Rates and patterns of comorbidity of adolescent behavioral syndromes as reported by parents and teachers in a Taiwanese nonreferred sample

The mediators for the link between autism and real-world executive functions in adolescence and young adulthood

LAY ABSTRACT

Childhood factors that predict real-world executive function in autism spectrum disorder during the transition into adulthood are largely unknown. This study aimed to identify the predictors for the behavioral and cognitive aspects of real-world executive function in late adolescent and young adult autistic populations. We followed up 289 autistic youth (mean age 11.6 years) and 203 non-autistic controls (10.7 years) to their ages of 16.9 and 15.8, respectively. The Behavior Rating Inventory of Executive Function scale was used to measure the real-world executive function at late adolescence and young adulthood at follow-up. Potential predictors such as autistic symptoms, inattention or hyperactivity symptoms, peer relationship, emotional symptoms, and parenting styles were assessed in childhood at first enrollment. The results showed that childhood inattention, withdrawn behaviors, social communication difficulties, and child-reported emotion and inattention/hyperactivity may predict real-world lower executive function in late adolescence and young adults with autism. When separating executive function into behavioral and cognitive aspects, we found that oppositional behaviors and peer problems were specific predictors for behavioral regulation and cognitive function, respectively. Our findings suggested that treating common predictors in childhood, such as inattention, may potentially improve real-world executive function in autism during the transition into adulthood.

Autistic Traits and Cyberbullying Involvement Mediated by Psychopathologies and School Functions in a Nationally Representative Child Sample

Cyberbullying has become an international concern among youth with autistic traits in the digital age. It draws the attention of professionals in mental health and education due to its potentially severe psychosocial and academic impacts. However, there is limited knowledge about the mediators for these associations. This study investigated whether school dysfunction and comorbid psychopathologies mediated the link between autistic traits and cyberbullying. We used a nationally representative sample of 9,483 students (9-14 years of age). The instruments included the Social Responsiveness Scale for autistic traits; the Cyberbullying Experiences Questionnaire for cyberbullying victimization and perpetration; the Swanson, Nolan, and Pelham, version IV for inattention, hyperactivity/impulsivity, and oppositional behaviors; the Child Behavior Checklist for anxiety/depression; and the Social Adjustment Inventory for Children and Adolescents for impaired school functions. Multiple mediation models were used for statistical analyses. The results showed that the 1-year prevalence rates of pure victims, pure perpetrators, and bully-victims of cyberbullying were 7.9 percent, 2.4 percent, and 5.7 percent, respectively. Cyberbullying victimization and perpetration were positively associated with autistic traits, school dysfunction, and comorbid psychopathologies. The associations between autistic traits and cyberbullying victims and bully-victims were significantly mediated by school dysfunction and hyperactivity/impulsivity (only for bully-victims), independent of sex and age. Our results suggest that early identification and intervention of these difficulties may mitigate the risks of cyberbullying. ClinicalTrials.gov ID: NCT02707848.

A Dimensional Approach to Discrepancy in Parenting Styles in Russian Families

We investigated the magnitude and direction of differences in parenting styles as they relate to children's mental health problems, as assessed using the CBCL. The sample consisted of 306 families residing in a large industrial city in Russia. We aimed to expand the cross-cultural literature on parenting styles by assessing a sample of Russian families and analyzing how agreement versus disagreement between self-reported and partner-reported parenting styles related to children's mental health problems. The findings suggested that both congruence and incongruence between parenting styles could be associated with children's mental health problems. When parents agreed about high warmth and matched on lower levels of demandingness, in line with the permissive parenting style, children tended to exhibit maladaptive behavior and externalizing problems. We also registered that children were likely to show low levels of mental health problems when fathers had higher self-reported warmth compared with mothers' reports. In contrast, children whose fathers had higher self-reported demandingness compared with the mothers' reports, exhibited moderate levels of mental health problems. This study expands the existing literature by providing a dimensional approach to children's mental health difficulties in the context of (dis)agreements in the parenting styles within a family.

Mother-Child Interaction of Boys With ADHD: A Behavioral Observation Study

PURPOSE

Investigate the quality of mothers' interactions with children with ADHD and a marginal disturbance in socioemotional competence (MDSC).

