Pediatric Functional Movement Disorders: Experience from a Tertiary Care Centre.

OBJECTIVES: Functional movement disorders (FMDs) pose significant diagnostic and management challenges. We aimed to study the socioeconomic and cultural factors, underlying psychopathology and the phenomenology of FMDs in children. METHODS: The study is a retrospective chart review of 39 children (16 girls and 23 boys) who attended our neurology OPD and the movement disorders clinic at the National Institute of Mental Health and Neurosciences (NIMHANS) between January 2011 and May 2020. The diagnosis of FMD was based on Fahn and Williams criteria and the patients were either diagnosed as "documented" or "clinically established". All the relevant demographic data including the ethnicity, socioeconomic and cultural background, examination findings, electrophysiological, and other investigations were retrieved from the medical records. RESULTS: The mean age at onset was 12.69 ± 3.13 years. Majority of the children were from urban regions (56.41%) and belonging to low socioeconomic status (46.15%). Thirty (76.92%) were found to have a precipitating factor. Myoclonus was the most common phenomenology observed in these patients (30.76%), followed by tremor (20.51%), dystonia (17.94%), and gait abnormality (7.69%). Chorea (5.12%) and tics (2.56%) were uncommon. Tremor (37.5%) and dystonia (18.75%) were more common in girls, whereas myoclonus (39.13%) was more common in boys. CONCLUSIONS: The symptoms of FMD have great impact on the mental health, social, and academic functioning of children. It is important to identify the precipitating factors and associated psychiatric comorbidities in these children as prompt alleviation of these factors by engaging parents and the child psychiatrist will yield better outcomes.

Coping strategies in young people during the COVID-19 pandemic: rapid review.

AIMS AND METHOD: To better understand factors supporting young people's (age <18 years) mental health during pandemic-type conditions, we aimed to identify whether coping strategies adopted during the COVID-19 pandemic could be dichotomised according to manifesting positive or negative psychological outcomes. Medline, EMBASE, CINAHL, PsycINFO, Scopus and ASSIA databases were used to identify empirical studies that examined coping strategies used by young people experiencing psychological challenges during COVID-19. RESULTS: Twenty-five international studies were included, identifying that coping strategies adopted could be significantly dichotomised according to reducing or exacerbating psychological challenges. Positive coping strategies were proactive and solutions-oriented, whereas negative coping strategies were more avoidant and emotion-oriented. CLINICAL IMPLICATIONS: An internal locus of control may account for why adolescents exercised more proactive coping compared with their younger counterparts, although parents of younger children may offset the impact of stressors by drawing on a proposed coping framework emphasising proactivity and engagement. This would be an invaluable addition to future pandemic preparedness planning cycles.

Individual and environmental factors in internalizing disorders in children and adolescents.

BACKGROUND: Literature has emphasized the role of biopsychosocial factors in internalizing disorders; however, the role of developmental competencies of a child have not been explored much in this context. The current study aimed to understand the differences in developmental competencies, temperament, parenting practices and psychosocial adversities between children with and without internalizing disorders. METHOD: The sample consisted of 200 children and adolescents aged seven to 18 years, with equal number of those with and without an internalizing disorder; and one of their parents. Psychopathology, temperament, interpersonal competence, emotion regulation, executive function, self-concept, adaptive behaviour, parenting practices, life events, family environment and abnormal psychosocial situations were measured using standardized tools. FINDINGS: Discriminant analysis revealed that temperamental domains of sociability and rhythmicity, developmental competencies of adaptive behaviour and self-concept, parenting practices involving father's involvement and overall positive parenting differentiated the clinical and control groups better. Among psychosocial adversities, family environment domains of cohesion and organization, and subjective stress from life events and abnormal psychosocial situations were the most important discriminators. CONCLUSION: The current study reveals that specific individual factors involving temperament and developmental competencies and environmental factors involving parenting practices and psychosocial adversities are significantly associated with internalizing disorders. This has implications for the mental health care of children and adolescents with internalizing disorders.

