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'Swatantra-Clinic' at NIMHANS, India, provides mental healthcare to vulnerable children. This study describes the clinical profile, vulnerability and protective factors of 77 adolescents in conflict with the law (CICL). 90.9 % (n=70) reported Adverse Childhood Experiences (ACEs), 58.4 % (n=45) had school-related difficulties, 68.9 % (n=53) reported child labour experiences, 64.9 % (n=50) had deviant peer associations, and 40 % (n=31) experimented with substance use. Despite vulnerabilities, 72.7 %(n=56) had a positive future orientation, 45.5 % (n=35) had supportive caregivers and exhibited prosocial skills. only 12 % (n=9) followed up on recommendations, highlighting the need for collaborative and transdisciplinary care to promote CICL rehabilitation and community integration., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Psychiatric practice faces many challenges in the first quarter of 21st century. Society has transformed, as have training requirements and patient expectations, underlining an urgent need to look at educational programmes. Meanwhile, awareness has grown around psychiatric disorders and there are evolving workforce trends, with more women going to medical school and specialising in psychiatry. Trainee psychiatrists carry different expectations for work-life balance and are increasingly becoming conscious of their own mental health. A tendency to see health as a commodity and the litigious nature of society has elicited additional pressures for healthcare professionals. Cartesian mind-body dualism has created further complexity and this can often be frustrating for patients and care-partners alike. In many cultures across Asia and beyond, patients can present with physical symptoms to express underlying psychological distress with increasing physical investigations. Simultaneously, in various countries, a shift from asylums to community-based interventions and then home treatments have changed psychiatric care in remarkable ways. These changes have added to pressures faced by mental healthcare professionals. However, trainees and other mental healthcare professionals continue to receive similar training as they did a generation ago. The tensions and differences in ideology/orientation between different branches of psychiatry have made responses to patient needs challenging. Recognising that it is difficult to predict the future, this World Psychiatric Association-Asian Journal of Psychiatry Commission makes recommendations that could help institutions and individuals enhance psychiatric education. This Commission draws from existing resources and recent developments to propose a training framework for future psychiatrists., Competing Interests: Declaration of Competing Interest No competing interests to declare in relation to this manuscript., (Copyright © 2023. Published by Elsevier B.V.)

In India, legal response to a sexual offence, namely, punishment of the perpetrator,relies nearly entirely on mandatory reporting provisions in child sexual abuse law.Mandatory reporting forms an important first step in the medico-legal processes of CSAwork, because it leads onto other legal interventions in CSA cases. However, social, stigma, perceived harassment, rampant gender stereotypes, the unwillingness of, family, disbelief of the victim, and threats by the perpetrator are a few of the many, barriers to mandatory reporting in the Indian context. One particularly insufficiently, addressed critical barrier in the global and Indian literature on CSA and law stems from the reluctance of children to allow child protection and mental health professionals to report to relevant authorities. There are few guidelines or practical strategies available,on how to engage children in mandatory reporting processes. This article uses a childcentric lens to propose the need to balance children's rights to participation and decision-making with the mandatory reporting law. It proposes a conceptual frameworkthat acknowledges the imperatives and challenges of the mandatory reporting law and its implementation, whilst also recognizing children's barriers to abuse disclosures andtheir rights to make decisions and provide consent on reporting issues. It culminates in a guideline for child mental health and protection service providers, offering step-bystep support on navigating the challenges and dilemmas of mandatory reporting through suggested scripts that engage children to enable more effective reporting ofCSA to child protection systems and relevant legal authorities., Competing Interests: Conflict of Interest None to Declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)

There are a multitude of stakeholders involved in the protection, education, mental health and psychosocial care of children for children in LMIC countries. The article presents how the current medical and public health models for child mental healthcare, do not adequately address the complexities of child protection and mental health. It argues for mental health professionals to: (a) recognise the role of Adverse Childhood Experiences (ACEs) in mental health morbidity; (b) adopt an alternative approach, namely that of transdisciplinarity, to enable more effective solutions to children's psychosocial and mental health issues, through systemic reform and transformation., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: The increasing rates of divorce in urban India has led to the subsequent parental battle for the child's custody. This paper discusses the behavioral and emotional issues of these children in relation to their psychosocial environmental factors and other relevant socio-demographic variables., Methods: We used samples from parent interviews concerning 52 children aged 7-17-years-old, involved in child custody cases in the Family court of urban Bengaluru. The Strengths and Difficulties Questionnaire was used to measure response variables of behavioral and emotional issues in these children. Predictor models of quantile and multiple linear regression were used to assess the influence of psychosocial environmental factors and socio-demographic variables on the response variables., Results: The predictor models revealed that risk of child suffering emotional and behavioral issues increased with factors such as excessive parental control, change of academic environment, general unrest at school, frequency of child's court visit, child's visitation of non-custodian parent on occasions and vacations, and negatively altered family relationship. The model however intriguingly showed that residing in nuclear household rather than with their grandparents in a non-nuclear household, decreased the risk of mental health issues in these children., Conclusions: This study is a novel attempt to understand the influence of the psychosocial issues on the child's mental health in the context of custody cases in India. Despite the minimum sample size, the findings imply that family-based intervention is the need of the hour in these cases. The implications for clinical practice and research are discussed., (Copyright © 2021 Elsevier B.V. All rights reserved.)

