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Dalwai S, Ahmed S, Udani V, Mundkur N, Kamath SS, Nair MKC. Consensus statement of the Indian academy of pediatrics on evaluation and management of autism spectrum disorder. Indian Pediatr 2017; 54:385-393. [DOI: 10.1007/s13312-017-1112-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Nair MKC, Leela LM, George B, Bhaskaran D, Pillai AN, Sarasamma HNGN. CDC Kerala--The Untold Story. Indian J Pediatr 2016; 83:426-33. [PMID: 26988580 DOI: 10.1007/s12098-016-2071-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
Abstract
This article is our life time experience in conceptualizing and systematically developing Child Development Centre (CDC) Kerala in the last 25 years, from a research project to a national training centre in child and adolescent development and premarital counseling. CDC Kerala's major contribution was in creating a 'conceptual framework' of a valid link between childhood disability, low birth weight, adolescent girls' nutrition and fetal onset adult lifestyle diseases. It all started with a randomized controlled trial (RCT) proving beyond doubt that early stimulation is effective in improving the neurodevelopmental status of high risk babies at one and two years and the same cohort was followed-up in detail at 5, 13, 16, 19 and 24 completed years. The process of establishing CDC Kerala is being presented under (i) clinical child development, (ii) adolescent care counseling, (iii) young adults and premarital counseling and (iv) institution building.
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Nair MKC, Harikumaran GSN, George B, Mini AO. Language Evaluation Scale Trivandrum (LEST 3-6 years) Development and Validation. Indian Pediatr 2016; 53:257-258. [PMID: 27029695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Language Evaluation Scale Trivandrum (LEST:3-6 years) with 31-items, was validated against extended REELS with a community sample-606 children (3-6yrs). One item and two item delay as LEST delay showed a sensitivity of (81%, 47%); specificity (68%, 94%), PPV (12%, 31%); NPV (98%, 97%) and accuracy (68.5%, 92%), respectively. LEST (3-6years) is a simple, valid, community screening tool.
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Juneja M, Mishra D, Russell PSS, Gulati S, Deshmukh V, Tudu P, Sagar R, Silberberg D, Bhutani VK, Pinto JM, Durkin M, Pandey RM, Nair MKC, Arora NK. INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD): development and validation. Indian Pediatr 2015; 51:359-65. [PMID: 24953575 DOI: 10.1007/s13312-014-0417-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To develop and validate INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD). DESIGN Diagnostic test evaluation by cross sectional design. SETTING Four tertiary pediatric neurology centers in Delhi and Thiruvanthapuram, India. METHODS Children aged 2-9 years were enrolled in the study. INDT-ASD and Childhood Autism Rating Scale (CARS) were administered in a randomly decided sequence by trained psychologist, followed by an expert evaluation by DSM-IV TR diagnostic criteria (gold standard). MAIN OUTCOME MEASURES Psychometric parameters of diagnostic accuracy, validity (construct, criterion and convergent) and internal consistency. RESULTS 154 children (110 boys, mean age 64.2 mo) were enrolled. The overall diagnostic accuracy (AUC=0.97, 95% CI 0.93, 0.99; P<0.001) and validity (sensitivity 98%, specificity 95%, positive predictive value 91%, negative predictive value 99%) of INDT-ASD for Autism spectrum disorder were high, taking expert diagnosis using DSM-IV-TR as gold standard. The concordance rate between the INDT-ASD and expert diagnosis for 'ASD group' was 82.52% [Cohen's k=0.89; 95% CI (0.82, 0.97); P=0.001]. The internal consistency of INDT-ASD was 0.96. The convergent validity with CARS (r = 0.73, P= 0.001) and divergent validity with Binet-Kamat Test of intelligence (r = -0.37; P=0.004) were significantly high. INDT-ASD has a 4-factor structure explaining 85.3% of the variance. CONCLUSIONS INDT-ASD has high diagnostic accuracy, adequate content validity, good internal consistency high criterion validity and high to moderate convergent validity and 4-factor construct validity for diagnosis of Autistm spectrum disorder.
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Nair MKC, Rajaraman V, Chacko D, Russell S, George B, Sumaraj L, Russell PSS. Comparison of the Diagnostic Accuracy and Validity of a Short Version of Teen Screen Questionnaire-Mental Health (TSQ -M-Short) for Use in Community. Indian J Psychol Med 2015; 37:201-4. [PMID: 25969607 PMCID: PMC4418254 DOI: 10.4103/0253-7176.155621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
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 α, 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.
