Yoga as an Add-on Therapy in Parkinson's Disease: A Single Group Open-label Trial.

OBJECTIVE: We aimed to evaluate the effect of yoga on motor and non-motor symptoms and cortical excitability in patients with Parkinson's disease (PD). METHODS: We prospectively evaluated 17 patients with PD at baseline, after one month of conventional care, and after one month of supervised yoga sessions. The motor and non-motor symptoms were evaluated using the Unified Parkinson's disease Rating Scale (motor part III), Hoehn and Yahr stage, Montreal Cognitive Assessment, Hamilton depression rating scale, Hamilton anxiety rating scale, non-motor symptoms questionnaire and World Health Organization quality of life questionnaire. Transcranial magnetic stimulation was used to record resting motor threshold, central motor conduction time, ipsilateral silent period (iSP), contralateral silent period (cSP), short interval intracortical inhibition (SICI), and intracortical facilitation. RESULTS: The mean age of the patients was 55.5 ± 10.8 years, with a mean duration of illness of 4.0 ± 2.5 years. The postural stability of the patients significantly improved following yoga (0.59 ± 0.5 to 0.18 ± 0.4, p = 0.039). There was a significant reduction in the cSP from baseline (138.07 ± 27.5 ms) to 4 weeks of yoga therapy (116.94 ± 18.2 ms, p = 0.004). In addition, a significant reduction in SICI was observed after four weeks of yoga therapy (0.22 ± 0.10) to (0.46 ± 0.23), p = 0.004). CONCLUSION: Yoga intervention can significantly improve postural stability in patients with PD. A significant reduction of cSP and SICI suggests a reduction in GABAergic neurotransmission following yoga therapy that may underlie the improvement observed in postural stability. CLINICALTRIALSGOV IDENTIFIER: CTRI/2019/02/017564.

Assessing Adult ADHD: An Updated Review of Rating Scales for Adult Attention Deficit Hyperactivity Disorder (ADHD).

METHOD: Scholarly articles on adult ADHD between 1996 and 2022 were reviewed using the PRISMA guidelines. ADHD rating scales with multiple citations were selected and their psychometric properties and symptom coverage were analyzed. RESULTS: Ten rating scales, with sound psychometric properties, were identified. Out of those reviewed two (BADDS and BAARS-IV) load on the inattentive domain of ADHD, while the rest focus on a comprehensive assessment of ADHD. Only one scale (BARRS-IV) incorporates an assessment of functional impairment. Some scales though widely utilized have not been adequately examined for their sensitivity. CONCLUSIONS: Rating scales are reliable and valid, in the assessment of adult ADHD. We present a review of recent scales, with an expanded focus, to help clinicians make informed decisions on diagnosis, identifying targets and planning interventions accordingly.

Insights from Magnetic Evoked Field Analysis in Patients with Wilson's Disease.

Aims: To study the latency, amplitude, and source localization of magnetic evoked field (MEF) responses to visual, auditory, and somatosensory stimuli in Wilson's disease (WD) using magnetoencephalography (MEG) and compare it with "healthy" controls, and correlate the observations with disease severity and brain MRI. Methods: MEF of 28 patients with neurological WD (age: 22.82 ± 5.8 years; M:F = 12:16) and 21 matched controls (age: 25.0 ± 4.6 years; M:F = 10:11) were recorded using MEG. Source localization was performed using standard models on the components of M100, M20, and M100 for visual, somatosensory, and auditory evoked fields, respectively and its latency/amplitude was correlated with disease severity. Results: There were significant differences in source location between control and WD during visual evoked field (VEF) and auditory evoked field (AEF) studies. Latencies of M20 (right-p = 0.02; left-p = 0.04) and M32 (right-p = 0.01) components of SSEF were significantly prolonged. The amplitude of M20 was significantly reduced in patients bilaterally (P = 0.001). There was a trend for the prolonged latency of M100 of VEF in patients (P = 0.09). Five patients had reduced right M145 compared to 8 controls. The left somatosensory evoked fields (SSEF) latency correlated with disease severity (P = 0.04). There was no significant correlation between major components of other MEF with disease severity or MRI score. Conclusions: This study, first of its kind to use MEF analysis in a large cohort of patients with WD, detected subclinical but a variable degree of abnormalities, most consistently of SSEF. It provides valuable insights of functioning and localization of various pathways in a disease known to have protean clinical manifestations and widespread MRI changes.

