Psychiatry and Society

Hi. I’m Jai. I’m 8 years old. This is my story. My doctor says I have an illness. I don’t feel sick. But I do know that grown-ups around me are annoyed with me most of the time. I’m constantly being told, “sit still’’, “stop dreaming”, “pay attention”. I can’t seem to be able to do just that. In class, I seem to lose track of what the teacher says . I try to listen, I really do. I start doing what she says, then I notice the insect fluttering on the window pane, I see the boy in the row ahead tapping his fingers on the desk, the office boy walking down the corridor and the sound of laughter from the next classroom. I don’t realise I have left my seat till teacher tells me “Jai, return to your seat”. My parents are frequently called to school to meet my class teacher . They are unhappy with my marks. They think I’m careless and lazy because I take all evening to do my homework. I tell my mother that I try hard. I feel sad and frustrated that she doesn’t understand or believe me. So...

Practical ADHD diet for the family ADHD Diet A high-protein, low-sugar ADHD diet can help improve ADHD symptoms in children. Parents of children with ADHD are overwhelmed with dietary advice that is often time-consuming and disruptive to the household. However, this need not be so. Research shows it is feasible to incorporate an ADHD diet as part of an ongoing ADHD treatment program. Medication with behaviour modification is the backbone of ADHD treatment. A practical diet can be incorporated into the family routine to supplement ADHD treatment. High Protein Foods rich in protein - poultry, fish, eggs, beans, nuts , soy, mutton and low-fat dairy products (milk, paneer , cheese) - may have beneficial effects on ADHD symptoms. Protein-rich foods are used by the brain to make neurotransmitters, the chemicals released by brain cells to communicate with each other. Protein can prevent surges in blood sugar, which increase hyperactivity. Giving your child protein for brea...

10yr window to treat mental health problems affecting academic performance Mental health & academic performance Mental health has a direct impact on academic performance in children. Neglected childhood psychiatric disorders like ADHD and Learning Disorders adversely affect the child’s academic performance and educational attainment. Poor educational outcomes affect the child’s health, employment, and status as an adult. This is especially so for psychiatric conditions that are seen at 7 years and persist beyond 16 years of age. Mental health disorders in children have a greater impact on academic performance than chronic physical illness. The presence of a single mental condition results in morel board exams failures and backlogs. This association is more than for chronic illnesses of the neurological, lung, heart, or digestive systems. Physical impairments are not associated with exam failures. More than half the teenagers who fail to complete their secondary edu...

   Conduct disorder and behaviour problems in children  make the news when a 5-year old or a grandmother is killed while extorting money. Aggression in children  is just one of the offenses associated with conduct disorders . The seemingly lesser offenses of stealing in thousands from the home, or smoking 'weed' with their friends, pale in contrast. At the lowest end of the spectrum are those children who repeatedly confront authority in school or at home. Dubbed as 'monster kids' these children are viewed indulgently as being mischievous, naughty, 'bad', or 'delinquent'. Very seldom are they seen as having a mental health problem - a conduct disorder. What is Conduct Disorder? Behaviour problems that are persistent , violate the rights of others, go against societal norms, and disrupt family life, indicate a conduct disorder and merit psychiatric assessment. Conduct disorder is amongst the commonest childhood disord...

ADHD treatment improves academic performance ADHD medication enhances academic performance when started early. ADHD drug treatment improves reading ability  in children with Attention Deficit Hyperactivity Disorder (ADHD) and Dyslexia. New research shows that drug treatment of ADHD also improves maths ability especially when started early - at least by the 4th standard. Children starting treatment a year or two later show progressively greater declines in academic performance. ADHD is characterised by inattention and hyperactive-impulsive behaviour . Parents who bring their children to the clinic are focused only on issues arising from the child's hyperactivity. Impairments due to inattention are not immediately apparent in the pre-school years. Depending on the severity of ADHD, inattention is unmasked when the child enters academic life in primary school or during the transitions to middle school, high school, and college. At each  of these...

Cannabis or marijuana use by teenagers and adolescents is highly associated with the onset of psychosis and schizophrenia. Cannabis goes by many names including hash , pot, grass, weed, or ganja . This gateway drug is falsely thought to be innocuous and as having no lasting effects. Cannabis use by teenagers is often not recognised as a problem. Cannabis is cheap and easily accessible in most student populations. Pune is a major hub for the cannabis drug trade. This week a quarter tonnne of ganja was found dumped in a well. Cannabis use is rampant in Pune colleges and hostels, where students assiduosly guard and maintain their 'stash'. During the 57th National School Games the highest number of students testing positive for marijuana came from Maharashtra. Regular cannabis use increases the risk for schizophrenia and psychosis by upto 4 times. There is increasing evidence that cannabis use can precipitate schizophrenia in vulnerable individuals. This is especially so...

