Deconstructing Dyslexia

Understanding Dyslexia
Dyslexia is a type of learning disability. A person with a learning disability has trouble processing words or numbers. There are several kinds of learning disabilities; dyslexia is the term used when people have difficulty learning to read, even though they are smart enough and are motivated to learn. The word dyslexia comes from two Greek words: dys, which means abnormal or impaired, and lexis, which refers to language or words.

Dyslexia is not a disease. It's a condition that you are born with, and it often runs in families. People with dyslexia are not stupid or lazy. Most have average or above-average intelligence, and they work very hard to overcome their learning problems.

Educators have not been able to agree on what dyslexia really is. Some authorities believe that is strictly a language processing problem that involves the distinguishing of sounds of letters—this is why the struggling reader cannot remember phonics sounds to decode a word. Others believe that it is a visual/perceptual problem since these children reverse words laterally (b/d) and vertically (m/w) as well as scrambling letters (“the” = “het”) when they read and write. They are both correct.

Dyslexia is an auditory/language problem, visual/perceptual problem, and often also a visual/motor (eye/hand) problem. My 30 years of experience working with these bright, yet struggling learners has taught me that it is essentially a midline problem. Our brain is divided into two main hemispheres: the right, our “automatic” hemisphere, and the left, our “thinking” hemisphere. When children are suffering from dyslexia the processes that should have been taken over by the right hemisphere (such as eye tracking, writing, and letter identification) are still in the left brain. This means that the child has to think about the processes. The learning processes can be likened to the driving process. If you had to think about how to turn the signals and when to brake and accelerate while you were driving, it would be a very difficult procedure. While reading, recognition of letters, sight words, and letter combinations need to be retrieved from the right hemisphere where our long-term memory is stored. This is not happening with dyslexics.

You can suspect dyslexia in your child if all three of these processing areas are impacted and your child is past the first grade. If your child has only a minor problem in the areas it can be considered a learning glitch. If the problem presents itself more frequently and your child is older, it would be considered a dysfunction. If the symptoms are much more frequent, your child is above first grade, and two years behind in reading or writing, it would be considered dyslexia. The degree of the problem and age of the child are major considerations in the determination of dyslexia. Many times these children are not reading or reading at least two years behind grade level. They write almost no sentences from memory since their right, visual hemisphere is not storing words efficiently (copying a sentence is not considered writing). Transposing numbers (19/91) is not considered dyslexia. When a child reverses letters or numbers, even if only once in a while, you know that there is stress in the writing system—the child has to think about the direction of the letters rather than the content of the writing. I always take reversals (reading and writing) seriously past the first grade. One way to eliminate them is with Brain Integration Therapy exercises.

 
The following items should provide useful guidelines for teachers and parents to follow and support:

In the class:

• Of value to all children in the class is an outline of what is going to be taught in the lesson, ending the lesson with a resume of what has been taught. In this way information is more likely to go from short term memory to long term memory.
• When homework is set, it is important to check that the child correctly writes down exactly what is required. Try to ensure that the appropriate worksheets and books are with the child to take home.
• In the front of the pupils' homework book get them to write down the telephone numbers of a couple of friends. Then, if there is any doubt over homework, they can ring up and check, rather than worry or spend time doing the wrong work.
• Make sure that messages and day to day classroom activities are written down, and never sent verbally. i.e. music, P. E. swimming etc.
• Make a daily check list for the pupil to refer to each evening. Encourage a daily routine to help develop the child's own self-reliance and responsibilities.
• Encourage good organizational skills by the use of folders and dividers to keep work easily accessible and in an orderly fashion.
• Break tasks down into small easily remembered pieces of information.
• If visual memory is poor, copying must be kept to a minimum. Notes or handouts are far more useful.
• Seat the child fairly near the class teacher so that the teacher is available to help if necessary, or he can be supported by a well-motivated and sympathetic classmate.

Copying from the blackboard:

• Use different colour chalks for each line if there is a lot of written information on the board, or underline every second line with a different coloured chalk.
• Ensure that the writing is well spaced.
• Leave the writing on the blackboard long enough to ensure the child doesn't rush, or that the work is not erased from the board before the child has finished copying.

