Articles on communication disorders

Delayed Speech: Can It Be Autism?

Dr. Rakesh K Jain, Neurologist
Autism spectrum disorder (ASD) is a range of complex neurodevelopment disorders, characterized by social impairments, communication difficulties, and restricted, repetitive,and stereotyped patterns of behaviour. Males are four times more likely to have an ASD than females. A recent study in US found 1 in 68 children suffering from autism.The main feature of ASD is impaired social interaction.  As early as infancy,a baby with ASD may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time.  A child with ASD may appear to develop normally and then withdraw and become indifferent to social engagement.Children with an ASD may fail to respond to their names and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behaviour. They lack empathy.Many children with anASD engage in repetitive movements such as rocking, or self-abusive behaviour such as biting or head-banging.  They also tend to start speaking later than other children. Children with an ASD don’t know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favourite topics, with little regard for the interests of the person to whom they are speaking.Children with characteristics of an ASD may have co-occurring conditions, including Fragile X syndrome (which causes mental retardation), tuberous sclerosis, epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. About 20to 30 percent of children with an ASD develop epilepsy by the time they reach adulthood. Very early indicators that require evaluation by an expert include:If you find any of these features in your child, please consult the local pediatrician or child neurologist if available who can assess your child in detail. There is no single blood test to diagnose autism. However, the doctor needs to look into certain disorders in which children have similar features or having features of autism in addition to other signs of that disorder. E.g. Tuber sclerosis, Landau-kleffner syndrome (a form of Epilpesy), other childhood epilepsies, some metabolic and genetic disease. So your doctor may do some blood test, hearing assessment, EEG, etc. depending upon the presenting features and assessment.Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, there is up to a 90 percent chance the other twin will be affected. In families with one child with ASD, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population.   For many children, symptoms improve with treatment and with age. Children whose language skills regress early in life (before the age of 3) appear to have a higher than normal risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with an ASD may become depressed or experience behavioural problems, and their treatment may need some modification as they transition to adulthood. People with an ASD usually continue to need services and supports as they get older, but many are able to work successfully and live independently or within a supportive environment.There is no cure for ASDs. However, it is important to diagnose it early and look for associated conditions like ADHD (Attention deficit hyperactive disorder), Epilepsy, sleep disorders, etc. Earlier is intervention, better is the outcome. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that meet the specific needs of individual children.  Educational/behavioural interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills, such as AppliedBehavioural Analysis. Family counselling for the parents and siblings of children with an ASD often helps families cope with the particular challenges of living with a child with an ASD.Medications:  Doctors may prescribe medications for treatment of specific autism-related symptoms, such as anxiety, depression, or obsessive-compulsive disorder. Antipsychotic medications are used to treat severe behavioural problems. Seizures can be treated with one or more anticonvulsant drugs. Medication used to treat people with attention deficit disorder can be used effectively to help decrease impulsivity and hyperactivity.Other therapies:  There are a number of controversial therapies or interventions available, but few, if any, are supported by scientific studies. Parents should use caution before adopting any unproven treatments. Although dietary interventions have been helpful in some children, parents should be careful that their child’s nutritional status is carefully followed.Conclusion: Autism is seen commonly now a day. The main features are delayed speech, poor eye contact and social interaction and restricted interest with repetitive behaviour. Parents and physician should aware of its early symptoms so that early intervention can be started.

