No abstract

Comorbidities are seen with obsessive-compulsive disorder (OCD) across the lifespan. Neurodevelopmental comorbidities are common in young children, followed by mood, anxiety, and obsessive-compulsive related disorders (OCRDs) in children, adolescents and adults, and neurological and degenerative disorders in the elderly. Understanding comorbidity prevalence and patterns has clinical and research implications. We conducted a systematic review and meta-analysis on comorbidities in OCD across the lifespan, with the objective to, first, estimate age-wise pattern and prevalence of comorbidities with OCD and, second, to examine associations of demographic (age at assessment, gender distribution) and clinical characteristics (age of onset, illness severity) with comorbidities. Four electronic databases (PubMed, EMBASE, SCOPUS, and PsycINFO) were searched using predefined search terms for articles published between 1979 and 2020. Eligible studies, across age, reported original findings on comorbidities and had an OCD sample size of ≥100. We excluded studies that did not use standardised diagnostic assessments, or that excluded patients on the basis of comorbidity. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol has been registered on the International Prospective Register of Systematic Reviews. A comorbidity rate of 69% was found in a pooled sample of more than 15,000 individuals. Mood disorders (major depressive disorder), anxiety disorders (generalised anxiety disorder), neurodevelopmental disorders (NDDs) and OCRDs were the commonest comorbidities. Anxiety disorders prevailed in children, mood disorders in adults, whereas NDDs were similarly prevalent. Higher comorbidity with any psychiatric illness, NDDs, and severe mental disorders was seen in males, vs. females. Illness severity was inversely associated with rates for panic disorder, tic disorders, OCRDs, obsessive compulsive personality disorder, and anorexia nervosa. This systematic review and meta-analysis provides base rates for comorbidities in OCD across the lifespan. This has implications for comprehensive clinical evaluation and management planning. The high variability in comorbidity rates suggests the need for quality, multi-centric, large studies, using prospective designs.Systematic Review Registration: Unique Identifier: CRD42020215904.

Background:Gut microflora influences neural development through complex mechanisms. Feeding practices, especially breastfeeding influence gut microbiome and thereby play a pivotal role in immune and neural development. Current understandings of the role of healthy distal gut microflora in the development of immune and neural systems provide insights into immunological mechanisms as one of the possible etiologies in autism spectrum disorder (ASD). Studies have shown that optimal breastfeeding is associated with lower odds of being at-risk for ASD and children with ASD are suboptimally breastfed.Methods:The feeding practices of children with ASD (n = 30) was compared to their typically developing siblings as matched controls (n = 30). Information regarding feeding practices was collected from mothers through a semi-structured questionnaire.Results:About 43.3% of children with ASD received exclusive breastfeeding, whereas 76.7% of their typically developing siblings were exclusively breastfed. Exclusive breastfeeding was associated with lower odds for ASD (odds ratio [OR] = 0.166; 95% confidence interval [CI] = 0.025–0.65), while early introduction of top feeds was associated with higher odds (OR = 6; 95% CI = 1.33–55.19). Difficulties in breastfeeding were attributed to child-related factors in 13.2% of the children.Conclusion:Children with ASD are suboptimally breastfed compared to their typically developing siblings. Exclusive breastfeeding may confer protection in vulnerable children. Further studies on larger prospective sample are required to establish the association.

Background: Concern is mounting regarding screen exposure among young children and its association with mental health. Children with attention deficit hyperactivity disorder (ADHD) may be more vulnerable to its effects such as increased externalizing behaviors and problems with language and cognitive development and biological functions such as sleep. We aimed to assess screen exposure in preschool children with ADHD and to study the correlation of screen time with the severity of ADHD and parental stress levels. Methods: Children of age 2.5–6 years, diagnosed with ADHD (n = 56) were included, and details of the total duration of screen exposure, maximum continuous screen exposure time, and types of screen-based devices used, reasons for screen exposure were collected from primary caregivers. ADHD symptom severity was assessed on Conner's Abbreviated Rating Scale. Family interview for stress and coping, adapted for ADHD, was used to measure parental stress. Results: Total screen exposure time in preschool children with ADHD was more than the recommended standards in 80.4% of children, with a median of 140.00 minutes (range: 20–500 minutes). The most commonly used modality was television (98.2%), followed by mobile phones (87.3%), tablets (17.9%), and laptops (10.7%). The severity of ADHD ( r = 0.29, P = 0.02) and parent stress levels ( r = 0.29, P = 0.03) were positively correlated to increased screen time exposure in the child. Conclusions: Preschool children with ADHD have screen exposure above the recommended duration of one hour/day. Structured parent training programs for children with preschool ADHD and providing developmentally appropriate interventions are essential in curtailing screen time exposure and also to address parental stress.

Background: Early interventions in children with autism spectrum disorder (ASD) reduce progressive symptom development. Delay in diagnosis and initiation of ASD-specific interventions is observed across settings. This study aimed to assess the trends in time to diagnosis and treatment initiation in a tertiary care pediatric setting. Methodology: Families of children with ASD ( n = 50) were assessed, and details regarding age at first symptom recognition, medical consultation, receiving the diagnosis, and initiation of treatment were collected, in addition to detailed clinical assessment. Results: About 70% of families met a pediatrician for initial concerns, and 20% received a diagnosis of ASD from the first-contact pediatrician. The mean age at initial symptom recognition was 22.22 ± 9.47 months, whereas the first consultation was 27.22 ± 10.83 months. The mean age at initiation of ASD-specific interventions was 36.58 ± 10.2 months, amounting to an overall delay of 14.38 months from initial symptom recognition to treatment initiation. The time delay in our study is found to be lesser compared with similar studies across settings. Discussion: Pediatricians have a significant role to play in early diagnosis and care of children with ASD in close liaison with child psychiatry teams. Improving awareness, routine screening, and prompt referral of children “at-risk” for ASD are imperative. Initiating ASD-specific interventions in pediatric or primary care settings is an effective alternative to curtail the delay in treatment initiation.