In India, children in difficult circumstances, like institutionalized children have higher mental health morbidity and complex psychosocial concerns than the non-institutionalized children. To cater to the complex needs of these children referred by the Juvenile Justice System, a specialized service called 'Swatantra Clinic' was initiated by the Department of Child and Adolescent Psychiatry at the National Institute of Mental Health and Neurosciences, India. This article thereby aims to describe the psychosocial characteristics of these children, along with the array of specialized interventions provided during the first year of its inception in June 2018. It was found that majority of these children were girls and were from lower socio-economic, urban background, primarily referred for externalizing or internalizing concerns. The majority of them reported experiences of physical and verbal abuse along with family stressors and almost half of them had a diagnosable psychiatric condition. The nature of the psychosocial services rendered at the clinic mostly comprised of brief, individual and family counseling along with liaison work with various governmental agencies for rehabilitation services. These form the key components of a comprehensive, collaborative, time-bound and holistic care model to cater to the distinct psychosocial issues of this vulnerable population of children in low - middle resource settings. Policy implications are discussed., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The dilemma of adolescent consent confounds dispensation of justice in child sexual abuse and juvenile justice contexts, with legal personnel struggling to discern between consent and coercion in cases of adolescents who are sexually abused and those who are accused of alleged sexual offences. Given that capacities for consent also determine personal safety and mental health, there is an imperative to build a child mental health research agenda for developing methodologies that incorporate psychological knowledge on abuse dynamics, adolescent mental health and development, vulnerability and risk, to assess adolescent sexual consent and sexual decision-making processes., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The present study aimed to develop a qualitative measure for assessment of child sexual abuse (CSA) awareness and perceived barriers to CSA disclosure based on adolescents' perspectives and expert consensus. Focus group discussions (FGD) were conducted with the adolescents (n = 10) and the Delphi method was used to gain expert consensus (n = 5). The FGDs were audio recorded and Delphi method was conducted via email. Salient domains and themes were identified through manual thematic analysis of the qualitative data obtained from both the methods. Data validity and authentication was obtained through data and researcher triangulation. The qualitative measure for assessment of CSA awareness and perceived barriers to CSA disclosure consisting of 13 qualitative questions was developed based on these domains and expert opinion. The test-version was administered to a pilot sample of 20 adolescents meeting the inclusion criteria for this study. Based on their feedback on ease of understanding and clarity, questions were modified and rearranged. Participation rate was found to be high amongst adolescents as they readily agreed to engage in the study. Findings further indicated that the ambit of CSA awareness includes knowledge of multiple aspects like forms of sexual abuse, characteristics associated with people at risk for perpetration and at risk for victimisation, prevalent beliefs about CSA, prevention strategies and CSA legislation in India. Perceived barriers to CSA disclosure were identified in the context of self, others and the society. Implications for research, and the need for preventive frameworks for CSA in Indian context are discussed., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Specific Learning Disability (SLD) is a neurodevelopmental disorder with significant problems in language processing, which are evident through difficulties in reading, writing, spelling, and mathematics. SLD was notified as a disability by the Government of India in 2016. Until then, it was primarily left to the discretion of the individual education boards to decide the assessment procedures and support measures for a child suspected to have SLD. However, with the enforcement of the Rights of Persons with Disabilities Act 2016 (RPWD Act), there is a legal binding to follow specific guidelines for assessment and certification mentioned in the RPWD Act. Nonetheless, there are issues inherent to the construct of SLD described in the diagnostic manuals and the current certification processes under the RPWD Act. In this context, this paper highlights the discrepancies in the requirements of the RPWD Act and the diagnostic criteria of the International Classification of Diseases -10 (ICD-10) and the Diagnostic and Statistical Manual- 