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Chen YL, Freeman AJ, Huang KJ, Kraus SW. Perceptions of youth internalizing symptoms: Cross-cultural comparisons between Taiwanese and U.S. mothers. Transcult Psychiatry 2025; 62:366-378. [PMID: 39529364 DOI: 10.1177/13634615241272997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
This study was designed to examine how cultural values affected mothers' perceptions of internalizing symptoms in youth, comparing Taiwanese and U.S. samples. We hypothesized that mothers' self-reported East Asian cultural values (e.g., conformity, emotional self-control, face culture) would mediate the relationship between their country of residence and perceptions of youth's depressed mood and anhedonia. Participants were 310 mothers from the United States and 294 mothers from Taiwan. All participants responded to questions regarding their adherence to specific East Asian cultural values. Four brief vignettes about a male adolescent experiencing internalizing symptoms were presented to all participants. After reading each vignette, participants rated their perceptions of the adolescent's symptoms. Results from a series of multilevel structural equation models indicated that Taiwan mothers reported more East Asian cultural values (conformity, emotional self-control, face culture) compared to U.S. mothers, which in turn led to rating youth internalizing problems as less acceptable, more impairing, and more problematic to the family, and feeling less proud and more ashamed of the youth. There was also an inconsistent mediation effect of East Asian cultural values on the relationship between country and rating of anhedonia. The mediation pathway was non-significant for the rating of depressed mood. In conclusion, to improve cultural understanding, researchers and clinicians should consider the driving force of the observed between-group differences to ensure appropriate conceptual frameworks in a cross-cultural context. Cross-cultural differences in ratings of youth symptoms highlight the importance of a culturally sensitive approach to assessing symptoms and functional impairment in different cultural groups.
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Affiliation(s)
- Yen-Ling Chen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA
| | | | - Kuan-Ju Huang
- Graduate School of Human and Environmental Studies, Kyoto University, Kyoto, Japan
| | - Shane W Kraus
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
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Chen CY, Chou WJ, Hsiao RC, Yen CF. Development and validation of the parental self-efficacy to manage child's online risk behaviors scale for parents of adolescents with and without attention-deficit/hyperactivity disorder. Acta Psychol (Amst) 2025; 254:104802. [PMID: 39961262 DOI: 10.1016/j.actpsy.2025.104802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 01/11/2025] [Accepted: 02/11/2025] [Indexed: 03/18/2025] Open
Abstract
The aim of this study was to develop and validate the Parental Self-Efficacy to Manage Child's Online Risk Behaviors Scale (PSEMCORBS). The study included 249 adolescents (122 adolescents with ADHD recruited from child psychiatry outpatient clinics in Taiwan and 127 adolescents without attention-deficit/hyperactivity disorder [ADHD] recruited through online advertising; mean age [SD] = 13.77 [2.10] years) and their parents (N = 249, mean age [SD] = 47.14 [4.89] years). This study examined the PSEMCORBS's factor structure by using the exploratory factor analysis (EFA), internal consistency by using McDonald's ω, concurrent validity by evaluating its correlations with adolescents' internet addiction severity, time spent on internet, and internalizing and externalizing problems, and known-group validity by comparing parental self-efficacy between parents of adolescents with and without online risk behaviors as well as between parents of adolescents with and without ADHD. The EFA results indicate that the 23-item PSEMCORBS has three factors, including monitoring, intervention, and parental reasoning. The overall PSEMCORBS and its three factors had excellent internal consistency (McDonald's ω: ranging from 0.922 to 0.958). The overall PSEMCORBS was significantly associated with children internet addiction severity, time spent on internet, child internalizing problem, and child externalizing problem (all p < 0.02). Parents of the children without online risk behaviors reported significantly higher scores on the entire PSEMCORBS and three factors than did those of the children with online risk behaviors (all p < 0.05). Parents of the children without ADHD reported significantly higher score than did those of the children with ADHD in the factor of parental reasoning (p < 0.05). The PSEMCORBS is considered a valuable and reliable tool in the study of parental self-efficacy to manage adolescents' online risk behaviors.
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Affiliation(s)
- Chao-Ying Chen
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; New Taipei City Tucheng Hospital (Chang Gung Medical Foundation), Department of Pediatric Internal Medicine, New Taipei City, Taiwan
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ray C Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA; Department of Psychiatry, Children's Hospital and Regional Medical Center, Seattle, WA, USA
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan.
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Lin PC, Tsai CS, Hsiao RC, Yen CF. Associations Between Peer Victimization and Aggression and Three Types of Domestic Violence in Adolescents with Attention-Deficit/Hyperactivity Disorder. CHILDREN (BASEL, SWITZERLAND) 2025; 12:422. [PMID: 40310061 PMCID: PMC12025371 DOI: 10.3390/children12040422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Revised: 03/25/2025] [Accepted: 03/26/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND/OBJECTIVES Peer victimization and aggression can be detrimental to the physical and mental health of adolescents. Adolescents with attention-deficit/hyperactivity disorder (ADHD) are one of the risk groups involved in peer victimization and aggression. The association between multiple types of domestic violence and engagement in peer victimization and aggression warrants more examination in adolescents with ADHD. This study examined the associations of parent-to-child aggression (PCA), witness to domestic violence (WDV), and child-to-parent violence (CPV) with the experiences of peer victimization and aggression among adolescents with a clinical diagnosis of ADHD in Taiwan. MATERIALS AND METHODS In total, 247 adolescents with ADHD (206 boys and 41 girls, mean age [SD] = 13.2 [2.0] years) agreed to participate in this study. Adolescents' peer victimization and aggression, PCA, WDV, and CPV in the previous year were collected. RESULTS This study found that 28.3% and 12.6% of adolescents with ADHD reported experiences of peer victimization and aggression, respectively. The rates of having PCA, WDV, and CPV ranged from 38.1% to 56.3%. The results of multivariable logistic regression analysis found that child-to-parent financial demand (p = 0.016) and child-to-parent control or domination (p = 0.018) significantly correlated with the experiences of peer victimization. PCA (p = 0.010) and child-to-parent control or domination (p = 0.042) significantly correlated with the experiences of peer aggression. CONCLUSIONS The results of this study show that both CPV and PCA significantly correlate with the experiences of peer victimization and aggression in adolescents with ADHD. CPV and PCA should be included in adolescent prevention programs.
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Affiliation(s)
- Po-Chun Lin
- Department of Psychiatry, E-Da Hospital, Kaohsiung 82445, Taiwan;
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Ching-Shu Tsai
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83341, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Ray C. Hsiao
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA 98195, USA;
- Department of Psychiatry, Children’s Hospital and Regional Medical Center, Seattle, WA 98105, USA
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Tsai CS, Lin CY, Hsiao RC, Yen CF. Psychometric Properties of the Chinese Version of the Child-to-Parent Violence Questionnaire in Adolescents with Attention-Deficit/Hyperactivity Disorder. CHILDREN (BASEL, SWITZERLAND) 2025; 12:408. [PMID: 40310025 PMCID: PMC12026313 DOI: 10.3390/children12040408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Revised: 03/17/2025] [Accepted: 03/19/2025] [Indexed: 05/02/2025]
Abstract
PURPOSE Child-to-parent violence (CPV) is a major concern for adolescents with attention-deficit/hyperactivity disorder (ADHD). The Child-to-Parent Violence Questionnaire (CPV-Q) is a valid instrument for assessing a wide variety of CPV behaviors and the reasons; however, the psychometric properties of the Chinese version of CPV-Q (C-CPV-Q) in adolescents with ADHD have not been examined yet. This study examined the psychometric properties of both child and parent versions of C-CPV-Q in adolescents with ADHD. PARTICIPANTS AND METHODS In total, 247 adolescents with ADHD and their parents participated in the study. Confirmatory factor analyses (CFAs) were conducted to examine the factor structure for CPV types and reasons. Internal consistency, cross-validation, and concurrent validity of the parent and child versions of C-CPV-Q were also evaluated. RESULTS The results of CFA found that both child and parent versions of the C-CPV-Q contained four domains of CPV types and two domains of CPV reasons in adolescents with ADHD. The correlations between parent and child reports of the C-CPV-Q assessing the same factors were stronger than those assessing different factors. Concurrent validity of the C-CPV-Q was supported by their positive correlations with internalizing, externalizing, attention deficit/hyperactivity, oppositional defiant, and conduct problems. Except for the financial aggression factor, the entire C-CPV-Q had acceptable internal consistency. CONCLUSIONS The results indicate that the child and parent versions of the C-CPV-Q are valid instruments for assessing a wide variety of CPV behaviors and the reasons among adolescents with ADHD.
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Affiliation(s)
- Ching-Shu Tsai
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83341, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Ray C. Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA;
- Department of Psychiatry, Seattle Children’s, Seattle, WA 98105, USA
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Ho CS, Chen YC, Lee MY, Chen CJ, Tsai HJ. Factors associated with Tourette syndrome among adolescents in Taiwan: A cross-sectional correlational study. J Pediatr Nurs 2023; 73:e75-e82. [PMID: 37544859 DOI: 10.1016/j.pedn.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Adolescents with Tourette syndrome (TS) may suffer from learning difficulties (attention-deficit/hyperactivity disorder), challenges in interpersonal interactions (especially with peers), disruptions of daily routines (disruptive behavior disorders), and increased psychosocial stress, which can result in internalizing and externalizing behavioral problems, such as venting depression and stress through self-harm. The aim of this study was to investigate peer attachment in adolescents with TS and associated risk factors. DESIGN AND METHODS Adolescents with TS aged 13-18 years were recruited from the outpatient departments of 2 hospitals in Taiwan. Participants completed a basic data sheet, the Beck Depression Inventory-II, the Chinese version of the State-Trait Anxiety Inventory, and the Chinese version of the Youth Self-Report. Descriptive statistics were performed. Structural equation modeling was used to verify the model proposed in this study and to analyze the overall fit and internal structure. RESULTS A total of 452 adolescents with TS aged 10-19 years participated in this study, which aimed to investigate factors affecting peer attachment, depression, anxiety, and psychosocial maladaptation and to explore causal relationships between these factors. Peer attachment was significantly associated with grade point average (rs = -0.240, p < .001), birth order (rs = -0.118, p = .012), parental marital status (rs = -0.111, p = .018), parenting style (rs = -0.138, p = .003), family monthly income (rs = 0.124, p = .008), and weekly hours on the internet (r = -0.164, p < .001). CONCLUSIONS These results suggest that depression, anxiety, and peer attachment affect psychosocial development. PRACTICAL IMPLICATIONS The findings may help clinical staff manage adolescents' severe emotional distress and psychosocial maladaptation.
