Development of Home-Based Intervention Module for Specific Learning Disorder Mixed Type: A Qualitative Study.

Background: Despite significant prevalence of specific learning disorder (SLD) in India, insufficient efforts have been taken to deal with its burden. Currently, the workforce is limited and resources are expensive and difficult for families to access. Consequently, developing an alternative remedial program in the form of a home-based intervention (HBI) is imperative. This article describes the development phase of a manualized HBI program for 7 to 12-year-old children with SLD. Methods: Extensive literature search, 7 focus group discussions with parents of children with and without SLD and teachers/counselors (n = 44), and 22 in-depth interviews with SLD children (n = 9) and professionals (n = 13) were conducted. A thematic analysis was done. Intervention strategies were identified based on themes. Experts' feedback about the content and structure of HBI was also taken. Results: The design and application of the HBI program integrate several intervention areas, including psychoeducation, learning strategies, cognitive, social, and behavioral techniques, and therapy for parents. HBI comprised 14 parent training sessions, the duration being 45 to 60 min per session, over six months. Parent training consisted of four steps. (a) The researcher/clinician describes the steps of reading, writing, or math strategies to the parents/caregivers; (b) the researcher/clinician implements the strategies with or without the presence of the child and observation by the parent; (c) the parent practices the strategies in front of the researcher/clinician; and (d) the researcher/clinician observes parents' practice and corrects them if required. Conclusion: HBI manual for children with SLD-mixed type has been developed, keeping with all stakeholders' perspectives. Further study is on the way to assess its acceptability, feasibility, and effectiveness.

A Cross-Sectional Comparative Study of Sleep Disturbances in Children with ADHD and Matched Controls.

Background: Systematic reviews conducted on sleep disturbances in attention deficit hyperactivity disorder (ADHD) have found inconsistent results due to the presence of several moderating variables which were not controlled for in previous studies. The aim of this study was to examine sleep disturbances in children with ADHD compared to their typically developing peers after controlling for moderating variables (age, sex, medication status, body mass index, and psychiatric and medical comorbidities). Methods: ADHD was diagnosed using DSM-IV-TR criteria (Diagnostic and Statistical Manual of Mental Disorders) and Conners' Parent Rating Scales. Children recruited (aged 6−12 years) for the ADHD group (n = 40) met the following criteria: IQ > 80, unmedicated, and no psychiatric or medical comorbidities. The control group consisted of age- and sex-matched typically developing peers (n = 40). Sleep was assessed subjectively (through parent reported questionnaires and sleep logs) and objectively (using video polysomnography). Results: 65% of children with ADHD had a sleep disorder, as compared to 17% of controls. The ADHD group reported more sleep disturbances and disorders, both on subjective measures and objective measures. Conclusions: Sleep disturbances and primary sleep disorders in children with ADHD exist independent of moderating variables and differences in sleep assessment methods, thereby bolstering support for previously documented literature on the ADHD and sleep connection.

Effectiveness of Metacognitive Therapy in Patients With Depression and Comorbid Anxiety Symptoms: A Case Series From India.

