CDC Kerala 12: Socio-demographic factors among children (2-6 y) with autism--a case control study

OBJECTIVES

To compare the socio-demographic factors among children between 2 and 6 y of age with autism and a control group of normal children.

METHODS

One hundred 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 more than 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 11 socio-demographic possible risk factors.

RESULTS

The multivariate analysis on socio-demographic characteristics as possible risk factors for autism has shown that (i) upper and upper middle socioeconomic status (OR: 7.13; CI: 3.26-15.57) and (ii) male gender (OR: 3.95; CI: 2.22-7.04) were significant risk factors for autism, whereas place of residence, rural (OR: 0.41; CI: 0.24-0.68) is a protective factor.

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 upper and upper middle socioeconomic status and (ii) male gender are significant risk factors for autism, whereas place of residence, rule is a protective factor.

CDC Kerala 8: Effectiveness of a clinic based, low intensity, early intervention for children with autism spectrum disorder in India: a naturalistic observational study

OBJECTIVE

To document the effectiveness of low intensity, clinic based intervention models for Autism Spectrum Disorders (ASD) in countries with low disability resources.

METHODS

Thirty-nine participants with a mean (SD) of 36.03(11.15) mo were assessed before and after intervention with Childhood Autism rating scale (CARS), and at baseline with the Denver Developmental Screening Test for quantifying the effectiveness of the clinic-based intervention in ameliorating autism symptoms and studying the effect of developmental disability respectively. Developmental therapists in the clinic gave low-intensity group intervention for 45-60 min to the child through mother and encouraged to continue the training, for 3-4 h, at home to address the specific goals in the three ASD symptom clusters. Most of the children were also placed in play-schools. Follow-up support was given either on a weekly, fortnightly or monthly basis. Data was analyzed using appropriate bivariate and multivariate techniques.

RESULTS

There was amelioration in the severity of autism after intervention, which was statistically and clinically significant. Intervention was useful to help children with mild to severe autism.

CONCLUSIONS

Low-intensity, clinic-based intervention can be effectively used in situation where there is paucity of disability resources.

Pre-intervention predictors for acquisition of adaptive behavior among children with intellectual disability

OBJECTIVE

To determine the predictive factors associated with the adaptive behavior acquisition among children with Intellectual Disability (ID) in two different training packages.

METHODS

Parents of 52 consecutive children completed a demographic data form. Pre-intervention quantification of ID, parental attitude and adaptive behavior assessments were done using the Binet-Kamat Test of Intelligence or Gessells Developmental Schedule, Parental Attitude Scale towards Management of Intellectual Disability and Vineland Social Maturity Scale respectively, by independent raters. Univariate and multiple logistic regression models were used to identify the predictive models for the training outcomes and further validated using re-sampling technique.

RESULTS

Predictive factors associated with the good outcome in the multimodal adaptive behavior training plus interactive group psycho-education group were: younger age of the parent trained, and more than two siblings. Among the multimodal adaptive behavior training plus didactic lectures group, education of parent trained predicted better adaptive behavior interventional outcome. There was no association between the place of residence, socio-economic status, profession of parent, level of disability or the parental attitude.

CONCLUSIONS

Different predictive factors are associated with potential short-term outcome of different adaptive behavior training for children with ID. Based on these pre-intervention predicators children and their parents can be given specific intervention packages.

Development and validation of Trivandrum Development Screening Chart for children aged 0-6 years [TDSC (0-6)]

OBJECTIVE

To develop and validate a simple screening tool for identifying developmental delay among children of 0-6 y of age in the community.

METHODS

The 51-items of Trivandrum Development Screening Chart for children of 0-6 y [TDSC (0-6 y)], were carefully prepared from the norms in various existing developmental charts/scales, by experts keeping in mind the face validity and content validity. The criterion validity was assessed in a community sample of 1,183 children of 0-6 y with a mean age of 35.38 mo (SD of 19.25) including 597 (50.46%) boys and 586 (49.54%) girls. TDSC (0-6 y) was validated against Denver Developmental Screening Test (DDST) as the 'Reference Standard'.

