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Diagnosing autism in low-income countries: Clinical record-based analysis in Sri Lanka / Hashan PEIRIS in Autism Research, 15-7 (July 2022)
[article]
Titre : Diagnosing autism in low-income countries: Clinical record-based analysis in Sri Lanka Type de document : Texte imprimé et/ou numérique Auteurs : Hashan PEIRIS, Auteur ; Darshana Chitraka WICKRAMARACHCHI, Auteur ; Pradeepa SAMARASINGHE, Auteur ; Philip VANCE, Auteur ; Dulangi DAHANAYAKE, Auteur ; Veerandi KULASEKARA, Auteur ; Madhuka NADEESHANI, Auteur Article en page(s) : p.1358-1367 Langues : Anglais (eng) Mots-clés : Asd ASD diagnosing standards ASD predictors Cars autism classification cultural factors logistic regression low-income countries Index. décimale : PER Périodiques Résumé : Use of autism diagnosing standards in low-income countries (LICs) are restricted due to the high price and unavailability of trained health professionals. Furthermore, these standards are heavily skewed towards developed countries and LICs are underrepresented. Due to such constraints, many LICs use their own ways of assessing autism. This is the first retrospective study to analyze such local practices in Sri Lanka. The study was conducted at Ward 19B of Lady Ridgeway Hospital (LRH) using the clinical forms filled for diagnosing ASD. In this study, 356 records were analyzed, from which 79.5% were boys and the median age was 33?months. For each child, the clinical form together with the Childhood Autism Rating Scale (CARS) value were recorded. In this study, a Clinically Derived Autism Score (CDAS) is obtained from the clinical forms. Scatter plot and Pearson product moment correlation coefficient were used to benchmark CDAS with CARS, and it was found CDAS to be positively and moderately correlated with CARS. In identifying the significant variables, a logistic regression model was built based on clinically observed data and it evidenced that "Eye Contact," "Interaction with Others," "Pointing," "Flapping of Hands," "Request for Needs," "Rotate Wheels," and "Line up Things" variables as the most significant variables in diagnosing autism. Based on these significant predictors, the classification tree was built. The pruned tree depicts a set of rules, which could be used in similar clinical environments to screen for autism. LAY SUMMARY: Screening and diagnosing autism in low-income countries such as Sri Lanka has always been a challenge due to limited resources and not being able to afford global standards. Due to these challenges, locally developed clinical forms have been used. This study is the first to analyze a clinical record set for autism in Sri Lanka to benchmark the local clinic form with a global standard. Furthermore, this study identifies the most significant diagnostic symptoms for children and based on these significant features, a simple set of IF-THEN rules are derived which could be used for screening autism in a similar clinical environment by health officials in the absence of consultants. En ligne : http://dx.doi.org/10.1002/aur.2765 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=477
in Autism Research > 15-7 (July 2022) . - p.1358-1367[article] Diagnosing autism in low-income countries: Clinical record-based analysis in Sri Lanka [Texte imprimé et/ou numérique] / Hashan PEIRIS, Auteur ; Darshana Chitraka WICKRAMARACHCHI, Auteur ; Pradeepa SAMARASINGHE, Auteur ; Philip VANCE, Auteur ; Dulangi DAHANAYAKE, Auteur ; Veerandi KULASEKARA, Auteur ; Madhuka NADEESHANI, Auteur . - p.1358-1367.
