Prevalence of Parent-Rated Attention Deficit Hyperactivity Disorder and Associated Parent-Related Factors in Primary School Children of Navi Mumbai—A School Based Study

Objectives

To study the prevalence of parent-rated attention deficit hyperactivity disorder and associated parent-related factors in primary school children of Navi Mumbai.

Methods

One hundred twenty two children including both boys and girls aged between 6 y and 11 y were selected from a school at Navi Mumbai and their parents were given the National Innovative for Children’s Healthcare Quality (NICHQ) Vanderbilt Assessment Scale to be filled and returned, which was subsequently analyzed using SPSS (version 16).

Results

The prevalence of attention deficit hyperactivity disorder was 12.3 % with boy to girl ratio of 3:2. It was more prevalent in nuclear type of family and in families where a single parent was working especially where the father was the sole breadwinner and doing semi-skilled or unskilled type of work. No significant relation was found between the numbers of work-related hours when parents were away from children and attention deficit hyperactivity disorder.

Conclusions

Attention deficit hyperactivity disorder is prevalent in the primary school-going population of Navi Mumbai, especially in boys. The increased prevalence in nuclear families and families with single working parent should further be explored. Further studies with larger sample size and longer period of follow up may be recommended. The study also recommends screening of school children for symptoms of attention deficit hyperactivity disorder (ADHD) for early diagnosis and treatment.     

Comparative short term efficacy and tolerability of methylphenidate and atomoxetine in attention deficit hyperactivity disorder

Objective

To compare the short term efficacy and tolerability of methylphenidate and atomoxetine in children with Attention deficit hyperactivity disorder (ADHD).

Design

Open label randomized parallel group clinical trial.

Setting

Child Guidance Clinic of a tertiary care hospital of Northern India from October 2010 to June 2012.

Participants

69 patients (age 6–14 y) with a diagnosis of ADHD receiving methylphenidate or atomoxetine.

Intervention

Methylphenidate (0.2–1 mg/kg/d) or atomoxetine (0.5–1.2 mg/kg/d) for eight weeks.

Main outcome measures

Treatment response (>25% change in baseline Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS); Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS); Clinical Global Impression Severity Scale (CGI-S) at eight weeks and adverse effects.

Results

Treatment response was observed in 90.7% patients from methylphenidate group and 86.2% patients of atomoxetine group at an average dose of 0.45 mg/kg/d and 0.61 mg/kg/d, respectively. The patients showed comparable improvement on VADPRS (P=0.500), VADTRS (P=0.264) and CGI-S (P=0.997). Weight loss was significantly higher in methylphenidate group (?0.57±0.78 kg; P=0.001), and heart rate increase was observed at higher rate in atomoxetine group (7± 9 bpm; P=0.021).

Conclusion

Methylphenidate and atomoxetine are efficacious in Indian children with ADHD at lesser doses than previously used. Their efficacy and tolerability are comparable.

Trial Registration No.

CTRI/2011/08/001981     

INCLEN diagnostic tool for autism spectrum disorder (INDT-ASD): Development and validation

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 κ=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.

Conclusion

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.     

Gesundheitszustand nach p?diatrischer Rehabilitation

Background

This article deals with the question of improvement in health status experienced by children and adolescents with chronic illnesses, such as obesity, bronchial asthma, atopic eczema and attention deficit hyperactivity disorder (ADHD)/behavior disorder, after inpatient medical rehabilitation.

Methods

Data were collected from 3,495 children and adolescents. Various endpoints were measured at the beginning of rehabilitation and after rehabilitation (e.g. quality of life, illness-related self-management and parameters of body structure and bodily function).

Results

The effects after rehabilitation varied depending on the diagnosis and endpoint. For obesity the clearest effects were achieved uniformly across all endpoints. For asthma the effects for self-management and for atopic eczema for skin condition were especially clear. For ADHD the effects were generally only slight but in some sub-groups there were moderate effects regarding quality of life.

Conclusions

The inpatient medical rehabilitation of children and adolescents generally achieved noticeable effects for endpoints for which there is clear impairment requiring treatment.     

