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Aim and Objectives: Although inclusive education of children with intellectual disability is currently an accepted practice, it is often challenged by negative attitude of schoolteachers. We undertook two surveillance studies aimed at Study A - identifying knowledge and teachers' attitudes towards children with intellectual disability and practices of inclusive education in a semi-urban school of South India. Study B -Determining the effect of educational intervention towards attitudes on inclusive education. Method: Knowledge, Attitude and Practice surveillance questionnaires (KAP and ATPD) were given to ninety-six consenting schoolteachers in Study A and twenty schoolteachers in Study B and analyzed. Results: In Study A, the overall attitude mean indicated a favorable attitude towards the children with intellectual disability. The mean overall attitude score was 77.1 (SD: 9.58), with a normal distribution. Forty to fifty percent were aware of intellectual disability and attributed them to biological causes. Ninety-two percent agreed on the need for education and stepwise training for a child with an intellectual disability. In real-life practice, results of classroom management were inaccurate. In Study B, knowledge, attitudes and practices towards inclusive education improved with educational intervention with a positive change of 7.19% on the ATDP scale. Conclusion: These findings suggest a generally positive attitude towards intellectual disability and inclusive education. Comprehensive training programs improve knowledge and attitudes towards inclusive education.

Abstract Background There is increasing interest in identifying adolescents with depression in primary care settings by paediatricians in India. This article studied the diagnostic accuracy, reliability and validity of Beck Depression Inventory (BDI) while used by paediatricians in a primary care setting in India. Methods 181 adolescents attending 3 schools were administered a back translated Tamil version of BDI by a paediatrician to evaluate its psychometric properties along with Children's Depression Rating Scale (CDRS-R) for convergent validity. Clinical diagnosis of depressive disorders, for reference standard, was based on ICD-10 interview by an independent psychiatrist who also administered the Impact of Event Scale (IES) for divergent validity. Appropriate analyses for validity and diagnostic accuracy both at the item and scale levels were conducted. Results A cut-off score of ≥ 5 (Sn = 90.9%, Sp = 17.6 %) for screening and cut-off score of ≥ 22 (Sn = 27.3%, Sp = 90%) for diagnostic utility is suggested. The 4 week test – retest reliability was good (r = 0.82). In addition to the adequate face and content validity, BDI has very good internal consistency (α = 0.96), high convergent validity with CDRS-R (r = 0.72; P = 0.001), and high discriminant validity with IES (r = 0.26; P = 0.23). There was a moderate concordance rate with the reference standard (54.5%) in identifying depression among the adolescents. Factor analysis replicated the 2-factor structure explaining 30.5 % of variance. Conclusion The BDI proved to be a psychometrically sound measure for use by paediatricians in a primary care setting in India. The possibility of screening for depressive disorders through the use of BDI may be helpful in identifying probable cases of the disorder among adolescents.

Byline: Mona. Basker, Paul. Russell, Sushila. Russell, Prabhakar. Moses Background: Adolescent depression needs to be identified and treated in the primary care settings. There is no clinician-rated measure validated in [...]

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

Objectives: Family dysfunction is observed in families with children with intellectual disability (ID). We study the prevalence, pattern of dysfunction, and severity of impairment in these special families using Systems approach. Methods: Sixty-two special families (a child with ID) and 62 typical families (all children with typical development) were included in the present study. The presence of ID was confirmed and quantified with the Binet--Kamat Scale of intelligence or Gesell's Developmental Schedule and Vineland Social Maturity Scales among the special families. In the typical families, brief ID scale was used to rule out ID. Prevalence, pattern, and severity of family dysfunction were assessed using Family Apgar Scale, Chicago Youth Development Study Family Assessment Scale and Global Assessment of Relational Functioning Scale, respectively. Appropriate bivariate analyses were used. Results: About 53% of special families and 19% of typical families had family dysfunction. About 21% of special families and 71% of typical families had the satisfactory relational unit. Areas of adaptability, partnership, growth, affection, resolve, beliefs about family, beliefs about development, beliefs about purpose, cohesion, deviant beliefs, support, organization, and communication were significantly different between special and typical families. The functional impairment was significantly more in the special families. Conclusion: Family dysfunction is more prevalent among special families in India using systems approach. These families should be screened for dysfunction, and family therapy be prescribed when required. [ABSTRACT FROM AUTHOR]