Lifetime child sexual abuse assessed at age 18: A survey of college students from Kerala, India.

Estimates of child sexual abuse (CSA) during adolescence may undercount exposure and retrospective recollection in adulthood may be prone to recall bias. Thus, a more accurate and CSA may be possible if the question is examined in a large sample of 18 years old. This study examined the prevalence and psychosocial correlates of CSA among college-going 18 years olds. This is a cross-sectional survey of college students. 1424 students from 58 colleges selected by cluster random sampling completed a self-administered questionnaire incorporating standardized instruments. Prevalence rates were calculated. Chi-square test was used to compare categorical variables and binary logistic regression analysis was used to examine the correlates of CSA. CSA was reported by 13.2% and significantly more common among males compared to females (18.4% vs. 10.4%, P < 0.05). In the full model of binary logistic regression analysis, students who reported sexual abuse were significantly more likely to report psychological distress and suicidal thoughts. The finding was replicated even when male and female students were analyzed separately. To conclude, CSA is common among college students. With an increasing number of young people enrolling in colleges in India, timely interventions on campuses are important to reduce the psychological morbidity in this population.

Retinal Changes in Parkinson's Disease: A Longitudinal Follow-up Study.

Background: There is definite evidence for the involvement of retina in Parkinson's disease (PD). However, a specific pattern has not been clear due to the cross-sectional nature of the majority of the previous studies. Objective: The aim of this work was to study the pattern of changes in the retinal layers in patients with PD on longitudinal follow-up. Materials and Methods: Twelve patients with PD (23 eyes) were evaluated at baseline with complete history, clinical examination, Unified Parkinson's Disease Rating Scale (UPDRS) motor part, visual acuity, and retinal imaging with spectral-domain Optical Coherence Tomography. After a mean duration of 3.7 ± 0.46 years, patients were re-evaluated. Results: The Central Macular Thickness (CMT) of the right eye was found to be significantly thicker during the follow-up (P = 0.002). The outer retinal layer in the temporal quadrant at 0.5 centimeters from the fovea of the left eye was found to be significantly thinner (P = 0.001). Conclusion: The serial evaluation of the retinal layers in patients with PD suggests a progressive loss of thickness of the outer retinal layer. The involvement of non-dopaminergic mechanisms, especially glutamatergic pathways, may be responsible for these changes.

Risk estimates of anxiety and depressive disorders among primary care patients with chronic medical illness - A Indian study.

Risk estimates of depression and anxiety disorders in primary care patients was studied in 7017 patients from 71 primary health centres in Kerala, India. When compared to those without, patients with a single chronic medical illness had approximately 3-4-fold higher rates of depression and anxiety disorders; this increases to 6-fold when the number of medical illnesses is two or more. Patients with hypertension, diabetes, epilepsy, tuberculosis, asthma, and arthritis had higher odds of depression after controlling for socio-demographic variables and co-occurring medical illnesses. The findings were replicated for anxiety disorders except for tuberculosis. Findings highlight the need for integrated interventions.

The Rationale of Yoga in Parkinson's Disease: A Critical Review.