Langues : Anglais (eng)
in Autism Research > 15-7 (July 2022) . - p.1358-1367
Mots-clés : Asd ASD diagnosing standards ASD predictors Cars autism classification cultural factors logistic regression low-income countries Index. décimale : PER Périodiques Résumé : Use of autism diagnosing standards in low-income countries (LICs) are restricted due to the high price and unavailability of trained health professionals. Furthermore, these standards are heavily skewed towards developed countries and LICs are underrepresented. Due to such constraints, many LICs use their own ways of assessing autism. This is the first retrospective study to analyze such local practices in Sri Lanka. The study was conducted at Ward 19B of Lady Ridgeway Hospital (LRH) using the clinical forms filled for diagnosing ASD. In this study, 356 records were analyzed, from which 79.5% were boys and the median age was 33?months. For each child, the clinical form together with the Childhood Autism Rating Scale (CARS) value were recorded. In this study, a Clinically Derived Autism Score (CDAS) is obtained from the clinical forms. Scatter plot and Pearson product moment correlation coefficient were used to benchmark CDAS with CARS, and it was found CDAS to be positively and moderately correlated with CARS. In identifying the significant variables, a logistic regression model was built based on clinically observed data and it evidenced that "Eye Contact," "Interaction with Others," "Pointing," "Flapping of Hands," "Request for Needs," "Rotate Wheels," and "Line up Things" variables as the most significant variables in diagnosing autism. Based on these significant predictors, the classification tree was built. The pruned tree depicts a set of rules, which could be used in similar clinical environments to screen for autism. LAY SUMMARY: Screening and diagnosing autism in low-income countries such as Sri Lanka has always been a challenge due to limited resources and not being able to afford global standards. Due to these challenges, locally developed clinical forms have been used. This study is the first to analyze a clinical record set for autism in Sri Lanka to benchmark the local clinic form with a global standard. Furthermore, this study identifies the most significant diagnostic symptoms for children and based on these significant features, a simple set of IF-THEN rules are derived which could be used for screening autism in a similar clinical environment by health officials in the absence of consultants. En ligne : http://dx.doi.org/10.1002/aur.2765 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=477 Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis / Matthew D. BURKEY in Journal of Child Psychology and Psychiatry, 59-9 (September 2018)
[article]
Titre : Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis Type de document : Texte imprimé et/ou numérique Auteurs : Matthew D. BURKEY, Auteur ; Megan HOSEIN, Auteur ; Isabella MORTON, Auteur ; Marianna PURGATO, Auteur ; Ahmad ADI, Auteur ; Mark KURZROK, Auteur ; Brandon A. KOHRT, Auteur ; Wietse A. TOL, Auteur Article en page(s) : p.982-993 Langues : Anglais (eng) Mots-clés : Child behaviour disruptive behaviour disorders psychosocial interventions low-income countries meta-analysis Index. décimale : PER Périodiques Résumé : Background Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. Methods We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). Results Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was ?0.25 (95% confidence interval (CI): ?0.41 to ?0.09; I2: 78%) and of treatment studies was ?0.56 (95% CI: ?0.51 to ?0.24; I2: 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: ?0.35; 95% CI: ?0.57 to ?0.14) and behavioural parenting interventions (SMD: ?0.43; 95% CI: ?0.66 to ?0.20), and that interventions were effective across age ranges. Conclusions Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings. En ligne : https://doi.org/10.1111/jcpp.12894 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=368
in Journal of Child Psychology and Psychiatry > 59-9 (September 2018) . - p.982-993[article] Psychosocial interventions for disruptive behaviour problems in children in low- and middle-income countries: a systematic review and meta-analysis [Texte imprimé et/ou numérique] / Matthew D. BURKEY, Auteur ; Megan HOSEIN, Auteur ; Isabella MORTON, Auteur ; Marianna PURGATO, Auteur ; Ahmad ADI, Auteur ; Mark KURZROK, Auteur ; Brandon A. KOHRT, Auteur ; Wietse A. TOL, Auteur . - p.982-993.
Langues : Anglais (eng)
in Journal of Child Psychology and Psychiatry > 59-9 (September 2018) . - p.982-993
Mots-clés : Child behaviour disruptive behaviour disorders psychosocial interventions low-income countries meta-analysis Index. décimale : PER Périodiques Résumé : Background Most of the evidence for psychosocial interventions for disruptive behaviour problems comes from Western, high-income countries. The transferability of this evidence to culturally diverse, low-resource settings with few mental health specialists is unknown. Methods We conducted a systematic review with random-effects meta-analysis of randomized controlled trials examining the effects of psychosocial interventions on reducing behaviour problems among children (under 18) living in low- and middle-income countries (LMIC). Results Twenty-six randomized controlled trials (representing 28 psychosocial interventions), evaluating 4,441 subjects, met selection criteria. Fifteen (54%) prevention interventions targeted general or at-risk populations, whereas 13 (46%) treatment interventions targeted children selected for elevated behaviour problems. Most interventions were delivered in group settings (96%) and half (50%) were administered by non-specialist providers. The overall effect (standardized mean difference, SMD) of prevention studies was ?0.25 (95% confidence interval (CI): ?0.41 to ?0.09; I2: 78%) and of treatment studies was ?0.56 (95% CI: ?0.51 to ?0.24; I2: 74%). Subgroup analyses demonstrated effectiveness for child-focused (SMD: ?0.35; 95% CI: ?0.57 to ?0.14) and behavioural parenting interventions (SMD: ?0.43; 95% CI: ?0.66 to ?0.20), and that interventions were effective across age ranges. Conclusions Our meta-analysis supports the use of psychosocial interventions as a feasible and effective way to reduce disruptive behaviour problems among children in LMIC. Our study provides strong evidence for child-focused and behavioural parenting interventions, interventions across age ranges and interventions delivered in groups. Additional research is needed on training and supervision of non-specialists and on implementation of effective interventions in LMIC settings. En ligne : https://doi.org/10.1111/jcpp.12894 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=368