5 (DSM-5) and draws implications for assessment and certification procedures which will affect the lives of millions of children in the Indian context. It also presents potential solutions and possible future directions related to the assessment of the SLD., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Novel Coronavirus disease 19 (COVID 19) pandemic has affected more than 2 million individuals and causing over 0.1 million deaths worldwide. In India, the pandemic has gained momentum in the last few weeks with over 10,000 cases and 400 deaths. In the absence of any pharmacological cure on the horizon, countries have resorted to the use of strict public health measures to curtail spread of further infection to fight the coronavirus. The pandemic and its social implications have triggered mental health concerns among the masses. Providing psychological first aid and psychosocial support is vital in mitigating the distress and enhance the coping strategies of people to deal with this biological disaster. Tele-mental health services play an important role in this regard. In this article we describe our preliminary experience in understanding the psychological concerns of general public and addressing them by providing psychological support through a national telephonic helpline., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This article reports on a Continuing Medical Education Programme (CME), organized by the Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, in March 2019. The theme, Adolescence: contemporary issues in the clinic and beyond, aimed to cover 'lesser understood and challenging' areas in adolescent mental health. The CME was attended by over 200 professionals from various fields - clinicians, post-graduate students in psychiatry, psychology and psychiatric social work, school counsellors, and members of non-governmental organisations working in the areas of childcare and law. The article covers key messages from the 8 sessions in this CME., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: There is a recent trend of increase in diagnosis of Autism Spectrum Disorder in India. Till date, there are few retrospective and prospective Indian studies with limited sample sizes ranging from 16 to 94 children. With this background, we planned a retrospective chart review of all new cases of Autism Spectrum Disorder for a period of 1 year in our tertiary care child psychiatry centre., Methodology: Objectives of this study were to compare the sociodemographic and clinical profile of children below and above 3 years of age and between those who were self-referred versus those referred by professionals., Results: Out of a total of 1957 case records, 201 children (10.3%) were diagnosed with Autism Spectrum Disorder. Male to female ratio was 4:1.2. Mean age of consultation was significantly higher in males. Seventy six percent had a comorbid disorder with Intellectual disability, Attention Deficit Hyperactivity Disorder and Epilepsy being the most common comorbidities. Most caregivers (92.5%) recognized symptoms by 3 years of age. Presenting complaint of poor social response was more prevalent in children <3 years and co-morbidities in children above 3 years. Presenting complaint of speech delay was more common in children who were referred by professionals when compared with those who were self-referred., Discussion: There is a need to sensitize parents and professionals for early intervention and to standardize protocols for assessment and intervention., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Post-Traumatic Stress Disorder (PTSD) presents unique challenges in toddlers and pre-schoolers as there are difficulties in assessment and overshadowing by comorbid illnesses. We present case descriptions of two pre-schoolers with developmental manifestations of the PTSD symptoms of intrusion, avoidance and alteration in arousal and reactivity following penetrative sexual abuse. These symptoms caused significant impairment and required a combination of pharmacological and psychotherapeutic intervention. This case report facilitates recognition of the disorder in preverbal and early verbal children and suggestions on management of PTSD in pre-schoolers are provided., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objectives: To study the clinical features of children with history of sexual abuse., Method: A chart review of 40 children (<16 years) with history of Child Sexual Abuse (CSA) evaluated at the Department of Child and Adolescent Psychiatry at NIMHANS during a three year period., Results: 52.5% (N=21) of the children came from broken families. The most common form of abuse was contact penetrative (67.5%) followed by contact non-penetrative abuse (30%). Seventy-Five percent (N=30) had a psychiatric diagnosis at baseline and 37.5% of these children had comorbidities. The commonest diagnoses were Depressive Disorder (35%) followed by Stress related disorders--PTSD and Acute Stress Disorder (25%). Children