RESULTS

When one item delay in TDSC (0-6 y) was considered as 'TDSC delay' (test positive), the sensitivity and specificity of TDSC (0-6 y) was found to be 84.62% (95% CI: 71.92-93.12) and 90.8% (95% CI: 88.97-92.43) respectively with a Negative Predictive Value of 99.23% (95% CI: 98.48-99.67) and LR (negative) of 0.17(95% CI: 0.09-0.32). The test-retest and inter-rater reliability [an interclass correlation (ICC) of 0.77 for test-retest and ICC of 0.97 for inter-rater] were good and acceptable.

CONCLUSIONS

TDSC (0-6 y) is a simple, reliable and valid screening tool for use in the community to identify children between 0 and 6 y with developmental delay, enabling early intervention practices.

ADad 9: Suicidal behavior in Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVE

The risk of suicidal behavior associated with Anxiety Disorders (AD) among adolescents is known. However, concurrent mood disorders complicate these findings, and no data is available from India as well as from the community. This study aimed to address the suicidal risk associated with AD from different perspectives.

METHODS

The authors prospectively collected data for 500 adolescents in a community with independent, trained raters. Risk for suicidal behavior was measured with SADPERSONS scale, socio-economic status with Modified Kuppuswamy Scale, depression and anxiety disorders with Beck Depression Inventory and Screen for Child Anxiety Related Emotional Disorders respectively. The relationship between predictors and need for preventive action was analyzed with univariate and multivariate regression analyses and a predictive model was built.

RESULTS

Suicidal behavior was increased by the presence of AD (adjusted OR = 6.28), the number of co-morbid AD (adjusted OR = 2.04), severity of the AD (adjusted OR = 4.98). Being a boy increased the risk of suicidal behavior associated with AD (adjusted OR = 9.37), Generalized Anxiety Disorder (adjusted OR = 5.65), Separation Anxiety Disorder (unadjusted OR = 3.28), Social Anxiety Disorder (unadjusted OR = 5.91) while controlling for the confounding effect of Depressive Disorder. Gender did not have an influence on Panic Disorder. Presence of AD and co-morbid Depressive Disorder significantly contributed to a risk model for suicidal behavior.

CONCLUSIONS

Anxiety Disorder is associated with the risk for potential suicidal behavior. Adolescent boys with AD and Depressive Disorder need to be identified as the high risk group for suicide prevention in the community.

ARSH 7: Community adolescent health care and education: experience of an innovative approach

OBJECTIVE

The main objective of the project was to create a community adolescent health care and education initiative with an innovative approach of educating all community stakeholders involved in promoting adolescent health.

METHODS

Step 1: Conceptualization and strategy planning for combined training; Step II: Preparation of teaching module, flip charts and pamphlets in local language; Step III: Hands on training of community trainers; Step IV: Sensitization of the stakeholder leadership to ensure the cooperation of all stakeholders; Step V: Formation of Teen clubs; Step VI: The combined health education programs at community outlets; Step VII: Detection of adolescent health issues by ASHA and anganwadi workers; Step VIII: Setting up of Saturday adolescent clinics at CHCs as a community referral facility.

RESULTS

Under 1,060 programs, 34,851 community stakeholders could be trained together including 15,777 mothers, 14,565 adolescents, 2,236 ASHA workers, 2,021 anganwadi workers, and 252 community leaders. The concept of combined training of community stakeholders was found to be feasible and acceptable to the participants.

CONCLUSIONS

The experience of the CDC-NRHM-AHDP project has shown that ASHA workers and anganwadi workers could be important link persons between adolescents and the health providers.

ADad 3: the epidemiology of Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVES

Despite being the most common mental health concern, there is paucity of literature on the epidemiology of anxiety disorders among the adolescent population in India. This study aimed to estimate the period prevalence of Anxiety Disorders (AD) among 11 to 19 y old adolescents in India.

METHODS

A representative sample of adolescents (N = 500) from a rural community in Southern India was assessed for the period prevalence of all and specific Anxiety Disorders using Screen for Child Anxiety Related Emotional Disorders (SCARED), and confirmed in a subsequent interview with Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL).

