Knowledge and Attitudes About Attention-Deficit/Hyperactivity Disorder and Specific Learning Disorder in an Urban Indian Population.

Attention-deficit/hyperactivity disorder (ADHD) and specific learning disorders (SLDs) are an important cause of scholastic backwardness among children and often go unrecognized. Few studies have examined knowledge and attitudes toward ADHD and SLD among school-aged children. To address this deficit, 120 school-aged children, attending a child guidance clinic in Mumbai, were interviewed using a questionnaire that examined children's knowledge and attitudes about ADHD and SLD. The results were compared both qualitatively and quantitatively with a frequently occurring medical illness, common cold. Approximately 80% to 100% of children were aware of their illness; however, a large variation was noted in the proportion of children (15%-80%) who could describe their symptoms, provide accurate attributions for their illness, and identify treatment modalities. Children with ADHD reported greater control over their illness. The study identified a significant lack of knowledge about ADHD and SLD among school-aged children in India and discusses implications of this finding.

SLD with and without ADHD: Comparison of cognitive profiles.

A quarter of children with Specific Learning Disorder (SLD) have a comorbid attention deficit hyperactivity disorder (ADHD), which impacts the testing of intelligence. ADHD is therefore treated before proceeding with the assessment of intelligence. It is expected that the treatment of ADHD will mitigate its effects on intelligence testing. Though this is frequently done in clinical practice, we could not find any study comparing IQ profiles of children having SLD with and without ADHD after treating ADHD to look for any changes between them. Therefore, we planned this study to compare the cognitive profiles of children having SLD with and without ADHD and describe any difference in their profiles. It was a retrospective cross-sectional study. We compared 695 children having SLD with treated ADHD to 721 children having SLD without ADHD on their WISC III profiles. We found that children having SLD with treated ADHD scored significantly lower on Digit Span and Coding. We suggest routine use of Cognitive Working Memory Training, peer tutoring, and task modifications in children having SLD with ADHD along with medicines and remedial education for better outcomes.

A Study of Assessment of Knowledge of Childhood Autism among Medical Students in Mumbai.

AIMS: This study is to study the knowledge and awareness on autism among medical students and the factors which impact their knowledge on autism. SETTINGS AND DESIGN: For the study, a multicenter cross-sectional research has been carried out among medical students in seven medical colleges in Mumbai. SUBJECTS AND METHODS: A total of 201 final-year medical students from seven medical colleges in Mumbai completed the knowledge on childhood autism among healthcare workers (KCAHW) survey and a semi-structured pro forma. Of the 201 students, 152 are from the public medical colleges and 37 from the private medical colleges. STATISTICAL ANALYSIS USED: Data collected have been represented in the form of frequency and percentage. SPSS 20.0 is used to analyze the mean distribution of KCAHW scores. A value of P < 0.05 is regarded as statistically significant. RESULTS: The total mean score in the KCAHW questionnaire is 11.85 ± 3.15 out of 19. This is considered as poor knowledge. Our study reveals that students' knowledge on autism is limited. Knowledge gaps identified in certain autism spectrum disorder (ASD) symptoms are associated with the obsessive and compulsive repetitive pattern of behavior and that autism is associated with epilepsies. CONCLUSIONS: It is thus important that these children displaying ASD symptoms are diagnosed correctly and at the earliest. To enable this, doctors in all fields must be able to accurately identify the diagnostic features of autism both within and outside the four walls of the hospital.

Psychological consequences in pediatric intensive care unit survivors: the neglected outcome.

