Search

Aim: Anxiety disorders usually remain undiagnosed in school students owing to the internalized nature of their symptoms. The present study was conducted with the primary objective of evaluating the prevalence of anxiety symptoms in school students in Mumbai. A secondary objective was to assess the impact of variables (age, gender, presence of sibling, and type of school curriculum or school) on anxiety symptoms., Materials and Methods: Study cases (8-15 year olds) were recruited by nonprobability sampling from four English-medium schools. Anxiety was measured using Spence Children's Anxiety Scale (SCAS)-child self-report questionnaire. T-scores (total and subscales) were calculated and cut-off scores of> 60 were considered as significant., Results: Symptoms of overall anxiety were present in 10.8% (53/493) of the students. Older students (12-15 year olds) had greater odds of having overall anxiety symptoms (crude OR = 4.36, 95% CI 2.27 to 8.39, P < 0.0001). Symptoms of all anxiety disorders were present in the 493 participants, with obsessions/compulsions and fears of physical injury being the most common (in 29.6% and 27.2%, respectively). Older students and boys had greater odds of having obsessions/compulsions (crude OR = 2.32, 95% CI 1.56 to 3.44, P < 0.0001; and crude OR = 1.54, 95% CI 1.04 to 2.27, P= 0.035, respectively]. Students with sibling (s) had greater odds of having fears of physical injury (crude OR = 0.48, 95% CI 0.30 to 0.78, P= 0.003)., Conclusions: There is an urgent need to screen school students in our city for anxiety disorders., Competing Interests: Sunil Karande is the Editor of the Journal of Postgraduate Medicine

Background and Objectives: School students with specific learning disabilities (SpLDs) experience chronic academic underachievement and resultant stress. The present study aimed to determine if school students with newly diagnosed SpLD were more likely to have anxiety than their regular peers., Materials and Methods: The study cases (aged 8-15 years) were recruited from our institute's learning disability clinic. The matched controls were recruited from four schools in Mumbai, Maharashtra, India. Anxiety was measured using the Spence Children's Anxiety Scale (SCAS)-child self-report version questionnaire. Median SCAS scores and the proportion of students with an SCAS score in the "clinical anxiety" range were compared between the groups., Results: SCAS scores were significantly higher in 8-11-year-old learning-disabled male and female students (P < 0.0001 for both groups) and 12-15-year-old female students (P = 0.004), as compared with matched controls. A significantly higher number of learning-disabled students were found to have "clinical anxiety" [24.64% vs. 4.35%, crude odds ratio (OR) = 7.19, 95% confidence interval (CI) 2.91-17.78, P = 0.0001], as compared with the controls regardless of gender, age group, presence of comorbid attention-deficit/hyperactivity disorder (ADHD), or associated medical conditions. A significantly higher proportion of 8-11-year-old learning-disabled students, especially males, were found to have "clinical anxiety" as compared with 12-15-year-old learning-disabled students (crude OR = 4.38, 95% CI 1.94-9.92, P = 0.0004). Gender, presence of comorbid ADHD or associated medical conditions, and type of school attended or curriculum did not impact the prevalence of "clinical anxiety" in learning-disabled students., Interpretation and Conclusions: Students with newly diagnosed SpLD have greater odds of being "clinically anxious" relative to their regular peers. We recommend screening for anxiety in children with SpLD immediately after diagnosis so that their optimum rehabilitation can be facilitated.

