Shoba Srinath

Introduction Children with Autism Spectrum Disorders (ASD) are known to require general anesthesia or sedation for undergoing procedures like Magnetic Resonance Imaging (MRI). The dose required for sedation may vary depending on multiple factors. The aim of this study was to compare the sedative requirements of children with ASD with those who do n...

Early motor and sensory developmental delays precede Autism Spectrum Disorder (ASD) diagnosis and may serve as early indicators of ASD. The literature on sensorimotor development in animal models is sparse, male centered, and has mixed findings. We characterized early development in a prenatal valproic acid (VPA) model of ASD and found sex-specific...

Background: Studies are sparse on caretaker perceptions about self-cutting (SC) in institutionalised adolescents. Methods: Five caretakers in a shelter home for adolescent girls were interviewed and the data were analysed using interpretative phenomenological analysis. Results: Nine major themes emerged: expected reactions from others led to secrec...

Purpose The need to enhance mental health in primary care settings for infants and toddlers is increasingly becoming apparent. However, the lack of trained healthcare personnel and culturally appropriate measures makes it a challenge in low‐ and middle‐income countries. A needs‐based assessment of the extent of the problems in toddlers will help ad...

Till date researchers have elucidated the neurobiological substrates in OCD using methods like neuroimaging. However, a potential biomarker is still elusive. The present study is an attempt to identify a potential biomarker in pediatric OCD using eye tracking. The present study measured pro-saccade and anti-saccade parameters in 36 cases of pediatr...

Background Anxiety spectrum disorders are the most prevalent psychopathology among children and adolescents. Qualitative research in childhood anxiety disorders can provide valuable insights regarding interventions. The objectives of this study were to examine the child's perspectives on the subjective experience of concerns, the impact of the symp...

Background Although anxiety disorders are the most prevalent psychiatric disorders among children and adolescents, there is a paucity of research on the course and outcome of anxiety spectrum disorders in low and middle-income countries. Methods 60 children and adolescents aged 6–16 years with anxiety spectrum disorders attending the child and ado...

Context Almost 1/5th of the adolescent population suffers from mental morbidity. In older adolescents, clinical challenges are accompanied by unique psychosocial and developmental needs. Recent legislations in India – the Mental Health Care Act, 2017 and the Juvenile Justice Act, 2015 – mandate specific arrangements and provisions for evaluation an...

Objective: To examine the differences in whole brain topology and connectivity in 17 children of the ages 3-8 years across severity of ASD, we performed resting state fMRI using a 3T MRI scanner and graph theoretical analysis of networks. Method: Patients were partitioned into two cohorts based on the severity of ASD, determined using the Childh...

In an effort to understand the functional differences in the brain (during a stage of development with mixed finding) and to ascertain possible interventions, we studied the brain networks of young children using graph theory and found significant increases in small-worldness and more localized sub-networks, as well as increased clustering in the H...

Background: Eating Disorders (ED) were largely thought of as a western phenomenon; however studies have shown that these disorders exist in India. The exact incidence & prevalence of ED is not known in India. We present data from a 10 year retrospective chart review from a tertiary care child and adolescent psychiatry centre in India. Methodology:...

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 Prolon...

Aims: To study the at-risk rate for Autism Spectrum Disorders (ASD) on a parent-report questionnaire in toddlers between the ages of 16-24 months. Materials and methods: 6237 toddlers from Kerala, India selected by cluster random sampling were surveyed by community nurses using the Modified Checklist for Autism in Toddlers - Revised (M-CHAT-R) t...

In addition to skeletal conditions, multiple studies have reported association of low level of 25-hydroxy Vitamin D (25(OH)D) levels to various health outcomes (Wacker and Holick, 2013). Meta-analysis of cross sectional studies in subjects with Autism Spectrum Disorder (ASD) has reported lower serum Vitamin D levels (Wang et al., 2015). However, no...

Lay summary: We studied rats prenatally exposed to valproic acid (VPA), an established rodent model of autism. Both male and female VPA rats had a range of attentional impairments with sex-specific characteristics. Importantly, with fixed rules, graded difficulty levels, and more time, VPA rats could be successfully trained on the attentional task...

