6. Clinical and other examinations .(3 PAGES )
During the personal interviews and the general interactive sessions allotted to us as part of the internship at ICCONS , the professionals working there have revealed a lot of information on the importance of clinical examination.
They have underlined the fact that DSM -5 and ICD -10 is followed for physical and other examinations there.
The patient is examined for any possible medical signs or symptoms of a medical condition.Any basic neurological clinical examiation of a patient consists of the evaluation of mental state , sensory systems , cranial nerves, motor systems and reflexes , coordination , gait , cortical function .
Observational skills are important as they will help in the detection of physical signs that may give a clue as to the neurological disability.
More specialised tests ,tools and rating systems are required for disorders such as depression or schizophrenia in the field of psychiatry.
After the clinical examinaton , a sreies of laboratary tests may be required in order to obtain the information that the clinical examination can not reveal.in consisitenices in the examination may lead to the possibility of functional organinc disorder.
Assessment of SLD :
A detailed clinical evaluation is the first stage of assessment of SLD.It is followed by a set of standrad psychometric assessments of the child's cognitive and academic assessment.
Children with SLD are either brought by their parents as self-referred or by referral from the school. Children with learning difficulties are often labelled as “lazy” or “stupid” or as being “trouble makers “if they have comorbid behavioral symptoms. They are often compared with others who perform well in academics and face punitive experiences in the home as well as school contexts.
The clinical presentation is quite variable with some children presenting primarily with complaints of poor academic performance whereas others can present with symptoms secondary to the poor academic performance which may include school refusal, oppositional behavior, aggression, poor motivation for studies, low self-esteem, sadness of mood, crying spells, changes in sleep and appetite, excessive engagement in extracurricular activities, somatic complaints (pain symptoms, fatigue), dissociative symptoms (pseudo seizures, dissociative sensory loss, dissociative amnesia etc.).
Academic difficulties include writing slowly, not completing classwork and homework, poor handwriting, omission of long answer questions, inability to completewriting in time, spelling mistakes, reading slowly, reading word by word, replacing difficult words with words of similar pronunciation, reading without punctuation, mistakes while doing arithmetic etc.
Prior to psychological testing, the psychiatrist should obtain a detailed history from parents and child followed by examination of the child. The clinical evaluation should be structured to include the components listed below :
1.Present complaints and their progress
2.History of any behavioural or emotional problems
3.Schooling history- attendace , classroom behaviour ,any change of school / behaviour / curriculum /academic difficulties / any interventions or accomodations provided at the school, impact of the interventions , family history of any neurodevelopmental disorders/ psychiatric illess / neurological disorders /
4. Family life and relationships
/ medical history /
5.History of any previous evaluation or ontervention
6.Family's awareness and perception about the child's problems
7.Behavoural examination and mental status of the child ,
8.Informal assessment of reading , writing ,spelling and arithmetical skills
9.Physical examination- especially neurological and sensory system examination.
10.Screening for comordities like AHD, ADHD,ODD, Depression and anxiety disorders
report from the class teacher./ school.
Psychometric testing
Psychometric testing helps in confirmation of diagnosis and in planning the intervention. The psychometric testing usually includes testing for cognitive abilities and testing for academic abilities. Assessment of the child's level of Intelligence by measuring IQ can be done using Standardized IQ tests.
The tests that can be used include Binet–Kamat Test, Malin's Intelligence Scale for Indian Children (MISIC), Wechsler's Intelligence Scale for Children-4th Edition etc. These have differing advantages (refer to table in article on Intellectual Disabilities) MISIC will provide Performance IQ, Verbal subscale IQ and Full-scale IQ. In children with SLD, there is a discrepancy between verbal and performance IQs with the performance IQ usually being higher. Another pattern named “ACID-profile” has been described where children may score low on subtests of Arithmetic, Coding, Information and Digit-span. WISC IV often reveals weaknesses in verbal comprehension, working memory, and processing speed.
After assessment of IQ, tests to evaluate academic abilities need to be administered. There are several tests which are useful in the evaluation of academic abilities. These include NIMHANS Index for SLD, Wide Range Achievement Test, Test of written language-4, Wechsler Individual Achievement Test, Woodcock-Johnson III/IV Tests of achievements (WJ-III), Kaufman Test of Educational Achievement, Peabody Individual Achievement Test-Revised, Aston Index Battery.
NIMHANS Index for SLD AND Wechsler's Intelligence Scale for Children is reported to be used here@ICCONS for evaluation.
iii. The departments of ICCONS and the facilities
iv. Registration of patients/ cases
vii. Procedure of Assessment at various departments / tests
viii. Identification of problems/ disorders/ disabilities
ix. Treatment/therapies/interventions and advice
x. Management / Rehabilitation process
xi. The types of cases came on the observation days
xii. The Parents’/ escorts’ roll during and after the treatment sessions
xiii. The improvements of the cases
xiv. The ideas got from the classes of experts and discussions
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