Reading:

• A structured reading scheme that involves repetition and introduces new words slowly is extremely important. This allows the child to develop confidence and self esteem when reading.
• Don't ask pupils to read a book at a level beyond their current skills, this will instantly demotivate them. Motivation is far better when demands are not too high, and the child can actually enjoy the book. If he has to labour over every word he will forget the meaning of what he is reading.
• Save the dyslexic child the ordeal of having to 'read aloud in class'. Reserve this for a quiet time with the class teacher. Alternatively, perhaps give the child advanced time to read pre-selected reading material, to be practiced at home the day before. This will help ensure that the child is seen to be able to read out loud, along with other children
• Real books should also be available for paired reading with an adult, which will often generate enthusiasm for books. Story tapes can be of great benefit for the enjoyment and enhancement of vocabulary. No child should be denied the pleasure of gaining access to the meaning of print even if he cannot decode it fully.
• Remember reading should be fun.

Spelling:

• Many of the normal classroom techniques used to teach spellings do not help the dyslexic child. All pupils in the class can benefit from structured and systematic exposure to rules and patterns that underpin a language.
• Spelling rules can be given to the whole class. Words for class spelling tests are often topic based rather than grouped for structure. If there are one or two dyslexics in the class, a short list of structure-based words for their weekly spelling test, will be far more helpful than random words. Three or four irregular words can be included each week, eventually this should be seen to improve their free-writing skills.
• All children should be encouraged to proof read, which can be useful for initial correction of spellings. Dyslexics seem to be unable to correct their spellings spontaneously as they write, but they can be trained to look out for errors that are particular to them.
• Remember, poor spelling is not an indication of low intelligence.

Maths:

• Maths has its own language, and this can be the root of many problems. Whilst some dyslexic students are good at maths, it has been estimated that around 90% of dyslexic children have problems in at least some areas of maths. General mathematical terminology words need to be clearly understood before they can be used in calculations, e.g. add, plus, sum of, increase and total, all describe a single mathematical process. Other related difficulties could be with visual/perceptual skills, directional confusion, sequencing, word skills and memory. Dyslexic students may have special difficulties with aspects of maths that require many steps or place a heavy load on the short-term memory, e.g. long division or algebra.
• The value of learning the skills of estimation cannot be too strongly stressed for the dyslexic child. Use and encourage the use of estimation. The child should be taught to form the habit of checking his answers against the question when he has finished the calculation, i.e. is the answer possible, sensible or ludicrous?
• When using mental arithmetic allow the dyslexic child to jot down the key number and the appropriate mathematical sign from the question.
• Encourage pupils to verbalize and to talk their way through each step of the problem. Many children find this very helpful.
• Teach the pupil how to use the times table square and encourage him to say his workings out as he uses it.
• Encourage a dyslexic child to use a calculator. Make sure he fully understand how to use it. Ensure that he has been taught to estimate to check his calculations. This is a way of 'proof reading' what he does.
• Put key words on a card index system or on the inside cover of the pupils maths book so it can be used for reference and revision.
• Rehearse mathematical vocabulary constantly, using multi sensory/kinesthetic methods.
• Put the decimal point in red ink. It helps visual perception with the dyslexic child.

Handwriting:

• Reasons for poor handwriting at any age can be poor motor control, tension, badly formed letters, speed etc. A cursive joined style is most helpful to children with dyslexic problems. Encourage the children to study their writing and be self-critical. Get them to decide for themselves where faults lie and what improvements can be made, so that no resentment is built up at yet another person complaining about their written work.
• Discuss the advantages of good handwriting and the goals to be achieved with the class. Analyze common faults in writing, by writing a few well chosen words on the board for class comment.
• Make sure a small reference chart is available to serve as a constant reminder for the cursive script in upper and lower case.
• If handwriting practice is needed it is essential to use words that present no problem to the dyslexic child in terms of meaning or spelling.
• Improvement in handwriting skills can improve self confidence, which in turn reflects favorably throughout a pupil's work.

Marking of work:

• Credit for effort as well as achievement are both essential. This gives the pupil a better chance of getting a balanced mark. Creative writing should be marked on context.
• Spelling mistakes pinpointed should be those appropriate to the child's level of spelling. Marking should be done in pencil and have positive comments.
• Try not to use red pens to mark the dyslexic child's work. There's nothing more disheartening for the child than to have work returned covered in red ink, when they've inevitably tried harder than their peers to produce the work.
• Only ask a pupil to rewrite a piece of work that is going to be displayed. Rewriting pages for no reason at all is soul destroying as usually much effort will have already been put into the original piece of work.

