Screening tools and guidline for CBR workers _Intellectual Disabilities_English.pdf

Early screening helps identify children with intellectual disabilities at the right time, so support, inclusion, and care can start early. Community-Based Rehabilitation (CBR) workers at the community level can now easily identify and start early intervention for these children using a simple, locally adapted screening tool which is adapted from Community-Based Rehabilitation (CBR) field practices and WHO “ICF and CBR Guidelines”, with contextual modifications for rural Bangladesh.

1. 1

Screening Tools and Guidelines on Intellectual Disabilities
for Community Based Rehabilitation workers at field level
(Adapted from Community-Based Rehabilitation (CBR) field practices and WHO “ICF and CBR
Guidelines”, with contextual modifications for rural Bangladesh)

Age-based Identification of Children with Intellectual Disabilities by Community Fieldworkers:
Screening knowledge is very important for CBR (Community-Based Rehabilitation) workers,
especially to identify children with intellectual or developmental disabilities. Early screening
helps identify children with intellectual disabilities at the right time, so support, inclusion, and
care can start early. Community-Based Rehabilitation (CBR) workers at the community level can
now easily identify and start early intervention for these children using a simple, locally adapted
screening tool in rural Bangladesh.
Why CBR workers need knowledge of screening
1. Early Identification
• Many parents do not realize that their child is developmentally delayed for their age.
• Early identification helps the child receive special education, therapy, and proper
support in time.
2. Ability to Refer
• Field-level CBR workers can help families reach specialists or special schools.
• Timely referral creates opportunities for the child to improve skills and independence.
3. Awareness Raising
• Workers can explain to families why the child needs special attention.
• They can also sensitize community leaders and local influencers.
4. Proper Planning and Services
• Helps in designing education and rehabilitation plans according to each child’s needs.
• Makes it easier to identify who needs more intensive support.
5. Reducing Discrimination and Neglect
• Early identification encourages families to care for the child instead of neglecting them.
• Increases social acceptance and inclusion.
When CBR workers have screening knowledge, they can quickly identify which children need
special support, refer them to appropriate services, and raise awareness among families and
communities.
This is the first step toward improving the quality of life for children with disabilities.

2. 2

Simple Age-based Screening Checklist for Community Fieldworkers
This checklist is written in simple language so that CBR fieldworkers in rural areas can use it with
minimal training.
Preliminary Screening Table for Identifying Children with Intellectual/Developmental
Disabilities
Age
(Years)
Vocabulary /
Speech Ability
Ability to Follow
Instructions
Daily Activities
and Behavior
Warning Signs (Referral
Needed)
1–2
years
Can say 2–5 simple
words (e.g.,
mother, father,
water)
Follows simple
commands (“come
here”)
Shows interest in
toys, eats with
hands
Cannot say any words,
does not look at people,
does not understand
instructions
3–4
years
Uses about 50
words, can make
short sentences
Follows two-step
commands (“bring
the ball and give it
to me”)
Eats by self,
partially toilet-
trained
Cannot speak clearly,
cannot follow simple
instructions
5–6
years
Can tell short
stories or events,
answers questions
Can follow more
complex
instructions
Starts to dress and
brush teeth
independently
Cannot understand
simple lessons, does not
play with other children
7–10
years
Uses learned
vocabulary, can
read and write
simple words
Follows rules and
social norms
Can participate in
school activities
Lags behind peers in
reading/writing, learns
very slowly
11–15
years
Participates in
regular
conversation
Understands rules,
instructions, and
social behavior
Helps at home or
school
independently
Cannot do daily tasks
independently, speaks or
understands very little

Instructions for Fieldworkers:
• Mark ✓ (can do) or ✗ (cannot do) in each column.
• Compare the child’s ability with the expected skills for their age.
• If the child repeatedly lags behind or fails to achieve age-level skills, refer to a specialist,
doctor, or special school for further assessment.

3. 3

Preliminary Screening and Scoring Guidelines (for field-level CBR workers)
Purpose:
To identify children with intellectual or developmental disabilities at the community level.

