New Horizons Group...New Horizons Group NEWSLETTER (QPM/ MNL-01, Vol. II Issue 11) | December, 2016...
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New Horizons Group NEWSLETTER (QPM/ MNL-01, Vol. II Issue 11) | December, 2016 Developmental Pediatrician Dr. Samir Dalwai (MD, DNB, DCH, FCPS, DNB and LLB) founded New Horizons Child Development Centre (NHCDC now NHD) in 2003. NHD has developed 5 centres and currently houses a team of more than 60 paramedical professionals. NHD provides multi-disciplinary services to more than 300 children daily with a ratio of one specialist to one child in each intervention session. New Horizons Health & Research Foundation (NHHRF now NHF), is a registered non-profit organization [Reg.No.U85100MH2012NPL2385 6; No.DIT(E)/80G/111/N/2014-15], which works in the areas of health, impairment and early childhood development. NHF follows a four-pronged approach: Research, Rehabilitation, Advocacy and Training. Established in 2014, New Horizons Institute of Education & Research (NHIER now NHI) is the educational wing of NHG. In May, 2015, TATA INSTITUTE OF SOCIAL SCIENCES (TISS), Mumbai and NHF entered a collaboration and offer diploma courses in Special Education and Rehabilitation Psychology. New Horizons Education and Training Solutions (NHETS now NHS) provides highly specialized solutions to schools in Mumbai. Our specialists are deputed at the school on a customized basis for conducting evaluation, intervention and counseling for children with academic, emotional and behavioural concerns. Dr. Waheeda Pagarkar started the New Horizons Audiology (NHA) and Hearing Aid Centre for Adults and Children in August 2014. In its first year, NHA has seen around 400 patients, out of which 20 were adults and the remaining 380 were children. 35 patients were diagnosed with hearing loss of varying type and degree while 10 were prescribed with hearing aids. PRESENTING NEW HORIZONS INSTITUTE OF EDUCATION AND RESEARCH (NHI): PLANTING THE SEEDS OF KNOWLEDGE In keeping with Dr. Samir Dalwai’s vision of imparting scientific knowledge about developmental concerns and creating more practising professionals in the field, New Horizons Institute of Education & Research (NHIER now NHI) was established in 2014 as the educational wing of the New Horizons Health and Research Foundation (NHF). The institute offers the following courses and programs: 1. Post Graduate Diploma in Special Education in collaboration with Tata Institute of Social Sciences, Mumbai since 2015. 2. Certificate in Special Education, an autonomous course by New Horizons Institute. 3. Foundation in Autism Spectrum Disorder by University of New Mexico. 4. Clinical Observership Program at New Horizons Child Development Centre. The institute aims to impart scientific, DOWN MEMORY LANE: SOME UNFORGETTABLE MOMENTS AND CREATIONS! TELL ME AND I FORGET, TEACH ME AND I MAY REMEMBER, INVOLVE ME AND I LEARN! THE COLOURS OF LIFE: ACHIEVEMENTS AND HIGHLIGHTS During the practical intervention program, PGDSE students engage in community-based teaching programs, working with children with academic difficulties. PGDSE batch 2016-2017 students are working simultaneously with two schools: Goregaon English School and Nityanand Marg BMC School. In Nityanand Marg BMC School, an organization named Parisar Asha looks after the teaching process in pre-primary grades. The school children were identified by school authorities with academic and behavioural concerns. Each child identified with concerns underwent a one-on-one informal academic evaluation, under supervision, to document their academic strengths and needs. A comprehensive evaluation tool was used, which was created by the students themselves, with inputs from their teachers. Then the students made customized intervention programs for children in both schools, to develop language and Math skills, based on their current mastery levels. At Goregaon English School, students are conducting one-to-one sessions, thrice a week with 44 school children, with grades ranging from Junior K.G. to grade VIII. At Nityanand Marg BMC School, the students are conducting one-to-one sessions, twice a week for 22 children from Junior K.G. to grade I. In Nityanand Marg BMC School, along with sessions with school children, interaction with classroom teachers is an ongoing process. Every intervention session is documented in log-sheets and plans for the next session with the child are written down. This exposure is very beneficial for students and is an important milestone for students’ learning because they learn to apply skills learnt in a professional manner and at the same time, give what they learnt back to the community. INDRADHANUSH – THE COLOURS OF LIFE was a program organized and presented by the PGDSE Batch 2015-2016 of the New Horizons Institute of Education and Research and Tata Institute of Social Sciences, Mumbai. The program was held at New Horizons Child Development Centre, Goregaon East, on 9th March, from 9:00 am to 11:30 am. The occasion was graced by Dr.Samir Dalwai and eminent paediatrician Dr. Rashid Merchant. This program aimed at involving family members and friends of the PGDSE students to be a part of their learning process. A collaborative effort was made by the members of NHI and its students to reach out to the wider community and make them aware about the concerns and issues involved in developmental aspects of children and adolescents. It was a highly interactive exercise and culminated in a day which was intellectually stimulating, enjoyable and memorable. POSTER PRESENTATION AT THE ANNUAL NATIONAL CONFERENCE OF THE IAP CHAPTER OF DEVELOPMENTAL PEDIATRICS, OCTOBER 2016 On 1 st and 2 nd October 2016, Indian Academy of Pediatrics (IAP), Mumbai and Navi Mumbai hosted the 13 th NCDP (Annual National Conference of the IAP Chapter of Developmental Pediatrics) along with the 18 th EMBICON, at Hotel Grand Hyatt, Kalina, Santa Cruz (E), Mumbai. Nirzari Pathak, student of the PGDSE Batch 2015-2016 presented a poster titled Effect of Music Therapy on Social and Communication Skills of Adolescents with Autism Spectrum Disorder. Students of PGDSE Batch 2016-2017 attended the event and gained knowledge from the eminent speakers. multi-disciplinary and integrated knowledge to keen learners who want to apply the knowledge in working with children with neuro-developmental concerns and their families. Students are trained by experienced professionals who have many years’ experience of working with children and families. We are grateful to our colloborator, Tata Institute of Social Sciences (TISS), Mumbai, for partnering us in our one-year diploma course. We especially thank Dr. Sujata Sriram, Professor and Dean; Dr. Rajani Konantambigi, Professor and Dr. Chetna Duggal, Associate Professor of the School of Human Ecology, TISS. We thank Dr. Samir Dalwai for his vision and guidance in starting the institute. We are deeply grateful to Advocate Dalwai and Mrs. Dalwai, trustees of Goregaon English School and Mrs. Amal Mullaji, Headmistress, for use of their premises. We are thankful to Mr. Jimmy B. Garda, General Manager of New Horizons for all his help and hard-work in starting this institute. We are grateful to Team New Horizons for all the support in logistics and teaching without which it would have been impossible to run this institute. New Horizons Group is proud and happy that six of our graduates, Ms. Tressy Renji, Ms. Sabani Sarkar, Ms. Radhika Shah, Ms. Jemima Jacob, Ms. Nirzari Pathak and Ms. Pratibha Arekar are currently working at New Horizons, completing a full circle, giving their knowledge back to children and living the New Horizons philosophy, Every Child Can Do Better! This is indeed an important milestone in a journey that started almost fourteen years ago, with Dr. Samir Dalwai’s vision of a society that was not limited by labels of disability but empowered by awareness, knowledge, documented interventions and scientific methodology. Unltd India is an incubator for social entrepreneurs which provides seed financing and incubation support to help social leaders develop and successfully launch their social ventures. New Horizons Health and Research Foundation (NHF) identified Unltd India as a potential funding and mentoring support organization in March 2015 and made an application based on the work done under New Horizons Health and Research Foundation (NHF) and New Horizons Institute of Education and Research (NHI). NHF was selected for a mock panel session with the mentors of Unltd India. After thorough brainstorming