Paul Swamidhas Sudhakar Russell

The psychometric properties of Beck Depression Inventory for adolescent depression in a primary-care paediatric setting in India

BackgroundThere is increasing interest in identifying adolescents with depression in primary care settings by paediatricians in India. This article studied the diagnostic accuracy, reliability and validity of Beck Depression Inventory (BDI) while used by paediatricians in a primary care setting in India.Methods181 adolescents attending 3 schools were administered a back translated Tamil version of BDI by a paediatrician to evaluate its psychometric properties along with Childrens Depression Rating Scale (CDRS-R) for convergent validity. Clinical diagnosis of depressive disorders, for reference standard, was based on ICD-10 interview by an independent psychiatrist who also administered the Impact of Event Scale (IES) for divergent validity. Appropriate analyses for validity and diagnostic accuracy both at the item and scale levels were conducted.ResultsA cut-off score of ≥ 5 (Sn = 90.9%, Sp = 17.6 %) for screening and cut-off score of ≥ 22 (Sn = 27.3%, Sp = 90%) for diagnostic utility is suggested. The 4 week test – retest reliability was good (r = 0.82). In addition to the adequate face and content validity, BDI has very good internal consistency (α = 0.96), high convergent validity with CDRS-R (r = 0.72; P = 0.001), and high discriminant validity with IES (r = 0.26; P = 0.23). There was a moderate concordance rate with the reference standard (54.5%) in identifying depression among the adolescents. Factor analysis replicated the 2-factor structure explaining 30.5 % of variance.ConclusionThe BDI proved to be a psychometrically sound measure for use by paediatricians in a primary care setting in India. The possibility of screening for depressive disorders through the use of BDI may be helpful in identifying probable cases of the disorder among adolescents.

Psychological treatments in intellectual disability: the challenges of building a good evidence base

Psychological treatments are widely used for the management of mental health and behavioural problems in people with intellectual disabilities. The evidence base, including the cost-effectiveness of such interventions, is limited. This editorial explores the current evidence base and analyses its strengths and limitations. The editorial also highlights current problems in conducting randomised controlled trials in this area and suggests a way forward.

Burden among the Caregivers of Children with Intellectual Disability: Associations and Risk Factors.

The study considers whether there is a pattern of demographic, caregiver and child characteristics that specifically predict burden among the primary caregivers of children with intellectual disability in a developing country, India. Thirty-one consecutive families with an intellectually disabled child were included. Caregivers and children were measured with a variety of instruments. The putative risk factors significant in the univariate analysis, namely income and expressed emotion, were entered stepwise into a logistic regression model to predict the level of burden. Expressed emotion towards the child with intellectual disability predicted a high level of burden among the caregivers. Age of child and income significant in the univariate analysis were also clinically associated with burden. These results are similar to those obtained in previous studies in industrialized countries and reinforce the importance of focused intervention to modify the family communication style.

Evidence Base for Using Atypical Antipsychotics for Psychosis in Adolescents

Atypical antipsychotic medications have been the first line of treatment for adolescents with psychosis in the past couple of decades. Till the late 90s, there were very few randomized controlled trials (RCTs) on the treatment of adolescents with psychosis, although a fifth of schizophrenia starts during adolescence. Most of the treatment guidelines for adolescents with psychosis were derived from data on adults. In the past 10 years, there has been increasing number of studies on adolescents with psychosis. The current paper summarizes the findings of trials on adolescents with psychosis in 4 groups: (a) atypical antipsychotic medications vs placebo, (b) atypical antipsychotic medication vs typical antipsychotic medications, (c) one atypical antipsychotic medication vs another atypical antipsychotic medication, and (d) Low dose vs standard dose of atypical antipsychotic medication. We included 13 RCTs, with a total of 1112 participants. Although our review suggest that atypical antipsychotic medications are as effective as typical antipsychotic medications as regards clinical efficacy, atypical antipsychotic medications have a preferred side effect profile and lesser drop-out rate from trials. Obviously, this is extremely important as treatment adherence is key to successful remission of psychotic symptoms and also in some case prevent relapse of illness. Treatment with olanzapine, risperidone, and clozapine is often associated with weight gain. Aripiprazole is not associated with increased prolactin or with dyslipidemia. Adolescents may respond better to standard-dose as opposed to lower dose risperidone, but for aripiprazole and ziprasidone, lower doses may be equally effective. Future trial should be longer term and have uniform ways of reporting side effects.

