Sleep problems and executive dysfunctions in pre-school children.

AIM: The aim of the study was to examine the relationship between sleep problems and executive functions in pre-school children as reported by parents/caregivers. METHODS: This cross-sectional study of caregiver-child dyads was conducted in a public kindergarten school in Northern Thailand. Sleep problems were evaluated using the Children's Sleep Habits Questionnaire (CSHQ), whereas executive functions were assessed using the Behavioural Rating Inventory of Executive Function - pre-school version (BRIEF-P). T-scores greater than 65 of the BRIEF-P were defined as deficits in executive functions. Multiple linear regressions were performed to assess the association between the executive function components and the total CSHQ scores. RESULTS: Participants included 356 children, with a mean age of 5.04 (0.54) years. The total CSHQ scores of the executive dysfunction group were significantly higher than those of the group with executive functions below the cutoff (P < 0.001), which indicated more of sleep problems, including sleep-onset delay, night waking and daytime sleepiness. However, the duration of night sleep, night awake, afternoon nap and total sleep time reported by parents did not differ between the two groups. Weak positive correlations between the total CSHQ and subscale scores and the Global Executive Composite score of the BRIEF-P were noted. After adjusting for confounding variables, including child's age, gender, prematurity, maternal age and education, family income and media viewing time from the multiple linear regression analysis, the total CSHQ scores were significantly correlated with worse Global Executive Composite scores, which is the summary of five domains of executive functions (P < 0.001). CONCLUSIONS: This study highlights the association between sleep problems and deficits in executive functions in healthy pre-school children. Health-care providers are encouraged to consistently advocate for proper sleep hygiene and practices to enhance executive functions in pre-schoolers.

Online positive parenting programme for promoting parenting competencies and skills: randomised controlled trial.

Positive parenting programmes (PPP), albeit effective, are not readily accessible to the general public, particularly during the COVID-19 pandemic. In 103 healthy caregiver-child dyads, we investigated the effectiveness of online PPP on parenting sense of competencies (primary outcome), parenting styles and behavioural concerns of children aged 3-6 years (secondary outcomes) between 2 blinded, parallel groups. After block of 4 randomisations, intervention group (n = 52) attended live, group-based, internet delivered PPP while both intervention and active control group (n = 51) received weekly general education via communication application. Outcomes were measured at baseline, 8 and 14 weeks. Most parents from both groups had high education and household income. From the intervention group, 87.5% of the parents attended live sessions while 8.6% subsequently watched recorded sessions. At 14 weeks, the intervention group reported higher sense of competence (Wald 9.63, p = 0.008); both groups reported using more authoritative parenting style (Wald 15.52, p ≤ 0.001) from Generalised Estimating Equations model. Compared to baseline, both groups had significant reduction of children's emotional problems at 14 weeks (mean change: Intervention = - 0.44, p = 0.033; Control = - 0.30, p = 0.046) and behavioural problems over time (Wald 7.07, p = 0.029). Online PPP offered an easily accessible, primary preventive measure to mitigate behavioural concerns and improve parental competency. Clinical Trial Registration: Thai Clinical Trials Registry ( https://www.thaiclinicaltrials.org/ ); TCTR20201030001 on 30/10/2020.

Factors affecting sibling bullying and its association with self-esteem and depression in middle school students.