Homework:

• By the end of a school day a dyslexic child is generally more tired than his peers because everything requires more thought, tasks take longer and nothing comes easily. More errors are likely to be made. Only set homework that will be of real benefit to the child.
• In allocating homework and exercises that may be a little different or less demanding, it is important to use tact. Self-esteem is rapidly undermined if a teacher is underlining the differences between those with difficulties and their peers. However, it should also be remembered that far more effort may be needed for a dyslexic child to complete the assignment than for their peers.
• Set a limit on time spent on homework, as often a dyslexic child will take a lot longer to produce the same work that another child with good literacy skills may produce easily.

Integration:

• A dyslexic child's ability to write down thoughts and ideas will be quite different from the level of information the child can give verbally. For successful integration, the pupil must be able to demonstrate to the teacher that he knows the information and where he is in each subject. Be prepared to accept verbal descriptions as an alternative to written descriptions if appropriate.
  
  Alternative ways of recording should be looked at, such as :
  • The use of computers for word processing.
  • Audio tapes for recording lessons that can then be written up at a later stage.
  • Written record of the pupil's verbal account, or voice activated software can be used.
• More time should be allocated for completion of work because of the extra time a dyslexic child needs for reading, planning, rewriting and proofreading their work.
• For a dyslexic child the feeling of being 'different' can be acute when faced with the obvious and very important need of 'specialist' help for his literacy and possibly mathematical skills. Some specialist methods can be incorporated into the classroom so all children can benefit from them, thus reducing the feeling of 'difference'.

Teachers with special skills ready to break education barriers

SSA trains 140 teachers to understand children with special needs
“In our school, we have children with autism studying with other children. After this training, we have the courage and skills to take care of them. We won’t get angry or put them in the last row. Now, we understand them. (Earlier), we didn’t know.”

This transformation in Prasad K.V.L.N., a teacher in Government Higher Primary School, Sajankady, Puttur, comes after a 10-day training programme organised by the Sarva Shiksha Abhiyan (SSA).

As many as 140 teachers from various government schools in the district attended the programme aimed to sensitise them so that no child with special needs — irrespective of the kind, category and degree of disability — is left behind. Some children with special needs (CWSN) might have one predominant disability with associated difficulties.

The training was an attempt to empower teachers as part of the Right to Education (RTE) Act, which mandates every school must have one teacher who is CWSN-friendly, and every child must get barrier-free education, said N. Shivaprakash, Co-ordinator, Sarva Shiksha Abhiyan. “We cannot have a child with low vision or hearing-impaired seated in the last row,” he said.

With the implementation of the RTE, more children, including CWSN, are joining regular schools, so teachers must know how to take care of them. The training sensitised the teachers to 10 disabilities defined by the Ministry of Human Resource Development (MHRD), with visits to special schools and interaction with doctors and specialists, Mr. Shivaprakash said.

Hanumanthappa, teacher, Government Higher Primary School, Mavinakatte, Belthangady, said the training, especially about identifying children with special needs and referring them early to the district psychologist, was helpful. “Earlier, the attitude was to send away the child to a special school,” he said.

Juliet, teacher, Government Primary School, Bantwal, said helping a child with special needs get access to education requires teamwork from students, doctors, psychologists and, especially parents.

Mr. Prasad said, “This (information) is not there in D.Ed... The training can help in every house.” Teachers can tell Accredited Social Health Activists, health centres or doctors visiting districts from special schools, about challenged children, he said.

Irene, Inclusive Education Resource Teacher, Mangalore Urban, said the training is for teachers of regular schools and is required because RTE emphasises inclusive education. The training helps teachers handle cerebral palsy, Down’s Syndrome, muscular dystrophy, speech and hearing problems and autism.

Do you have an entrepreneur in you?

What does it take to start a company of your own? Is it money, vision, belief, courage? Any entrepreneur would tell you it is all this and more! The way there is a method to madness, similarly there is a method to becoming an entrepreneur.

Many college goers don’t harp on corporate dreams anymore, thanks to the entrepreneurial vibes in the air. Most college students are attracted by the prospects of making an idea the central point of their life and experiencing the obsession of starting a venture.

Meet Hullas Arora, a final-year student of Shaheed Sukhdev College of Business Studies (CBS), University of Delhi who is burning the midnight oil preparing for his semester exams. Though he has a placement offer from a leading MNC, Arora is contemplating if he wants to take up the job or pursue his dreams.

