Disability Certification in
Psychiatry
Dr. Ranjeet Kumar
Associate Professor
Clinical Psychology
What Is Autism?
• Lifelong Neurodevelopmental condition.
• Affects, among other things, the way an
individual relates to his or her environment
and their interaction with other people.
• ‘Spectrum' describes the range of difficulties
that people on the autism spectrum may
experience and the degree to which they may
be affected.
• Particular difficulties in some or all of the
following areas:
Communication TRIAD OF IMPAIRMENTS
Social interaction
Imagination
Spectrum of Autism
Self-Absorbed Quirky
Social
Aggressive,
Odd
Destructive
Behavior
Non-Verbal Highly Verbal
Communication
Awkward Agile
Motor
Hyposensitive Hypersensitive
Sensory
Profound Intellectual
Disabilities Gifted
Measured I.
Q.
3
EVALUATION AND ASSESSMENT FOR AUTISM
The National Institute for Mentally Handicapped (NIMH)
developed the Indian Scale for Assessment of Autism
(ISAA) for diagnosing and measuring the severity of
autism in 2009.
It has 40 items divided under six domains – social
relationship and reciprocity; emotional
responsiveness; speech, language and
communication; behavior patterns; sensory aspects
and cognitive component.
The items are rated from 1 to 5, increasing score
indicating increasing severity of the problem.
A score of <70 indicates no autism,
70-106 (mild autism),
107-153 (moderate autism),
and >153 (severe autism).
It takes about 15 to 20 minutes for administration of ISAA.
The ISAA was devised with the aim of quantifying the
severity of autistic symptoms so as to enable measurement
of associated disability.
Quantification of disability would help in getting disability
benefits.
A symptom severity score of 70 in ISAA corresponds to
40% disability;
71-88 (50%),
89-105 (60%),
106-123 (70%),
124-140 (80%),
141-158 (90%),
whereas >158 (100%) disability.
The subgroup of mild autism (70-106) has two different
disability scores and the group with moderate autism
(107-153) has different disability scores. A score of 153
would mean severe autism, but 100% disability benefits
can be expected only if disability score is >158.
Disability Certification in Psychiatric Practice
Rehabilitation Committee of the Indian Psychiatric
Society (IPS) came up with the Indian disability
evaluation and assessment scale (IDEAS) in 2002. IDEAS
was field tested in nine centers all over India and has
now been gazetted by the Ministry of Social Justice and
Empowerment, Government of India, as the
recommended instrument to measure psychiatric
disability.
Patients with the following diagnoses are eligible for
disability benefits:
1. Schizophrenia.
2. Bipolar Disorder.
3. Dementia.
4. Obsessive Compulsive Disorder.
Duration of illness - = at least 2 years – the number of
months the patient was symptomatic in the last 2 years
The IDEAS, evaluates disability in four areas (termed
items in the scale), namely, Self care, Interpersonal
activities, Communication and Understanding, and
Work.
Each item is scored on a 5 point scale with a range of 0-4, i.
e. from no (0) to profound disability (4).
The total disability score is obtained by summing up the
ratings on each item.
Global Disability Total Disability score +MI2Y score =
Global Disability score (range: 1-20)
Weightage for duration of illness
• < 2 years of illness: add 1 score
• 2-5 years: add 2 score
• 6-10 years: add 3 scores
• > 10 years: add 4 scores
Percentages For the purpose of welfare benefits, 40% will
be the cut-off point.
The scores above 40% have been categorized as
Moderate, Severe and Profound based on the Global
disability score.
This grading will be used to measure change over time.
Score of 0 - No Disability = 0%
1 -7 - Mild Disability = < 40 %
8 and above = > 40 %
(8 -13 Moderate Disability;
14-19 = Severe Disability;
20 = Profound Disability)
MENTAL RETARDATION
A condition of arrested or incomplete development of the
mind, which is especially characterised by impairment of
skills manifested during the development period which
contribute to the overall level of intelligence, i.e.,
cognitive, language, motor and social abilities.
Categories of Mental Retardation
Mild Mental Retardation - The range of 50 to 69
(standardised IQ test) is indicative of mild retardation.
Moderate Mental Retardation - The IQ is in the range of
35 to 49.
Severe Mental Retardation - The IQ is usually in the range
of 20 to 34.
Profound Mental Retardation - The IQ in this category
estimated to be under 20.
Definition - THE GAZETTE OF INDIA
2018
• Intellectual disability, a condition
characterized by significant limitation both in
intellectual functioning (reasoning, learning,
problem solving)
• and in adaptive behaviour which covers a
range of every day, social and practical skills.
Diagnosis:
• The screened children will be referred to Child/
clinical psychologists for Adaptive functioning and IQ
• testing. The tools that can be used for the same
include:
• (i) Adaptive functioning: VSMS
• (ii) IQ testing: BKT/ MISIC
• Based on the above the diagnosis of IQ will be
confirmed.
• Based on adaptive functioning assessment, severity
scoring will be done and disability for IQ charted.
Disability calculation:
• .The disability calculation will be done based on
VSMS score. The following will be used
• for disability calculation:
• (i) VSMS score 0-20: Profound Disability-100%
• (ii) VSMS score 21-35: Severe Disability-90%
• (iii) VSMS score 36-54: Moderate Disability-75%
• (iv) VSMS score 55-69: Mild Disability-50%
• (v) VSMS score 70-84: Borderline Disability-25%
Age for certification:
• The minimum age for certification will be:
• one (01) completed year.
• Children above one year and up to the age of
5 years shall be given a diagnosis as Global
Developmental Delay (GDD).
• Children above the age of 5 years shall be
given a diagnosis and certificate as
Intellectual Disability.
Medical Authority:
• The Medical Superintendent or Chief Medical
Officer or Civil Surgeon or any other equivalent
authority as notified by the State Government
shall be the head of the Medical Board.
• The Authority shall comprise of:
• (a) The Medical Superintendent or Chief Medical
Officer or Civil Surgeon or any other equivalent
authority as notified by the State Government
• (b) Pediatrician or Pediatric Neurologist
(where available )/or Physician
• (if age>18years)
• (c) Clinical or Rehabilitation Psychologist
• (d) Psychiatrist
Validity of Certificate:
• (i) Temporary certificate for children less than 5
years:
• The certificate will be valid for maximum 3 years/
5 years age (whichever is earlier).
• (ii) For children more than 5 years:
• The certificate will mention a renewal age. The
certificate will have to be renewed at age of 5
years, 10 years and 18 years.
• The certificate issued at 18 years age will be valid
lifelong.
THANK YOU