on the goal and vision and the intended impact in the community, NHF was selected for the final panel in May 2015 and bagged Level 1 Funding support from Unltd India for June 2015 to May 2016. With induction training, peer support sessions, individual mentoring and many hours of discussion on pertinent aspects of success of social enterprises such as theory of change, impact indicators, outcome mapping, financial reviews and milestone reviews, NHF completed one year of support and was selected again for Level 1 funding and mentoring support from June 2016 to May 2017. Unltd India has groomed the strategy of NHF in the process of beneficiary segmentation, milestone documentation, outcome indicators charting and measuring, and has helped cover recurring expenses of the training institute. Through Unltd India, New Horizons Institute of Education and Research (NHI) has got selected for the TATA pro engage program whereby a TATA employee will volunteer with NHI for 6 months to develop a plan for an e-learning module for online NHI training courses. NHI received 8 applications from the best of positions of the TATA group. This is the 3rd largest number of applicants, with employees ranging from TATA Steel, TATA Capital, TCS, TATA Interactive, Tata Technologies and positions ranging from Senior Business Analysts, Enterprise Architects, Technology Leaders and Senior Managers. The pro-engage program will really help NHI achieve new milestones in training people across India. ACCEPTANCE OF PAPER FOR PUBLICATION IN THE WORLD CONGRESS ON EDUCATION (WCE-2015) A case-study paper based on the efficacy of the remedial intervention program for a child from Goregaon English School was accepted for publication in the World Congress on Education (WCE-2015). Ms. Sandhya Kulkarni presented the paper titled Impact on Language Ability of a First Generation English Learner in India, by Short Term Remedial Intervention at a conference held in Dublin (Ireland) from October 19 to 21, 2015. On the occasion of World Autism Month – April 2016, New Horizons Health and Research Foundation (NHF) along with Indian Academy of Pediatrics (IAP), Mumbai, IAP chapter of Neurodevelopmental Pediatrics and Nanavati Super Specialty Hospital, in association with Shiamak Davar’s Victory Arts Foundation had organized a fun-filled event. The event was held on 7th April, 2016 at Balabhai Nanavati Auditorium, Nanavati Hospital, Santacruz West, with veteran film personality Mr. Prem Chopra as the chief guest. Students of the PGDSE Batch 2015-2016 performed a play to create awareness about ASD. WORLD AUTISM MONTH – APRIL 2016 STUDENTS OF PGDSE BATCH 2015-2016 PERFORMING A PLAY DURING WORLD AUTISM MONTH - APRIL 2016 FUNDING AND MENTORING SUPPORT FROM UNLTD INDIA MS. DEEPTI KANADE-MODAK, IN-CHARGE, NEW HORIZONS HEALTH AND RESEARCH FOUNDATION STUDENTS' VOICES ENROLL NOW! TO TEACH IS TO TOUCH LIVES FOR EVER: LIST OF FACULTY Dr. Samir Dalwai, Developmental Pediatrician (MD [Ped], DCH, DNB, FCPS, LLB), Principal Ms. Sandhya Kulkarni, Masters in Biophysics, DMRIT, Chairperson and Core Faculty Dr. Sujata Sriram, Ph.D, Professor and Dean, The School of Human Ecology, TISS Dr. Rajani Konantambigi, Ph.D, Professor, The School of Human Ecology, TISS Dr. Chetna Duggal, Ph.D, Associate Professor, The School of Human Ecology, TISS Ms. Nita Mehta, MA, Psychology (Clinical Psychology), DHRM, Academic Head and Core Faculty Ms. Dikshita Choudhury, MA, Psychology (Industrial Psychology), B.ed, Core Faculty Ms. Alaknanda Sengupta, PGDSE (Multiple Disabilities: Physical & Neurological), Core Faculty Ms. Deepti Kanade Modak, MA, Psychology (Clinical Psychology), Guest Faculty Ms. Sohini Chatterjee, MA, Psychology (Clinical Psychology), DHRM, Guest Faculty Dr. Ameya Bondre, MBBS, M.S.P.H, Guest Faculty Dr. Bansari Bhoite, MBBS, Guest Faculty Ms. Dikshita Choudhury, MA, Psychology (Industrial Psychology), B.ed, Core Faculty Ms. Alaknanda Sengupta, PGDSE (Multiple Disabilities: Physical & Neurological), Core Faculty Ms. Deepti Kanade Modak, MA, Psychology (Clinical Psychology), Guest Faculty Ms. Sohini Chatterjee, MA, Psychology (Clinical Psychology), DHRM, Guest Faculty Dr. Ameya Bondre, MBBS, M.S.P.H, Guest Faculty Dr. Bansari Bhoite, MBBS, Guest Faculty My journey and association with New Horizons goes back to 2014. Prior to that, I had been a pre-primary teacher for 14 years. Without a B. Ed or any teachers’ training degree, I realized that I was missing out on something. Also during my working years, I found that a few of my children needed extra special care and methodology to cater to their academic needs. Thus I was inspired to join the PGDSE course started by New Horizons Institute of Education and Research (NHI) and I am proud to be a member of the first batch to earn the one year Diploma. There was no looking back, and I became a Special Educator not just an Educator and joined New Horizons Child Development Centre (NHD) immediately after the completion of the course. Today, I am proud to be a part of the organization, and cherish the positive feedback of the parents when I am able to bring a little change for the better, in their child’s academic performance and confidence. - Ms. Sabani Sarkar, PGDSE 2014-2015 This course changed me as a person. It took us through so many topics which initially I thought were not applicable to me but as the year passed, I saw how the minutest aspects are intertwined for child development. The unconditional love and support from the faculty has been so incredible here which I have not seen in any other university or college. PGDSE made me more open towards disability and working with children, which I was not previously. - Ms. Shibani Sirur, PGDSE 2015-2016 I, Ms. Shadia Antulay, on the completion of Certificate Course in Special Education – January 2016, would firstly like to thank the mastermind behind the Kulkarni Ma’am and other faculty members who have made substantial contribution in their respective fields. The presentations, observations, project work, research reviews along with regular examinations have helped me understand the “nitty-gritties” of teaching children with special needs. The course provided a holistic approach including various disciplines. I genuinely take pride in being called an alumnus of New Horizons Institute of Education and Research (NHI), where the faculty worked as mentors! This certificate is not just a piece of paper but it has laid a foundation for reaching out a helping hand towards children with academic needs. - Ms. Shadia Antulay, Certificate Batch January 2016 I have been associated with New Horizons for the last 2.5 years as a parent and the experience has been great. With the support of a team of dedicated professionals at the Centre, my son has shown commendable progress in all disciplines. With the thought of helping my son overcome challenges in academics, I joined the Certificate Course in Special Education being conducted at the New Horizons Institute of Education and Research (NHI) and yes, it has been really very helpful and enlightening for me. I have become more patient with my son and have learnt quite a few strategies of adapting and modifying the general education curriculum in reading, writing and Math as per the special needs of my child. I am hopeful of being able to support the academic, social as well as vocational development of my son. All thanks to my teachers at New Horizons Institute of Education and Research!! - Ms. Ajita Pandey, Certificate Bacth July 2016 course, Dr. Samir Dalwai, who sketched out a perfect way to spread the ideologies of New Horizons by the means of a 6 months’ journey of intensive hands-on-experience and knowledge-imparting lectures for a group of non-paramedical students. Coming from a Commerce background and the profession of teaching, I could not have asked for more than being taught by the likes of Sandhya Dr. Roshani Desai, MBBS, MS, DNB, FICO, FMRF, Guest Faculty Dr. Tanvee Priya, MBBS, DCH, Guest Faculty Dr. Bhavya Gour, B. OTh, M. OTh (Neurology), Guest Faculty Ms. Lopamudra Dutta, PGDSE (Multiple Disabilities: Physical & Neurological), Guest Faculty Ms. Zeenal Shah, PGDSE (Multiple Disabilities: Physical & Neurological), Guest Faculty Ms. Marina Shaju, B.Ed Special Education, Guest Faculty NHD - Dadar (East) 1st Floor, Jeevak Nursing Home, Sai Kunj, MMSG Marg, Dadar (East), Mumbai - 400 014. Tel: 022 65287397 / 022 24144596 / 7506171230 NHD - Bhandup (West) Pawar Public School, Opp. Dreams Mall, Off LBS Marg, Bhandup (West), Mumbai - 400 078. Tel: 022 21663024 / 9769669332 NHD and NHA Goregaon (West) 2nd Floor,Techniplex II, Techniplex Complex, Veer Savarkar Flyover, Goregaon (West), Mumbai - 400 062. Tel: 022 60600650 / 7506171240 NHD - Goregaon (East) Ground Floor, Saira Mansion, Pahadi School Road 2, Goregaon (East), Mumbai - 400 063. Tel: 022 65711586 NHD - Santa Cruz (West) Shop No. 47, 1st Floor, Hi-Life Mall, Opp. Santa Cruz Station, Santa Cruz (West), Mumbai - 400 054. Tel: 022 26465649 / 9819224415 www.enablemychild.org [email protected] www.facebook.com/newhorizonscdc New Horizons Group - www.enablemychild.org THE DOCTOR IS IN – COMPILED BY MS. MADHUMITHA CHANDRASEKARAN AND MS. JEMIMA JACOB WITH INPUTS FROM MS. PARSIES SHAH, MS. RIZWANA BEGUM, MS. ASHMI SHAH, MS. GEETHA PREMKUMAR, MS. RASIKA PALEKAR AND TEAM MEMBERS. JOY TO THE WORLD – CHRISTMAS 2016! When a Developmental Pediatrician is taking the case-history of a child on the first visit, why is the head circumference noted down? What is the importance of knowing the length of the gestational term? What impact may the gender of the child have on the history taking and intervention? These were some of the questions that Dr. Samir Dalwai posed to the clinical team at the Weekly Clinical Meeting on 24th November, 2016. Team-members put on their thinking caps and switched to research mode! CRUCIAL FACTORS IN CASE-HISTORY TAKING IN A PEDIATRIC NEUROLOGICAL EXAMINATION A Pediatrician is often one among the first line of medical professionals who treats a child, among other healthcare professionals or paramedical professionals during the course of their childhood. A number of neurodevelopmental disabilities and other medical concerns often have their onset during the early years. For this very reason it is crucial for medical and paramedical professionals to monitor growth factors during a child’s routine well-child visits. Among these, the GESTATION PERIOD is the first crucial factor. Whether the delivery was full-term, pre-term or post-term plays an important factor associated with the developmental process. A child born between 37-40 weeks of pregnancy is considered full term. A child born before 37 weeks of pregnancy is considered to be pre-term or pre-mature, whereas a child born after 40 weeks is regarded as post-term. A premature baby is less able to shiver and to maintain homeostasis. They are susceptible to intraventricular brain haemorrhage with serious long-term effects. Prevalence of neurodevelopmental impairment is significantly associated with the length of gestation. Lower gestation period is associated with greater complications. Pre-term children are more likely to have lower intelligence quotients and lower academic achievement experiencing learning difficulties. A broad range of neuro-developmental impairments including Cerebral Palsy, intellectual disability and visual and hearing impairments are prevelant in pre-term children. Pre-term infants are more likely to have disabling Cerebral Palsy (CP) than full-term infants. More subtle disorders of the central nervous system including language disorders, learning disabilities, Attention-Deficit/ Hyperactivity Disorder (ADHD), neuro-motor impairment, developmental co-ordination disorder (DCD) are prevelant in pre-term children. Pre-term children are significantly more likely to be overactive, easily distractible, impulsive, disorganised and lacking in persistence. They are also susceptible to social-emotional and behavioural problems. There are also medical and health complications associated with post-term babies. The risk associated with post-term babies are: fetal macrosomia, which is defined as an infant who is over 8 pounds, 13 ounces when born. This may cause childhood diabetes, obesity, and metabolic syndrome. After 37 weeks of pregnancy, the placenta reaches its maximum size and its functions begin to reduce afterwards. Placental insufficiency, also known as uteroplacental vascular insufficiency, occurs when the placenta fails to deliver adequate oxygen and nutrients to the infant. The longer an infant goes without proper nutrition and oxygen, the more at-risk they become for a host of health problems, including oxygen deprivation that can lead to Cerebral Palsy and learning disorders. Infants who are born post-term are more likely to have a bowel movement while still in utero. Meconium aspiration is marked by an infant breathing in amniotic fluid and meconium (newborn feces) shortly after birth. Meconium aspiration is considered extremely dangerous and can lead to oxygen deprivation, lung inflammation, and lung infection. In rare cases it can also lead to persistent pulmonary hypertension of the newborn (PPHN) and permanent brain damage. Another crucial factor is the BIRTH WEIGHT of the child. An Average Indian baby weighs 2.5 to 2.9 kg when born at full term. A baby’s weight at birth is strongly associated with the developmental process. Major concerns are associated with low birth weight. A child weighing less than 2.5 kg at birth is termed as having low birth weight. The complications associated with low birth weight are as follows: • Developmental delays • Impairment in immune function • Tendency to remain undernourished with reduced muscle strength resulting in delay in normal developmental milestones. • Hypotonia resulting in delay in other developmental milestones like sitting and standing • Delay in speech and language development as mild hypotonia may result in difficulty in oral movements resulting in delayed expressive language development • Impairments in cognitive and social development High birth weight or fetal macrosomia, is defined as an infant who is over 8 pounds, 13 ounces when born. This may cause childhood diabetes, obesity, and metabolic syndrome. Another crucial growth factor is a child’s HEAD CIRCUMFERENCE (HC). Head circumference along with other growth-monitoring factors may indicate an underlying medical condition that may be diagnosed and prognosticated in time, as well as aid in prevention or intervention. Measurement of head circumference is part of monitoring of growth that is important in identifying whether a child is growing normally or deviating from the norm. Measurement of head circumference is an integral part of the Pediatric Neurological Examination. During the antenatal period the head grows at a fast rate, as well as during the first three months of life.The normal values of Head Circumference (HC) by age is: Pregnancy to birth - 0 to 33 cm (maximum growth), birth to 1 year: 33 to 35 cm, 1st to 2nd year: 35 to 45 cm and 2nd to 3rd year: 45 to 47 cm. Head circumference increases at a rate of 3 centimetres per month. Between 4 to 6 years of age, HC increases by 1 cm per year. It is an indicator of brain growth in children under 2 years. It is measured by using a non-elastic tape. HC, also called occipital frontal circumference is determined by measuring the most prominent part on the back of the head (occiput) and just above the eyebrows, that is, the distance from above the occipital prominence to the frontal prominence. Measurements must be plotted on the appropriate chart for sex and conceptional age. Measuring HC acts as a quick and non-invasive means of determining the presence of micro or macrocephaly as well as aids in assessing the development of the central nervous system and helps in identifying children at a high-risk of developing neurodevelopmental disorders or those who have undiagnosed conditions. Measurement of HC may alert us to the presence of macrocephaly in a child. Children with macrocephaly clinically present with a large head size, that is, larger than 2 standard deviations from the normal distribution. It may be suggestive of hydrocephaly or the presence of excess fluid in the brain. Among the conditions that constitute macrocephaly are, benign familial macrocephaly (FM). It is an inherited condition where a family is predisposed to having a larger head circumference. Research indicates that a small percent of children with FM have developmental concerns and that FM may be a risk for a delay in learning. Macrocephaly has also been observed in children with Autism Spectrum Disorder. It has been observed to occur in 15-35% of these children as well as in children with other forms of pervasive developmental disorders. Macrocephaly is said to be the most common physical finding among children with ASD. However, it has been observed that macrocephaly in these children becomes evident around the age of 1 to 3 years and is usually not present at birth. This is yet another reason why HC needs to be