Aggression is uncommon in school children and should be addressed A Pune teenager was kidnapped and murdered by his school friends a few weeks ago. The victim was deliberately selected and his parents were manipulated for a ransom. Violence, theft and destructiveness are end stage behaviours of conduct problems in children and adolescents. Trajectories of aggression in children The commonest path of violence in children is ' adolescence-limited ' . The antisocial behaviours usually occur when the adolescents are 'hanging out' in a group.  This type of aggression reflects an anti- authoritarianism . Anti-authoritarianism results from frustration over being denied the benefits of full adult independence despite reaching physical maturity. Adolescent limited aggression is less violent, relies on peer encouragement, and generally diminishes by adulthood  These adolescents are usually able to integrate into society as young adults. A ...

Psychological development is a key aspect of any ‘Healthy Baby Contest”. Pathfinder Clinic judged the psychological development of toddlers participating in one such local event. Healthy baby contests are among the most attractive activities organized by many preschools and communities. Assessment is a sensitive issue at any Healthy Baby competition. Parents of contestants are concerned regarding partiality and subjective errors. Judging a Healthy Baby Contest objectively is crucial to the credibility of the event. Can psychological development be objectively assessed in 5 minutes? Psychological assessment can be time consuming and difficult to operationalize. The child’s development is captured in speech, social interaction, and manipulation of every- day objects. Usually a child’s developmental milestones are judged ‘objectively’ based on the parents responses to available screening questionnaires. We decided to get our knees dirty and go down to toddler level to get ...

Checklists and psychological screening questionnaires for mental illness are effective, easy to use and widely available. Pune was shocked into considering the need for mental health screening of its bus drivers after one of them wilfully killed eight people and injured 32 others. He hijacked a bus at the depot and mowed down victims in broad daylight. Amidst the protests, and outrage the Pune administration has decided that all its bus driver undergo psychological testing. We have already looked at screening of police personnel for mental health problems , and also screening of teenagers for alcohol and drug abuse . Here we specifically examine the feasibility of regularly screening the 8600 PMPL staff and Pune bus drivers for mental health problems. Mental illness in bus drivers Mental health problems are higher for bus drivers who suffer from back pain, are dissatisfied with their jobs or undertake long-distance driving. This is more so for employees who have worked fo...

Difficulty with reading, spelling and maths is rampant among Indian students. Two recent reports have highlighted this academic underachievement. The academic infrastructure is definitely a major contributor. However, unrecognised dyslexia  or other learning disability  also needs to be considered by every concerned parent and enlightened teacher. We have already discussed the management of dyslexia . Here we underline the urgent need for action. India ranked 72nd of 73 countries in a comparative international survey (PISA) of 15-year-old students. All students were assessed on the same test for knowledge and skills in reading, mathematical and scientific literacy. A sample of more than 5000 students from 200 Indian schools were assessed in this program. In none of these categories did more than 17% of Indian students scored above baseline levels as compared to 81% of students from OECD countries (US, UK, Australia etc). 15-year-olds scoring above baseline...

Turn off the television and speak to your toddler . Talking is the best thing you could do today for your child’s psychological development. Talking is an interactive process in which your child exercises a core feature of being human - communicating through speech. Your child's vocabulary is directly proportional to the amount of time you spend talking. Talking primes your child for independence. Speech evolves through attempts to communicate needs and feelings. Infants and toddlers are driven by evolution to master this complex process. You, the parent, play a key role in this two-way interaction. Infancy and toddler-hood are stages for developing secure bonding and attachment. The child is primed to bond with the mother or caregiver. The initial bond is secured by direct contact with the caregiver - through warmth, touch and voice. A secure attachment bond enables the infant seeks to explore the environment by attempts to crawl and later walk. The exploring toddler returns ...