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Affiliation(s)
- Che-Sheng Ho
- Division of Paediatric Neurology, Department of Paediatrics, MacKay Children Hospital and Department of Medicine, MacKay Medical College, Taipei, Taiwan. #92, Sec. 2, Chung-Shan N. Road, Taipei 10449, Taiwan.
| | - Yi-Chang Chen
- Department of Rehabilitation, Jen-Teh Junior of Medicine Nursing and Management, Miaoli County, Taiwan. 3F.-3, No. 20-3, Ln. 128, Sec. 3, Taichung Port Rd., Situn Dist., Taichung City 40764, Taiwan, ROC
| | - Mei-Yin Lee
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, No. 365, Ming-te Rd., Peitou Dist., Taipei City 252, Taiwan.
| | - Chen-Jung Chen
- Department of Nursing, MacKay Medical College, Taipei, Taiwan. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan.
| | - Huang-Ju Tsai
- Department of Occupational Therapy, Da-Yeh University, Changhua, Taiwan. No.168, University Rd., Dacun, Changhua, 515006, Taiwan, ROC.
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Lin YC, Lee WY. Correlation Analyses Between Childhood Behavioral Disturbance and Maternal Alexithymia: An Observational Study. Neuropsychiatr Dis Treat 2023; 19:1665-1674. [PMID: 37534333 PMCID: PMC10392813 DOI: 10.2147/ndt.s421458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose Caregivers' responses have an impact on children's emotional and behavioral development. The inability of caregivers to perceive their own emotions affects their responses to children. This study aims to examine the relationship between a mother's difficulties in emotional expression and children's emotional and behavioral disorders. Patient and Methods A total of 78 cases, aged between 3 and 15 years old, were included in this study. The mothers completed the Taiwan version of the "Toronto Alexithymia Scale" (TAS) and "Children's Behavior Checklist" (CBCL) questionnaires, which served as research tools. TAS consists of three factors: difficulty in distinguishing emotions (Factor 1, F1), difficulty in expressing feelings (Factor 2, F2), and an externally oriented thinking style (Factor 3, F3). CBCL represents a child's behavior profile. The Mann-Whitney test and correlation analyses were used for follow-up analysis. Results Our analysis revealed that F1, F2, F3, and total scores of TAS (TAS-Total) correlate positively with the somatic complaint subscale of CBCL (F1: p = 0.003; F2: p = 0.002; F3: p = 0.034, TAS-Total p=0.002). Additionally, TAS-F1 was positively correlated with the internalizing problems subscale of CBCL (p = 0.020) and the withdrawn (WD) subscale of CBCL (p = 0.044). We also found a significant association between TAS-F1 and WD of CBCL in boys alone (p = 0.022). However, we observed a negative association between TAS-F3 and the social problems subscale of CBCL in boys alone (p = 0.038). Conclusion Mothers with alexithymic features are more likely to have children who internalize emotions, leading to withdrawal and somatic expression. Boys tend to exhibit withdrawal traits associated with internalization. This study provides initial evidence of a partial correlation between maternal alexithymia and children's emotional and behavioral disorders, emphasizing the importance of investigating caregivers' emotional traits for a better understanding of children's development in the future.
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Affiliation(s)
- Yu-Chen Lin
- Department of Psychiatry, Veteran General Hospital-Taichung, Taichung, 407, Taiwan, Republic of China
| | - Wei-Yang Lee
- Department of Psychiatry, Cheng Gung Memorial Hospital, Taoyuan City, 333, Taiwan, Republic of China
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Chen YC, Lin HY, Chien Y, Tung YH, Ni YH, Gau SSF. Altered gut microbiota correlates with behavioral problems but not gastrointestinal symptoms in individuals with autism. Brain Behav Immun 2022; 106:161-178. [PMID: 36058421 DOI: 10.1016/j.bbi.2022.08.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/09/2022] [Accepted: 08/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite inconsistent results across studies, emerging evidence suggests that the microbial micro-environment may be associated with autism spectrum disorder (ASD). Geographical and cultural factors highly impact microbial profiles, and there is a shortage of data from East Asian populations. This study aimed to comprehensively characterize microbial profiles in an East Asian sample and explore whether gut microbiota contributes to clinical symptoms, emotional/behavioral problems, and GI symptoms in ASD. METHODS We assessed 82 boys and young men with ASD and 31 typically developing controls (TDC), aged 6-25 years. We analyzed the stool sample of all participants with 16S V3-V4 rRNA sequencing and correlated its profile with GI symptoms, autistic symptoms, and emotional/behavioral problems. RESULTS Autistic individuals, compared to TDC, had worse GI symptoms. There were no group differences in alpha diversity of species richness estimates (Shannon-wiener and Simpson diversity indices). Participants with ASD had an increased relative abundance of Fusobacterium, Ruminococcus torques group (at the genus level), and Bacteroides plebeius DSM 17135 (at the species level), while a decreased relative abundance of Ruminococcaceae UCG 013, Ervsipelotrichaceae UCG 003, Parasutterella, Clostridium sensu stricto 1, Turicibacter (at the genus level), and Clostridium spiroforme DSM 1552 and Intestinimonas butyriciproducens (at the species level). Altered taxonomic diversity in ASD significantly correlated with autistic symptoms, thought problems, delinquent behaviors, self dysregulation, and somatic complaints. We did not find an association between gut symptoms and gut microbial dysbiosis. CONCLUSIONS Our findings suggest that altered microbiota are associated with behavioral phenotypes but not GI symptoms in ASD. The function of the identified microbial profiles mainly involves the immune pathway, supporting the hypothesis of a complex relationship between altered microbiome, immune dysregulation, and ASD that may advance the discovery of molecular biomarkers for ASD.
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Affiliation(s)
- Yu-Chieh Chen
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yiling Chien
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yu-Hung Tung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Hsuan Ni
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei City, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Lee MJ, Lai HC, Kuo YL, Chen VCH. Association between Gut Microbiota and Emotional-Behavioral Symptoms in Children with Attention-Deficit/Hyperactivity Disorder. J Pers Med 2022; 12:jpm12101634. [PMID: 36294773 PMCID: PMC9605220 DOI: 10.3390/jpm12101634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Previous studies have explored the role of the microbiome in attention-deficit/hyperactivity disorder (ADHD). However, whether the microbiome is correlated with emotional-behavioral disturbances, the most common comorbid symptom of ADHD, remains unclear. We established a cross-sectional study in which 6- to 18-year-old children with ADHD who were receiving no medication and a healthy control group of children without ADHD were recruited to analyze their microbiome composition. Microbiota of fecal samples were collected and analyzed using a 16s rRNA gene sequencing approach. In comparison with the healthy control group, the gut microbiota in children with ADHD exhibited significantly lower beta diversity. The abundance of the phylum Proteobacteria and the genera Agathobacter, Phascolarctobacterium, Prevotella_2, Acidaminococcus, Roseburia, and Ruminococcus gnavus group was increased in the ADHD group compared with the healthy group. Linear discriminant effect size (LEfSe) analysis was used to highlight specific bacteria phylotypes that were differentially altered between the ADHD and control groups. A regression analysis was performed to investigate the association between microbiota and emotional-behavioral symptoms in children with ADHD. A significant association was noted between withdrawal and depression symptoms and Agathobacter (p = 0.044), and between rule-breaking behavior and the Ruminococcus gnavus group (p = 0.046) after adjusting for sex, age, and the ADHD core symptoms score. This study advances the knowledge of how gut microbiota composition may contribute to emotional-behavioral symptoms in children with ADHD. The detailed mechanisms underlying the role of the gut microbiota in ADHD pathophysiology still require further investigation.
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Affiliation(s)
- Min-Jing Lee
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi 613, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsin-Chih Lai
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Microbiota Research Center and Emerging Viral Infections Research Center, Chang Gung University, Taoyuan 333, Taiwan
- Central Research Laboratory, Xiamen Chang Gung Hospital, Xiamen 361, China
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Research Center for Chinese Herbal Medicine and Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
| | - Yu-Lun Kuo
- Biotools Co., Ltd., New Taipei City 221, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi 613, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-5-3621000 (ext. 2315); Fax: +886-5-3623002
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Tzang RF, Chang YC. Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy. World J Psychiatry 2022; 12:787-800. [PMID: 35978969 PMCID: PMC9258275 DOI: 10.5498/wjp.v12.i6.787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/15/2021] [Accepted: 05/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder (ADHD) is reported to be poor, possibly due to heterogeneity of ADHD symptoms. Little is known about poor treatment efficacy owing to ADHD heterogeneity.
AIM To use generalized structural equation modeling (GSEM) to show how the heterogeneous nature of hyperactivity/impulsivity (H/I) symptoms in ADHD, irritable oppositional defiant disorder (ODD), and the presentation of aggression in children interferes with treatment responses in ADHD.
METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests. ODD scores from the Swanson, Nolan, and Pelham, version IV scale were obtained. The child behavior checklist (CBCL) and parent’s satisfaction questionnaire were completed. The relationships were analyzed by GSEM.
RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD, ODD symptoms, and childhood aggressive behavior. ODD directly mediated ADHD symptom severity. The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494% [= exp (2.602)] in children with comorbid ADHD and ODD [odds ratio (OR) = 2.602, 95% confidence interval (CI): 1.832-3.373, P = 0.000] after adjusting for the effects of other factors. Childhood aggression mediated ODD symptom severity. The chance of reaching remission based on ODD symptoms was lowered by 11.000% [= 1 - exp (-0.117)] in children with more severe baseline symptoms of aggression based on the CBCL score at study entry [OR = -0.117, 95%CI: (-0.190)-(-0.044), P = 0.002].
CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity. More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment, e.g., symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.
