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The World Health Organization-Caregiver Skills Training Program, a parent-mediated early intervention facilitated by non-specialist providers piloted in urban India was evaluated using mixed-methods for feasibility and effects on child and caregiver outcomes. Caregivers (n = 22) of children (2-9 years) with social-communication delays participated in a single-group pre-post study. High rates of caregiver attendance, improved caregiver fidelity, and facilitator competency suggested program feasibility. Caregivers voiced acceptability of various intervention-components. The intervention was associated with improved caregiver-reported skills and knowledge (p < 0.00), reduction in stress (p = 0.03), improved child developmental outcomes on communication and social interaction (p < 0.00), and adaptive behaviors (p < 0.00). Challenges about logistics and availability of time were highlighted. Implications of results in resource-poor settings and recommendations for future feasibility trials are discussed. [The WHO-CST Team contributed to the writing of this article.]

The World Health Organization-Caregiver Skills Training Program, a parent-mediated early intervention facilitated by non-specialist providers piloted in urban India was evaluated using mixed-methods for feasibility and effects on child and caregiver outcomes. Caregivers (n = 22) of children (2-9 years) with social-communication delays participated in a single-group pre-post study. High rates of caregiver attendance, improved caregiver fidelity, and facilitator competency suggested program feasibility. Caregivers voiced acceptability of various intervention-components. The intervention was associated with improved caregiver-reported skills and knowledge (p < 0.00), reduction in stress (p = 0.03), improved child developmental outcomes on communication and social interaction (p < 0.00), and adaptive behaviors (p < 0.00). Challenges about logistics and availability of time were highlighted. Implications of results in resource-poor settings and recommendations for future feasibility trials are discussed., Author(s): Koyeli Sengupta [sup.1] , Henal Shah [sup.2] , Subharati Ghosh [sup.3] , Disha Sanghvi [sup.1] , Sanchita Mahadik [sup.1] , Allauki Dani [sup.2] , Oshin Deshmukh [sup.1] , Laura [...]

BackgroundMisconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base.MethodsWe reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder.ResultsWe generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents.ConclusionsMany findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.

ASD is a neurodevelopmental disorder characterized by impairments in social communication and social interaction, repetitive and stereotyped behaviours, and/or sensory aberrations. OCD is characterized by the presence of obsessions and/or compulsions. Schizophrenia consists of delusions, hallucinations, negative and cognitive symptoms. Children often present with overlapping symptoms and complex psychopathologies and adolescence is often the period where these symptoms get heightened or get noticed. Furthermore, some psychiatric disorders like OCD, ASD and psychosis often have overlaps with confusing presentations. We present a case of a 15year old male child who presented with overlapping symptoms. [ABSTRACT FROM AUTHOR]

SUMMARY: In this reflection we summarise the various obstacles to accessing healthcare encountered by people with neurodevelopmental disorders (intellectual disability, autism and attention-deficit hyperactivity disorder) with and without mental health problems. We outline different service models from around the world, ranging from the person centred to the institutional. Finally, we suggest ways of addressing some of the problems identified, including a model of integrated care involving intellectual disability, neurodevelopmental and mental health services that would better serve this population. [ABSTRACT FROM AUTHOR]

The health workforce of the 21st century has enormous challenges; health professionals need to be both experts in their field and equipped with leadership and managerial skills. These skills are not part of the regular curriculum, so specific programs bridging this gap are required. Since 2001, FAIMER®, with eight centers across the globe, has worked to create health professions education leaders through transformational learning experiences, developing a global community of practice encompassing over 40 countries. We describe the design, implementation, evaluation, and evolution of the leadership and management curriculum component of the global Institute over 15 years. The curriculum is developed and updated through practices that keep faculty and fellows connected, aligned, and learning together. The article highlights the unique features, challenges faced, and sustainability issues. With a robust mixed methods evaluation, there are substantial reasons to believe that the model works, is adaptable and replicable to meet local needs. The program is playing an important role of answering the call for training positive, strengths-based, collaborative leaders who are socially accountable and embrace the challenges for high quality equitable health care around the globe.