Background: There is a recent trend of increase in diagnosis of Autism Spectrum Disorder in India. Till date, there are few retrospective and prospective Indian studies with limited sample sizes ranging from 16 to 94 children. With this background, we planned a retrospective chart review of all new cases of Autism Spectrum Disorder for a period of...

Autism spectrum disorders (ASD) are well known to be influenced by various environmental factors. Among these influencers, social experiential deprivation (SED) in infancy is one of them which is not well reported. We explored factors contributing to SED in 11 young children diagnosed to have ASD and compared them to 24 children without SED also ha...

Abstract Objective: To assess the prevalence of neurodevelopmental and psychiatric co-morbidities in children and adolescents diagnosed with attention-deficit hyperactivity disorder at a tertiary care child and adolescent psychiatry centre. Methods: A total of 63 children and adolescents who were diagnosed with attention-deficit hyperactivity disor...

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...

Research on psychosocial interventions looks at answering questions about the effectiveness of counselling and psychotherapy and also attempts to uncover the crucial ingredients and change processes. Maintaining the ethical frame is paramount in the therapy room and this extends to any intervention research which involves human participants. The co...

Introduction: Vitamin D deficiency has been proposed to contribute to the pathophysiology of Autism Spectrum Disorder (ASD) 1. The aim of this study was to investigate the potential role of Vitamin D in Indian children with ASD. Methods: 29 children (3 to 12 years of age) with ASD (DSM 5 criteria), were recruited from Child and Adolescent Psychiatr...

Objective: To study the prevalence and correlates of self-reported ADHD symptoms among school-going adolescents from Kerala, India. Method: Seven thousand five hundred sixty students from Classes 8, 10, and 12, aged 12 to 19 years, across 73 schools selected by cluster random sampling, were invited to participate, but only 7,150 successfully comple...

Objectives: To study the clinical features of children with history of sexual abuse. Method: A chart review of 40 children (<16 years) with history of Child Sexual Abuse (CSA) evaluated at the Department of Child and Adolescent Psychiatry at NIMHANS during a three year period. Results: 52.5% (N=21) of the children came from broken families. Th...

Introduction: Adult patients with Obsessive Compulsive Disorder (OCD) have been shown to have gray matter (GM) volume differences from healthy controls in multiple regions - the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), medial frontal gyri (MFG), striatum, thalamus, and superior parietal lobule. However, there is paucity of data...

Context: Autism is a serious behavioral disorder among young children that now occurs at epidemic rates in developing countries like India. We have used tract-based spatial statistics (TBSS) of diffusion tensor imaging (DTI) measures to investigate the microstructure of primary neurocircuitry involved in autistic spectral disorders as compared to...

Purpose To assess the psychiatric diagnoses and outcome in children with psychogenic non-epileptic seizures (PNES). Methodology This hospital based observational study was performed on 44 children aged <16 years, who suspected to have psychogenic non-epileptic seizures based on video-EEG, from August 2005 to August 2012. The parameters noted were...

This prospective cross-sectional study compared 25 children with pervasive developmental disorder and epilepsy and 25 children having pervasive developmental disorder without epilepsy on pervasive developmental disorder scores, Childhood Autism Rating Scale scores, language disability, presence of regression, and epileptiform abnormalities. Epileps...

Early intervention in specific learning disability (SpLD) results in better outcome and prevents comorbidity. Understanding the pathways is therefore important. To study and compare the pathways to care for children with SpLD and mental retardation (MR) before reaching a tertiary care center. A cross-sectional study was conducted for pathways to ca...

Background: Few studies in India have focussed on psychosocial issues and caregiver perspectives on in-patient aggression, which can potentially impact the way aggression is understood and managed. Aims & Objectives: To study the psychosocial variables and caregiver perceptions on the nature, severity, precipitating, provoking factors and the metho...

Introduction A retrospective study in India had showed high rate of comorbid disruptive disorders in children with Attention deficit hyperactivity disorder, but not depression and anxiety disorders as opposed to western literature. Studies using structured assessment tools are lacking in Indian population and thus valid data on prevailing pattern o...

Identification and management of aggression is a major mental health priority in hospitalised patients. However, no such studies have been done in child and adolescent in-patients in India. To study the clinical and demographic features; characteristics of the aggression and methods employed to manage aggression in child and adolescent in-patients....

