Presenting symptoms of autism in Sri Lanka: analysis of a clinical cohort.

Introduction: Diagnosis of autism is based on the presence of social interactional and communication impairment and certain behavioural characteristics. Most documented accounts on symptom profiles in autism come from developed countries and studies on ethnically different populations are few, although this knowledge is crucial to screening and early recognition. Common presentation of autism in Sri Lanka has not been identified. Method: The data for this descriptive study was obtained from an existing computerised data-base of a clinical cohort of children diagnosed with autism. Diagnosis was made on prospective data gathered from: (i) parental report on development and behaviour and (ii) direct observational assessment of social interaction and communication, quality of play and abnormal patterns of behaviour. Final diagnosis of autism was made on fulfillment of DSM IV-TR diagnostic criteria. Results: Data on 244 children was analysed. Mean age was 35.8 months (SD 12.44, median 35.8, mode 30 months, range 13 to 96 months). Average age of diagnosis of the sample was 35.8 months. 48.2% presented at 25-36 months of age. The majority (77.4%) were male. Poor development of speech for age was the primary concern of parents in 82.3%. Hyperactivity, abnormal play behaviour, and social un-connectedness were reported as presenting problems only in 4.9%, 1.2% and 1.2% respectively. On assessment, the presence of a range of behavioural problems (14.6%), stereotyped behaviours (24.3%) and regression of speech (47.3%) was elicited. Co-occurring physical disorders were present in 18.8% with 10.6% having a seizure disorder. Atypical autism was diagnosed in 20.8%. There was no statistically significant association between age of presentation and type of presenting problem or associated disorders (p>0.05). Conclusions: Poor development of speech was the primary concern of parents to seek medical help irrespective of age. The rate of recognizing social impairment and other main characteristics of autism was low.

Depression in children and adolescents.

Among children and adolescents, the prevalence of depressive symptoms is about 15%. Clinically significant depression occurs in 5%. Depression in children overlaps with other childhood emotional and behavioural disorders. Depression in children is multifactorial and includes biological, psychological and social factors. Tricyclic antidepressants such as imipramine are ineffective in children and have limited effect in adolescents. SSRIs are also of limited value. For total health benefit in the treatment of depression, cognitive behaviour therapy (CBT) is found to be more beneficial than SSRIs.

Somatization in children: teaching a difficult subject to medical students.

The article describes a specific teaching / learning assignment for medical undergraduates on somatization in children. The setting for learning for the students was a non-specialist paediatric outpatient service. The students followed a selected working definition in identifying their cases for study and used a semi-structured questionnaire to further investigate the presenting complaints, possible aetiology and the impact of symptoms in the child’s life. The students then presented their findings at a seminar with an ensuing discussion to understand the relevant diagnoses, psycho-physiological processes in symptom generation and the clinical management. The challenges in learning about somatization for the undergraduate and in applying this learning to clinical practice are discussed.