measured in a consistent, serial fashion so as to be able to implicate an abnormal growth in head size at different ages. Macrocephaly may also manifest in syndromes with cutaneous findings such as, Neurofibromatosis (NF1) and Hemimegalencephaly. It may also be manifest in syndromes with intellectual disability such as Fragile X Syndrome. They may also be symptomatic of metabolic diseases such as Leukodystrophies such as Alexander disease, Canavan disease and Megalencephalic Leukoencephalopathy. Macrocephaly may also be due to Neuro-Cardio-Facio-Cutaneous syndromes such as Noonan syndrome, LEOPARD as well as Costello syndrome. Syndromes of overgrowth such as Sotos, Weaver, Simpson-Golabi-Behmel and Beckwith-Wiedemann syndromes may also present with macrocephaly. The converse of macrocephaly is microcephaly, which is indicated by a small head size. Microcephaly is indicated by a head size that is 2 standard deviations below mean for age and sex. A clinical finding of microcephaly may indicate that the brain in not developing appropriately. It may or may not be an indication of underlying pathology. It may be evident at birth or a few years after. It is observed that cases of microcephaly are usually accompanied by intellectual disability, poor speech and motor function, abnormal facial features as well as dwarfism. Microcephaly may be congenital as in the case of X-linked microcephaly, Cornelia de Lange syndrome, Down’s syndrome and Edward Syndrome. It may also be due to congenital cytomegalovirus infection and as has been most recentlyobserved, the Zika virus. It may also be manifest in cases of Fetal alcohol syndrome and maternal malnutrition. Postnatally microcephaly may be due to inborn errors of metabolism, traumatic brain injuries, meningitis or syndromes such as Rett syndrome and Cohen syndrome, among others. It is important to note that children with microcephaly or macrocephaly will not always display impairments in intelligence, they may develop normally. This is why head circumference must be interpreted in conjunction with other clinical features that are present in a child to provide an accurate clinical diagnosis in case of comorbid conditions as well as in formulating therapy interventions. GENDER is an important factor in terms of predisposition of individuals to certain medical conditions. The incidence of different diseases will vary according to gender. Various genetic conditions may be gender-specific. Manifestation of symptoms of conditions occurring in both genders may also be unique or gender–specific. With respect to Attention Deficit/ Hyperactivity Disorder (ADHD), the manifestation of symptoms varies between males and females. Males typically display externalising symptoms, while females may display internalising symptoms. If the clinician is unaware of these she or he may be unable to diagnose the child for a certain condition, which for that child would mean that she or he is deprived of treatment or intervention opportunities. It will also lead to an overall discrepancy in diagnosis between genders. It is important for a clinician to be aware of differences in symptom manifestation of the same condition, in both genders as it will help in symptom identification and management as well. Certain neurodevelopmental concerns are diagnosed more in males than in females, among them is Autism Spectrum Disorder (ASD). The bias in diagnosis or limitations in diagnosing females due to ignorance of gender-specific manifestations in different conditions among other reasons, would mean that females, on the whole are missing out on being diagnosed, which results in them being deprived of interventions or treatments for their individual conditions. Gender is also an important factor in terms of determining the presence of X-linked or Y-linked disorders. Females or males may be carriers for specific disorders. Being aware of these gender–specific disorders would mean that the clinician can narrow the list of prospective diagnoses to the most probable ones keeping the patient’s gender in mind. This would be beneficial in terms of prevention or intervention as well as symptom management. Certain syndromes may exclusively affect females such as Rett syndrome and Goltz syndrome. Haemophilia A is an example of an X-linked recessive disease, for which the carriers are females. XYY syndrome and Klinefelter syndrome are conditions that occurs only in males. Genetic disorders that are present in families may also be uncovered through which concerned members may be screened for diseases as well as be counseled accordingly to make informed decisions. In certain societies, females are not given equal access to healthcare facilities. A vigilant clinician can ensure the parent or parents are counselled appropriately and also encourage follow-up in such cases. There also exist social myths such as, boys talk late and other false assumptions that are specific to genders in relation to the achievement of certain milestones. This again may lead to a lack of early intervention due to delayed diagnosis or the absence of consulting the appropriate clinician in such a case. AGE is another crucial factor involved in understanding the developmental process. Milestone development, whether age appropriate or delayed, is determined in terms of age of attainment. A child who at 1 year old still sits with support indicates deleyed development. Age plays a role in terms of assessing the severity or significance of a symptom/ concern with respect to age. For instance, a 5 year old child throwing a tantrum may be considered acceptable for his/her age versus a 12 year old child throwing a tantrum. Similarly, for other academic/ behavioral concerns, their occurance at a certain age may be a part of normal development. Age is important for making a decision about the diagnosis. DSM gives age related criteria for onset of symptoms. In neurodevelopmental disorders, the onset/ concerns are noted at stages of early development rather than a sudden onset at a later age. Hence, even when a child is evaluated at a later age, finding the age of onset will help to understand the past history of the concern and in making a clinical diagnosis. For clinical evaluations, age plays an important role as the many of the standardized tests use age-based norms for scoring. Age will be one of the determining factors for planning intervention methods and strategies, and for determining prognosis. Children receiving early intervention are considered to have a better prognosis than children receiving intervention at an older age. References: www.ncbi.nlm.nih.gov/books/NBK11356 www.birthinjuryguide.org/birth-injury/c auses/post-term-pregnancy “Unltd India training and mentoring support has helped me grow in presentation skills and developed in me the skill to present my objectives and implementation plans in a precise and objective manner. My mentor Kavita from Unltd India has been a strong guide who has redirected my thoughts and helped me think from an outcome oriented perspective. I developed the skill to present big ideas in a simple, consolidated and methodical way. The theory of change, definition of problems, aligning activities to address problems….all these concepts were included in my deliverables but I was unable to define, document and measure them. UnLtd India has helped me in this important cognitive retraining.” – Ms. Deepti Kanade-Modak, In-charge, NHF Dr. Samir Dalwai - Founder Director, New Horizons Group And Principal, New Horizons Institute Of Education And Research The Pioneers - PGDSE Batch 2014-2015 With Faculty Members Dr. Samir Dalwai And Ms. Sandhya Kulkarni Speaking To PGDSE Batch 2015-2016 Certificate Batch January 2016 With Faculty Members Dr. Samir Dalwai Speaking To PGDSE Batch 2015-2016 Ms. Nita Mehta Speaking To Certificate Batch July 2016 The Pioneers - Certificate Batch August 2014 With Faculty Members Ms. Sandhya Kulkarni And Ms. Nita Mehta Speaking To Certificate Batch July 2015 Professor Anne Stewart Of James Madison University, USA With PGDSE Batch 2015-2016 Orientation Program For Certificate Batch January 2017 For exciting career opportunities with New Horizons Group, visit: http://www.enablemychild.org/new-horizons-group/nhg-careers/ PGDSE Batch 2014-2015 with Children of Goregaon English School PGDSE Batch 2015-2016 Working With Parisar Asha at Nityanand Marg BMC School Convocation Ceremony For PGDSE Batch 2015-2016
Transcript of New Horizons Group...New Horizons Group NEWSLETTER (QPM/ MNL-01, Vol. II Issue 11) | December, 2016...