Metacognitive therapy (MCT) is a transdiagnostic intervention used to treat different psychiatric disorders. This intervention is based on the concept that persistent emotional distress is a consequence of a particular way of responding to negative thoughts and emotions. MCT for depression and anxiety aims at targeting rumination, worry, and the dysfunctional metacognitive beliefs underlying these thought processes. The purpose of this study was to explore MCT as a treatment for adult patients with depression (either major depressive disorder (MDD) or recurrent depressive disorder, dysthymia, or mixed anxiety depressive disorder) with comorbid anxiety symptoms. Four men diagnosed with depressive disorder with comorbid anxiety symptoms seeking treatment from the outpatient clinic of the Department of Psychiatry at the All India Institute of Medical Sciences, New Delhi, were recruited for the study. Each patient received 10 individual weekly sessions of MCT, lasting up to 1 hour each. Participants were assessed at baseline, post-intervention (right after completing MCT), and at one-month and two-month follow-ups. Primary outcome measures were a reduction in the severity of depression, anxiety, worry, and rumination. Secondary outcome measures were changes in dysfunctional metacognitive beliefs about worry and rumination. All outcomes were assessed via self-report using standardized questionnaires at baseline, post-intervention, one-month, and two-month follow-up. Data for all the outcome measures (at baseline, post-intervention, one month, and two-month follow-up) were plotted on a graph for visual examination. Additionally, we calculated clinically significant change (≥50% reduction in symptom severity and one other standardized criteria for clinically significant changes) for all the primary outcome measures across the above-mentioned four time points. All four men were single, well-educated, and had a mean age of 25.5±4.79 years. Their mean illness duration was 21±0.64 months. None of them had ever received any psychotherapy for their current illness. They had severe depressive and anxiety symptoms at baseline. Three participants had high scores on the rumination and worry scales. At post-intervention, all the participants had significant improvement on all the primary outcome measures, and they maintained their gains on follow-up assessments. Our study generated preliminary evidence supporting the effectiveness of MCT in treating depressive disorders with comorbid anxiety symptoms in the Indian context.

The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders.

Metacognitive therapy (MCT) is a novel and promising transdiagnostic psychotherapy intervention based on the Self-Regulatory Executive Function model of conceptualizing emotional disorders. It was developed by Adrian Wells in 2009. Its therapeutic response occurs by reducing dysfunctional metacognitive beliefs regarding worry and rumination, often seen in patients with psychiatric disorders. Since its inception, it has been increasingly applied to a wide spectrum of psychiatric illnesses, but mainly focusing on mood and anxiety disorders. To our knowledge, no study has detailed its existing therapeutic scope in psychiatry. In this comprehensive narrative review, we describe the various psychiatric illnesses in which MCT has been used, the advantages of MCT, and the limitations of the MCT research. In addition, we propose some solutions to systematically examine its place in psychiatry. We encountered its potential role in treating trauma and stress-related disorders, obsessive-compulsive spectrum disorders, personality disorders, psychotic disorders, substance use disorders, and sexual disorders.

Substance use and its associated factors among school students.

Background: . There is lack of comprehensive data on substance use and associated factors among school students in Delhi, India. Methods: . We used a cluster sampling method based on sections of classes in schools to conduct this study in two government-run schools in Delhi. All enrolled students from 8th, 9th and 11th grades participated (n = 405). The WHO Student Drug Use questionnaire was administered in a single session for a class section for assessing substance use. Results: . The participation rate was 90.6%. The rates of past 12 months' use of tobacco, alcohol, cannabis and inhalants were 22%, 12.1%, 12.1% and 8.6%, respectively, while rates for 'sedatives and tranquillizers' were 4.9%, opium 2.7% and other opioids 1.2%. Lifetime use of heroin was reported by two students and use in the past 12 months by one student. Multiple substance use was high. Higher age was associated with the use of alcohol and cannabis. According to logistic regression model results, use by a family member significantly increased the probability of using tobacco (adjusted odds ratio [AOR] 11.3; 95% confidence interval (CI) 3.4-37.8) and alcohol (AOR 3.75; 95% CI 5.1-1059.3). Similarly, use by peers significantly increased the probability of tobacco (AOR 7.7; 95% CI 2.0-29.8) and cannabis use (AOR 5.7; 95% CI 1.5-21.5). Having poor harm perception significantly increased the chances of inhalant use by students (AOR 5.5; 95% CI 1.5-20.1). Conclusion: . The study results bring to attention the prevalent and important problem of substance use among schoolchildren. We recommend that (i) intervention strategies for school settings are important and need to factor in the use of illicit substances (cannabis); (ii) psychosocial intervention by trained school counsellors in school settings is the mainstay for intervention for cannabis and inhalants; and (iii) heroin users should be referred to healthcare facilities for detoxification.

Psychiatric Co-morbidities and Body Shape Dissatisfaction in Adolescents with Obesity - A School Based Case Controlled Study.