RESULTS

The prevalence for all AD using the international, Indian SCARED cut-offs and DSM-IV-TR criteria was 8.6 % (boys = 2%; girls = 6.6%), 25.8% (boys = 6.6%; girls = 19.2%) and 14.4 % (boys = 4.8%; girls = 9.6%) respectively. There were significant gender differences in the prevalence for all Anxiety Disorders (χ (2) = 3.61, df = 1; P < 0.05), Separation Anxiety Disorder (χ (2) = 22.27, df = 1; P < 0.001) and Social Anxiety Disorder (χ(2) = 4.29, df = 1; P < 0.03). Significant age difference in the prevalence of Panic Disorder (χ(2) = 10.32; df = 1; P = 0.00) and Generalized Anxiety Disorder (χ(2) = 5.87; df = 1; P = 0.05) was noted.

CONCLUSIONS

The prevalence of Anxiety Disorders in South Indian adolescents was higher than found in the western literature. Prevalence of specific AD was age and gender specific. Adolescent and mental health policies must integrate anxiety disorder of public health significance.

ADad 11: Needs and service provisions for Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVE

Despite the need to have adolescent-centric policies and mental health services, India is yet far from having one. The authors aimed at generating opinions on the need to have adolescent focused policies and clinical services using the data on Anxiety Disorders they collected from the community.

METHODS

This qualitative study used Focus Group Discussions (FGD) to generate opinions on the various needs to enhance better mental health services and policies for adolescents in India. A Modified Delphi technique was used with experts in mental health to prioritize these needs. Experts gave their plans on how to approach the needs during the in-depth interviews.

RESULTS

The mental health professionals viewed scaled-up mental health services to include adolescent mental health services; improve the consumer opinion about public sector health providers; strengthening the government hospitals; capacity building among the health sector and non-health sector; research in service delivery models and policy changes as the needs. The parents felt the need to address the stigma associated with their children's mental illness, minimize the barriers in approaching mental health services and involve non-medical agencies in mental health care. These needs were prioritized and solutions to these problems were discussed.

CONCLUSIONS

India-centric and adolescent specific mental health policies and services need to be developed as well as integrated into the existing health system in India.

ADad 4: the symptomatology and clinical presentation of Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVES

Anxiety Disorders (AD) in children and adolescents present with unique clinical features and exhibit phenotypic diversity. The symptom presentation varies with regard to age of onset, developmental factors and gender. This study documents the clinical presentation of AD among adolescents in India, and explores the symptom clusters among the different age groups as well as gender.

METHODS

Five hundred adolescents aged between 11 and 19 y from Pattanakad ICDS block, of Allapuzha district in Kerala were recruited and assessed using the self-rated Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire to identify symptom clusters of anxiety and this was followed by confirmation of the diagnosis using DSM-IV TR within a week. Anxiety symptom clusters and severity (obtained from continuous SCARED scores) were compared between early, middle and late adolescence subgroups as well as between sexes.

RESULTS

The most predominant anxiety symptoms across the subtypes were the anxious mood, which was noted in 12.60% followed by cognitive symptoms in 9.94% of the cases and finally physical symptoms in 9.22% of the study sample. The symptom clusters varied among the subtypes with anxious mood being commoner in Panic Disorder (PD), cognitive symptoms in Generalised Anxiety Disorder (GAD) and physical symptoms were prominent among Separation Anxiety (SeAD) and Social Anxiety Disorders (SoAD). The severity of anxiety disorder in general and its various subtypes were mostly of mild intensity although significant proportion had a severe form of the disease(s). The severity of the AD among girls was statistically significantly higher than boys (P = 0.02). There was no significant difference on symptom frequency or anxiety severity with regard to age.

CONCLUSIONS

Understanding of age appropriate presentation of anxiety symptoms may help in streamlining the treatment guidelines and yield a better estimate of the disease process.

ADad 2: the validation of the Screen for Child Anxiety Related Emotional Disorders for Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVE

Screen for Child Anxiety Related Emotional Disorders (SCARED), a measure found useful in different settings and cultures has not been validated in the subcontinent. This study validated this measure for identifying Anxiety Disorder (AD) among adolescents in an Indian community context.