Says he, “I happened to visit the corridors of a leading MNC and was shocked to see the fate of the employees. Everyone was glued to their computer screens and didn’t budge even for a second. The atmosphere was eerie and reminded me of a mortuary. I can’t imagine myself to be sitting like this someday.”

Chances are that Arora would not even need to cross the corporate corridors if things materialise as per plan. “I have so many ideas, and plan to start various ventures,” he says. However, at present, Fabrica (a venture started by him and his friends) is his motivation. “Fabrica India is a business organisation that deals in corporate merchandising and has developed a reputation for providing quality apparel, corporate gifts and promotional products at competitive prices. We have made a strong footing in the industry and want to take it further,” he adds.

The inception of Fabrica India goes back to close to a year. Recalls Pulkit Bakshi, co-founder Fabrica, “I had a marketing company and was finding various associates for it including apparel partner and associate too. Meanwhile Varsha Chaudhary, (Business Development Head, Fabrica India) who was then the vice president of Gargi College, wanted to get some T-Shirts made for her college. So we set out together looking for quality suppliers who would give us good stuff at reasonable prices. Luckily, we were unable to find anyone and Varsha sensed some scope here. She had an interest in fashion, and this industry offered abundant scope for her. So one of those days we spent a lot of time talking about this. One thing led to another and finally we decided to open our own company. We ransacked all our contacts and exploited our entire network for finding and organising the best suppliers, distributor’s, designers, delivery guys, etc.”

After a year, Fabrica is a brand many reckon with. But was the start as smooth? “From starting with only two people referred to as T-Shirt vendors by the people, Fabrica India today has eight core employees, numerous sub-employees and interns. From just being a startup to a registered legal entity, and from a facebook page to having a full-fledged website, we have come a long way. We worked towards market capitalisation for eight straight months after which we decided to get our company registered, get it a website, hire employees and expand it to other corporate and institutional sectors. We used all our earnings from Fabrica to get all these things done and organised a team of efficient committed and talented people to help Fabrica achieve its potential. Today, we are as a registered organisation called The Fab Enterprises, carrying the Brand Fabrica India,” prides Pulkit.

Ask him what next about Fabrica and him and he says, “We today are one of the largest and fastest growing merchandising brands of the country and plan to come up with our stores soon which shall mark every prominent street of the country in no time. We have become synonymous to quality, client delight and punctuality and we wish to now become a synonym to merchandise.”

With like-minded friends, Hullas plans to strengthen his entrepreneurial roots. “The future plan is to float a few ventures and work on taking them to a certain level. I have come to realise that closed door jobs are not my cup of tea.”

Rights of children with disabilities

The Right to Education Act (amendment) Bill passed recently in the Rajya Sabha to widen the beneficiary net for children with disabilities is a retrogressive step since it defeats the very purpose of the Act, which is to promote social inclusion in elementary schools. The amendment is in contradiction of the United Nations Convention on the Rights of Persons with Disabilities and the recent Supreme Court judgment (April 2012) on RTE, since it seems to suggest that home-based education may be the best option for children with 'severe disability.'

The very notion of what constitutes 'severe disability' is a contested term and the assumption that 'certain children' may be best educated at home rather than schools, defeats the very premise of inclusive education that espouses the belief that every child, including those with differing abilities have an entitlement to study with their peers and not be excluded from mainstream education. Even if we were to presume that certain parents 'choose' home-based education for say their child who has severe medical complications with impairment , how would the state governments find the human resources to make home-based education a reality?

Currently, there are a total of 415 institutions which are recognised by Rehabilitation Council of India (RCI) to run rehabilitation councils, and the total number of registered rehabilitation professionals in the country is approximately 35,000, with special educators included in this figure.

A recent study has highlighted that in 2007, the total number of special teachers' requirement for all categories of children with disabilities stood at 1,79,116 ( IAMR, 2009) - a current shortfall of approximately 1.4 lakh special teachers. According to MHRD, the number of out-of-school children with disabilities remains a high 35% (SRI-IMRB , 2009) and currently coverage of children with disabilities stands at 26.4 lakh in mainstream schools and 2.4 lakh through home-based education. Is homebased education going to be the vehicle to legitimatise rejection of children with disabilities from schools?