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Crasta JE, Benjamin TE, Suresh APC, Alwinesh MTJ, Kanniappan G, Padankatti SM, Russell PSS, Nair MKC. Feeding problems among children with autism in a clinical population in India. Indian J Pediatr 2014; 81 Suppl 2:S169-72. [PMID: 25413215 DOI: 10.1007/s12098-014-1630-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 09/30/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare the prevalence and profile of feeding problems (FP) and their relationship with sensory processing in children with autism and intellectual disability (ID). METHODS Children between ages 3 to 10 y with autism (N = 41) and ID (N = 56) were recruited and assessed with Brief Autism Mealtime Behavior Inventory, Sensory Profile Questionnaire, Childhood Autism Rating Scale and Binet-Kamat Scale of Intelligence or Gesell's Developmental Schedule. Assessments were done by independent raters. Bivariate and multivariate analyses were used appropriately. RESULTS The prevalence of FP were 61 and 46.4% among children with autism and ID respectively. Feeding problems were severe among children with autism (P 0.001), especially in young children with autism (P 0.05), and gender was not related to FP. Disruptive meal-time behaviors (P 0.001) and food over-selectivity (P 0.02) were significantly more among children with autism in the bivariate and multivariate analysis. Feeding problems and various dimensions of sensory processing were significantly associated after controlling the confounders. CONCLUSIONS These findings underscore the need for mandatory assessment of FP in children with developmental disabilities, and if present, they need to be addressed with multimodal-multidisciplinary interventions.
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Nair MKC, Princly P, Leena ML, Swapna S, Kumari I L, Preethi R, George B, Russell PSS. CDC Kerala 17: Early detection of developmental delay/disability among children below 3 y in Kerala--a cross sectional survey. Indian J Pediatr 2014; 81 Suppl 2:S156-60. [PMID: 25294730 DOI: 10.1007/s12098-014-1579-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To conduct a community survey to understand the prevalence and type of developmental delay/disability among a representative state wide community sample of children below 3 y. METHODS A state wide community based cross sectional survey was done with the help of the Integrated Child Development Services (ICDS) network in Kerala after giving one day training program at Child Development Centre (CDC), for one randomly selected anganwadi worker in each of the panchayath/municipal ward, from all districts of Kerala, to equip them to screen all children below 3 y in their anganwadi areas, using simple community screening tools like Trivandrum Developmental Screening Chart (TDSC) 0-3 and Language Evaluation Scale Trivandrum (LEST) 0-3. Those children with one or more item delay in TDSC or LEST were called to the developmental evaluation camps held at ICDS block level and trained pediatrician/medical officer re-evaluated the children with developmental delay. RESULTS A total of 32,664 children below 3 y were screened across the state and overall 2.5% prevalence of developmental delay was observed using TDSC and 2.8% using LEST 0-3 y and 3.4% using TDSC and/or LEST positive. Out of the total 1,110 children clinically evaluated by a trained pediatrician, 69.3% children had developmental delay, 14.3% speech delay, 5.7% global delay, 5.3% gross motor delay and 3.6% suspected of hearing impairment. CONCLUSIONS The study results showing 3.4% prevalence of developmental delay using TDSC and/or LEST by trained anganwadi workers or ASHA workers could be replicated in other states in India, under Rashtria Bal Swasthya Kariyakram.
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Nair MKC, Sunitha RM, Leena ML, George B, Bhaskaran D, Russell PSS. CDC Kerala 2: Developmental intervention package for babies <1,800 g--outcome at 6 mo using DASII. Indian J Pediatr 2014; 81 Suppl 2:S73-9. [PMID: 25429998 DOI: 10.1007/s12098-014-1624-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe the experience of using developmental intervention package among low birth weight babies less than 1,800 g and developmental outcome at the end of 6 mo monthly intervention. METHODS Babies below 1,800 g, discharged from neonatal intensive care unit (NICU) of Sree Avittom Thirunal (SAT) hospital, over the last 3 y, were followed at Child Development Centre (CDC) Kerala and offered monthly evaluation by different tools and developmental intervention using a package by trained developmental therapists and mothers were encouraged to continue the same at home. At the end of 6 mo the developmental outcome was assessed using Developmental Assessment Scale for Indian Infants (DASII). RESULTS Out of a total of 821 babies enrolled for early stimulation program, 740 babies successfully completed 6 mo follow up and stimulation program. Comparing the outcome at 4 and 6 mo, both grading for head holding and gross motor part of DDST showed a statistically significant reduction in abnormal findings. At 6 mo assessment on DASII, motor DQ abnormalities were a high 80% for 600-900 g, as against 17.1% abnormalities for 1,500-1,800 g birth weight group. CONCLUSIONS The results of this intensive early stimulation program for babies below 1,800 g have shown the importance of monthly early intervention using a mother oriented systematic developmental stimulation package.
