Predictors of Attention Deficit Hyperactivity Disorder in Sri Lankan Children: A School Based Community Study.

OBJECTIVE: To evaluate potential risk-factors of ADHD among primary school-children (PSC) in state schools in Colombo district of Sri Lanka. METHOD: A case-control study was conducted with 73 cases and 264 controls selected randomly among 6 to 10-year-old PSC from Sinhala medium state schools in Colombo district. Primary care givers completed the SNAP-IV P/T-S scale to screen for ADHD and an interviewer-administered questionnaire on risk-factors. Children's diagnostic status was confirmed by a Consultant Child and Adolescent Psychiatrist based on DSM-5 criteria. RESULTS: A binomial regression model identified male sex (aOR = 3.45; 95% CI [1.65, 7.18]), lower educational level of the mother (aOR = 2.99; 95% CI [1.31, 6.48]), birth weight <2,500 g (aOR = 2.83; 95% CI [1.17, 6.81]),a neonatal complications (aOR = 3.82; 95% CI [191, 7.65]) and child having witnessed verbal/emotional aggression between parents (aOR = 2.08; 95% CI [1.01, 4.27])as significant predictors of ADHD. CONCLUSION: Primary prevention should focus on strengthening neonatal, maternal and child health services within the country.

Emotional and behavioral problems among children and adolescents in a residential care institution in Colombo, Sri Lanka - Implications for service delivery.

BACKGROUND: There is evidence that children in residential care institutions (RCI) have higher rates of psychological problems, suicide and criminal behaviour. There is only one study in Sri Lanka which has examined the psychological well-being of children in RCIs. Further evidence is needed to formulate policies related to the mental health of institutionalized children in the local context. METHODS: A cross sectional descriptive study was carried out in a selected RCI, in Colombo, Sri Lanka. All children (> 4 years) and adolescents who have been in the institution for more than 3 months were included. The caregiver rated version of the Strength and Difficulties Questionnaire (SDQ) was used to assess the extent of emotional and behavioural problems. RESULTS: The sample included 103 children and adolescents, between 5-17years. Majority (51.5%) were females. Mean age at entering care was 6.48 years. The mean score for externalizing problems was 6.72 (SD=3.702) and the mean score for internalizing problems was 4.12 (SD=2.312). Peer problems (23.4 %) and conduct problems (21.5 %) were the commonest problems encountered. Only 40 % of the children having clinically significant levels of problems were in contact with mental health services. CONCLUSION: A quarter of the participants had elevated levels of emotional and behavioural problems. Routine screening programmes should be carried out at regular intervals in the RCI's for early detection of children with psychological problems in institutionalized children.

The knowledge of Public Health Midwives on Autism Spectrum Disorder in two selected districts of the Western Province of Sri Lanka.

BACKGROUND: Early interventions are important for improving outcome in autism. However, the diagnosis of autism is often delayed for 3-4 years, which leads to missed opportunities to initiate early intensive behavioural interventions, thus jeopardizing its prognosis. The lack of knowledge among healthcare workers about the features of autism is postulated to be the main reason for this delay. METHODOLOGY: A descriptive cross-sectional study was carried out among the PHMs in the Colombo and Kalutara districts of the Western Province, Sri Lanka. A specifically designed self-administered questionnaire was used to obtain information about the socio-demographic details. The knowledge about the signs and symptoms and common comorbidities of ASD were assessed using the "Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire". RESULTS: Out of 406 participants, 56.9 % (n = 231) were from the Colombo District. The mean knowledge of the participants on the "Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire" was 13.23/19 (SD = 2.647). The knowledge was significantly higher in those who had participated in training programmes on autism (p < 0.01) and in those who have had contact with a child with autism (p < 0.05). Of the participants, 17.2 % (n = 70) believed that autism could be completely cured. 43.6 % and 42.2 % believed that poor attention from parents and parental conflicts during pregnancy and early childhood caused autism in children respectively. CONCLUSION: The knowledge of PHMs on autism is inadequate, with regard to the comorbidities, aetiology and treatment options. In service programmes are useful in improving the knowledge of PHMs on autism.

Parenting with mental illness among patients presenting to a teaching hospital in Sri Lanka: Challenges and perceived care needs.

Parenting with mental illness is associated with family conflicts, parenting difficulties, low parental confidence and increased mental health and behavioural problems in children. Family focused interventions improve child outcomes by about 40 %. However, such services are not available in Sri Lanka.A cross sectional descriptive study was carried out in the general adult psychiatry follow-up clinics in a Teaching Hospital in Colombo, Sri Lanka to assess the needs of parents with mental illness. A specifically designed interviewer administered questionnaire was used to collect sociodemographic details, difficulties with parenting and perceived care needs. A specifically designed data extraction form was used to gather information from the clinic records, about the parents' illness.Our study revealed that 45.1 % of children knew that their parent had a psychiatric disorder. A total of 67.3 % of parents believed that their mental illness had an impact on their parenting of which, 26.8 % thought that this impact was marked. 67.8 % of parents believed that their illness was having an impact on their children. A total of 36.4 % of parents reported having concerns about their children's behaviour, emotions or relationships but only 16.4 % of them said that they would discuss these with their treating doctor. Our study showed that mental illness in parents had a substantial impact on parenting and their children. However, those who sought professionals help in this regard were few and far between. Services aimed at the specific needs of these parents should be developed.