OBJECTIVE: To compare the psychiatric co-morbidity and Body image disturbances of obese adolescents with age and gender matched normal weight controls. METHODS: A case control study was conducted in a school in New Delhi. Nine hundred seventy six students were screened for height and weight and body mass index (BMI) was calculated. Thirty one consenting obese students as per International Obesity Task Force (IOTF) guidelines and 31 age and gender matched normal weight students were recruited for the study. Semi-structured questionnaires were used to assess socio-demographic details, psychiatric co-morbidity using the Mini International Neuropsychiatric Interview- child and adolescent version (MINI-KID), and body image disturbances by Body Shape Questionnaire- the 8 items shorter version (BSQ-8C). The authors examined the relationships between variables measured on these scales and anthropometric data. RESULTS: Of the 976 students screened, 33 (3.38%) students were obese; 21 boys (3.25%) and 12 girls (3.65%). Of the 31 consenting obese subjects and an equal number of age and sex matched controls included in the study, 68% and 7% of them were diagnosed with a DSM-IV disorder based on MINI-KID respectively. The most common diagnosis in the obese group was social phobia (36%) followed by specific phobia (19%) and major depressive disorder (19%). Ninety percent of the obese samples expressed concern over body shape as against 29% in the control subjects. Among obese subjects, 36% expressed mild concern, another 36% expressed moderate concern and 19% expressed marked concern over body shape. CONCLUSIONS: Psychiatric co-morbidity and body shape dissatisfaction are common in obese non-treatment seeking adolescents and warrants need for comprehensive evaluation and management of these issues to manage the epidemic of adolescent obesity in India.

Smartteen- a computer assisted cognitive behavior therapy for Indian adolescents with depression- a pilot study.

The prevalence of unipolar depression among adolescents in India is high. Cognitive behavior therapies (CBTs) are considered the current gold standard treatment for depression in adolescents; however, their access is limited in India. Given the ubiquity of technology including smartphones and computers, technology can be leveraged to improve access of CBT treatment in India. Our team developed smartteen- a computer application designed to augment in-person CBT for treatment of depression in adolescents. This paper will present results of the pilot evaluation of smartteen (a cCBT) for its feasibility, acceptability and effectiveness in reducing depressive symptoms. Twenty-one adolescents with unipolar depression seeking treatment at a tertiary care hospital were randomly assigned to smartteen (n = 11) and TAU (n = 10). Both groups received twelve weeks of treatment and were assessed at baseline, mid-treatment (6 weeks) and post-treatment (12 weeks) using four clinical measures including BDI-II, CDRS-R, CGI-S and CGAS. smartteen was shown to be feasible and acceptable treatment to adolescents. At 6 weeks, both treatments were effective in reducing depression. At 12 weeks, smartteen was significantly more effective than TAU in reducing depression symptoms and improving functioning on CGAS. Treatment compliance was better in smartteen group. smartten was shown to reduce the time spent by therapist to deliver 12 sessions of CBT treatment for depression. Results indicate that smartteen may be subjected to more rigorous evaluations with larger samples and considered for wider implementation if found effective.

Study of functional magnetic resonance imaging (fMRI) in children and adolescents with specific learning disorder (dyslexia).

BACKGROUND: Dyslexia is a type of specific learning disability (SLD) which has neurobiological origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. The impaired reading in dyslexia is associated with inability to process the sensory input that enters the nervous system. Functional magnetic resonance imaging (fMRI) has emerged as a potential source in understanding the neurobiology and to identify the brain basis of sensory stimuli processed in dyslexic patients. METHODOLOGY: The present study was conducted to assess the difference in neural changes using fMRI in children and adolescents with SLD compared with normal children and also the correlation of clinical parameters with BOLD - fMRI changes. Sixteen children and adolescents diagnosed as dyslexia were assessed with All India Institute of Medical Sciences (AIIMS) SLD Battery, Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI KID) and Aggregated Neurobehavioral Student Health and Educational Review (ANSER) system and compared with 15 controls matched with age and sex. Participants of both groups were asked to perform 3 tasks during the fMRI acquisition (phonological, picture-naming and semantic tasks). RESULT: As compared to control group, the participants with dyslexia show phonological decoding problem. During picture task, the participants with dyslexia use more areas of brain involve in recalling the memory events while during semantic tasks processing the occipito-temporal (fusiform) gyrus was less activated when in contrast to control. CONCLUSION: This study shows that participants with dyslexia fail to use normal brain regions specialized in language processing, but rather use different areas.