Methylphenidat mit modifizierter Freisetzung in der Routineversorgung

Background

This open label multi-centre non-interventional study examines the effectiveness and tolerability of a modified-release methylphenidate (MPH) preparation with a 50% immediate-release component (Medikinet? retard) in children and adolescents with attention deficit hyperactivity disorder (ADHD).

Methods

A total of 447 patients aged 6?C17?years with ADHD and an indication for treatment with this preparation were included. Primary outcome measures were ADHD severity and side effects evaluated by the physicians and the parents at the start of the medication changeover and 4?C6?weeks later.

Results

ADHD symptom severity declined significantly. Oppositional behavior and side effects as evaluated by the parents were also reduced.

Conclusions

This MPH preparation causes a further reduction of ADHD symptoms in hitherto sub-optimally treated patients. It is well tolerated and has been proven to be effective in clinical routine care.     

The Effect of Stress Management Program Using Cognitive Behavior Approach on Mental Health of the Mothers of the Children With Attention Deficit Hyperactivity Disorder

Background:

Attention deficit hyperactivity disorder is one of the most common psychiatric disorders in children.

Objectives:

The study aimed to evaluate the effectiveness of stress management program using cognitive behavior approach on mental health of the mothers of the children with attention deficit hyperactivity disorder.

Patients and Methods:

In this interventional study, 90 mothers of the children with attention deficit hyperactivity disorder were randomly allocated into three intervention, placebo, and control groups. The general health questionnaire was used to measure mental health. Besides, stress was assessed through the depression-anxiety-stress scale. The two instruments were completed at baseline, immediately after, and one month after the intervention by the mothers. Afterwards, within group comparisons were made using one-sample repeated measurement ANOVA. One-way ANOVA was used for inter group comparisons. Mothers in the placebo group only participated in meetings to talk and express feelings without receiving any interventions.

Results:

At the baseline, no significant difference was found among the three groups regarding the means of stress, anxiety, depression, and mental health. However, a significant difference was observed in the mean score of stress immediately after the intervention (P = 0.033). The results also showed a significant difference among the three groups regarding the mean score of mental health (P < 0.001). One month after the intervention, the mean difference of mental health score remained significant only in the intervention group (P < 0.001).

Conclusions:

The study findings confirmed the effectiveness of stress management program utilizing cognitive behavior approach in mental health of the mothers of the children with attention deficit hyperactivity disorder.     

INCLEN diagnostic tool for epilepsy (INDT-EPI) for primary care physicians: Development and validation

Objective

To evaluate the diagnostic accuracy of a new diagnostic instrument for epilepsy — INCLEN Diagnostic Tool for Epilepsy (INDT-EPI) — with evaluation by expert pediatric neurologists.

Study design

Evaluation of diagnostic test.

Setting

Tertiary care pediatric referral centers in India.

Methods

Children aged 2–9 years, enrolled by systematic random sampling at pediatric neurology out-patient clinics of three tertiary care centers were independently evaluated in a blinded manner by primary care physicians trained to administer the test, and by teams of two pediatric neurologists.

Outcomes

A 13-item questionnaire administered by trained primary care physicians (candidate test) and comprehensive subject evaluation by pediatric neurologists (gold standard).

Results

There were 240 children with epilepsy and 274 without epilepsy. The candidate test for epilepsy had sensitivity and specificity of 85.8% and 95.3%; positive and negative predictive values of 94.0% and 88.5%; and positive and negative likelihood ratios of 18.25 and 0.15, respectively.

Conclusion

The INDT-EPI has high validity to identify children with epilepsy when used by primary care physicians.     

Methylphenidattherapie bei epilepsiekranken Kindern

Background

The efficacy and safety of methylphenidate (MPH) in children with epilepsy and attention deficit disorder (ADHS) were evaluated because MPH is thought to be associated with seizure aggravation.

Patients and methods

The patient collective included 65 children, 50 with epilepsy and 15 with pathological symptoms in the electroencephalogram (EEG) and/or occasional convulsions. The average age was 9.3 years. In a double blind standardized trial the patients received MPH (high against low dose) versus placebo over a period of 5 weeks. Before and during the study Conners’ rating scale, a questionnaire for teachers, pencil and paper test, alertness and go/no go tests from the TAP (transl. test battery for attention testing) were performed as well as a weekly EEG and evaluation of seizures.

