**"Parents in general have less patience when it comes to treatment. Most of the time they ask for medicine for quick recovery and fail to understand psychological treatment and counseling.*

"Often parents refuse to accept diagnosis of the impairment."***

Her clear light-green eyes looked away in the distant, as people showered her with questions. She remained quiet as if she could not hear them speak. "She is not talking today but she does when she feels well," her mother Nasima insisted. Dressed in royal pink, twelve-year old Cynthia was waiting at the corridor of the department of Child, Adolescent and Family Psychiatry section in the National Institute of Mental Health (NIMH), Bangladesh.

"She was a adorable child, bom after two brothers so we hardly let her down from our lap," recalled her mother explaining why it took her some time to understand that Cynthia was different than her other children. Initially, she did not notice that Cynthia repeats words or sentences and becomes restless among strangers. She was more concerned about Cynthia’s continuous fever and cold which at times turned her blue. "We have been to many doctors but no one could diagnose the illness. Lastly a doctor referred us here," she said.

Early detection of impairments among children is a challenge in our country. Professor Shaheen Akhter, Program Coordinator, Centre for Neurodevelopment and Autism in Children (CNAC), Bangabandhu Sheikh Mujib Medical University (BSMMU), said, "In villages, a child suffering from mal-nutrition often walk and speak late. People often mistake an autistic child for a quiet child, who likes to be left alone."

"In a similar manner, a hyper-active child is seen as a naughty boy or girl and absence seizures in children as often mistaken for inattentiveness and goes undiagnosed," she said adding that because of failure of early detection and intervention, teaching development skills to children with mental disabilities becomes difficult.

CNAC, which started its journey on September 1999, provided treatment to about 22,000 children. Among them roughly 24 percent suffered from epilepsy, 19 percent from cerebral palsy, 23 percent from growth and speech delay, nine percent from autism spectrum disorder, 2 percent from Down’s syndrome and rest from other intellectual disability, headache etc.

Though there is no comprehensive data on the prevalence of mental disabilities among children in Dhaka, Dr Md Faruq Alam, Associate Professor of Child, Adolescent and Family Psychiatry, NIMH, said 'A study conducted with support from World Health Organisation in 2008-2009 in Dhaka division showed prevalence of mental disability in children below 18 years is 18 percent."

"Among them 3.8 percent children suffered from mental retardation and 2.2 percent from epilepsy," he said giving a brief idea about the findings of the report. 'Severe autism, conduct disorder, hyperactivity are prevalent among boys whilst girls suffer mostly from hysteria, depression and anxiety disorder." According to Dr Alam, prenatal

birth injury and birth complications often lead to mental disorder at a later stage.

In Bangladesh most child births take place at homes. Unicefs report on the state of world's children -2013 shows that only 32 percent births are attended by skilled health personnel (doctor, midwife, nurse).

Dr Alam said parents in general have less patience when it comes to treatment. 'Most of the time they ask for medicine for quick recovery and fail to understand psychological treatment and counseling. As a result follow-up rate is very low. * Drop-out rate is higher after 8-10 sessions, he informed.

Often parents refuse to accept diagnosis of the impairment. Dr Farzana Islam, child and adolescent mental health specialist. Child Development Centre

(CDC), Dhaka Shishu Hospital, said, "We noticed that when we tell parents about the diagnosis they reject it. Mothers become mentally distressed when they hear their child have development problems from birth." "So we rather tell parents about the strengths and skills of the child, so that parents feel positive about their child's ability to develop life skills," she said.

However, things have started to change. Dr Farzana said that community awareness have been raised through Meena cartoon and in many villages through traditional theatre, with the help of Ministry of Social Welfare. They are also planning to impart training to field level health workers about child development to increase early detection and intervention of impairment.