New Horizons Group
NEWSLETTER (QPM/ MNL-01, Vol. II Issue 11) | December, 2016
Developmental PediatricianDr. Samir Dalwai (MD, DNB, DCH,FCPS, DNB and LLB) founded NewHorizons Child DevelopmentCentre (NHCDC now NHD) in2003. NHD has developed 5centres and currently houses ateam of more than 60paramedical professionals. NHDprovides multi-disciplinaryservices to more than 300children daily with a ratio of onespecialist to one child in eachintervention session.
New Horizons Health & ResearchFoundation (NHHRF now NHF), isa registered non-profitorganization[Reg.No.U85100MH2012NPL23856; No.DIT(E)/80G/111/N/2014-15],which works in the areas ofhealth, impairment and earlychildhood development. NHFfollows a four-pronged approach:Research, Rehabilitation,Advocacy and Training.
Established in 2014, NewHorizons Institute ofEducation & Research (NHIERnow NHI) is the educationalwing of NHG. In May, 2015,TATA INSTITUTE OF SOCIALSCIENCES (TISS), Mumbai andNHF entered a collaborationand offer diploma courses inSpecial Education andRehabilitation Psychology.
New Horizons Educationand Training Solutions(NHETS now NHS) provideshighly specialized solutionsto schools in Mumbai. Ourspecialists are deputed atthe school on a customizedbasis for conductingevaluation, intervention andcounseling for children withacademic, emotional andbehavioural concerns.
Dr. Waheeda Pagarkarstarted the New HorizonsAudiology (NHA) and HearingAid Centre for Adults andChildren in August 2014. In itsfirst year, NHA has seenaround 400 patients, out ofwhich 20 were adults and theremaining 380 were children.35 patients were diagnosedwith hearing loss of varyingtype and degree while 10 wereprescribed with hearing aids.
PRESENTING NEW HORIZONS INSTITUTE OF EDUCATION AND RESEARCH (NHI): PLANTING THE SEEDS OF KNOWLEDGE
In keeping with Dr. Samir Dalwai’s vision of imparting scientific knowledge about developmental concerns and creating more practising professionals in the field, New Horizons Institute of Education & Research (NHIER now NHI) was established in 2014 as the educational wing of the New Horizons Health and Research Foundation (NHF). The institute offers the following courses and programs:
1. Post Graduate Diploma in Special Education in collaboration with Tata Institute of Social Sciences, Mumbai since 2015.
2. Certificate in Special Education, an autonomous course by New Horizons Institute.
3. Foundation in Autism Spectrum Disorder by University of New Mexico.
4. Clinical Observership Program at New Horizons Child Development Centre.
The institute aims to impart scientific,
DOWN MEMORY LANE: SOME UNFORGETTABLE MOMENTS AND CREATIONS!
TELL ME AND I FORGET, TEACH ME AND I MAY REMEMBER, INVOLVE ME AND I LEARN!
THE COLOURS OF LIFE: ACHIEVEMENTS AND HIGHLIGHTS
During the practical intervention program, PGDSE students engage in community-based teaching programs, working with children with academic difficulties.
PGDSE batch 2016-2017 students are working simultaneously with two schools: Goregaon English School and Nityanand Marg BMC School. In Nityanand Marg BMC School, an organization named Parisar Asha looks after the teaching process in pre-primary grades.
The school children were identified by school authorities with academic and behavioural concerns. Each child identified with concerns underwent a one-on-one informal academic evaluation, under supervision, to document their academic strengths and needs. A comprehensive evaluation tool was used, which was created by the students themselves, with inputs from their teachers. Then the students made customized intervention programs for children in both schools, to develop language and Math skills, based on their current mastery levels.
At Goregaon English School, students are conducting one-to-one sessions, thrice a week with 44 school children, with grades ranging from Junior K.G. to grade VIII. At Nityanand Marg BMC School, the students are conducting one-to-one sessions, twice a week for 22 children from Junior K.G. to grade I. In Nityanand Marg BMC School, along with sessions with school children, interaction with classroom teachers is an ongoing process. Every intervention session is documented in log-sheets and plans for the next session with the child are written down. This exposure is very beneficial for students and is an important milestone for students’ learning because they learn to apply skills learnt in a professional manner and at the same time, give what they learnt back to the community.
INDRADHANUSH – THE COLOURS OF LIFE was a program organized and presented by the PGDSE Batch 2015-2016 of the New Horizons Institute of Education and Research and Tata Institute of Social Sciences, Mumbai. The program was held at New Horizons Child Development Centre, Goregaon East, on 9th March, from 9:00 am to 11:30 am. The occasion was graced by Dr.Samir Dalwai and eminent paediatrician Dr. Rashid Merchant. This program aimed at involving family members and friends of the PGDSE students to be a part of their learning process. A collaborative effort was made by the members of NHI and its students to reach out to the wider community and make them aware about the concerns and issues involved in developmental aspects of children and adolescents. It was a highly interactive exercise and culminated in a day which was intellectually stimulating, enjoyable and memorable.
POSTER PRESENTATION AT THE ANNUAL NATIONAL CONFERENCE OF THE IAP CHAPTER OF DEVELOPMENTAL PEDIATRICS, OCTOBER 2016
On 1st and 2nd October 2016, Indian Academy of Pediatrics (IAP), Mumbai and Navi Mumbai hosted the 13th NCDP (Annual National Conference of the IAP Chapter of Developmental Pediatrics) along with the 18th EMBICON, at Hotel Grand Hyatt, Kalina, Santa Cruz (E), Mumbai. Nirzari Pathak, student of the PGDSE Batch 2015-2016 presented a poster titled Effect of Music Therapy on Social and Communication Skills of Adolescents with Autism Spectrum Disorder. Students of PGDSE Batch 2016-2017 attended the event and gained knowledge from the eminent speakers.
multi-disciplinary and integrated knowledge to keen learners who want to apply the knowledge in working with children with neuro-developmental concerns and their families. Students are trained by experienced professionals who have many years’ experience of working with children and families.
We are grateful to our colloborator, Tata Institute of Social Sciences (TISS), Mumbai, for partnering us in our one-year diploma course. We especially thank Dr. Sujata Sriram, Professor and Dean; Dr. Rajani Konantambigi, Professor and Dr. Chetna Duggal, Associate Professor of the School of Human Ecology, TISS.
We thank Dr. Samir Dalwai for his vision and guidance in starting the institute. We are deeply grateful to Advocate Dalwai and Mrs. Dalwai, trustees of Goregaon English School and Mrs. Amal Mullaji, Headmistress, for use of their premises. We
are thankful to Mr. Jimmy B. Garda, General Manager of New Horizons for all his help and hard-work in starting this institute. We are grateful to Team New Horizons for all the support in logistics and teaching without which it would have been impossible to run this institute.
New Horizons Group is proud and happy that six of our graduates, Ms. Tressy Renji, Ms. Sabani Sarkar, Ms. Radhika Shah, Ms. Jemima Jacob, Ms. Nirzari Pathak and Ms. Pratibha Arekar are currently working at New Horizons, completing a full circle, giving their knowledge back to children and living the New Horizons philosophy, Every Child Can Do Better! This is indeed an important milestone in a journey that started almost fourteen years ago, with Dr. Samir Dalwai’s vision of a society that was not limited by labels of disability but empowered by awareness, knowledge, documented interventions and scientific methodology.
Unltd India is an incubator for social entrepreneurs which provides seed financing and incubation support to help social leaders develop and successfully launch their social ventures. New Horizons Health and Research Foundation (NHF) identified Unltd India as a potential funding and mentoring support organization in March 2015 and made an application based on the work done under New Horizons Health and Research Foundation (NHF) and New Horizons Institute of Education and Research (NHI). NHF was selected for a mock panel session with the mentors of Unltd India. After thorough brainstorming on the goal and vision and the intended impact in the community, NHF was selected for the final panel in May 2015 and bagged Level 1 Funding support from Unltd India for June 2015 to May 2016.