METHODS

Five hundred adolescents were assessed with SCARED and DSM-IV-TR reference standard for diagnosis of AD. The interviewers were experienced raters who were further trained to interview participants using Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL). Sensitivity, specificity, likelihood ratios and predictive values for various SCARED cut-off scores were calculated. Test-retest reliability and inter-rater reliability of SCARED were examined. The dichotomized SCARED score was correlated with the DSM-IV-TR clinical diagnosis of AD to establish the criterion validity of SCARED as a measure of AD.

RESULTS

A SCARED total score of ≥21(Sn = 84.62%, Sp = 87.36%; AUC = 90%) is suggested for diagnostic use in Indian population. Specific threshold scores were identified for the Panic Disorder, Generalized Anxiety Disorder, Separation Anxiety Disorder and Social Anxiety Disorder subscales. The inter-rater reliability (ICC = 0.87) and test-retest reliability (ICC = 0.90) for SCARED is good. Besides the adequate face and content validity, SCARED demonstrates good internal consistency (Cronbach's α = 0.89) and item-total correlation. There is a high concordance rate with the reference standard, DSM-IV-TR diagnosis [81%; Cohen's κ = 0.42 (95% CI = 0.31 to 0.52); P = 0.001] in classifying AD.

CONCLUSIONS

SCARED has adequate psychometric properties and is now available for clinical and research work in India.

ARSH 2: Reproductive and sexual health knowledge, attitude and practices: comparison among boys and girls (10-24 y)

OBJECTIVE

To compare the knowledge, attitude and practice of boys and girls on reproductive sexual health and their perspective on the needs of adolescents on this aspect.

METHODS

This comparative study was conducted among boys and girls between 10 and 24 y in three districts of Kerala; through a cross sectional community survey using a pretested structured schedule with additional sexuality related questions for 15-24 y age group.

RESULTS

Higher percentage of boys knew about condoms (95.1%, p 0.001) whereas higher percentage of girls (56.5%, p 0.001) knew about copper-T. Girls had a better knowledge on legal age of marriage (91%, p 0.001), that both the partners are equally responsible for the problem of infertility (89.7%, p 0.009) and that the gender of the baby is determined by male sperm (60.4%, p 0.001). Above 90% of boys and girls demanded adolescent care services and facilities for counseling.

CONCLUSIONS

This comparative study on knowledge, attitude and practice of boys and girls between 10 and 24 y has shown that greater proportion of girls had correct knowledge on the legal age of marriage, ideal age of pregnancy, preferred an arranged marriage and felt the need for premarital counseling.

ARSH 4: Parental understanding of adolescent issues: parent-adolescent dyad agreement

OBJECTIVE

To elicit areas of discordance between the parent-adolescent dyad with regard to reproductive sexual health issues using the same questions to both and to elicit the gender sensitivity of the parents.

METHODS

This study was conducted using similar questions for both adolescents and young adults and their parents in three districts of Kerala. Data analysis was done comparing unmarried adolescents and young adults' response to reproductive and sexual health issues and the parental agreement status with their ward's responses.

RESULTS

There were a total of 3,625 parent-unmarried young adults dyads. Parental attitudinal difference towards their sons and daughters on selected parenting issues was observed. With regard to the following reproductive and sexual health problems, (i) knew about menstruation before menarche (64.1%), (ii) got information on hygiene practices from home (80.8%), (iii) have menstrual problems (66.4%), agreement with adolescent response was high, whereas with regard to (i) anxious about adolescent physical and mental changes (29.2%), (ii) received information on reproductive sexual health (RSH) from mother (26.7%), (iii) do not have any abnormal vaginal discharge (46.7%), (iv) parents taken precautions to prevent sexual abuse (17.5%), (v) have been sexually abused (15.6%), agreement with unmarried young adults' response was low and all these differences were statistically significant.

CONCLUSIONS

The results of 3,625 parent-unmarried adolescents and young adults dyad data showed poor agreement on vital issues like sexual abuse apart from gender inequality favouring sons.

ARSH 5: Reproductive health needs assessment of adolescents and young people (15-24 y): a qualitative study on 'perceptions of community stakeholders'

OBJECTIVE

To explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among adolescents in order to improve reproductive health services for adolescents.

