pediatric primary care providers. To assess outcomes, such as changes in identification rates and referrals for developmental and behavioral concerns, we reviewed medical charts of all of the 2- and 3-year-olds present at Children's Hospital Primary Care Center well-child care visits in the periods before and after screening implementation. Providers found routine screening easier than expected and feasible to conduct in a busy primary care setting. The practice change resulted in screening of 61.6% of eligible children. Compared with same-aged children before screening, after screening was implemented more behavioral concerns were detected in the 2-year-old group, and more children with developmental concerns were identified in the 3-year-old group. Referral rates for additional evaluation increased only for 3-year-olds, although the types of referrals (ie, audiology and early intervention) were consistent as those found before screening started. Implementation of validated screening by using the Parents' Evaluation of Developmental Status was feasible in large, urban settings. Effectiveness was demonstrated via chart review documenting an increased rate of identification of developmental and behavioral concerns. Perceived obstacles, such as the time requirement, should not prevent widespread adoption of screening (Schonwald A ,et. al., 2009).

The prominent British and American pediatric organizations do not recommend the routine administration of developmental screening tests. A process of developmental surveillance which encompasses all primary care activities involved in monitoring child development has been suggested. A feasible integration of child development with other components of child health monitoring is the current goal in the context of developing countries. The standard development tests are too cumbersome for routine use and need to be simplified and modified to suit the local cultural norms. (Bodhankar and Shashikala, 1995).

PARENTAL INPUT REACTIONS AND ATTITUDE TOWARDS SCREENING It has been suggested that screening for impairments in early childhood may cause anxiety to parents. This work studied the attitudes of parents of 6-9 months old infants towards screening. There was evidence of lack of appreciation, both forth purpose of screening tests and implications of test failure. There was suggestion of a mismatch between the topics which were of concern to mothers and the areas which are emphasized during assessment. For example, the examination of the infant focuses on growth and development, where as the main course of concern for mothers were minor medical problems like cough, cold, nasal discharge, skin rash etc. The challenge is to suggest measures to alleviate these minor problems, and refer the infants who require special attention. (Johnson, Sherratt and Holmes, 1991)

Studies also indicate that when, what and how diagnostic information is provided to parents is vitally important. It can affect the family’s attitude toward their child, towards the professionals involved and the services offered. Most research has concluded that information should be given as soon as possible, in a factual but compassionate manner, in a place of privacy by an authoritative staff, while both the parents and child are present. Parents also require opportunities to ask questions and to absorb the information given. (Piper and Howling, 1992).

Significant concern has been raised about the validity, reliability andscreening efficacy of many procedures designed to identify young children at risk for developmental delay. One approach that has been suggested to enhance the validity and reduce cost of screening is to systematically include information from parents in the identification of developmental delay. Parents current concerns about their child’s development have been reported to be as effective as formal standardized measures in identifying young children with speech, language or developmental delays. (Diamond, 1993).

Mothers are the best managers in jeopardized effectively the scarce resources for her children. Management skills are jeopardized during periods of stress such as repeated child birth and scarcity of food in a poverty situation. At her hour of need, trained health workers available locally can enhance her capacity as a primary care manager to tide over children’s illness. Simple measures adopted by the mother can improve her health and socio-economic status. The mother is therefore the child health worker par excellence and deserves all support from health workers. (Chaudhuri S., 1991)

One request investigator ordinarily makes to parents is to review the sequence of events leading to final diagnosis of hearing loss. It has been found that before a child with profound hearing loss is one year old, family members have been suspicious about the hearing status, but have not shared concern with one another. Such obstacles prevent the family from reaching the professionals for assessment (Ross M., 1990).

Screening brings the mother in contact with health visitor. It appears that particular concerns and anxieties were not resolved by this contact, though some mothers stated that they found the assessment reassuring. Such tests provide opportunities for mothers to discuss their concerns with health visitors. Assessment which provides information on areas of less concern or which appears irrelevant is likely to be less acceptable ( Johnson, Sherat and Holmes, 1991)

The review of literature was an important step in research. It helped the investigator to gain an overview of previous work in the area and helped in understanding the emerging trends. It warned the investigator about basic flaws and limitations experienced in previous similar research works. Review also helped in reaching a number of important goals, like, clearly defining the objectives of study, assimilating current knowledge, seeking new approaches and gaining insights into current opinions and methods.

This article describes an alternative approach in an evidence-based technique relying on professional elicitation and interpretation of parents' concerns. 971 children from pediatric practices, day-care centers, public schools, and their siblings were taken. Research shows that parents' concerns are as accurate as quality screening tests and those parents are equally able to raise important concerns regardless of differences in education and child-rearing experience. Parents' concerns can be elicited quickly, and 92% of parents can answer questions in writing while in exam or waiting rooms. Parents' concerns can help make a range of other important decisions about children's developmental and behavioral needs. (Glascoe FP, 1999)

Provision and use of information about their children is a major concern to families who have a child with a disability .Strategies or systems to influence parent’s abilities to receive, give and use information in a way that is satisfying to them have not been well validated. Parent’s perceptions of their ability, confidence and satisfaction when using information improved significantly after using the KIT. Parent’s perceptions of care, as measured with the measure of process of care, also improved significantly in the areas of Enabling /partnership and providing general information. Parents who received and actively use the parent information KIT experienced significant increase in their perception of their ability and self confidence in getting, giving and using information to assist their child with a disability. (Stewart D, 2006)

The objectives of this study are: (1) to describe parental coping in a cohort of children with physical disabilities (PDs) (2) to determine whether socio demographic factors such as child’s age , maternal education and family structure are associated with parental coping .The findings underscore the importance of helping parents of children with PDs maintain social support .It is important to help parents understand their child’s medical situation , especially those whose children have more severe mobility dysfunction (Cavallo S, 2008).

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