RESEARCH METHODS

A total of 49 mother-boy dyads were included, and we observed their communication on neutral and conflict topics for children with ADHD and MDSC, children with ADHD alone, and children with typical development (TD). The Chinese version of the Specific Affect Coding System 20-code was used to examine the affective presentation in communication.

RESULTS

Mothers of children with ADHD and MDSC had less negative disengagement affect compared with those of children with ADHD alone. Boys with ADHD and MDSC and boys with TD had constant positive engagement between neutral and conflict conditions in parent-child interaction. Boys with ADHD and MDSC had significantly less positive affect and more neutral affect than children with ADHD only.

CONCLUSIONS AND IMPLICATIONS

Boys with ADHD and MDSC and their mothers had worse quality of observed mother-child communication than children with ADHD only and their mothers.

Health-related quality of life in mothers of children with attention deficit hyperactivity disorder in Taiwan: The roles of child, parent, and family characteristics

BACKGROUND

No study has examined how child and maternal psychopathological difficulties and family factors contribute to the health-related quality of life (HRQOL) of mothers of children with attention deficit hyperactivity (ADHD).

AIMS

To investigate the impact of children's diagnosis of ADHD, children's and maternal psychopathology and significant sociodemographic variables of the children, parents and family on HRQOL of mothers of children with ADHD and those of children with typical development (TD) in Taiwan.

METHODS AND PROCEDURES

Children with ADHD (n = 257) and children with typical development (n = 324) and their mothers were recruited from a psychiatric clinic of a medical center and 10 elementary schools and four high schools in northern Taiwan. Maternal HRQOL was assessed with the World Health Organization Quality of Life - BREF, while the other factors were screened using the Chinese version of the Childhood Autism Spectrum Test for autistic traits, the Swanson, Nolan, and Pelham, version IV scale for ADHD symptoms, the Child Behavior Checklist for behavioral and emotional problems, The Center for Epidemiologic Studies Depression Scale for maternal depression and interpersonal problems, the Adult ADHD Self-report Scale for maternal ADHD symptoms, and the Family APGAR for family support.

OUTCOMES AND RESULTS

Mothers of children with ADHD had significantly worse HRQOL in all four domains compared with those of children with typical development. Multiple regressions found that factors consistently related to the HRQOL of mothers of children with ADHD and those of children with TD were maternal depression and perceived family support after controlling for several familial, parental and child variables. HRQOL of mothers of children with ADHD and those of children with TD was more closely related to her own and family factors rather than mother- or teacher-rated ADHD symptoms, clinical diagnosis of ADHD or psychopathology of the child.

CONCLUSIONS AND IMPLICATIONS

Screening for maternal HRQOL, depressive symptoms and family support systems and mental health services for mothers of children with ADHD are warranted based on these findings.

Teacher-rated aggression and co-occurring behaviors and emotional problems among schoolchildren in four population-based European cohorts

Aggressive behavior in school is an ongoing concern. The current focus is on specific manifestations such as bullying, but the behavior is broad and heterogenous. Children spend a substantial amount of time in school, but their behaviors in the school setting tend to be less well characterized than at home. Because aggression may index multiple behavioral problems, we used three validated instruments to assess means, correlations and gender differences of teacher-rated aggressive behavior with co-occurring externalizing/internalizing problems and social behavior in 39,936 schoolchildren aged 7-14 from 4 population-based cohorts from Finland, the Netherlands, and the UK. Correlations of aggressive behavior were high with all other externalizing problems (r: 0.47-0.80) and lower with internalizing problems (r: 0.02-0.39). A negative association was observed with prosocial behavior (r: -0.33 to -0.54). Mean levels of aggressive behavior differed significantly by gender. Despite the higher mean levels of aggressive behavior in boys, the correlations were notably similar for boys and girls (e.g., aggressive-hyperactivity correlations: 0.51-0.75 boys, 0.47-0.70 girls) and did not vary greatly with respect to age, instrument or cohort. Thus, teacher-rated aggressive behavior rarely occurs in isolation; boys and girls with problems of aggressive behavior likely require help with other behavioral and emotional problems. Important to note, higher aggressive behavior is not only associated with higher amounts of other externalizing and internalizing problems but also with lower levels of prosocial behavior.