1. Step 1: Fill up the screening table
• In the columns for “vocabulary, following instructions, daily activities,” mark ✓ (can do) or ✗
(cannot do) according to the child’s ability and age.
2. Step 2: Give scores
• For each skill:
✓ = 1 point
✗ = 0 point
Each age group can have a maximum score of 3 points.
3. Step 3: Interpret results
• Normal development → If the child scores 2–3 points for their age.
• At risk / doubtful → If the child scores 1 point for their age.
• Possible intellectual/developmental disability → If the child scores 0 point or consistently
performs at the level of a child two age groups younger.
4. Step 4: Decision / Referral
• At risk / doubtful → Advise parents and repeat screening after 3–6 months.
• Possible intellectual disability → Refer to a specialist doctor, psychologist, or special school
for assessment.
• In the report, write: “The child has not achieved age-appropriate skills. Further assessment
required.”
Important Note:
This tool is for preliminary screening only, not for final diagnosis.

4. 4

Child Screening Form
(Age-based Questions for Intellectual Disabilities)
Child’s Name: ___________
Parent’s Name: ___________
Age (months/years): ___________
Village: ___________
Date: ___________

Age 12–23 months (1–1.9 years):
1. Does your child sit, crawl, or walk later than other children? (Yes / No)
2. Does your child play with toys meaningfully (e.g., pick up small things, bang two toys
together)? (Yes / No)
3. Does your child say a few meaningful words (e.g., mama, papa, water)? (Yes / No)
4. Does your child respond when called by name or when hearing sounds? (No / Somewhat
/ Very little response)
5. Does your child try to hold a cup or spoon and feed themselves? (Yes / No)

Age 24–59 months (2–4.11 years):
1. Does your child have difficulty understanding simple instructions? (No / Somewhat / A
lot of difficulty)
2. Do strangers usually understand your child’s speech? (No / Somewhat / A lot of
difficulty)
3. Does your child have trouble learning self-help tasks (like dressing, washing hands/face,
eating)? (No / Somewhat / A lot of difficulty)
4. Does your child have difficulty playing or mixing with other children? (No / Somewhat /
A lot of difficulty)
5. Does your child show unusual behavior (e.g., always angry or completely silent) that
worries you? (Yes / No)
6. Can your child stack blocks, imitate drawing, or follow two-step instructions? (Yes / No)
Age 5–9 years:

5. 5

1. Does your child have more difficulty than others of the same age in learning to read,
write, or do arithmetic? (No / Somewhat / A lot of difficulty)
2. Does your child have trouble understanding what others say? (No / Somewhat / A lot of
difficulty)
3. Does your child have problems with memory or maintaining attention? (No / Somewhat
/ A lot of difficulty)
4. Does your child have difficulty doing self-care activities (such as dressing or bathing)
compared to other children of the same age? (No / Somewhat / A lot of difficulty)
5. Is your child’s behavior at school or home (e.g., very aggressive, too withdrawn, cries
easily) a matter of concern? (Yes / No)

Age 10–15 years:
1. Does your son/daughter have difficulty with schoolwork (understanding lessons, keeping
up with studies)? (No / Somewhat / A lot of difficulty)
2. Does your child have difficulty expressing themselves or understanding others? (No /
Somewhat / A lot of difficulty)
3. Does your child have difficulty remembering things, following multiple instructions, or
maintaining attention? (No / Somewhat / A lot of difficulty)
4. Does your child need help in doing personal tasks compared to peers? (No / Somewhat /
A lot of difficulty)
5. Is your child’s behavior at home or school (e.g., very aggressive or completely isolated) a
cause for concern? (Yes / No)

Instructions for Fieldworkers:
• Refer immediately (urgent):
If the child’s response to any question is “a lot of difficulty,” especially in learning,
understanding, speaking, or performing daily activities or if the child has lost previously
acquired skills (for example, could do something before but cannot now).

• Refer and include in the CBR group:
If the child scores “somewhat of a difficulty” in two or more questions, or in younger
children, if an important developmental milestone (e.g., still not speaking any words at
age 2) is missing.

6. 6


• Give advice and observe:
If the child scores “somewhat of a difficulty” in only one question, advise parents to
encourage the child through play, stories, songs, and simple communication.
Reassess the child after 3 months.