Children's vulnerabilities and pathways to conflict with the law: Insights from Swatantra Clinic, a specialised mental health service at a tertiary care centre in India.

'Swatantra-Clinic' at NIMHANS, India, provides mental healthcare to vulnerable children. This study describes the clinical profile, vulnerability and protective factors of 77 adolescents in conflict with the law (CICL). 90.9 % (n=70) reported Adverse Childhood Experiences (ACEs), 58.4 % (n=45) had school-related difficulties, 68.9 % (n=53) reported child labour experiences, 64.9 % (n=50) had deviant peer associations, and 40 % (n=31) experimented with substance use. Despite vulnerabilities, 72.7 %(n=56) had a positive future orientation, 45.5 % (n=35) had supportive caregivers and exhibited prosocial skills. only 12 % (n=9) followed up on recommendations, highlighting the need for collaborative and transdisciplinary care to promote CICL rehabilitation and community integration.

Balancing the law with children's rights to participation and decision-making: Practice guidelines for mandatory reporting processes in child sexual abuse.

In India, legal response to a sexual offence, namely, punishment of the perpetrator,relies nearly entirely on mandatory reporting provisions in child sexual abuse law.Mandatory reporting forms an important first step in the medico-legal processes of CSAwork, because it leads onto other legal interventions in CSA cases. However, social, stigma, perceived harassment, rampant gender stereotypes, the unwillingness of, family, disbelief of the victim, and threats by the perpetrator are a few of the many, barriers to mandatory reporting in the Indian context. One particularly insufficiently, addressed critical barrier in the global and Indian literature on CSA and law stems from the reluctance of children to allow child protection and mental health professionals to report to relevant authorities. There are few guidelines or practical strategies available,on how to engage children in mandatory reporting processes. This article uses a childcentric lens to propose the need to balance children's rights to participation and decision-making with the mandatory reporting law. It proposes a conceptual frameworkthat acknowledges the imperatives and challenges of the mandatory reporting law and its implementation, whilst also recognizing children's barriers to abuse disclosures andtheir rights to make decisions and provide consent on reporting issues. It culminates in a guideline for child mental health and protection service providers, offering step-bystep support on navigating the challenges and dilemmas of mandatory reporting through suggested scripts that engage children to enable more effective reporting ofCSA to child protection systems and relevant legal authorities.

North East England South Asia Mental health Alliance (NEESAMA): an exemplar of global north and global south collaboration to improve research, training and service delivery in mental healthcare.

Despite the worldwide burden of mental illness and recent interest in global approaches to address this, progress on increasing awareness, lessening stigma, reducing the treatment gap, and improving research and training in mental health has been slow. In 2018, the North East England South Asia Mental health Alliance (NEESAMA) was developed as a collaboration between high-income (global north) and low- to middle-income (global south) countries to address this slow progress. This paper outlines how the joint priority areas for research, training and service delivery were identified across the life course (child and adolescent, adults and older people) between partner organisations spanning Afghanistan, Bangladesh, India, Nepal, Pakistan, Sri Lanka and the UK. It describes the progress to date and proposes a way forward for similar alliances to be forged.

Developmental competencies, temperament, parenting practices and psychosocial adversities in children with internalising disorders - A pilot study.

Research on the aetiology of internalising disorders has focussed on biological and environmental factors, however, the role of developmental competencies that a child acquires has not been explored much. The current report aimed to understand the association among the developmental competencies, temperament, parenting practices and psychosocial adversities in internalising disorders. The sample consisted of 30 children and adolescents with internalising disorders belonging to the age group of six to 18, and one of their parents. All the participants were assessed for functional impairment, temperament, interpersonal competence, emotion regulation, executive function, self-concept, adaptive behaviour, parenting practices, life events and family environment using standardised tools. The findings revealed that positive parenting shares a negative relationship with functional impairment(ρ=-0.62; p <.001). On comparison with non-clinical samples in previous studies, interpersonal competence and self-concept were found to be at lower levels in the current sample. In conclusion, the current study indicates that children with internalising disorders differ from control groups in specific developmental competences. These findings have specific implications for intervention and research in the area of internalising disorders in children and adolescents.