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Affiliation(s)
- Ruu-Fen Tzang
- Department of Child and Adolescent Psychiatry, Mackay Memorial Hospital, Taipei 104, Taiwan
- Department of Childhood Care and Education, Mackay Junior College of Medicine, Nursing, and Management, New Taipei City 112, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City 251, Taiwan
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Liu J, Chan C, Leung PWL. Youth psychopathology: Universal or culture-specific? Testing the syndrome models of youth self-report in Chinese population. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2022; 35:126-141. [PMID: 34595782 PMCID: PMC10082997 DOI: 10.1111/jcap.12353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/10/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM The debate on whether psychiatric symptoms are universal and to what extent they are affected by culture is generally divided between the universalist and relativist approaches. METHODS This study compared Achenbach/Rescorla's model and Weisz's model of youth self-report in 2521 Chinese adolescents (mean age = 12 years). Indigenous exploratory factor analyses were conducted to explore the factor structure of youth self-report (YSR), and the derived models were tested with confirmatory factor analysis. FINDINGS These analyses indicated good support of the Chinese YSR models for males and females. Further analyses revealed three syndromes, namely anxious/depressed, somatic complaints, and aggressive behaviors, which represented broad internalizing and externalizing factors. These syndromes consistently demonstrated high correlations across the different models, indicating their universal nature. Conversely, some unique factors emerged in the Chinese YSR model, such as weight concern and rule-breaking behavior, which may reflect underlying culture-bound factors. CONCLUSIONS Our findings support a combined perspective to the universalist and relativist approaches, which argues that some syndromes including Anxious/Depressed, Somatic Complaints, Aggressive Behavior and Attention Problems are more likely to be universal in male adolescents, while a new emerging syndrome like Weight Concern may reflect the socioeconomic, culture, and lifestyle changes that are currently emerging in China.
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Affiliation(s)
- Jianghong Liu
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Clare Chan
- Chinese University of Hong Kong, Hong Kong, China
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Hsiao MN, Tai YM, Wu YY, Tsai WC, Chiu YN, Gau SSF. Psychopathologies mediate the link between autism spectrum disorder and bullying involvement: A follow-up study. J Formos Med Assoc 2022; 121:1739-1747. [DOI: 10.1016/j.jfma.2021.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/29/2021] [Accepted: 12/29/2021] [Indexed: 12/28/2022] Open
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Structural Equation Modeling (SEM): Childhood Aggression and Irritable ADHD Associated with Parental Psychiatric Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910068. [PMID: 34639370 PMCID: PMC8507797 DOI: 10.3390/ijerph181910068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022]
Abstract
Background: Children with attention deficit hyperactivity disorder (ADHD) co-occurring with Oppositional Defiant Disorder (ODD) further present aggressive behavior and may have a depressive parent. A child with co-occurring ADHD and ODD has differentially higher levels of behavioral and emotional difficulties. Little is known about how the irritable subtype of ADHD in children mediates the development of parental symptomatology. This study aims to elucidate the direct or indirect influence of childhood disruptive ADHD with aggressive behavior on their parental symptom using Structural Equation Modeling (SEM). Methods: A total of 231 ADHD children and their parents completed the Swanson, Nolan, and Pelham Version IV questionnaire for symptoms of ADHD, Oppositional Defiant Disorder (ODD) scale for irritable symptoms, Child Behavior Check List (CBCL) for aggression, and Symptom Checklist (SCL) for parental symptom. Results: The three-factor confirmatory factor analysis (CFA) model found symptoms of inattention, hyperactivity/impulsivity, irritable ODD, and aggression were inter-related. Mediational analyses demonstrated ODD mediates symptoms directly predicting the risk of increasing ADHD severity. Disruptive child symptoms (ADHD + ODD + aggression) may increase the risk of depression-related symptoms in the parent. When the child’s aggression increases by one standard deviation (SD), parental psychiatric symptoms increase by 0.235 SD (p < 0.001). Conclusions: By this SEM pathway analysis, there is the correlation between the disruptive, more aggressive subtype of ADHD in children/adolescents and the existence of psychopathological symptomatology of their parents. ADHD + ODD + aggression in children should be classified as an irritable subtype of ADHD, warranting early diagnosis and intensive treatment.
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Lu W, Daleiden E, Higa-McMillan C, Liu S, Leong A, Almeida A, Kelleher K. Revised Child Anxiety and Depression Scale: a Psychometric Examination in Chinese Youth. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tsai CJ, Lin HY, Tseng IWY, Gau SSF. White matter microstructural integrity correlates of emotion dysregulation in children with ADHD: A diffusion imaging tractography study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110325. [PMID: 33857524 DOI: 10.1016/j.pnpbp.2021.110325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Emotion dysregulation (ED) is prevalent in youths with attention-deficit hyperactivity disorder (ADHD) and causes more social impairment and poor adaptive function. Alterations in the integrity of white matter (WM) tracts might have important implications for affective processing related to ED. However, little is known about the WM correlates underpinning ED in ADHD. METHODS Using diffusion spectrum image tractography, we obtained generalized fractional anisotropy (GFA) values of 76 WM tracts in 77 children with ADHD and 105 typically developing controls (TDC). ED severity was defined by the dysregulation profile from the child behavior checklist. Canonical correlation analysis (CCA) was performed to identify modes that relate WM microstructural property to ED severity and cognitive measures. RESULTS The application of CCA identified one significant mode (r = 0.638, FWE-corrected p = 0.046) of interdependencies between WM property patterns and diagnosis, ADHD total symptom levels, dysregulation by diagnosis interaction, and full-scale intellectual quotient (FIQ). GFA values of 19 WM tracts that were linked to affective-processing, sensory-processing and integration, and cognitive control circuitry were positively correlated with ED severity in TDC but negatively correlated with ED severity in ADHD. ADHD symptom severity and diagnosis were negatively associated with the GFA patterns of this set of tract bundles. In contrast, FIQ was positively correlated with this set of tract bundles. CONCLUSIONS This study used the CCA to show that children with ADHD and TDC had distinct multivariate associations between ED severity (diagnosis by ED interaction) and microstructural property in a set of WM tracts. These tracts interconnect the cortical regions that are principally involved in emotion processing, integration, and cognitive control in multiple brain systems. The WM microstructure integrity impairment might be an essential correlate of emotion dysregulation in ADHD.
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Affiliation(s)
- Chia-Jui Tsai
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Wen-Yih Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Susan Shur-Fen Gau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences and Department of Psychology, National Taiwan University, Taipei, Taiwan.
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Tsai CJ, Lin HY, Tseng IWY, Gau SSF. Brain voxel-based morphometry correlates of emotion dysregulation in attention-deficit hyperactivity disorder. Brain Imaging Behav 2021; 15:1388-1402. [PMID: 32700253 DOI: 10.1007/s11682-020-00338-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) has a high prevalence of co-occurring with emotion dysregulation (ED). Youths with ADHD and ED are more likely to have increased functional impairment. There is accumulating research on defining the features, behavioral, and physiological manifestations of ED, but there are currently few studies elucidating neuroanatomical correlations of ED in ADHD. Structural magnetic resonance imaging data from 118 children (aged 7-18 years) with ADHD (50 ADHD+high ED, 68 ADHD+low ED), and 104 typically developing controls (TDC) were processed using voxel-based morphometry. We used both dichotomous and continuous indices of ED to examine the possible correspondence between ED and ADHD. Relative to ADHD+high ED, ADHD+low ED had greater gray matter (GM) volumes over the left anterior prefrontal cortex (PFC). ADHD+low ED and ADHD+high ED shared a negative association of ED levels with the left middle temporal pole GM volume. TDC and ADHD+low ED also shared negative relationships of ED levels with the right temporal volume, and positive relationships with the left dorsolateral PFC volume. Besides, ED-by-group interactions were also noted. Specifically, medial PFC GM volumes increased and decreased with ED severity in ADHD+low ED and ADHD+high ED, respectively; and left cerebellum Crus GM volumes decreased and increased with ED severity in ADHD+low ED and ADHD+high ED, respectively. Our findings add to the evidence that some specific neural correlates are underpinning ED across ADHD and TDC. These findings suggest the importance of incorporating ED problems when considering heterogeneity in studies of ADHD.
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Affiliation(s)
- Chia-Jui Tsai
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Wen-Yih Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- Graduate Institute of Brain and Mind Sciences and Department of Psychology, National Taiwan University, Taipei, Taiwan.
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A benchmark dose study of prenatal exposure to di(2-ethylhexyl) phthalate and behavioral problems in children. Int J Hyg Environ Health 2019; 222:971-980. [PMID: 31221485 DOI: 10.1016/j.ijheh.2019.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Prenatal exposure to di(2-ethylhexyl) phthalate (DEHP) has been reported to be associated with adverse effects on neurodevelopment that yield behavior syndromes in young children with an estimated median exposure lower than the currently recommended tolerable daily intake (TDI) and reference dose (RfD). OBJECTIVES Our aim was to derive the benchmark dose for prenatal exposure to DEHP for the neurodevelopmental health in children. METHODS A total of 122 mother-child pairs from the Taiwan Maternal and Infant Cohort Study were analyzed for the dose-response relationship between maternal exposure to DEHP and children's behavioral syndromes evaluated at 8 years (n = 122, 2009), 11 years (n = 96, 2012), and 14 years (n = 78, 2015) of age. We employed a multivariate regression model to assess the statistical associations between the estimated maternal average daily intake of DEHP and child's individual CBCL scores for boys and girls at each separate age, followed by a mixed model for all the children across three ages accounting for individual variations. We then employed structural equation models by combining the children's specific behavioral problem scores at different ages and obtained a simulated overall latent score in relation to maternal exposure. Based on the established dose-response relationship, we derived the benchmark dose (BMD) and the lower limit (BMDL). RESULTS Associations of maternal DEHP exposure (median 4.54μg/kg_bw/day) with the Child Behavior Checklist (CBCL) scores were all significant, except for somatic complaints, adjusting for child's age, gender, IQ, and family income. The BMDL, given a benchmark response of 0.10 (0.05) and a background response of 0.05, was 6.01 (2.16) μg/kg_bw/dayfor an integrated CBCL score. CONCLUSIONS The current TDI (RfD) of 50 (20) μg/kg_bw/day for DEHP might not protect pregnant women for their children from behavioral problems. There remains the lack of comparable toxicological data. Further investigations are needed.