Sibling bullying is an unwanted aggressive behavior of a sibling that is associated with peer bullying and emotional problems. However, the prevalence of sibling bullying, the factors that affect this condition, and its impact on depression and self-esteem are understudied, especially in Thailand. This study aims to examine the prevalence of sibling bullying, factors that affect sibling bullying, and its association with self-esteem and depression during the pandemic. From January to February 2022, a cross-sectional study was conducted in grades 7-9 (age 12-15 years) who had at least one sibling. Demographic characteristics, sibling bullying, self-esteem, and depression were collected using the revised Olweus bully/victim questionnaire, the Rosenberg self-esteem scale, and Patient Health Questionnaire-9, respectively. Binary logistic regression was analyzed to determine associations between sibling bullying and outcomes. Of 352 participants (30.4% female), 92 (26.1%) were victims and 49 (13.9%) were bullies of sibling bullying in the previous 6 months. Factors associated with an increased risk of being victims included female (OR = 2.46; 95%CI 1.34-4.53), peer victimization (OR = 12.99; 95%CI 5.27-32.04), domestic violence (OR = 4.48; 95%CI 1.68-11.95), and perpetrating sibling bullying (OR = 9.81; 95%CI 4.62-20.81). Factors associated with an increased risk of depression were female (OR = 2.59; 95%CI 1.57-4.26), sibling bullying victimization (OR = 2.08; 95%CI 1.22-3.56), physical abuse (OR = 9.50, 95%CI 1.13-79.71) and domestic violence (OR = 3.44; 95%CI 1.40-8.45).  Conclusion: Sibling bullying was not uncommon in Thai young adolescents and was associated with female, peer bullying, domestic violence, and depression. Such associations should be identified early so preventive measures and management could be properly implemented. What is Known: • Sibling bullying increases the risk for engaging in peer bullying, aggressive behaviors, violence, and emotional difficulties during life course trajectories. • Victims of sibling bullying are at increased risk of depression, anxiety, mental distress, self-harm, and decreased well-being. What is New: • The rate of sibling bullying in Thai middle school students, even during the pandemic, was comparable to previous studies of different cultural backgrounds without the pandemic. • Victims of sibling bullying were associated with female sex, peer victimization, domestic violence, perpetrating sibling bullying, and depression. Perpetrating sibling bullying was also associated with bullies in cyberbullying.

Online positive parenting programme for promoting parenting competencies and skills: randomised controlled trial.

Positive parenting programmes (PPP), albeit effective, are not readily accessible to the general public, particularly during the COVID-19 pandemic. In 103 healthy caregiver-child dyads, we investigated the effectiveness of online PPP on parenting sense of competencies (primary outcome), parenting styles and behavioural concerns of children aged 3-6 years (secondary outcomes) between 2 blinded, parallel groups. After block of 4 randomisations, intervention group (n = 52) attended live, group-based, internet delivered PPP while both intervention and active control group (n = 51) received weekly general education via communication application. Outcomes were measured at baseline, 8 and 14 weeks. Most parents from both groups had high education and household income. From the intervention group, 87.5% of the parents attended live sessions while 8.6% subsequently watched recorded sessions. At 14 weeks, the intervention group reported higher sense of competence (Wald 9.63, p = 0.008); both groups reported using more authoritative parenting style (Wald 15.52, p ≤ 0.001) from Generalised Estimating Equations model. Compared to baseline, both groups had significant reduction of children's emotional problems at 14 weeks (mean change: Intervention = - 0.44, p = 0.033; Control = - 0.30, p = 0.046) and behavioural problems over time (Wald 7.07, p = 0.029). Online PPP offered an easily accessible, primary preventive measure to mitigate behavioural concerns and improve parental competency.Clinical trial registration Thai Clinical Trials Registry; https://www.thaiclinicaltrials.org/ ; TCTR20201030001; October 30, 2020.

Screen media use in hospitalized children: a prospective observational study.

Screen media use in hospitalized children is more prevalent than such media use in a home setting. Research on characteristics and extent to which screen media are used in hospitalized children in addition to associated factors is scarce. This study aims to examine the duration and factors associated with screen media use in hospitalized children. From February to November 2020, a cross-sectional study was conducted in hospitalized children (age range 1-194 months, median age 44.5 (IQR 14-123.5) months) and their caregivers at a single tertiary care hospital using a media questionnaire combined with a thorough interview. Of 254 participants who were enrolled, 239 (94%) had been exposed to screen media in the hospital with a median duration of exposure of 6 (IQR 2-11) h/day. Children who used more than one screen media device (standardized beta (ß) = 0.16, p < 0.001), having difficulty stopping media use (ß = 0.16, p < 0.001), having lower numbers of positive discipline techniques over media use (ß = 0.16, p = 0.001), and less media co-viewing with verbal interaction with their caregivers (ß = 0.12, p = 0.004) were significantly associated with longer screen media use in a hospital setting.   Conclusion: Hospitalized children spent 6 h/day on screen media. Fostering positive discipline over media use and co-viewing with verbal interaction during screen time may minimize screen media overuse in hospitalized children. What is Known: • Screen media use in hospitalized children is often observed during ward rounds. • Hospitalized children had increased access to screen media in hospital rooms compared to their homes. What is New: • Difficulty stopping media use, having lower numbers of positive discipline techniques over media use, and less media co-viewing with caregivers were associated with longer screen media use in hospitalized children. • Fostering positive discipline over media use and verbal interaction from caregivers during media co-viewing may minimize screen media overuse in hospitalized children.

