There is a contradiction in recent theorizing about adolescent suicidal risk. On the one hand, by all objective standards, the quality of life for adolescents in recent times is far better in comparison to earlier times. Therefore, it is expected the reduction in incidence of suicidal behavior. However the incidence of youth suicide seems to have risen in some nations of the world in recent years, and so some scholars have concluded that the quality of life for adolescents must have declined.
The most important correlate for youth suicide is a previous attempt. Injurious suicide attempts by adolescents are more frequent than completed suicides. Suicide attempts among youth have been shown to be associated with depression, substance use, loss of a family member or friend to suicide, access to firearms, and female gender. Other factors contributing to suicide risk have included a family history of either suicide or unemployment among older youth, a history of sexual abuse and a previous suicide attempt. Chronic medical conditions such as type 1 diabetes mellitus, asthmaand epilepsy have also been implicated.
Suicidal behavior is also risk factors for involvement in interpersonal violence among youth, including alcohol and illicit drug use, and experiencing somatic symptoms. Exposure of adverse life events may make a fundamental contribution to suicidal behaviour.In adolescents Suicidal behaviour may indicate an attempt to resolve, solve or escape personal difficulties or stresses associated with life event exposure. Presence of life events may contribute indirectly to suicidal behaviors by precipitating psychiatric symptoms (notably, depression) which may become important risk factors for suicidal behaviour. Some studies reveal that the major stressors for this group are personal identity difficulties (sexuality, personal violation), family problems (illness and conflict) and external problems (achievement pressure and failure).
Emotional well-being is also a major protective factor for attempting suicide, consistent with the findings of others that the majority of adolescent suicides are characterized by psychopathology, primarily depression. The question that needs to be attended is why are the majority of adolescents who commit suicide still those with personal and social risk factors? Identifying the environmental risk factors especially in family and in school is advisable. Applying family level interventions to adolescents at a high risk for suicidal behavior, including those with previous suicidal behavior or depression, is also supported by the significant protective effect of parent-family connectedness on attempting suicide in some study.
Some research reports suggest a profile by which professionals working with this client group may identify individuals at the pre-act stage. A vulnerable adolescent appears to be depressed, with feelings of hopelessness and with a tendency toward self-blame and impulsivity. He/she is likely to be experiencing personal worries with pressure from school or relationships. Most specifically, a susceptible individual is also not able to delineate his problem and solve it. All adolescents with a possible suicide attempt
should receive a comprehensive mental health and psychosocial assessment.
Identifying some friendly relative member within the family or the school/college system would go some way to addressing the adolescent’s immediate needs. Further potential approaches include routine screening of adolescents to identify those at risk and helping teachers recognize such pupils.
Currently practising Child and Adult psychiatry in a Multidisciplinary Set up for last 25 years, specially working on children with Dyslexia.
Qualification - M.B.B.S. with 5 gold medals and distinctions (December 1971)
- Pt.J.N.M.MedicalCollege, Raipur
M.D. (Psychiatry) (June 1977)
- All India Institute of Medical Sciences, N.Delhi
Teaching Experience –
As Pool officer and Assistant professor of Psychiatry for about 7 years and then took charge of Child Guidance Clinic at Civil Hospital and BJ Medical College, Ahmedabad. Worked from 1985 to 1998 teaching Child Psychiatry to Post graduate students.
Other Activities –
Having undertaken School counselling programs for social skill training for adolescents, I also hold workshops for Personality Enhancement, Stress Management, and Effective Parenting.
Conducted workshops and lectures on Child Mental Health all over Gujarat as well as in other states for various organisations of Physicians, Pediatricians and Psychiatrists.
Television, Internet and Mobile Addiction
By Dr.Ratna Bilwani
It is essential for mental health professional to study the influence of media on children and adolescents as most of their time is utilized in television, computers and cell phones. Media not only plays a role in socializing and educating society but also promotes various detrimental effects especially on children.
Are these Media tools addictive?
If someone can be addicted to television internet, mobile phones, then people could be addicted toanything- this criticism stands true for many cases. Addictions are usually described as either physical dependence and or psychological addiction, these addictions are only behavioral not physical.
