Evaluation of parental anxiety following three methods of pre-anesthesia counseling: Video, brochure and verbal communication.

BACKGROUND: The purpose of this study is to provide comprehensive and efficient pre-anesthesia counseling (PAC) utilizing audiovisual aids and to examine their effect on parental anxiety. METHODS: For this prospective, controlled study, 174 parents were recruited and randomized into three groups of 58 (Group A: video, Group B: brochure, and Group C: verbal). During pre-anesthesia counseling, the parent was provided with a detailed explanation of preoperative preparation, fasting instructions, transport to the operating room, induction, the emergence of anesthesia, and nursing in the post-anesthesia care unit based on their assigned group. We evaluated parental anxiety using Spielberger's State-Trait Anxiety Inventory before and after the pre-anesthesia counseling. RESULTS: The results of our study show a statistically significant difference in the final mean STAI scores among the three groups (Group A: 34.69 ± 5.31, Group B: 36.34 ± 8.59, and Group C: 43.59 ± 3.39; p < .001). When compared to the brochure and verbal groups, the parents in the video group have the greatest difference in mean baseline and final Spielberger's State-Trait Anxiety Inventory scores (12.207 ± 5.291, p .001). CONCLUSION: The results of our study suggest that pre-anesthesia counseling by video or a brochure before the day of surgery is associated with a higher reduction in parental anxiety when compared to verbal communication.

Designing and Validation of a Hindi-language Parent Self-report Developmental Screening Tool.

AIM: To design and validate Hindi-language parent self-report developmental screening questionnaires for 9-month and 18-month-old Indian children. DESIGN: Cross-sectional study. SETTING: Tertiary-care pediatric hospital from April 2014 to March 2016. PARTICIPANTS: In each age group (9-month and 18-month), 45 children were enrolled for designing of questionnaires (30 for obtaining parental observations of current development and 15 for pre-testing). For validation of tool, 100 children (60 low risk and 40 high risk) were enrolled in each age group. METHODS: For designing, observations regarding current developmental milestones were obtained from parents and a list of all enumerated milestones was prepared. After detailed discussion by a team of developmental pediatricians, pediatric resident, clinical psychologist and language specialist, milestones were chosen for drafting of questionnaires. In each age group, drafts were pre-tested and required modifications were done. The final questionnaires contained 20 items each to be scored on a Likert scale (total score ranging from 20 to 60, a lower score indicating a higher risk of developmental delay). These questionnaires were validated against Developmental Assessment Scale for Indian Infants (DASII), a gold standard instrument. RESULTS: On ROC analysis, the 9-month and 18-month screening tool had area under curve of 0.988 and 0.953, respectively, for detecting developmental delay. Score ≤50 on the 9-months questionnaire had sensitivity of 100% and specificity of 87.2%. Score ≤49 on the 18-months questionnaire had sensitivity of 91.4% and specificity of 88.7%. CONCLUSION: The new questionnaires have a promising role in developmental screening of children at the time of routine immunizations in our country.

Effects of picture exchange communication system on communication and behavioral anomalies in autism.

Communication skills deficits and stereotyped behaviors are frequently found among people with pervasive developmental disabilities like autism. These communication and behavioral oddities of autism are often considered to be difficult to treat and are challenging. Picture exchange communication system (PECS) is a six-phase picture system based on applied behavior analysis and is specially designed to overcome these communication difficulties in children with autism by encouraging the child to be the communication initiator. The present paper throws light on the process of using PECS along with other traditional behavioral approaches in managing communication deficits and behavioral stereotypies in a seven-year-old male child diagnosed as having childhood autism. The identified target behaviors of repeated head turning, flapping his hands, poor communication skills were assessed using various rating scales including visual analogue scale as per clinician observation and parental reports and managed using PECS as an adjunct to traditional behavioral techniques of contingency management, differential reinforcement, task direction and reprimand. Outcome was assessed using same tools after thirty-two sessions of interventions spread over three months. Significant improvements of around 60% were observed in the target behaviors.

Neurobehavioral management of behavioral anomalies in frontal lobe syndrome.

Neurobehavioral approach uses behavioral paradigm towards comprehensive rehabilitation by identifying the neurological or neuropsychological constraints that can interfere with learning and behavior of an individual. The present case study highlights the role of functional skills approach in neurobehavioral management towards cognitive rehabilitation to manage behavioral deficits in a 55-year-old man with nicotine dependence having frontal lobe lesions owing to gliosis of fronto-temporal brain regions. Based on detailed neuropsychological and behavioral assessment, a behavioral package was made involving techniques like behavioral counseling, chaining, shaping and operant methods and was carried out with the patient daily (with the help of primary caregiver) over a period of 2 months. Results showed improvement in his self-care and decrease in behavioral problems, on 12-month follow-up.