With induction training, peer support sessions, individual mentoring and many hours of discussion on pertinent aspects of success of social enterprises such as theory of change, impact indicators, outcome mapping, financial reviews and milestone reviews, NHF completed one year of support and was selected again for Level 1 funding and mentoring support from June 2016 to May 2017.
Unltd India has groomed the strategy of NHF in the process of beneficiary segmentation, milestone documentation, outcome indicators charting and measuring, and has helped cover recurring
expenses of the training institute. Through Unltd India, New Horizons Institute of Education and Research (NHI) has got selected for the TATA pro engage program whereby a TATA employee will volunteer with NHI for 6 months to develop a plan for an e-learning module for online NHI training courses.
NHI received 8 applications from the best of positions of the TATA group. This is the 3rd largest number of applicants, with employees ranging from TATA Steel, TATA Capital, TCS, TATA Interactive, Tata Technologies and positions ranging from Senior Business Analysts, Enterprise Architects, Technology Leaders and Senior Managers. The pro-engage program will really help NHI achieve new milestones in training people across India.
ACCEPTANCE OF PAPER FOR PUBLICATION IN THE WORLD CONGRESS ON EDUCATION (WCE-2015)
A case-study paper based on the efficacy of the remedial intervention program for a child from Goregaon English School was accepted for publication in the World Congress on Education (WCE-2015). Ms. Sandhya Kulkarni presented the paper titled Impact on Language Ability of a First Generation English Learner in India, by Short Term Remedial Intervention at a conference held in Dublin (Ireland) from October 19 to 21, 2015.
On the occasion of World Autism Month – April 2016, New Horizons Health and Research Foundation (NHF) along with Indian Academy of Pediatrics (IAP), Mumbai, IAP chapter of Neurodevelopmental Pediatrics and Nanavati Super Specialty Hospital, in association with Shiamak Davar’s Victory Arts Foundation had organized a fun-filled event. The event was held on 7th April, 2016 at Balabhai Nanavati Auditorium, Nanavati Hospital, Santacruz West, with veteran film personality Mr. Prem Chopra as the chief guest. Students of the PGDSE Batch 2015-2016 performed a play to create awareness about ASD.
WORLD AUTISM MONTH – APRIL 2016
STUDENTS OF PGDSE BATCH 2015-2016 PERFORMING A PLAY DURING WORLD AUTISM MONTH - APRIL 2016
FUNDING AND MENTORING SUPPORT FROM UNLTD INDIA
MS. DEEPTI KANADE-MODAK, IN-CHARGE, NEW HORIZONS HEALTH
AND RESEARCH FOUNDATION
STUDENTS' VOICES
ENROLL NOW!
TO TEACH IS TO TOUCH LIVES FOR EVER: LIST OF FACULTY
Dr. Samir Dalwai, Developmental Pediatrician (MD [Ped], DCH, DNB, FCPS, LLB), Principal
Ms. Sandhya Kulkarni, Masters in Biophysics, DMRIT, Chairperson and Core Faculty
Dr. Sujata Sriram, Ph.D, Professor and Dean, The School of Human Ecology, TISS
Dr. Rajani Konantambigi, Ph.D, Professor, The School of Human Ecology, TISS
Dr. Chetna Duggal, Ph.D, Associate Professor, The School of Human Ecology, TISS
Ms. Nita Mehta, MA, Psychology (Clinical Psychology), DHRM, Academic Head and Core Faculty
Ms. Dikshita Choudhury, MA, Psychology (Industrial Psychology), B.ed, Core Faculty
Ms. Alaknanda Sengupta, PGDSE (Multiple Disabilities: Physical & Neurological), Core Faculty
Ms. Deepti Kanade Modak, MA, Psychology (Clinical Psychology), Guest Faculty
Ms. Sohini Chatterjee, MA, Psychology (Clinical Psychology), DHRM, Guest Faculty
Dr. Ameya Bondre, MBBS, M.S.P.H, Guest Faculty
Dr. Bansari Bhoite, MBBS, Guest Faculty
Ms. Dikshita Choudhury, MA, Psychology (Industrial Psychology), B.ed, Core Faculty
Ms. Alaknanda Sengupta, PGDSE (Multiple Disabilities: Physical & Neurological), Core Faculty
Ms. Deepti Kanade Modak, MA, Psychology (Clinical Psychology), Guest Faculty
Ms. Sohini Chatterjee, MA, Psychology (Clinical Psychology), DHRM, Guest Faculty
Dr. Ameya Bondre, MBBS, M.S.P.H, Guest Faculty
Dr. Bansari Bhoite, MBBS, Guest Faculty
My journey and association with New Horizons goes back to 2014. Prior to that, I had been a pre-primary teacher for 14 years. Without a B. Ed or any teachers’ training degree, I realized that I was missing out on something. Also during my working years, I found that a few of my children needed extra special care and methodology to cater to their academic needs. Thus I was inspired to join the PGDSE course started by New Horizons Institute of Education and Research (NHI) and I am proud to be a member of the first batch to earn the one year Diploma. There was no looking back, and I became a Special Educator not just an Educator and joined New Horizons Child Development Centre (NHD) immediately after the completion of the course. Today, I am proud to be a part of the organization, and cherish the positive feedback of the parents when I am able to bring a little change for the better, in their child’s academic performance and confidence. - Ms. Sabani Sarkar, PGDSE 2014-2015
This course changed me as a person. It took us through so many topics which initially I thought were not applicable to me but as the year passed, I saw how the minutest aspects are intertwined for child development. The unconditional love and support from the faculty has been so incredible here which I have not seen in any other university or college. PGDSE made me more open towards disability and working with children, which I was not previously. - Ms. Shibani Sirur, PGDSE 2015-2016
I, Ms. Shadia Antulay, on the completion of Certificate Course in Special Education – January 2016, would firstly like to thank the mastermind behind the
Kulkarni Ma’am and other faculty members who have made substantial contribution in their respective fields. The presentations, observations, project work, research reviews along with regular examinations have helped me understand the “nitty-gritties” of teaching children with special needs. The course provided a holistic approach including various disciplines. I genuinely take pride in being called an alumnus of New Horizons Institute of Education and Research (NHI), where the faculty worked as mentors! This certificate is not just a piece of paper but it has laid a foundation for reaching out a helping hand towards children with academic needs. - Ms. Shadia Antulay, Certificate Batch January 2016
I have been associated with New Horizons for the last 2.5 years as a parent and the experience has been great. With the support of a team of dedicated professionals at the Centre, my son has shown commendable progress in all disciplines. With the thought of helping my son overcome challenges in academics, I joined the Certificate Course in Special Education being conducted at the New Horizons Institute of Education and Research (NHI) and yes, it has been really very helpful and enlightening for me. I have become more patient with my son and have learnt quite a few strategies of adapting and modifying the general education curriculum in reading, writing and Math as per the special needs of my child. I am hopeful of being able to support the academic, social as well as vocational development of my son. All thanks to my teachers at New Horizons Institute of Education and Research!! - Ms. Ajita Pandey, Certificate Bacth July 2016
course, Dr. Samir Dalwai, who sketched out a perfect way to spread the ideologies of New Horizons by the means of a 6 months’ journey of intensive hands-on-experience and knowledge-imparting lectures for a group of non-paramedical students.Coming from a Commerce background and the profession of teaching, I could not have asked for more than being taught by the likes of Sandhya
Dr. Roshani Desai, MBBS, MS, DNB, FICO, FMRF, Guest Faculty
Dr. Tanvee Priya, MBBS, DCH, Guest Faculty
Dr. Bhavya Gour, B. OTh, M. OTh (Neurology), Guest Faculty
Ms. Lopamudra Dutta, PGDSE (Multiple Disabilities: Physical & Neurological), Guest Faculty
Ms. Zeenal Shah, PGDSE (Multiple Disabilities: Physical & Neurological), Guest Faculty
Ms. Marina Shaju, B.Ed Special Education, Guest Faculty
NHD - Dadar (East)
1st Floor, Jeevak Nursing Home, Sai Kunj, MMSG Marg, Dadar (East), Mumbai - 400 014.