abused multiple times were more likely to have psychiatric illness following CSA. Children abused by multiple perpetrators were more likely to have depression, psychiatric comorbidity and more prone to exhibit sexualized behaviour. Sixty five percent of children did not follow up 8 weeks after the initial consultation., Discussion: Psychiatric morbidity is high in the population of children with history of CSA. It is necessary to assess the risk factors, circumstances of abuse along with psychiatric morbidity in order provide flexible and tailor made interventions for this population. In order to ensure the best possible care for these families, focused and time limited intervention that respect the needs of the child and addresses the ground realities of the circumstances of the family and the health system are the need of the day., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Pervasive refusal syndrome is described as a condition comprising varying degrees of refusal across several domains; social withdrawal; resistance to treatment and is potentially life threatening with no detectable organic cause. Female predominance, refusal to eat with low weight, body image distortion, depressive features, premorbid personality issues similar to eating disorders have been noted, with 67% cases having complete recovery. In this paper, we describe what is probably the first case reported from India, of a child, who presented with neuropsychiatric symptoms, and treated with electroconvulsive therapy along with medications, but, sadly had a fatal outcome., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Aims and Objectives: The use of electroconvulsive therapy (ECT) in children and adolescents is a controversial issue. This study was done to examine the pattern and practice as well as the outcome of electroconvulsive therapy administered to children and adolescents admitted to a tertiary care centre., Methodology: A 10 year retrospective chart review of all children and adolescents (up to 16 years of age) admitted in the Child and Adolescent Psychiatry Centre, National Institute of Mental Health and Neurosciences (NIMHANS) who had received at least 1 session of ECT was done. Information regarding diagnosis, reasons for prescribing electroconvulsive therapy, details regarding the procedure and outcome variables was collected from the records. Clinical Global Impressions (CGI) scale rating of the severity of illness and improvement seen were done by 2 trained psychiatrists independently., Results: 22 children and adolescents received electroconvulsive therapy over 10 years. There were an equal number of boys and girls. All received modified ECT. Most patients who received electroconvulsive therapy were severely ill. Catatonic symptoms 54.5% (12) were the most common reason for prescribing electroconvulsive therapy. It was efficacious in 77.3% (17) of the patients. Electroconvulsive therapy was relatively safe, and most experienced no acute side effects. 68.2% (15) who were on follow up and did not experience any long term side effects due to the electroconvulsive therapy., Conclusions: Electroconvulsive therapy has a place in the acute management of severe childhood psychiatric disorders. Further long term prospective studies are required., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background and Need for the Study: Identification and management of aggression is a major mental health priority in hospitalised patients. However, no such studies have been done in child and adolescent in-patients in India., Objectives: To study the clinical and demographic features; characteristics of the aggression and methods employed to manage aggression in child and adolescent in-patients., Materials and Methods: Child and adolescent in-patients between the ages of 4 and 16 years who were aggressive were included. The tools used were the MINI-International Neuropsychiatric Interview (M.I.N.I) KID, Overt Aggression Scale (OAS), Children's Global Assessment Scale (CGAS), and a Semi-structured interview regarding each aggressive episode., Results: 31 patients displayed aggressive behaviour out of the 131 patients who were admitted during the study period. Aggressive acts were more common in males, those with academic difficulties, who had a past history of aggression, with suicidal ideation or suicidal attempts. Aggression occurred across diagnostic categories but a significant proportion was diagnosed to have Disruptive Behaviour Disorders either as a primary diagnosis or as comorbidity. 90.6% were on psychotropic medication prior to admission. Around 2/3rd of aggressive episodes occurred in the evening and family members (85.7%) were the most common targets of aggression., Conclusion: There are a few factors that can possibly help identify and predict aggression in children and adolescents in a hospital setting. More research is required to understand aggression in clinical settings., (Copyright © 2013 Elsevier B.V. All rights reserved.)