According to DSM IV criteria for substance abuse disorder we can see lot of similarities in applicability of these criteria to addiction to TV, Internet and Mobiles. The criteria like Tolerance, Withdrawal, Use of Substance for longer/ larger amounts, desire to control, excessive time spent to obtain, and compromise with social occupational activities are very much applicable.
For mental health professionals, television addiction is believed to exist as a type of behavioral addiction similar to pathological gambling. In 1990, a symposium at the convention of the American Psychological Association developed the definition of TV addiction as "Heavy television watching that is subjectively experienced as being to some extent involuntary, displacing more productive activities, and difficult to stop or curtail." Though not considered an "official" mental disorder, there is a growing body of evidence that pieces together the framework of the TV addict.
Now a new form of addiction, "mobile phone addiction" seems to have overtaken many people and children are no exception. Gaming addiction has also been increasingly reported as an area of concern in adolescents.
What makes gadgets addictive? - TV, internet and other such modes can be addictive as viewing is passive, emotionally gratifying with out any negative, painful and punitive interactions.
Boredom, not being involved in their own constructive activities, inconsistent discipline and inadequate supervision can add to being addicted. Association with emotional and behavior problems are seen in most cases presented in clinic for help.
Teenagers are more at risk as they are unsupervised.
Management- as most of the children reported for treatment have associated Emotional, behavior and educational problems.
They need integrated multidisciplinary therapy
Not only stopping the addictive behavior but a switch from - inaction to action.
Set behavior strategy to face consequences of misuse (prefixed by a contract).
Preventive steps by parents –
In childhood one needs to explore, experience smell, touch and enjoy chores with parents, as young children learn through direct exploration and manipulation.
Parents need to actively help child set goals and work on their priorities. Understand the basic principles of rearing children towards healthy happy and emotionally balanced personalities.
Conclusion – Technology today is a part and parcel of our lives. Every change brings with it its merits and demerits; so too with electronic media. But so far merits have far outweighed demerits. We have to take care of our future generations by bringing up our children to be mature and mentally healthy adults so we need to teach them the right mode of handling these Gen-next gadgets.
Information on various aspects of TV, internet, mobile phones and video games can usefully contribute to better and holistic understanding and management of psychiatric ailments in children and adolescents. Prevention at all levels should be essential part of our practice.
(Diploma in Child & Adolescent Psychiatry - Institutes of Psychiatry & Institute of Child Health)
M.RCPsych U.K. Aug 2004
Profile :
Did M.B.,B.S. from ThanjavurMedicalCollege, Tamilnadu. Later D.P.M. and M.D. from NIMHANS, Bangalore. Continued at NIMHANS as Senior Resident. Went on a British Council Scholarship to UK in 1991 to do the Diploma in Child Psychiatry at the renounced MaudsleyHospital, London. Also did a fellowship at the famous Scripps Institute, SanDiego in 1996.
Have been a Faculty at NIMHANS since 1993. Also a consultant at NIMHANS for the Geriatric Services past 6 years. Has more than 20 years of Teaching Experience.
Worked at the NHS at UK as a Psychiatry consultant in 2004.
Areas of interest and work are
Old Age Onset Depression and Dementia. Has been guiding residents in research in various aspects of old age onset depression including APOe allele frequency
Health Promotion using Life Skills Approach for Adolescents at Secondary Schools. She has been working in this for the past 10 years. This program has been developed by Dr. Srikala Bharath. Recognized by the WHO. It is now run in 265 government schools of Karnataka past 3 years. It focuses on the personality development of the adolescents and promotion of skills like decision making, problem solving etc. Has been initiated in 69 Navodaya Schools also in the Southern Region
Stress Management in Working Women. Ran courses Women Executives in the Government Sector in collaboration with the Administrative Training Institute, Mysore for many years. Other Women executives from Coffee Board and Vidhan Soudha, Bangalore have been trained in this program.
Children at Risk for Psychological Problems – children of mentally parents, children with medical conditions like Cerebral Palsy and cancer and street children.
Psychosocial Rehabilitation in Disasters. Has worked in all disasters since Latur Earthquake.