Background: The ability to recognize emotional facial expressions (EFEs) is an important skill for a mother and may impact her parenting. This ability is innate but affected by multiple factors. Aims: This study aims to study the mother's ability to recognize a child's facial emotions and its association with present depressive symptoms, alexithymia, parenting practices, and styles. Materials and Methods: Seventy-five mothers of children being evaluated for academic problems were assessed through purposive sampling at a tertiary care child guidance clinic. The mothers completed the National Institute for Mental Health Child Emotional Faces Picture test, Patient Health Questionnaire-9 (PHQ), Toronto Alexithymia Scale (TAS), Coping with children's negative emotions scale, and Parenting style questionnaire. Statistical Analysis: Statistical Program for Social Science (SPSS Version 21) for Windows was used. Descriptive analysis was carried out using mean and standard deviation. Other tests used for analysis were Student's t-test, ANOVA, Pearson's Product Moment, and Spearman's rho. Results: The proportion of EFEs correct responses (PC) was 0.776. The happy EFE had the highest PC and neutral the least. PC of happy EFE correlated positively with emotion-focused reactions and inversely with TAS score and authoritative parenting. PC of sad EFE correlated inversely with TAS subscale of difficulty identifying emotions and positively with expressive encouragement and authoritative style of parenting. PC of angry EFE correlated with expressive encouragement and inversely with distress and minimization reactions. PC of afraid EFE inversely correlated with TAS score, PHQ-9 total score, punitive and distress reactions, and authoritarian parenting and positively with expressive encouragement. PC of neutral EFE correlated with TAS score, minimization reactions, and authoritative parenting style. Conclusions: Impairments in EFE recognition affect mother's parenting styles and practices. Alexithymia and depressive symptoms can affect the ability to correctly identify EFEs. [ABSTRACT FROM AUTHOR]

The article focuses on a unique scholarship program, Indian Teachers of Psychiatry (IToP)-Scholarship for Teachers towards Enrichment in Psychiatry teaching Skills (STEPS) IToP-STEPS for psychiatry teachers in India. Topics include the need for psychiatry teachers in India with the importance of the faculty development program; and IToP-STEPS scholarship is tailored to psychiatry teachers in India and provides a faculty development program that rewards successful candidates.

Byline: Samia. Ellias, Henal. Shah Aims: This study is to study the knowledge and awareness on autism among medical students and the factors which impact their knowledge on autism. Settings [...]

Psychological assessment process involves administration, scoring, interpretation, and report writing. In addition to the human resource, time, and effort required for the training, the assessment process itself requires significant time and effort on the part of trained professionals. This automatically translates into the cost, which sometimes can be significant. Given the significantly limited number of trained psychologists who are in clinical practice in India compared to the extent of the population of the country, the amount of assessment work can take away precious time from the intervention services. On the other hand, a significant number of psychological assessment tests used in India are generally old with outdated norms, are poorly standardized, and are not keeping pace with the global development. Given these issues, mental health profession on the whole, as well as the clients/patients can question the validity of the psychological assessments or some specific assessments. This article tries to discuss some of the issues related to the validity of the psychological assessments in general and in specific domains, such as ability, achievement, and psychopathology. In addition to mentioned issues, the article also tries to suggest possible measures to overcome those limitations. [ABSTRACT FROM AUTHOR]

Research in psychopharmacology in children and adolescents is an area of growing interest with numerous newer modalities becoming available in recent years. Nevertheless, it still lags significantly behind research in adult psychopharmacology although, in the last decade, the gap is beginning to be bridged with FDA approval for newer agents for the paediatric age group. The purpose of this selective narrative review is to examine the latest advances in psychopharmacology in the last decade and their safety, tolerability and applicability in children and adolescents. In methodology, we identified 4 main areas of recent advances in psychopharmacology, viz. Ketamine, Nitrous Oxide, Cannabidiol and cannabis derivates and the area of pharmacogenomics. We then conducted a comprehensive search of the literature using PubMed, Embase and Ovid databases to identify the most recent updates in these areas, especially focussed on the paediatric population. The search was limited to English language studies and focussed on recent updates in these four areas. In the results, it was seen that all the four identified areas have potential applicability in children and adolescents with some studies evaluating their safety and tolerability in the paediatric population. However, literature on the long-term safety and efficacy of these newer modalities in the paediatric population is limited and none of the identified agents are currently recommended for routine clinical use in children and adolescents. Overall, it could be concluded that the results of this selective narrative review suggest that newer modalities in psychopharmacology offer promising treatments for psychiatric disorders in children and adolescents. However, further research is needed to fully understand the long-term safety and efficacy of these treatments as well as optimal dosing and monitoring strategies to ensure their safe and effective use in the paediatric population. [ABSTRACT FROM AUTHOR]

