Handling the Psychological Distress of Parents of Children with Autism Spectrum Disorders: Feasibility of Group Work Approach

Autism Spectrum Disorders are pervasive developmental disorders affecting many children today. Parenting a child with special needs, such as children with autism, is very taxing, as they need intensive and life-long intervention in diverse areas. This paper is an attempt to assess the need of those parents of children with autism and to develop an intervention programme to take care of the psychosocial issues. The study had two phases. In the first phase 120 parents of children with autism spectrum disorders were interviewed using a semi structured interview schedule and GHQ 28. In the second phase, an intervention module was prepared and implemented with 20 parents. The results show that the mean psychological distress was significantly higher for mothers compared to fathers. The scores on subscales show that mothers have higher level of somatic symptoms, anxiety and insomnia, social dysfunction and depression compared to fathers. The pre and post analysis of the group intervention shows that there is a drop in the level of distress and increase in the awareness on child’s illness in parents after the group intervention. The findings show that addressing parental needs in a group setting can be very effective and beneficial in helping parents reduce their distress levels and hence making them better equipped to look after their child with a disability like autism

The effectiveness of a low-intensity problem-solving intervention for common adolescent mental health problems in New Delhi, India: protocol for a school-based, individually randomized controlled trial with an embedded stepped-wedge cluster randomized controlled recruitment trial

Background Conduct, anxiety and depressive disorders account for over 75% of the adolescent mental health burden globally. The current protocol will test a low-intensity problem-solving intervention for school-going adolescents with common mental health problems in India. The protocol also tests the effects of a classroom-based sensitization intervention on the demand for counselling services in an embedded recruitment trial. Methods We will conduct a two-arm individually randomized controlled trial in six Government-run secondary schools in New Delhi. The targeted sample is 240 adolescents in grades 9-12 with persistent, elevated mental health symptoms and associated impact. Participants will receive either a brief problem-solving intervention delivered over 3 weeks by lay counsellors (intervention), or enhanced usual care comprised of problem-solving booklets (control). Self-reported adolescent mental health symptoms and idiographic problems will be assessed at 6 weeks (co-primary outcomes) and again at 12 weeks post-randomization. In addition, adolescent-reported impact of mental health difficulties, perceived stress, mental wellbeing and clinical remission, as well as parent-reported adolescent mental health symptoms and impact scores, will be assessed at 6 and 12 weeks post-randomization. We will also complete a parallel process evaluation, including estimations of the costs of delivering the interventions. An embedded recruitment trial will apply a stepped-wedge, cluster (class)-randomized controlled design in 70 classes across the six schools. This will evaluate the added impact of a classroom-based sensitization intervention over school-level recruitment sensitization activities on the primary outcome of referral rate into the host trial (i.e. the proportion of adolescents referred as a function of the total sampling frame in each condition of the embedded recruitment trial). Other outcomes will be the proportion of referrals eligible to participate in the host trial, proportion of self-generated referrals, and severity and pattern of symptoms among referred adolescents in each condition. Power calculations were undertaken separately for each trial. A detailed statistical analysis plan will be developed separately for each trial prior to unblinding. Discussion Both trials were initiated on 20 August 2018. A single research protocol for both trials offers a resource-efficient methodology for testing the effectiveness of linked procedures to enhance uptake and outcomes of a school-based psychological intervention for common adolescent mental health problems

Affective disorders : current status and controversies

Affective disorders are common during childhood and adolescence and often pose a challenge in clinical settings. The clinical presentation of affective disorders varies with the developmental age of the child and the classical symptoms increase with age and severity. From a developmental perspective, the disruptive mood dysregulation disorder as a new diagnostic category in DSM 5 addresses this concern as well as the unparalleled increase in pediatric bipolar diagnoses. Use of developmentally appropriate assessments has helped address some of the controversies centred around diagnosis of depression in the young. However, there is sparse evidence of effectiveness of pharmacological and psychological means of treatment and controversies continues to exist regarding effective management of affective disorders in children and adolescents in bringing about a more favourable outcome. This chapter focuses on the current status and particularly controversies related to diagnosis of preschool depression, disruptive mood dysregulation disorder, pediatric bipolar and the differences in pattern of comorbidities across western and Indian literature; current insights into the course and outcome of affective disorders and controversies regarding management of affective disorders

Childhood disorders in international classification of diseases and related health Problems-11 and their relationship to diagnostic and statistical manual of mental Disorders-5 and international classification of diseases and related health Problems-10

Disorders in latest editions of the classificatory systems ICD-11 and DSM-5 have been categorised from a developmental lifespan perspective which is step in the right direction. Other laudatory features include highlighting developmental presentations, grouping neurodevelopmental disorders and including new diagnoses such as Complex PTSD and Prolonged Grief Disorder among others. However, conditions such as Conduct Disorder confined to the family context and Mixed Neurodevelopmental Disorder have been eliminated from the new classificatory system. These changes which have special clinical relevance especially from the Indian context have been reviewed and discussed below