METHODS

The study was conducted in three districts of Kerala and need assessment was done qualitatively using focus group discussions (FGDs), five each from all the three districts among junior public health nurses (JPHNs), anganwadi workers (AWWs), non-government organizations (NGOs), community leaders and adolescents.

RESULTS

Majority of community stakeholders expressed that adolescents get knowledge regarding personal hygiene from their family itself and that they have poor knowledge about genital hygiene. Pain and associated problems are the most important difficulties faced by adolescent girls during menstrual periods. Most of the adolescents believed that excessive masturbation is a very dangerous practice. Most of the community stakeholders pointed out that though our adolescents know about HIV, they have very poor knowledge about other STIs and that parental ignorance increases vulnerability for sexual abuse among adolescents. They also suggested family life education sessions at schools and colleges for younger ones and premarital counseling for older ones, apart from counseling services and adolescent clinics. The important barriers in the utilization of services for adolescents are lack of awareness of parents, stigma to utilize services, economic factors, facility available at faraway places, and non-availability of services.

CONCLUSIONS

The need for adolescent friendly health services and premarital counseling services in the community attached to health facilities, has been highlighted.

ADad 6: the predictive factors for Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVE

Development of Anxiety Disorders (AD) among adolescents is the interplay of risk and protective factors that have a biological and environmental basis. This study documents the predictive factors associated with the presence of AD among adolescents in India.

METHODS

The authors prospectively collected data for 500 adolescents in a community with independent, trained raters. Data on the dependent variable of AD and its subtypes was collected with Screen for Child Anxiety Related Emotional Disorders (SCARED), Socio-economic status with Modified Kuppuswamy Scale, depression with Beck Depression Inventory and the other independent variables with a specially designed proforma. The predictive factors for the presence of AD were analyzed with univariate and multivariate regression analyses appropriately, and a parsimonious predictive model was built.

RESULTS

Gender (adjusted OR = 1.96), and presence of Depressive Disorder (adjusted OR = 24.14) emerged as independent risk factors. Level of education came-out as a protective factor (adjusted OR = 0.66). Adolescent girls were at risk of developing Separation Anxiety Disorder (SeAD) (adjusted OR = 3.51) and Social Anxiety Disorder (SoAD) (adjusted OR = 1.69). Level of education had a protective influence on SeAD (adjusted OR = 0.39) and SoAD (adjusted OR = 0.59) among those doing high school. This protective effect increased if they were in higher-secondary school for SeAD (adjusted OR = 0.21) and SoAD (adjusted OR = 0.22). In the multivariate model age of the adolescent also gained significance and the 3-factor model had a good model fit. Panic Disorder and Generalized Anxiety Disorder were not related to any specific variable.

CONCLUSIONS

Identifying the factors associated with AD and the subtypes can be used to predict, prevent or treat these disorders in this population. Educating adolescent girls to higher-secondary school level seem to be an important step in this direction.

ADad 1: rationale and study design for Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVE

The Anxiety Disorders among adolescents (ADad) study aimed to document the prevalence, clinical pattern, co-morbidities, predictive factors, relationship with depression, associated suicidal phenomenon and school phobia of Anxiety Disorders in a rural community population in India. This paper reviews the rationale and study design used as well as discusses the strengths and limitations of the survey.

METHODS

The ADad was a cross-sectional study that recruited 537 adolescents, with anganwadi workers, representative of the population aged 11-19 y. Trained raters independently administered the Screen for Child Anxiety Related Emotional Disorders (SCARED), Beck Depression Inventory (BDI), SAD PERSONS scale and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL). Appropriate bivariate and multivariate statistical analyses were done.

RESULTS

Five hundred adolescents opted to participate and completed the study. About 37% of boys and 63.4% of girls responded to the measures, almost comparable with the gender distribution in the panchayat.

CONCLUSIONS

The ADad study creates a comprehensive database on validation of measure, the prevalence, clinical pattern, co-morbidities, predictive factors, relationship with depression, associated outcomes of suicidal phenomenon, school phobia, impairment associated with Anxiety Disorders and policy recommendations in a community population of adolescents in India. These data will enable policy makers to rationally plan clinical services and prevention programs for the target population.

