Simplified assessment of handicaps in children

ABSTRACT

The assessment of disabled children usually requires experienced, trained professionals. WHO, in their manual "Training the Disabled in the Community" devised a questionnaire to be used by community workers (CWs) to assess handicaps and develop rehabilitation plans. This has been used for over 14 years in many third world countries but has never been evaluated. Our study on 5,468 Clarendon children allowed us to do a full evaluation of its use in the hands of CWs. A previous paper reported inter-rater reliability and facility of use. The questionnaire was adminstered to the caregivers of a subsample of 1219 2-9 year old children who tested positive on the ten question screen for disability and 8 percent of screen negative children in a population based survey conducted by CWs in 1987 to 88. Negative responses were labelled "handicaps". These children were referred for medical and psychological assessment to determine wether they had a disability. The responses to the questionnaire were analysed for achievement of milestones of development, associations with severity of impairment and disability, and with other handicaps. All screen negative children reached the milestone of moving round the house in 2 years, self feeding, washing, toiletting, and dressing by 6 years and understanding and expressing speech by 5 years. 100 percent were going to school and participating in family activities by 5 years and doing daily household tasks by 6 years. "Handicaps" were found in 0.5 percent of screen negative, 12 percent of screen positive, 4 percent, 19 percent, 38 percent and 84 percent of children with no impairment, and mild, moderate and severe degrees of disability respectively. 67 percent of children with disabilities had no handicaps and 46 percent of children with handicaps had no disability. This investigation has given a useful baseline for using milestones of development to indicate "handicaps" in children. Failure to achieve these correlates well with severity of impairment and disability. The 67 percent of disabled, non-handicapped children also correlates with an earlier finding that 30 percent of disabled children can benefit from CBR. These "handicaps" are amenable to rehabilitation by CWs. However, the questionnaire needs restructuring to facilitate interpretation and meaningful action. (AU)