At I CAN Pathways School System , Islamabad each child is assessed and his/her  problems and disorders are  diagnosed deploying the most modern techniques and assessment tools . In fact a thorough assessment requires a multifaceted and empirically supported approach. Before assessment is carried out , the purpose of assessment is determined because  if one knows the purpose or the goal of an assessment, then the kind of flexibility in the process  is easily achieved which is required to have a meaningful and useful assessment. At I Can Pathways , qualified clinical psychologists , speech therapists and experienced teachers join hand to make an assessment for the following purpose at hand .

1. Understanding a child’s development and whether or not it is proceeding adequately focusing on child’s abilities, and educational performance .
2. Having clearly defined categories or dimensions that can be discriminated from each other.
3. Reliable and valid classification and diagnosis particularly the one   helpful in  directing  treatment and preparing management plans .
4. Helping disordered children’s parents and teachers through guidance and counselling .

After the initial assessment , children admitted to I CAN Pathways School system are continuously observed  to determine developmental standards or landmarks as regards different abilities and capacities of the child in different domains of human functioning . Of particular interest to Clinicians at I CAN Pathways are developmental delays (according to the standard norms of different developmental tasks like sitting , crawling , babbling, speaking , communicating and doing basic academic things like alphabets , or simple arithmetic) . Other areas of development that are of particular relevance to child psychiatry are:

• Sensory–motor reflexes and perceptions
• Motor skills;
• Bladder and bowel control; and
• Mental Abilities / Intelligence
• Attention and activity regulation;
• Speech and language;
• Scholastic attainments, particularly in reading, spelling and mathematics.

Emotional   Problems a child my face are of focal interests to Psychologists at I CAN Pathways school system. Issues like Anxiety , fear, avoidance ,  misery and,  associated depressive features including worthlessness, hopelessness, self-harm, anhedonia, poor appetite, sleep dis­turbance and lassitude are recorded carefully . Classical symptoms of obsessive-compulsive disorder can be present in young children, even preschoolers. However the  young children’s emotional problems have  somatic expression  through physical ailments like tummy aches may be underlying anxiety about school or separation.

The conduct problems among children are less reported , particularly in Pakistan , than learning disabilities and academic issues. At I Can Pathways school system  enquiry is  focus on three main domains of behaviour:

• defiant behaviour, often associated with irritability and temper outbursts;
• aggression; and
• endencies and dispositions for antisocial behaviours such as stealing, fire-setting and substance abuse.

Reports from parents and teachers are likely to be the main source of information on conduct problems, though children and teenagers sometimes tell about misdeeds that their parents or teachers do not know about. There is only limited value in asking children about their defiant behaviours since children (like adults) often find it hard to recognise when they are being unreasonable, disruptive or irritable, however good they are at recognising these traits in others.

Assessing children's difficulties in social relatedness is another taxing task, partly because

• Children's relationships change with development.
• In addition, it is not always clear whether a child's problems getting on with other people reflect primarily on the child or on the other people. For example, if a child with cerebral palsy is unable to make or keep friends, how far does this reflect the child's social ineptness, and how far does it reflect the prejudice of other children.
• Change also happens because of mood , physical conditions , and other factors which are difficult to assess reliably .
• The most striking impairments in relatedness are seen in the autistic disorders, generally taking one of three forms: an aloof indifference to other people as people; a passive willingness either to play alone or to interact pro­vided others take the initiative and tell them what to do; and an awkward and rather un empathic social interest that tends to put others off  because of its gaucheness.' Dis-inhibition and lack of reserve with strangers are prominent in some autistic, hyperkinetic and attachment disorders, and may be accompanied by a pestering, importuning style. In small doses, some of these traits may  seem quite charming - after a few minutes acquaintance, you may judge the child to be delightfully frank or open or eccentric. The charm generally palls with longer acquaintance, however, and the history usually makes it clear that the child's manner soon becomes very wearing for the children and adults in regular contact with the child.
• Some children have difficulty relating to most social partners, whether adults or children, strangers or friends. Other children have problems with specific types of social relationship, e.g. with attachment or friendship relationships. The problems may even he specific to one important social partner. Thus, most children are specifically attached to a relatively small number of key people, and the quality of a child's attachment-secure, resistant, aloof, disorganised may vary depending on which of these key people the child is relating to. For example, the attachment may be insecure with the main caregiver but secure with the other caregivers. Similar specificity can be seen in, sibling relationships.

When judging current levels of functioning or development , psychologist at I CAN Pathways School system are able to draw on direct observations of the child as well as reports from parents and teachers. Asking parents about developmental milestones tell a lot  about the child's previous developmental trajectory.

• Parental reports are the primary source of information on the emotional symptoms of young children.
• however in case of older children, child's own account is quite  important.
• At times  parent and child reports of emotional symptoms may  disagree. When faced with discrepant reports, it is sometimes straightforward to decide who to believe.
• In case there is a discrepancies between teachers and parents’ reports, one can gather information on a child's social relationships from several sources. Observing the family interactions in the waiting room or consulting room can be very helpful.

The approach adopted at I CAN Pathways in assessing children gives lot of importance to co morbidity , i.e. co-occurring of more than one disorders at one given time. This has important implications for treatment and management. Only a minority of children   have symptoms restricted to just one domain . For example : children with generalised anxiety disorder may have pure emotional symptoms, children with socialised conduct disorder may have pure conduct problems, and children with dis-inhibited attachment disorder may have pure relationship difficulties. Similarly ,  many children have pure developmental delays, such as primary enuresis, receptive language disorder or specific reading disorder. There are chances that these  children are not usually seen by child psy­chiatrists in the absence of other symptoms. Some hyperactive children seen by child clinical psychologist do seem to have fairly pure delays in the development of attention and activity control. However, most children have symptoms from more than one domain. For example, children with conduct disorder also commonly have emotional symptoms, peer problems, and developmental delays, such as specific reading disorder or hyperactivity.

At I CAN Pathways School system , assessment takes into consideration the element of Impact a disorder has on different domains of human functioning like the following ;

1. Social Impairment
2. Family Life
3. Classroom Learning
4. Friendships
5. Leisure Activities
6. Distress For The Child
7. Disruption for Others

Clinical Psychologits at I CAN Pathways are fully aware of the importance of knowing strengths and positive points of the child. Identifying these  also has very important implications for treatment and management plans. The predominant effort at I CAN Pathways is to boost self esteem of the child and enhance his / her basic life skills and also make him/ her  have a feeling of wrathfulness and impertinence  but essentially and only in a positive way.

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