Intellectual disability (ID) can be caused by various environmental and genetic factors and can lead to significant disability. There are numerous challenges in the field in terms of diagnosis and management. In this article, we have reviewed the literature in this field. A dependable estimate of the prevalence in India still remains to be made. Preventive measures and screening play an important role. The country could greatly benefit from a national newborn screening program, presence of more trained professionals, and public awareness measures. Drug treatments spanning beyond the usual drug classes have not yet found a breakthrough. Persons with ID face many challenges in the field of education, disability certification, access to government schemes, job placements, and living arrangements. We must take cognizance of these challenges at the earliest and work toward rectifying them. [ABSTRACT FROM AUTHOR]

Affective disorders in children and adolescents generally have a severe course of the illness, higher suicidal behavior, and adverse effect on overall development and life course. Presentation of pediatric depression and bipolar is usually different from adults, leading to longer delays in help-seeking and effective management. This narrative review highlights the magnitude, clinical presentation, comorbidity, differential diagnosis, and management approach of depression and bipolar in children and adolescents. Better awareness and expertise are essential for timely identification, comprehensive assessment, and holistic treatment. [ABSTRACT FROM AUTHOR]

Self-injurious behavior is a common symptom in neurodevelopmental disorders which is often the least understood and difficult to treat. In this narrative review, we intend to focus on the symptomatology, causal and risk factors for SIBs along with the nonpharmacological and pharmacological management of SIBs in NDD. A manual search was done using the electronic databases of Pubmed, Google scholar on relevant publications or cross-references till December 2022 and the data was then collated to give the prevalence, epidemiology, risk factors, treatment and management of SIB in NDD. Results showed that the behaviors begin in developmental phase and are seen in nearly 30% of children with NDD. Many SIBs become chronic over time and are characterized by being repetitive in nature, compulsive or episodic. They could be superficial or deep and are best treated by nonpharmacological methods using functional behavior assessment (FBA). Despite lack of robust evidence for psychotropics some second-generation antipsychotics have been approved for pharmacological treatment of SIB. We can conclude that until more data are available, clinicians must continue to rely upon the limited available evidence, clinical judgement, and expertise, and carefully monitored response(s) to therapy when managing SIBs in children. SIB is outcome of multiple factors that initiate and maintain the behavior. Judicious use of various groups of pharmacological agents is advised. Physician preferences, history of response and safety are part of pharmacological interventions. [ABSTRACT FROM AUTHOR]

Suicide is the second leading cause of death among adolescents in the age group of 15 to 19 years. As per the National Crime Record Bureau, India loses 1 student to suicide every hour. The COVID pandemic saw an alarming rise in the number of children/adolescents attempting suicide. The state of Kerala lost 173 children in the age group of 10 to 18 years, during the first wave of the pandemic (March-October 2020). This review article has been written with the aim of exploring causes of aggression, suicide, and self-harm in children and adolescents. It also strives to bring forth the various interventions which can be taken in order to reduce the rate of suicide and self-harm in children and adolescents. [ABSTRACT FROM AUTHOR]

The effects of digital technology on early brain development have been hotly debated for a long time. The COVID-19 pandemic increased these worries to a greater scale as it led to an inevitable surge in the use of digital technology across age groups. The risks and benefits of screens or gadgets are often discussed at length on multiple platforms. Technology has become a part of everyday life for humans of all age groups. Exposure to screens often starts in the first few months of life. It therefore becomes imperative to study the various ways by which it may affect the development of the human brain. Emerging clinical studies show that it may have a positive as well as negative effects on multiple aspects of brain development. In spite of the available research, there is no conclusive evidence to link the effects of digital technology with developmental disorders. The purpose of this review is to summarize the current evidence and conceptual understanding in this area. [ABSTRACT FROM AUTHOR]