The mental health of immigrant mother's offspring in Taiwan: A national epidemiological study

BACKGROUND/PURPOSE

With globalization, transnational marriages become more and more common in the world. The mental health of the offspring of immigrants is a significant public health issue. The present study aimed to investigate whether children of immigrant mothers demonstrate more emotional and behavioral problems than those of native mothers in Taiwan.

METHODS

In a sample of 6242 children in grade 3, grade 5, and grade 7 from a national epidemiological study of child mental disorders, 617 (9.9%) children were born by immigrant mothers (Chinese, Vietnam, Indonesia, and other countries) and 5625 children by Taiwanese parents. The children reported on Achenbach Youth Self-report, and their parents reported about them on the Child Behavior Checklist, Parental Bonding Inventory, and Family APGAR for assessing emotional and behavioral problems, mother's parenting style, and perceived family support.

RESULTS

Compared with children of native mothers, children of immigrant mothers reported themselves and were reported by their parents to have more externalizing and internalizing problems. However, after considering the effects of sociodemographics, parenting style, and family function, only significant differences in externalizing problems between children with native or immigrant mothers were found.

CONCLUSION

Our findings indicate that right parenting style and family support; may offset emotional and behavioral problems in children of immigrant mothers, and suggest that improving maternal parenting and family function is beneficial to child development, regardless of immigrant or native mothers.

Comparative Efficacy of Methylphenidate and Atomoxetine on Emotional and Behavioral Problems in Youths with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

Methylphenidate and atomoxetine are efficacious in reducing core symptoms of attention-deficit/hyperactivity disorder (ADHD), but little is known about their efficacy in improving emotional/behavioral problems among youths with ADHD.

METHODS

One hundred sixty drug-naïve youths with DSM-IV-defined ADHD, aged 7-16 years, were recruited and randomly assigned to osmotic-release oral system methylphenidate (OROS-methylphenidate; n = 80) and atomoxetine (n = 80) in a 24-week, open-label, head-to-head clinical trial. The primary efficacy measure was parent-reported Child Behavior Checklist (CBCL), and the secondary efficacy measures included Youth Self Report (YSR) and Strengths and Difficulties Questionnaire (SDQ), which was based on the ratings of parents, teachers, and subjects.

RESULTS

For CBCL, both methylphenidate and atomoxetine groups showed significant improvement in all scores at weeks 8 and 24 except Somatic Complaints in the atomoxetine group. For SDQ, both treatment groups showed significant improvements in the Hyperactive and Conduct subscales for parent ratings, and the Externalizing subscale for teacher ratings at week 24. Methylphenidate was associated with greater improvements in Aggressive Behavior and Somatic Complaints of CBCL and in Conduct subscale of self-reported SDQ at week 24 compared with atomoxetine.

CONCLUSIONS

Our findings provide evidence to support that both methylphenidate and atomoxetine were effective in improving a wide range of emotional/behavioral problems in youths with ADHD after 24 weeks of treatment, with greater improvement in aggressive behavior, somatic complaints, and conduct problems in the methylphenidate group.

Attention-deficit hyperactivity disorder and suicidality: The mediating effects of psychiatric comorbidities and family function

OBJECTIVE

To explore the association between Attention-Deficit Hyperactivity Disorder ("ADHD") and suicidality in children. Mediating effects of family function and psychiatric co-morbidities were also explored.

METHODS

This is a national representative cross-sectional survey of school-based sample of 4739 children aged 7-15. Logistic regression was used to assess the excess risks of suicidality (i.e., suicidal ideation, suicide plan, and suicide attempts) in 412 children with ADHD. Serial multiple mediator models were conducted to assess the mediating effects of family function and psychiatric comorbidities.