Rapid Eye Movement (REM) Sleep Behavior Disorder and REM Sleep with Atonia in the Young.

BACKGROUND: Rapid eye movement (REM) sleep behavior disorder (RBD) and REM sleep without atonia (RWA) have assumed much clinical importance with long-term data showing progression into neurodegenerative conditions among older adults. However, much less is known about RBD and RWA in younger populations. This study aims at comparing clinical and polysomnographic (PSG) characteristics of young patients presenting with RBD, young patients with other neurological conditions, and normal age-matched subjects. METHODS: A retrospective chart review was carried out for consecutive young patients (<25 years) presenting with clinical features of RBD; and data were compared to data from patients with epilepsy, attention deficit hyperactivity disorder (ADHD), and autism, as well as normal subjects who underwent PSG during a 2-year-period. RESULTS: Twelve patients fulfilling RBD diagnostic criteria, 22 autism patients, 10 with ADHD, 30 with epilepsy, and 14 normal subjects were included. Eight patients with autism (30%), three with ADHD (30%), one with epilepsy (3.3%), and six patients who had presented with RBD like symptoms (50%) had abnormal movements and behaviors during REM sleep. Excessive transient muscle activity and/or sustained muscle activity during REM epochs was found in all patients who had presented with RBD, in 16/22 (72%) autistic patients, 6/10 (60%) ADHD patients compared to only 6/30 (20%) patients with epilepsy and in none of the normal subjects. CONCLUSION: We observed that a large percentage of young patients with autism and ADHD and some with epilepsy demonstrate loss of REM-associated atonia and some RBD-like behaviors on polysomnography similar to young patients presenting with RBD.

Troubles du comportement en sommeil paradoxal et sommeil paradoxal sans atonie musculaire chez les jeunes. Contexte: Les troubles du comportement en sommeil paradoxal (TCSP) et le sommeil paradoxal sans atonie musculaire ont acquis une grande importance clinique. En effet, des données à long terme ont montré de quelle façon ils pouvaient progresser chez des adultes âgés atteints de maladies neurodégénératives. Toutefois, on en sait beaucoup moins au sujet des TCSP et du sommeil paradoxal sans atonie musculaire au sein des groupes d'âges plus jeunes. Cette étude entend donc comparer les caractéristiques cliniques et polysomnographiques (PSG) de jeunes patients donnant à voir des signes de TCSP à celles d'autres jeunes patients atteints d'autres troubles neurologiques et de sujets en bonne santé appariés en fonction de l'âge. Méthodes: Nous avons passé en revue de façon rétrospective les dossiers de jeunes patients (< 25 ans) donnant à voir des signes cliniques de TCSP et ayant été vus consécutivement. Les données recueillies ont été comparées aux données de patients atteints d'épilepsie, de troubles de l'attention avec hyperactivité et d'autisme ainsi qu'à celles de sujets en bonne santé soumis à des examens de PSG pendant une période de deux ans. Résultats: Au total, on a diagnostiqué chez 12 patients des TCSP. Ajoutons que 22 d'entre eux étaient atteints d'autisme alors que 10 étaient atteints de troubles de l'attention avec hyperactivité et 30 d'épilepsie. Mentionnons par ailleurs que 14 sujets en bonne santé ont été inclus dans cette étude. Après analyse, il s'est avéré que 8 patients atteints d'autisme (30 %), 3 de troubles de l'attention avec hyperactivité (30 %), 1 d'épilepsie (3,3 %) et 6 ayant donné à voir des symptômes ressemblant à ceux des TCSP (50 %) montraient des mouvements et des comportement anormaux en sommeil paradoxal. Des signes d'activité musculaire transitoire excessive et/ou d'activité musculaire durable lors d'épisodes de sommeil paradoxal ont été détectés chez tous les patients satisfaisant aux critères des TCSP, chez 16 patients autistes sur 22 (72 %), chez 6 patients atteint de troubles de l'attention avec hyperactivité sur 10 (60 %) en comparaison avec seulement 6 patients épileptiques sur 30 (20 %) et aucun parmi les sujets en bonne santé. Conclusion: Lors d'examens polysomnographiques, nous avons en définitive observé qu'une forte proportion de jeunes patients atteints d'autisme et de troubles de l'attention avec hyperactivité, ainsi que quelques-uns atteints d'épilepsie, donnaient à voir des signes de perte de sommeil paradoxal associés à l'atonie musculaire ainsi que des comportements ressemblant à ceux de jeunes patients atteints de TCSP.