BACKGROUND: Patients with Parkinson's disease (PD) commonly use complementary and alternative medications. Yoga is a mind-body intervention that is being increasingly explored as a tool in the therapeutic armamentarium of PD. OBJECTIVE: To critically evaluate the studies and summarize the utility of Yoga in PD. MATERIAL AND METHODS: We performed a systematic literature search in the Medline and Cochrane databases and included randomized controlled trials (RCT) of Yoga in PD. The studies were evaluated for internal validity and the relevant data were extracted. RESULTS: A total of seven studies were included in the analysis. We collated the data on the changes in motor function, gait and balance parameters, anxiety, depression and quality of life scores observed after intervention (Yoga) in patients with PD and highlighted the limitations of these studies. CONCLUSION: Anxiety, depression, and balance issues in PD may benefit from Yoga. Yoga has potential as an add-on therapy in PD.

What Happens after Therapy? Quality of Life and Neurocognitive Functions of Children with Malignant Posterior Fossa Tumors after Adjuvant Therapy.

PURPOSE: The health-related quality of life (HRQoL) is an important endpoint in modern clinical practice with improved survival of pediatric posterior fossa malignant brain tumors (PFMBTs). We evaluated the effect of environmental and psychosocial milieu on QoL and cognitive functioning (CF) of Indian children with PFMBT. METHODS: In a cross-sectional study, 47 children <18 years of age with medulloblastoma or anaplastic ependymoma were evaluated ≥6 months after completion of adjuvant therapy. All clinical and socioeconomic details, educational status of child and family members, socioeconomic status, environmental factors affecting QoL were documented. Children underwent HRQoL evaluation using Pediatric quality of life Inventory (PedsQL) questionnaire and neuropsychological evaluation. RESULTS: The median age of the cohort at presentation was 7 years (1-18) and median duration of evaluation after adjuvant therapy was 16 months. In 47 families, 72.34% had low monthly income and 76.6% of mothers took formal education. QoL scores were above median values. Parents reported scores highlighted that Lansky performance score (P = 0.001) and maternal education (P = 0.043) significantly influenced the cognitive component of QoL. Twenty-seven children had below-average IQ. Young age at presentation (P = 0.020), maternal education (P = 0.032), high socioeconomic status (P = 0.001) influenced the IQ score. Even though the majority of children (57.44%) had below-average IQ, they had a score of more than 50 on the cognitive functioning scale. A total of 72.5% of the eligible children in our cohort went back to school following therapy, though often with a delay of one academic year. CONCLUSIONS: Overall cognitive functioning scores of these children are good, but they are not representative of actual neurocognitive tasks based performance or IQ scores. Children should remain under regular follow-up with a neurocognitive assessment and psychological counseling at regular intervals.

EEG-based P300 in mesial temporal lobe epilepsy and its correlation with cognitive functions: A case-control study.

OBJECTIVE: P300 is an event-related potential, being explored as an objective tool to assess cognition. This study aimed to investigate the characteristics of auditory and visual P300 in patients with TLE having unilateral HS using electroencephalography (EEG) and to study its correlation with cognition. METHODS: This is a cross-sectional case-control study, where P300 characteristics in thirty patients with unilateral hippocampal sclerosis with refractory epilepsy were compared with fifteen age-, gender-, and years of education-matched healthy controls (M: F-10:5, mean age-28 ±â€¯4.76 years). Among patients, 15 belonged to the right HS group (M: F-9:6, age at onset-12.92 ±â€¯10.22 years, duration of epilepsy-16.67 ±â€¯9.38 years) and 15 to the left HS group (M: F-8:7, age at onset-10.62 ±â€¯7.18 years, duration of epilepsy-15.53 ±â€¯10.14 years). All subjects underwent EEG-based auditory and visual oddball tasks and cognitive assessment. The P300 latencies (in milliseconds) as well as amplitudes (in microvolts) were predicted in EEG and were correlated with cognitive scores. Source localization of P300 was performed with the CLARA algorithm. RESULTS: The auditory P300 latencies in controls, right HS, and left HS were 323.93 ±â€¯40.28, 351.06 ±â€¯47.23, and 328.80 ±â€¯36.03, respectively (p = 0.18) and its amplitudes were 2.3040 ±â€¯1.46, 2.77 ±â€¯1.19, and 2.68 ±â€¯1.78, respectively (p = 0.48). Visual P300 latencies in controls, right HS, and left HS were 365.87 ±â€¯47.37, 359.67 ±â€¯64.45, and 376.00 ±â€¯60.06, respectively (p = 0.51) and its amplitudes were 3.93 ±â€¯2.28, 2.09 ±â€¯1.45, and 3.56 ±â€¯1.74, respectively (p = 0.014). Further, when compared to the control group the cognitive scores were lower in the patient group (p < 0.05). SIGNIFICANCE: In comparison to the controls, patients with right HS recorded lesser amplitude on visual P300 and lower scores on cognitive tests. P300 and cognitive parameters exhibited varied relationship. P300 could be a complementary objective tool to assess cognition in patients with TLE.