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Nair MKC, George B, Nair GSH, Bhaskaran D, Leena ML, Russell PSS. CDC Kerala 1: Organization of clinical child development services (1987-2013). Indian J Pediatr 2014; 81 Suppl 2:S66-72. [PMID: 25189815 DOI: 10.1007/s12098-014-1566-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The main objective of establishing the Child Development Centre (CDC), Kerala for piloting comprehensive child adolescent development program in India, has been to understand the conceptualization, design and scaling up of a pro-active positive child development initiative, easily replicable all over India. METHODS The process of establishing the Child Development Centre (CDC) Kerala for research, clinical services, training and community extension services over the last 25 y, has been as follows; Step 1: Conceptualization--The life cycle approach to child development; Step 2: Research basis--CDC model early stimulation is effective; Step 3: Development and validation of seven simple developmental screening tools; Step 4: CDC Diagnostic services--Ultrasonology and genetic, and metabolic laboratory; Step 5: Developing seven intervention packages; Step 6: Training--Post graduate diploma in clinical child development; Step 7: CDC Clinic Services--seven major ones; Step 8: CDC Community Services--Child development referral units; Step 9: Community service delivery models--Childhood disability and for adolescent care counselling projects; Step 10: National capacity building--Four child development related courses. RESULTS CDC Kerala follow-up and clinic services are offered till 18 y of age and premarital counselling till 24 y of age as shown in "CDC Kerala Clinic Services Flow Chart" and 74,291 children have availed CDC clinic services in the last 10 y. CONCLUSIONS CDC Kerala is the first model for comprehensive child adolescent development services using a lifecycle approach in the Government sector and hence declared as the collaborative centre for Rashtriya Bal Swasthya Karyakram (RBSK), in Kerala.
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George B, Padmam MSR, Nair MKC, Leena ML, Russell PSS. CDC Kerala 13: Antenatal, natal and postnatal factors among children (2-6 y) with autism--a case control study. Indian J Pediatr 2014; 81 Suppl 2:S133-7. [PMID: 25338492 DOI: 10.1007/s12098-014-1594-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/25/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To compare antenatal, natal and postnatal factors among children between 2-6 y of age with autism and a control group of normal children. METHODS One hundred and forty three confirmed cases of 2-6 y-old children with autism, attending autism clinic of Child Development Centre, who had a CARS score of ≥ 30 were included in the study. Two hundred normal children in the same age group were recruited from the well-baby/immunization clinic of SAT Hospital, Thiruvananthapuram. Data was collected using a structured pre-piloted questionnaire consisting of 21 antenatal, 8 natal and 6 postnatal risk factors. RESULTS The multivariate analysis on antenatal, natal and postnatal possible risk factors for autism showed statistically significant high odds ratios for (i) excess fetal movement (OR = 11.44; 95% CI: 2.85-45.98); (ii) maternal respiratory infection/asthma (OR = 6.11; 95% CI: 1.56-24.02; (iii) maternal vaginal infection (OR = 5.20; 95% CI: 1.72-15.73); (iv) maternal hypothyroidism (OR = 4.25; 95% CI: 1.38-13.07) and (v) family history of neuro-developmental disorders (OR = 2.90; 95% CI: 1.72-4.88). CONCLUSIONS This case control study involving 143 children between 2 and 6 y with autism as per CARS criteria and a control group of 200 normal children has shown that excess fetal movement, maternal respiratory infection/asthma, maternal vaginal infection, maternal hypothyroidism and family history of neuro-developmental disorders are possible risk factors for autism.
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Nair MKC, Harikumaran Nair GS, Beena M, Princly P, Abhiram Chandran S, George B, Leena ML, Russell PSS. CDC Kerala 16: Early Detection of developmental delay/disability among children below 6 y--a district model. Indian J Pediatr 2014; 81 Suppl 2:S151-5. [PMID: 25297644 DOI: 10.1007/s12098-014-1589-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/18/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop a district model for establishing early detection of childhood disability below 6 y of age and to develop appropriate referral linkages for confirmation of the diagnosis and establish home based early intervention therapy to all needy children. METHODS Trained Accredited Social Health Activist (ASHA) workers conducted the preliminary survey for identifying developmental delay/disability among children below 6 y of age using Trivandrum Developmental Screening Chart (TDSC) (0-6 y) and a team of experts assessed the screen positives in developmental evaluation camps conducted at primary health centres (PHCs). RESULTS Community survey was carried out and 1,01,438 children below 6 y of age in Thiruvananthapuram district were screened by ASHA workers and 2,477 (2.45%) positive cases (TDSC two or more item delay) were identified and these children were called for the developmental evaluation camps conducted at 80 PHCs in the district. Among the 1,329 children who reached the evaluation camps 43.1% were normal. 24.98% children had speech and language delay and 22.95% children had multiple disabilities. Developmental delay was observed among 49.89% children and cerebral palsy in 8.43% and intellectual disability 16.85% were confirmed. Visual impairment in 3.31% and neuromuscular disorders in 1.35 were found among children evaluated in the camp. CONCLUSIONS The results of this district wide early detection of disability survey by trained ASHA workers among children below 6 y of age showed a community prevalence of 3.08% observed, based on two or more item delay in TDSC and among these children, 43.1% were normal, 49.89% had developmental delay, 24.98% had speech and language delay and 22.95% had multiple disabilities.
