Attention Deficit Hyperactivity Disorder (ADHD) is a symptom complex characterized by poor ability to attend to a task, motor over activity and impulsivity. These children are fidgety, have a difficult time remaining in their seats in school, are easily distracted, have difficulty awaiting their turn, impulsively blurt out answers to questions, have difficulty following instructions and sustaining attention, shift rapidly from one uncompleted activity, talk excessively intrude on others, often seem not to listen what is being said, lose items regularly and often engage in physically dangerous activities (DSM). It is important to know that the attention span increases with age.
The normal attention span is said to be 3 - 5 minutes per year of age. E.g: A three year old child will have approximately an attention span of 10 to 15 minutes, by 6 years of age it may be around 20 minutes. It is important to understand that ADHD is seen as a primary neurologically based disability on the part of brains "wiring" and therefore beyond the willful control of the child.
PREVALENCE:
ADHD affects 3 - 4 % of children in the USA (1). Boys are more affected than girls in a 6 : 1 ratio. Age of onset is usually before 4 years but diagnosis is made around 3 - 4 years of age. No statistical data, is not available for the Indian children, experts agree that it is roughly the same percentage as in the western population.
The management is based on 3 approaches namely environmental accommodation, behaviour modification and drug therapy.
CCDD offers a comprehensive diagnostic and management program for these children. It also offers a parental education program in developing coping strategies and monitoring the drug therapy.
To know more ADHD, take an appointment with with our Developmental Pediatrician.
Sensory Integration Program in CCDD is a therapeutic approach for treatment of children living with Sensory Processing disorder (SPD) to help them overcome motor, social, emotional and behavioral challenges in their day to day living. CCDD is one of the premier centres to treat children with sensory issues and privileged to bring difference in many children's life in India as well as abroad.
Our brain has to process incoming information from different senses and use them to direct appropriate motor and behavioral responses. The way we interact and behave in an environment such as sitting in a class room, playing with peers, social interaction, age appropriate motor behaviors, etc. requires appropriate processing of senses that we encounter in our daily life. The senses which we talk about are vision, hearing, taste/smell, touch and Movement senses (vestibular and proprioceptive). Children having difficulty in processing these senses may exhibit behaviors like hyperactive/impulsiveness, fidgety, poor sitting tolerance, pulling and pinching behaviors, limited socialization, and poor fine motor skills, poor feeding, smelling non-food objects, reacts negatively to loud noises, poor physical and balance skills and much more...
This inability of a child to meaningfully process sensory information is called as Sensory Processing Disorder(SPD). The SPD can manifest itself in the form of abnormal sensory, behavioral, social and motor responses. Sometimes senses could be quiet stressful for children with SPD and moreover a child with sensory challenges doesn't know exactly how to vent stressful events and self-regulate to keep themselves focused on the task at hand.
Children living with SPD may range from being an over responders (intolerance to senses)/ under responders (little or no reaction to senses) or Sensory Seekers (being fidgety). Certain children may also have sensory based motor issues such as generalized weakness, clumsiness, and poor gross and fine motor skills.
Sensory processing disorder is quite common in
In CCDD, Children with SPD will be carefully evaluated using standard sensory based measurement tools to understand the type of difficulties they have with any of the senses mentioned above. A unique treatment design will be developed based on the initial evaluation and later modified based on the progress, the child show during treatment sessions.
Our intervention strategies are fun-filled activities to help children streamline their sensory issues and be functional in Home, School and other environments. We also provide a personalized sensory diet chart to help families living with SPD and teachers to address their child's sensory needs at home and school environment respectively.
To know whether your child has SPD, call us now and take an appointment to meet our Developmental Pediatrician and Sensory Integration Therapist or submit an enquiry form.
Children with learning problem present with a wide spectrum of complaints ranging from difficulties in school with poor academic performance to behavioral and emotional problems. Apart from difficulties in learning to read, there may be difficulties with math, computation and understanding basic concepts such as addition, subtraction etc. Problems with attention, orientation, auditory or visual perception, memory and fine and gross motor coordination are also common. Children may exhibit a combination of symptoms with problems involving one or more areas.