REBT is an evidence-based approach that helps people manage cognitive, emotional, and behavioral disturbances in sustainable, healthy ways. It takes a holistic view of emotional disturbances, including depression. In keeping with the concept of psychological interactionism, REBT views depression as a thinking-feeling-behaving pattern and not a diagnostic label alone. Depressive thinking-feeling-behaving is a common consequence in teens in response to such adversities and can manifest in different ways. Some may want to resign to their fate and let others make these choices for them, some may want to gain more control by trying to make perfect choices, and some may want to escape the conflict by hurting themselves, overly consuming online content, binge eating junk food, and so on, and others may want to rebel and make extreme choices. Most of these ways prove to be short-term ways of coping with or managing these challenges and may be in fact harmful in the long term. REBT argues that therapy can teach teenagers to identify, practice, and internalize healthy, long-term ways of coping which they can eventually use independently across different situational contexts. [ABSTRACT FROM AUTHOR]

Psychiatric disorders in children and adolescents have a varied and heterogeneous presentation. Many risk factors play a role in the emergence of the disorder. Newer molecules have been tried for comorbidities in ASD and ADHD. Many have shown efficacy but need more robust evidence for clinical use. Oxytocin in ASD has shown efficacy however is not yet in clinical use. Viloxazine in ADHD has been FDA-approved and has shown efficacy in ADHD. Neuromodulation is tried in almost all disorders; however, studies are limited. Computer-based cognitive training has proven to be helpful in psychotic disorders. More trials are warranted to consolidate the evidence. Digital interventions and virtual reality can be a new way forward. Studies are limited. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) are increasingly recognized in children and adolescents. Anorexia nervosa (AN) and bulimia nervosa (BN) are less common in children and adolescents than adults, but both disorders can occur in this age group. Binge-eating disorder (BED) is the most common ED in children and adolescents and is more prevalent in females than males. EDs may present differently in children and adolescents than in adults, and parents or caregivers may be the first to notice changes in eating patterns or body weight. Diagnostic criteria for EDs in children and adolescents include disturbances in eating behavior, weight or shape concerns, and significant distress or impairment in social, academic, or occupational functioning. Multidisciplinary approaches are recommended for treating EDs in children and adolescents, including medical management, nutritional counseling, and psychological interventions. Evidence-based treatments for AN and BN include family-based therapy, cognitive-behavioral therapy, and interpersonal psychotherapy. Cognitive-behavioral therapy and interpersonal psychotherapy are recommended for children and adolescents with BED. Hospitalization may be necessary in severe cases. Early identification and intervention are crucial for improving treatment outcomes and reducing the risk of long-term complications. Treatment approaches should be tailored to developmental and cultural needs and involve a multidisciplinary team. Continued research is needed to improve early detection, prevention strategies, and treatments for this vulnerable population. EDs in children and adolescents are a significant public health concern that can have serious physical and psychological consequences. It is important for healthcare providers and caregivers to be aware of the signs and symptoms of EDs in young people and to seek prompt and appropriate treatment [ABSTRACT FROM AUTHOR]

Psychotherapies for the youth have resulted from the confluence of 3 major disciplines: adult psychology and psychiatry, developmental neurology and pediatrics, and developmental psychology and ethology. Since their humble origins in the psychoanalytically oriented play therapy and the related theories in the pre-War Germany, over more than a century, they have embraced diverse theoretical views that include but not limited to the integration of developmental issues, evolution of the child guidance movement, and the various influences of institutional and social policies. Such a rich journey has eventually resulted in evidence-based practices (EBPs)—powerful interventions for children and families for complex behavioral problems. In this chapter, we attempt to trace the blooming field of youth psychotherapies in their historical contexts, provide an account of the existing gaps of knowledge, briefly narrate the modern-day developments, mostly regarding the multimodal/eclectic treatment aspects and finally, given their rapid growth, we speculate about their (positive) future. Child and adolescent therapies have progressed considerably, as reflected in the number of controlled studies, their methodological quality, and identification of evidence-based treatments. Despite the methodological difficulties in outcome studies, the field has witnessed major advances regarding the efficacy of selected treatments in child and adolescent psychotherapy and good quality meta-analyses do suggest that 75% of children and young people who attend therapy benefit from it. However, despite the comforting data related to efficacy, major challenges still remain, especially in regard to patient engagement and dropout rates, gap in knowledge about what works and why it works, cultural sensitivity, and data of cost- effectiveness—just to quote a few. Several key areas have been neglected in research, such as the mechanisms of change, the moderators of treatment outcome, and the generalizability of the research findings to the clinical practice arena—this has greatly limited what we know about treatment and partly explains the relative lack of personalized psychotherapies and scarcity in their dissemination/generalization despite the documented evidence on their efficacy. Tailoring treatment more specifically to each patient may be necessary to reduce this nonresponsiveness and dropping outs, as one treatment does not fit all. This necessitates the need for eclecticism—to combine youth psychotherapies with other modes of treatments, such as medications, neuromodulation interventions, and Yoga and mindfulness-based cognitive therapy. Future practice for treatment of mental health conditions in the youth will likely adapt to this huge need for development of eclectic modalities and also reflect cost effectiveness and cultural sensitivity to an increasingly diverse population. [ABSTRACT FROM AUTHOR]