Purpose: To analyze children with psychogenic non epileptic seizures and propose a modified new classification. Methods: This retrospective analysis included 56 children aged <18 years (M:F=26:30; mean age: 12.3±4.0 years) diagnosed PNES on video-EEG monitoring. The semiological characteristics like pattern of bodily movements, emotional signs,...

This report describes the process of psychotherapy for a 7-y-old boy who witnessed the gruesome murder of his mother by the father. Expressive therapy techniques such as play, art and storytelling were used to help the child emote, achieve independence and emotional maturity. The child was seen as an in-patient for 3 mo on a daily basis, followed b...

Background There is paucity of data on white matter (WM) abnormalities in juvenile obsessive-compulsive disorder (OCD). This study aimed to identify WMmicrostructure changes in juvenile OCD.Methods Fifteen children and adolescents with OCDand 15 matched healthy controls underwent diffusion tensor imaging using a 3 Tesla (Achieva, Best, The Netherla...

Background: To find the efficacy of multimodal intervention on attention deficit and hyperactivity, behavioral prob-lems in home and school situations and on academic achievement of children with ADHD and the impact of family stress and coping on the outcome of multi-modal intervention. Method: A sample (N = 40) of children aged 5 -10 years registe...

Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability in this age group and their longlasting effects throughout life, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. In this report w...

Anxiety disorders are common among children and adolescents with bipolar disorder. Among adults, anxiety disorder comorbidity is associated with a more severe form of bipolar disorder and a poorer outcome. There is limited data on the effect of comorbid anxiety disorder on bipolar disorder among children and adolescents. To study the prevalence of...

Global epidemiological data indicate a significant burden of child and adolescent mental health (CAMH) problems. Collating similar data from Asian countries, the majority of which have vast needs but limited resources in CAMH, will help in improving the policy-making, service development and clinical practice. A nonclinic-based English literature s...

To provide a panoramic view of the recent developments and current situation in epidemiology, legislation, policies, services, and research in intellectual disability in India. A wide variation in point prevalence of intellectual disability has been reported, from around 1/1000 to 32/1000, depending on the case definition, methodology, and populati...

Sex has been postulated as one of the factors mediating heterogeneity in obsessive-compulsive disorder (OCD). This study investigated the sex differences in OCD with respect to sociodemographics, symptom profile, and comorbidity including spectrum disorders. Two hundred thirty-one subjects diagnosed with OCD by Diagnostic and Statistical Manual of...

Introduction: Evidence from phenomenological, family, genetic, and treatment studies from Western centers have suggested that tic-related obsessive-compulsive disorder (OCD) could be different from non-tic-related OCD. This study from India investigated the differences in OCD with and without tics, with respect to sociodemographics, symptom profil...

Background: Global literature suggests concerns in rising trends of autism spectrum disorders (ASD). Objectives: This study aims at comparing the diagnostic profiles of inpatients in an Indian tertiary child and adolescent psychiatric unit over three decades. Methods: Data from the inpatient Child and Adolescent psychiatry (CAP) unit at the Nati...

To assess prospectively the psychiatric diagnostic status, psychosocial correlates, and short-term outcome of youngsters with school refusal. Thirty-three subjects (8-16 years) presenting with school refusal to a tertiary Child and Adolescent Psychiatry service were evaluated. Instruments administered at baseline and after 3 months (including an ou...

To estimate the lifetime prevalence of bipolar II disorder in children and adolescents presenting with DSM-IV major depressive disorder (MDD). Sixty-one consecutive subjects aged < or =18 years attending the outpatient services of the Child and Adolescent Psychiatric (CAP) services of the National Institute of Mental Health and Neurosciences (NIMHA...

Objective: To study the socio-demographic factors, clinical characteristics, and long-term outcome of dissociative disorders in inpatient children and adolescents. Methods: Chart data of forty-four subjects (8-15 years) with a diagnosis of dissociative disorder admitted to a specialist Child and Adolescent Psychiatry (CAP) unit between September 20...

There is some evidence to suggest that attention deficit hyperactivity disorder (ADHD) and juvenile bipolar disorder could be related. This is based on studies of comorbidity and some preliminary family study data. However, doubts continue to be raised about the relationship between the two disorders. This study examined the comorbidity of disrupti...

