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Nair M.K.C.,Medical College | Russell P.S.,Child and Adolescent Psychiatry Unit
Journal of Clinical Epidemiology | Year: 2013

Objective: To develop, standardize, and validate a developmental scale for children, 3-4 years old, attending Anganwadis (Integrated Child Development Scheme) in India, as a follow-up assessment, using a normative approach. Study Design and Setting: After the development of the 12-item Developmental Assessment Tool for Anganwadis (DATA-II), its internal consistency as well as face, content, and construct validities were studied in 100 children in Anganwadis and were found to be appropriate. A total of 385 children with a mean (standard deviation) age of 43.05 (5.02) months from randomly selected 36 Anganwadis were recruited for its standardization. Raw scores were converted to standardized T scores. Scoring pattern for domains and aggregate developmental scores were formulated. Results: Except for four items in the original scale, all the items were endorsed by parents suggesting a good content validity, and Kuder-Richardson Formula 20 coefficient of 0.80 suggested a high internal consistency. Factor analysis replicated the six-factor structure explaining 76.5% of variance. An aggregated developmental score based on the standardized T scores demonstrated that a DATA-II score between 29 and 33 suggested "at risk" for developing developmental delays. A score of 28 or less suggested already delayed milestones. A score of 19-28 suggested a "mild delay," 8-18 suggested a "moderate delay," and 7 or less suggested a "severe delay" in development. Conclusion: The DATA-II is a measure for use in Anganwadis for identifying children at risk or with developmental delays during the first follow-up assessment, in India, for appropriate referrals and interventions. © 2013 Elsevier Inc. All rights reserved.


Russell P.S.,Child and Adolescent Psychiatry Unit
Indian journal of pediatrics | Year: 2013

There is significant paucity of studies on the impairment associated with Anxiety Disorders (AD) among adolescents. This study focuses on the prevalence and pattern of impairment as well as impairment in the context of severity of AD, co-morbidities, suicide, age and gender in this population. In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders (SCARED) and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime to collect the required data. Descriptive statistics and Chi-square tests were done to evaluate the prevalence and profile of impairment, compare the impairment among different types of AD, severity of AD, number of co-morbidities, age and gender on impairment, effect of impairment on the need for suicide prevention. Impairment in adolescents with AD was a rule, noted in 94.4%. Irrespective of the type of AD diagnosed, impairment at home was significant in adolescents with AD. The presentation of impairment among different Anxiety Disorders was different with different functional settings. Severity of AD and the number of co-morbidities was related to the impairment. Need for suicide related interventions were not different in those with and without impairment. Age and gender did not influence the presence of impairment. Anxiety Disorders among adolescents in India result in significant functional impairment. Clinically, in this population assessment of impairment is required. Community policies and plans should have special management strategy to address impairment in adolescents with Anxiety Disorders.


Ever since Freud's Three Essays on the Theory of Sexuality (1905d), infant sexuality has been an important topic for psychoanalysts. The author describes her psychoanalytic work with a six-year-old girl to illustrate child development in this connection from initial confusion to a degree of understanding about the way things hang together.


Russell P.S.,Child and Adolescent Psychiatry Unit
Indian journal of pediatrics | Year: 2013

Anxiety Disorders (AD) have been known to have high prevalence of intra-AD and extra-AD co-morbidities. This study documents the prevalence and profile of intra and extra-AD co-morbidities, the effect of the presence and number of co-morbidities on the severity of anxiety symptoms and the influence of age as well as gender on the co-morbidity. In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders (SCARED) and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) to collect the required data. Descriptive statistics, independent t tests, one-way ANOVA and Chi-square tests were done to evaluate the prevalence and profile of co-morbidity presentation, compare the effect of co-morbidity on severity of anxiety symptoms as well as analyse the influence of age groups and gender on intra-AD co-morbidities. Among those with AD, 14.2% had a DSM-IV-TR intra-AD co-morbidity and 70% had SCARED based intra-AD co-morbidity. Adolescents with Separation Anxiety Disorder and Generalised Anxiety Disorder had the highest SCARED and DSM-IV-TR prevalence of intra-AD co-morbidity respectively. Also, 23.7% had overlapping extra-AD co-morbidity. Presence and number of intra-AD co-morbidity was significantly associated with severity of total anxiety score and subscale scores (all with P = 0.001). Age and gender of adolescents were not related to the co-morbidity. Intra and extra-AD co-morbidities are quite prevalent among adolescents with Anxiety Disorders in India. As such, co-morbidities increase the severity of anxiety symptoms, they should be identified and appropriate management should be established.