Age-old societal beliefs are being challenged and constantly changing with urbanization, industrialization, and modernization, which have blurred the typical family gender roles and structure. The studies conducted 2 to 3 decades back showed that family instability can negatively affect children's development. The absence or loss of one parent and conflicts between separated and divorced parents affect not only the child's mental health but also the child's physical health, overall growth, and future relationships. Single parents are often overburdened with the responsibilities of 2 parents, face social stigma, and lack social support, as a result they have difficulty spending time with their children. Hence children of single parents have poor academic performance, decreased social interactions, emotional and behavioral problems. Newer research has focused on the positive outcomes and protective factors that can steer the child towards better outcome. We need to focus on such protective and resilience-building factors to help the child adjust in the short and long run. [ABSTRACT FROM AUTHOR]

The philosophy of childhood which deals with issues related to conception about childhood, children's rights, and moral status, etc., is important for clarifying attitudes towards the children in care provision and ethical and legal conundrums related to child and adolescent mental health. This is highlighted through the implications of philosophy of childhood on the age of consent, in particular, in reference to medical and sexual consent. [ABSTRACT FROM AUTHOR]

Somatic Symptoms or Medically Unexplained Symptoms are commonly found in children and adolescents. These symptoms generally reflect the underlying psychological distress and cause significant distress to the child. Presenting symptoms include abdominal pain, headaches, and musculoskeletal pain. The nature of illness prompts multiple visits to clinical setups, burdening the existing health resources. Risk factors include individual, family, and environmental factors. Most stressful factors are seen to arise from day-to-day problems in children like academic problems, bullying, familial disharmony, temperamental traits, abuse, financial constraints, and parenting issues. Psychiatric and physical comorbidities are prevalent. During the assessment, it is pertinent to rule in positive signs and keep in mind the common psychiatric/physical differentials. Management includes a multidisciplinary approach involving the child and family. An overall visualization of the biopsychosocial framework of the child is done to cater to specific needs. Psychoeducation remains a key strategy, while incorporating behavioral management. This includes promoting strengths and positive behavior in child, gradual reduction in secondary gains, promotion of general well-being, focus on a well-rounded schedule incorporating different activities, and relaxation training. Psychosocial factors are worked upon at length while enhancing coping skills. Familial factors are taken into consideration and home environment may be improved. Comorbidities if present can be managed with medications. The goal is functional recovery and rehabilitation, which can be time taking and requires patience from the treating team. [ABSTRACT FROM AUTHOR]

Attention deficit hyperactivity disorder (ADHD) is the most common neuro-behavioral disorder characterized by a classical triad of hyperactivity-impulsivity and inattention prevalent in 5% of school-going children, mostly in boys. It is a chronic disorder with persistent of symptoms in a significant proportion of children diagnosed in childhood and impairing in most domains of socio-occupational functioning. Challenges in diagnosis occur due to symptoms domains of ADHD representing extremes of developmental processes of hyperactivity and inattention. Temperament is another construct that is important while evaluating a child with ADHD to avoid misdiagnosis and/or overdiagnosis. There is literature to support that the presentation of ADHD is not just limited to the triad of symptoms described in DSM 5, but it manifests a plethora of symptoms which, in the majority of cases, often go unnoticed. These symptoms may be a result of executive function deficits, emotion dysregulation, the presence of comorbid disorders, and/or psychosocial issues. Impairments of ADHD continue into adolescence and adulthood. However, ADHD in adults is still an under-researched area. The article aims to provide a bird's eye view of the various hidden difficulties inherent in ADHD but which often is missed in clinical practice. [ABSTRACT FROM AUTHOR]

The article focuses on special focus on child custody, corporal punishment, and the relevance of the Mental Health-Care Act for children and adolescents.