Assessment for familial pattern and association of polymorphisms in KIAA0319 gene with specific reading disorder in children from North India visiting a tertiary care centre: A case-control study.

Genetic association studies have identified KIAA0319 gene as a possible susceptibility locus for reading disorder; however, very few studies are available from India. The study was planned to investigate the familial pattern and association of KIAA0319 polymorphisms among children with reading disorder visiting a tertiary centre in North India. This is a case-control, familial, and genetic association study on 30 children diagnosed with reading disorder (ICD-10) and 30 matched healthy controls and their families. The Aggregate Neurobehavioral Student Health and Educational Review System was administered on parents of probands and controls for reading problems in their siblings, and Adult Reading Questionnaire was administered for parents of both groups. The blood sample was taken from probands, and DNA was isolated. Four KIAA0319 coding sequence single nucleotide polymorphisms (SNPs; rs4504469, rs6935076, rs2038137, and rs2179515) were genotyped using SNaPshot single nucleotide extension. The incidence of reading problem was significantly higher in families of probands as compared with families of controls. There were no significant differences in both groups regarding the frequency of alleles of four SNPs. The reading disorder showed a significant familial pattern, but KIAA0319 gene did not appear to be a susceptibility factor. Future replications with larger samples and whole genome studies are warranted.

Subjective sleep problems and sleep hygiene among adolescents having depression: A case-control study.

Sleep research has often focussed heavily on polysomnography while ignoring subjective sleep complaints of individuals, especially the young ones. Discordance has been seen between objective and subjective parameters of sleep among children and adolescents. There has been a trend towards worsening of sleep hygiene among adolescents, which may predispose to psychiatric disorders like depression. So, we compared the subjective sleep quality and sleep hygiene among depressed and normal adolescents. A sample of 31 depressed adolescents and 32 healthy controls were compared on sleep parameters using Adolescent Sleep Wake Scale (ASWS), Adolescent Sleep Hygiene Scale (ASHS) and School Sleep Habits Survey. Depressed adolescents were found to have significantly worse sleep quality [ASWS score 3.72 ±â€¯0.952 vs 4.79 ±â€¯0.552, p < 0.001], longer sleep onset latency [68.23 ±â€¯62.98 vs 19.53 ±â€¯19.48 minutes, p < 0.001], and shorter sleep duration [414.19 ±â€¯110.78 vs 498.28 ±â€¯56.86 minutes, p < 0.001]. Sleep quality significantly correlated with depression severity (measured on Children's Depression Rating Scale- revised), i.e., higher the severity of depression, poorer was the sleep quality (r = -0.605, p < 0.01). But sleep hygiene was statistically similar between the two groups [ASHS score 3.21 ±â€¯0.60 vs 3.36 ±â€¯0.51, p = 0.293], and was inadequate (< 3.8) among all adolescents irrespective of depression. Hence, despite the lack of evidence from objective sleep measures, there seem to be subjective sleep impairments among adolescents having depression. Future research needs to address the underlying etiological factors and causal directions for depression and sleep impairments among adolescents. Sleep hygiene education must be a part of broader primary prevention strategies for psychiatric disorders.