Tel: 022 65287397 / 022 24144596 / 7506171230
NHD - Bhandup (West)
Pawar Public School, Opp. DreamsMall, Off LBS Marg, Bhandup (West),Mumbai - 400 078.
Tel: 022 21663024 / 9769669332
NHD and NHAGoregaon (West)
2nd Floor,Techniplex II, Techniplex Complex,Veer Savarkar Flyover, Goregaon (West),Mumbai - 400 062.
Tel: 022 60600650 / 7506171240
NHD - Goregaon (East)
Ground Floor, Saira Mansion,Pahadi School Road 2, Goregaon (East),Mumbai - 400 063.
Tel: 022 65711586
NHD - Santa Cruz (West)
Shop No. 47, 1st Floor, Hi-Life Mall, Opp. Santa Cruz Station, Santa Cruz (West), Mumbai - 400 054.
Tel: 022 26465649 / 9819224415
[email protected]/newhorizonscdc
New Horizons Group - www.enablemychild.org
THE DOCTOR IS IN – COMPILED BY MS. MADHUMITHA CHANDRASEKARAN AND MS. JEMIMA JACOB WITH INPUTS FROM MS. PARSIES SHAH, MS. RIZWANA BEGUM, MS. ASHMI SHAH, MS. GEETHA PREMKUMAR, MS. RASIKA PALEKAR AND TEAM MEMBERS.
JOY TO THE WORLD – CHRISTMAS 2016!
When a Developmental Pediatrician is taking the case-history of a child on the first visit, why is the head circumference noted down? What is the importance of knowing the length of the gestational term? What impact may the gender of the child have on the history taking and intervention? These were some of the questions that Dr. Samir Dalwai posed to the clinical team at the Weekly Clinical Meeting on 24th November, 2016. Team-members put on their thinking caps and switched to research mode!
CRUCIAL FACTORS IN CASE-HISTORY TAKING IN A PEDIATRIC NEUROLOGICAL EXAMINATION
A Pediatrician is often one among the first line of medical professionals who treats a child, among other healthcare professionals or paramedical professionals during the course of their childhood. A number of neurodevelopmental disabilities and other medical concerns often have their onset during the early years. For this very reason it is crucial for medical and paramedical professionals to monitor growth factors during a child’s routine well-child visits.
Among these, the GESTATION PERIOD is the first crucial factor. Whether the delivery was full-term, pre-term or post-term plays an important factor associated with the developmental process. A child born between 37-40 weeks of pregnancy is considered full term. A child born before 37 weeks of pregnancy is considered to be pre-term or pre-mature, whereas a child born after 40 weeks is regarded as post-term.
A premature baby is less able to shiver and to maintain homeostasis. They are susceptible to intraventricular brain haemorrhage with serious long-term effects. Prevalence of neurodevelopmental impairment is significantly associated with the length of gestation. Lower gestation period is associated with greater complications. Pre-term children are more likely to have lower intelligence quotients and lower academic achievement experiencing learning difficulties. A broad range of neuro-developmental impairments including Cerebral Palsy, intellectual disability and visual and hearing impairments are prevelant in pre-term children. Pre-term infants are more likely to have disabling Cerebral Palsy (CP) than full-term infants. More subtle disorders of the central nervous system including language disorders, learning disabilities, Attention-Deficit/ Hyperactivity Disorder (ADHD), neuro-motor impairment, developmental co-ordination disorder (DCD) are prevelant in pre-term children. Pre-term children are significantly more likely to be overactive, easily distractible, impulsive, disorganised and lacking in persistence. They are also susceptible to social-emotional and behavioural problems.
There are also medical and health complications associated with post-term babies. The risk associated with post-term babies are: fetal macrosomia, which is defined as an infant who is over 8 pounds, 13 ounces when born. This may cause childhood diabetes, obesity, and metabolic syndrome. After 37 weeks of pregnancy, the placenta reaches its maximum size and its functions begin to reduce afterwards. Placental insufficiency, also known as uteroplacental vascular insufficiency, occurs when the placenta fails to deliver adequate oxygen and nutrients to the infant. The longer an infant goes without proper nutrition and oxygen, the more at-risk they become for a host of health problems, including oxygen deprivation that can lead to Cerebral Palsy and learning disorders. Infants who are born post-term are more likely to have a bowel movement while still in utero. Meconium aspiration is marked by an infant breathing in amniotic fluid and meconium (newborn feces) shortly after birth. Meconium aspiration is considered extremely dangerous and can lead to oxygen deprivation, lung inflammation, and lung infection. In rare cases it can also lead to persistent pulmonary hypertension of the newborn (PPHN) and permanent brain damage.
Another crucial factor is the BIRTH WEIGHT of the child. An Average Indian
baby weighs 2.5 to 2.9 kg when born at full term. A baby’s weight at birth is strongly associated with the developmental process. Major concerns are associated with low birth weight. A child weighing less than 2.5 kg at birth is termed as having low birth weight. The complications associated with low birth weight are as follows:
• Developmental delays• Impairment in immune function• Tendency to remain undernourished
with reduced muscle strength resulting in delay in normal developmental milestones.
• Hypotonia resulting in delay in other developmental milestones like sitting and standing
• Delay in speech and language development as mild hypotonia may result in difficulty in oral movements resulting in delayed expressive language development
• Impairments in cognitive and social development
High birth weight or fetal macrosomia, is defined as an infant who is over 8 pounds, 13 ounces when born. This may cause childhood diabetes, obesity, and metabolic syndrome.
Another crucial growth factor is a child’s HEAD CIRCUMFERENCE (HC). Head circumference along with other growth-monitoring factors may indicate an underlying medical condition that may be diagnosed and prognosticated in time, as well as aid in prevention or intervention.
Measurement of head circumference is part of monitoring of growth that is important in identifying whether a child is growing normally or deviating from the norm. Measurement of head circumference is an integral part of the Pediatric Neurological Examination. During the antenatal period the head grows at a fast rate, as well as during the first three months of life.The normal values of Head Circumference (HC) by age is: Pregnancy to birth - 0 to 33 cm (maximum growth), birth to 1 year: 33 to 35 cm, 1st to 2nd year: 35 to 45 cm and 2nd to 3rd year: 45 to 47 cm. Head circumference increases at a rate of 3 centimetres per month. Between 4 to 6 years of age, HC increases by 1 cm per year. It is an indicator of brain growth in children under 2 years. It is measured by using a non-elastic tape. HC, also called occipital frontal circumference is determined by measuring the most prominent part on the back of the head (occiput) and just above the eyebrows, that is, the distance from above the occipital prominence to the frontal prominence. Measurements must be plotted on the appropriate chart for sex and conceptional age. Measuring HC acts as a quick and non-invasive means of determining the presence of micro or macrocephaly as well as aids in assessing the development of the central nervous system and helps in identifying children at a high-risk of developing neurodevelopmental disorders or those who have undiagnosed conditions.