Psychotherapy.
Women and Mental Health
Published in academic journals and also manuals in pertinent areas.
HEALTH PROMOTION using LIFE SKILLS EDUCATION for ADOLESCENTS in
SCHOOLS– NIMHANS MODEL
By Dr. Srikala Bharath
Professor of Psychiatry, NIMHANS
Dr. KV Kishore Kumar
Senior Psychiatrist, NIMHANS
Abstract
THE CONCEPT
The education, currently prevalent in India places stress on acquiring information, knowledge and technical skills rather than psychosocial competence and realizing one’s potentials. It is achievement oriented than child oriented.
Life Skills Education on the other hand promotes empowerment of the child
Life Skills (LS) are abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands, challenges and stress of every day life. These are ‘HOW’ of life than ‘WHAT’ of life. Childhood and adolescence are the developmental periods during which one acquires these skills through various methods and people.
LIFE SKILLS EDUCATION
Life Skills Education is a novel promotional program that teaches generic Life Skills through Participatory Learning Methods. Conceptual understanding and practicing of the skills occurs through experiential learning in a non-threatening setting. Such initiatives provide the individual with a wide range of alternative and creative ways of solving problems pertaining to various health and psychosocial issues like Nutrition, Drug Use, Sexual Abuse, Early Sexual Experimentation, Teenage Pregnancy, Bullying etc. Life Skills are the processes that will make the target of Values possible.
NIMHANS MODEL of LIFE SKILLS PROGRAM
In a country like India, where resources and trained professionals are sparse and few, it is more be practical to involve and work with the teachers. The teachers are the personnel who are interacting with the adolescent closely.
This methodology ensures reproducibility of the program within the existing infrastructure year after year at no extra cost. Experience of working with secondary school teachers has shown that teachers can be trained to impart LSE effectively. Training the Teachers is the methodology, which might have a wider coverage, continuity and cost-effectiveness.
THE WORKSHOP in CME
The focus of the workshop would be on the Methodology of training the teachers . Components would be
Experiential Learning
Participatory Methods
Use of Activities in a group
Peer Based Learning
Role of the teacher as a Life Skills Facilitator
Any Mental Health Professional would plans to initiate a School Mental Health Program would have orientation by this workshop on skill based training.
DR. AJITANAYAK is an Associate Professor & Head of unit at the Department of Psychiatry, SethG.S.MedicalCollege & KEMHospital, Mumbai .She has worked as a Lecturer and Asso.Professor at the T.N.MedicalCollege,NairHospital where she has worked extensively with children at the School Mental Health Clinic. She has carried out many research projects which have won awards at the BPS and West Zone level.She has been the Secretary of Bombay Psychiatric Society and Treasurer of Research Society of Nair Hospital .She has published articles in national & international journals on child and adolescent psychiatry, schizophrenia, music therapy, etc.
LIST OF PUBLICATIONS
1) “DEPRESSION IN WOMEN”- DR.H.S.DHAVALE, DR. AJITA RANE
2).ATTENTION DEFICIT HYPERACTIVITY DISORDER OF CHILDREN-DR.AJITA RANE,MS.LEENA DAMANI,DR.H.S.DHAVALE.PEDIATRIC CLINICS OF INDIA(1996) VOL.NO.31(3) 1-5.
3)EXPERIENCE OF SCHOOL MENTAL HEALTH CLINIC IN THE CITY OF BOMBAY.-DR.H.S.DHAVALE.DR.AJITA RANE. PEDIATRIC CLINICS OF INDIA(1996) VOL.NO.31(3) 31-35.
4)WHAT IS NEW IN PSYCHIATRY? –DR.AJITA RANE, DR.K.S.AYYAR.THE JOURNAL OF GENERAL MEDICINE(1996)VOL9(1).39-49.
5)A STUDY OF MR STUDENTS ATTENDING SPECIAL CLASSES . DR.H.S.DHAVALE ,DR.AJITA RANE, MR.B.H.PATIL, MRS.P.THAKKER. RESEARCH ENDEAVOURS IN CHILD & ADOLESCENT PSYCHIATRY IN INDIA.(1997).54-59.