OBJECTIVES: To determine whether Pediatric Intensive Care Unit (PICU) hospitalization results in adverse psychological effects and to identify the contributory factors. SETTING: Level III PICU of a tertiary center. DESIGN: Prospective cohort study. METHODS: Consecutive patients 5 years or older admitted to PICU for at least 48 hours constituted the study population. Controls were age and sex matched children hospitalized in the pediatric wards for at least 48 hours. Severity of illness was assessed by the Pediatric Risk of Mortality (PRISM) score. Level of therapeutic intervention was determined by the Therapeutic Interventions Scoring System (TISS--76 score). Temperament Measurement Schedule was used to assess the premorbid temperament. Psychological assessment was performed using Impact of Event Scale (IES), Birleson Depression Scale and the Self-Esteem Scale. Follow-up evaluation was done one month after discharge. RESULTS: There were 30 children each in the study and control groups. They had comparable pre-morbid temperament as well as scores on the self-esteem and depression scales. Significantly higher proportion of patients in PICU had intrusive thoughts (43%) as compared to controls (6.7%). Development of intrusive thoughts correlated significantly with the degree of intervention. Demographic parameters, nature of the disease, duration of hospitalization and severity of illness did not correlate with the psychological outcome. One month after discharge, scores in both groups were comparable. CONCLUSIONS: Children subjected to therapeutic interventions in the PICU develop transient psychological impairment manifested by experiencing intrusive thoughts that resolve within a month.

The role of a Psychiatric Society: Aligning our aims to needs of the community.

Psychiatric Societies and Associations have variegated roles and functions. They provide their members an academic resource and a place for social networking. They also have responsibilities to the profession and to the community they serve. The nature of work they conduct should be aligned to the needs of all stakeholders. Only when there is such harmonious working will the community respect the fraternity and the Association. We, therefore, need to respond to the need of the hour, which in the current time is prevention of suicide in children and adolescents and facilitation of continuing professional development for our members.

Are Indian parents of children with Down syndrome engaged in the blame game?

OBJECTIVES: To study blame ascription among parents of children with Down syndrome and to study its correlation with sociodemographic factors, parental perception of dysmorphisms and parents' knowledge about Down syndrome. This is a prospective, observational, non-interventional case control study. METHODS: Interview of biological parents of children with Down syndrome less than 12 y of age was taken. Dysmorphism and parents' feeling of blame was assessed and graded by Likert's scale. Controls were parents of age and gender matched children with non-genetic chronic disorders. RESULTS: During the study period, 50 mothers and 46 fathers of cases and 50 control parents were interviewed. Parents in the study group were older; the mothers were better educated and had more frequent antenatal visits. There was no significant difference in the proportion of parents counseled but genetic counseling was associated with a significantly higher proportion of parents having knowledge about Down syndrome. A higher proportion of parents perceived their child with Down syndrome being dysmorphic. Blame ascription was not significantly different among the two groups and was seen only in a small proportion of parents of cases. When it did occur, it was directed at health professionals. CONCLUSIONS: Blame ascription is not frequent in a cohort of Indian parents of children with Down syndrome even when dysmorphism is perceived by parents. Genetic counseling was associated with better knowledge about Down syndrome in the parents.

Neurological soft signs in children with attention deficit hyperactivity disorder.

CONTEXT: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with wide repercussions. Since it is etiologically related to delayed maturation, neurological soft signs (NSS) could be a tool to assess this. Further the correlation of NSS with severity and type of ADHD and presence of Specific Learning Disability (SLD) would give further insight into it. AIMS: To study neurological soft signs and risk factors (type, mode of delivery, and milestones) in children with ADHD and to correlate NSS with type and severity of ADHD and with co-morbid Specific Learning Disability. SETTINGS AND DESIGN: The study was carried out in Child care services of a tertiary teaching urban hospital. It was a cross-sectional single interview study. MATERIALS AND METHODS: 52 consecutive children diagnosed as having ADHD were assessed for the presence of neurological soft signs using Revised Physical and Neurological Examination soft Signs scale (PANESS). The ADHD was rated by parents using ADHD parent rating scale. STATISTICAL ANALYSIS: The data was analyzed using the chi-squared test and Pearson's co-relational analysis. RESULTS AND CONCLUSIONS: Neurological soft signs are present in 84% of children. They are equally present in both the inattentive-hyperactive and impulsive-hyperactive types of ADHD. The presence of neurological soft signs in ADHD are independent of the presence of co-morbid SLD. Dysrrhythmias and overflow with gait were typically seen for impulsive-hyperactive type and higher severity of ADHD is related to more errors.