Objective: Brief Intellectual Disability Scale (BIDS) is a measure validated for identification of children with intellectual disabilities (IDs) in countries with low disability resources. Following the publication of the exploratory factor analysis of BIDS, the authors have documented the confirmatory factor analysis (CFA) of BIDS in this study. Materials and Methods: A prospective cross-sectional study was conducted to document the CFA of the BIDS. Primary caregivers (N = 124) of children with ID were recruited and rated the BIDS. We used alternative fit indices for the evaluation of comparative fit index (CFI) and root mean square error of approximation (RMSEA) to evaluate the model fit. The 2-index fit strategy was used to select the best factor model. Results: The model fit index for the original 3-factor model and alternative 2-factor and 1-factor models with 9 items of the BIDS was under identified along with another 3-factor, 7-item model. Another 1-factor, 7-item model was identified but did not satisfy the 2-index fit strategy. A short version of the scale with a 2-factor and 7-item model of BIDS presented the best fit indices of CFI = 0.952 and RMSEA = 0.069. Conclusion: Although the original factor structure of BIDS was not confirmed in this study, another alternative a priori model for the construct validity of BIDS was confirmed. Therefore, the BIDS factor structure has been revised, refined, and trimmed to the final 2-factor, 7-item shorter version. Further documentation of the diagnostic accuracy, validity, and reliability of this shorter version of BDI is recommended. [ABSTRACT FROM AUTHOR]

Background: A few self-administered questionnaires are available for assessing mental health among adolescents in primary-care settings. Brief measures are desirable for use in big-data, epidemiological studies. Objectives: To evaluate a 7-item version, of the Teen Screen Questionnaire-Mental Health (TSQ-M), the TSQ-M-Short. Materials and Methods: In this prospective cross-sectional study of 140 adolescents, recruited from 6 rural or urban schools, the newly developed TSQ-M-Short as the measure for validation and General Health Questionnaire-12 item (GHQ-12) as the gold standard measure were administered by independent trained raters. Tests for diagnostic accuracy and validity were conducted. Results: A total TSQ-M-Short score of = 6 had a sensitivity of 76%, specificity of 74%, positive likelihood ratio of 2.99, negative likelihood ratio of 0.33, positive predictive value of 6% and a negative predictive value of 82.1%. The area under curve (AUC) in the Receiver Operating Characteristic (ROC) for the TSQ-M-Short version was 0.84 (95% cumulative incidence (CI) = 0.76-0.89). The AUC for the TSQ-M-Short version was higher than the AUC for the original version, and the difference between the areas was 0.10 (95% CI = 0.02- 0.19), which was statistically significant (z = 2.49; P = 0.01). The internal consistency of TSQ-M-Short, as measured by chronbach's a, was 0.34 (95% CI = 0.15-0.48). The construct validity demonstrated a 3-factor structure, which explained 55% of the variance. Conclusion: The TSQ-M-Short has an overall diagnostic accuracy which is better than the original TSQ-M. Although the original version includes symptoms for more mental health disorders, providing a wider screen. This short version will prove useful in big-data studies. [ABSTRACT FROM AUTHOR]

Objective: To validate effectiveness of low intensity, home based early intervention (EI) models in autism for countries with low disability resources. Methods: Fifty-two toddlers and young children were assessed before and after intervention with Childhood Autism Rating Scale, Vineland Social Maturity Scale, and Receptive-Expressive Emergent Language Scale. Developmental and speech therapists helped mothers assemble low-cost training kits based on the developmental age of the child, gave initial training in the basic behavioral technique to address the three autism symptom clusters at home. Follow-up support was given either on a weekly, fortnightly or monthly basis. Most of the children were also placed in play-schools. Data was analyzed using appropriate bivariate and multivariate techniques. Results: There was statistical and clinical amelioration in the severity of autism, with acquisition of social skills and language skills (all P = 0.001) after intervention in children with mild to severe autism. Gender showed a trend in becoming a significant predictor for intervention response. Conclusions: Low-intensity, home-based EI can be effectively used in situations where there is paucity of disability resources in countries like India, especially in primary-care and community settings. [ABSTRACT FROM AUTHOR]