6) A STUDY OF APPLICATION OF CONNORS’ PARENT SYMPTOM QUESTIONNAIRE-,DR.AJITA RANE, DR.H.S.DHAVALE , DR. P. GUPTA ,DR. R. PALSODKAR. RESEARCH ENDEAVOURS IN CHILD & ADOLESCENT PSYCHIATRY IN INDIA.(1997).195- 200.
7)EFFECT OF AN AYURVEDIC FORMULATION ON ATTENTION ,CONCENTRATION AND MEMORY IN NORMAL SCHOOL GOING CHILDREN-BINDRA KAUR,JOGLEKAR ADHIRAJ,PANDIT PRASAD,RANE AJITA,DESAI SHANTA,DHAVALE HEMANGI. INDIAN DRUGS(1998).35(4).200-203.
8)PROFILE OF MENTALLY HANDICAPPED CHILDREN ATTENDING SPECIAL CLASSES IN MUNICIPAL SCHOOLS IN MUMBAI.- DR.H.S.DHAVALE,DR.AJITA RANE,MR.B.J.PATIL,MRS.POORNIMA THACKER.PEDIATRIC CLINICS OF INDIA(1998)VOL.33(4).49-53.
9)GENETICS IN AFFECTIVE DISORDERS .DR.AJITA RANE , DR.K.S.AYYAR.TOPICS IN BIOLOGICAL PSYCHIATRY (1998).23-27.
10)LONGITUDINAL CHANGES IN PERSONALITY OF MEDICAL STUDENTS ON 16 PF.- MRS.POORNIMA THACKER, MR.G.N.KAMBLE, DR.H.S.DHAVALE,
DR.AJITA RANE, DR.SUMIT SHARMA.INDIAN JOURNAL OF PSYCHOLOGICAL ISSUES(2001) VOL9(2).27-33.
11)PROPHYLAXIS OF ANTIPSYCHOTIC – INDUCED EXTRAPYRAMIDAL SIDE EFFECTS IN EAST INDIANS:A CULTURAL PRACTICE OR BIOLOGICAL NECESSITY?H.S.DHAVALE,CHARLES PINTO,JYOTI DASS,AJITA NAYAK,JHANAVI KEDARE ,MANISHA KAMAT,MANTOSH DEWAN.JOURNAL OF CLINICAL PRACTICE(2004)VOL.10(3).200 – 202.
12).STUDY OF PERCEIVED STRESS IN AN ADOLESCENT POPULATION AND ITS RELATION TO GENDER , ALCOHOL, SMOKING AND ANXIETY.H.S.DHAVALE, A.S.NAYAK, P.TENDOLKAR, R.PALSODKAR, V.PANWAR, R.D.TEMBE, V.SAWANT, A.RATHI. ARCHIVES OF INDIAN PSYCHIATRY(2005) VOL.7(1).73-76.
OTHER POSTS HELD
1.HON.SECRETARY OF BOMBAY PSYCHIATRIC SOCIETY-1996-2000.
2.EXECUTIVE COMMITTEE MEMBER OF BOMBAY PSYCHIATRIC SOCIETY-2000 – 2002.
3. EXECUTIVE COMMITTEE MEMBER OF RESEARCH SOCIETY OF NAIR HOSPITAL-2001 – 2003.
4. TREASURER OF RESEARCH SOCIETY OF NAIR HOSPITAL-2003 – 2005.
5. EXECUTIVE COMMITTEE MEMBER OF STAFF SOCIETY OF SETHG.S.MEDICALCOLLEGE & KEMHOSPITAL -2007 – 2008.
Schools play an important part in the intellectual, cognitive, emotional, social and moral development of a child. A child who fails in one or more subjects or in one or more classes and a child who is in the lowest 10th percentile in class is broadly categorized as being scholastically backward. Scholastic backwardness is seen in 20 -30% of school going children. Scholastic backwardness usually leads to a sense of inadequacy in children. This in turn can have a negative impact on the emotional and social functioning of the child. Hence learning problem is an issue of concern not only for students, but also for parents and all the professionals involved in child welfare.