RESULTS

The prevalence of suicidality in children with ADHD was approximately 20% in Taiwan. After adjusting for potential confounders, the risk of suicidality among children with ADHD was approximately four times higher than among non-ADHD children [(adjusted Odds Ratio ["OR"] = 3.82, 95% Confidence Interval ("CI") (2.73, 5.34)] for suicidal ideation, adjusted OR = 4.18, 95% CI (2.57, 6.80) for suicide plan and adjusted OR = 4.45, 95% CI (1.99, 9.93) for suicide attempts. The mediating effects of anxiety/depression and conduct problems were about 20% and 8%, respectively, across all suicide outcomes. The mediating effects of family function were around 6-7% for suicidal ideation and 16-18% for suicide plan and suicide attempts. The effects of ADHD on suicidality, in general, remained after considering the mediating roles of family function and psychiatric comorbid conditions.

CONCLUSIONS

Children with ADHD are at a high risk of suicide. Although the family function and psychiatric co-morbidities partially mediate this association, ADHD in itself is a potent suicide risk factor and should be an important target for suicide prevention.

Altered frontal aslant tracts as a heritable neural basis of social communication deficits in autism spectrum disorder: A sibling study using tract-based automatic analysis

Investigating social behaviors and brain structural alterations in unaffected siblings of individuals with autism spectrum disorder (ASD) may help identify intermediate phenotypes of social communication deficits in ASD. This study hypothesized that such intermediate phenotypes could be identified in white matter tracts of the social communication model that exhibited reduced tract integrity and associations with social communication deficits. Boys with ASD (N = 30), unaffected male siblings (N = 27), and typically developing (TD) boys (N = 30) underwent clinical evaluation and MRI scanning. Group differences in generalized fractional anisotropy (GFA) values, a white matter integrity index derived from diffusion MRI data, and the relationships of GFA with the Social Responsiveness Scale (SRS) scores and the Child Behavior Checklist (CBCL/4-18) scores were investigated. Significant differences were found in the GFA values of the frontal aslant tract (FAT) among the three groups, with the decreasing order of GFA from TD to siblings to ASD. The GFA values of the FAT were associated with the social communication scores (on the SRS) in the sibling group, and those of the superior longitudinal fasciculus III were associated with the social problems scores (on the CBCL/4-18) in the boys with ASD. Due to the altered tract integrity and association with social communication deficits in the unaffected siblings of individuals with ASD, the FAT might be a heritable neural basis for social communication deficits of ASD. Autism Res 2019, 12: 225-238 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Autism spectrum disorder (ASD) is a group of highly heritable disorders with social communication deficits as one of the core symptoms. This study aimed to identify a neural trait of social communication deficits in individuals with ASD. We investigated brain structural alterations and their associations with social communication scores in unaffected siblings of individuals with ASD. The siblings' frontal aslant tract was found to be impaired, and this tract showed a significant association with the social communication scores. Our findings support that the frontal aslant tract might be a potential neural trait of social communication deficits in ASD.

Aripiprazole/Methylphenidate Combination in Children and Adolescents with Disruptive Mood Dysregulation Disorder and Attention-Deficit/Hyperactivity Disorder: An Open-Label Study

OBJECTIVES

Disruptive mood dysregulation disorder (DMDD) is characterized by nonepisodic irritability and has a high rate of comorbidity with attention-deficit/hyperactivity disorder (ADHD). This is the first study to explore the effects of aripiprazole combined with methylphenidate on clinical symptoms and cognitive functions in patients with DMDD and ADHD.

METHODS

Patients with DMDD and ADHD (the DMDD-ADHD Group, n = 24; aged 7-17 years) completed a 6-week, open-label trial of aripiprazole and methylphenidate. The pre- and posttreatment outcome measures included the parent-rated Swanson, Nolan, and Pelham Scale-version IV, Child Behavior Checklist, and self-reported Beck Youth Inventories-II, as well as a neuropsychological battery composed of the Children's Color Trail Test and Conner's Continuous Performance Test. The comparison group consisting of patients with ADHD (the ADHD Group, n = 27) was recruited to investigate the differences in clinical and neuropsychological profiles between the two groups at baseline.