These children may also present with symptoms such as school refusal or somatic symptoms such as headaches, wrist/hand pain and stomachaches. Undiagnosed and untreated, these problems increase until the child dislikes school, refuse to do homework, and physically provocative. Successful intervention with these children requires the diagnosis and treatment of learning problems in early school years.
The learning program at CCDD evaluates these children comprehensively with a team of Developmental Pediatrician, Child Psychologists, Special Educationist and Occupational Therapist.
The first interview is with the Developmental Pediatrician to ascertain the problems and any associated problems which could hamper learning; this could be deficiency of thyroid hormones. The child on antiepileptic medication may require a scan of the brain, etc..
Next a full diagnostic assessment is done to find complete and comprehensive details of the problem by psychological and other testing.
Then a full report is generated and discussed with the parents to ensure that they have understood the problems of the child and the possible measures they can undertake at home, school and at the remedial center.
A copy of the report is also sent to the referring Physicians or the schools.
Children wanting remedial programs are enrolled in the center. A detailed Individual education plan is formulated. A home program is also drawn and discussed with the parents as what to do at home. At times a program at school is also made and the class teacher is given the program.
Review of the child is done monthly by the Developmental Pediatrician to see progress and changes to be made as and when needed. Review also helps in not just seeing the progress of the child but also how parents perceive the difficulty of the child.
To know more about your child's learning difficulties call us or write to us .
Autism is a neurodevelopment disorder affecting the communicative and social interactive skills with or without restricted and repetitive behavior patterns. It presents in early childhood and persists into adulthood.
Features of autism are present at a very young age. Autism can be suspected in the first year of life in an infant who does not have a good reciprocal social smile and eye contact, has delayed babbling and insufficient gestures and who responds inconsistently to name. However, the gold standard tests can be applied only after completion of 2 years of age; hence a definitive diagnosis can be arrived at only then. This is one of the common developmental problems in children, and frequently missed in the earlier years
The autism management program at CCDD starts with an extensive interview with the parents or the caregiver. The detailed interview is to ascertain the child's and the issues the family faces with the child.
The Developmental Pediatrician then conducts the ADI (AUTISM DIAGNOSTIC INTERVIEW) with the care giver. This usually lasts for about an hour
The child is then scheduled for a detailed assessment to see the socio emotional level, adaptive functions, detailed language assessment, Child Behavioral Checklist, ADOS (AUTISM DIAGOSTIC OBSERVATION SCHEDULE) and Sensory Profile. Detailed written reports are drawn, discussed and given to the parents. This would take two or more sessions.
The next step is to enroll the child in the autism intervention program. Parents are an integral part of the program and a home management program is given to them to carry out. Centre has well planned intervention program adapted from Early Start Denver model of intervention and Hanen's language and communication program.
The child comes three or four times to the centre for intervention strategies with the autism trained specialist and the occupational therapist.
Monthly reviews are done with a multidisciplinary team to see progress and taking the program forward.
You can call or write to us for appointment.
The first 5 years are the period when foundation is laid for optimum development in areas of language, cognition, emotion and creativity skills.
This is the time when the brain is growing rapidly and is very neuroplastic and malleable. Parent interaction and environment influence the development during this period and bring up a happy and a motivated child who is bubbling with life and a enthusiastic learner.
The total child firm foundation program supports and strengthens the caregiver to help their children navigate these years to develop a solid intellectual, social and emotional life .
Scope of the program
This addresses areas of,
Assessment process at CCDD is means of gathering critical information about your child's development. The methods used to gather information includes observation of the child, interviews with the family, checklists, informal tests and standardized formal test measures. The information obtained thorough assessment procedures will aid in diagnosis and identifying the child as eligible for developmental intervention. Following are the list of assessment tools used in our center.
NEUROPSYCHOLOGICAL DIAGNOSTIC MEASUREMENT TOOLS
The Diagnostic Assessment include referral batteries with sub tests critical to the diagnosis of specific disorders.
Recommended referral batteries include Learning Differences- Reading, Learning Differences - Math, Attention /Concentration, Behavior Management, Language Delays/Disorders, Perceptual and/or Motor Delays/Disorders, School Readiness and Social/Interpersonal Differences. Following is the assessment battery used as standard Neuropyschological diagnostic tool @ CCDD.