Screen for Child Anxiety Related Emotional Disorders (SCARED), a measure found useful in different settings and cultures has not been validated in the subcontinent. This study validated this measure for identifying Anxiety Disorder (AD) among adolescents in an Indian community context. Five hundred adolescents were assessed with SCARED and DSM-IV-TR reference standard for diagnosis of AD. The interviewers were experienced raters who were further trained to interview participants using Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL). Sensitivity, specificity, likelihood ratios and predictive values for various SCARED cut-off scores were calculated. Test-retest reliability and inter-rater reliability of SCARED were examined. The dichotomized SCARED score was correlated with the DSM-IV-TR clinical diagnosis of AD to establish the criterion validity of SCARED as a measure of AD. A SCARED total score of ≥21(Sn = 84.62%, Sp = 87.36%; AUC = 90%) is suggested for diagnostic use in Indian population. Specific threshold scores were identified for the Panic Disorder, Generalized Anxiety Disorder, Separation Anxiety Disorder and Social Anxiety Disorder subscales. The inter-rater reliability (ICC = 0.87) and test-retest reliability (ICC = 0.90) for SCARED is good. Besides the adequate face and content validity, SCARED demonstrates good internal consistency (Cronbach's α = 0.89) and item-total correlation. There is a high concordance rate with the reference standard, DSM-IV-TR diagnosis [81%; Cohen's κ = 0.42 (95% CI = 0.31 to 0.52); P = 0.001] in classifying AD. SCARED has adequate psychometric properties and is now available for clinical and research work in India.


Psychoanalytic theory derives many or its concepts from psychic processes assumed to exist in babies and infants and further assumed to subsequently influence the adult psyche. The author contends that mother-infant psychoanalytic treatment (MIP) is a variant of general psychoanalysis and that many classic psychoanalytic concepts can and should be integrated into the theory pertaining to this form of treatment. For example, infant sexuality plays a major role in many mother-child disorders. Regardless of this, many mother-child therapists make little use of infant sexuality to explain such disturbances. If infant sexuality is to be of any clinical value, it must be clearly distinguished from attachment and understood in the context of the mother's «enigmatic messages» to her child, as proposed by Jean Laplanche. The author discusses two example cases. One is the video recording of a newborn chid and its parents, the other a clinical situation in which the analyses infant sexuality materialises in a comment addressed to a 3-month-old child.


Russell P.S.,Child and Adolescent Psychiatry Unit
Indian journal of pediatrics | Year: 2013

The Anxiety Disorders among adolescents (ADad) study aimed to document the prevalence, clinical pattern, co-morbidities, predictive factors, relationship with depression, associated suicidal phenomenon and school phobia of Anxiety Disorders in a rural community population in India. This paper reviews the rationale and study design used as well as discusses the strengths and limitations of the survey. The ADad was a cross-sectional study that recruited 537 adolescents, with anganwadi workers, representative of the population aged 11-19 y. Trained raters independently administered the Screen for Child Anxiety Related Emotional Disorders (SCARED), Beck Depression Inventory (BDI), SAD PERSONS scale and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL). Appropriate bivariate and multivariate statistical analyses were done. Five hundred adolescents opted to participate and completed the study. About 37% of boys and 63.4% of girls responded to the measures, almost comparable with the gender distribution in the panchayat. The ADad study creates a comprehensive database on validation of measure, the prevalence, clinical pattern, co-morbidities, predictive factors, relationship with depression, associated outcomes of suicidal phenomenon, school phobia, impairment associated with Anxiety Disorders and policy recommendations in a community population of adolescents in India. These data will enable policy makers to rationally plan clinical services and prevention programs for the target population.


Russell P.S.,Child and Adolescent Psychiatry Unit
Indian journal of pediatrics | Year: 2013

The risk of suicidal behavior associated with Anxiety Disorders (AD) among adolescents is known. However, concurrent mood disorders complicate these findings, and no data is available from India as well as from the community. This study aimed to address the suicidal risk associated with AD from different perspectives. The authors prospectively collected data for 500 adolescents in a community with independent, trained raters. Risk for suicidal behavior was measured with SADPERSONS scale, socio-economic status with Modified Kuppuswamy Scale, depression and anxiety disorders with Beck Depression Inventory and Screen for Child Anxiety Related Emotional Disorders respectively. The relationship between predictors and need for preventive action was analyzed with univariate and multivariate regression analyses and a predictive model was built. Suicidal behavior was increased by the presence of AD (adjusted OR = 6.28), the number of co-morbid AD (adjusted OR = 2.04), severity of the AD (adjusted OR = 4.98). Being a boy increased the risk of suicidal behavior associated with AD (adjusted OR = 9.37), Generalized Anxiety Disorder (adjusted OR = 5.65), Separation Anxiety Disorder (unadjusted OR = 3.28), Social Anxiety Disorder (unadjusted OR = 5.91) while controlling for the confounding effect of Depressive Disorder. Gender did not have an influence on Panic Disorder. Presence of AD and co-morbid Depressive Disorder significantly contributed to a risk model for suicidal behavior. Anxiety Disorder is associated with the risk for potential suicidal behavior. Adolescent boys with AD and Depressive Disorder need to be identified as the high risk group for suicide prevention in the community.