RESULTS

The DMDD-ADHD Group showed worse irritability, disruptive behaviors, anxious/depressed symptoms, and social problems relative to the ADHD Group at baseline assessments. The combination treatment significantly improved irritability, externalizing symptoms, depression, anxiety, attention, social problems, and reaction time variability. The effect sizes of reductions in parent-rated irritability, oppositional defiant symptoms, and inattention were comparable (Cohen's d = 1.26, 1.11, and 1.40, respectively).

CONCLUSIONS

This pilot study showed the tolerability of the aripiprazole/methylphenidate combination by patients with DMDD and ADHD and its efficaciousness for treating clinical symptoms and for improving cognitive function. Further randomized, controlled, cross-over studies are needed.

Altered white-matter integrity in unaffected siblings of probands with autism spectrum disorders

Despite the evidence of altered white-matter tract property in individuals with autism spectrum disorder (ASD), little is known about their unaffected siblings. This study aimed to investigate white-matter integrity in unaffected siblings of ASD probands. Thirty-nine unaffected siblings (mean age 15.6 ± 6.0 years; 27 males, 69.2%) and 39 typically developing controls (TDC) (14.2 ± 5.6 years; 26 males, 66.7%) were assessed with diffusion spectrum images and neuropsychological tests. Using the tract-based automatic analysis and the threshold-free cluster weighted (TFCW) scores, we searched for the segments among 76 tracts with the largest difference over the entire brain compared to TDC. Tract integrity was quantified by calculating the mean generalized fractional anisotropy (mGFA) values of the segments with the largest difference in TFCW scores. Unaffected siblings showed reduced mGFA in the bilateral frontal aslant tracts, the right superior longitudinal fasciculus 2 (SLF2), the frontostriatal tracts from the right dorsolateral and left ventrolateral prefrontal cortices, the thalamic radiations of the left ventral and the right dorsal thalamus, the callosal fibers of the splenium, and the increased mGFA of the callosal fibers of the precuneus and the left inferior longitudinal fasciculus. Among these, reduced right SLF2 mGFA was associated with social awareness deficits; impaired frontostriatal tract was associated with internalizing problems, while right frontal aslant tract integrity was associated with visual memory deficits. In conclusion, unaffected siblings showed the aberrant integrity of several white-matter tracts, which were correlated with clinical symptoms and neurocognitive dysfunction. The altered tract integrity could be further examined in the probands with ASD. Hum Brain Mapp 38:6053-6067, 2017. © 2017 Wiley Periodicals, Inc.

ADHD-related symptoms and attention profiles in the unaffected siblings of probands with autism spectrum disorder: focus on the subtypes of autism and Asperger's disorder

BACKGROUND

The presence of attention-deficit/hyperactive disorder (ADHD) symptoms and impaired attention performance are commonly noted in individuals with autism spectrum disorder (ASD). However, little is known about attention performance in their unaffected siblings. This study aimed to investigate the ADHD-related traits and attention performance in unaffected siblings of probands with autism and Asperger syndrome (AS), as well as the clinical correlates of ADHD-related traits.

METHODS

We assessed the intention, hyperactivity-impulsivity, and oppositional symptoms, and attention profiles of 199 probands with a diagnosis of ASD (122 autism, 77 AS), their unaffected siblings, and 196 typically developing controls (TD) by their parents' reports on the ADHD-related symptoms and the Connors' Continuous Performance Test (CCPT), respectively.

RESULTS

Compared to TD, unaffected siblings of ASD probands were more hyperactive/impulsive and oppositional, particularly unaffected siblings of AS probands. In CCPT, unaffected siblings of AS have intermediate levels of performance between probands with AS and TD on focused attention and sustained attention but were not statistically different from AS probands or TD in these attention profiles. In contrast, unaffected siblings of autism probands have significantly better CCPT performance when compared to autism probands but not to TD. In addition, stereotyped behaviors predicted ADHD-related traits in both sibling groups, but distinctive patterns of other correlates for ADHD-related traits were found between the two sibling groups.

CONCLUSIONS

This work suggested that unaffected siblings of AS, but not autism, have more hyperactive/impulsive traits and a trend of pervasive attention deficits assessed by CCPT which might serve as potential endophenotypes for genetic studies in AS.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01582256.

Parent-child discrepancies in the report of adolescent emotional and behavioral problems in Taiwan

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 7^th-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.

