Every child deserves the opportunity to learn, grow, participate and live with dignity. Early diagnosis is not merely a medical process it is the first step toward understanding a child’s needs and protecting their future. When developmental concerns are identified early, children can receive timely intervention, appropriate education, rehabilitation services and family support. However, the diagnosis of a child with special needs should never depend on the opinion of a single Rehab professional alone. A comprehensive and multidisciplinary assessment is essential for the best interest of the child.
A diagnosis should accurately reflect the child’s developmental profile and should be clearly communicated to parents, with appropriate recommendations for intervention and support. When assessments are incomplete, delayed or contradictory, the consequences can be serious. An incorrect or inconsistent diagnosis can affect a child’s access to education, therapy, disability certification, social protection and long-term opportunities.
A few weeks ago, a parent of a child with special needs contacted me for seeking information and assistance regarding how to apply for the monthly disability pension. During our conversation, he informed me that his four-year-old daughter had been diagnosed with Down syndrome with ID in Disability Certificate.
The parent told me that he had visited a Central Government institute working for persons with disabilities to obtain a comprehensive psychological assessment of his 4 year old daughter. According to him, the clinical psychologist’s report mentioned an “impression of Mild Autism” and psychologist recommends reassessment after 6 month.
The parent informed me that he was confused by the initial assessment, in which the psychologist had mentioned “Mild Autism.” Therefore, he decided to seek a second opinion. He subsequently visited a Government hospital, where another psychologist conducted a comprehensive psychological assessment. According to the parent, the second assessment mentioned “Down Syndrome with Intellectual Disability (ID)” in the report.
Subsequently, the parent approached a Senior Resource Person (Rehabilitation Therapist) from the Government Education Department for an independent assessment of the child. The parent, reported me the Resource Person also recorded “Down Syndrome with Intellectual Disability (ID)” in the relevant official records. This further reinforced the parent’s understanding that the child’s condition was consistent with Down syndrome with Intellectual disability.
Following these multiple assessments and supporting documents, the parent approached the CMO Medical Disability Board for Disability Certificate. The child was examined by a multidisciplinary panel comprising a Physician, orthopedician Specialist, Ophthalmologist, ENT Specialist, and Senior Psychiatrist. The Board reviewed the available assessment reports and other relevant medical documents before conducting its evaluation. Subsequently, the child’s Disability Certificate recorded the diagnosis as “Down Syndrome with Intellectual Disability.” The parent was further informed that, according to the Board’s assessment, the child did not have Mild Autism.
In the best interests of the child with special needs, and with the objective of ensuring appropriate assessment, intervention, and future support for other children with special needs who may be assessed by the same psychologists at these government institutions and Government hospital, as well as ensuring that eligible children receive accurate disability certification from the competent Disability Board, I approached the concerned authorities and offices to ascertain the facts and circumstances surrounding the conflicting assessments.
My objective was to establish the factual position, ensure that the child receives an accurate disability certificate and appropriate support and services, and help prevent similar discrepancies from adversely affecting other children with special needs and their families in the future.
First, I approached the psychologist at the concerned Government Hospital and discussed the case with her. She was very cooperative and explained that she had conducted an assessment of the child and subsequently carried out follow-up assessments to further understand the child’s developmental and clinical profile and arrive at an appropriate diagnostic conclusion. According to her, following these assessments and follow-up observations, she concluded that the child had Down Syndrome with Intellectual Disability. She further stated that, if there were any concerns or doubts regarding the assessment or diagnosis, the child could be referred for a reassessment.
I also approached the Chief Medical Officer (CMO) and the Deputy Director of Health Services, Kashmir, regarding the issue. They informed me that they would share the contact details of the doctors associated with the Disability Board. Subsequently, I received the list of doctors associated with the Board and contacted one of the doctors to discuss the child’s case, including the discrepancy between the diagnosis recorded in the psychological assessments and the diagnosis subsequently reflected in the Disability Certificate.
During the discussion, the doctor informed me that the members of the Disability Board had reviewed the available reports and, based on their assessment, recorded “Down Syndrome with Intellectual Disability (ID)” in the Disability Certificate. I also informed the doctor that a psychologist at another institution had reportedly mentioned “Mild Autism.” In response, the doctor stated that it was possible that the assessment mentioning Mild Autism may have been conducted by an intern at that institution. He further stated that, if a clinical psychologist identifies autistic characteristics in a child with Down syndrome, it may, depending on the assessment and available clinical evidence, be more appropriate to document “autistic features” rather than conclusively recording “Mild Autism,” particularly where a definitive diagnosis has not been established through a comprehensive assessment.