6 Tips for Communication With the Hearing Impaired

Dr. Rajesh Kr. Bhardwaj
As per WHO's 2005 report, 63 million persons (6.3 percent of the population) have a significant hearing impairment. That means roughly one person out of a dozen has a significant hearing loss.Some concepts need to be understood before we can proceed -&nbsp;1. Difference between speech and language - speech is the spoken word, whereas language is an overall communication which includes reception and expression. Speech requires proper motor skills of articulation, vocal cord function etc whereas language is more related to comprehension and making sense of it all.2. Communication - Effective social interaction is communication. For instance a person who is hearing impaired and has no speech can still communicate. She can articulate simple demands like I need water by gesturing towards a glass of water. A person can communicate her sorrow, anger, frustration etc without having to resort to speech.Hearing impairment does not necessarily mean that the person is totally deaf - there is usually some hearing available.While speaking with a hearing Impaired person, kindly keep the following in mind :1. Speak up a little- Do not whisper or speak softly and do not shout&nbsp;- speak just &nbsp;a little above your normal volume2. Speak clearly - do not mumble - articulate your sounds well3. Reduce background noise - speak in as quiet a room as possible because background noise distorts your sound signal to the patient.4. Keep your lips and face clearly in front&nbsp;of the hearing impaired person- hearing impaired persons are very good lip readers and can judge what you are saying by reading your lips5. Use gestures liberally&nbsp;so as to illustrate what you are saying - this helps them to get the context of what you are saying.&nbsp;6. Learn Sign Language - if you are the primary care giver of a hearing aid person and the person is completely deaf, sign language will help the both of you communicate effectively with each other. Remember that it takes a while to master sign language.If you think it is frustrating for you to communicate with a hearing impaired person, imagine the frustration the person suffers from her inability to hear and communicate effectively. Kindly be patient, polite, and do not get frustrated if your message is not going through- try again.

Bipolar Disorder- What Is It? (Symptoms)

Dr. Milan Balakrishnan, Psychiatrist
What Is Bipolar Disorder?Bipolar disorder, also commonly known as manic depression, is a brain disorder that causes shifts in a person’s mood, energy, and ability to function. The symptoms of bipolar disorder can result in damaged relationships, difficulty in working or going to school, and even suicide. There are generally periods of normal mood as well, but left untreated, people with bipolar disorder continue to experience these shifts in mood. The good news is that bipolar disorder can be treated, and people with this illness can lead full and productive lives.What Are the Symptoms of Bipolar Disorder?Bipolar disorder can cause dramatic mood swings—from high and feeling on top of the world, or uncomfortably irritable and excited, to sad and hopeless, often with periods of normal moods in between. The periods of highs and lows are called episodes of mania and depression.MANIC PHASE• Feeling on top of the world. A sensation of sheer and utter happiness that nothing—not even bad news or a horrifying event or tragedy can change.• Sudden or extreme irritability or rage. While mania is often portrayed as a pleasurable experience, that is not thecase for many people with bipolar disorder.• Grandiose delusions. Individuals believe that they have special connections with God, celebrities, or political leaders.• Invincibility or unrealistic beliefs in one’s abilities. The person feels that nothing can prevent him or her from accomplishing any task.• Hyperactivity. Scheduling more events in a day than can be accomplished; inability to relax or sit still.• Excessively risky behavior. Reckless driving, outlandish spending sprees, foolish business investments, or out-of character sexual behavior.• Uncontrollable racing thoughts/rapid speech. Ideas that abruptly change from topic to topic expressed in loud, rapid speech that becomes increasingly incoherent.• Less need for sleep.DEPRESSED PHASE• Intense sadness or despair. The person feels helpless, hopeless, and worthless.• No interest in activities they once enjoyed.• Loss of energy, fatigue.• Sleep difficulties. Either sleeping too much or not at all.• Changes in appetite. Either a noticeable increase in appetite or a substantial weight loss unrelated to dieting.• Difficulty concentrating, remembering, making decisions.• Thoughts of death or suicide.PS. 30th of March is World Bipolar Day. Birthday of Vincent Van Gogh who committed suicide due to the disorder. Follow #WBD2016 #Mumbai on Twitter.