Objective: 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. Methods: 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. Results: 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. Conclusions: SCARED has adequate psychometric properties and is now available for clinical and research work in India. [ABSTRACT FROM AUTHOR]

Objectives: Anxiety Disorders (AD) in children and adolescents present with unique clinical features and exhibit phenotypic diversity. The symptom presentation varies with regard to age of onset, developmental factors and gender. This study documents the clinical presentation of AD among adolescents in India, and explores the symptom clusters among the different age groups as well as gender. Methods: Five hundred adolescents aged between 11 and 19 y from Pattanakad ICDS block, of Allapuzha district in Kerala were recruited and assessed using the self-rated Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire to identify symptom clusters of anxiety and this was followed by confirmation of the diagnosis using DSM-IV TR within a week. Anxiety symptom clusters and severity (obtained from continuous SCARED scores) were compared between early, middle and late adolescence subgroups as well as between sexes. Results: The most predominant anxiety symptoms across the subtypes were the anxious mood, which was noted in 12.60 % followed by cognitive symptoms in 9.94 % of the cases and finally physical symptoms in 9.22 % of the study sample. The symptom clusters varied among the subtypes with anxious mood being commoner in Panic Disorder (PD), cognitive symptoms in Generalised Anxiety Disorder (GAD) and physical symptoms were prominent among Separation Anxiety (SeAD) and Social Anxiety Disorders (SoAD). The severity of anxiety disorder in general and its various subtypes were mostly of mild intensity although significant proportion had a severe form of the disease(s). The severity of the AD among girls was statistically significantly higher than boys ( P = 0.02). There was no significant difference on symptom frequency or anxiety severity with regard to age. Conclusions: Understanding of age appropriate presentation of anxiety symptoms may help in streamlining the treatment guidelines and yield a better estimate of the disease process. [ABSTRACT FROM AUTHOR]

There is no agreement about the measure to quantify the intellectual/developmental level in children with the dual disability of intellectual disability and autism. Therefore, we studied the psychometric properties and utility of Psycho-Educational Profile-Revised (PEP-R) as a developmental test in this population. We identified I 16 children with dual disability from the day care and inpatient database of a specialised Autism Clinic. Scale and domain level scores of PEP-R were collected and analyzed. We examined the internal consistency, domain-total correlation of PEP-R and concurrent validity of PEP-R against Gesell's Developmental Schedule, inter-rater and test-retest reliability and utility of PEP-R among children with dual disability in different ages, functional level and severity of autism. Besides the adequate face and content validity, PEP-R demonstrates a good internal consistency (Cronbach's a ranging from 0.91 to 0.93) and domain-total correlation (ranging from 0.75 to 0.90). The inter-rater reliability (intraclass correlation coefficient, ICC = 0.96) and test-retest reliability (ICC = 0.87) for PEP-R is good. There is moderate-to-high concurrent validity with GDS (r ranging from 0.61 to 0.82; all Ps = 0.001). The utility of PEP-R as a developmental measure was good with infants, toddlers, pre-school and primary school children. The ability of PEP-R to measure the developmental age was good, irrespective of the severity of autism but was better with high-functioning children. The PEP-R as an intellectual/developmental test has strong psychometric properties in children with dual disability. It could be used in children with different age groups and severity of autism. PEP-R should be used with caution as a developmental test in children with dual disability who are low functioning. [ABSTRACT FROM AUTHOR]