Perfluoroalkyl substances in cord blood and attention deficit/hyperactivity disorder symptoms in seven-year-old children

OBJECTIVE

The effect of perfluoroalkyl substances (PFASs) on the development of neurotoxicity in children is still controversial. This study aimed to evaluate the association between in utero exposure to four PFASs and the development of neurobehavioral symptoms related to attention deficit hyperactivity disorder (ADHD) in early childhood.

METHODS

Eligible study subjects were selected from the Taiwan Birth Panel Study and the Taiwan Early-Life Cohort, which enrolled a total of 1526 mother-infant pairs during 2004 and 2005. We collected umbilical cord blood and analyzed perfluorooctanoic acid (PFOA), perfluorooctanyl sulfonate (PFOS), perfluorononanoic acid (PFNA), and perfluoroundecanoic acid (PFUA) levels. When a child was 7 years old, to evaluate ADHD related neurobehavioral symptoms, their parents completed the Swanson, Nolan, and Pelham IV scale (SNAP-IV), the Child Behavior Checklist (CBCL), and the Strengths and Difficulties Questionnaire (SDQ) questionnaires. We used linear regression models with inverse probability weighting to explore the association between prenatal exposure to four PFASs and ADHD rating scores.

RESULTS

A total of 282 subjects have completed the PFASs analysis and questionnaire survey. After adjusted for potential confounders, we observed that PFNA is inversely associated with inattention and oppositional defiant disorder of SNAP-IV, and hyperactivity/inattention of SDQ. No association between PFOA, PFOS, or PFUA and ADHD symptoms was found.

CONCLUSIONS

Prenatal exposure to PFNA was found to associate with neurobehavioral symptoms related to ADHD among Asian seven-year-old children. Further studies are needed to elucidate the causal relationship.

Intra-individual reaction time variability based on ex-Gaussian distribution as a potential endophenotype for attention-deficit/hyperactivity disorder

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.

Mechanisms and processes of relational and physical victimization, depressive symptoms, and children's relational-interdependent self-construals: Implications for peer relationships and psychopathology

This 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.

Executive function as a mediator in the link between attention-deficit/hyperactivity disorder and social problems

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.

Psychometric properties of the Chinese version of Strength and Difficulties Questionnaire

This study aimed to establish the norms and to examine the psychometric properties of the Chinese version of the Strengths and Difficulties Questionnaire (SDQ). Sample included a representative sample of 3534 students (grades 1 to 8) from one city and one suburb each in Northern and Southern Taiwan by using a multistage sampling method and 211 psychiatric outpatients diagnosed with attention-deficit hyperactivity disorder (ADHD), aged 6 to 15, consecutively recruited from a medical center in Taipei. All the parents and teachers and participants with grade 4 or higher completed the SDQ. Parents and teachers also completed the Child Behavior Checklist and the measures about inattention, hyperactivity, and oppositional symptoms. Similar to Western studies, principal component analyses confirmed the five psychological dimensions of the SDQ for the parent, teacher, and student forms. The three forms of the Chinese SDQ showed satisfactory test-retest reliability, internal consistency, concurrent validity, and discriminant validity. All the subscales of the three forms of the Chinese SDQ clearly distinguished clinical participants with ADHD from school-based participants. Like Western studies, our findings indicate that the Chinese SDQ demonstrates a reliable and valid instrument for measuring internalizing, externalizing, and prosocial behaviors in Taiwanese child and adolescent population.

Parent-child interaction of mothers with depression and their children with ADHD

Attention deficit/hyperactivity disorder (ADHD) is a developmental disorder that may have a chronic and pervasive impact on the child's function and cause long-term stress to parents. A higher rate of depression is associated with mothers of children with ADHD. This observational study aimed to investigate the effect of maternal depression and the child's ADHD on the quality of the parent-child interaction in children with ADHD and their mothers with depression. The study participants comprised 39 mother-son dyads including children with ADHD and mothers with depression, children with ADHD and mothers without depression, and children without ADHD and mothers without depression. The Specific Affect Coding System, 20-code version was used to code interactional affect, including positive engagement, negative engagement, negative disengagement, and neural affect. There were no statistically significant group-by-context interaction effects or group effects on all affective variables between the group of children with ADHD and mothers without depression and the group of children without ADHD and mothers without depression. Stimulant medication may account for these nonsignificant findings. No significant difference of positive affect between neutral and conflict-solving contexts was observed in depressed mothers whose children were diagnosed as ADHD. Children with ADHD whose mothers were depressed were less positive in their parent-child interaction compared with children in the other groups. Maternal depression may play an important role in the affective presentation of dyads of children with ADHD and mothers with depression. Implications for clinical practice and future research are provided.