7 Reasons Behind Failed Communication

Ms. Sneha Bhat, Psychologist
We are social beings with a need to connect and craving to be heard. Communication is our second nature. We are on it all the time, whether through words or otherwise. There are times when communications fail irrespective of our intention behind or effectiveness at it. We might spend a lifetime wondering about a failed communication while things seemed just right. Let&rsquo;s take a look at possible reasons and track prime factors behind failed communications.Somebody listen!1. We Don&apos;t like to listen..?First, second, third, fourth and hundredth factor of great communication isn&rsquo;t what you say but how you listen. Think about a time when you really and thoroughly listened to someone in a 2-way communication, when there was no pressure or compulsion involved. A rare incident, right? This indeed is a natural phenomenon because every word said by another is triggering your own opinions and each nonverbal clue is putting you in different mental state, as other person is speaking. Once a strong opinion or mental state is triggered; you are rather listening to it &amp; fine tuning it in your head than lending ears to what other person is saying. A mental state here is the state triggered by how the other person said what she/he said. A dominating or demanding non-verbal could automatically put you in defensive state rather than an accepting state which is needed for effective listening.2. We fail to look from another point of view, which is very different from our ownWe all carry our worlds with us, wherever we go. One&rsquo;s belief system, values, needs &amp; perspective constitutes his/her inner world. This world, we carry, is a huge obstruction while we are relating to another person. &nbsp;Every similarity here creates an overlap between the worlds and a difference distances them. It is a blunder to voice an altogether different perspective without creating a firm common ground to stand on. This primary requirement creates the necessity to listen and understand another person&rsquo;s point of view before pitching in your own, so that you see the boundaries of another&rsquo;s world and begin your side with that part from your world, which overlaps with the other world and eventually expand it, hence expanding the boundaries of both worlds.I am not on same page and I don&apos;t want to be!3. We advise instead of validating or understandingWhen we are short on listening or lack an appreciation for deviating perspectives we tend to advice from where we stand rather than understanding or appreciating other person&rsquo;s requirements. Many of us like to share which doesn&rsquo;t mean that we are fishing for different perspectives. We rather want to bring clarity in our own perspective by sharing the experience. An uncalled for advice is to force a perspective when the other person has hardly made sense of his own experience. This would lead to defensive emotions like denial, irritation, confusion or anger rather than really helping the person. Another important intention when we share things is to have a validation for the emotions we feel. It is to know that in the given situation, from where the person stands, the experienced emotions are relevant. Most of the communication is the expectation for clarity and validation rather than need for expansion of perspectives.4. We take another&rsquo;s opinion as a judgement about usAre you judging me?What is the reason for us to get defensive when people share their opinions of us, with us? Firstly, the opinions come from their world and might not make as much sense to us as they do to them. Secondly, we might not sense the exact intention behind the opinions and thirdly, the opinion shared tend to be mostly negative which goes across as a blame or criticism to us, automatically putting us in defensive shoes. &nbsp;One tends to have much more to him/her than what is perceived, so blame or criticism is interpreted as reduction of our whole personality to few trivial details, hence, a judgement is passed about what we are. On top, we can take opinions constructively, only from people who understand and respect what we are.5. We feedback even when others do not need to be fed backDoes she really want to be fed?Feedback is something which needs a willing receiver. Feeding back rarely makes any sense when other person hasn&rsquo;t asked for it or isn&rsquo;t ready for it however honest and genuine the intentions are. Feedback has its own time and place and one needs to wait for his clue before jumping in and showering feedback on a clueless pray. Though it&rsquo;s a worthy act to feed the hungry, it will be worthless to force-feed the needless how much ever delicious and rare the food is. See if the other person is ready for what you are saying, when you are saying else say only that what he is ready for.6.&nbsp;We express impulsively instead of containing till there is clarity &amp; needThere are 2 sorts of communications. One which is triggered by impulses which might not be the way we would behave on a calmer day and the other which is well thought of &amp; well-reasoned alternative. The first kind of communication satisfies the momentary need, however, the second one keeps the long term need satisfied. First one, is a reaction to a trigger and second one is a clear response. No one is free of reactions when taken over by emotions, however, every impulsive communication ought to be followed by reflection to understand the inner turmoil &amp; reaction pattern better hence gaining a clarity &amp; understanding with each experience. It also need to be followed by a well thought out communication between affected parties to gain from the rain rather than letting relation flood away by force of the rain. A better option would be to eventually learn to contain emotions and process them within rather than expressing it on another person.7.&nbsp;We have little acceptance for diverse perspectivesHe isn&apos;t like me!The most important reason for the failed communication is the level of acceptance. We all walk on a thin rope when it comes to accepting self and others. Just one or two incidents might make us stop believing in ourselves just the way one or two instances of criticism can create a gap between people.&nbsp;We need to know our worth irrespective of situations or other people&rsquo;s opinion. A few flaws in one&rsquo;s thought process, impulses or behaviour doesn&apos;t make one a flawed person. We need to stop equating ourselves to the way we are perceived and realise that perception is just a small part of ourselves and there is a lot more to us than what has met our own or other&rsquo;s eyes. We need to stop judging or limiting ourselves based on the story which is yesterdays and expose ourselves to a magician called change, who can broaden what we think we are.Communication is the bread and butter of evolution. End of the day, only criteria to validate the quality of life is to check if we got any better communicating with self and the other as the days pass...!