Insomnia: Focus on Children.

Pediatric insomnia is relatively common in general pediatric practice and has an even higher prevalence in those with neurodevelopmental disorders. Detailed sleep history, sleep diary, associated daytime symptoms, and factors contributing to insomnia should be thoroughly evaluated to determine the diagnosis and further plan for management. Behavioral management should be the first step for the management of insomnia in children and adolescents. Although there is no FDA-approved medication for the treatment of insomnia in children, some medications may be prescribed with caution, particularly if behavioral management is not effective, in selected conditions, and if the benefits outweigh the risks.

Effectiveness of mobile application on changing weight, healthy eating habits, and quality of life in children and adolescents with obesity: a randomized controlled trial.

BACKGROUND: A technology-based intervention, such as a mobile application, was a growing interest and potentially effective modality for treating obesity. The study aimed to evaluate the effectiveness of the OBEST, a new mobile/tablet-based application in reducing weight and encouraging healthy eating behaviors and quality of life in children with obesity. The application could assist healthcare professionals to treat children and adolescents with obesity. METHODS: A randomized controlled trial was conducted in the hospital and school settings in Chiang Mai, Thailand. Seventy-seven children and adolescents with obesity were randomized into two groups; one received standard care combined with the OBEST application, and the other received only standard care. The outcomes were changes in weight, healthy eating behaviors, and quality of life assessed by the Pediatric Quality of Life Inventory (PedsQL) from baseline to six-month follow-up between the two groups. RESULTS: The results showed that the intervention group reduced more body mass index (BMI) and had a higher number of participants engaging in healthy eating behaviors than the standard care group but did not reach a statistically significant level, except for less frequent consumption of fast food. The participants in the intervention group had 4.5 times higher odds of decreased engaging in fast-food consumption than the standard care group at 6 months follow-up (odds ratio, 4.5 [95% CI, 1.41 to 14.35]). There were no statistically significant changes in PedsQL scores over 6 months in between groups. CONCLUSIONS: The current study was unable to detect a significant effect of the OBEST application as an adjunct tool to the standard treatment on reducing weight in obese children and adolescents. However, the mobile application might help to increase engaging in healthy eating behaviors. Further studies with a larger sample are needed to confirm our findings. TRIAL REGISTRATION: The trial was retrospectively registered at the Thai Clinical Trials Registry (trial registration number: TCTR20200604008 , on June 4, 2020).

Effect of early screen media multitasking on behavioural problems in school-age children.

Screen media multitasking (SMM), the act of exposure ≥ 2 screen media simultaneously, is increasing nowadays. Single media use was associated with child's behavioural problems in previous studies. However, the associations between SMM since early childhood and behavioural problems in school-age children had not been elucidated. This study aimed to investigate the association between SMM from age 6 months to 4 years and behavioural problems in 6-year-old children. Two hundred and ninety-one (52.6% girls) healthy children were enrolled since age 6 months and 259 participants were followed-up until age 6 years. SMM was obtained at age 6, 12, 18, 24 months, 3 and 4 years. Behavioural concerns were assessed at age 4 years by the Child Behaviour Checklist and by both the Strengths and Difficulties Questionnaire with the Conners Kiddie Continuous Performance Test at age 6 years. Parenting style, cognitive ability, and baseline characteristics were also ascertained. Partial least squares path modelling was performed to determine both direct and indirect relationships among variables. Results showed that children who had been exposed to SMM for longer duration, specifically at age 18 months, showed more behavioural problems at age 4 and 6 years. Positive parenting during preschool and behavioural concerns at age 4 years were main mediators of those associations. Moreover, SMM in minutes at age 18 months was related to decreased preschool cognition. To minimise behavioural problems in school-age children, SMM should be avoided before 2 years of age so that positive parenting may be successfully implemented since early childhood.