The pediatrician is a primary column of support for children and adolescents with a myriad of mental health problems in low-mental health care resource countries like India. While majority of mental health consultations happen in primary-care, and only 10% are referred successfully for specialised help, there is a clear role for pediatrician psychotherapists in primary care. The primary-care pediatricians should be aware of the indications for psychotherapy, the various approaches that could be used in primary-care settings, the structure and the process of the psychotherapeutic technique involved, the suggested specific techniques for the Priority Mental Health Disorders and the evidence available to support their use as well as the developmental modifications that are required based on the cognitive development of the child or adolescent. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy of a self-rated and a clinician rated measure of depression for primary care use in school setting by pediatricians. Methods: Two tools for screening depression were administered to early adolescents in three schools. These included the self-rated Beck Depression Inventory (BDI), pediatrician rated Children's Depression Rating Scale-Revised (CDRS-R), and ICD-10 clinical interview by a psychiatrist as reference standard. These tools were compared for their overall performance using Areas Under the Curve (AUC) of Receiver Operating Characteristic (ROC) curves. The optimal screening threshold score for both tools were identified from their sensitivity and specificity plotted for all threshold scores. For the optimal cut-off scores, the diagnostic accuracy parameters like sensitivity, specificity, predictive values, likelihood ratio and diagnostic odds ratio were calculated using contingency table. Results: The area under the curve for BDI was 0.67 and CDRS was 0.50 suggesting that BDI as a screening tool has better diagnostic accuracy. The optimal screening threshold score for BDI was 18 with a sensitivity of 63 and specificity of 70. For the CDRS-R cut-off score of 59, the sensitivity was 36 and specificity was 82 respectively. Using both tools concurrently improved the diagnostic accuracy. Conclusions: Using the ROC characteristics and various validity indices, the authors showed that BDI has better sensitivity and CDRS-R a better specificity. It might be prudent to use both these instrument simultaneously to improve the identification of depression in primary care settings like school health clinic. [ABSTRACT FROM AUTHOR]

Objective: To compare the type of life events experienced and coping styles used by adolescents with and without psychopathology, attending a primary-care adolescent clinic. Methods: One hundred adolescents with and without psychopathology attending a drop-in adolescent clinic in a tertiary-care teaching hospital were recruited. Face-to-face interview used Child Behaviour Checklist, Life Event Scale, Coddington's life event scale, Impact of Event Scale and Modified Jalowiec coping scale as measures after getting written, informed consent from the primary care-giver and verbal assent from the adolescents. Bivariate and multivariate comparisons were done between the groups appropriately. Results: Adolescents with psychopathology had experienced more parental fights, increased arguments with parents, increased arguments between parents, serious illness requiring hospitalization of the adolescent. The intrusive symptoms of PTSD were noted more than avoidant symptoms among those adolescents with life events. Confrontative, emotive and optimistic coping styles were most often used in adolescent with psychopathology. Conclusions: In India, adolescents with psychopathology attending a primary care clinic have significant life events and different coping styles. Therefore, adolescents with psychopathology in this setting should be screened for life events as well as dysfunctional coping styles and given appropriate intervention. [ABSTRACT FROM AUTHOR]

India has a huge child and adolescent population. Psychiatric disorders are widely prevalent and the mental health needs of these children are well recognized. Nonetheless, there are no country-centric and child specific mental health policies, plans or programs. There is also a significant lack of human resources for child and adolescent mental health in India. This combination of factors makes the primary care a critical setting for the early identification, treatment, consultation and referral of children and adolescents with mental health and developmental needs. Even though the importance of primary care as a system for addressing the mental health care has been recognized for decades, its potential requires further development in India as the Child and Adolescent Mental Health Services (CAMHS) emerge and evolve. A country and child specific mental health policy, plan and program needs to be formulated as well an integrated, multi-tier CAMHS with a focus on the primary-care physicians as care providers for this population has to be developed. [ABSTRACT FROM AUTHOR]

Objective: To revise, translate, explore the construct validity and define the sensitivity of the Post Traumatic Stress Disorder Scale of the Child Behavior Checklist (CBCL‐PTSD). Method: Language and content experts revised the translated CBCL‐PTSD scale. This 13‐item CBCL‐PTSD‐TR scale was administered to 100 adolescents who had undergone various traumatic life events. Exploratory factor analysis was conducted. Screening threshold was determined for the final six‐item version. Results: The DSM IV‐TR construct for PTSD was reflected in the CBCL‐PTSD‐TR scale by the exploratory factor analysis and provided information for refining the instrument. A CBCL‐PTSD‐TR cut‐off score of 0.5 was an effective threshold for screening purposes. Conclusions: We were able to show that the CBCL‐PTSD‐TR scale compiled from the original CBCL scale items has satisfactory construct validity of DSM‐IV‐TR and can be used for screening adolescents with PTSD. Implications for assessment and treatment utilization are discussed. [ABSTRACT FROM AUTHOR]