This retrospective study analyzed the quality of 1069 referral letters written by school principals to our learning disability clinic. Utilizing a self-devised checklist having four domains (with 26 items), the audit revealed that in only nine (34.6%) items, the necessary information was available in >90% of referral letters. [ABSTRACT FROM AUTHOR]

Background : Parents of children with specific learning disability (SpLD) undergo stress in coping with their child′s condition. Aim : To measure the levels of anxiety and find out the cause of anxiety in mothers of children with SpLD at time of diagnosis. Settings and Design : Prospective rating-scale and interview-based study conducted in our clinic. Materials and Methods : One hundred mothers of children (70 boys, 30 girls) with SpLD were interviewed using the Hamilton anxiety rating scale (HAM-A) and a semi-structured questionnaire. Detailed clinical and demographic data of mothers were noted. Statistical Analysis : Chi-square test or unpaired student′s t-test was applied wherever applicable. Results : The mean age of mothers was 40.14 years (±SD 4.94, range 25.07-54.0), 73% belonged to upper or upper middle socioeconomic strata of society, 67% were graduates or postgraduates, 58% were full-time home-makers, and 33% lived in joint families. Levels of anxiety were absent in 24%, mild in 75%, and moderate in 1% of mothers. Their mean total anxiety score was 5.65 (±SD 4.75, range 0-21), mean psychic anxiety score was 3.92 (±SD 3.11, range 0-13), and mean somatic anxiety score was 1.76 (±SD 2.05, range 0-10). Their common worries were related to child′s poor school performance (95%), child′s future (90%), child′s behavior (51%), and visits to our clinic (31%). Conclusion : Most mothers of children with SpLD have already developed mild anxiety levels by the time this hidden disability is diagnosed. These anxieties should be addressed by counseling to ensure optimum rehabilitation of these children.

Aims: The primary objective of this study was to evaluate the economic burden of slow learners (students with "borderline intellectual functioning") by estimating its direct, indirect, and intangible costs. The secondary objective was to assess the impact of variables on the economic burden. Settings and Design: Cross-sectional, single-arm descriptive study. Setting: Learning disability clinic in a public medical college in Mumbai. Materials and Methods: The study cases (age ≥5 - 18 years) were recruited by nonprobability sampling. A structured questionnaire was used to interview the parent to collect data related to direct and indirect costs. Intangible costs data were collected by documenting the willingness-to-pay value using the contingent valuation technique. Statistical Analysis Used: A quantile regression model was used to assess the impact of predictor variables on the costs. Results: The direct, indirect, and intangible costs of slow learners were INR 6,065,915, 10,298,613, and 145,172,800, respectively. Indirect costs comprised 62.9% of the total costs. Expenditure on tuitions, medications, and remedial education comprised 57.38%, 16.18%, and 10.30% of the direct costs, respectively. The average annual total costs of slow learners were INR 3,544,880. The average annual learning disability clinic costs were INR 2,250,194. The average annual total costs per student were INR 57,951. Longer duration of poor school performance was predictive of higher direct and total costs. Conclusion: The economic burden of slow learners is enormous (intangible > indirect > direct costs). Tuitions are the most costly component of direct costs. Parental loss of earnings is the most costly component of indirect costs. [ABSTRACT FROM AUTHOR]

Aims: The primary objective of the present study was to evaluate the economic burden of specific learning disability (SpLD) by estimating its direct, indirect, and intangible costs. A secondary objective was to assess the impact of variables on the economic burden. Settings and Design: Cross-sectional single-arm descriptive study. Setting: Learning disability clinic in a public medical college in Mumbai. Subjects and Methods: The study cases (aged ≥8 years) were recruited by non-probability sampling. A structured questionnaire was used to interview the parent/guardian to collect data related to direct and indirect costs. Intangible costs data were collected by documenting the willingness-to-pay value using the contingent valuation technique. Statistical Analysis Used: A quantile regression model was used to assess the impact of predictor variables on the costs. Results: The direct, indirect, and intangible costs due to SpLD were Indian Rupees (INR) 5,936,053, 29,261,220, and 42,295,000, respectively. Indirect costs comprised 83.1% of the total costs. Expenditure on tuitions and remedial education comprised 61.61% and 64.39% of the indirect and direct costs, respectively. The average annual learning disability clinic costs were INR 2,169,888. The average annual total costs per student were INR 90,773. Longer duration of poor school performance was predictive of higher direct, indirect, and total costs; and higher socioeconomic status was predictive of lower intangible costs. Conclusion: SpLD is a cost-intensive disability (intangible > indirect > direct costs). Tuitions, which are not the therapy for SpLD, are the most costly component of indirect costs. Remedial education is the most costly component of direct costs. [ABSTRACT FROM AUTHOR]