A case of an unusual presentation of obsessive compulsive disorder in an adolescent.

Children and adolescents with Obsessive Compulsive Disorder (OCD) can present in atypical and unusual ways. We present the case of a 13 year old boy with an unusual presentation of OCD. He presented with irritability, aggression, poor sleep, reduced attention, hyperreligiosity, social withdrawal and disinhibition (i.e. inappropriately touching females) for 1 week and was found to have obsessional thoughts and impulses related to sex and the compulsion of seeking absolution from lord buddha. He was diagnosed as OCD after excluding organic causes, manic episode, acute psychotic episode, drug induced psychosis and sexual abuse. He initially responded to fluoxetine 20mg, olanzapine 2.5 and a short course of lorazepam. He was functioning well for 2 weeks and thus olanzapine and lorazapam were tailed off. A week later he presented with similar symptoms with the added symptoms of singing, masturbating in public and talking excessively to his mother about sex. He was found to have obsessional thoughts, impulses and images and the compulsions of reassurance seeking from his mother and seeking absolution from lord buddha. He responded to an increase in fluoxetine to 40mg and olanzapine 2.5mg. He has now remained in remission for 4 months with good functioning. This case shows that in contrast to adults, children may not recognize that their obsessional thoughts are irrational and may not be able to resist the obsessions as a result. It stresses the importance of being mindful of the atypical presentations of OCD in children to avoid misdiagnosis.

Psychological Problems and Socioemotional Wellbeing among Children of Mothers with Depression and Their Association with Sociodemographic Factors in a Sri Lankan Setting.

BACKGROUND: Maternal depression is known to be associated with anxiety, depression, oppositional and conduct disorders, neurocognitive deficits, ADHD, substance abuse, and personality disorder in the offspring. We aimed to describe the proportion of psychological problems among children of mothers with depression in Sri Lanka and to describe the associated sociodemographic factors. METHODS: A cross-sectional descriptive study was conducted on 100 children and adolescents between 4 and 16 years, whose mothers have a diagnosis of depression and are currently in remission. Specifically designed instruments were used to extract sociodemographic details and data on mother's illness. Strengths and Difficulties Questionnaire (SDQ) was used to detect psychological problems in children. RESULTS: 14% of the children scored abnormally high in hyperactivity, 13% in conduct problems, 12% in emotional problems, 9% in peer problems, and 10% in total difficulties. Children (4-12 years) scored significantly higher than the adolescents in hyperactivity and externalizing problems (p < 0.05). Significant differences were also found in peer problems (p < 0.05), internalizing problems (p < 0.05), and total difficulties (p < 0.05) in relation to the age of the mother. CONCLUSION: Screening the children of mothers with depression for psychological problems and developing a holistic management plan, which includes measures to ensure their wellbeing, is important.

Characteristics of mothers' depressive illness as predictors for emotional and behavioural problems in children in a Sri Lankan setting.

INTRODUCTION: Maternal depression has been shown to be associated with neurodevelopmental, emotional and behavioural disorders in offspring. We aimed to describe the proportion of psychological problems among children of mothers with depression in Sri Lanka and to describe the association with the characteristics of the mothers' illness. METHODS: A cross-sectional descriptive study was conducted on 100 children and adolescents between 4-16 years whose mother has a diagnosis of depression and currently in remission. Specifically designed instruments were used to extract socio-demographic details and data on mother's illness. Strengths and Difficulties Questionnaire (SDQ) was used to detect psychological problems in children. RESULTS: 14 % of the children scored abnormally high in hyperactivity, 13 % in conduct problems, 12 % in emotional problems, 9 % in peer problems. Hyperactivity, internalizing problems, and total difficulties were significantly higher in where mothers' had a history of a moderate depressive episode and recurrent depressive disorder. Children whose mothers had no attempts of self-harm scored significantly higher in both emotional problems and internalizing problems. Children whose mothers have comorbid illness scored significantly higher in hyperactivity, conduct problems, emotional problems, externalizing problems, internalizing problems and total difficulties. CONCLUSIONS: Screening for psychological problems in children and developing a holistic management plan which include steps to ensure the well-being of the children is important in managing mothers with depression.

Dandy-Walker Malformation Presenting with Psychological Manifestations.

Dandy-Walker malformation, which is a congenital malformation of the cerebellum, is documented in literature to be associated with psychotic symptoms, obsessive compulsive symptoms, mood symptoms, hyperactivity, and impulsive behavior. The pathogenesis of psychiatric symptoms in Dandy-Walker malformation is thought to be due to disruption of the corticocerebellar tracts, resulting in what is known as cerebellar cognitive affective syndrome. We present a case of Dandy-Walker malformation presenting with psychiatric symptoms. This case highlights the necessity to be aware of psychiatric manifestations of cerebellar disease as it has an impact on the diagnosis and treatment.