Results

In children with epilepsy a significant improvement of attention and impulsivity was found with MPH (76?% of cases). Children with an IQ <?70 had a benefit in 63?%, the EEG and seizure frequency did not deteriorate and in two cases the EEG was improved.

Conclusions

Treatment with MPH in children with epilepsy and ADHS was found to be safe and effective and could improve attention and impulsivity in 76?% of treated patients without having deleterious effects on epilepsy and EEGs.     

ADD-H-Comprehensive Teacher’s Rating Scale (ACTeRS): A Measure for Attention Deficit Hyperactivity Disorder Among Children with Intellectual Disability in India

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.

     

Ambulatory clinical parameters and sleep respiratory events in a group of obese children unselected for respiratory problems

Background

Obstructive sleep apnea in children is frequently due to tonsil and adenoid hypertrophy. This study aimed to investigate the relationship between ambulatory clinical parameters and sleep respiratory events in obese children.

Methods

We carried out a prospective respiratory sleep study between 2013 and 2015. Nails obstruction, tonsils enlargement and palate position were subjectively measured. Italian attention deficit hyperactivity disorder (ADHD) rating scale for parents was also performed. The polygraph study was performed using a portable ambulatory device.

Results

Forty-four obese children were consecutively recruited into this study. Mild sleep respiratory disturbance was showed in 31.8 % of patients; 18.2% previously had an adeno (tonsillectomy). In 50% of these obese children, both apnea-hypopnea index and oxygen desaturation index showed polygraph abnormal results. ADHD rating scale for parents scores were positive in 9.1% of patients.

Conclusions

We found a high rate of mild sleep respiratory disturbance and ADHD-like symptoms referred by parents. The respiratory disturbance was not totally cured by surgery. Finally, otorhinolaryngology variables were not able to explain mild sleep respiratory disturbance.

     

Sprachentwicklungsdiagnostik bei Mehrsprachigkeit

Background

In Germany the linguistic abilities and skills of children are assessed on a regular basis in pediatric examinations. Because of time limitations this examination is highly selective and does not always reflect the current state of language acquisition research.

Additional problem in multilingualism

In the case of bilingual children to date almost no instruments are available which are capable of reliably differentiating typically developing second language learners of German from language impaired children.

Diagnostic options in multilingualism

In this article the central problems in the assessment of young bilingual children are summarized and the test LiSe-DaZ® (linguistic assessment of language development for German as a second language) is introduced which measures children’s development in core grammatical areas and which takes into account the age of first exposure and the duration of exposure to the target language. In addition, results are reported from a study examining how pediatricians deal with diagnostic challenges. It is argued that the diagnosis of language impairment in bilingual children requires a standardized assessment of central grammatical properties and that this can in principle be accomplished without testing the first language.     

Physical activity as a clinical tool in the assessment of malnutrition

Objective

To measure physical activity in children with wasting and to look for association between poor physical activity and wasting.

Methods

Physical activity was measured in 56 children with wasting, using Children’s Activity Rating Scale, and compared with age- and sex-matched controls.

Results

A significant association was found between poor physical activity and malnutrition as determined by weight-for-height Z Score <-2 (P=0.001) and midupper-arm circumference (P=0.002).

Conclusion

Physical activity can be used as clinical parameter to assess malnutrition.     

A 5-Year Hospital Prevalence of Child and Adolescent Psychiatric Disorders from Central India

Objective

To examine the 5-year hospital prevalence of child and adolescent mental disorders from Central India.

Methods

Using systemic random sampling method, of the 4410 families screened, 4278 children (607 aged 0 to 3 y and 3671 between 4 to 16 y) attending outpatient services of department of pediatrics at the tertiary rural hospital from June 2006 through December 2010 were evaluated. Standardized appropriate psychometric tools were used for both groups. Diagnostic interviews were administered and DSM-IV diagnoses were determined by consensus between two psychiatrists. A comprehensive hospital registration system provided the denominator.