Russell P.S.,Child and Adolescent Psychiatry Unit
Indian journal of pediatrics | Year: 2013

Anxiety Disorders (AD) often co-exist with the heterotypic co-morbidity of Major Depressive Disorder (MDD) and Dysthymia (DysD). This study documents the prevalence of concurrent Depressive Disorder and its subtypes among AD, relationship between specific AD and Depressive Disorders, influence of severity of Depressive Disorders (DD) on AD and vice-versa, as well as the effect of age and gender on this co-morbidity. In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders, Beck Depression Inventory and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version to collect the required data. Descriptive statistics, Independent t tests and Chi-square tests were done to evaluate the prevalence of concurrent Depressive Disorders among AD, relationship between specific AD and Depressive Disorders, severity of DD, and effect of age and gender on this co-morbidity. Depressive Disorders were concurrently present in 23.7% of adolescents with AD, while 13.9% had concurrently only MDD, 8.3% had only DysD and 1.5% had both. More adolescents with AD had multiple mood disorders than otherwise. Twenty percent of adolescents with Panic Disorder, 12.1% with Generalised anxiety Disorder, 5.3% with Separation Anxiety Disorder and 12% with Social Anxiety Disorder had Depressive Disorders. Dysthymic disorder was statistically significantly more among those with PD (P = 0.009). Depressive Disorders were more severe among those with AD (P = 0.001) and the AD was more severe in those with DD (P = 0.01). As the severity of AD increased the severity of the DD also increased (P = 0.001). While DD were more prevalent among the late adolescence (P = 0.001), gender did not have any influence. The two-way overlap between AD and DD is prevalent. Adolescents with Anxiety Disorders should be screened for Depressive Disorders, and when present should be treated.


Mammen P.,Child and Adolescent Psychiatry Unit | Russell P.S.S.,Child and Adolescent Psychiatry Unit | Nair M.K.C.,Thiruvananthapuram Medical College | Russell S.,Child and Adolescent Psychiatry Unit | And 2 more authors.
Journal of Clinical Epidemiology | Year: 2013

Objective: To develop and validate a concise, parent-completed Brief Intellectual Disability Scale (BIDS) for children in low-disability resource and high-disability care burden countries. Study Design and Setting: In this prospective cross-sectional study of 124 children recruited from a facility for intellectual disability (ID), the newly developed BIDS as the measure for validation as well as for the gold standard and convergent and divergent validities was administered by independent raters. Tests for diagnostic accuracy, reproducibility, and validity were conducted at the item and scale levels. Results: The BIDS scores of ≥5 (sensitivity [Sn] = 71.43%, specificity [Sp] = 80.95%) and ≥11 (Sn = 4.29%, Sp = 100%), with area under the curve of 0.79, are suggested, respectively, for screening and diagnostic use in Indian populations. The inter-rater reliability (intra-class correlation coefficient [ICC] = 0.96) and test-retest reliability at 4 weeks (ICC = 0.95) for BIDS are strong. Besides the adequate face and content validities, BIDS demonstrates good internal consistency (Cronbach α = 0.80) and item-total correlation. There is moderate convergent validity with Binet-Kamat Test of Intelligence or Gesell's Developmental Schedule (r = -0.66, P = 0.001) as well as with adaptive behavior measure of Vineland Social Maturity Scale (r = -0.52, P = 0.001) and low divergent validity with the subscales of Attention Deficit Disorder with Hyperactivity: Comprehensive Teacher Rating Scale (r = -0.11, P = 0.7; r = 0.18, P = 0.5; r = 0.13, P = 0.6; r = 0.08, P = 0.7). An exploratory factor analysis demonstrated a three-factor structure, explaining 60% of variance. Conclusion: The BIDS shows promise as a psychometrically adequate, yet brief measure for identifying ID in countries with low disability care resources and high disability-related burden. © 2013 Elsevier Inc. All rights reserved.

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