Attitude of Parents and Teachers towards Adolescent Reproductive and Sexual Health Education

ObjectiveTo assess parents’ and teachers’ attitude towards Adolescent Reproductive Sexual Health Education (ARSHE).MethodsThe study group consisted of a random sample of 795 parents and 115 teachers belonging to three urban schools (one boys only, one girls only and one co-education) and one co-education rural school at Thiruvananthapuram district, Kerala, where an ICMR supported ARSHE intervention programme was done subsequently. A self-administered questionnaire for parents and teachers developed by an ICMR taskforce for ARSHE programme was used to assess their opinion on the need, content and the appropriate person to provide adolescent reproductive sexual health education in a school setting.Results65.2% of parents and 40.9% teachers have not discussed growth and development issues with their adolescents. Only 5.2% teachers and 1.1% parents discussed sexual aspects with adolescents. 44% of parents agreed that information on HIV/AIDS/STD should be provided. More than 50% of parents were not sure whether information on topics like masturbation, dating, safe sex, contraceptives, pregnancy, abortion and childcare should be provided to adolescents.ConclusionsResults pointed out the need for introducing reproductive and sexual education in the school setting. Only 1.1% of parents and 5.2% teachers actually discussed sexual aspects with adolescents which highlights the need for parent and teacher awareness programs before ARSHE is introduced in the schools.

Family intervention and acquisition of adaptive behaviour among intellectually disabled children

A trial was designed to evaluate the role of enhanced parental attitude towards management of intellectual disability in the acquisition of adaptive behaviour. Fifty-seven children with intellectual disability and their parents were randomly assigned to 12 weeks of either multimodal adaptive behaviour training plus interactive group psycho-education (intervention group); or multimodal adaptive behaviour training plus didactic lectures (control group). Blinded raters were involved. Completers’ and intention-to-treat analyses were conducted. In the intention-to-treat sample, 22 of 29 children in the intervention group compared with four of 28 children in the control group showed a significant improvement in the acquisition of adaptive behaviour. The minimum additive efficacy provided by the enhanced parental attitude was 80 percent. Meaningful clinical benefits on various measures were found for the intervention group after training. Parental attitude intervention should be included in adaptive behaviour training for children with intellectual disability, as enhanced parental attitude has short-term positive effects.

Challenging Behaviours among Children with Intellectual Disability The Hope Busters

Hope helps in coping among parents with intellectually disabled children. This study compared the level of hope among parents of such children with and without challenging behaviour. The participants were parents of children with multiple, single and no challenging behaviours. These three groups were compared for their total and subscale hope scores with analysis of variance. Multiple regression analysis was conducted with the total hope score as the dependent variable. The results showed that hopelessness was related to challenging behaviour. The post hoc test showed different levels of hopelessness between parents in challenging behaviour groups in relation to the control group. In particular, only the parents of intellectually disabled children who had multiple challenging behaviours had significantly lower hope scores than the other two groups. Multimodal parental attitude intervention models should address the role challenging behaviours play in contributing to hopelessness among parents.

Multimodal intervention for selective mutism in mentally retarded children.

MULTIMODAL INTERVENTION FOR SELECTIVE MUTISM IN MENTALLY RETARDED CHILDREN Sushila Raj;Jacob John; Journal of the American Academy of Child & Adolescent Psychiatry

Outcomes of disconnective surgery in intractable pediatric hemispheric and subhemispheric epilepsy.

Objectives: To study the outcome of disconnective epilepsy surgery for intractable hemispheric and sub-hemispheric pediatric epilepsy. Methods: A retrospective analysis of the epilepsy surgery database was done in all children (age <18 years) who underwent a peri-insular hemispherotomy (PIH) or a peri-insular posterior quadrantectomy (PIPQ) from April 2000 to March 2011. All patients underwent a detailed pre surgical evaluation. Seizure outcome was assessed by the Engels classification and cognitive skills by appropriate measures of intelligence that were repeated annually. Results: There were 34 patients in all. Epilepsy was due to Rasmussens encephalitis (RE), Infantile hemiplegia seizure syndrome (IHSS), Hemimegalencephaly (HM), Sturge Weber syndrome (SWS) and due to post encephalitic sequelae (PES). Twenty seven (79.4%) patients underwent PIH and seven (20.6%) underwent PIPQ. The mean follow up was 30.5 months. At the last follow up, 31 (91.1%) were seizure free. The age of seizure onset and etiology of the disease causing epilepsy were predictors of a Class I seizure outcome. Conclusions: There is an excellent seizure outcome following disconnective epilepsy surgery for intractable hemispheric and subhemispheric pediatric epilepsy. An older age of seizure onset, RE, SWS and PES were good predictors of a Class I seizure outcome.

Can only intelligent children do mind reading: The relationship between intelligence and theory of mind in 8 to 11 years old

BackgroundThe mind reading ability of children has evoked wide interest, but its relationship with general cognitive abilities remains obscure.MethodsWe studied the relationship between the mind reading ability and general intelligence. Children (N = 105) between 8 to 11 years from educational institutions were assessed for the mind reading ability using Picture Sequencing Task and Unexpected Contents Theory of Mind task. We used Strengths and Difficulties Questionnaire to rule out psychiatric morbidity. An independent investigator quantified intelligence and adaptive behavior with Binet- Kamat Test of intelligence and Vineland Adaptive Behavior Scale respectively. We employed bivariate and multivariate statistical tests.ResultsWe demonstrated that mind reading ability was not significantly related to general intelligence or its domains except for the social intelligence after controlling the confounders methodologically and statistically.ConclusionThese findings argue that mind reading skill exists as an independent cognitive domain and has clinical, research as well as educational implications.