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Huang HB, Kuo PH, Su PH, Sun CW, Chen WJ, Wang SL. Prenatal and childhood exposure to phthalate diesters and neurobehavioral development in a 15-year follow-up birth cohort study. ENVIRONMENTAL RESEARCH 2019; 172:569-577. [PMID: 30875510 DOI: 10.1016/j.envres.2019.02.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Longitudinal studies on neurobehavioral development in relation to prenatal and postnatal exposure to phthalates in school-age children and adolescents are limited. We investigated the association of prenatal and childhood phthalate exposure with the development of behavioral syndromes in 8-14-year-old children. METHOD We recruited 430 pregnant women from 2000 to 2001 and followed their children at the ages of 2, 5, 8, 11, and 14 years, yielding 153 mother-child pairs in total. Urine samples from pregnant women in the third trimester and from children at 2-8 years of age were analyzed for the concentrations of seven urinary phthalate metabolites: monomethyl phthalate, monoethyl phthalate, monobutyl phthalate, monobenzyl phthalate (MBzP), and three di(2-ethylhexyl) phthalate (DEHP) metabolites, namely mono-2-ethylhexyl phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate, and mono(2-ethyl-5-oxohexyl) phthalate. Behavioral syndromes in children aged 8-14 years were assessed using the Child Behavior Checklist. We constructed mixed models to examine these associations after adjustments for potential covariates. RESULTS Maternal urinary MEHP levels were associated with higher scores for internalizing problems (β = 0.028, 95% confidence interval [CI]: 0.0004, 0.055) and externalizing problems (β = 0.040, 95% CI: 0.013, 0.066). Associations of the maternal urinary sum of DEHP metabolite levels with delinquent behavior scores and externalizing problems scores were positive (β = 0.035, 95% CI: 0.013, 0.057 for delinquent behavior; β = 0.026, 95% CI: 0.001, 0.050 for externalizing problems). Furthermore, children's urinary MBzP levels were associated with higher scores for social problems (β = 0.018, 95% CI: 0.001, 0.035). Similar patterns were observed for borderline and clinical ranges. CONCLUSION Early-life exposure to phthalates may influence behavioral syndrome development in children. Future studies are needed to replicate these findings, and efforts to reduce exposures to phthalates during critical early life stages may be warranted.
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Affiliation(s)
- Han-Bin Huang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.
| | - Po-Hsiu Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pen-Hua Su
- Department of Pediatrics, Chung-Shan Medical University Hospital, School of Medicine, Taichung, Taiwan
| | - Chien-Wen Sun
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shu-Li Wang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan; National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Safety, Health, and Environmental Engineering, National United University, Miaoli, Taiwan.
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Chuang WC, Yeh CB, Wang SC, Pan PY, Shyu JF, Liu YP, Gau SSF, Lu RB. Potential Negative Effects of Dextromethorphan as an Add-On Therapy to Methylphenidate in Children With ADHD. Front Psychiatry 2019; 10:437. [PMID: 31333511 PMCID: PMC6620613 DOI: 10.3389/fpsyt.2019.00437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/03/2019] [Indexed: 12/28/2022] Open
Abstract
Objectives: Methylphenidate (MPH) is highly effective in controlling the symptoms of attention-deficit/hyperactivity disorder (ADHD), but some children with ADHD either do not respond to, or do not tolerate, treatment. Dextromethorphan (DM) is a neuroprotective agent which has been used in the treatment of neuropsychiatric disorders. This clinical trial had examined the effect of DM on the use of MPH in the children with ADHD. Methods: This randomized double-blind clinical trial had evaluated 44 male outpatients, aged between 6 and 12 years, with a diagnosis of ADHD. The study subjects were randomly assigned into one of the two groups: receiving MPH alone (15-60 mg per day) or MPH plus DM (30-60 mg per day) for 8 weeks. Assessments, comprising the Chinese version of the Child Behavior Checklist (CBCL-C) scale and the Swanson, Nolan and Pelham Questionnaire (SNAP)-IV rating tests conducted by parents and the serum cytokines measured by microarray and enzyme-linked immunosorband assay (ELISA), were compared between groups at baseline and at 8 weeks after the medication was started. Results: There were a significant decrease at the mean scores of both CBCL-C and SNAP-IV scales after 8 weeks of treatment, but no significant differences between MPH and MPH+DM groups. Compared with the MPH-only group, the mean scores of some psychometric parameters reported on the CBCL-C and SNAP-IV scales regarding time effects as well as the attention problems on the CBCL-C scale regarding group effect were significantly higher in the DM+MPH group. Although there were no significant differences in the levels of various serum cytokines between groups, the subjects in the DM-MPH group had relatively fewer and lower levels of adverse effects. Significant interactions were found between the withdrawn/depression item reported on the CBCL-C scale and tumor necrosis factor α (ခTNF-α) (p = 0.027), as well as between thought problems item on the CBCL-C and TNF-α (p = 0.028) in subjects who had received DM+MPH treatment. Conclusion: Following the trial, DM+MPH was not superior to MPH alone for the treatment of children with ADHD, yet DM may potentially have negative effects on ADHD symptoms when combined with MPH. Clinical Trial Registration: Clinicaltrials.gov, trial number: NCT01787136.
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Affiliation(s)
- Wei-Chen Chuang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Songshan Branch, Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Chiang Wang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Songshan Branch, Taipei, Taiwan
| | - Pei-Yin Pan
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jia-Fwu Shyu
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Biology & Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Yia-Ping Liu
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Physiology, National Defense Medical Center, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Ru-Band Lu
- Institute of Behavioral Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan.,Addiction Research Center, National Cheng Kung University, Tainan, Taiwan.,Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
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Chen YC, Fortson BL, Tiano JD. Preliminary Validity of the Eyberg Child Behavior Inventory with Taiwanese Clinic-Referred Children. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:3816-3830. [PMID: 31118549 PMCID: PMC6527371 DOI: 10.1007/s10826-018-1236-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Eyberg Child Behavior Inventory (ECBI) has previously been shown to be a psychometrically sound instrument used to assess disruptive behaviors in children in the United States and in other cultures/countries but not in Taiwan. The purpose of this study was to examine the factor structure and to establish the discriminative validity of the ECBI with two groups of Taiwanese children: 70 clinic-referred children with clinically elevated externalizing behavior problems and 70 community-based matched comparison children. Exploratory factor analyses resulted in a six-factor model for the clinic-referred sample and a five-factStrengths and Difficultieor model for the matched comparison sample, indicating that the ECBI is not unidimensional. Adequate convergent and divergent validity also were established between the ECBI Intensity and Problem Scales and another measure of child externalizing (for assessing convergent validity) and internalizing (for determining divergent validity) behavior. The results of the present study suggest that the ECBI is a valid measure of assessing externalizing behavior problems in Taiwanese children. Future research may seek to refine the factor structure of the ECBI in a Taiwanese sample. Future studies are also needed to examine other psychometrics of the ECBI, replicate this study with a larger sample, and establish its normative data in Taiwan.
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Affiliation(s)
- Yi-Chuen Chen
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
| | - Beverly L. Fortson
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Chen CJ, Sung HC, Chen YC, Wang CH. An Investigation of the Factors Related to Low Parent-Adolescent Attachment Security in Taiwan. J Am Psychiatr Nurses Assoc 2018; 24:332-342. [PMID: 28891382 DOI: 10.1177/1078390317727596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adolescence may involve increases in many behavioral problems and psychosocial maladaptation. Adolescents must successfully cope with these challenges to achieve positive developmental milestones. OBJECTIVES To investigate whether low parental attachment security among adolescents in Taiwan is associated with their demographic characteristics, psychosocial maladaptation, and depression. DESIGN A cross-sectional survey. A total of 335 adolescents completed the questionnaires. The Inventory of Parent and Peer Attachment, the Chinese version of the Youth Self-Report, and the Beck Depression Inventory-II were used to survey the participants. Correlation and multiple linear regressions, using low attachment security as the response variable, were used in the statistical analysis. RESULTS The prevalence of Taiwanese adolescents with low parental attachment security was 38.5%. Low parental attachment security in adolescents was significantly associated with parental remarriage status and psychosocial maladaptation. CONCLUSIONS By considering these risk factors, nursing educators and nurses could develop effective interventions to strengthen parent-adolescent attachment security.
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Affiliation(s)
- Chen-Jung Chen
- 1 Chen-Jung Chen, PhD, RN, Mackay Medical College, Taipei, Taiwan
| | - Huei-Chuan Sung
- 2 Huei-Chuan Sung, PhD, RN, Tzu Chi University of Science and Technology, Hualien, Taiwan
| | - Yi-Chang Chen
- 3 Yi-Chang Chen, OTR/L, National Taiwan University, Taichung City, Taiwan
| | - Chih-Hung Wang
- 4 Chih-Hung Wang, PhD, National Changhua University of Education, Changhua, Taiwan
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Chen YL, Shen LJ, Gau SSF. The Mandarin version of the Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiological version for DSM-5 - A psychometric study. J Formos Med Assoc 2017; 116:671-678. [PMID: 28709821 DOI: 10.1016/j.jfma.2017.06.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 05/21/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Changes of diagnostic coverage and criteria for psychiatric disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013 cause a need for updating the Kiddie-Schedule for Affective Disorders and Schizophrenia-Epidemiological version (K-SADS-E). This study examined the preliminary psychometric properties, including inter-rater reliability, and convergent and divergent validity of the modified K-SADS-E for DSM-5. METHODS A national survey of a school-based sample of 3242 students in grade 3, 5, and 7 from 44 schools was conducted in Northern, Central, and Southern Taiwan. Psychiatric diagnoses were made by the K-SADS-E interviews. Clinical questionnaires for attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and emotional and behavioral problems were examined using the Chinese version of the Swanson, Nolan, and Pelham IV scale, Social Responsiveness Scale, and Child Behavior Checklist. RESULTS The K-SADS-E showed satisfactory inter-rater reliability (prevalence adjusted bias adjusted kappa = 0.80-1.00) among eight interviewers. The diagnoses of K-SADS-E demonstrated good convergent and divergent validity with most corresponding clinical questionnaires. CONCLUSION Our finding suggests that the K-SADS-E is a reliable and valid instrument for diagnosing child and adolescent psychiatric disorders based on DSM-5. Further study will examine the sensitivity, specificity, and test-retest reliability of the K-SADS-E in clinical and community samples.