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Nair MKC, Mini AO, Leena ML, George B, Harikumaran Nair GS, Bhaskaran D, Russell PSS. CDC Kerala 7: Effect of early language intervention among children 0-3 y with speech and language delay. Indian J Pediatr 2014; 81 Suppl 2:S102-9. [PMID: 25179239 DOI: 10.1007/s12098-014-1555-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/05/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the effect of systematic clinic and home based early language intervention program in children reporting to the early language intervention clinic with full partnership of specially trained developmental therapist and the parents. METHODS All babies between 0 and 3 y referred to Child Development Centre (CDC) Kerala for suspected speech/language delay were assessed and those without hearing impairment were screened first using Language Evaluation Scale Trivandrum (LEST) and assessed in detail using Receptive Expressive Emergent Language Scale (REELS). Those having language delay are enrolled into the early language intervention program for a period of 6 mo, 1 h at the CDC clinic once every month followed by home stimulation for rest of the month by the mother trained at CDC. RESULTS Out of the total 455 children between 0 and 3 y, who successfully completed 6 mo intervention, the mean pre and post intervention language quotient (LQ) were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant. The developmental diagnosis included developmental delay (62.4%), global developmental delay (18.5%), Trisomy and other chromosomal abnormalities (10.5%), microcephaly and other brain problems (9.9%), misarticulation (8.4%), autistic features (5.3%) and cleft palate and lip (3.3%) in the descending order. CONCLUSIONS In the present study among 455 children between 0 and 3 y without hearing impairment, who successfully completed 6 mo early language intervention, the mean pre and post intervention LQ were 60.79 and 70.62 respectively and the observed 9.83 increase was statistically significant.
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Nair MKC, Russell PSS, George B, Prasanna GL, Bhaskaran D, Leena ML, Russell S, Mammen P. CDC Kerala 9: Effectiveness of low intensity home based early intervention for autism spectrum disorder in India. Indian J Pediatr 2014; 81 Suppl 2:S115-9. [PMID: 25141828 DOI: 10.1007/s12098-014-1474-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/24/2014] [Indexed: 11/24/2022]
Abstract
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.
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Nair MKC, Russell PSS, Ellangovan K. A neurodevelopmental follow-up model in India: advances in the evidence base. Indian J Pediatr 2014; 81 Suppl 2:S63-5. [PMID: 25413214 DOI: 10.1007/s12098-014-1619-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
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Nair MKC, Russell PSS, George B, Prasanna GL, Bhaskaran D, Shankar SR, Singh Y. CDC Kerala 10: Diagnostic accuracy of the severity scores for childhood autism rating scale in India. Indian J Pediatr 2014; 81 Suppl 2:S120-4. [PMID: 25408269 DOI: 10.1007/s12098-014-1623-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 10/22/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To document the diagnostic accuracy of the Childhood Autism Scale (CARS) thresholds to identify mild, moderate and severe autism in India. METHODS The CARS scores of 623 children, with and without autism were compared against the Diagnostic and Statistical Manual for Mental Disorders 4th edition (DSM-IV-TR) for ASD diagnosis and clinical consensus between two developmental paediatricians as the reference standard for autism severity using the Receiver operating characteristics (ROC) curve analyses and contingency tables. RESULTS The CARS total score for mild, moderate and severe autism ranged from 30.5 to 35, 35.5-40 and ≥40.5 respectively in this study. The overall diagnostic accuracy of CARS total score in the mild range was moderate [AUC = 0.68 (95%CI = 0.62-0.88), z = 1.34; P = 0.18], moderate range was high [AUC = 0.90 (95%CI = 0.77-0.97), z = 8.62; P = 0.0001] and severe range was also high [AUC = 0.85 (95%CI = 0.77-0.90), z = 7.09; P = 0.0001]. CONCLUSIONS There are validated severity scores for Childhood Autism Rating Scale for clinical and research use in India.