CAUSES
The reasons for scholastic backwardness can be related to the child, or in the environment or both.
A)Intelligence -Backwardness may be specific (in 1 or 2 subjects) or may be general (in all subjects).According to Schonnell, 65 to 80% of children with scholastic backwardness have dull or below average intelligence. In other studies analysis of the cognitive profile of children with scholastic backwardness has revealed that 51.79% had average intelligence, 20% had high average intelligence, 7% were superior, and 21% had dull average intelligence. Learning disorders affects about 10% of school going children,
B) Psychiatric Disorders - Other causes include emotional and behavioral disorders including attention deficit hyperactivity disorder and conduct disorder. Children with reduced motivation and inadequate time management also have scholastic backwardness.
C) Physical Defects – Burt has found that in 70% of these children there is low physical development leading to an inherent lack of vitality or development. Other studies have found that 64% children manifested processing defects in auditory discrimination, auditory memory, visual discrimination, visual sequential memory, visual motor integration, left-right orientation, arithmetic reasoning and precision in language. Chronic illnesses like bronchitis, epilepsy, etc. can also lead to scholastic problems.
D) Environmental Factors-These include predominantly the home (in about 27%) and the school environment (in about 40%). Family factors include family disruption , parental psychopathology, marital disharmony , alcoholism / drug abuse in family members, poor discipline, sibling rivalry, overambitious attitude of parents, substitute parenting , inconsistent family relationship and interactional problems with parents and peers. Poverty and the consequent lack of daily facilities and amenities also contribute to scholastic backwardness. Crowded homes provide few oppurtunities for parental encouragement and stimulation. School related factors include breaks and changes in child's school life , difficulty in coping with the medium of instruction , irregular attendance, late admission, transfers and migration, inefficient and uninteresting teaching, rigidity and narrowness of the curriculum.
PRESENTING FEATURES
Scholastic backwardness is one of the major complaints with which children are brought to the child guidance clinic. These children are usually branded as “lazy”. The scholastically backward suffer from deep frustrations in life and relapse into delinquency and antisocial activities . Many of them become problem children and behave like mentally sick and maladjusted. The most common reasons for referral include failure in examinations, not writing down notes in class, forgetfulness, not concentrating in studies / not interested in studies, reluctance to go to school, low self esteem , social isolation, behavior problems, anxiety and multiple physical symptoms (investigations being normal).
EVALUATION
Knowledge of the correct methods of diagnosis and observation is necessary. Assessment of the child's problem should be made through case history, play observations, psychiatric assessment, neuropsychological assessment, educational assessment, social investigations, speech and language assessment. The intellectual level of child should be assessed using standardized intelligence tests both verbal and performance. Child’s temperament and emotional characteristics should also be assessed. These include persistence, assertiveness, attention to details, sensitiveness to approval and disapproval, concentration , attitude towards schoolwork and emotional stability .
MANAGEMENT
A good teacher is a leader and diagnostician than just a instructor who is able to introduce new methods of instruction. Individualized education planning to bridge learning gaps , teaching with a gentle gradient, more flexibility and syllabus in form of projects than lectures is indicated. To improve students' performance, teachers should conduct coaching classes after school hours. It is important to make the school atmosphere attractive and provide necessary educational and sports material. Learning disability, should be managed through intensive one on one remedial training in a very supportive environment. Good therapist child relationship is essential. Behavioral and emotional problems should be managed through behavior therapy and psychotherapy. Motivational counseling and life skills training have an important role in improving the motivation and time management of children. Family counseling and parental guidance are also necessary. Parents should never compare the academic performance of their children with their classmates or peer group. They should support the child having academic stress and help the child to overcome the learning problem.
PROGNOSIS
Studies have shown that with adequate treatment self worth and academic functioning improves significantly. If not identified and corrected at the earliest, children can have tremendous academic stress and it can lead to anxiety disorders , somatoform disorders depression , conduct problems ,eating disorders and suicidal ideations.
Hence any child with difficulty in reading or arithmetic skills or deterioration in academic performance should be evaluated and managed at the earliest. Improvement in academic performance will help the child to excel in future life.