Does academic streams influence alcohol use in colleges?

BACKGROUND: Alcohol use among college students is a major public health priority owing to its high prevalence and numerous negative outcomes. Most interventions targeting alcohol use among college students consider them as a homogenous entity. There is preliminary evidence from high-income countries that patterns of alcohol use differ across academic streams. This remains unstudied in India. AIMS: To compare the prevalence and correlates of alcohol use among students enrolled in various collegiate educational streams (medical, nursing, engineering, arts and science, and others [law/fisheries]) in the state of Kerala, India. SETTINGS AND DESIGN: This is a cross-sectional survey conducted among college students. MATERIALS AND METHODS: 5784 students completed a self-administered questionnaire assessing alcohol use and its correlates in the psycho-social domains. STATISCAL ANALYSIS: Lifetime prevalence and severity of alcohol use was determined across examined academic streams. A multivariable logistic regression analysis was done separately for each course, to identify factors influencing alcohol use. RESULTS: The lifetime prevalence of alcohol use varied between 10.6% among nursing students to 41.7% among students pursuing "other" stream (law/fisheries). Students pursuing medicine and nursing had a relatively lower proportion of hazardous users. Consistently across all academic streams, being male and using tobacco increased the risk, while those from the Muslim community had a lower risk of alcohol use. Other examined psychosocial correlates showed varying relationship across courses. CONCLUSION: The prevalence and psychosocial correlates of alcohol use vary among students pursuing various academic streams. This finding has public health importance as the incorporation of course level characteristics in intervention programs will improve effectiveness.

Role of pulse methylprednisolone in epileptic encephalopathy: A retrospective observational analysis.

OBJECTIVES: To study the effect of monthly pulses of intravenous methylprednisolone (IVMP) on seizure and global outcomes in children with epileptic encephalopathy (EE). METHODS: This retrospective study was undertaken in a tertiary care epilepsy center in India. Consecutive patients with EE who had received IVMP as adjunctive therapy for a minimum of 3 months and had at least one pre-and post-steroid EEG each, were identified and a structured questionnaire was used to collect information including outcomes at 3 months post-steroid course completion and beyond, as available. RESULTS: Ninety-seven patients (M:F=71:26) fulfilling the inclusion criteria with a mean age at onset of seizures being 20.52 ± 25.69 months were included. Commonest seizure types were myoclonic (66%); Lennaux-Gastaut and West Syndromes accounted for 57 % and 24 % patients respectively. The etiology was unknown in 52 %. All children were on a combination of standard anti-seizure drugs. The duration of IVMP pulse therapy was 7.72 ± 6.25 months. One-fourth (26 %) patients experienced minor adverse events. Greater than 50 % seizure burden reduction was seen in 66 % patients at 3 months with seizure-freedom in 25 %. A total of 45 (46 %) patients became seizure-free in the cohort eventually with continuation of steroids beyond 3 months. Children with idiopathic EEs, normal neuroimaging, myoclonic jerks, and West syndrome showed the best response. The presence of burst-suppression and generalized paroxysmal fast activity (GPFA) predicted inadequate response. CONCLUSIONS: Adjunct pulse doses of IVMP are safe, well-tolerated, and effective in reducing seizures and improving global outcomes in children with idiopathic EEs, West syndrome, normal neuroimaging, and myoclonic jerks. Seizure freedom might be delayed in a subset of these patients, hence duration of therapy beyond 3 months may be warranted.