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Affiliation(s)
- Yi-Lung Chen
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Lih-Jong Shen
- Department of Mental and Oral Health, Ministry of Health and Welfare, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences and Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Chen YY, Ho SY, Lee PC, Wu CK, Gau SSF. Parent-child discrepancies in the report of adolescent emotional and behavioral problems in Taiwan. PLoS One 2017. [PMID: 28644832 PMCID: PMC5482441 DOI: 10.1371/journal.pone.0178863] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The majority of studies on parent-child discrepancies in the assessment of adolescent emotional and behavioral problems have been conducted in Western countries. It is believed that parent-adolescent agreement would be higher in societies with a strong culture of familism. We examined whether parent-adolescent discrepancies in the rating of adolescent emotional and behavioral problems are related to parental and family factors in Taiwan. Participants included 1,421 child-parent pairs of 7th-grade students from 12 middle schools in Northern Taiwan and their parents. We calculated Pearson’s correlation coefficients to assess the relationship between parental (Child Behavior Checklist, CBCL) and adolescent (Youth Self Report, YSR) report of emotional/behavioral problem syndromes. Regression models were used to assess parent-adolescent differences in relation to parental psychopathology and family factors. We found that parent-adolescent agreement was moderate (r = 0.37). Adolescents reported higher symptom scores than their parents (Mean Total Problem Score: CBCL: 20.79, YSR: 33.14). Parental psychopathology was related to higher parental ratings and better informant agreement. Parents with higher socioeconomic status (SES) tended to report lower scores for adolescent problem syndromes, resulting in higher levels of disagreement. Greater maternal care was related to higher parent-adolescent agreement. Based on our study findings, we conclude that familism values do not seem to improve parent-child agreement in the assessment of adolescent problem syndromes. The finding that higher SES was related to increased discrepancies speaks to the need to explore the culture-specific mechanisms giving rise to informant discrepancies.
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Affiliation(s)
- Ying-Yeh Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health and Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Suk-Yin Ho
- Child Developmental Assessment & Intervention Center, Taipei City Hospital, Taipei, Taiwan
| | - Pei-Chen Lee
- National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Chia-Kai Wu
- National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Susan Shur-Fen Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Psychology, School of Occupational Therapy, Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Abstract
Morningness/eveningness (M/E) preference is an important circadian rhythm indicator with strong individual variation. M/E chronotype has been found to be correlated with depression in adults, yet the relationship is less clear in children and adolescents. Additionally, poor sleep quality is another commonly studied risk factor for depression. The aims of the present study are to investigate the independent effects of M/E chronotype on youth depression using both self-report and parental-report questionnaires. We also evaluated how poor sleep quality may affect the relationship through a mediating or moderating effect. In total, 2,139 students attending grades 1 to 7 participated in this study. They completed questionnaires regarding M/E chronotype, depression, and sleep quality. A total of 1,708 parents also participated and filled out parental-reports of emotional and behavioral problems of their children. The prevalence of self- and parental-report depression was 16.8% and 12.8% among young students, respectively. Overall, 15.4% of the students were the eveningness type. Being an eveningness type was independently associated with self-report depression after adjustment for poor sleep quality (OR = 1.86, 95% CI = 1.07-3.24). We also observed that poor sleep quality mediated the influence of M/E chronotype on self-report depression among students aged 7-13 years (p < 0.001). On the other hand, being an eveningness type was associated with a number of parental-report emotional and behavioral problems in the students, in addition to depression, although these associations become non-significant after adjusted for poor sleep quality. Our results demonstrate the importance of M/E chronotype on youth depression and poor sleep quality partly mediates this effect.
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Affiliation(s)
- Wen-Hsuan Chiu
- a National Taiwan University, Department of Public Health & Institute of Epidemiology and Preventive Medicine , College of Public Health , Taipei , Taiwan
| | - Hao-Jan Yang
- b Department of Public Health , Chung Shan Medical University, College of Health Care and Management , Taichung , Taiwan.,c Chung Shan Medical University Hospital , Department of Family and Community Medicine , Taichung , Taiwan
| | - Po-Hsiu Kuo
- a National Taiwan University, Department of Public Health & Institute of Epidemiology and Preventive Medicine , College of Public Health , Taipei , Taiwan.,d National Taiwan University , Research Center for Genes, Environment and Human Health , Taipei , Taiwan
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Liu ST, Chen SH. A Community Study on the Relationship of Posttraumatic Cognitions to Internalizing and Externalizing Psychopathology in Taiwanese Children and Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:1475-1484. [PMID: 25957269 DOI: 10.1007/s10802-015-0030-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A growing number of studies indicate that posttraumatic cognitions play a crucial role in the development and maintenance of posttraumatic stress disorder (PTSD). However, the effects of posttraumatic cognitions on general psychopathology beyond PTSD remain unclear. The current study aimed to validate the Chinese version of the Child Posttraumatic Cognitions Inventory (CPTCI-C) and to investigate the relationship between posttraumatic cognitions and psychopathology. A community sample of 285 school-aged children and adolescents (aged 9-17, 160 [56.1 %] female) reported their trauma-related cognitions on the CPTCI-C and completed measures of symptoms of PTSD, depression, and generalized anxiety. Parents reported their children's internalizing and externalizing problems. We validated a revised version of the CPTCI-C based on the results of confirmatory factor analyses. The resulting evidence suggests that this revised CPTCI-C possesses good internal consistency, fair 6-week temporal stability, and good concurrent validity. In addition to significant correlations between posttraumatic cognitions and internalizing and externalizing psychopathology, after controlling for age, gender, and trauma types, both the revised CPTCI-C subscale scores conveyed unique contributions to psychological distress while only the maladaptive appraisals of the trauma remained weakly associated with externalizing problems. Structural equation modeling analysis showed that maladaptive appraisals of the trauma had a direct longitudinal impact on chronic PTSD severity. No mediation effect of posttraumatic cognitions on the relationship between acute and chronic PTSD activity was observed. The implications of our findings are discussed for the specificity of posttraumatic cognitions to posttraumatic internalizing psychopathology and cognitive interventions that target negative trauma-related cognitions.
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Affiliation(s)
- Shu-Tsen Liu
- Department of Psychology, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 106, Taiwan.,Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County, 640, Taiwan
| | - Sue-Huei Chen
- Department of Psychology, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 106, Taiwan.
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Kawabata Y. Relational aggression, depressive symptoms, and interdependence among school-age children. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.04.073] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liang HY, Chang HL. Disabled Children in Special Education Programs in Taiwan: Use of Mental Health Services and Unmet Needs. Psychol Rep 2016; 100:915-23. [PMID: 17688111 DOI: 10.2466/pr0.100.3.915-923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite national health insurance coverage in Taiwan, many health care needs remain unmet. In the current study, the behavior and emotional problems of 1,042 disabled children in special education programs were evaluated using the Chinese version of the Child Behavior Checklist (CBCL-C) and the Teacher's Report Form (TRF). Using the 60th percentile on the two tests as a cutoff representing a clinical indication, students who reached this cutoff point but did not receive mental health services in the past six months were considered to have “unmet mental health needs.” Of the special education students in the study 73.9% reached clinical indications, but did not receive mental health care.
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Affiliation(s)
- Hsin-Yi Liang
- Department of Child Psychiatry Chang Gung Children's Hospital, Kweishan, Taoyuan, Taiwan
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Chen YC, Fortson BL. Predictors of treatment attrition and treatment length in Parent-Child Interaction Therapy in Taiwanese families . CHILDREN AND YOUTH SERVICES REVIEW 2015;56:28-37. [PMID: 26705373 PMCID: PMC4687451 DOI: 10.1016/j.childyouth.2015.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Parent-Child Interaction Therapy (PCIT) has been used successfully in the United States and in other countries around the world, but its use in Asian countries has been more limited. The present study is the first of its kind to examine the predictors of treatment attrition and length in a sample of Taiwanese caregivers and their children. It is also the first to examine PCIT outcomes in Taiwanese families. Maladaptive personality characteristics of the caregiver were the best predictor of attrition, followed by single-parent, removal of the child from the home, and lower levels of caregiver education. Treatment length was predicted by child minority status and parent-child interactions (i.e., parent commands and negative parent talk). In terms of outcomes, statistically significant treatment changes were noted for all treatment outcome variables at post-treatment and at 3-month follow-up. These findings suggest that PCIT is a promising intervention for this population. The predictors of treatment attrition and length can be used when Taiwanese caregiver-child dyads present for services so that additional assistance can be provided prior to or during treatment to increase adherence to the recommended number of treatment sessions for maximal impact. Future studies may replicate the present study with a larger clinical sample to examine the long-term effects of PCIT and to include a no-treatment control condition to afford a more robust empirical evaluation.
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Affiliation(s)
- Yi-Chuen Chen
- Department of Psychology, National Chung Cheng University, Taiwan
| | - Beverly L. Fortson
- Centers for Disease Control and Prevention, Division of Violence Prevention, Atlanta, GA, USA
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Lin HY, Hwang-Gu SL, Gau SSF. Intra-individual reaction time variability based on ex-Gaussian distribution as a potential endophenotype for attention-deficit/hyperactivity disorder. Acta Psychiatr Scand 2015; 132:39-50. [PMID: 25612058 DOI: 10.1111/acps.12393] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Intra-individual variability in reaction time (IIV-RT), defined by standard deviation of RT (RTSD), is considered as an endophenotype for attention-deficit/hyperactivity disorder (ADHD). Ex-Gaussian distributions of RT, rather than RTSD, could better characterize moment-to-moment fluctuations in neuropsychological performance. However, data of response variability based on ex-Gaussian parameters as an endophenotypic candidate for ADHD are lacking. METHOD We assessed 411 adolescents with clinically diagnosed ADHD based on the DSM-IV-TR criteria as probands, 138 unaffected siblings, and 138 healthy controls. The output parameters, mu, sigma, and tau, of an ex-Gaussian RT distribution were derived from the Conners' continuous performance test. Multi-level models controlling for sex, age, comorbidity, and use of methylphenidate were applied. RESULTS Compared with unaffected siblings and controls, ADHD probands had elevated sigma value, omissions, commissions, and mean RT. Unaffected siblings formed an intermediate group in-between probands and controls in terms of tau value and RTSD. There was no between-group difference in mu value. Conforming to a context-dependent nature, unaffected siblings still had an intermediate tau value in-between probands and controls across different interstimulus intervals. CONCLUSION Our findings suggest IIV-RT represented by tau may be a potential endophenotype for inquiry into genetic underpinnings of ADHD in the context of heterogeneity.
