“Correlation of severity of autism with risk factors and EEG abnormalities in children aged 3-12 years attending child guidance clinic at Institute of child health and hospital for children” Dissertation submitted for M.D. DEGREE EXAMINATION BRANCH VII- PAEDIATRIC MEDICINE THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY CHENNAI INSTITUTE OF CHILD HEALTH AND HOSPITAL FOR CHILDREN MADRAS MEDICAL COLLEGE CHENNAI APRIL 2015 CERTIFICATE This is to certify that the dissertation titled “ Correlation of severity of autism with risk factors and EEG abnormalities in children aged 3- 12 years attending child guidance clinic at Institute of child health and hospital for children ”submitted by Dr. KAVITHA .H. R , to the Faculty of Pediatrics, The Tamil Nadu Dr. M.G.R. Medical University, Chennai in partial fulfilment of the requirement for the award of M.D., Degree (Pediatrics) during the academic year 2012 – 2015 is a bonafide research work carried out by her under our direct supervision and guidance. Dr.R.VIMALA, M.D., Dr.S.SUNDARI, M.D., The Dean, Professor and Head of the Dept., Madras Medical College & Director & Superintendent Rajiv Gandhi Govt. General Hospital, Institute of Child Health & Chennai – 3 Hospital for Children Egmore, Chennai – 8 DR.R.SOMASEKAR, Dr.SHANTHI NAMBI, M.D., D.C.H., M.D.,DPM, Professor of Pediatrics, Professor of Child Psychiatry, Guide, Co Guide, Institute of Child Health & Institute of Child Health & Hospital for Children Hospital for Children Egmore, Chennai – 8 Egmore, Chennai –8 DECLARATION I solemnly declare that this dissertation entitled “Correlation of severity of autism with risk factors and EEG abnormalities in children aged 3-12 years attending child guidance clinic at Institute of child health and hospital for children” has been prepared by me at Madras Medical College and Institute of child health, during 2012-2015. This dissertation is submitted to the Tamil Nadu Dr.M.G.R. Medical University towards the partial fulfilment of requirements for the award of M.D. Degree in Pediatrics (Branch-VII). Signature of Candidate Place : Chennai Date : SPECIAL ACKNOWLEDGEMENT My sincere thanks to Prof.Dr.R.VIMALA, M.D., the dean, Madras Medical College, for allowing me to do this dissertation and utilize the institutional facilities. ACKNOWLEDGEMENT I would like to express my sincere gratitude to Prof.Dr.S.SUNDARI, M.D., Professor of Pediatrics, Director and superintendent of Institute of child health and hospital for children for permitting me to carry out this study and for her valuable guidance. I am greatly indebted to my guide and teacher, Prof.Dr.R. SOMASEKAR, MD., Professor of Paediatrics for his supervision, guidance and encouragement while undertaking this study. I express my heartful gratitude, admiration and sincere thanks to my co- guide Prof.Dr. SHANTHI NAMBI MD, DPM., Professor of Child Psychiatry, and Dr.VIMAL DOSHI, MD., Assistant professor of child psychiatry, Institute of Child Health and Hospital for Children, for their valuable guidance. I express my sincere thanks and gratitude to Prof.Dr.C. LEEMA PAULIN, MD, DM., Professor of Paediatric Neurology and Dr.L.RAVI, MD, DM , Institute of Child Health and Hospital for Children, for reporting EEG and for their valuable guidance. I express my sincere thanks to Prof.Dr.Jayaprakash Ramaswamy,MD., Professor of Psychiatry, Institute of Mental Health for permitting me to do EEG at IMH hospital. I would like to thank to my Assistant Professors, Dr.RAMKUMAR,MD,DCH., Dr.RAVISHANKAR,MD., and Dr.BALAMURUGAN,MD., for their valuable suggestions and support. I would like to thank Dr.KANNAN MD., Assistant Professor, Department of Psychiatry, for his valuable suggestion and guidance during my initial period of study. I gratefully acknowledge the help and guidance received from Dr.S.SRINIVASAN, DCH., Registrar at every stage of this study. I also thank all the members of the Dissertation Committee for their valuable suggestions. My sincere thanks to Mrs UMA, EEG technician and Mr CHANDRAN for their technical help and support. I also express my gratitude to all my fellow postgraduates for their kind cooperation in carrying out this study and for their critical analysis. I thank the Dean and the members of Ethical Committee, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai for permitting me to perform this study. I thank all the parents and children who have ungrudgingly lent themselves to undergo this study without whom, this study would not have seen the light of the day. CONTENTS S.NO. TOPIC PAGE.NO. 1 INTRODUCTION 1 2 REVIEW OF LITERATURE 6 3 OBJECTIVES 22 4 STUDY JUSTIFICATION 23 5 METHODOLOGY 24 6 RESULTS 30 7 DISCUSSION 90 8 CONCLUSION 99 9 LIMITATIONS 101 FUTURE DIRECTIONS FOR THE 10 102 FURTHER STUDY 11 BIBLIOGRAPHY 1 ANNEXURES 1. PROFORMA 2. DSM V 3. MASTER CHART