The doctor further stated that, according to his professional experience, the co-occurrence of Autism Spectrum Disorder in children with Down syndrome is relatively rare, and that he had encountered only a limited number of such cases. He stated that, in this particular case, the Disability Board recorded “Down Syndrome with Intellectual Disability (ID)” based on its assessment and the available reports. The doctor was cooperative and expressed his willingness to provide further professional guidance or clarification regarding the matter, if required.
Lastly, I also approached the Director of the institution where the Clinical Psychologist had reportedly mentioned “Mild Autism” in the child’s psychological assessment. However, despite my repeated attempts, the Director did not respond to my telephone calls or WhatsApp messages.
Thereafter, I approached the Head of the concerned unit, who requested me to provide the child’s name and CRR number. She advised me to approach all the institutions and organizations where the child had been assessed and from which the child had received psychological assessment reports and a Disability Certificate. I informed her that I had already approached the concerned offices and authorities in this regard.
She advised me to obtain the relevant reports and responses from the other concerned offices and forward them for further examination then only something can be done. She also stated that the child could be reassessed by their institution and informed me that the parents had again been contacted and advised to bring the child for reassessment. Instead of conducting any verification regarding the “Mild Autism” assessment report, she stated that the Clinical Psychologist had written and recorded an observation that was consistent with what the parent had reported. She further informed me that, for any further clarification or enquiry in the matter, I could approach the Director of the institution.
This situation raises an important concern, how can a four-year-old child receive different clinical impressions from different professionals, and what safeguards are in place to ensure that a child’s diagnosis is accurate, consistent and based on a comprehensive assessment?
When assessments differ significantly, parents are left confused emotionally disturb, while the consequences may extend beyond diagnosis. Such discrepancies can potentially affect access to disability certification, pension and social-security benefits, inclusive education, rehabilitation, early intervention and other essential services.
I spoke with Ms. Hema Gowri, a senior rehabilitation professional with more than 25 years of experience in the disability sector, regarding concerns surrounding the assessment of children with special needs. She explained that disability services may broadly involve three approaches to professional collaboration, Multi disciplinary, Interdisciplinary, and Trans disciplinary approaches.
In a multidisciplinary approach, professionals work independently within their respective areas of expertise and provide separate assessments, with limited coordination or information-sharing among team members. In an inter disciplinary approach, professionals share information discuss the child needs, while each continue to work within their own respective professional roles. In a Trans disciplinary approach, professionals work as an integrated team, share responsibilities and knowledge across disciplines, and maintain a higher level of coordination in order to provide comprehensive support to the child. She said however interdisciplinary teams are very useful.
She further referred to the Rashtriya Bal Swasthya Karyakram (RBSK), launched in 2013, under which different health professionals follow an interdisciplinary approach, working together for the screening, early identification, assessment, and referral of children requiring support. She emphasized that, particularly in cases involving children with disabilities, effective coordination and information-sharing among professionals are essential to minimize conflicting assessments and to ensure that decisions regarding the child’s education, intervention, rehabilitation, and future support are based on a comprehensive understanding of the child’s needs. Therefore, a coordinated, child-centred, and interdisciplinary approach should be followed, with the best interests of the child kept at the forefront.
Ms. Hema Gowri also said under the 2024 Gazette new assessment Guidelines, the clinical psychologist must resist rushing into diagnostic labeling based on a single encounter. Instead they should transition toward a multi method, comprehensive assessment battery to prevent the premature categorization of applicants based on isolated numeric scores generated during a single, time-constrained clinic session.
For a child with special needs, a diagnosis is not merely a label; it can significantly influence the support, interventions, services, educational provisions, and opportunities available to the child throughout childhood and beyond. Therefore, assessments must be conducted carefully, objectively, and in the child’s best interests. Where appropriate, assessment and diagnostic decisions should also involve meaningful collaboration and professional coordination among the rehabilitation professionals working with the child, so that the child’s developmental profile, functional needs, and individual circumstances are comprehensively considered
One child cannot have two conflicting clinical realities without a clear explanation. When a psychological assessment records “Mild Autism” while the Disability Certificate records “Down Syndrome with Intellectual Disability,” the contradiction demands transparent clinical review, proper documentation, and accountability.
The real question is not merely “Who made the mistake?” but “Who is responsible for ensuring that the child receives an accurate, coordinated, and evidence-based assessment?” Conflicting diagnoses can affect a child’s education, therapies, rehabilitation, benefits, and long-term future.
A child’s rights must never become the casualty of poor coordination between Rehab professionals or institutions. Every assessment must be evidence-based, every discrepancy must be investigated, and every decision must be guided by one principle: the best interests of the child.
The writer is Sr. Pediatric Rehab Therapist & Social Worker (MSW) Working for Child & Disability Rights. zaheerjan2019@gmail.com