Sleep problems in children with autism spectrum disorder and typical development.

BACKGROUND: Although higher sleep problems have been mostly reported in children with autism spectrum disorder (ASD) compared with typically developing (TD) children, particularly in Western countries, such evidence is relatively scarce in developing countries. We therefore investigated sleep difficulties in Thai children aged 3-16 years with ASD compared with age- and gender-matched TD children by using the Children's Sleep Habits Questionnaire (CSHQ)-Thai version. METHODS: Sixty-five children with ASD (mean age 97.7, SD 44.5 months; boys 70.8%) and 65 TD individuals (mean age 98.5, SD 43.5 months) were enrolled at a university-based hospital in Bangkok. Background characteristics, sleep duration variables, and the CSHQ were completed by the participants' parents. The CSHQ subscales and total score between children with ASD and TD controls were then compared. RESULTS: Children with ASD were more likely to have longer sleep latency than TD individuals for both weekdays and the weekend. Those with ASD had higher CSHQ subscales including bedtime resistance, sleep onset delay, sleep anxiety, and night waking in addition to the CSHQ total scores than TD controls. In the ASD group, those who took psychostimulants for treatment of ADHD had lower scores on the sleep duration subscale compared with unmedicated individuals. CONCLUSIONS: Sleep difficulties were more prevalent in children with ASD compared with TD individuals. Parents should be advised to be aware of sleep problems in individuals with ASD. As such, sleep disturbances will be identified early, resulting in appropriate management and improved quality of life, not only for those with ASD but also their families.

Screen media exposure in the first 2 years of life and preschool cognitive development: a longitudinal study.

BACKGROUND: Associations between screen media and child cognition are complex. This study aimed to examine whether age of onset of media exposure, cumulative effect of high media exposure, and verbal interaction during screen time in the first 2 years of life were associated with 4-year-old cognition by including parenting behaviors into the final construct. METHODS: There were 274 healthy participants who were followed up until age 4 years. Screen media data were collected at age 6, 12, 18 months, and 2 years. Cognition or early learning composite (ELC) was evaluated at age 2, 3, and 4 years, where the latter variable was the primary outcome. Positive parenting was obtained by Parenting Styles and Dimensions Questionnaire. RESULTS: ELC at age 2 years was associated with later age of onset of media exposure (ß = 0.113, p < 0.05), fewer months of high media exposure above the upper quartile (ß = 0.282, p < 0.001), and more months of verbal interaction during screen time (ß = 0.261, p < 0.001). ELC at age 4 years was associated with ELC and positive parenting at earlier ages. CONCLUSION: Delayed introduction of screen media, appropriate screen time, and increased verbal interaction during media use in the first 2 years of life were associated with better cognitive development in preschoolers. IMPACT: Associations between screen media exposure and children's cognitive development in existing literature mainly focused on duration of screen media viewing or the content of electronic media in which other factors are rarely explored. Earlier age of onset of media exposure, more months of excessive screen media exposure (>6.5 h/day), and fewer months of verbal interaction with children during media use in the first 2 years of life had associations with decreased preschool cognition. To mitigate undesirable effects of inappropriate screen media use on cognition, delayed introduction of screen media, appropriate electronic media exposure, and increased verbal interaction during media use with children should be recommended at health supervision visits. Lower positive parenting was a mediator for the relationship between cumulative months of high screen media exposure and decreased child cognition.

Behavioral problems in perinatally HIV-infected young children with early antiretroviral therapy and HIV-exposed uninfected young children: prevalence and associated factors.