ADad 5: the co-morbidity in Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVE

Anxiety Disorders (AD) have been known to have high prevalence of intra-AD and extra-AD co-morbidities. This study documents the prevalence and profile of intra and extra-AD co-morbidities, the effect of the presence and number of co-morbidities on the severity of anxiety symptoms and the influence of age as well as gender on the co-morbidity.

METHODS

In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders (SCARED) and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) to collect the required data. Descriptive statistics, independent t tests, one-way ANOVA and Chi-square tests were done to evaluate the prevalence and profile of co-morbidity presentation, compare the effect of co-morbidity on severity of anxiety symptoms as well as analyse the influence of age groups and gender on intra-AD co-morbidities.

RESULTS

Among those with AD, 14.2% had a DSM-IV-TR intra-AD co-morbidity and 70% had SCARED based intra-AD co-morbidity. Adolescents with Separation Anxiety Disorder and Generalised Anxiety Disorder had the highest SCARED and DSM-IV-TR prevalence of intra-AD co-morbidity respectively. Also, 23.7% had overlapping extra-AD co-morbidity. Presence and number of intra-AD co-morbidity was significantly associated with severity of total anxiety score and subscale scores (all with P = 0.001). Age and gender of adolescents were not related to the co-morbidity.

CONCLUSIONS

Intra and extra-AD co-morbidities are quite prevalent among adolescents with Anxiety Disorders in India. As such, co-morbidities increase the severity of anxiety symptoms, they should be identified and appropriate management should be established.

ADad 7: Relationship between depression and Anxiety Disorders among adolescents in a rural community population in India

OBJECTIVES

Anxiety Disorders (AD) often co-exist with the heterotypic co-morbidity of Major Depressive Disorder (MDD) and Dysthymia (DysD). This study documents the prevalence of concurrent Depressive Disorder and its subtypes among AD, relationship between specific AD and Depressive Disorders, influence of severity of Depressive Disorders (DD) on AD and vice-versa, as well as the effect of age and gender on this co-morbidity.

METHODS

In a prospective community survey of 500 adolescents, independent raters administered the Screen for Child Anxiety Related Emotional Disorders, Beck Depression Inventory and Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version to collect the required data. Descriptive statistics, Independent t tests and Chi-square tests were done to evaluate the prevalence of concurrent Depressive Disorders among AD, relationship between specific AD and Depressive Disorders, severity of DD, and effect of age and gender on this co-morbidity.

RESULTS

Depressive Disorders were concurrently present in 23.7% of adolescents with AD, while 13.9% had concurrently only MDD, 8.3% had only DysD and 1.5% had both. More adolescents with AD had multiple mood disorders than otherwise. Twenty percent of adolescents with Panic Disorder, 12.1% with Generalised anxiety Disorder, 5.3% with Separation Anxiety Disorder and 12% with Social Anxiety Disorder had Depressive Disorders. Dysthymic disorder was statistically significantly more among those with PD (P = 0.009). Depressive Disorders were more severe among those with AD (P = 0.001) and the AD was more severe in those with DD (P = 0.01). As the severity of AD increased the severity of the DD also increased (P = 0.001). While DD were more prevalent among the late adolescence (P = 0.001), gender did not have any influence.

CONCLUSIONS

The two-way overlap between AD and DD is prevalent. Adolescents with Anxiety Disorders should be screened for Depressive Disorders, and when present should be treated.

Pregnancy among unmarried adolescents and young adults

OBJECTIVES

To determine the risk factors for pregnancy among unmarried adolescents and young adults.

METHODS

Case-control study was done over a period of 2 years. Data collected from 181 unmarried abortion seekers and 181 unmarried non-pregnant controls (≤24 years) attending three Medical Colleges of Kerala.

RESULTS

Logistic regression analysis showed a strong association between unmarried adolescent pregnancy and lack of parental supervision and control (OR 8.74, P = 0.000), poor intra-family relationship (OR 7.01, P = 0.000), family problem (OR 4.41, P = 0.000), lack of knowledge on sexual and reproductive health (OR 4.95, P = 0.0003), and non-engagement of adolescent in any productive activity (OR 4.41, P = 0.0373).