Sex difference in the rates and co-occurring conditions of psychiatric symptoms in incoming college students in Taiwan

OBJECTIVE

The authors investigated the sex difference in the rates and co-occurring patterns in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-referenced psychiatric symptoms among incoming first-year college students in Taiwan.

METHODS

This was a college-based questionnaire survey. The participants included 2731 incoming first-year college students (male, 52.4%; mean age, 19.3 ± 2.6 years). The participants completed the Chinese version of the Adult Self Report Inventory-4 for the assessment of a wide range of psychiatric symptoms according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptom criteria. The participant rate was 74.1%.

RESULTS

There were 55% of the participants having at least one psychiatric symptom. Symptoms of agoraphobia, body dysmorphic, and gender identity disorder were more prevalent in women; those of obsession-compulsion, tics, conduct problems, schizoid personality, and kleptomania were more prevalent in men. The magnitude of symptom correlations between compulsion and gender identity disorder, dysthymia, and antisocial personality, and between gender identity disorder and schizophrenia was significantly greater in male participants, whereas that between conduct problems and obsession and motor tics was significantly greater in female participants.

CONCLUSIONS

The Chinese version of the Adult Self Report Inventory-4 identified similar sex difference in psychiatric symptoms as Western studies. The sex difference in co-occurring psychiatric conditions warrants further investigation.

Determinants of activity and participation in preschoolers with developmental delay

According to the International Classification of Functioning, Disability and Health model endorsed by the World Health Organization, activity (the execution of a task or action by an individual), and participation (involvement in a life situation) are important components in the assessment of health and functioning of an individual. The purpose of this study was to compare the activity performance and school participation of preschool children with developmental delay (DD) and age-matched typically developing children, and to identify the determinants of activity and participation in preschoolers with DD. Fifty-four children with DD (37 boys, 17 girls; mean age: 66 months) and 54 age-matched typically developing children (34 boys, 20 girls; mean age: 65 months) were recruited from the mainstream preschools with integrated program units. Activity and participation were evaluated using the Vineland Adaptive Behavior Scales (VABS) and School Function Assessment (SFA). Other factors that may influence activity and participation such as impairments in sensory, motor, and mental functioning, and other contextual factors (e.g. family income) were also measured. The DD group had significantly lower VABS (p < 0.001) and SFA (p<0.001) scores than controls, indicating suboptimal activity and participation. Multiple regression analysis revealed that deficits in social and motor skills, and in inattention/hyperactivity, were significantly associated with activity and participation in children with DD, accounting for approximately 35-37% of the variance in the VABS and SFA scores ( p<0.001). In conclusion, deficits in social and motor functioning, and attention-deficit hyperactivity disorder-related symptoms, are important determinants of activity and participation in preschoolers with DD. One may consider targeting these specific areas to enhance activity and participation amongst these children.

Emotional/behavioral problems and functional impairment in clinic- and community-based children with attention-deficit/hyperactivity disorder in Taiwan

Using a sample of 268 patients and 137 community-based children with DSM-IV ADHD, and 268 school controls, aged 6-15, this study aimed to compare the emotional/behavioral problems and functional impairment between clinic- and community-based children with ADHD. Children's ADHD-related symptoms, a wide range of emotional/behavioral problems, and functional impairments were assessed by the psychiatric interviews and self-, parent- and teacher-reported questionnaires. Both ADHD groups scored higher in parent- and teacher-reported ADHD-related symptoms, wide-ranging emotional/behavioral problems, and impairments in the school, peer, family, and leisure time domains than school controls. However, clinic-based children with ADHD had more physical/developmental problems, more severe functional impairments and teacher-reported hyperactivity/impulsivity symptoms, and higher family burdens than their community counterparts. Our findings suggest that a higher maternal educational level, parent's perceived child functional impairment, teacher's perceived impaired peer relationship and hyperactivity-impulsivity, and child physical and developmental problems may be related to the psychiatric referrals of children with ADHD.