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Benjamin TE, Crasta JE, Suresh APC, Alwinesh MJT, Kanniappan G, Padankatti SM, Nair MKC, Russell PSS. Sensory Profile Caregiver Questionnaire: a measure for sensory impairment among children with developmental disabilities in India. Indian J Pediatr 2014; 81 Suppl 2:S183-6. [PMID: 25338495 DOI: 10.1007/s12098-014-1603-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is no validated measure for assessing sensory processing among children with Developmental Disorders (DD) in India, and therefore, the authors validated the Sensory Profile Caregiver Questionnaire (SPCQ). METHODS Parents of 119 children with DD or typical development completed the SPCQ. The diagnosis of DD was confirmed by psychologists using standardized measures. Two experienced occupational therapists independently diagnosed sensory processing dysfunction by consensus as reference standard diagnosis. The convergent and divergent validity were assessed by another rater. The data was analyzed for diagnostic accuracy, reliability and validity appropriately. RESULTS A total SPCQ score of ≤ 481 (Sn = 81.58%, Sp = 85.19%; AUC = 0.90, z = 14.95; P 0.0001) is appropriate for the diagnosis of sensory processing dysfunction. The inter-rater reliability (ICC = 0.87), test- retest reliability (ICC = 0.90), internal consistency (Cronbach's α = 0.86), section-total correlation, face and content validity for the SPCQ were good. Convergent validity with the Sensory Processing Measure (r = -0.76, P 0.001), and divergent validity with the subscale scores for social skills/ oppositional behavior of ADD-H Comprehensive Teacher Rating Scale (r = 0.32; P 0.1/ r = 0.08; P 0.6) was established. CONCLUSIONS The SPCQ has adequate psychometric properties for use in the Indian population for identifying sensory processing dysfunction.
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Tsheringla S, Minju KA, Russell S, Mammen P, Russell PSS, Nair MKC. A meta-analysis of the diagnostic accuracy of Autism Diagnostic Observation Schedule Module-1 for autism spectrum disorders. Indian J Pediatr 2014; 81 Suppl 2:S187-92. [PMID: 25377926 DOI: 10.1007/s12098-014-1627-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 10/22/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Autism Diagnostic Observation Schedule (ADOS) is considered gold standard for the diagnosis of Autism Spectrum Disorders (ASD). The authors evaluated the cumulative diagnostic accuracy of ADOS-Module 1 (ADOS(M1)) using the original diagnostic algorithm with meta-analysis and meta-regression. METHODS The authors, electronically and manually searched for studies from 1999 to 2013 that evaluated the accuracy of ADOS(M1) using the original diagnostic algorithm in detecting ASD. Primary results of Sensitivity (Sn), Specificity (Sp) and Diagnostic Odds Ratio (DOR) for ADOS(M1) were summarized using random-effects model. Summary Receiver Operating characteristic Curves and its Area Under the Curve (SROC-AUC) were used to summarize overall diagnostic accuracy of ADOS(M1). The modifying effects of quality of study and sample size, on the diagnostic odds ratio, were investigated using meta-regression. RESULTS A total of 7 cross-sectional studies provided data on 4057 children. The pooled Sn, Sp, DOR and SROC-AUC for the overall diagnostic accuracy of ADOS (M1) were: 0.91 (95 %CI=0.89 to 0.93), 0.73 (95 % CI=0.69 to 0.76), 44.20 (95 %CI=15.89 to 122.95) and 0.90 respectively [corrected]. Meta-regression analysis showed a non-significant relationship between ADOS(M1) and study quality as well as sample size. There were subgroup differences in the DOR. CONCLUSIONS It is concluded that ADOS (M1) with the original diagnostic algorithm has the overall diagnostic accuracy and pooled specificity suggesting moderate accuracy. The pooled sensitivity is high to be used as a screening test for Autism Spectrum Disorders. ADOS( M1)with the revised diagnostic algorithm should be used for diagnostic purpose [corrected] ADOS(M1) with the revised diagnostic algorithm should be used instead for the diagnosis of this group of disorders.
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Nair MKC, Krishnan R, Harikumaran Nair GS, Bhaskaran D, Leena ML, George B, Russell PSS. CDC Kerala 4: TDSC items based developmental therapy package among low birth weight babies--outcome at 18 months using DASII. Indian J Pediatr 2014; 81 Suppl 2:S85-90. [PMID: 25186565 DOI: 10.1007/s12098-014-1551-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/23/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the effectiveness of Trivandrum Developmental Screening Chart (TDSC) items based intervention package developed at Child Development Centre, Kerala on the developmental outcome of children at 18 mo of age using Developmental Assessment Scale for Indian Infants (DASII) and compare the same in different birth weight groups. METHODS Five hundred consecutive discharges from the Neonatal Intensive Care Unit (NICU), Sree Avittam Thirunal hospital, were recruited and followed up till 18 mo of age including 240 low birth weight (LBW;<2,500 g) babies and 260 normal birth weight babies. All 240 LBW babies were offered early intervention at monthly intervals till 12 mo of age, whereas the normal birth weight (NBW) group received only immunization service as per the routine of the hospital. The early intervention package for the low birth weight group was designed based on Trivandrum Developmental Screening Chart (TDSC 0-2 y) items delay. At 18 mo of age both the groups were offered developmental assessment using DASII by specially trained and experienced developmental therapists who were blind to the intervention status of the babies. RESULTS It was observed that the LBW (<2,500 g) group, who received intervention had a DASII mental age of 18.31 as against 18.16 in the NBW (≥2,500 g) group and mental DQ 101.84 (LBW group) and 98.65 (NBW group) and the observed differences were not statistically significant. Similarly, the LBW, who received intervention group had a DASII motor age of 18.68 as against 18.47 in the NBW group and motor DQ 139.40 (LBW group) and 135.39 (NBW group) and the observed differences were not statistically significant. CONCLUSIONS The results of this TDSC based intervention package among low birth weight babies showed that at 18 mo of age there was no statistically significant difference in the developmental outcome using DASII, between low birth weight babies on intervention and the normal birth weight babies without any intervention.
