Identifying Children with Functional Difficulties or Disabilities: A Global Imperative for Early Detection and Intervention

Children with disabilities represent one of the most vulnerable groups in society. Early identification of developmental delays or impairments is crucial, especially in the first three years of life, which is a critical period for child development. If developmental issues are not addressed early, they can lead to lifelong challenges. It is essential for professionals across various fields—healthcare, education, social services, and beyond—to recognize the importance of timely detection and support for children with disabilities.

Why Early Detection Matters: The Critical First Years

The early years of a child’s life are formative, and delays in reaching developmental milestones can act as warning signs for underlying disabilities. These delays may impact a child's cognitive, motor, language, or social skills. However, if these issues are identified early, the child can receive the necessary support to mitigate future challenges and achieve their full potential. The identification of these developmental "red flags" allows for early interventions, including medical treatment, physical rehabilitation, and other support services that enable children to participate more fully in society.

For practitioners in healthcare, education, and social services, early detection is not just an option—it's a necessity. It enables professionals to connect children and families to the right resources and interventions before developmental difficulties become entrenched.

The Global Challenge: Gaps in Identification and Support

Despite the critical importance of early detection, children with disabilities often remain under-identified, especially in low-resource settings. Many children with developmental delays are not recognized in time to benefit from early intervention, which can exacerbate the challenges they face. Additionally, children in rural or marginalized communities may experience even greater difficulty in accessing health services, further perpetuating inequalities.

A major issue in addressing these gaps is the lack of systematic, universal identification processes. In many regions, children with disabilities remain "invisible" to health systems, education providers, and social services, making it difficult to target interventions effectively. This underscores the need for a coordinated, global approach to monitoring child development and ensuring that services are accessible to all.

International Frameworks: A Shared Responsibility

Various international frameworks underscore the importance of identifying and supporting children with disabilities. The United Nations Convention on the Rights of the Child (UNCRC), particularly Article 23, stipulates that children with disabilities must enjoy a full and decent life. This includes access to services that ensure dignity, self-reliance, and participation in the community. To achieve this, high-quality data on children with disabilities is essential for informed decision-making, which can shape effective policies and practices in healthcare, education, and social protection.

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) further emphasizes the need for data collection on persons with disabilities. The UNCRPD calls on governments to develop policies that address the needs of people with disabilities and to include them in international cooperation efforts. With 174 countries having ratified this convention, there is an increasing legal obligation for governments to collect relevant disability data to improve access to services and inclusion.

Similarly, the African Union and the Incheon Strategy in Asia and the Pacific have recognized the importance of collecting disaggregated data on disability to address gaps, especially in rural and underserved areas. These international agreements provide a framework for countries to work together and ensure that children with disabilities are not overlooked.

Tools for Identifying Disabilities: A Multi-Faceted Approach

To address the challenges in identifying disabilities early, various tools have been developed across multiple disciplines. These tools aim to identify children who may require additional support and facilitate early intervention:

1. Washington Group on Disability Statistics:

The Washington Group provides sets of questions used in censuses and surveys to assess functional difficulties in children. These questions address basic daily activities, such as seeing, hearing, and communicating. The tool is useful for gathering population-level data that informs policy and intervention strategies. However, it’s important to note that current questions do not cover children under the age of two, a key age for early identification.

The Washington Group was established in 2001 due to the need for internationally comparable data on persons with disabilities. The Washington Group developed several sets of questions for different age groups and purposes. The sets of questions can be integrated into larger surveys or censuses. (Washington Group on Disability Statistics, 2017)

• Short Set of Questions

The Short Set of Questions was the first tool developed by the WG. The questions’ purpose is to identify whether people have challenges performing basic activities of daily life in six domains (seeing, hearing, walking, remembering, self-care, and communicating).

• Extended Set of Questions on Functioning (ES-F)

While the short set of questions intends to be inserted into existing censuses or surveys, the goal of the extended set of questions on functioning is to collect data on disability where more information is required. The extended set of questions on functioning includes the following domains: Vision. Hearing, mobility, cognition, affection (anxiety & depression), pain, fatigue, communication and upper body functioning.

2.      Child Functioning Module (CF):

The WG realized that the two existing sets of questions have their limitations in identifying children with disabilities or functional difficulties. This is due to the reason that questions for adults are not always appropriate for children. For example, identifying communication problems in adults is easier than in children who are still developing these skills as part of their development. Therefore, this tool is designed specifically for children and helps caregivers assess developmental difficulties in children aged 2-4 years. The tool focuses on functional areas like behaviour, cognitive development, and social skills, helping identify children who may need support.

3.      Child Functioning Module Teacher Version (CFM TV):

 An exciting recent development in the field of disability identification is the introduction of the Child Functioning Module Teacher Version (CFM Teacher Version). This version of the Child Functioning Module (CFM) has been designed specifically to support teachers and educators in identifying and assessing functional difficulties and disabilities in children. Through the CFM Teacher Version, educators can gain insight into a child’s functional development and identify any areas where they may need additional support.

This version is particularly valuable in school settings, where teachers interact with children on a daily basis and are well-positioned to notice developmental delays or difficulties. By using this tool, teachers can screen children for potential functional difficulties and issues and refer them for further assessment if needed.

4. Developmental Milestone Assessment Tools (DMATs):

DMATs are designed to track a child’s development from birth through age six, assessing milestones in areas such as motor skills, language, and social development. When a child fails to meet certain developmental benchmarks, it triggers the need for further evaluation and early intervention. DMATs are valuable for healthcare professionals, educators, and social workers who are involved in identifying delays and providing timely support.

5. WHO Disability Assessment Schedule (WHODAS 2.0):

This tool measures disability across six domains: cognition, mobility, self-care, interaction, life activities, and participation. While more commonly used for adults, it can also be adapted to assess children’s functioning, particularly in assessing their participation in daily life and society.

6. Physical Screening Tools:

Physical screenings help detect physical and sensory impairments in children, especially newborns. These tools support healthcare professionals in identifying potential issues that require medical attention, and they contribute to early diagnosis and intervention.

The Importance of Cultural Sensitivity

One key challenge in assessing developmental milestones is ensuring that tools are culturally sensitive. Children’s developmental progress can be influenced by a variety of factors, including environmental and cultural differences. In some settings, children may not have access to the same resources, which can affect their rate of development. Therefore, tools must be adapted to reflect the cultural context in which a child is growing up to ensure accurate and meaningful results.

Moving Forward: A Collaborative Approach

For professionals in healthcare, education, and social services, the task is clear: early detection of disabilities or functional difficulties is critical to ensuring that children receive the support they need to thrive. Governments, international organizations, and local stakeholders must work together to create systems that can identify children with disabilities early, provide timely interventions, and ensure that all children—regardless of their abilities—can access the services they need.

By adopting and implementing effective identification tools, professionals can help reduce the risks posed by developmental delays and provide the necessary support to children and families. The goal is not just early detection, but also creating an environment where children with disabilities can reach their full potential, participate fully in their communities, and lead fulfilling lives.

Ultimately, ensuring the identification and support of children with disabilities is not just a moral imperative—it’s an essential aspect of building inclusive societies where all children, regardless of their challenges, can succeed.