Prevalence of ADHD in Primary School Children, in Colombo District, Sri Lanka

Objective: To determine prevalence of ADHD among primary school children in Colombo district, Sri Lanka. Methods: A descriptive cross-sectional study was conducted among 1,125 primary school children aged 6 to 10 years in Sinhala medium state schools in Colombo district. Prevalence was assessed with validated Sinhala version of Swanson, Nolan, Pelham—IV (SNAP-IV-S) scale where primary care givers and class teachers were the respondents and diagnosis was confirmed by a Consultant Child and Adolescent Psychiatrist. Results: The mean age of the sample was 7.9 years ( SD = 1.2) and largely males ( n = 603, 56.6%). Overall prevalence of ADHD was 6.5% (95% CI [5.1, 8.1]) with combined as the commonest subtype. Prevalence was higher among males (9.6%) than females (2.9%) with a sex ratio of 1:3.8 and was highest in the 7 to 8 year old age group (7.4%–7.5%). Conclusion: School based screening enabling early detection of ADHD and timely referral is the need of the hour.

INteractive Virtual Expert-Led Skills Training: A Multi-Modal Curriculum for Medical Trainees

Background: Internationally, pediatric depression and suicide are significant issues. Additionally, in the context of the COVID-19 pandemic, pediatric mental health needs are rising astronomically. In light of Child & Adolescent Psychiatrist (CAP) subspecialist shortages in the United States (US), there is an increasing call for primary care physicians in Family Medicine and Pediatrics to address an increasingly broad variety of patient needs. Here we report on the development and preliminary evaluation of medical student and resident perceptions on the “INteractive Virtual Expert-led Skills Training” (INVEST) medical education curriculum, a virtual synchronous CAP curriculum employing active learning strategies, including expert-led discussion and video modeling, and discussion designed to meet those priorities.Methods: In a standardized 60-min training format, our curriculum leverages audience response system polling, video modeling of key clinical skills, and interactive discussion with an expert subspecialist, over a virtual video conferencing platform. The primary educational strategy relies on use of video modeling to demonstrate best practice with CAP led group discussion to solidify and explain important concepts. Five waves of medical students and residents (N = 149) participated in the INVEST curriculum and completed pre- and post-training surveys regarding knowledge and comfort in the management of pediatric patients with depression and suicidality.Results: Trainee participants reported significant positive gains in perceived likelihood of encountering pediatric suicidality as well as knowledge/comfort with depression screening and suicidality assessment in a primary care setting. Across some competency areas, there was an effect of medical learner level. Learners at lower levels generally reported the highest benefit. Medical students reported significant increases in their comfort interpreting and discussing positive depression screens and evidenced the greatest relative benefit in comfort with discussing suicidality.Conclusion: To our knowledge, INVEST is the first fully virtual, multimodal curriculum led by expert CAP subspecialists. Our findings suggest that INVEST shows promise for equipping medical learners with baseline knowledge for caring for patients with pediatric depression and suicidality. This synchronous, virtually delivered curriculum allows for critical training delivered to diverse medical learners regardless of geographic location, a particular benefit during the current COVID-19 pandemic.

Experiences of psychiatrists assessing under 18s on an “all age” rota. An evaluation of the current service

AimsGloucestershire Health Care Trust operates an “all age” out of hours on-call rota, staffed by Registrars and Consultants who cross-cover all psychiatric sub-specialities. Our aim was to understand the challenges faced by psychiatrists of different professional backgrounds when assessing under 18 year olds in a health-based Place of Safety (POS).MethodWe circulated a survey to all psychiatrists on the on-call rota, to gather quantitative and qualitative information on the challenges posed by assessments of under-18s in a POS and assess whether an under-18 specific policy was needed.ResultOut of the 50 psychiatrists invited, 27 completed this survey (during February 2021). 33.3% of respondents reported that they had completed a POS assessment of an under 18-year-old when a Consultant Child and Adolescent Psychiatrist/Registrar was not available to join. 33.3% of respondents had been asked to complete such an assessment as the sole psychiatrist joining the AMHP, with 24% of those respondents reporting feeling uncomfortable doing these assessments without a second doctor present, and an additional 24% feeling comfortable only sometimes. 48.1% of the doctors surveyed did not invite parents or carers to take part in the assessment, despite this being considered best practice, citing reasons such as: being unaware that this was a possibility, assessments conducted at unsociable hours, safeguarding concerns involving the parents, and social distancing in the context of COVID-19. 41% of respondents had assessed vulnerable young people (children looked after or with a diagnosis of an autism spectrum condition) in the POS and reported that these assessments posed significant challenges to safe discharge planning and identifying appropriate placements. 81.5% felt that a tailored policy for young people was needed. Qualitative findings suggest psychiatrists think such a policy should include clear procedures (flowcharts), potential outcome scenarios/options for safe discharge, referral criteria for CAMHS, contact details for key staff members, a handover protocol. Respondents felt a shared policy with all stakeholders (AMHP service, Mental Health Services, police) was required.ConclusionOur survey highlights the challenges for non-CAMHS specialists assessing under 18s in a health-based POS and the need for an under-18 policy to support safe practice. Major themes will be further explored in a focus group to guide policy development.

Psychotherapy, psychological education, medical education in the work of a particular child / adolescent psychiatrist

In order to develop a comprehensive methodology for outpatient psychiatric care for children and adolescents that can improve the social adaptation of patients, we analyzed the data of long-term clinical catamnestic follow-up of a cohort of patients with various mental disorders in childhood and adolescence. The methods of psychotherapy, psycho-education and medical education suitable for outpatient care are discussed.