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Affiliation(s)
- H-Y Lin
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - S-L Hwang-Gu
- Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - S S-F Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.,Department of Psychology, Graduate Institute of Brain and Mind Sciences, Graduate Institute of Epidemiology and Preventive Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
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Psychiatric diagnoses, emotional-behavioral symptoms and functional outcomes in adolescents born preterm with very low birth weights. Child Psychiatry Hum Dev 2015; 46:358-66. [PMID: 24879118 DOI: 10.1007/s10578-014-0475-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Children born preterm with very low birth weight (VLBW; birth weight ≤1,500 g) run risks of neurodevelopmental disorders. Studies of adolescent outcome are relatively few. In this follow-up survey, we examined the emotional-behavioral symptoms, psychiatric diagnoses and functional status in a geographically-based birth cohort of VLBW adolescents (average 13.4 years) as registered in a level III center of a recently developed Asian country. Psychiatric interviews were conducted. Parents were asked to fill out the Child Behavioral Checklist and the Current Status Survey. Results revealed that neonatal survival rate was 75.7% (112/148). In the follow-up, 26.2% of the adolescents required individualized educational plan; 52.5% were with at least one neuropsychiatric diagnosis (e.g. cerebral palsy 24.6%, intellectual disabilities 21.3%, attention deficit/hyperactivity disorder 19.7%), and 32.8% of the participants were disabled. Logistic regression found that neonatal sepsis and grade III/IV intraventricular hemorrhage were most predictive of a disabled status in adolescence.
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LV M, WAN Y, FU H. INFLUENCE OF INTERNALIZING PROBLEMS ON ACADEMIC ACHIEVEMENT IN CHINESE ADOLESCENTS: THE MEDIATING EFFECT OF ATTENTION PROBLEMS. PSYCHOLOGIA 2015. [DOI: 10.2117/psysoc.2015.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Meizhen LV
- Department of Psychology, Peking University
- School of Psychology, Nanjing Normal University
| | - Yingjia WAN
- School of Psychology, Nanjing Normal University
| | - Hong FU
- School of Psychology, Nanjing Normal University
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Lien YJ, Ku HY, Su PH, Chen SJ, Chen HY, Liao PC, Chen WJ, Wang SL. Prenatal exposure to phthalate esters and behavioral syndromes in children at 8 years of age: Taiwan Maternal and Infant Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:95-100. [PMID: 25280125 PMCID: PMC4286269 DOI: 10.1289/ehp.1307154] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/02/2014] [Indexed: 05/24/2023]
Abstract
BACKGROUND Few studies have shown an association between prenatal phthalate exposure and adverse effects on neurodevelopment and behavior in young children. OBJECTIVES We aimed to assess the relationship between prenatal exposure to phthalate esters and behavior syndromes in children at 8 years of age. METHODS A total of 122 mother-child pairs from the general population in central Taiwan were studied from 2000 to 2009. Mono-methyl phthalate (MMP), mono-ethyl phthalate (MEP), mono-butyl phthalate (MBP), mono-benzyl phthalate (MBzP), and three di-(2-ethylhexyl) phthalate (DEHP) metabolites-mono-2-ethylhexyl, mono-2-ethyl-5-hydroxyhexyl, and mono-2-ethyl-5-oxohexyl phthalates (MEHP, MEHHP, and MEOHP)--were measured in maternal urine collected during the third trimester of pregnancy using liquid chromatography-electrospray ionization-tandem mass spectrometry. Behavioral syndromes of children at 8 years of age were evaluated using the Child Behavior Checklist (CBCL). Associations between log10-transformed creatinine-corrected phthalate concentrations and standardized scores of the CBCL were estimated using linear regression models or multinomial logistic regressions with adjustments for potential confounders. RESULTS Externalizing problem scores were significantly higher in association with a 1-unit increase in log10-transformed creatinine-corrected concentrations of maternal MBP (β = 4.29; 95% CI: 0.59, 7.99), MEOHP (β = 3.74; 95% CI: 1.33, 6.15), and MEHP (β = 4.28 ; 95% CI: 0.03, 8.26) after adjusting for the child's sex, intelligence, and family income. Meanwhile, MBP and MEOHP were significantly associated with Delinquent Behavior and Aggressive Behavior scores. The same pattern was found for borderline and/or clinical ranges. CONCLUSIONS Our findings suggest positive associations between maternal DEHP and dibutyl phthalate (DBP) exposure and externalizing domain behavior problems in 8-year-old children.
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Affiliation(s)
- Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
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Prevalence of psychiatric disorders among children and adolescents in northeast China. PLoS One 2014; 9:e111223. [PMID: 25360718 PMCID: PMC4215989 DOI: 10.1371/journal.pone.0111223] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 09/26/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To describe the prevalence of DSM-IV disorders and comorbidity in a large school-based sample of 6-17 year old children and adolescents in northeast China. METHODS A two-phase cross-sectional study was conducted on 9,806 children. During the screening phase, 8848 children (90.23%) and their mothers and teachers were interviewed using the Strengths and Difficulties Questionnaire (SDQ). During the diagnostic phase, 1129 children with a positive SDQ and 804 randomly selected children with a negative SDQ (11%), and their mothers and teachers, were interviewed using the Development and Well-Being Assessment (DAWBA). RESULTS The overall prevalence of DSM-IV disorders was 9.49% (95% CI = 8.10-11.10%). Anxiety disorders were the most common (6.06%, 95% CI = 4.92-7.40), followed by depression (1.32%, 95% CI = 0.91-1.92%), oppositional defiant disorder (1.21%, 95%CI = 0.77-1.87) and attention-deficit hyperactivity disorder (0.84%, 95% CI = 0.52-1.36%). Of the 805 children with a psychiatric disorder, 15.2% had two or more comorbid disorders. CONCLUSIONS Approximately one in ten Chinese school children has psychiatric disorders involving a level of distress or social impairment likely to warrant treatment. Prevention, early identification and treatment of these disorders are urgently needed and pose a serious challenge in China.
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Wang LJ, Wu CC, Lee SY, Tsai YF. Salivary neurosteroid levels and behavioural profiles of children with attention-deficit/hyperactivity disorder during six months of methylphenidate treatment. J Child Adolesc Psychopharmacol 2014; 24:336-40. [PMID: 24956271 DOI: 10.1089/cap.2013.0122] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This prospective study aimed to investigate the relationships between salivary levels of neurosteroids, including dehydroepiandrosterone (DHEA), cortisol, and DHEA/cortisol ratios, and behavioral symptoms in patients with attention-deficit/hyperactivity disorder (ADHD) during treatment with methylphenidate (MPH). METHODS Fifty-eight ADHD patients (48 boys and 10 girls) were included in the study initially. Forty patients (mean age: 7.77±1.64 years; 32 boys and 8 girls) who completed the study received treatment with oral MPH with a dose range of 5-15 mg/day (mean dose: 12.47±7.74 mg/day.) for 6 months at the discretion of the psychiatrist. DHEA and cortisol levels were determined from saliva samples collected at 0800 h at baseline and 6 months from baseline. ADHD symptoms were evaluated with the Child Behavior Checklist (CBCL). RESULTS Salivary DHEA levels (mean difference=9.05 pg/mL, p=0.027) and DHEA/cortisol ratios (mean difference=32.42, p=0.007) in ADHD patients were significantly increased, but the cortisol levels did not change significantly. During a 6 month follow-up, all behavioral problems assessed using the CBCL improved significantly. Changes in salivary DHEA levels were positively correlated with changes in salivary cortisol levels (r=0.44, p=0.004); however, changes in salivary levels of DHEA, cortisol, and the DHEA/cortisol ratio were not significantly correlated with change in any subscales of the CBCL. Mean doses of MPH were not significantly correlated with changes in neurosteroid levels and behavioral symptoms. CONCLUSIONS These findings provide evidence that MPH administration might affect DHEA levels and DHEA/cortisol ratios. Whether levels of neurosteroids are directly associated with brain function or behavioral problems in ADHD patients warrants further investigation.
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Affiliation(s)
- Liang-Jen Wang
- 1 Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
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Yang HJ, Kuo YJ, Wang L, Yang CY. Culture, parenting, and child behavioral problems: a comparative study of cross-cultural immigrant families and native-born families in Taiwan. Transcult Psychiatry 2014; 51:526-44. [PMID: 24803539 DOI: 10.1177/1363461514532306] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the interplay of cultural, parenting, and sociodemographic/socioeconomic factors on children's behavioral problems, especially within culturally mixed families in Chinese society. This study compares the presence of behavioral problems between children from families with an immigrant mother and those from native-born families in a randomly selected sample of 957 children aged 6 to 12 years from three counties in central Taiwan. Behavioral problems were assessed using the Child Behavior Checklist completed by parents and the Teacher's Report Form. Parenting styles were assessed using the Parental Bonding Instrument completed by children. Children of immigrant mothers had higher scores for all behavioral syndromes based on the parent's report. However, in the teacher's report a difference was only observed for withdrawn/depressed syndrome. Children of immigrant mothers were more likely, and children with high paternal care were less likely, to have internalizing and total problems in the parent's report. For the teacher's report, only high education in fathers was associated with decreased internalizing and total problems in children. These findings suggest that children growing up in a cross-cultural environment with an immigrant mother, as opposed to a native-born Taiwanese family environment, are more likely to have higher internalizing problems and total behavioral problem scores, due to a number of cultural, parenting, and sociodemographic factors. Children's behaviors appear to be more influenced by fathers' than mothers' parenting styles, regardless of family type. The study findings imply that unequal health and social conditions exist between cross-cultural and native-born families.
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Mechanisms and processes of relational and physical victimization, depressive symptoms, and children's relational-interdependent self-construals: Implications for peer relationships and psychopathology. Dev Psychopathol 2014; 26:619-34. [DOI: 10.1017/s0954579414000273] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis short-term longitudinal study examined the associations between relational and physical victimization and depressive symptoms, and the moderating role of school-aged children's relational-interdependent self-construals in these associations. The participants were 387 children (51.8% boys) who were in the fifth grade (M= 10.48 years,SD= 0.55) in Taiwan and followed at two time points (a 6-month interval) during a calendar year. A multiple-informant approach was used where forms of peer victimization, depressive symptoms, and relational-interdependent self-construals were assessed via peer nominations, teacher reports, and child reports, respectively. All measures had favorable psychometric properties. The results of a multigroup cross-lagged model demonstrated that relational victimization (not physical victimization) was positively predictive of subsequent depressive symptoms, and the effect was evidenced for highly interdependent children only. The opposite link was also significant, such that depressive symptoms predicted subsequent relational victimization (not physical victimization) for children who exhibited low and high levels of relational-interdependent self-construals. In contrast, physical victimization predated a lower level of depressive symptoms for highly interdependent children. These effects were unaffected by the gender of the child. The findings, especially the interactive effects of relational victimization (as a contextual factor) and relational-interdependent self-construals (as an individual vulnerability) on depressive symptoms, are discussed from a developmental psychopathology perspective.