There are limited data on child mental health needs in our country. Therefore, an epidemiological study to determine the prevalence rates of child and adolescent psychiatric disorders was initiated as a two-centre (Bangalore and Lucknow) study by the Indian Council of Medical Research. It also aimed to study the psychosocial correlates of the psych...

Background: From a theoretical point of view, the issue of diagnosing co-morbidity in Pervasive Developmental Disorder (PDD) is controversial, with some researchers favouring the practice and others questioning it. From the clinical point of view, however, it is perhaps a useful practice, as specific strategies can be directed towards alleviation o...

Data on outcome of juvenile onset bipolar disorder is limited. This study examined the course and outcome of bipolar disorder and assessed the rate and predictors of recovery and relapse in a sample of children and adolescents over a 4-5 year period. Twenty-five consecutively ascertained subjects (9-16 years) with a diagnosis of mania (mean duratio...

Studies on the naturalistic course of early-onset bipolar disorder are few and studies evaluating the efficacy of pharmacotherapy consist largely of open trials of thymoleptics and neuroleptics on small samples. The current study was undertaken to map the course of the disorder and the prevailing prescribing practice in early-onset bipolar disorder...

Juvenile obsessive-compulsive disorder (OCD) has been hypothesized to be different from adult-onset OCD suggesting that juvenile OCD may be a developmental subtype of the disorder. There is some evidence that juvenile OCD may be phenotypically different from juvenile-onset adult OCD. This study examines the phenotypic characteristics of juvenile OC...

The relationship between obsessive-compulsive disorder (OCD) and putative obsessive-compulsive (OC) spectrum disorders is unclear. This study investigates the prevalence of putative OC spectrum disorders in OCD subjects in a controlled clinical design. The putative OC spectrum disorders studied included somatoform disorders (body dysmorphic disorde...

To study the long-term course and outcome of juvenile obsessive-compulsive disorder (OCD). Two to 9-year follow-up of largely self-referred, drug-naïve subjects (n = 58) by employing catch-up longitudinal design. The mean follow-up period was 5 years. Nearly three-fourth of the sample was adequately treated with medications. Only 21% of the subject...

Recent studies of patients with juvenile bipolar disorder report low rates of recovery and high rates of chronicity. However, we lack data on the short-term outcome. This study examines the pattern of recovery from the index episode in an aggressively treated juvenile sample. We assessed 25 subjects (< 16 years) with a diagnosis of mania, using the...

Population studies have shown that overall prevalence of mild to severe mental retardation ranges from 2.5 to 5 per thousand. Genetic contribution to this group accounts for 15-30%. The role of chromosomal fragile sites in cancer, recurrent abortions and fertility failure were reported in the literature, which prompted us to look in to the possible...

Autism is a behavioural disorder in children with male predominance. The genetic basis of autism is now well established with twin and family studies. Association of autosomal fragile sites play an important role in the absence of any other genetic etiological factors. Fragile site at Xq27.3, which is a common defect among mentally retarded childre...

To determine whether juvenile obsessive-compulsive disorder (OCD) is familial and whether the rate of Tourette syndrome (TS) and tic disorders is higher among relatives of patients with OCD than among relatives of controls subjects. We assessed first-degree relatives of 35 juvenile OCD probands (aged 16 years or less) and 34 matched, psychiatricall...

Bipolar disorder in children and adolescents is less well studied than bipolar disorder in adults. This review addresses issues related to its underdiagnosis, precursors of bipolarity, comorbidity, natural course and treatment. Literature from Medline and other searches, and earlier relevant articles including references from recent review articles...

Using minimal exclusion criteria, to assess systematically the psychiatric comorbidity in children and adolescents with obsessive-compulsive disorder (OCD) and compare the findings with those of previous studies. Fifty-four children and adolescents who satisfied DSM-III-R criteria for OCD were assessed using a structured interview schedule, the Chi...

Stress and coping in the families caring for their member with mental retardation has recently received worldwide research attention. There is no comprehensive instrument to study these issues in India. This study reports on development and standardization of a new instrument to fill this lacuna. Family Interview for Stress and Coping in Mental Ret...