CONCLUSIONS

Lack of parental control, family problem, poor intra-family relationship, lack of knowledge on sexual and reproductive health, and lack of engaging in any productive activity were found to be significant predictors for unmarried adolescent pregnancy.

Development and normative validation of Developmental Assessment Tool for Anganwadis for 3- to 4-year-old children (DATA-II)

OBJECTIVE

To develop, standardize, and validate a developmental scale for children, 3-4 years old, attending Anganwadis (Integrated Child Development Scheme) in India, as a follow-up assessment, using a normative approach.

STUDY DESIGN AND SETTING

After the development of the 12-item Developmental Assessment Tool for Anganwadis (DATA-II), its internal consistency as well as face, content, and construct validities were studied in 100 children in Anganwadis and were found to be appropriate. A total of 385 children with a mean (standard deviation) age of 43.05 (5.02) months from randomly selected 36 Anganwadis were recruited for its standardization. Raw scores were converted to standardized T scores. Scoring pattern for domains and aggregate developmental scores were formulated.

RESULTS

Except for four items in the original scale, all the items were endorsed by parents suggesting a good content validity, and Kuder-Richardson Formula 20 coefficient of 0.80 suggested a high internal consistency. Factor analysis replicated the six-factor structure explaining 76.5% of variance. An aggregated developmental score based on the standardized T scores demonstrated that a DATA-II score between 29 and 33 suggested "at risk" for developing developmental delays. A score of 28 or less suggested already delayed milestones. A score of 19-28 suggested a "mild delay," 8-18 suggested a "moderate delay," and 7 or less suggested a "severe delay" in development.

CONCLUSION

The DATA-II is a measure for use in Anganwadis for identifying children at risk or with developmental delays during the first follow-up assessment, in India, for appropriate referrals and interventions.

A panchayat level primary-care approach for adolescent services

OBJECTIVE

To develop a model for providing community adolescent care services in the primary care setting

METHODS

Need assessment was done among adolescents and perceived problems of adolescents were studied using qualitative and quantitative methods. Based on the results of these studies, a Family Life Education (FLE) module was prepared. Awareness programs were organized for all stakeholders in the community on adolescent issues. All anganwadi workers in the panchayat were trained to take interactive sessions for all the adolescents in the panchayat using the FLE module. Ward based Teen Clubs were formed in all the 13 wards of the Panchayat separately for boys and girls and FLE classes were given to them through anganwadi workers. An Adolescent Clinic was set up to provide necessary medical and counseling facilities. Adolescent Health Card was distributed to all Teen Club members and those who attended the adolescent clinics.

RESULTS

The present approach stresses the need and feasibility of adolescent-centered, community-based interventions. The authors' experience showed that before starting any adolescent program, community awareness generation about the need and content of the program is very important for its success. The experience of this model has made it possible to up-scale the program to seven districts of southern Kerala as a service model.

CONCLUSIONS

The experiences of the program gave a realistic picture of the needs and problems of adolescents and a simple feasible model for providing services to adolescents in the primary care setting that can be easily replicated in other parts of India.

Priority mental health disorders of children and adolescents in primary-care pediatric setting in India 1: developing a child and adolescent mental health policy, program, and service model

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

School based adolescent care services: a district model

OBJECTIVE

To study the perceived problems of higher secondary school students in a district and to document the effect of a family life and life skill education package.

METHODS

A survey was conducted among 11501 adolescents belonging to 103 higher secondary schools in Thiruvananthapuram district, using Teenage Screening Questionnaire-Trivandrum (TSQ-T). Family life and life skill education package was given to class XI students and post intervention evaluation of improvement in knowledge level was assessed after 6 months by a structured pre-tested self-administered questionnaire.

RESULTS

61.2% adolescents reported scholastic problem, 22.1% family related problems, 31.9% personal problems and 15.2% adjustment problems, with boys reporting higher percentage. 65.8% reported body image related problems, 26.4% had dental, 21.3% ENT and 16.2% had dermatological complaints. Among girls 50.2% reported menstrual problems. 506 adolescents volunteered for medical check-up and 1247 for detailed psychological assessment. Family life and life skill education package showed consistent improvement in knowledge even after a gap of 6 months.

CONCLUSIONS

The study results showed that a school based adolescent care service programme is effective and feasible.