Impaired spelling and arithmetic in Standard 3 boy with Learning Disorder Learning Disorder (LD) is characterised by impaired acquisition of academic skills. This impairment in scholastic skills is not due to intellectual disability, physical disorders, emotional disturbances, or environmental, cultural, or economic disadvantage. There is a gap between ability and application. The child may know what is asked, is able to explain it verbally, but is unable to put it down in writing. Learning Disorder could affect any of the three scholastic Rs – R eading, w R iting or a R ithmetic. Types of Learning Disability Dyslexia – is the commonest learning disability (80%). It is marked by impairment of the ability to recognize and understand written words. Dyscalculia  – problems with doing math, understanding time, using money. Dysgraphia – problems with handwriting, spelling. Dyspraxia – problems with hand-eye coordination and balance, difficulties with fine motor skill...

Parental supervision protects boisterous children from injury: More time unsupervised corresponds to more injury  “To my parents we were just two girls in the bedroom” . What exactly was going on? Without adequate supervision the parents of this teenager never found out; the memories returned to haunt her in adulthood. Studies comparing children with and without parental supervision show that lax parental supervision is associated with injury in toddlers and preschoolers; conduct problems in school going children; and road accidents, addictions, gambling and sexual risk taking in teenagers. Parental supervision has three dimensions (Gitanjali 2004) Attention - watching or listening  Proximity - within or beyond reach  Continuity - constant, intermittent, or not at all  Two factors determine the degree to which a child would be left unsupervised (Morrongiello 2008) Parent’s conscientiousness  - the more conscientious the parent more the sup...

Inclusive Education Inclusive education for children with autism and other developmental disabilities is now approaching reality in Pune. Nine children with autism appeared for the Maharashtra 10th standard (SSC) board exam. The accommodations and waivers granted to these students reflect an infusion of the fresh breath of inclusion into the corridors of the board of education . Sarva Shiksha Abhiyan (SSA) in Maharashtra The Education for All Movement , the central government’s flagship SSA, seeks to ensure that every child, including those with special needs, is provided an elementary education. As far as disability is concerned the SSA has adopted a zero rejection policy. It provides for universal access to infrastructure and curricula in schools. Maharashtra is at the forefront of this scheme. In all 380000 teachers from Maharashtra attended workshops on inclusive education through the SSA. 414277 children with special needs were identified and 380723 enrolled under the SSA in...

(or why the 25 year age-bar on alcohol consumption could be reasonable) Does alcohol have specific neurotoxic effects on the adolescent or young adult brain? This question is the only important one for deciding whether the 25 year age-bar on alcohol consumption in Maharashtra is justifiable. While the debate rages two students from the premier medical college of India drowned in an alcohol fuelled swimming pool misadventure, and in an unrelated incident on the same night five inebriated youths were arrested for disturbing the peace in a residential area. We have seen how to recognise problem alcohol drinking in teenagers , and how to refuse alcohol . This article probes the specific effects of alcohol on the maturing brain. Infancy Alcohol is a neurotoxin. It distorts the normal architecture of the developing brain. This distortion starts during pregnancy when imbibed maternal alcohol crosses the placenta into the foetus. In the foetus alcohol acts on the specially vulnerab...

Bullying by children in schools has serious mental health effects on the victim and the bully. Up to 25% of high school students report being victimised by bullies. 13% of victims have considered suicide. In rural India 31% of middle school students report being bullied (Kshirsagar 2007). Bullying is twice more prevalent in coeducational schools than in girl schools. The prevalence of bullying increases from 13% in the 3rd grade to 46% in the 6th grade. Bullying is higher in classes with more retained students. Bullying occurs in a variety of settings that are an extension of your child's school life. Bullying can occur face to face, by texting or on the web (cyberbullying). Bullying is not a phase of growing up, it is not a joke, and it is not a sign that boys are being boys. Bullying can cause lasting harm - to the victim, the bully and the bully-victim (children who are bullied and also bully other children). Bullying takes many forms Verbal : Name calling, teasing ...

Parents worry that social networks like Facebook could have harmful psychological effects on their children. They seek consultation for social network related behaviour of their teenagers when academic grades fall due to excessive time spent on Facebook, when the teenager is subjected to cyberstalking, or when they themselves are disturbed by the online self-profile of their child. What do we know about some of these social networking behaviours that bring parents and their children to the Clinic? Friends, self-presentation and self-esteem Posting a profile assists the teenager in gaining self-awareness. Becoming self-aware by viewing one's own Facebook profile enhances self-esteem (Gonzales and Hanock, 2010). A larger number of Facebook friends and  an exaggerated positive self-presentation does enhance the teenager’s well-being. However this is not necessarily associated with a sense of belonging to a supportive group. A more honest self-presentation does increase ha...