Bipolar disorder in adults is known to run an episodic course. However, little information exists on the long-term naturalistic course of bipolar disorder in juvenile populations. The present study was undertaken with the objectives of (i) documenting the rates of recovery and relapse, (ii) identifying the predictors of recovery and relapse and (ii...

In a previous study in adult obsessive compulsive disorder (OCD) from our setting, a familial excess was not observed. The current study aimed to study the familial rates of OCD in a cohort of childhood OCD patients. Thirty-five OCD probands were assessed on CY-BOCS and LOI-CY and compared with 34 not ill controls. A structured interview was admini...

Mental retardation due to fragile X syndrome is one of the genetic disorders caused by triplet repeat expansion. CGG repeat involved in this disease is known to exhibit polymorphism even among normal individuals. Here we describe the development of suitable probes for detection of polymorphism in CGG repeat at FMR1 locus as well as the diagnosis of...

The short-term in-patent facility of the Child and Adolescent Psychiatry Unit in the National Institute of Mental Health and Neurosciences, Bangalore is described. Its clientele over one year is reviewed. Totally 152 admissions were made. Hysterical neurosis (30.8%), Psychoses (25.2%), Conduct disorder (10.5%) and Hyperkinetic syndrome (9.8%) were...

To see whether classic DSM-III-R criteria for mania are applicable to Indian youngsters and to examine the clinical presentation of mania in an Indian child and adolescent psychiatric sample. Fifty subjects with a diagnosis of functional psychosis as per the definition in ICD-9 were recruited from the population referred during the study period of...

Mental retardation is caused by either genetic or environmental factors. Etiology of mental retardation comprises a variety of genetic factors which can be classified under various known genetic disorders. Cytogenetic assessment follows the study of karytype through various means fbr the study of association and implications of chromosomal aberrati...

Early detection has a central role in the prevention and management of mental retardation. The purpose of this present study is to delinerate the characteristics of developmentally delayed infants and their families attending Mental Retardation Clinic. The sample consisted of 101 infants who were registered in Mental Retardation Clinic of NIMHANS,...

A formal, mandatory psychotherapy training programme for psychiatry residents at NIMHANS was started in 1983. It has made qualitatively encouraging progress. It has also focussed on issues demanding attention in the years to come. This paper is a descriptive account of the programme.

This study examined the rate, correlates, and clinical outcome of childhood hysteria in a sample of inpatients in India. For comparison, the rate of this disorder among outpatients was computed. Data were derived from case records of inpatient (n = 143) and outpatient admissions (n = 640) during a 1-year interval at the Child and Adolescent Psychia...

Classification of psychosis in childhood and adolescence has always been controversial due to the possible developmental modulation of symptom expression. Major classificatory systems have no special criteria for children, and recommend the use of adult criteria. Hence, this study aimed to study the nosology of psychosis of childhood and adolescenc...

Cerebrospinal fluid (CSF) concentrations of the serotonin and dopamine metabolites, 5-hydroxyindoleacetic acid (5HIAA) and homovanillic acid (HVA), respectively, were measured in a group of 17 children with Autistic Disorder (DSM-III-R). The group means observed for 5HIAA (135 +/- 91 nmol/L) and HVA (502 +/- 324 nmol/L) in the autistic children wer...

Two cases of Gilles de la Tourette syndrome from India are presented. The symptomatology of Tourette syndrome is the same as that documented in western populations which suggests biological factors in the aetiology of the syndrome.

While hallucinations are known to occur as conversion symptoms in non-psychotic psychiatric states such as hysteria and grief, there is a lack of distinction between true and pseudo-hallucinations in such cases. We discuss the rationale which has necessitated this distinction, affirm that true hallucinations can occur in non-psychotic states, discu...

Earlier, we reported that true hallucinations may present as a conversion symptom. We here reiterate this and suggest that cultural sanction may be one factor that can lead to hallucinations being classified as true in non-psychotic psychiatric states.

The obsessions and compulsions noted in 16 cases of obsessive-compulsive disorder in children were compared to the phenomenology seen in 398 cases during a decade. Less obsessions, more compulsions, more frequent washing and repeating compulsions characterised the childhood group.