The Indian Practitioner

Samir H. Dalwai ¹, Shreya Mahesh Jaokar ², Manish Rammohan Garg ³, Barkha Chawla ¹

Affiliations
1 Developmental and Behavioural Paediatrician, New Horizons Child Development Centre, Goregaon East, Mumbai, IN
2 Research Associate, New Horizons Foundation, Mumbai, IN
3 In-Charge, New Horizons Health and Research Foundation, Mumbai, IN

Abstract

Positive parent-child interactions are critical for effectively navigating the course of a child’s development. In children with developmental and behavioural disorders intervention plan needs to cater to both the child as well as the entire family, to ensure positive changes for both. Due to limited data, time and resource constraints, clinicians in India often are not able to optimally engage and optimize caregiver involvement in the treatment plan. A 2 years and 9-months-old boy presented to a multidisciplinary child development centre due to delayed speech and hyperactivity. In addition, he was found to be fidgety, restless, could not wait for his turn, stubborn, showed head banging when demands were not met and temper tantrums. A battery of developmental assessment led to a diagnosis of attention deficit hyperactivity disorder (ADHD), predominantly hyperactive-impulsive type (DSV-IV-TR). The child received an individualized goal based multi-disciplinary intervention involving parental counselling, occupational therapy and speech and language therapy over a period of 2 years. In addition, parents were actively engaged and coached to implement best practices i.e., reduced screen time, increase play time, home cooked food, sleep hygiene and parent diary. This collaborative approach with parents helped to accelerate and sustain the effectiveness of the multidisciplinary intervention. In a child with ADHD, predominantly hyperactive-impulsive type, caregiver-centred approach plays a vital role in augmenting and sustaining the desired outcomes achieved by a multidisciplinary intervention

Keywords

Behavior Therapy, Screen Time, Parent-Child Relationship, Developmental Disabilities, ADHD, Parenting, India.

Full Text

     

Samir H. Dalwai ¹, Shreya Mahesh Jaokar ², Manish R. Garg ³, Barkha Chawla ⁴

Affiliations
1 Developmental and Behavioural Paediatrician, New Horizons Child Development Centre, Saira Mansion, near Pahadi School, Road Number 2,Peru Baug, Jay Prakash Nagar, Goregaon East, Mumbai-400066, IN
2 New Horizons Foundation, Mumbai, IN
3 New Horizons Health and Research Foundation, Mumbai, IN
4 New Horizons Child Development Centre, Mumbai, IN

Abstract

Although anxiety in children is prevalent in India, evidence regarding their divergent etiopathologies, and holistic intervention approaches are limited. In the present case of a child experiencing acute anxiety the influences of external environment on anxiety-symptomology and a family-centric therapy have been resorted to. The primary concerns of the six-year-old female included obsession over marks on the body, ritualistic behaviours (hand washing), specific fears (ghosts, selective foods and bathing) and situation-based aversions. The Children Apperception Test revealed fears about losing closed ones, injury from non-human forms and perception of environment as ‘anxiety provoking.’ Pre-intervention MR Spectroscopy highlighted slight reduction in N-acetyl aspartate levels which serve as biomarkers for neurological and psychiatric conditions. Parent and child counselling led to reduction of child’s anxiety symptoms and improvements in child-parent interaction. The coping plan developed by the child, parent and psychologist served as a tool to manage her anxiety in social settings other than home. The anxiety episodes completely subsided post intervention. The case report highlights the need to acknowledge and incorporate influences of psychosocial factors and parent-child dyad at all stages of mental health care delivery.

Keywords

Anxious Child, Psychosocial, Parent-Child Interaction.

Full Text

     

Samir Dalwai ¹, Hilla Sookhadwala ², Barkha Chawla ³

Affiliations
1 Developmental and Behavioral Pediatrician, Founder Director, New Horizons Child Development Centre, IN
2 Fellowship in Developmental and Behavioral, IN
3 New Horizons Child Development Centre, IN

Abstract

In the gloom of uncertainties, the COVID era most certainly has necessitated a bevy of transitions in the healthcare domain. Moving on with these metamorphoses, the world is moving onto the virtual platform for healthcare, accepting it as one of the primary means of availing healthcare services. The effect of the pandemic on children with special needs, especially on children with Autism Spectrum Disorder (ASD) has been of utmost concern since then. The aim of this program was to help overcome the challenges faced by families in accessing developmental pediatrician led multidisciplinary treatment for ASD (e.g., in smaller cities etc.) and delivering an intervention program in the home and community. With the virtual format quickly gaining traction, theE-nable Parent Coaching program was thus introduced, facilitating improvement in developmental trajectories and functional outcomes in children with Autism Spectrum Disorder (ASD) with complex neurodevelopmental profiles across the globe through an outcome- based, individualized, interdisciplinary approach based on the Theory of interaction. Five cases of children with ASD with varying severity have been reported that illustrate the functional improvement across various domains within months of the program; much in contrast to long term therapies often failing to deliver the desired clinical outcomes. Our findings revealed resolution of co-morbidities without the role of exogenous pharmacotherapy or long standing intensive behavioural interventions. The paradigm shift from conventional therapies to targeted goal- oriented interventions solely based on meticulously designed and structured parent coaching based on the Theory of Social Interaction has shown remarkable clinical outcomes.

Keywords

Autism Spectrum Disorder, COVID, Interventions, Online, Parent.

Full Text