Results

Of the 4410 families screened, 4278 (97 %) of the subjects completed interviews. The overall prevalence of psychiatric disorders was found to be 20.8 %. Most common psychiatric disorders in group A were mental retardation (5.6 %) followed by epilepsy (2 %) whereas in group B, depressive disorder (3.73 %) were followed by non-organic enuresis (2.18 %) and ADHD (1.7 %). Eighty one percent of the parents from group A and 83 % of parents from group B of the children affected with psychiatric disorders and neurobehavioral problems had reported that they have had never thought of taking psychiatric consultation for their children.

Conclusions

The results of the study have helped in bridging and supporting the propositions in child epidemiology in India and also have implications for clinical training and practice.     

Diagnostic errors in interpretation of pediatric musculoskeletal radiographs at common injury sites

Background

Extremity pain represents one of the most common reasons for obtaining conventional radiographs in childhood. Despite the frequency of these examinations little is known about the incidence of diagnostic errors by interpreting pediatric radiologists.

Objective

The purpose of this study was to develop a standard error rate of pediatric radiologists by double-reading of extremity radiographs (elbow, wrists, knees and ankles) in children presenting with a history of trauma or pain.

Materials and methods

During a 6-month period all major extremity radiographs (excluding digits) obtained at a large pediatric referral hospital for evaluation of pain or trauma were reviewed by two senior pediatric radiologists and compared to the official interpretation. All radiographs were interpreted initially by a board-certified pediatric radiologist with a Certificate of Added Qualification (CAQ). We reviewed 3,865 radiographic series in children and young adults 2–20 years of age. We tabulated misses and overcalls. We did not assess the clinical significance of the errors.

Results

There were 61 miss errors and 44 overcalls in 1,235 abnormal cases and 2,630 normal cases, for a 1.6% miss rate and a 1.1% overcall rate. Misses and overcalls were most common in the ankle.

Conclusion

Interpretive errors by pediatric radiologists reviewing certain musculoskeletal radiographs are relatively infrequent. Diagnostic errors in the form of a miss or overcall occurred in 2.7% of the radiographs.     

Evaluation of Effectiveness of Integrated Intervention in Autistic Children

Objectives

To assess the effectiveness of integrated therapy over the past 3 y on the recipient autistic children and its correlation with the following variables - age at admission, duration of therapy given and initial severity of symptoms.

Methods

The index study was a retrospective study with 18 autistic children as subjects; the maximum duration of intervention was 3 y. The integrated approach consisted of special education using principles of applied behavior analysis, occupational and speech therapy. The progress records, the occupational therapy and the speech therapy progress reports were tabulated as data. The Childhood Autism Rating Scale (Schopler, Reichler and Renner, 1986) was used for evaluation of severity of symptoms at admission and in present day. The data was then compared and analyzed.

Results

The present study showed significant positive results. Only few domains requiring very high integrated cognitive and sensorimotor functioning showed non-significant results. Age at intervention correlated negatively and, duration of therapy given and initial severity of symptoms correlated positively with effectiveness of therapy.

Conclusions

Continuous feedback and modification of the therapy is required to maintain performance and develop target interventions for problematic areas identified. Longitudinal as well as comparative studies are required to better understand the benefits of integrated approach.     

Dynamic US study in the evaluation of infants with vertical or oblique talus deformities

Background

Congenital vertical talus (CVT) is a rare foot deformity that is sometimes difficult to differentiate from oblique talus (OT) by physical examination and foot radiography.

Objective

The purpose of this study was to summarize our experience with US in evaluation of CVT and OT deformities.

Materials and methods

We identified all children (2005–2011) younger than 6 months who underwent dynamic focused US of the foot at our tertiary-care facility to evaluate clinically equivocal cases of CVT. Diagnostic criteria for CVT were persistent talonavicular dislocation on forced plantar flexion of the foot. OT was diagnosed based on reduction of the talonavicular dislocation on forced plantar flexion. Medical and imaging charts were reviewed for diagnosis on US and plain radiographs (when available) and for underlying neuromuscular disorders, treatment and outcome on follow-up.

Results

Ten patients (eight boys and two girls, mean age 33 days) were evaluated by US for CVT. Radiographs of the foot were obtained in only two children and were non-diagnostic. Thirteen feet were evaluated by US. Diagnosis of CVT was confirmed by surgery in seven children, three of whom had bilateral CVT. Diagnosis of OT in three children was supported by response to casting treatment.