Serum S100B levels in patients with depression.

BACKGROUND: The biochemical basis of depression has been related to blood-brain barrier (BBB) allowing/restricting a number of components to enter the brain milieu from the peripheral plasma milieu. S100B has been associated with BBB damage and is used as a marker of its integrity. Several studies have reported that depressive patients have increased levels of S100B in serum and cerebrospinal fluid. MATERIALS AND METHODS: Forty-two confirmed cases of depression, 13-25 years of ages were recruited from the Department of Psychiatry, All India Institute of Medical Sciences during the period from January 2013 to June 2014 along with 42 healthy controls of comparable age and sex. Psychometric evaluation of the patients and controls was done to assess the severity of depression using Beck's Depression Inventory-II and Hamilton Depression Rating Scale. Medical assessment and laboratory investigations were done. Serum S100B levels were measured using Sandwich ELISA. The results obtained were statistically analyzed. RESULTS: Levels of serum S100B were significantly elevated in patients with major depression as compared to controls. Significantly higher levels of S100B were seen only in females as compared to their healthy counterparts. Serum S100B was higher in depressed participants with the recurrent disorder than those with single episode. No correlation of levels of this marker was seen with clinical severity of the patients. It was found that with increased duration of illness for which the patient was being treated with antidepressants, the patients had higher levels of S100B. CONCLUSIONS: Serum S100B can be used as a biomarker of depression.

Perception of Families of Children with Specific Learning Disorder: An Exploratory Study.

BACKGROUND: Parents have a tremendous influence on their children's academic and social success. Unfortunately, a majority of them do not have a concrete idea on how to assist their children, impacting negatively on both the parents and the child. Currently, there is sparse research on parents' experiences in dealing with children with specific learning disorders (SLD). The current study was planned to explore the perception of families of children with SLD. MATERIALS AND METHODS: Five focus group discussions (FGDs) including 30 parents of children with SLD aged between 8 and 14 years were carried out. Each group composed of five - seven participants. A format to guide FGDs was made to bring uniformity across groups. The transcripts were analyzed using the content analysis method to extract key conceptual themes. RESULTS: The parents showed lack of conceptual knowledge with regard to the SLD symptomatology as well as proper guidelines to deal with their child's problem. They displayed negative attitudes and reactions toward their child's diagnosis of SLD, such as rejection, denial, over-protection, and loss of hope. Their caregiving was also perceived to place physical, personal, social, financial, and emotional burden by the majority of parents. CONCLUSION: The study highlights the experiences of parents dealing with SLD in terms of their inadequate knowledge, adaptational difficulties, and burden. The findings also reiterate the need to focus on family perspective and experiences when working with a learning-disabled child. Various supportive strategies are required to empower families, which would help alleviate their burden. Moreover, parents' training to strengthen child's learning skills is also warranted.

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

BACKGROUND: Neurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden. METHODS AND FINDINGS: We assessed 3,964 children (with almost equal number of boys and girls distributed in 2-<6 and 6-9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6-9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2-<6 year olds ranged from 2.9% (95% CI 1.6-5.5) to 18.7% (95% CI 14.7-23.6), and for any of nine NDDs in the 6-9-year-old children, from 6.5% (95% CI 4.6-9.1) to 18.5% (95% CI 15.3-22.3). Two or more NDDs were present in 0.4% (95% CI 0.1-1.7) to 4.3% (95% CI 2.2-8.2) in the younger age category and 0.7% (95% CI 0.2-2.0) to 5.3% (95% CI 3.3-8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5-11.2) and 13.6% (95% CI 11.3-16.2) in children of 2-<6 and 6-9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6-9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population. CONCLUSIONS: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.

Familial study of attentional and behavioural problems in children with Dyslexia and their first-degree relatives in Indian setting.

