Difficulties in real world applications of the gazette guidelines for disability certification

Dear Editor,

We have read ‘The Gazette of India, Extraordinary’ published on March 12, 2024 and would like to congratulate the organizers and stakeholders for putting together a comprehensive guideline for assessment and certification for Person/People With Disabilities (PWD). As clinical psychologists with several years of experience in disability assessment and certification, we would like to draw your attention to certain parts [Part II-Sec. 3 (ii), IV] of the Gazette which either are inconsistent or require more details and can potentially create confusion in both assessment and certification in a field beset with myriad complications.[1]

In the Section (Part II-Sec. 3 (ii), IV A) on Intellectual Disability,[1] Disability Calculation tables through Vineland Social Maturity Scale (VSMS) have been reported differently in pages 489–490 and 491. While the table on pages 489–490 gives whole percentages [like VSMS score 55–69 (mild)-50% disability], the flowchart on page 491 provides a range [like VSMS Score 55–69 is 40-59% disability] which is inconsistent and a potential source for ambiguity.

Moreover, Intelligence Quotient (IQ) categories as assessed through standardized intelligence tests are sometimes discrepant with the VSMS category. This is because VSMS assesses the gamut of socioadaptive functioning which is related to but not influenced by intellectual functioning alone. A person with mild deficits in intellectual functioning could have severe deficits in socioadaptive functioning owing to other associated conditions (e.g., locomotor impairment). This is not an uncommon picture with multiple disabilities. A specific mention of the pathway for certification for such cases where IQ and VSMS scores show marked difference could lend more clarity.

In the Section on Specific Learning Disability (SLD) (Part II-Sec. 3 (ii), IV B),[1] the attempt at pellucidity through a pathway for assessment is commendable; however, marked challenges in certification remain. First, the tools mentioned for assessment are not equipped to assess adults (already mentioned in the Gazette). Second, adults or students at grade 12 or above (college students) who have come for learning assessment without a previous certificate for SLD pose challenges with insufficient school documents or unavailability of thorough observations recorded by the teachers along with the first. Third, some of those who had been identified in childhood improve with remedial education and no longer qualify for ‘3 standard deviations below’ performance on ‘NIMHANS Index for Specific Learning Disabilities’[2] at 12^th grade level or above and can posit a dilemma whether they ought to qualify for benchmark disability at present. Whether a once held diagnosis of SLD holds true for disability certification after Grade 12 when assessment (not tailor made for adults) no longer shows ‘more than 3 standard deviations below’ performance is an important clarification needed. Without an intelligible and agreed upon procedure for translation of data into adult standards, there is risk for significant subjectivity in interpretation which can compromise the integrity and defeat the purpose of certification by making it liable to be misused through overinclusion. Meanwhile, revision of criteria for certification in adults, like inclusion of school reports of having availed remedial education for specific problems of reading, spelling, and arithmetic skills with recorded response to intervention for some specified number of years (e.g. three consecutive school grades) could be considered as a mandatory requirement.

In the Section on Autism Spectrum Disorder (Part II-Sec. 3 (ii), IV C, p. 496),[1] the rationale for assessing children under 6 years only to be mandatorily given a disability singularly for moderate autism thereafter is unclear at best. What should then be the course of action if assessment below 6 years yield Mild or Severe scores? Also, clarity is needed in the manner categories of Autism, as assessed by Indian Scale for Assessment of Autism (ISAA), Mild, Moderate and Severe Autism, have been associated with a Disability Percentage range in the Gazette,[1] as to whether a whole percentage or a range be assigned. Like, Moderate Autism with ISAA score 107 to 153 corresponds to 60 to 79% disability, so say a score of 132 should receive 60–79%, 79%, 60% or any number in between? A clear decision rule is needed.

The Gazette of India is a glorious example of systematic effort to serve the needs of a vulnerable community. Clarity on the issues mentioned would help those associated with the process of certification to better serve the unique requirements of our persons with disabilities.

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Conflicts of interest

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