In the Grasp of Anxiety - When Worrying Has Become a Disorder

Ms. Pallavi Tomar, Psychologist
Everyone is familiar with anxiety.It may pop up as a feeling of unexplained apprehension, or a flood of constant worrying thoughts, a sudden burst of panic, or even an intense dread or fear. These feelings are all to situations, things and people perceived as overwhelming, unsafe or threatening. In all its manifestations, it is unpleasant and it is quite natural to want to avoid or eliminate these feelings.But before we move on to discussing anxiety as a disorder, lets understand the evolutionary function of this seemingly out of control beast.The essential evolutionary function of an anxiety response is to prepare an individual to deal effectively with danger and threat. That is why it exists at all.Take a look at a few symptoms and the function they may serve:The feeling of restlessness and increased heart rate may keep us physically prepared for action.Our interpretation of ambiguous information as threatening may actually be aimed at reducing the probability of missing any threats around us.Our mind racing with multiple thoughts of all that which can happen may actually keep us prepared for all possibilities and scenarios.The lack of sleep will allow us to be constantly alert.It propels us, makes us strive, challenges us and pushes our limits. Toss away anxiety and you may lose out a great deal of your motivation, persistence, excitement and caution.So ideally if anxiety is experienced in the right manner, for the right reasons and for the right duration – it is only natural!But how do we recognize the transformation of this natural experience of anxiety into a disorder?There are a few things to consider. Anxiety reactions manifest in three basic forms:As an emotion: The fear, the apprehension, the worry, and the despair.As a thought: Of an impending doom, of things going wrong, of death, of injury.As a physical response: To avoid, to evade, to check, to run, to become immobile, increased heart rate, difficulty breathing etc.In an anxiety disorder, these three basic forms of anxiety may be experienced as difficulties in any of the four below mentioned domains.Intensity – Is the experience of anxiety exaggerated and far too intense than what may be warranted in a situation? Does the individual find it difficult to contain and manage the anxiety? Is the individual finding it difficult to cope with the intensity of the signs and symptoms?Frequency – Are the signs of anxiety experienced too frequently by the individual? Is the individual repeatedly reacting to the same stressor/threat without developing newer ways to cope or deal with it?Pervasiveness – Are the signs or symptoms of anxiety experienced at most times across all situations? Does it seem to be pervading across all aspects of an individual's life?Dysfunction – Is the experience of anxiety impacting the individual's functioning in their personal, professional or social life? Does the individual have to make too many changes to accommodate and cope with the experience of anxiety? Is it affecting others around the individual?If your answer is affirmative to any of these questions, your experience of anxiety may not be serving the evolutionary purpose it is essentially meant for. But before you go ahead and diagnose yourself, I encourage you to talk to a mental health professional about your concern.

Eating Disorder: Things You Should Know!

Ms. Swati Kapoor, Dietitian/Nutritionist
A harmless remark by an educated parent on the physical attribute of their growing teenage girls resulted in a shocking “anorexia pact” by the duo at the age of 11. Now at the age of 33 and being doctors they don’t lead a normal life. Eating disorders might start at a very early , if not identified and treated can stay with you for life.Anorexia nervosa is one of the most common eating disorder that is associated with abnormally low weight achieved by extreme dieting, fasting and followed by compulsive exercising. &nbsp;Mostly young girls are afflicted from this disorder especially in the absence of early parental care and support to inculcate healthy eating habits. Eating disorders have been around forever but finally society is accepting the seriousness of this ailment &nbsp;and encouraging parents, friends to come together and support the person suffering from it. &nbsp;There is a higher success rate of controlling and reversing it through family and social support .Eating disorders mostly start from home and parents play an extremely critical role in stimulating and curbing them. &nbsp;Children very closely watch and imitate their parents. If the parents fuss too much about their looks and being thin the kids will imitate them. Similarly if the parents eat a lot of unhealthy food the kids would be inclined towards junk food even when they grow up. Therefore it is mostly parent’s responsibility to inculcate healthy eating habits amongst children.Eating disorder can have serious repercussions on health like weakness, fatigue, &nbsp;anaemia, heart &amp; kidney problems, osteoporosis, infertility, disruption of sugar levels &nbsp;and even death. Nature and nurture is equally responsible for this condition. Therefore it is imperative to apply a three pronged approach to dealing with it.First restore the healthy weight of an individual, second to treat the psychological factors that may have caused this situation and lastly ensure there is total support and care to prevent relapse.Healthy Food does not make you fat. Its unhealthy eating patterns like eating too much processed food that only has empty calories and not nutrition. Also controlling the portions even at an early stage is important. This does not mean dieting it means regulating a healthy meal pattern in children where importance is give to a balanced diet that includes fruits, vegetables, dairy and grains. If a healthy food routine is followed the kids will tend to eat less junk as they will be fuller for longer resulting in optimum growth, overall health and better immunity.Also teens suffering from eating disorders tend to be very sensitive and emotional. Its important as a parents need to be more tuned to their emotion needs, provide them that extra affection and care.