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Poor sleep quality measured by polysomnography in non-obese asthmatic children with or without moderate to severe obstructive sleep apnea. Sleep Med 2014; 15:1062-7. [PMID: 25018024 DOI: 10.1016/j.sleep.2014.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/18/2014] [Accepted: 04/15/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The co-effect of asthma and obstructive sleep apnea (OSA) on sleep quality among children remained unclear. OBJECTIVE To compare sleep quality and emotional/behavioral problems among asthmatic and non-asthmatic children with or without moderate to severe obstructive sleep apnea. METHOD An AHI-range-matched BMI-range-matched cross-sectional design was used to examine polysomnographic evaluation and emotional/behavioral problems in 102 non-obese children aged between 6 and 12 years old, categorized as with or without asthma and sleep disordered breathing. RESULTS Asthmatic children in AHI ≤ 5/h group revealed a significantly longer sleep latency, a greater leg movement index (LMI), and a lower ratio of slow wave sleep compared with non-asthmatic AHI ≤ 5/h group. Compared with non-asthmatic AHI > 5/h group, asthmatic children displayed a higher ratio of REM sleep, sleep stage 1 and 2, a lower ratio of slow wave sleep, as well as a greater respiratory arousal index and LMI. There was no significant difference in emotional/behavior problems among groups. CONCLUSION Sleep disturbance exists in asthmatic children with or without moderate to severe obstructive sleep apnea. Non-obese asthmatic children had less slow wave sleep compared with non-asthmatic children. We might recommend that sleep quality could be noticed and evaluated in children with asthma.
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Yen CF, Chen YM, Cheng JW, Liu TL, Huang TY, Wang PW, Yang P, Chou WJ. Effects of cognitive-behavioral therapy on improving anxiety symptoms, behavioral problems and parenting stress in Taiwanese children with anxiety disorders and their mothers. Child Psychiatry Hum Dev 2014; 45:338-47. [PMID: 24002227 DOI: 10.1007/s10578-013-0403-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aims of this intervention study were to examine the effects of individual cognitive-behavioral therapy (CBT) based on the modified Coping Cat Program on improving anxiety symptoms and behavioral problems in Taiwanese children with anxiety disorders and parenting stress perceived by their mothers. A total of 24 children with anxiety disorders in the treatment group completed the 17-session individual CBT based on the modified Coping Cat Program, and 26 children in the control group received the treatment as usual intervention. The Taiwanese version of the MASC (MASC-T), the Child Behavior Checklist for Ages 6-18 (CBCL/6-18) and the Chinese version of the Parenting Stress Index (C-PSI) were applied to assess the severities of anxiety symptoms, behavioral problems and parenting stress, respectively. The effects of CBT on improving anxiety symptoms, behavioral problems and parenting stress were examined by using linear mixed-effect model with maximum likelihood estimation. The results indicated that the CBT significantly improved the severities of MASC-T Physical Symptoms and Social Anxiety subscales, CBCL/6-18 DSM-oriented Anxiety Problem subscale, and C-PSI Child domains Mood and Adaptability subscales. Individual CBT based on the modified Coping Cat Program can potentially improve anxiety symptoms in Taiwanese children with anxiety disorders and some child domains of parenting stress perceived by their mothers.
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Affiliation(s)
- Cheng-Fang Yen
- Department of Psychiatry, Faculty of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Food additives and behavior in 8- to 9-year-old children in Hong Kong: a randomized, double-blind, placebo-controlled trial. J Dev Behav Pediatr 2013; 34:642-50. [PMID: 24217026 DOI: 10.1097/dbp.0000000000000005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To test the individual effect of artificial food colorings (AFCs) and a preservative on the behavior of the general Chinese population. METHOD One hundred thirty children (70 boys and 60 girls) in Hong Kong with a mean age of 8.64 years were enlisted to the study with a within-subject crossover between AFCs, a preservative (sodium benzoate), and a placebo capsule. Two behavior scores were used including the strengths and weaknesses of attention deficit hyperactivity disorder and normal behavior rating scale and the child behavior checklist-teacher report form. RESULTS Capsule A containing AFCs and Capsule B containing sodium benzoate had no significant adverse effect compared with placebo in both behavior scores. This result persisted when analysis was restricted to children with 85% consumption of capsule (per protocol analysis). CONCLUSION There seem to be no significant associations between AFCs and a preservative on Chinese children's behavior at the age of 8 to 9 years. Future directions and implications of this research are discussed.
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Tseng WL, Gau SSF. Executive function as a mediator in the link between attention-deficit/hyperactivity disorder and social problems. J Child Psychol Psychiatry 2013; 54:996-1004. [PMID: 23574361 DOI: 10.1111/jcpp.12072] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive processes and mechanisms underlying the strong link between attention-deficit/hyperactivity disorder (ADHD) and social problems remain unclear. Limited knowledge also exists regarding a subgroup of youth with ADHD who do not have social problems. This study investigated the extent to which executive function (EF) mediated the association between ADHD and social problems and compared ADHD symptoms, comorbidities, and EF among ADHD youth with and without social problems and controls. METHODS The sample consisted of 279 youth with ADHD and 173 controls without ADHD (11-17 years of age) in Taiwan. Among youth with ADHD, two subgroups were further identified: 70 ADHD youth with social problems and 31 ADHD youth without social problems. EF was assessed with four subtests from the Cambridge Neuropsychological Test Automated Battery (Spatial span, Spatial working memory, Intra-dimensional/extra-dimensional shifts, Stockings of Cambridge). Social problems were assessed by mother and child reports. RESULTS Executive function measures in working memory and planning mediated the effect of ADHD on social problems, independent of age, gender, and IQ. The two ADHD groups with and without social problems did not differ in ADHD severity or comorbidities; however, ADHD youth without social problems performed better on certain measures of EF such as working memory, planning, and response inhibition. CONCLUSIONS These findings suggest that deficits in some aspects of EF may account for social problems often experienced by youth with ADHD.
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Affiliation(s)
- Wan-Ling Tseng
- Institute of Child Development, University of Minnesota, Twin Cities, MN, USA
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Wang LJ, Chen CK, Huang YS. Changes in Behaviour Symptoms of Patients with Attention Deficit/Hyperactivity Disorder during Treatment: Observation from Different Informants. Psychiatry Investig 2013; 10:1-7. [PMID: 23482303 PMCID: PMC3590425 DOI: 10.4306/pi.2013.10.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 10/16/2012] [Accepted: 11/06/2012] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine changes in behaviour among patients with attention deficit/hyperactivity disorder (ADHD) by different informants during treatment in the clinical setting. METHODS Seventy-nine patients with ADHD were recruited. They completed 12-months of treatment with oral short-acting methylphenidate, two-to-three times per day, at a dose of 0.3-1.0 mg/kg. Among the 79 patients (mean age, 9.1±1.9 years), 39 were classified as the ADHD-C/H type (hyperactive-impulsive type and combined type) and 40 as the ADHD-I type (inattentive type). At baseline, and after 12 months, their behaviour was assessed using the Child Behaviour Checklist (CBCL), Teacher's Report Form (TRF), ADHD Rating Scale (ADHD-RS), and Clinical Global Impression-Severity (CGI-S). RESULTS Patients classified as the ADHD-C/H type had higher scores on three CBCL subscales, on the ADHD-RS and CGI-S compared to the ADHD-I type patients. After 12-months of treatment, for all patients, there were significant improvements in the four subscales of the TRF as well as the ADHD-RS and CGI-S scores, but not on the CBCL. In addition, the patients with the ADHD-C/H type had greater improvements on the four subscales of the TRF after treatment. However, there were no differences noted on the CBCL, ADHD-RS and CGI-S. CONCLUSION The results of this study showed that during treatment, in the clinical setting, there are different assessments of behaviour symptoms, associated with ADHD, reported by different informants. Assessments of behaviour profiles from multiple informants are crucial for establishing a fuller picture of patients with ADHD.
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Affiliation(s)
- Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
- Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Yu-Shu Huang
- Chang Gung University School of Medicine, Taoyuan, Taiwan
- Department of Child Psychiatry and Sleep Centre, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan
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Huang YH, Chung CY, Ou HY, Tzang RF, Huang KY, Liu HC, Sun FJ, Chen SC, Pan YJ, Liu SI. Treatment effects of combining social skill training and parent training in Taiwanese children with attention deficit hyperactivity disorder. J Formos Med Assoc 2013; 114:260-7. [PMID: 25777975 DOI: 10.1016/j.jfma.2012.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 08/14/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Children with attention-deficit/hyperactivity disorder (ADHD) often have problems in social interactions. We investigated the social and behavioral effects of providing both social skill training and parent training to school-aged children with ADHD in Taiwan. METHODS Seven consecutive 8-week behavioral-based social skill training (SST) group sessions were held for 48 children with ADHD; parallel 8-week parent group sessions were provided simultaneously. Fifty-five children with ADHD were recruited as a control group. All children took medication as prescribed by their doctors. The effects were assessed using the teacher and parent version of the Chinese version of Swanson, Nolan, and Pelham, version IV scale (SNAP-IV), the Chinese version of the Child Behavior Check List (CBCL-C), child and teacher version of the modified Social Skill Rating System (SSRS-C and SSRS-T), at baseline, post-treatment, and 4 months from baseline. The doses of methylphenidate and drug compliance were controlled during the analysis. RESULTS The mixed-effects model demonstrated the main effect of group sessions on the Oppositional subscale of SNAP-P, the Anxious/Depressed subscale of CBCL-C, the Self Control subscale of SSRS-C, and the Active Participation subscale of SSRS-T, all in favor of the experimental group. However, the improvement on the Oppositional subscale of SNAP-P and the Self Control subscale of SSRS-C were noted only between baseline and post-treatment period and were not sustained at the end of the follow-up period. CONCLUSION Our study demonstrated that children with ADHD could benefit from this low intensity psychosocial program, although some improvements were not maintained at follow-up assessment.
