Implementation of the International Classification of Diseases 11th revision behavioural indicators for disorders of intellectual development with co-occurring autism spectrum disorder.

BACKGROUND: The classification of mental, behavioural and neurodevelopmental disorders in the World Health Organization's International Classification of Diseases 11th revision (ICD-11) includes a comprehensive set of behavioural indicators (BIs) within the neurodevelopmental disorders grouping. BIs can be used to assess the severity of disorders of intellectual development in situations in which standardised measures of intellectual functioning and adaptive behaviours are not available or feasible. This international study examines the implementation characteristics of the BIs and compares them to standardised measures for assessing the severity of intellectual impairment and adaptive behaviours in disorders of intellectual development and autism spectrum disorder (ASD). The clinical utility of the ICD-11 and the fidelity of its application in international clinical settings were also assessed. METHODS: A total of 116 children and adolescents (5-18 years old) with a suspected or established diagnosis of disorders of intellectual development were included across four sites [Italy (n = 18), Sri Lanka (n = 19) and two sites in India (n = 79)]. A principal component analysis was conducted to evaluate the application of the ICD-11 guidance for combining severity levels. RESULTS: Assessment using the BIs showed a higher proportion of individuals classified with mild severity, whereas the standardised measures indicated a higher proportion of severe ratings. Additionally, individuals with co-occurring ASD tended to have more severe impairments compared with those without ASD, as indicated by both BIs and standardised measures. Overall, the BIs were considered clinically useful, although more time and consideration were required when applying the guidelines for individuals with a co-occurring disorder of intellectual development and ASD. The principal component analysis revealed one principal component representing overall disorders of intellectual development severity levels. CONCLUSIONS: The ICD-11 BIs can be implemented as intended in international clinical settings for a broad range of presentations of individuals with neurodevelopmental disorders. Use of the BIs results in similar severity diagnoses to those made using standardised measures. The BIs are expected to improve the reliability of severity assessments in settings where appropriate standardised measures for intellectual and adaptive behaviours are not available or feasible.

An international field study of the ICD-11 behavioural indicators for disorders of intellectual development.

BACKGROUND: The World Health Organization (WHO) has approved the 11th Revision of the International Classification of Diseases (ICD-11). A version of the ICD-11 for Mental, Behavioural and Neurodevelopmental Disorders for use in clinical settings, called the Clinical Descriptions and Diagnostic Requirements (CDDR), has also been developed. The CDDR includes behavioural indicators (BIs) for assessing the severity of disorders of intellectual development (DID) as part of the section on neurodevelopmental disorders. Reliable and valid diagnostic assessment measures are needed to improve identification and treatment of individuals with DID. Although appropriately normed, standardised intellectual and adaptive behaviour assessments are considered the optimal assessment approach in this area, they are unavailable in many parts of the world. This field study tested the BIs internationally to assess the inter-rater reliability, concurrent validity, and clinical utility of the BIs for the assessment of DID. METHODS: This international study recruited a total of 206 children and adolescents (5-18 years old) with a suspected or established diagnosis of DID from four sites across three countries [Sri-Lanka (n = 57), Italy (n = 60) and two sites in India (n = 89)]. Two clinicians assessed each participant using the BIs with one conducting the clinical interview and the other observing. Diagnostic formulations using the BIs and clinical utility ratings were collected and entered independently after each assessment. At a follow-up appointment, standardised measures (Leiter-3, Vineland Adaptive Behaviour Scales-II) were used to assess intellectual and adaptive abilities. RESULTS: The BIs had excellent inter-rater reliability (intra-class correlations ranging from 0.91 to 0.97) and good to excellent concurrent validity (intra-class correlations ranging from 0.66 to 0.82) across sites. Compared to standardised measures, the BIs had more diagnostic overlap between intellectual and adaptive functioning. The BIs were rated as quick and easy to use and applicable across severities; clear and understandable with adequate to too much level of detail and specificity to describe DID; and useful for treatment selection, prognosis assessments, communication with other health care professionals, and education efforts. CONCLUSION: The inclusion of newly developed BIs within the CDDR for ICD-11 Neurodevelopmental Disorders must be supported by information on their reliability, validity, and clinical utility prior to their widespread adoption for international use. BIs were found to have excellent inter-rater reliability, good to excellent concurrent validity, and good clinical utility. This supports use of the BIs within the ICD-11 CDDR to assist with the accurate identification of individuals with DID, particularly in settings where specialised services are unavailable.

Long and short-term outcomes of Gestational Diabetes Mellitus (GDM) among South Asian women - A community-based study.