Conclusion

Dynamic US can reliably distinguish between CVT and OT deformities.     

Psychological, cognitive and maternal stress assessment in children with primary ciliary dyskinesia

Background

Primary ciliary dyskinesia (PCD) is a rare disorder due to structure and functional abnormalities of respiratory cilia. There are no reports on the behavioral and psychological aspects of children and adolescents with PCD. This study was undertaken to assess the cognitive and behavioural characteristics, and the parental stress of a population of school-aged children with PCD.

Methods

Ten PCD and 34 healthy school-aged children underwent Wechsler Intelligence Scale for Children-III edition, Child Behavior Check-List questionnaire (CBCL), Parenting Stress Index-Short Form tests in order to perform a behavioural and psychological evaluation.

Results

PCD children showed significant behavioral and social competent problems in CBCL scale than control children, in particular with regard to internalizing problems score (P<0.001). Parental distress, parent-child interaction and total stress in the mothers of PCD patients were higher than those in the controls’ parents (P<0.001).

Conclusion

Our findings pinpoint the importance of specific psychological support in the clinical management of children with PCD.     

MRI for clinically suspected pediatric appendicitis: an implemented program

Background

Emergent MRI is now a viable alternative to CT for evaluating appendicitis while avoiding the detrimental effects of ionizing radiation. However, primary employment of MRI in the setting of clinically suspected pediatric appendicitis has remained significantly underutilized.

Objective

To describe our institution’s development and the results of a fully implemented clinical program using MRI as the primary imaging evaluation for children with suspected appendicitis.

Materials and methods

A four-sequence MRI protocol consisting of coronal and axial single-shot turbo spin-echo (SS-TSE) T2, coronal spectral adiabatic inversion recovery (SPAIR), and axial SS-TSE T2 with fat saturation was performed on 208 children, ages 3 to 17?years, with clinically suspected appendicitis. No intravenous or oral contrast material was administered. No sedation was administered. Data collection includes two separate areas: time parameter analysis and MRI diagnostic results.

Results

Diagnostic accuracy of MRI for pediatric appendicitis indicated a sensitivity of 97.6% (CI: 87.1–99.9%), specificity 97.0% (CI: 93.2–99.0%), positive predictive value 88.9% (CI: 76.0–96.3%), and negative predictive value 99.4% (CI: 96.6–99.9%). Time parameter analysis indicated clinical feasibility, with time requested to first sequence obtained mean of 78.7 +/? 52.5?min, median 65?min; first-to-last sequence time stamp mean 14.2 +/? 8.8?min, median 12?min; last sequence to report mean 57.4 +/? 35.2?min, median 46?min. Mean age was 11.2 +/? 3.6?years old. Girls represented 57% of patients.

Conclusion

MRI is an effective and efficient method of imaging children with clinically suspected appendicitis. Using an expedited four-sequence protocol, sensitivity and specificity are comparable to CT while avoiding the detrimental effects of ionizing radiation.     

Wandering spleen in children: a report of 3 cases and a brief literature review underlining the importance of diagnostic imaging

Background

Wandering spleen is a rare condition in children that is often caused by loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of children with wandering spleen have splenic torsion as a complication.

Objective

To provide up-to-date information on the diagnosis, clinical management and diagnostic imaging approaches for wandering spleen in infants and children and to underline the importance of color Doppler US and CT in providing important information for patient management.

Materials and methods

We report a series of three children with wandering spleen treated at our children’s hospital over the last 6 years. All three underwent clinical evaluation, color Doppler US and CT and were surgically treated. We also reviewed 40 articles that included 55 patients younger than 18 years reported in the Medline database from 2002 to 2012.

Results

We correlated pathological data with imaging findings. Color Doppler US, the first imaging modality in investigating abdominal symptoms in children with suspected wandering spleen, yielded a diagnostic sensitivity of 54.9%, whereas CT achieved about 71.7%.

Conclusion

Radiologic evaluation has a major role in confirming the diagnosis of a suspected wandering spleen and avoiding potentially life-threatening complications requiring immediate surgery.