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Affiliation(s)
- Yu-Hsin Huang
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chao-Ying Chung
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsing-Yi Ou
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Kuo-Yang Huang
- Department of Psychiatry, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Hui-Ching Liu
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-Chin Chen
- Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Shen-Ing Liu
- Department of Medicine, Mackay Medical College, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan.
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Rescorla L, Ivanova MY, Achenbach TM, Begovac I, Chahed M, Drugli MB, Emerich DR, Fung DSS, Haider M, Hansson K, Hewitt N, Jaimes S, Larsson B, Maggiolini A, Marković J, Mitrović D, Moreira P, Oliveira JT, Olsson M, Ooi YP, Petot D, Pisa C, Pomalima R, da Rocha MM, Rudan V, Sekulić S, Shahini M, de Mattos Silvares EF, Szirovicza L, Valverde J, Vera LA, Villa MC, Viola L, Woo BSC, Zhang EY. International epidemiology of child and adolescent psychopathology ii: integration and applications of dimensional findings from 44 societies. J Am Acad Child Adolesc Psychiatry 2012. [PMID: 23200284 DOI: 10.1016/j.jaac.2012.09.012] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. METHOD Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. RESULTS CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. CONCLUSIONS Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children.
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Affiliation(s)
- Leslie Rescorla
- Psychology, Bryn Mawr College, 101 N. Merion Avenue, Bryn Mawr, PA 19010, USA.
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Ho J, Yeh M, McCabe K, Lau A. Perceptions of the acceptability of parent training among Chinese immigrant parents: contributions of cultural factors and clinical need. Behav Ther 2012; 43:436-49. [PMID: 22440078 DOI: 10.1016/j.beth.2011.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 10/11/2011] [Accepted: 10/13/2011] [Indexed: 11/16/2022]
Abstract
Parent training (PT) is well established for reducing child externalizing problems; however, lower rates of engagement in PT among ethnic minority/immigrant families have been found. We assessed PT acceptability among Chinese immigrant parents and explored clinical and cultural factors that may be associated with acceptability. Participants were a community sample of 145 Chinese immigrant parents (84% mothers) between the ages of 32 and 65 years (M=43.3 years, SD=6.2) who had children (84 boys, 59 girls) between the ages of 4 and 17 years (M=10.7 years, SD=3.6). Results suggest that parents found positive reinforcement techniques significantly more acceptable, less problematic, and more likely to be supported by others than punishment-based techniques. Parents who endorsed the Chinese child-rearing value of shaming were less likely to find PT acceptable. Parents who reported greater dysfunction in parent-child interactions rated PT as more acceptable, and families with prior Child Protective Services (CPS) involvement rated PT as less acceptable. However, previous mental health treatment appears to bolster acceptability among parents with prior CPS involvement. Clinical implications for addressing barriers to PT engagement and future research directions are discussed.
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Affiliation(s)
- Judy Ho
- Graduate School of Psychology, Pepperdine University, 6100 Center Drive, Los Angeles, CA 90045, USA.
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Wu YT, Chen WJ, Hsieh WS, Chen PC, Liao HF, Su YN, Jeng SF. Maternal-reported behavioral and emotional problems in Taiwanese preschool children. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:866-873. [PMID: 22236631 DOI: 10.1016/j.ridd.2011.11.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 11/20/2011] [Accepted: 11/21/2011] [Indexed: 05/31/2023]
Abstract
There has been limited epidemiologic information concerning preschoolers' behavioral and emotional problems in Eastern societies. This study was therefore aimed to investigate behavioral and emotional problems in a large sample of Taiwanese preschoolers using the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). The CBCL/1.5-5 was scored by mothers of 645 Taiwanese preschoolers aged 24-71 months. Psychometric features of the scale as well as the raw scores and prevalence rates of behavioral problems of Taiwanese preschoolers were compared with those of American counterparts. Several demographic variables with the Total Problems and syndromes scores were also examined. The CBCL/1.5-5 was found to have good to excellent levels of reliability (internal consistency, test-retest reliability and inter-parent agreement) and an acceptable model fit of seven-syndrome factor structure (root mean square error of approximation=0.055) when used with Taiwanese preschoolers. The prevalence rate of Total Problems, Internalizing syndrome and Externalizing syndrome score in the clinical range was 25.1%, 11.2% and 25.4%, respectively. Cross-cultural comparisons showed that Taiwanese preschoolers had higher scores in six narrow-band syndromes (effect size d=0.17-0.43, all p's<0.005) and prevalence rates of four Internalizing-related syndromes and Sleep Problems than American sample (odds ratio=2.4-4.9, all p's<0.005). Analyses of behavioral correlates revealed associations of first birth order with higher Internalizing, Externalizing and Total Problems scores (all p's<0.05). Furthermore, younger ages (24-47 months) and male gender were associated with higher Externalizing and Total Problems scores (all p's<0.05). Our data have provided important epidemiologic information to assist in clinical assessment and management of preschoolers' behavioral and emotional problems in an Eastern society.
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Affiliation(s)
- Yen-Tzu Wu
- National Taiwan University College of Medicine, Taipei, Taiwan
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45
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Tsai FJ, Liu ST, Lee CM, Lee WT, Fan PC, Lin WS, Chiu YN, Gau SSF. ADHD-related symptoms, emotional/behavioral problems, and physical conditions in Taiwanese children with epilepsy. J Formos Med Assoc 2012; 112:396-405. [PMID: 23927979 DOI: 10.1016/j.jfma.2011.08.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 07/25/2011] [Accepted: 08/08/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Little is known about whether Asian children with epilepsy have more attention-deficit hyperactivity disorder (ADHD)-related symptoms, emotional/ behavioral problems, and physical conditions compared with those described in Western studies. The authors investigated the rates of ADHD-related symptoms, emotional/behavioral problems, and physical conditions among pediatric patients with epilepsy. METHODS We recruited 61 patients with epilepsy, aged 6-16 years, and 122 age-, sex-, and parental education-matched school controls. Data on demographics, parental reports on the Child Behavior Checklist (CBCL) and Swanson, Nolan, and Pelham, version IV scale (SNAP-IV), and medical records were collected. RESULTS The average full-scale intelligence quotient of the case group was 95.8. There were 11 (18.0%), 7 (11.5%), 26 (42.6%), and 26 (42.6%) of children with epilepsy ever clinically diagnosed with developmental delay, overt ADHD symptoms, allergies reported by physicians, and behavior problems measured by the CBCL, respectively. Those children with epilepsy had more severe ADHD-related symptoms and a wider range of emotional/behavioral problems than controls (Cohen's d 0.36-0.80). The rate of potential cases of ADHD among children with epilepsy was 24.6%. A history of developmental delay predicted ADHD- related symptoms and internalizing and externalizing problems. Among children with epilepsy, a longer duration of treatment with antiepileptic drugs predicted externalizing problems, and an earlier onset of epilepsy predicted inattention and hyperactivity/impulsivity. CONCLUSION Our findings imply that clinicians should assess physical and emotional/behavioral problems among children with epilepsy in order to provide interventions to offset possible adverse psychiatric outcomes.
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Affiliation(s)
- Fang-Ju Tsai
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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Psychosocial and emotional adjustment for children with pediatric cancer and their primary caregivers and the impact on their health-related quality of life during the first 6 months. Qual Life Res 2012; 22:625-34. [DOI: 10.1007/s11136-012-0176-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2012] [Indexed: 01/22/2023]
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Kawabata Y, Tseng WL, Murray-Close D, Crick NR. Developmental Trajectories of Chinese Children’s Relational and Physical Aggression: Associations with Social-Psychological Adjustment Problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:1087-97. [DOI: 10.1007/s10802-012-9633-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lin CCH, Kuo PH, Su CH, Chen WJ. The Taipei Adolescent Twin/Sibling Family Study I: Behavioral Problems, Personality Features, and Neuropsychological Performance. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.9.6.890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe present study aimed to investigate genetic and environmental influences on behavioral problems, personality features, and neuropsycho-logical performance among adolescents in Taipei, Taiwan. Between 1996 and 1998, with the assistance of the Twin Association and junior high schools in Taipei City, we solicited a list of twins from 51 junior high schools in Taipei. Names, addresses, and telephone numbers of the twins enrolled in these schools were obtained. The vast majority of the recruited twins were between 12 and 16 years old. The recruited twins received assessments for behavioral problems, general and schizotypal personality, and cognitive functions. Their parents rated their children on behavioral/ emotional problems and were assessed on their own general and specific personality. Same-sex sibling pairs (ages vary within 2 years) and their parents from three schools were also recruited to increase sample size for the group with a kinship coefficient of .50. Twins' zygosity was determined by a combination of DNA typing and physical similarity. The Mx program was used to estimate parameters for the full model and its reduced models. The recruitment, measurements, data managements, and published results are described in this article.
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49
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Kuo SY, Pi-Hua PH, Chuang LM, Chen WJ. The Taipei Adolescent Twin/Sibling Family Study II: Depression, Insulin Resistance, and Hormonal Factors. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.9.6.895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIn this ongoing longitudinal study of adolescent twins/sibling pairs and their parents in Taipei, we aimed to investigate the genetic and environmental influences on adolescent behavioral development, metabolic risk factors, and the associations between the two. Special focus is on anxious depression, metabolic profile, and hormonal factors such as cortisol and leptin. The first wave of assessment was completed during the period of 2002 to 2005 and included 192 twin pairs, 6 triplets, 56 sibling pairs and their first-degree relatives (484 parents and 142 siblings). We are currently in the process of a second wave assessment as follow-up. Dimensional psychological assessments using self-report questionnaires, as well as categorical assessments based on semistructured clinical interviews, were performed. All subjects received a 2-hour oral glucose tolerance test at the examination site. The metabolic phenotypes including body mass index, blood pressure, levels of glucose, insulin, and lipid profile as well as related hormonal levels were measured. Zygosity was determined using DNA, except for a few twins whose DNA was not available. Such a combination of detailed psychological assessments and metabolic function tests is expected to help shed light on the interrelation of psychological well-being and metabolic functioning.
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50
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Cross-cultural application of Achenbach System of Empirically Based Assessment: instrument translation in Chinese, challenges, and future directions. World J Pediatr 2012; 8:5-10. [PMID: 22105575 PMCID: PMC4247332 DOI: 10.1007/s12519-011-0329-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 04/01/2011] [Indexed: 10/15/2022]
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