AIMS: To quantify short and long-term outcomes of Gestational Diabetes Mellitus (GDM) among South Asians. METHODS: Prospective cohort-study in Gampaha District, Sri Lanka following a community-prevalence study (WHO 1999 criteria). All women with GDM (exposed) and within sample non-GDM (non-exposed) were recruited. Data was gathered at selected intervals until one-year post-partum by interviewer-administered questionnaire, anthropometry, blood pressure, post-partum 75gOGTT and cholesterol. Two groups were compared for pregnancy outcomes; and age, parity, first-trimester BMI adjusted odds ratios (aOR) calculated. RESULTS: GDM and non-GDM (n = 194 each) had 169 (87.1%) and 178 (91.8%) responders respectively. Significant differences in outcomes: Antenatal/Perinatal - obstetric and/or medical complications (aOR = 1.8; 95% CI = 1.1-2.7), pregnancy induced hypertension (aOR = 3.1; 95% CI = 1.5-6.5), birth-weight ≥ 3.5 kg (aOR = 2.8; 95% CI = 1.4-5.5), special baby-care for prematurity (aOR = 4.1; 95% CI = 1.1-15.1), low mean POA at delivery (p = 0.005), vaginal moniliasis (aOR = 4.9; 95% CI = 1.4-17.4) and breast-engorgement (aOR = 2.6; 95% CI = 1.02-6.4). Two months postpartum: impaired glucose tolerance (IGT) (aOR = 6.1; 95% CI = 2.7-13.8) and abnormal glucose tolerance [AGT = diabetes, impaired fasting glucose (IFG) and IGT collectively] (aOR = 9.1; 95% CI = 4.3-19.1). One-year postpartum (participation rate = 39.7%): exclusive breastfeeding for six months (aOR = 0.3; 95% CI = 0.1-0.7), diabetes mellitus (aOR = 4.1; 95% CI = 1.1-15.7), IGT (aOR = 5.8; 95% CI = 1.5-21.8), AGT (aOR = 7.7; 95% CI = 2.9-20.6). CONCLUSIONS: Hyperglycaemia in Pregnancy detected and followed up in a sub-urban community setting in Sri Lanka, had significantly worse pregnancy outcomes with a high risk of maternal pre-diabetes/diabetes in first post-partum year.

Prevalence of gestational diabetes mellitus in a Suburban District in Sri Lanka: a population based study

Introduction: GDM is a leading metabolic cause of morbidity to mother and offspring. Determining its prevalence is important for health planning and implementation. Objective: Assess prevalence of GDM in the District of Gampaha. Method: Community based cross-sectional study was conducted in women attending field-based ante-natal clinics in two Medical Officer of Health (MOH) areas between January 2014 to March 2015. Consecutive women were recruited by cluster sampling with probability proportionate to size using strict exclusion criteria. GDM diagnosis was based on fasting 75 g OGTT, WHO 1999. All responders underwent 2 hr PPBS in first trimester- >200 mg/dl with symptoms identified as abnormal, probably diabetes in pregnancy (DIP); those >120 and <200 mg/dl proceeded to OGTT before 16 weeks POA; all negatives were tested by OGTT between 24-28 weeks. Negatives for GDM at 24-28 weeks underwent OGTT between 32-36 weeks; venous plasma glucose tested by accredited laboratory. Results: Sample consistedof 160, non-response 4.2% (67); 1533 underwent 2 hr PPBS with 40 exceeding 120mg: 4 >200 mg diagnosed as GDM / DIP, 36 (PPBS >120 < 200 mg) underwent OGTT before 16 weeks with 15 GDM. One hundred and thirty four (8.38%) miscarried including one with early abnormal OGTT. Of 1381 eligible for OGTT (24- 28 weeks) 150 had GDM (10.86%). Only 344 (27.94% of normal 1231) consented for third trimester OGTT, of whom 25 had GDM- yielding a total of 194 with GDM (13.9%). Conclusions: The current community prevalence of GDM in the suburban Gampaha District, Sri Lanka is high.

Prevalence of behavioral and emotional problems among seven to eleven year old children in selected schools in Kandy District, Sri Lanka.

BACKGROUND: Behavioral and emotional problems comprising internalizing, externalizing and mixed disorders consist of psychiatric disorders in childhood and adolescents. Prevalence rates of 8.3% for preschoolers, 12.2% for preadolescents and 15.0% for adolescents have been reported from around the world. This study aimed to measure the prevalence of emotional and behavioral disorders in 7-11 year-old school children studying in Kandy District Sri Lanka which was a first for the geographic area. METHOD: This was a community based study at the primary section of the selected schools. The questionnaire, Child behavior Checklist-Sinhala (CBCL-S) was administered in a group setting to the main caregiver of 562 subjects selected randomly. The questionnaire identified problems in 8 subscales under three main sub categories : internalizing, externalizing and other. Data were analyzed using The Syndrome Scales for Boys and Girls developed for analyzing the questionnaire CBCL. RESULTS: Indicated a prevalence of 13.8% of emotional and behavioral problems in the study population. 8.8% of children showed internalizing problems and 8.8% externalizing problems. These findings are in line with the prevailing rates from previous studies of the world. Children in school types 1AB and 1C had less emotional and behavioral problems compared to type 2 and 3 schools. LIMITATIONS: Only 20 schools in KEZ and Sinhala speaking population of the Kandy were studied. CONCLUSIONS: This study showed the extent of childhood emotional and behavioral problems and also confirms that the schools with advanced level classes have lesser problems amongst primary children.