World Psychiatric Association-Asian Journal of Psychiatry Commission on Psychiatric Education in the 21st century.

Psychiatric practice faces many challenges in the first quarter of 21st century. Society has transformed, as have training requirements and patient expectations, underlining an urgent need to look at educational programmes. Meanwhile, awareness has grown around psychiatric disorders and there are evolving workforce trends, with more women going to medical school and specialising in psychiatry. Trainee psychiatrists carry different expectations for work-life balance and are increasingly becoming conscious of their own mental health. A tendency to see health as a commodity and the litigious nature of society has elicited additional pressures for healthcare professionals. Cartesian mind-body dualism has created further complexity and this can often be frustrating for patients and care-partners alike. In many cultures across Asia and beyond, patients can present with physical symptoms to express underlying psychological distress with increasing physical investigations. Simultaneously, in various countries, a shift from asylums to community-based interventions and then home treatments have changed psychiatric care in remarkable ways. These changes have added to pressures faced by mental healthcare professionals. However, trainees and other mental healthcare professionals continue to receive similar training as they did a generation ago. The tensions and differences in ideology/orientation between different branches of psychiatry have made responses to patient needs challenging. Recognising that it is difficult to predict the future, this World Psychiatric Association-Asian Journal of Psychiatry Commission makes recommendations that could help institutions and individuals enhance psychiatric education. This Commission draws from existing resources and recent developments to propose a training framework for future psychiatrists.

Lived Experiences of Siblings of Individuals with Autism Spectrum Disorder in India: An Interpretative Phenomenological Analysis.

Background: Autism spectrum disorder (ASD) can impact the individual and their families. The impact on siblings is unique because they evolve from being another child in the family to a future adult who can be a potential resource to the family in supporting a member with ASD. Since the quality of care and support can be affected by the lived experiences of the carer and there are not many studies on siblings, this study examined the lived experiences of siblings of individuals with ASD. Methods: Fourteen siblings of individuals with ASD, aged 15-36 years, were recruited from a tertiary hospital, schools, and private institutes. A semistructured interview schedule was used to explore the lived experiences. Interpretative phenomenological analysis (IPA) was used to identify the themes. Results: The themes based on IPA indicated that the siblings have very basic concerns like understanding the condition and complex issues such as coping, preparing for current and future roles, personal needs and expectations, need for a support system, and positive aspects of the sibling relationship. Nonetheless, the siblings minimized reporting their difficulties and focused more on the needs of the sibling with ASD. Conclusion: Siblings have diverse lived experiences, with a small element of positive experiences. Appropriate supports are needed to address the complexities of the lived experiences.

A transdisciplinary public health model for child and adolescent mental healthcare in low- and middle-income countries.

Despite the high burden of child and adolescent mental health problems in LMICs, attributable to poverty and childhood adversity, access to quality mental healthcare services is poor. LMICs, due to paucity of resources, also contend with shortage of trained mental health workers and paucity of standardized intervention modules and materials. In the wake of these challenges, and given that child development and mental health concerns cut across a plethora of disciplines, sectors and services, public health models need to incorporate integrated approaches to responding to the mental health and psychosocial care needs of vulnerable children. This article presents a working model for convergence, and the practice of transdisciplinary Public Health, in order to address the gaps and challenges in child and adolescent mental healthcare in LMICs. Located in a state tertiary mental healthcare institution, this national level model reaches (child care) service providers and stakeholders, duty-bearers, and citizens (namely parents, teachers, protection functionaries, health workers and other interested parties) through capacity building initiatives and tele-mentoring services, public discourse series, developed for a South Asian context and delivered in diverse languages. Role of Funding Source: The Ministry of Women and Child Development, Government of India, provides financial support to the SAMVAD initiative.