Objective: This study validates the Tamil version of Impact of Event Scale among adolescents. Method: IES was translated into Tamil and 100 adolescents attending an adolescent clinic who had been exposed to diverse traumatic events completed the Impact of Event Scale along with the Child Behaviour Checklist. Appropriate analyses both at the item and scale levels were conducted. Results: In addition to adequate face and content validity, the scale has satisfactory internal consistency (α from 0.77 to 0.90), moderate convergent validity with CBCL‐PTSD scale (r from 0.22 to 0.29), and high discriminant validity with PTSD‐thought problem subscale (r = 0.01–0.10). Factor analysis replicated the two‐factor structure, avoidance factor (five items) and intrusion factor (three items), explaining 68.4% of variance. A threshold IES score of 17 was associated with 93% sensitivity and 85% specificity. Conclusions: The Tamil IES for adolescents has satisfactory psychometric properties and should be useful in international studies as well as clinical care. [ABSTRACT FROM AUTHOR]

A trial was designed to evaluate the role of enhanced parental attitude towards management of intellectual disability in the acquisition of adaptive behaviour. Fifty-seven children with intellectual disability and their parents were randomly assigned to 12 weeks of either multimodal adaptive behaviour training plus interactive group psycho-education (intervention group); or multimodal adaptive behaviour training plus didactic lectures (control group). Blinded raters were involved. Completers’ and intention-to-treat analyses were conducted. In the intention-to-treat sample, 22 of 29 children in the intervention group compared with four of 28 children in the control group showed a significant improvement in the acquisition of adaptive behaviour. The minimum additive efficacy provided by the enhanced parental attitude was 80 percent. Meaningful clinical benefits on various measures were found for the intervention group after training. Parental attitude intervention should be included in adaptive behaviour training for children with intellectual disability, as enhanced parental attitude has short-term positive effects. [ABSTRACT FROM PUBLISHER]

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]580.95%) 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 (intraclass 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 a50.80) and item-total correlation. There is moderate convergent validity with BineteKamat Test of Intelligence or Gesell's Developmental Schedule (r50.66, P50.001) as well as with adaptive behavior measure of Vineland Social Maturity Scale (r5 0.52, P50.001) and low divergent validity with the subscales of Attention Deficit Disorder with Hyperactivity: Comprehensive Teacher Rating Scale (r50.11, P50.7; r50.18, P50.5; r50.13, P50.6; r50.08, P50.7). 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. [ABSTRACT FROM AUTHOR]

Aim: Most children with autism do not receive early intervention, unless parents are trained, in countries with low child mental health resources. To maximize the existing resource, we evaluated the feasibility and effectiveness of an intensive, parent mediated, multi-component, early intervention for autism in India. Methods: Data of 77 children with an ICD-10 diagnosis of autism who completed a 12- week, five days a week, intervention program and regular practice at home was collected from the database of a teaching hospital. Intervention components included the standard intervention protocol, the Psycho-Educational Profile intervention (PEP-R) and the Carolina Curriculum for Infants and Toddlers with Special Needs. Pre and postintervention PEP-R rating of parents were used to evaluate the intervention outcome. Appropriate bivariate, multivariate and resampling techniques were used to evaluate the intervention effectiveness. Results: The effect size (ES) for the intervention was moderate to large for the PEP-R developmental age as well as perception, fine motor, gross motor, eye-hand coordination,cognitive performance and cognitive verbal domain among children with mild to moderate (ES ranged from 0.70 to 0.88) and severe autism (ES ranged from 0.73 to 0.87). There was no difference in the intervention effect between the groups (ES ranged from 0.004 to 0.30). The effectiveness of the intervention continued after controlling the confounding effect of baseline developmental quotient, developmental age and adaptive skills. Conclusion: It is feasible to provide an effective parent mediated early intervention for mild to severe autism in countries where parents are the cornerstone in childhood disability care. [ABSTRACT FROM AUTHOR]

The goal of this session is to assess the anthropometric status of children with ASD in India. Higher education in parents had positive correlation with height for age z-score (p < 0.001). Vineland Social Maturity Scale (VSMS) scores showed positive correlation for weight for age z-score (p = 0.018) and for height for age z-score (p = 0.006). [Extracted from the article]