Neuropsychological Assessment II [NEPSY - II] The NEPSY-II is the only single comprehensive measure to assess neuropsychological development in children, ages 3-16 years across six functional domains. The test domains are Social, Perception, Executive, Functioning/Attention, Language, Memory and Learning, Sensorimotor Functioning, Visuospatial Processing. The tool allows clinician to create a tailored assessment across six domains, specific to a child's situation in order to inform diagnostic concerns and aid in intervention of variety of childhood disorders.
With integrated NEPSY-II, Clinician can:
The most common types of assessment using the NEPSY-II are
AUTISM RELATED MEASURES
Screening Tools
Modified Checklist for autism in Toddlers [M-CHAT]
M-CHAT is a developmental screening tool for toddlers between 16 to 30 months of age. It is designed to identify children who may benefit from a more thorough developmental and autism evaluation.
Childhood Autism Rating Scale [CARS]
CARS is a behavior rating scale intended to help diagnose autism. It is designed to differentiate children with autism from those with other developmental delays such as mental retardation.
Diagnostic Tools
ADOS / ADI-R
ADOS - Autism Diagnostic Observation Schedule The ADOS is an instrument used for diagnosing and assessing Autism / Autism spectrum disorders. The assessment involves the social interaction between the assessor and the individual. It consists of a series of structured and semi-structured tasks that takes between 30 and 60 minutes. The assessor observes and identifies segments of the individual's behaviour and assigns these to predetermined observational categories.Categorized observations are subsequently combined to produce quantitative scores for analysis.Research-determined cut-offs identify the potential diagnosis of autism or related autism spectrum disorders.
ADI-R = Autism Diagnostic Interview - Revised
The Autism Diagnostic Interview-Revised (ADI-R) is a structured interview conducted with the parents of individuals who have been referred for the evaluation of possible autism or autism spectrum disorders.The ADI-R interview covers 93 questions, spanning the three main behavioral areas: Language/Communication, Reciprocal Social Interactions and Restricted, Repetitive and Stereotyped Behaviours and Interests. An autism diagnosis is indicated when scores in all three behavioral areas exceed the research determined minimum cutoff scores.
Therapeutic Tool
Early Start Denver Model (ESDM) Curriculum Checklist
The ESDM Curriculum Checklist is used to comprehensively assess the skills of toddlers and preschoolers with autism across multiple developmental domains. The domains include receptive communication, expressive communication, social skills, play skills, cognitive skills, gross motor skills, fine motor skills and adaptive behavioral skills. The checklist is designed to establish unique and individualized teaching goals for intervention.
ASSESSMENT OF LANGUAGE DEVELOPMENT
Rosetti Infant Toddler language Scale
It is a criterion reference instrument designed to assess the language skills of children from birth through 36 months of age. The scale assesses preverbal and verbal areas of communication and interaction including interaction attachment, pragmatics, gestures, play and language comprehension and language expression.
Cognitive Adaptive Scale [CAT] and Clinical Linguistic and Auditory Milestone Scale [CLAMS]
CAT & CLAMS are used as an instrument for detecting cognitive and language milestone delays.
PROBLEM BEHAVIOURS IN CHILDREN
Child Behavior Checklist [CBCL]
CBCL is a parental rating scale used to detect various beha in children.
Vanderbilt ADHD Parental Rating Scale
It is a questionnaire rated by parents to detect Attention Deficit Hyperactivity Disorder. The Scale follow closely the criteria set forth in DSM-IV (Diagnostic and Statistical Manual - IV) and allow clinician to not only to make a diagnosis of ADHD, but also categorize the disorder into of its subtypes such as inattentive, hyperactive/impulsive or combined.
TEST OF INTELLIGENCE
Malin's Intelligence Scale for Indian Children [MISIC]
MISIC is the Indian adaptation of Wechsler Intelligence Scale for Children [WISIC]. It's made for children from 6-15yrs of age assessing the verbal and non-verbal areas of intelligence.
Binet-Kamat Test of Intelligence [BKT]
The tool assesses verbal and non-verbal aspects of intelligence from the age group of 3 to 22 years.