Background: Specific learning disability (SpLD) often remains undetected, resulting in the afflicted child experiencing chronic poor school performance. Aims: To measure and analyze the self-perceived healthrelated quality of life (HRQoL) of children with newly-diagnosed SpLD. Settings and Design: Cross-sectional questionnaire-based study in our clinic. Materials and Methods: From February to December 2008, 150 children consecutively diagnosed as having SpLD were enrolled and their HRQoL documented using the DISABKIDS chronic generic module self-report version instrument. Statistical Analysis: Multiple regression analysis was carried out for determining the 'independent' impact that each of the clinical and socio-demographic variables had on a poor facet score outcome and on a poor total score outcome. Results: Clinically significant deficits were detected in all 6 facets, namely: 'large deficits (effect size ⩾-0.8)' in ''social exclusion'', ''emotion'', ''limitation'', ''treatment'', and ''independence''; and 'medium deficit (effect size -0.5 to <-0.8)' in ''social inclusion''; and 'large deficit' in ''total score''. Multivariate analysis revealed that: (i) not belonging to the upper socio-economic strata of society was an independent predictor of a poor ''independence'' facet outcome (P=0.010, OR=1.99, 95% CI: 1.18 to 3.37); (ii) not having experienced class detainment was an independent predictor of a poor ''emotion'' facet outcome (P=0.008, OR=3.04, 95% CI: 1.34 to 6.85); (iii) first-born status was an independent predictor of a poor ''limitation'' facet outcome (P=0.022, OR=2.60, 95% CI: 1.15 to 5.90); and (iv) female gender was an independent predictor of a poor ''social exclusion'' facet outcome (P=0.024, OR=0.28, 95% CI: 0.09 to 0.85) and a poor ''overall health' 'outcome (P=0.025, OR=0.32, 95% CI: 0.12 to 0.87). Conclusions: Children with newly-diagnosed SpLD perceive their psychosocial, physical, and overall HRQoL to be significantly compromised. [ABSTRACT FROM AUTHOR]

Background: Parents of children with specific learning disability (SpLD) undergo stress in coping up with their child's condition. Aims: To document the parenting practices of parents having a child with newly diagnosed SpLD and to analyze their impact on parent-child relationships. Settings and Design: Cross-sectional questionnaire-based study in our clinic. Materials and Methods: From May 2007 to January 2008, 150 parents (either mother or father) of children consecutively diagnosed as having SpLD were enrolled. Parenting practices and parent-child relationships were measured by the Alabama Parenting Questionnaire-Parent Form (APQ-PF) and the Parent Child Relationship Questionnaire (PCRQ), respectively. Statistical Analysis Used: Pearson correlation coefficients between subscales of APQ-PF and PCRQ were computed. Multiple regression analysis was carried out for statistical significance of the clinical and demographic variables. Results: Parents who were: (i) "involved" in parenting had a good "personal relationship and disciplinary warmth," (ii) practicing "positive parenting" had good "warmth, personal relationship and disciplinary warmth," (iii) "poorly supervising" their child's activities lacked "warmth and personal relationship," (iv) practicing "inconsistent discipline' had a higher "power assertion" and (v) practicing "corporal punishment" lacked "warmth" and had a higher "power assertion and possessiveness" in their relationships with their child. Parent being poorly educated or currently ill and child having all three types of SpLD present concomitantly or a sibling or a sibling with a chronic disability or being in class standard IX to XI were variables that independently predicted a poor parenting or parent-child relationship subscale score. Conclusions: The present study has identified parenting practices that need to be encouraged or excluded for improving parent-child relationships. Initiating these measures would help in the rehabilitation of children with SpLD. [ABSTRACT FROM AUTHOR]