Feeding Difficulties Among Children With Special Needs: A Cross-Sectional Study From India.

Deficits in feeding can lead to impairments in occupational performance for children with special needs. This correlational study assessed the relationship between oromotor deficits, behavior problems related to feeding, and caregiver perception of the behavior in children with special needs. We included children with neurodevelopmental disorders (n=79), between 2 and 12 years of chronological age, and their caregivers. Those fulfilling the selection criteria were administered the Behavioral Pediatric Feeding Assessment Scale (BPFAS) and Schedule for Oromotor Assessment (SOMA). More than half the sample had skill deficits and behavioral problems related to feeding. There was a statistically significant correlation of oromotor deficits with specific food consistencies and feeding-related behavior problems. Children with special needs have impaired participation in feeding. Deficits at the body system level are associated with parental and cultural factors, which would have to be mitigated to optimize performance.

Predictive components in the structure of an intensive, parent mediated, early intervention for children with autism spectrum disorders in India.

INTRODUCTION: The predictive factors of parent mediated, Early Intervention (EI) for children with Autism Spectrum Disorders (ASD) have not been studied in India; we document the structural therapeutic factors, which predict the EI outcome. METHODS: Data of 77 children with an ICD 10 diagnosis of Pervasive Developmental Disorder (ASD in DSM 5), and completed a 12-week EI with proven effectiveness was collected from the database of a teaching hospital. We studied the structural therapeutic factors associated with EI outcome, as measured by Psycho-Educational Profile-Revised (PEP-R), while controlling the confounders with multiple linear regression analyses. RESULTS: The Fine-motor skills improved in residential patients (t = 2.54, P = 0.02; 15 units). As the duration of intervention decreased at home per day, there was a significant decrease in Gross-motor skills (t = -2.67, P = 0.02; -15 units). With increase in duration of intervention in hospital per day, there was a significant increase (t = 2.86, P = 0.01; 30 units) in the Eye-hand integration. Cognitive-verbal skills acquisition decreased (t = -2.90, P = 0.01; 33 units) as the duration of intervention decreased at hospital. The use of medication did not predict any of the outcome factors. CONCLUSION: The above mentioned predictive factors should be monitored and titrated in the family context when children with ASD undergo parent mediated, EI programme. It is important to that the multidisciplinary family medicine teams reinforce these parents, who are the main column of support in primary-care settings for children with neuro-developmental disabilities in India.

The clinical usefulness of three depression screens for adolescents in India: A need in primary-care settings.

INTRODUCTION: Adolescent Depression (AD) although is widely prevalent and is a prioritized disorder, it is under-diagnosed and under reported in primary-care. We document the post-test probability of three measures and select the best measure for identifying AD in primary-care settings in India based on the clinical utility. MATERIALS AND METHODS: Three measures have been validated in India for AD and thus can be further evaluated for primary-care use; we calculated the positive (+PTP) and negative (-PTP) post-test probability from the prevalence of AD in India for Beck Depression Inventory-21 item version (BDI-21), Patient Health Questionnaire-9 item version (PHQ-9), and Children's Depression Rating Scale-Revised version (CDRS-R) using the Bayes theorem. The usefulness of the measure was defined a priori based on the odds ratio (OR) of +PTP (OR > 3) and -PTP (OR < 0.1). RESULTS: The +PTP and -PTP for BDI-21 was 43% (95%CI = 40, 45%; OR = 0.7) and 25% (95%CI = 13, 43%; OR = 0.3) respectively. Similarly, the +PTP and - PTP for PHQ-9 was 74% (95%CI = 66, 81%; OR = 2.9) and 10% (95%CI = 6, 17%; OR = 0.1). Finally, +PTP and - PTP for CDRS-R was 78% (95%CI = 69, 84%; OR = 3.5) and 12% (95%CI = 7, 18%; OR = 0.1). Only CDRS-R achieved the useful decided a priori as can be seen in the Fagan's Nomograms. CONCLUSION: This research provides the evidence base for selecting CDRS-R as the screening measure, for Adolescent Depression, for clinical use in Primary-care settings in India.

INCLEN diagnostic tool for attention deficit hyperactivity disorder (INDT-ADHD): development and validation.

OBJECTIVE: To develop and validate INCLEN Diagnostic Tool for Attention Deficit Hyperactivity Disorder (INDT-ADHD). DESIGN: Diagnostic test evaluation by cross sectional design. SETTING: Tertiary care pediatric centers. PARTICIPANTS: 156 children aged 65-117 months. METHODS: After randomization, INDT-ADHD and Connors 3 Parent Rating Scale (C3PS) were administered, followed by an expert evaluation by DSM-IV-TR diagnostic criteria. MAIN OUTCOME MEASURES: Psychometric evaluation of diagnostic accuracy, validity (construct, criterion and convergent) and internal consistency. RESULTS: INDT-ADHD had 18 items that quantified symptoms and impairment. Attention deficit hyperactivity disorder was identified in 57, 87 and 116 children by expert evaluation, INDT-ADHD and C3PS, respectively. Psychometric parameters of INDT-ADHD for differentiating attention deficit hyperactivity disorder and normal children were: sensitivity 87.7%, specificity 97.2%, positive predictive value 98.0% and negative predictive value 83.3%, whereas for differentiating from other neuro-developmental disorders were 87.7%, 42.9%, 58.1% and 79.4%, respectively. Internal consistency was 0.91. INDT-ADHD has a 4-factor structure explaining 60.4% of the variance. Convergent validity with Conner's Parents Rating Scale was moderate (r =0.73, P= 0.001). CONCLUSIONS: INDT-ADHD is suitable for diagnosing attention deficit hyperactivity disorder in Indian children between the ages of 6 to 9 years.

INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD): development and validation.

OBJECTIVE: To develop and validate INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD). DESIGN: Diagnostic test evaluation by cross sectional design. SETTING: Four tertiary pediatric neurology centers in Delhi and Thiruvanthapuram, India. METHODS: Children aged 2-9 years were enrolled in the study. INDT-ASD and Childhood Autism Rating Scale (CARS) were administered in a randomly decided sequence by trained psychologist, followed by an expert evaluation by DSM-IV TR diagnostic criteria (gold standard). MAIN OUTCOME MEASURES: Psychometric parameters of diagnostic accuracy, validity (construct, criterion and convergent) and internal consistency. RESULTS: 154 children (110 boys, mean age 64.2 mo) were enrolled. The overall diagnostic accuracy (AUC=0.97, 95% CI 0.93, 0.99; P<0.001) and validity (sensitivity 98%, specificity 95%, positive predictive value 91%, negative predictive value 99%) of INDT-ASD for Autism spectrum disorder were high, taking expert diagnosis using DSM-IV-TR as gold standard. The concordance rate between the INDT-ASD and expert diagnosis for 'ASD group' was 82.52% [Cohen's k=0.89; 95% CI (0.82, 0.97); P=0.001]. The internal consistency of INDT-ASD was 0.96. The convergent validity with CARS (r = 0.73, P= 0.001) and divergent validity with Binet-Kamat Test of intelligence (r = -0.37; P=0.004) were significantly high. INDT-ASD has a 4-factor structure explaining 85.3% of the variance. CONCLUSIONS: INDT-ASD has high diagnostic accuracy, adequate content validity, good internal consistency high criterion validity and high to moderate convergent validity and 4-factor construct validity for diagnosis of Autistm spectrum disorder.

Adolescent suicide: characterizing the need and identifying the predictive factors for preventive consultation or hospitalization in a rural community setting.

BACKGROUND: Studies from India consistently document the highest suicide rates in the world, and the majority of completed suicides had been within adolescents. OBJECTIVE: To characterize the need and identify the predictive factors for preventive consultation or hospitalization for adolescent suicide in a community setting. SUBJECTS: We prospectively collected data from 500 adolescents in a rural South Indian community with independent, trained raters. METHODS: The need for suicide prevention was measured with the SAD PERSONS scale, socio-economic status with the Modified Kuppusamy Scale, depression and anxiety disorders with the Beck Depression Inventory and the Screen for Child Anxiety Related Emotional Disorders, respectively. The relationship between predictors and the need for preventive action was analyzed with univariate and multivariate regression analyses and a predictive model was built. RESULTS: Of those investigated, 2% and 0.6% required emergency consultation and hospitalization, respectively. Males needed more preventive action (p=0.04). Age (OR=3.40, p=0.07), gender (OR=3.13, p=0.05), presence of anxiety (OR=16.35, p=0.001), or depressive (OR=42.59, p=0.001) disorder independently predicted a need for protective action and, together, contributed to a parsimonious predictive model. CONCLUSIONS: The majority of adolescents in the community do not require preventive steps to address suicide risk. These predictors could identify the high-risk adolescents for suicide prevention and reduce the burden of care in the community.

Diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale in India.

BACKGROUND: Since there is no established measure for autism in India, we evaluated the diagnostic accuracy, reliability and validity of Childhood Autism Rating Scale (CARS). METHODS: Children and adolescents suspected of having autism were identified from the unit's database. Scale and item level scores of CARS were collected and analyzed. Sensitivity, specificity, likelihood ratios and predictive values for various CARS cut-off scores were calculated. Test-retest reliability and inter-rater reliability of CARS were examined. The dichotomized CARS score was correlated with the ICD-10 clinical diagnosis of autism to establish the criterion validity of CARS as a measure of autism. Convergent and divergent validity was calculated. The factor structure of CARS was demonstrated by principal components analysis. RESULTS: A CARS score of > or =33 (sensitivity = 81.4%, specificity = 78.6%; area under the curve = 81%) was suggested for diagnostic use in Indian populations. The inter-rater reliability (ICC=0.74) and test-retest reliability (ICC=0.81) for CARS were good. Besides the adequate face and content validity, CARS demonstrated good internal consistency (Cronbach's alpha=0.79) and item-total correlation. There was moderate convergent validity with Binet-Kamat Test of Intelligence or Gessell's Developmental Schedule (r=0.42; P=0.01), divergent validity (r=-0.18; P=0.4) with ADD-H Comprehensive Teacher Rating Scale, and high concordance rate with the reference standard, ICD-10 diagnosis (82.52%; Cohen's kappa=0.40, P=0.001) in classifying autism. A 5-factor structure explained 65.34% of variance. CONCLUSION: The CARS has strong psychometric properties and is now available for clinical and research work in India.

Predictive factors for polypharmacy among child and adolescent psychiatry inpatients.

BACKGROUND: Aim was to determine the predictive factors for polypharmacy among inpatient children and adolescents with psychiatric disorders. METHODS: Blinded, case-note review of children and adolescents with ICD 10 diagnosis of psychiatric disorders on psychotropic medication was conducted. Data on demography, illness, and treatment was analyzed with univariate and multivariate techniques. RESULTS: Proscribing non-pharmacological interventions (OR = 4.7) and pro re nata medication (OR = 3.3), increased the risk of polypharmacy. Prescribing physical restraint reduced the risk of receiving multiple medications (OR = 0.3). CONCLUSION: Proscribing non-pharmacological interventions, pro re nata medication and physical restraints increased polypharmacy.