Sleep profile and Polysomnography in patients with drug-resistant temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) and the effect of epilepsy surgery on sleep-a prospective cohort study.

OBJECTIVES: We analyzed changes in sleep profile and architecture of patients with drug-resistant TLE-HS using three validated sleep questionnaires- Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), NIMHANS Comprehensive Sleep Disorders, and polysomnography (PSG). We studied the effect of epilepsy surgery in a subset of patients. METHODS: In this prospective observational cohort study, sleep profile of 40 patients with drug-resistant TLE-HS was compared to 40 healthy matched controls. Sleep architecture of 22 patients was studied by overnight PSG and compared to 22 matched controls. Sleep profile was reassessed in 20 patients after a minimum period of three months after epilepsy surgery. RESULTS: The mean PSQI was higher among patients compared to controls(P=0.0004) while mean ESS showed no difference. NCSDQ showed fewer patients feeling refreshed after a night's sleep compared to controls (p=0.006). PSG revealed a higher time in bed (p=0.0001), longer total sleep time (p=0.006) and more time spent in NREM stage 1 (p=0.001) and stage 2 (p=0.005) while spending less time in stage 3 (p=0.039) among TLE patients. Sleep efficiency was worse in patients on ≥3 ASMs compared to those on 2 ASMs (p-0.044). There was no change in mean ESS (p=0.48) or PSQI (p=0.105) after surgery. CONCLUSIONS: Patients with drug-resistant TLE-HS have an altered sleep profile and architecture. Patients on ≥3 ASMs have a lower sleep efficiency. Reassessment at short intervals after epilepsy surgery did not reveal significant changes in sleep profile.

P300 in mesial temporal lobe epilepsy and its correlation with cognition - A MEG based prospective case-control study.

PURPOSE: To assess the role of P300 in patients with temporal lobe epilepsy (TLE) with unilateral hippocampal sclerosis (HS) using magnetoencephalography (MEG) based auditory and visual oddball tasks, and to assess its correlation with neuropsychological tests. METHODS: Thirty-patients (M:F-17:13, onset-11.77 ±â€¯8.75 years, duration-16.10 ±â€¯9.61 years) with TLE-HS (Left:15, Right:15) and fifteen-healthy age, gender and years of education matched controls (M:F-10:5, age-28.13 ±â€¯4.76 years) underwent auditory and visual oddball tasks in MEG and cognition assessment using Indian Council of Medical Research (ICMR)-cognitive test battery. Independent component analysis (ICA) was applied to the magnetic evoked field responses for the detection of the P300 component. Source localization of P300 was performed with Classical LORETA Analysis Recursively Applied (CLARA). The latency and amplitude of P300 were estimated and subsequently correlated with cognitive scores. RESULTS: The visual P300 amplitude in the TLE group was lower when compared to the control group. In subgroup comparison (controls vs. right HS vs. left HS), visual P300 amplitudes were lower in the right HS group compared to both left HS and control groups (p-value = 0.014). On the other hand, no significant difference for auditory P300 latency or amplitude was noted between patients and controls as well as between subgroups. A negative correlation found between the MEG visual P300 amplitude and Indian Trial Making Test (TMT)-B duration in the patient group. CONCLUSION: Patients with TLE-HS have decreased visual-P300 amplitude. A significant correlation found between visual P300 amplitude and cognitive tests of visuospatial attention and working memory. Overall, MEG based visual P300 amplitude can be further explored with large sample size studies to establish as a complementary objective test for cognitive assessment in TLE.