SOCIO-EMOTIONAL FUNCTIONING AND ADAPTIVE/MALADAPTIVE BEHAVIOURAL SCALES
Vineland Social maturity Scale [VSMS]
The Vineland Social Maturity Scale is a nonprojective personality measure designed to assess social competence from birth to adulthood. The test scores based on parent's interview and consists of 8 sub-scales measuring Communication skills, General self-help ability, Locomotion skills, Occupation skills, Self-direction, Self-help eating, Self-help dressing, and Socialization skills.
Vineland Adaptive Behavior Scale [VABS]
VABS is an individually administered measure of adaptive behavior from birth through 90yrs. Vineland-II forms aid in diagnosing and classifying mental retardation and other disorders, such as autism, Asperger Syndrome, and developmental delays. The test items of the scale are organized in to four domains: Communication, Daily Living skills, Socialization, Motor Skills and Maladaptive behavioral index.
DEVELOPMENTAL ASSESSMENT
Developmental assessment scale for Indian infants (DASII)
DASII is the most comprehensive measurement tool that evaluates development in Indian children, ages 0-3 yrs. The measure consist of series of developmental play tasks that evaluates motor (gross and fine motor) and mental development (Cognition, Language and social development).
N VM Early intervention developmental profile (EIDP)
NVMEIDP is a diagnostic manual developed by a Developmental Pediatrician and a Clinical Psychologist for practicing doctors and professionals dealing with high risk infants in India. The scale helps in identifying children who may require special attention to maximize their development. The scale outlines development in the first three years of life from birth to 36 months, considering being the most crucial years of development. The scale assesses the following areas; Gross Motor, Perceptual/Fine Motor, Language, Self care, Social/Emotional.
EVALUATION OF MOTOR FUNCTION
Test of Gross Motor Development (TGMD-2)
The TGMD-2 is a measure of common gross motor skills of children ages 3 through10 years. It helps identify children who are significantly behind peers in gross motor skill development and who may need special services in physical education. The test consist of two subtest: Locomotion and object control.
GMFM
GMFM is a clinical measurement tool designed to evaluate gross motor function in children with Cerebral Palsy. The items of GMFM are grouped under four activities; lying, rolling, alking, running and jumping skills. The scale provides in-depth information about level of gross motor difficulty that will assist in goal directed intervention.
NDT Posture and Movement analysis
Posture and Movement analysis is a non-structured evaluation measure based on NDT principles The Evaluation is done by a Certified Neuro-Developmental therapist (NDTA, USA). The evaluation involves handling the child in various postures and movement to determine the bodily systems that are responsible to gross and fine motor deficits. The evaluation is based on NDT enablement model which is an extension of WHO's International Classification of Functioning, Disability and Health. The impairments identified during an assessment are used to set functional goals and to choose appropriate NDT based treatment strategies.
HANDWRITING EVALUATION
Evaluation tool for Children's Handwriting
ECTH evaluates manuscript and cursive handwriting skills of students in Grade 1 -6. The test assess student's legibility components, speed of writing, pencil grasp, hand preference, manipulative skills with writing tool. The writing task includes alphabet, numerical, near-point copying, far point copying, dictation and sentence generation.
ASSESSMENT OF SENSORY PROCESSING DISORDER
Sensory Profile
The Sensory Profile is a caregiver questionnaire which measures children's responses to sensory events in everyday life (for children 3-10 years of age). The Sensory Profile contains 125 items in sections corresponding to each sensory system, sections which indicate the modulation of sensory input across sensory systems, and sections which indicate behavioral and emotional responses that are associated with sensory processing. The caregiver completes by reporting how their child respond to particular item in a 5 point likert scale. The scores obtained from the scale informs about sensory processing patterns that leads to diagnosis and also provide guidance for intervention.
Infant / toddler sensory profile
The Infant/ Toddler Sensory Profile is a caregiver questionnaire which measures children's responses to sensory events in everyday life. The profile has 48 items related to sensory processing that evaluates children ages 7-36 months.The caregiver completes by reporting how their child respond to particular item in a 5 point likert scale. The scores obtained from the scale informs about sensory processing patterns that leads to diagnosis and also provide guidance for intervention.
SCHOOL READINESS
School Readiness
School Readiness is the ability of a child to transit in to pre-school/kindergarten with skills that are required for school success. The School Readiness is influenced by five developmental domains that are intrinsically interrelated. The Domains are Physical, Cognitive, Linguistic, Social and Emotional development. School readiness evaluation at CCDD is a comprehensive one that evaluates all the domains of development that is necessary for pre-school preparedness.