Female Sexual Disorder & the Current Thinking Internationally!

Dr. Sharmila Majumdar, Sexologist
Sexual dysfunction is broadly defined as the inability to fully enjoy sexual intercourse.&nbsp;The disorder must be deemed to have caused significant distress. In addition to the existing specifiers of lifelong vs acquired &amp; generalized vs situational, a new severity scale was added: the disorder can be described as mild, moderate or severe.A new criteria called “associated features” was introduced. It is subdivided into 5 categories:&nbsp;Partner factors (e.g., partner sexual problem; partner health status);&nbsp;Relationship factors (e.g., poor communication);&nbsp;Individual vulnerability factors (e.g., poor body image; history of sexual or emotional abuse), psychiatric comorbidity (e.g., depression; anxiety), or stressors (e.g., job loss; bereavement);Cultural or religious factors (e.g., inhibitions related to prohibitions against sexual activity); andMedical factors relevant to prognosis.Causal Factors in Sexual Dysfunction - predisposing factors, precipitating factors and maintaining factors.About 43% of women and about 31% of men have experienced sexual dysfunction based on several surveys. This makes sexual dysfunction one of the most common psychological problem.Specific techniques to overcome some of the disorder symptoms are to increase communication between the couple, increase self understanding and sensate focus exercises will help the couple Immensely alleviate some issues with immediate intervention and help of their doctor i.e. A sexologist or an andrologist.