BACKGROUND: Dyslexia is one of the common problems seen in children worldwide. There is high co-morbidity of dyslexia with attentional and behaviour problems which could have familial pattern. This study aims to compare the attentional and behavioural problems in children with dyslexia and their first-degree relatives with controls. METHODS: This is a cross-sectional comparative study with single interview method in an out-patient setting. Formally diagnosed (ICD-10) cases of 30 children with specific reading disorder and 30 healthy matched controls and their first-degree relatives were assessed using scales in a single setting after application of inclusion and exclusion criteria. RESULTS: The children with dyslexia had significantly more problems in the domains of selective attention and behavioural problems as compared to controls and the siblings of the cases had significant problems in selective attention but not in behavioural problems. Also, no difference was seen in ADHD symptoms of parents in cases and controls. CONCLUSION: The results from our study are keeping with most of the published literature. We expect that this study will help in laying a good foundation for further studies with stronger methodologies incorporating molecular genetics.

Thyroid and Cortisol hormones in Attention Deficit Hyperactivity Disorder: A case-control study.

AIM: There is paucity of research in the putative role of hormonal biomarkers in Attention Deficit Hyperactivity Disorder (ADHD). The current study aimed to analyze the clinical profile, socio-demographic status, co-morbidity, hormonal biomarkers namely Thyroid hormones and Cortisol in children with ADHD and compare them with healthy controls and to explore the association of the hormonal biomarkers with severity of ADHD. METHODS: Thirty children with DSM-IV TR diagnosis of ADHD were assessed using semi structured proforma, Conners' Parent Rating Scale revised short (CPRS - R: S) , Mini international neuropsychiatric interview for children and adolescents and Childrens' Global Assessment Scale as well as serum levels of total Triiodothyronine (T3) ,total Thyroxine (T4) , Thyroid Stimulating Hormone (TSH) and Cortisol using chemiluminescent immunometric assay and compared with 30 age- and gender -matched controls. RESULTS: The typical profile of cases of ADHD was of a male with mean age of 9.47 years (S.D=2.43) belonging to Hyperactive subtype of ADHD. Serum T4 was significantly lower in cases compared to controls. No significant difference was found in serum T3, TSH and Cortisol levels. No significant correlation between the CPRS : R-S scores and the hormonal biomarkers. CONCLUSIONS: There is need for exploration of Serum T4 as putative biomarker for ADHD with replication in future studies. It may also be important to report the negative finding of Cortisol as a biomarker of ADHD in the context of effective utilization of resources for research with special relevance to resource deficit developing countries.

AFB1 hepatocarcinogenesis is via lipid peroxidation that inhibits DNA repair, sensitizes mutation susceptibility and induces aldehyde-DNA adducts at p53 mutational hotspot codon 249.

Aflatoxin B1 (AFB1) contamination in the food chain is a major cause of hepatocellular carcinoma (HCC). More than 60% of AFB1 related HCC carry p53 codon 249 mutations but the causal mechanism remains unclear. We found that 1) AFB1 induces two types of DNA adducts in human hepatocytes, AFB1-8,9-epoxide-deoxyguanosine (AFB1-E-dG) induced by AFB1-E and cyclic α-methyl-γ-hydroxy-1,N2-propano-dG (meth-OH-PdG) induced by lipid peroxidation generated acetaldehyde (Acet) and crotonaldehyde (Cro); 2) the level of meth-OH-PdG is >30 fold higher than the level of AFB1-E-dG; 3) AFB1, Acet, and Cro, but not AFB1-E, preferentially induce DNA damage at codon 249; 4) methylation at -CpG- sites enhances meth-OH-PdG formation at codon 249; and 5) repair of meth-OH-PdG at codon 249 is poor. AFB1, Acet, and Cro can also inhibit DNA repair and enhance hepatocyte mutational sensitivity. We propose that AFB1-induced lipid peroxidation generated aldehydes contribute greatly to hepatocarcinogenesis and that sequence specificity of meth-OH-PdG formation and repair shape the codon 249 mutational hotspot.