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George B, Padmam MSR, Nair MKC, Leena ML, Russell PSS. CDC Kerala 14: Early child care practices at home among children (2-6 y) with autism--a case control study. Indian J Pediatr 2014; 81 Suppl 2:S138-41. [PMID: 25366290 DOI: 10.1007/s12098-014-1602-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To compare early child care practices at home as possible risk factors among children between 2 and 6 y of age with autism and a control group of normal children without any symptom of autism, presenting at the well-baby/immunization clinic. METHODS This case control study was undertaken at the autism clinic of CDC Kerala, comparing possible risk factors for autism among 143 children between 2 and 6 y with autism as per CARS criteria and a control group of 200 normal children of the same age from well-baby/immunization clinic of SAT hospital. The data was collected using a structured pre-piloted questionnaire, which included 11 questions administered by the same senior social scientist, on early child care practices at home that have been universally considered as important for child development. RESULTS On multivariate analysis on early child care practices at home as possible risk factors for autism, it was observed that statistically significant high odds ratios were present for (i) no outings (OR = 3.36; 95% CI: 1.39-8.16; p 0.007); (ii) child does not play with children of same age (OR = 19.57; 95% CI: 9.50-40.32); (iii) do not tell stories/sing songs to the child (OR = 3.21; 9 % CI: 1.61-6.41); and (iv) breastfeeding duration nil/ < 6 mo (OR = 3.40; 95% CI: 1.28-8.99). CONCLUSIONS This case control study involving 143 children between 2 and 6 y with autism as per CARS criteria and a control group of 200 normal children has shown that early child care practices at home, specifically breastfeeding duration nil/ < 6 mo, child does not play with children of same age, do not tell stories/sing songs to the child and no outings for the child are possible risk factors for autism.
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Suresh APC, Benjamin TE, Crasta JE, Alwinesh MTJ, Kanniappan G, Padankatti SM, Nair MKC, Russell PSS. Comparison of burden among primary care-givers of children with autism and intellectual disability against children with intellectual disability only in a hospital population in India. Indian J Pediatr 2014; 81 Suppl 2:S179-82. [PMID: 25387661 DOI: 10.1007/s12098-014-1626-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/22/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the burden among the primary caregivers (PCG) of children with autism and intellectual disability (ASD + ID) against intellectual disability (ID) only, and identify the factors that predict high caregiver burden. METHODS Children with either ASD + ID (N = 41) or ID (N = 56) and their PCG were recruited and assessed using the Family Burden Interview Schedule, Binet Kamat Scale of Intelligence or Gesell's Developmental Schedule and Vineland Social Maturity Scale, Childhood Autism Rating Scale, Sensory Profile and Brief Autism Mealtime Behavior Inventory after collecting the socio-demographic details. Appropriate bivariate and multivariate statistical test were used. RESULTS The total burden and level of burden was similar among PCG of children with ASD + ID and ID (P = 0.8). However, financial burden (P = 0.03) and burden due to the effects on the physical health of other family members (P = 0.03) was more among the ID group. The burden due to the effects on family interaction was more (P = 0.009) in the ASD + ID group. The socio-economic status (OR = 3.60; P = 0.03) and the kinship of the primary care-giver (OR = 0.37; P = 0.008) were significantly associated with high level of burden. In addition, the diagnosis, and gender of the child contributed to the prediction model for high level of burden. CONCLUSIONS The interventions for children with ASD + ID and ID should have modules to address burden among PCG. Disability specific burden alleviating strategies should be used among PCG who are at risk of having high burden.