The Infant Stimulation Program at Center for Child Development and Disabilities is a comprehensive one. It helps in maximizing the child's potential in all streams of development. The program enjoys immense credibility with the pediatricians and parents alike.
The program director Dr Nandini Mundkur is a well known Developmental Pediatrician with several scientific publications in this subject. She along with her team of therapists conducts this program.
From conception till the age of three the child learns to walk, speak, think, and develop its cognitive and emotional skills. During this period the brain passes through a series of developmental phases and any insult during this time can result in child developing problems in movement, speech and language, cognition, social and emotional skills. Some groups of children are considered at higher risk of developmental problems especially preterm babies, babies born below 2 kg birth weight or undergone severe illnesses requiring ventilation and intensive care support.
It is seen that only 30% of children pass through these developmental phases without any problems.
Under the complete child program parents are advised to review their babies development at 4, 8 and 12 months of age in the first year and at one and half years, two years and three years of age thereafter. During this time they can discuss with the developmental pediatrician as how to maximize the child's potential and also deal with any behavioral issues parent may be concerned with.
The other 70% of children develop some developmental delay or the other some of which may become obvious only later as the child grows and starts to go to school. These could be problems like lack of concentration, problems with reading, writing, or co-ordination. This is seen in about 40% of children.
The rest 30% of children can have major problem in motor areas as delayed sitting and walking or as language delay which appear even before first year of life.
Our complete child program would benefit these 70% children with delayed development.
The program comprises of detailed assessment in all streams of development by well qualified professionals from the field of physiotherapy, specialists in early childcare and child psychology.
Then these children are enrolled in suitable program to compensate for the areas in which early intervention is required.
A typical program would have children coming to the center for therapies as scheduled and reviewed monthly with the developmental pediatrician to see progress and amendment of the program. Simultaneously a home program is given and parents trained to execute the program at home as parents form a integral part of the early intervention team.
The complete child program at Center for child development and disabilities is very popular among the doctors who refer children with suspected developmental delay for assessment and stimulation. CCDD reaches out to over hundred children monthly. This program is executed from two child development centers located at Malleswaram and New BEL road in the city of Bengaluru, India.
You can access help with us if you have any concern with development of your child. It is just a phone call away. Call 91/80/23342035 or 80 23603394 or write to us at [email protected] or [email protected]
CCDD, right from its inception has developed its own reputation in providing services to children with neuromotor disorders. Our ability to be receptive for new emerging treatment methods and the changing needs of children and families living with cerebral palsy or other neuromotor disorders makes us a stand apart service provider. Our vision is to bring independency in children living with neuromotor disorders and enable them to be an active member of every facet of our society.
HOW DO WE HELP YOUR CHILD?
During initial visit, Developmental Pediatrician would examine your child to ascertain the areas of concern and then followed by a detailed developmental evaluation by one of our NDT trained/ certified Physiotherapist. The evaluation procedure is a combination of standardized measurement tools, physical observation and direct handling of your child to understand his/her strengths and challenges. Based on the evaluation reports, a comprehensive unique treatment program will be designed in participation with you to address the various needs of your child not just posture and movement deficits. This is the very reason, why we believe in the following quote.
"It is not just about therapy but seeing the world through children's eyes and teach them how to live"
The Program involves team of experts from the field of Developmental Pediatrics, Pediatric Neurology, Pediatric Orthopedics, Physiotherapy, Child Psychology, Special Education and Orthotics. The team works together incolloboration with the parents to help children achieve better functional outcomes.
Our therapy program is based on NDT philosophy and NDT trained/certified Physiotherapist treat your child every session. The Interventional strategies which we use are dynamic in nature based on child's performance and the goals are achieved during each treatment session. Before beginning the therapy sessions, your child's challenges and the rationale behind our treatment strategies will be thoroughly explained to you, for better understanding of how our treatment works.
We also provide a custom made Home Exercise Programme integrated into child day to day task. Parents are taught to handle their child during therapy sessions that will enable them to reciprocate techniques at home environment to augment their child's function.
The range of patient we treat using NDT principles are
To know more, take an appointment with our Developmental Pediatrician & Therapy experts.