The above mentioned figures are based on Census 2001 estimates of 2.3% of the population with disability . Census 2011 results are due and expected to show an increase in the national population of children with disabilities. Is exclusion and segregation going to be the path that India chooses to meet the fundamental right to education of children with disabilities in the country? This is a contradiction to India's commitment to ensure access to quality education for all children including those with disabilities.

Teen slaps Principle

A class IX student of St Elias High School in Khar (west) verbally abused and then slapped his principal on Monday after she scolded him for disturbing other students during a school examination. The incident occurred at 9:15am, when the 15-year-old schoolboy, who resides at Khar Danda, was asked to leave the class during the algebra exam.

"The school was conducting the final exams. The three-hour exam started at 7am. This student had finished answering the questions at 9.15am and started disturbing other students. I then asked him to leave the class. He called me some bad words and slapped me,'' the principal said. TOI has decided to withhold their identities.

Earlier in February, a class IX student in Chennai allegedly killed his teacher of St Mary's Anglo-Indian School after the school sent adverse reports to his parents.

The St Elias High School principal lodged a complaint with the Khar police station but said she did not wish to pursue it. "For my safety, I made a police complaint in Khar but I have told not to take action against the child.

He is under the influence of alcohol and drugs. We will have to counsel him. He hit me but I brought him back to school. But he did not appear for the exam on Wednesday," the principal said. She said the school was keen on reforming the boy.

"We do not want him to become a boisterous person later. He should be useful to society," the principal said. The student has a past record of being a wayward, problem child, but the school did not expel the boy as it wanted to provide him with a chance to reform . "I have been counselling him for about a year. He is short-tempered and did not regret his action," she said.

Mainstream they must swim but it’s best to start them on the side

Meenal Chopra, 15, was in a "special needs" school till Class IX. She now likes it at the Rohini private school she attends but would have felt more comfortable if her teachers were better equipped to handle visually-impaired kids like her. "In my previous school, there were trained teachers who looked after us. But the environment didn't allow much freedom. I am more independent here. Though the teachers are helpful, they aren't fully trained to deal with our needs," she says. Chopra's admission into a mainstream school was facilitated by the All India Confederation of the Blind.

This is the reality for many disabled children placed in mainstream schools. Although there are policies promoting integration of disabled kids - identified as children with special needs or CWSN by Sarva Shiksha Abhiyan (SSA) - experts and activists say attempts at mainstreaming have largely failed in Delhi.

"Is the system accessible?" asks G Syamala of Action for Ability Development and Inclusion (AADI). It's a rhetorical question, really. "Putting a disabled child into a regular school doesn't mean successful integration. A child who cannot see will depend on hearing and a child who cannot hear will depend on sight. Are books available in all these formats?" she asks.

According to 2009-10 SSA data, all government schools in Delhi (3,475) have "barrier-free access" - school buildings have ramps and handrails. "When a child is two-and-a-half, she needs to be put into playschool which requires kids to be toilet-trained. These schools don't know how to handle a child who is not talking or walking," says Syamala.

"After RTE, no school can reject the application of a child on the basis of disability but they are expected to learn a lot before they enter - taking care of self, managing the environment. A child with impairment needs more help and more time. But schools are not ready to give that." Even the admission procedure is difficult as parents are asked to take their kids to "special schools" or pressed to produce "disability certificates".

Dr Madhumita Puri of Society for Child Development, says that the student-to-teacher ratio in regular schools doesn't help either. "A teacher with a class that's filled to capacity gets nervous if a child with special needs is put in. She is not only unsure of her own competence to handle the child but the necessary equipment is also limited. That's when the marginalization happens."

"Training of teachers is important. If teachers aren't equipped to handle disabled kids, the latter will drop out," says an expert on inclusive education (IE). She says categorically that part of SSA "hasn't taken off in Delhi. However, SSA data from end-2010 claims that 88.94% of CWSN (12,068 out of 13,568) have been enrolled in schools - a statistic that most activists and experts working in the field reject. "A major chunk of the disabled in Delhi is out of school," she says, "Usually, only enrolled kids are included in the data." She goes on to explain that private schools don't solve the problem either. "In most private schools, there's only partial mainstreaming, not full inclusion," she says. And "special needs" wings of such schools are too expensive. "These schools spend more on resources and special educators and most children can't afford that," says another activist. However, there are also cases, where disabled children have been successfully integrated into mainstream courses like commerce and science. Rohan Garg, 16, who's visually impaired, was admitted into the commerce stream of a reputed private school. He's only being charged the regular fees and finds the teachers very supportive.