Measurement of HC may alert us to the presence of macrocephaly in a child. Children with macrocephaly clinically present with a large head size, that is, larger than 2 standard deviations from the normal distribution. It may be suggestive of hydrocephaly or the presence of excess fluid in the brain. Among the conditions that constitute macrocephaly are, benign familial macrocephaly (FM). It is an inherited condition where a family is predisposed to having a larger head circumference. Research indicates that a small percent of children with FM have developmental concerns and that FM may be a risk for a delay in learning.
Macrocephaly has also been observed in children with Autism Spectrum Disorder. It has been observed to occur in 15-35% of these children as well as in children with other forms of pervasive developmental disorders. Macrocephaly is said to be the most common physical finding among children with ASD. However, it has been observed that macrocephaly in these children becomes evident around the age of 1 to 3 years and is usually not present at birth. This is yet another reason why HC needs to be measured in a consistent, serial fashion so as to be able to implicate an abnormal growth in head size at different ages. Macrocephaly may also manifest in syndromes with cutaneous findings such
as, Neurofibromatosis (NF1) and Hemimegalencephaly. It may also be manifest in syndromes with intellectual disability such as Fragile X Syndrome. They may also be symptomatic of metabolic diseases such as Leukodystrophies such as Alexander disease, Canavan disease and Megalencephalic Leukoencephalopathy. Macrocephaly may also be due to Neuro-Cardio-Facio-Cutaneous syndromes such as Noonan syndrome, LEOPARD as well as Costello syndrome. Syndromes of overgrowth such as Sotos, Weaver, Simpson-Golabi-Behmel and Beckwith-Wiedemann syndromes may also present with macrocephaly.
The converse of macrocephaly is microcephaly, which is indicated by a small head size. Microcephaly is indicated by a head size that is 2 standard deviations below mean for age and sex. A clinical finding of microcephaly may indicate that the brain in not developing appropriately. It may or may not be an indication of underlying pathology. It may be evident at birth or a few years after. It is observed that cases of microcephaly are usually accompanied by intellectual disability, poor speech and motor function, abnormal facial features as well as dwarfism. Microcephaly may be congenital as in the case of X-linked microcephaly, Cornelia de Lange syndrome, Down’s syndrome and Edward Syndrome. It may also be due to congenital cytomegalovirus infection and as has been most recentlyobserved, the Zika virus. It may also be manifest in cases of Fetal alcohol syndrome and maternal malnutrition. Postnatally microcephaly may be due to inborn errors of metabolism, traumatic brain injuries, meningitis or syndromes such as Rett syndrome and Cohen syndrome, among others.
It is important to note that children with microcephaly or macrocephaly will not always display impairments in intelligence, they may develop normally. This is why head circumference must be interpreted in conjunction with other clinical features that are present in a child to provide an accurate clinical diagnosis in case of comorbid conditions as well as in formulating therapy interventions.
GENDER is an important factor in terms of predisposition of individuals to certain medical conditions. The incidence of different diseases will vary according to gender. Various genetic conditions may be gender-specific. Manifestation of symptoms of conditions occurring in both genders may also be unique or gender–specific. With respect to Attention Deficit/ Hyperactivity Disorder (ADHD), the manifestation of symptoms varies between males and females. Males typically display externalising symptoms, while females may display internalising symptoms. If the clinician is unaware of these she or he may be unable to diagnose the child for a certain condition, which for that child would mean that she or he is deprived of treatment or intervention opportunities. It will also lead to an overall discrepancy in diagnosis between genders. It is important for a clinician to be aware of differences in symptom manifestation of the same condition, in both genders as it will help in symptom identification and management as well.
Certain neurodevelopmental concerns are diagnosed more in males than in females, among them is Autism Spectrum Disorder (ASD). The bias in diagnosis or limitations in diagnosing females due to ignorance of gender-specific manifestations in different conditions among other reasons, would mean that females, on the whole are missing out on being diagnosed, which results in them being deprived of interventions or treatments for their individual conditions.
Gender is also an important factor in terms of determining the presence of X-linked or Y-linked disorders. Females or males may be carriers for specific disorders. Being aware of these gender–specific disorders would mean that the clinician can narrow the list of prospective diagnoses to the most probable ones keeping the patient’s gender in mind. This would
be beneficial in terms of prevention or intervention as well as symptom management. Certain syndromes may exclusively affect females such as Rett syndrome and Goltz syndrome. Haemophilia A is an example of an X-linked recessive disease, for which the carriers are females. XYY syndrome and Klinefelter syndrome are conditions that occurs only in males. Genetic disorders that are present in families may also be uncovered through which concerned members may be screened for diseases as well as be counseled accordingly to make informed decisions.
In certain societies, females are not given equal access to healthcare facilities. A vigilant clinician can ensure the parent or parents are counselled appropriately and also encourage follow-up in such cases.
There also exist social myths such as, boys talk late and other false assumptions that are specific to genders in relation to the achievement of certain milestones. This again may lead to a lack of early intervention due to delayed diagnosis or the absence of consulting the appropriate clinician in such a case.
AGE is another crucial factor involved in understanding the developmental process. Milestone development, whether age appropriate or delayed, is determined in terms of age of attainment. A child who at 1 year old still sits with support indicates deleyed development. Age plays a role in terms of assessing the severity or significance of a symptom/ concern with respect to age. For instance, a 5 year old child throwing a tantrum may be considered acceptable for his/her age versus a 12 year old child throwing a tantrum. Similarly, for other academic/ behavioral concerns, their occurance at a certain age may be a part of normal development. Age is important for making a decision about the diagnosis. DSM gives age related criteria for onset of symptoms. In neurodevelopmental disorders, the onset/ concerns are noted at stages of early development rather than a sudden onset at a later age. Hence, even when a child is evaluated at a later age, finding the age of onset will help to understand the past history of the concern and in making a clinical diagnosis. For clinical evaluations, age plays an important role as the many of the standardized tests use age-based norms for scoring. Age will be one of the determining factors for planning intervention methods and strategies, and for determining prognosis. Children receiving early intervention are considered to have a better prognosis than children receiving intervention at an older age.
References:www.ncbi.nlm.nih.gov/books/NBK11356www.birthinjuryguide.org/birth-injury/causes/post-term-pregnancy
“Unltd India training and mentoring support has helped me grow in presentation skills and developed in me the skill to present my objectives and implementation plans in a precise and objective manner. My mentor Kavita from Unltd India has been a strong guide who has redirected my thoughts and helped me think from an outcome oriented perspective. I developed the skill to present big ideas in a simple, consolidated and methodical way. The theory of change, definition of problems, aligning activities to address problems….all these concepts were included in my deliverables but I was unable to define, document and measure them. UnLtd India has helped me in this important cognitive retraining.” – Ms. Deepti Kanade-Modak, In-charge, NHF
Dr. Samir Dalwai - Founder Director, New Horizons Group And Principal, New Horizons Institute Of Education And Research
The Pioneers - PGDSE Batch 2014-2015 With Faculty Members
Dr. Samir Dalwai And Ms. Sandhya Kulkarni Speaking To PGDSE Batch 2015-2016
Certificate Batch January 2016 With Faculty Members
Dr. Samir Dalwai Speaking To PGDSE Batch 2015-2016
Ms. Nita Mehta Speaking To Certificate Batch July 2016 The Pioneers - Certificate Batch August 2014 With Faculty Members
Ms. Sandhya Kulkarni And Ms. Nita Mehta Speaking To Certificate Batch July 2015
Professor Anne Stewart Of James Madison University, USA With PGDSE Batch 2015-2016
Orientation Program For Certificate Batch January 2017
For exciting career opportunities with New Horizons Group, visit: http://www.enablemychild.org/new-horizons-group/nhg-careers/
PGDSE Batch 2014-2015 with Children of Goregaon English School
PGDSE Batch 2015-2016 Working With Parisar Asha at Nityanand Marg BMC School
Convocation Ceremony For PGDSE Batch 2015-2016