Demographic and perinatal factors for behavioral problems among children aged 4-9 in Taiwan

AIM

To investigate the effects of age, gender, prenatal/perinatal factors, and maternal psychological distress on childhood emotional/behavioral problems, and the gender difference in the patterns of comorbid emotional/behavioral problems.

METHODS

The sample included 1391 children aged 4-9 in Taipei using a multi-stage sampling method. Their mothers completed questionnaires including demographics, prenatal/perinatal variables, the Child Behavior Checklist, and the Chinese Health Questionnaire. The linear and non-linear mixed model was used for data analysis.

RESULTS

Boys scored higher on externalizing problems, and girls scored higher on internalizing problems. Gender also modified the comorbid patterns of emotional/behavioral problems. Aggressive behaviors decreased, but attention and thought problems increased with age. Prenatal/perinatal exposure to alcohol and coffee, vaginal bleeding, and gestational diabetes, low birthweight, and postnatal incubation and resuscitation, and maternal psychological distress predicted the risk for several childhood emotional/behavioral problems.

CONCLUSION

Prenatal/perinatal and maternal care, and gender-specific measures are important for prevention of childhood emotional/behavioral problems.

Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale - parent form

This study aimed to establish the psychometric properties of parent ratings on the Chinese version of the Swanson, Nolan, and Pelham IV scale (SNAP-IV) in a school-based sample of 3534 students in grades 1 to 8 from two cities and two suburbs in Taiwan and 189 children diagnosed with attention deficit/hyperactivity disorder (ADHD) (aged 6 to 15) consecutively recruited from a medical center in Taipei. Parents completed the Chinese versions of the SNAP-IV, Strengths and Difficulties Questionnaire, and Child Behavior Checklist. The Chinese SNAP-IV demonstrated similar three factor structure (Inattention, Hyperactivity/Impulsivity, and Oppositional) as its English version, and satisfactory test-retest reliability (intraclass correlation = 0.59 approximately 0.72), internal consistency (alpha = 0.88 approximately 0.90), concurrent validity (Pearson correlations = 0.56 approximately 0.72), and discriminant validity. Boys scored higher than girls across the eight school grade levels. The SNAP-IV clearly distinguished children with ADHD from school-based participants. Comorbidity with oppositional defiant disorder/conduct disorder predicted higher SNAP-IV scores among children with ADHD. Our findings suggest that the Chinese SNAP-IV is a reliable and valid instrument for rating ADHD-related symptoms in both clinical and community settings in Taiwan.

Association between childhood sleep problems and perinatal factors, parental mental distress and behavioral problems

The aim of this study was to examine the effect of age, gender and perinatal risk factors on the risks for sleep problems, and investigate the relation between childhood sleep problems and children's behavioral syndromes and parental mental distress in early and middle childhood. We recruited a representative sample of 1391 children, ages 4-9, from nine kindergartens and three elementary schools by using a multistage sampling method. Parents of child participants completed a questionnaire including perinatal risk factors, sleep habits and problems, the Child Behavior Checklist (CBCL) and the Chinese Health Questionnaire (CHQ). A mixed model was used for data analysis to address cluster effect from the same classes and schools. Results showed that boys suffered from more sleep problems than girls. Early insomnia, sleep terrors and enuresis decreased with ages, but sleepwalking increased with ages. Perinatal exposure to alcohol, coffee and non-prescribed medication, vaginal bleeding, artificial delivery, first-born order and higher parental CHQ score (> or =4) were significantly associated with several childhood sleep problems. In addition, children with sleep problems had higher T-scores of the eight behavioral syndromes derived from the CBCL. Our findings indicated that the childhood sleep problems were associated with perinatal risk factors, parental psychopathology and children's behavioral problems.