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Tsheringla S, Simon A, Russell PSS, Shankar S, Russell S, Mammen P, Nair MKC. ADD-H-Comprehensive Teacher's Rating Scale (ACTeRS): a measure for attention deficit hyperactivity disorder among children with intellectual disability in India. Indian J Pediatr 2014; 81 Suppl 2:S161-4. [PMID: 25265891 DOI: 10.1007/s12098-014-1572-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 08/21/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There is no validated measure for assessing Attention Deficit Hyperactivity Disorder (ADHD) in India, and therefore, the authors validated the ADD-H Comprehensive Teacher's Rating Scale (ACTeRS). METHODS Teachers/parents/clinicians of 110 children with ADHD completed the ACTeRS. The diagnosis of ADHD was confirmed by an independent multi-disciplinary team using ICD-10 diagnosis for diagnostic accuracy and criterion validity. The convergent and divergent validity were assessed by another rater. The data was analyzed for diagnostic accuracy, reliability and validity appropriately. RESULTS An ACTeRS score of ≥61 [Sensitivity (Sn) =85.51%; Specificity (Sp) = 90.24%; Area under the curve (AUC) = 0.94] is appropriate for the diagnosis of ADHD. The test-re-test reliability [Intra-class correlation coefficient (ICC) = 0.87], internal consistency (Cronbach's α = 0.80; range of 0.89-0.93), section-total correlation, face and content validity for the ACTeRS were good. Convergent validity of attention deficit, hyperactivity and oppositional subscales of ACTeRS with the corresponding subscales of Swanson, Nolan & Pelham Rating Scale-Revised (SNAP-IV) was moderate (r = 0.60, P = 0.005; r = 0.49, P = 0.02; r = 0.58, P = 0.008 respectively), and negative correlation with the Childhood Autism Rating Scale (r = -0.36; P =0.1) for divergent validity was found. The criterion validity analysis showed a high concordance rate of 82.52% between ACTeRS and International Classification of Diseases, Edition10 (ICD-10) diagnosis of ADHD. A 4-factor structure was replicated. CONCLUSIONS The ACTeRS has adequate psychometric properties for use in the Indian population for identifying ADHD.
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Nair MKC, Krishnan R, Harikumaran Nair GS, George B, Bhaskaran D, Leena ML, Russell PSS. CDC Kerala 3: At-risk baby clinic service using different screening tools--outcome at 12 months using Developmental Assessment Scale for Indian Infants. Indian J Pediatr 2014; 81 Suppl 2:S80-4. [PMID: 25124327 DOI: 10.1007/s12098-014-1526-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/23/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe CDC Kerala experience of establishing an at-risk baby clinic and the comparison of different developmental screening tools at 12 mo against the gold standard Developmental Assessment Scale for Indian Infants (DASII). METHODS At risk baby clinic of CDC, Kerala was established as a facility for follow up of NICU graduates from Sree Avittam Thirunal Hospital at 2, 4, 6, 8 and 12 mo corrected age and during each visit the mother is taught the CDC model early stimulation by developmental therapists and encouraged to continue to do the same at home. At 12 mo, assessment results of four simple developmental tools were compared with the gold standard DASII administered by a senior developmental therapist. RESULTS Out of a total of 800 babies, outcome measurements at 12 mo were available for 604 infants. The prevalence of developmental delay using the screening tools, CDC grading for standing, Amiel Tison angles and DDST II (Denver II) gross motor were 24.8, 24 and 24.3% respectively and using DASII, a diagnostic tool (13.3%). Also the combination of Amiel Tison angles, CDC standing grading and DDST gross motor against DASII motor DQ had high specificity (94.15%) and negative predictive value (NPV) (70.18%) but with a very low sensitivity of 14.58% and low positive predictive value (PPV) of 53.85%. It was observed that a significant odds ratio for DASII mental deviation quotient (DQ) was seen for neonatal seizures (2.34) and low birth weight (1.49). CONCLUSION The prevalence of developmental delay using the screening tools, CDC grading for standing, Amiel Tison angles and DDST II (Denver II) gross motor were 24.8, 24 and 24.3% respectively and together they had a high specificity, NPV and accuracy against DASII motor DQ as gold standard at one year assessment.
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Nair MKC, Resmi VR, Krishnan R, Harikumaran Nair GS, Leena ML, Bhaskaran D, George B, Russell PSS. CDC Kerala 5: Developmental therapy clinic experience--use of Child Development Centre grading for motor milestones. Indian J Pediatr 2014; 81 Suppl 2:S91-8. [PMID: 25124328 DOI: 10.1007/s12098-014-1534-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/26/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To document the experiences of the intervention given to children who attended the developmental therapy clinic of Child Development Centre (CDC) Kerala, a specialized clinic for providing developmental intervention/therapy for babies less than two years with developmental delay/disability. METHODS All the babies referred to this speciality clinic from developmental screening/evaluation clinics of CDC were registered in the clinic and re-evaluation was done using CDC grading for head holding, sitting, standing, Amiel Tison passive angles, and Trivandrum Developmental Screening Chart (TDSC) 0-2 y. RESULTS Out of a total of 600 consecutive babies below 2 y with developmental delay/disability referred to developmental therapy clinic, on comparing the test results at enrollment and after 6 mo of intervention, a statistically significant reduction was observed (i) in the 2-4 mo age group with regard to abnormal TDSC (25.5%), (ii) in the 4-8 mo age group with regard to abnormal head holding grade (87.1%) and abnormal TDSC (19.4%), (iii) in the 8-12 mo age group, with regard to abnormal sitting grade (71.7%) and (iv) in the above 12 mo age group with regard to abnormal sitting grade (35.3%) and abnormal standing grade (78.8%). CONCLUSIONS The experience of organizing the developmental intervention/therapy clinic at CDC Kerala has shown that therapy services by developmental therapists in a centre and supportive therapy by mother at home is useful in improving the developmental status of children with developmental delay.