"Delhi has two sets of agencies - both central and state - yet it has nothing," comments Javed Abidi, an IE-expert. With too many agencies in the field, no one takes ownership. There are lots of NGOs but the government hasn't entered into partnerships with them," he says. Under SSA, there are 250-300 resource teachers and about 100 volunteers, which is nowhere near the kind of manpower required to tackle the disability sector. For that reason, a 90-day training programme for teachers was formulated with Rehabilitation Council of India. But, its enforcement had been hugely resisted.

"Even the 90-day training is not a comprehensive programme. It's only a foundation-course that teaches how to identify the disabled and refer them to special educators," says a senior government official. Shanti Auluck of Muskaan says that for the professionals who come into the field, it's the last option. "The quality of training is no

Bumps galore, it’s an unequal race

A handful of youths rendered disabled by polio joined college this year. They are also professional dancers with their wheelchairs and crutches doubling as stage props. Gulshan Kumar, Vijay Kumar, Ajay Kumar and Manish Kumar were all drawn out of their homes, often against the wishes of their parents, trained as dancers for years by an NGO and placed in schools. Belonging to economically weak families, these kids, once considered liabilities, are now supporting their families.

"We prepare the disabled for independent thinking and living free of cost," says Syed Salauddin Pasha of the Ability Unlimited Foundation (AUF) that works mostly with disabled kids coming from economically weak backgrounds. He teaches them to dance, do yoga and sword-play - all on wheelchair.

In 2011, one of his wards, Gulshan Kumar, affected by polio, even broke the world record for wheelchair-spinning. "We work as professionals and our efforts are funded by shows. When we started, I had to keep writing to festival organizers to get a platform for my students. They'd not reply or refused outright. This year, we had to turn down offers for many shows. We were just not free," says Pasha.

However, few get a break like that. The support structure for the disabled in Delhi is incomplete - even 17 years after the Persons with Disabilities Act, 1995, came into being, work on it is going painfully slow. Even the existing systems do not work in tandem with each other. Occupational therapy is available in hospitals and even private centres but getting to these places is difficult. Public transport is hopelessly inaccessible to the disabled, especially to those with locomotive disabilities; roads are dangerous for the wheelchair-bound.

The means for diagnosis and identification of disability are easy but referrals and follow-ups are rare; awareness is growing among parents but information about existing resources and support systems are scattered. Most facilities are in private hands and medical help, considered the only remedy instead of alternative lifestyles, is forbiddingly expensive. "The approach to the rehabilitation of the disabled," says Arun C Rao of The Deaf Way Foundation, "is fundamentally flawed".

"You can't thrust a hearing-aid or medical procedures such as cochlear implants at the deaf and consider them rehabilitated," continues Rao. "There has to be regular follow-up and monitoring, which are missing. But for the disabled person, it's a life-long matter. Rehabilitation involves improvement of the quality of life, requiring help on all fronts - medical, social, educational and vocational." Parents look for a permanent solution. "I've known many families that have gone bankrupt looking for a cure," says G Syamala of the Action for Ability Development and Inclusion (AADI).

Most importantly, the process of rehabilitation for those born with disabilities has to start early. "Facilities are available in urban areas but how many people know about them? A child is brought into an OPD and his parents have specific questions. If those aren't answered and the doctor omits details, it leaves the parents clueless. By the time the parent learns about available help, valuable time is lost," says Dr Madhumita Puri, executive director, the Society for Child Development.

The concept of screening babies at birth for any kind of impairment and referral to specialists and organizations exists in many parts of the world, even developing ones such as Brazil. In India, disabilities do get spotted but referrals and follow-ups are absent, even for new-borns, making early interventions almost impossible. "If the mother doesn't see any support or any resources, the child becomes a liability," says Syamala.

Institutions catering to the disabled exist but are woefully few and, often, very expensive. "With growing awareness among parents, the demand is about 70% higher than what we are able to give. And typically, such centres deal with specific needs of a particular impairment. But there is also co-morbidity, associated problems such as low self-esteem and depression that are not addressed," says Dr Bhavna Burmi, clinical and child psychologist with Fortis Escorts.

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