The Emotional Roller Coaster: Borderline Personality Disorder

Dr. Kavita Sagarkar, Psychiatrist
For someone suffering from Borderline Personality Disorder (BP) and for the parents, siblings, partner or children of those having BP, it is usually &nbsp;a frustrating journey literally from hell to nowhere....your very own emotional roller coaster ride!How would you know if someone suffers from BP?The patients of BP usually would be seen by a Psychiatrist during one of these &nbsp;scenarios....they have become suicidal,&nbsp;attempt to cut their wrists, burn themselves or are threatening to kill themselves or family members because they hate them! &nbsp;This may have been happening for some time before family members realize it to be a Psychiatric disorder.It is pretty scary for the family. BP patients can get completely out of control with rage, the very family members they idolized may suddenly be the hated ones. So, they are suicidal and depressed. But it is&nbsp;more than just plain Depression. They are literally on a path of self destruction. They tend to over idolize&nbsp;&nbsp;people and a seemingly small remark can make them get into a rage and lead to self destructive behaviors. They become uncontrollable and unmanageable-&nbsp;one minute ago they were fine and the next minute you might find them suicidal or homicidal!Most of these&nbsp;behaviors &nbsp;occur with family members only&nbsp;and to outsiders they may appear either &nbsp;happy individuals or sometimes shy or under confident , that's all! Because of this trait they are usually&nbsp;labelled&nbsp;as being 'manipulative'&nbsp;by family members who get frustrated by their&nbsp;mood swings&nbsp;and constant suicide threats...They also tend to&nbsp;go from one failed relationship to another and usually these relationships are&nbsp;abusive...they tend to get into relationships with controlling, demanding and abusive people and may do almost anything to cling to the relationship...or sometimes just as suddenly their idolization can turn to bitter hatred leading usually to&nbsp;self destructive behaviors in the form of Alcoholism or drug abuse or drug overdose...While the diagnosis may be based on history of the symptoms described above , Psychological tests like Rorschach and MMPI personality tests may also aid in concluding the diagnosis of BP.&nbsp;Usually a history of childhood neglect and/or abuse is there.&nbsp;Even prior to the diagnosis and definitely after the diagnosis, these patients go from one Psychiatrist to the other or from one counselor to another in the hope of getting relief. While it has been proved that people with BP have imbalances in their brain chemicals(Neurotransmitters),&nbsp;medication may at most help in controlling aggression or alleviating Depression to some extent. Also, as symptoms vary at different times it becomes a mess of a number of anti-psychotics, anti- depressants, mood stabilizers , etc..But there is hope...Specific therapies like Dialectical Behavior Therapy( DBT)&nbsp;,&nbsp;Rational Emotive Therapy&nbsp;and &nbsp;NLP(Neuro-Linguistic Programming)&nbsp;based techniques can help patients and families deal with BP.The goal of therapy&nbsp;is multi-fold.First and foremost, is Emotion regulation, &nbsp;bringing about&nbsp;control on our emotions&nbsp;through various mindfulness techniques , NLP based&nbsp;techniques and understanding how our perceptions cause us distress.&nbsp;Second, would be impulse control&nbsp;through simple techniques like&nbsp;body scan&nbsp;and 3 minute&nbsp;&nbsp;breathing technique.&nbsp;Learning to identify triggers and moving from reactivity to responsiveness. Try this 'Step out of the waterfall' technique for impulse you feel yourself falling into a cascade of negativity like a cascading waterfall, imagine stepping out of the waterfall and observing calmly the rushing water go&nbsp;by...soon you will realize that &nbsp;the negative impulse did not can now think about things affecting you calmly.Third, is to bring about improvement in Interpersonal relationships and lastly,&nbsp;to&nbsp;improve self- image. These patients usually have a love-hate relationship with family members as well as suffer from self-loathing. They are dialectical in their thinking patterns, opposing thoughts co-exist within them . &nbsp;This can be handled by correcting faulty belief systems usually developed in childhood due to neglect or abuse.&nbsp;The road ahead may be long and arduous but together we can succeed!&nbsp;

Take This Quiz to Check if You Have a Sleep Disorder!

Dr. Sukhant Bagdia, Pulmonologist
The&nbsp;Epworth Sleepiness Scale&nbsp;(ESS) is a&nbsp;scale&nbsp;intended to measure daytime&nbsp;sleepiness&nbsp;that is measured by use of a very short questionnaire. This can be helpful in diagnosing&nbsp;sleep disorders in people complaining of snoring during sleep. It was introduced in 1991 by Dr Murray Johns of&nbsp;Epworth Hospital&nbsp;in&nbsp;Melbourne, Australia.&nbsp;This questionnaire asks you to rate your probability of falling asleep on a scale of increasing probability from 0 to 3 for EIGHT different situations that most people engage in during their daily lives, though not necessarily every day.&nbsp;The scores for the eight questions are added together to obtain a single number.&nbsp;A number in the 0–9 range is considered to be NORMAL while a number in the 10–24 range is considered to be ABNORMAL which&nbsp;indicates that expert medical advice need to be taken.How to SCORE the increasing PROBABILITY of DOZING:0 = no chance of dozing1 = slight chance of dozing2 = moderate chance of dozing3 = high chance of dozingSCORING finally according to following situations:SITUATIONCHANCE OF DOZING1. Sitting and reading_?0__?1__?2__?3_2. Watching TV_?0__?1__?2__?3_3. Sitting inactive in a public place (e.g a theater or a meeting)_?0__?1__?2__?3_4. As a passenger in a car for an hour without a break_?0__?1__?2__?3_5. Lying down to rest in the afternoon when circumstances permit_?0__?1__?2__?3_6. Sitting and talking to someone_?0__?1__?2__?3_7. Sitting quietly after a lunch without alcohol_?0__?1__?2__?3_8. In a car, while stopped for a few minutes in traffic_?0__?1__?2__?3_Total your SCORE and JUDGE your PROBABILITY for Snoring Related Health Problem.