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Nair MKC, Lakshmi MA, Latha S, Lakshmi G, Harikumaran Nair GS, Bhaskaran D, George B, Leena ML, Russell PSS. CDC Kerala 15: Developmental Evaluation Clinic (2-10 y)--developmental diagnosis and use of home intervention package. Indian J Pediatr 2014; 81 Suppl 2:S142-50. [PMID: 25326156 DOI: 10.1007/s12098-014-1587-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/10/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To describe the last 5 years' experience of Child Development Centre (CDC), Kerala Developmental Evaluation Clinic II for children between 2 and 10 y, referred for suspicion of developmental lag in the preschool years and scholastic difficulty in the primary classes with specific focus on developmental profile and the experience of the home based intervention package taught to the mothers. METHODS A team of evaluators including developmental therapist, preschool teacher with special training in clinical child development, speech therapist, special educator, clinical psychologist and developmental pediatrician assessed all the children referred to CDC Kerala. Denver Developmental Screening Test (DDST-II), Vineland Social Maturity Scale (VSMS) and Intelligent Quotient (IQ) tests were administered to all children below 6 y and those above 6 with apparent developmental delay. RESULTS Speech/delay (35.9%), behavior problem (15.4%), global delay/ intellectual disability (15.4%), learning problem (10.9%), pervasive developmental disorders (7.7%), seizure disorder (1.7%), hearing impairment (0.7%), and visual impairment (0.7%) were the clinical diagnosis by a developmental pediatrician. Each child with developmental problem was offered a home based intervention package consisting of developmental therapy and special education items, appropriate to the clinical diagnosis of the individual child and the same was taught to the mother. CONCLUSIONS The experience of conducting the developmental evaluation clinic for children between 2 and 10 y has shown that a team consisting of developmental therapist, speech therapist, preschool teacher, special educator, clinical child psychologist and developmental pediatrician, using appropriate test results of the child could make a clinical diagnosis good enough for providing early intervention therapy using a home based intervention package.
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Thomas N, Singh A, Sankaran S, Russell PSS, Tsheringla S, Viswanathan SA, Nair MKC. ICD-10 and alternative diagnostic criteria for childhood autism among children with intellectual disability. Indian J Pediatr 2014; 81 Suppl 2:S173-8. [PMID: 25297645 DOI: 10.1007/s12098-014-1591-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The diagnosis of Childhood Autism (CA) among children with Intellectual Disability (ID) based on clinical criteria validated for populations with average intelligence compromises it's diagnostic accuracy in this special population. This study documents the diagnostic accuracy of ICD-10 and alternative criteria for CA in ID population. METHODS Consensus clinical diagnosis of autism made by a multi-disciplinary team as the reference data were extracted from the case notes and psychological tests details by two trainee psychologists, and ICD-10 based clinical diagnosis, demographics, ID, CA related data documented independently of the psychiatrist. The appropriate statistical analyses were completed. RESULTS Repetitive behaviors formed the most common symptom cluster. The high internal consistency (κ = 0.75) among the three groups of ICD-10 symptoms indicate their usefulness in the diagnosis of CA among children with ID, but significantly more children with ID failed to meet the ICD-10 criteria for CA. The fourth alternative criteria had the highest concordance with the reference standard (100%) and the first alternative criteria had the highest agreement with the reference standard (κ = 0.88) in identifying CA among ID. The diagnostic accuracy of all the alternative criteria was significantly better than that of ICD-10 with the first alternative criteria having the best diagnostic accuracy (Sn = 98%; Sp = 100%; PPV = 1; NPV =0.83) closest to the reference standard. CONCLUSIONS The symptom clusters in ICD-10 for CA should be retained, however reorganising the diagnostic criteria is required for diagnosing CA accurately among children with ID. The first alternative criteria can significantly improve the case identifying ability and diagnostic accuracy altering there by the epidemiological data on Childhood Autism among children with Intellectual Disability.
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