Anupama Bhave

Aetiology of intellectual disability in paediatric outpatients in Northern India

Aim  To study the aetiology of intellectual disability in patients presenting to hospital and the diagnostic yield of a standardized examination.

Prevalence and risk factors for neurological disorders in children aged 6 months to 2 years in northern India.

To study prevalence and risk factors for neurological disorders – epilepsy, global developmental delay, and motor, vision, and hearing defects – in children aged 6 months to 2 years in northern India.

West syndrome: response to valproate

Management of West syndrome is unsatisfactory. In our clinic we observed that a significant proportion of patients respond to usual dose of valproate. Objective: To prospectively assess the efficacy of valproate in controlling infantile spasms in West syndrome. Methods: Consecutive patients presenting with West syndrome to the Pediatric Neurology Clinic or general outpatient department (OPD) were enrolled for study. Those who were not on any treatment were given valproate in a dose of 30 mg/kg/day while awaiting investigations. Patients were followed up every 2 weeks. Predefined criteria for definition of West syndrome and response were used. Those showing partial/poor response or relapse on valproate were given hormonal therapy. Results: One hundred children with West syndrome were enrolled. Ninety one children were started on valproate. Of these 36 (39.5%) showed a good response, but seven later relapsed while on same dose of valproate and three were lost to follow up. Later age at onset and typical hypsarrhythmia on EEG were associated with good sustained response to valproate while a history of delayed cry at birth was associated with partial or poor response. Sixty two patients who responded poorly to or relapsed on valproate were put on hormonal treatment in addition. Of these 36 (58.1%) had a good response but 11 later relapsed after stopping treatment and two were lost to follow up. Conclusion: Valproate may have a role in treatment of West syndrome in a selected group of patients.

Development and Validation of a New Lucknow Development Screen for Indian Children Aged 6 Months to 2 Years

A chart was prepared using selected milestones from Baroda norms of Bayley Scales of Infant Development and Gesell’s schedules on y-axis and age in months on x-axis. A child failing to achieve any milestone to the left of the chronological age was screen positive. Interrater and test-retest reliability were calculated. For validation, the screen was administered to mothers of 142 children aged 6 to 24 months attending Pediatric Outpatients or Neurology Clinic of CSM Medical University, Lucknow, India. Acutely ill children were excluded. A full Developmental Assessment Scale for Indian infants was then done on the same children. Sensitivity and specificity were 95.9% and 73.1%, respectively. It is concluded that Lucknow Development Screen can be effectively used for screening in the community.

Hospital and Community Validation of a Screening Instrument for Detection of Neurodisability in Indian Children Aged 6 Months to 2 Years

Objective: To develop and validate a screening instrument for neurological disorders in children aged 6 months to 2 years in the community. Methods: A comprehensive parent-administered instrument was developed to screen for hearing, vision, seizures, motor deficits and development in Indian children aged 6–24 months. This was tested for reliability and validated in the hospital setting by comparing with pre-decided gold standards. It was then used in a community survey in a two-phase design in which all screen positives and a random sample of screen negatives were validated. Result: The screening instrument had overall sensitivity, specificity and positive predictive values of 95.8, 68.1 and 76.1%, respectively, in the hospital setting. In the field setting, these figures changed to 95.4, 51.8 and 20.6%, respectively. The reasons for this are discussed. Conclusion: Community surveys must use a two-phase design to get the true prevalence. A falsely high prevalence will be computed if only a single-phase design or hospital validation is used.

Correlation between developmental quotients (DASII) and social quotient (Malin's VSMS) in Indian children aged 6 months to 2 years

Aim:  To determine correlation between developmental quotients (DQ) (DASII) and social quotients (SQ) (Malins Vineland Social Maturity Scale (VSMS)).

Survey of Neurological Disorders in Children Aged 9-15 Years in Northern India

The prevalence of neurological disorders in resource-poor settings, although likely to be high, is largely unexplored. The prevalence and risk factors for neurological disorders, including epilepsy and intellectual, motor, vision, and hearing deficits, in children aged 9 to 15 years in the community were investigated. A new instrument was developed, validated, and used in a 2-stage community survey for neurological disorders in Lucknow, India. Screen-positives and random proportion of screen-negatives were validated using predefined criteria. Prevalence of different neurological disorders was calculated by weighted proportions. Of 6431 children screened, 221 were positive. A total of 214 screen-positives and 251 screen-negatives were validated. Prevalence of neurological disorders was 31.3 per 1000 children of this age group (weighted 95% confidence interval = 16.5, 46.4). The final model for risk factors included age, mud house, delayed cry at birth, and previous head injury. The prevalence of neurological disorders is high in this region. Predictors of neurological disorders are largely modifiable.

Adaptation: Vineland Adaptive Behavior Scale for 3–9 year-old Indian children

Abstract Aim: This study aimed to translate the Vineland Adaptive Behavior Scale (VABS) II Survey Form into Hindi and then adapt and use it in evaluating 3–9 year-old Indian children. Methods: The VABS II was translated to Hindi and its reliability and validity were checked. Then, it was used in a sample of 3–9 year-old children. Adaptive behavior composite (ABC) Scores, domain standard scores (DSS) and maladaptive-v scores (MBI) were compared. Results: Out of 433 items, 44 (10.16%) needed adaptation but no satisfactory adaptation could be made for 16 (3.6%). The adapted instrument was proven reliable and valid. Significant differences were found in all domains (except MBI) with higher scores for urban vs. rural children, school-goer vs. non-school-goer, working vs. housewife mothers and higher socioeconomic status (SES), but not between children of joint and nuclear families. Motor development significantly correlated with weight-for-age percentage, which in turn, correlated to the variables studied. Conclusions: The VABS was satisfactorily translated and adapted for Indian children. In addition, it was found that socioeconomic status significantly affected the social development.

Validation of a new Lucknow Intelligence Screening Test for Indian children aged 9 to 15~yr

Identification of cognitive impairment in the community is vital for need based planning of rehabilitative services. There is a need for a screening questionnaire to detect subnormal intelligence in older children in the community. The aim of this study was to validate an indigenously developed screening tool for detecting intellectual disability in the community amongst children aged 9 to 15 yr. This study was conducted in Pediatric Outpatient Department of Chhatrapati Shahuji Maharaj Medical University Lucknow, India. A screening questionnaire was developed with learning, language, cognition and social domains. This was pretested and checked for reliability. It was then validated on 144 children aged 9 to 15 yr attending the hospital who were not acutely ill and whose parents consented for the study. A literate layperson with some training administered the screening questionnaire to parents of such children. Validation was done by a Child Psychologist using the Binet Kamat Test (Indian version of Stanford Binet test) and Seguin Form Board for intelligence quotient and Vineland Social Maturity Scale (Malins-Indian version) for social quotient (SQ). Validation was considered positive if both intelligence quotient and SQ were less than 85 or if used alone SQ was less than 85. Sensitivity and specificity were calculated as 86.2% and 81.7% respectively. This study concludes that the Lucknow Intelligence Screening Test is a valid parent-administered intellectual disability-screening instrument for easy and effective use in the community.