Tobacco Use Among College Students Across Various Disciplines in Kerala, India.

BACKGROUND: Tobacco use is a major public health concern in India. Its use in young people is linked to increased severity, longer duration, and reduced efforts to seek treatment for tobacco use. A significant proportion of young people are enrolled in colleges, and early prevention during this period has better effectiveness. There is preliminary evidence that prevalence may vary across courses even among students of the same sociocultural background. Hence, we compared the prevalence and correlates of tobacco use among college students enrolled in five common streams of collegiate education (medical, nursing, engineering, arts/science and others, law/fisheries) in Kerala, India. METHODS: 5784 college students from 58 colleges (medical, nursing, engineering, arts, and law and fisheries) selected by cluster random sampling in the district of Ernakulum, Kerala, completed a self-administered questionnaire incorporating standardized instruments. R software was used for analyses. Lifetime prevalence and severity of tobacco use were determined. Sociodemographic variables of tobacco users and nonusers enrolled in various courses were compared using chi-square test and two-way ANOVA. Furthermore, for each course, factors influencing tobacco use were identified using multivariable logistic regression analysis. RESULTS: The mean age of the sample was 19.5 ± 1.9 years, with the majority being female (65.3%). Lifetime prevalence of tobacco use varied from 0.5% in nursing students, 4.2% in medical students, 8.2% in students of arts and science, 12.5% in engineering students, and 22.8% among other students (law/fisheries). Approximately two-thirds of all tobacco users across courses showed signs of nicotine dependence. Dependent users also showed variance with none in nursing, 2.6% among medicine, 1.6% among arts and science, 1.9% among engineering, and 6.3% among others. Male gender and alcohol use were consistently associated with tobacco use across courses, whereas other examined psychosocial correlates showed variance. CONCLUSIONS: To conclude, it appears that among college students, course-level characteristics may influence risk of tobacco use. This has public health importance as it suggests that interventions need to be tailored bearing this in mind. Future research needs to examine campus-level characteristics that may explain variance.

Insomnia Among Elderly Primary Care Patients in India.

OBJECTIVE: To assess insomnia and its health correlates among elderly primary care patients in India. METHODS: A multicenter, cross-sectional survey was administered to 1,770 elderly primary care patients from 71 government primary health centers in Kerala, India, from May to December 2016. Insomnia was evaluated using the Insomnia Severity Index. Basic demographics and information about medical illness were collected. Study instruments included the Patient Health Questionnaire-Somatic, Anxiety, and Depression Symptoms; Alcohol Use Disorders Identification Test; Fagerström Test for Nicotine Dependence; 12-item World Health Organization Disability Assessment Schedule; and World Health Organization Quality of Life-BREF. RESULTS: Valid responses were received from 1,574 (89%) patients, of whom the mean age was 68.6 years and 55.5% were women. Clinical insomnia was reported by 11.8%, whereas 30.4% had subclinical insomnia. Primary care attendees with subclinical as well as clinical insomnia had increased odds of being older and female and having chronic medical illness compared with those without insomnia. Patients with clinical insomnia had increased odds of common mental disorders (anxiety, depression, and somatization) and greater disability compared with the subclinical or no insomnia groups. Those with subclinical insomnia had poor satisfaction with life compared to those with no insomnia. CONCLUSIONS: Insomnia in the elderly is frequent in primary care patients in India and has multiple negative health correlates. This study reiterates the need for more awareness with regard to detection and management of insomnia in the elderly population.

Gender-Specific Correlates of Alcohol Use Among College Students in Kerala, India.

BACKGROUND: Studies of alcohol use among college students in India have reported a male preponderance, but a recent large study suggested that alcohol use is increasing in young females. This increase in use among the young females is of concern as they experience poorer outcomes and a higher risk for addiction. Hence, we aimed to examine the gender-specific correlates of alcohol use among college students in the district of Ernakulum, Kerala. METHODS: From 58 colleges, 5,784 students completed a self-administered questionnaire that assessed use of alcohol, use of tobacco and illicit drugs, psychological distress, suicidality, symptoms of attention deficit hyperactivity disorder, and history of sexual abuse. RESULTS: Of the questionnaires, 342 had incomplete responses and had to be discarded, and the rest (n = 5,442, 94.1%) were analyzed. lifetime alcohol use was reported by 39% males and 12.6% females. In the multivariable logistic regression analysis using a full model, male students using alcohol compared to male non-users were older, non-Muslim, had poor academic performance, and used other substances. Female users, compared to female non-users, were non-Muslim, had urban residence, used tobacco, and had higher psychological distress, higher suicidal thoughts, and higher lifetime exposure to sexual abuse. CONCLUSION: Gender-specific differences extend across sociodemographic and psychological domains. Incorporation of these may improve the effectiveness of public health strategies addressing alcohol use.

Prevalence and Correlates of Self-Reported ADHD Symptoms in Children Attending School in India.

Objective: To study the prevalence and correlates of self-reported ADHD symptoms among school-going adolescents from Kerala, India. Method: Seven thousand five hundred sixty students from Classes 8, 10, and 12, aged 12 to 19 years, across 73 schools selected by cluster random sampling, were invited to participate, but only 7,150 successfully completed the questionnaire incorporating standardized instruments. Results: Three hundred five (4.3%) self-reported symptoms for ADHD combined type, 131 (1.8%) for ADHD hyperactive-impulsive type, and 102 (1.4%) for ADHD inattentive type with a male predominance. Binary logistic regression analysis showed that those with symptoms of ADHD (combined type) compared with the non-ADHD group had poorer academic performance, significantly higher substance use, psychological distress, suicidality, and sexual abuse. Conclusion: The high prevalence of self-reported ADHD symptoms and its association with negative correlates previously reported in literature in those with a diagnosis of ADHD suggests that clinically significant self-reported ADHD symptoms could be as disabling as ADHD.

Association of Childhood Attention Deficit Hyperactivity Disorder Symptoms with Academic and Psychopathological Outcomes in Indian College Students: a Retrospective Survey.

OBJECTIVE: To survey the prevalence of retrospectively recalled clinically significant symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and determine the association of ADHD symptoms in childhood with current academic achievement and psychopathological outcomes among college students in the state of Kerala, India. METHODS: A self-administered questionnaire was distributed to 5784 students from 58 colleges selected by cluster random sampling. The Barkley Adult ADHD Rating Scale-IV was used for recollection of childhood ADHD symptoms; a total score of ≥60 (indicating the 99 percentile) was taken as the cut-off for clinically significant ADHD symptoms in childhood. The Alcohol, Smoking and Substance Involvement Screening Test was used to assess lifetime use of alcohol and tobacco. The Kessler Psychological Distress Scale was used to assess non-specific psychological distress. Lifetime suicidality and exposure to sexual abuse were assessed by asking relevant questions. Students who recalled having clinically significant ADHD symptoms in childhood were compared with those who did not. RESULTS: Of 5784 students, 639 (11.5%) did not complete the questionnaire. Of the remaining 5145 students, 1750 (34.8%) were men and 3395 (65.2%) were women, with a mean age of 19.4 years. 143 (2.8%) students reported clinically significant ADHD symptoms in childhood. Childhood ADHD symptoms were significantly more common in men and in those living in urban areas. In the bivariate analysis, those with clinically significant ADHD symptoms in childhood had significantly higher odds of poorer academic performance, alcohol use, tobacco use, psychological distress, suicidal thoughts, suicidal attempts, and contact and non-contact sexual abuse, after adjusting for sex and residence. CONCLUSIONS: Clinical evaluation and appropriate management may be warranted for adults who retrospectively recall clinically significant ADHD symptoms in childhood.