Although behavioral problems have been observed in children and adolescents with perinatally-acquired HIV infection (PHIV), behavioral information regarding younger PHIV children are scarce. This study aims to identify behavioral problems in PHIV and HIV-exposed uninfected (HEU) children and to evaluate factors associated with such problems. A prospective study of PHIV and HEU young children was conducted. Behavioral problems were assessed with the Child Behavior Checklist (CBCL) at baseline and 12 months later among children aged 18-60 months old. The Patient Health Questionnaire-9 and the Parenting Styles & Dimensions Questionnaire identified primary caregivers' symptoms of depression and parenting styles, respectively, at both visits. Chi-squared analyses were used to compare the prevalence of behavioral problems between groups. Factors associated with behavioral problems were analyzed by logistic regression. From 2016 to 2017, 121 children (41 PHIV and 80 HEU) were assessed with no significant differences in prevalence of Total, Internalizing, Externalizing, and Syndrome scales problems between PHIV and HEU at both visits (p > 0.5). Primary caregivers' depression and lower education in addition to authoritarian and permissive parenting styles were significantly related to child behavioral problems. Family-centered care for families affected by HIV, including positive parenting promotion, mental health care, and education are warranted.

Positive mother-child interactions and parenting styles were associated with lower screen time in early childhood.

AIM: This study examined long-term associations between mother-child interactions and parenting styles and electronic screen time. METHODS: We studied 280 healthy children (53.2% girls) enrolled at a mean age of 36 ± 0.4 months from February 2015 to September 2016. The study included retrospective data on 267 children who had been recruited from medical facilities in Thailand at 6 months of age. Mother-child interaction, parenting styles and screen time were assessed at various ages and path analyses were performed to elucidate the directionality and relationships between the variables. RESULTS: Increased mother-child interaction at 18 months of age was positively associated with less screen time at 2 and 3 years of age. Likewise, nurturing authoritative parenting at 3 years of age was directly related to lower media exposure at 4 years. The total screen time at younger ages had positive direct relationships with relaxed permissive and strict authoritarian parenting styles, but negative direct relationships with nurturing authoritative parenting in subsequent years. CONCLUSION: Early mother-child interaction and nurturing authoritative parenting were associated with subsequent decreased screen time, while media exposure at the age of two was related to relaxed permissive and strict authoritarian parenting at 3 years of age.

Low risk of neurodevelopmental impairment among perinatally acquired HIV-infected preschool children who received early antiretroviral treatment in Thailand.

INTRODUCTION: Antiretroviral therapy (ART) is recommended in perinatally HIV-infected (PHIV) infants immediately upon diagnosis. We aimed to compare neurodevelopmental outcomes between PHIV children who initiated ART within 12 months of life and perinatally HIV-exposed uninfected (PHEU) children and to assess neurodevelopmental outcomes by timing of ART. METHODS: This prospective cohort study included Thai children aged 12 to 56 months who were assessed with the Mullen Scales of Early Learning (MSEL) at enrolment and at 48 weeks. Global Developmental Impairment (GDI) was defined as Early Learning Composite (ELC) ≤ 70 on the MSEL; typical developmental pattern was defined as ELC > 70 at both visits. Logistic regression was used to compare prevalence of any GDI. Predictors of changing ELC scores were analysed with generalized estimating equations linear regression model. RESULTS: From 2016 to 2017, 50 PHIV (twenty-seven early ART within three months and twenty-three standard ART within three to twelve months) and 100 PHEU children were enrolled. Median (IQR) age at first assessment was 28 (19 to 41) months. PHIV children had lower age-relevant Z scores for weight, height and head circumference compared to the PHEU group (p < 0.05). The prevalence of overall GDI was 18% (95% CI 11 to 27) and 32% (95% CI 20 to 47) in PHEU and PHIV children respectively (p = 0.06). In subgroup analysis, 22% (95% CI 9 to 42) of early ART PHIV children and 44% (95% CI 23 to 66) of standard ART PHIV children had overall GDI. There was a higher rate of GDI in standard ART PHIV children (p = 0.01), but not in the early ART group (p = 0.62) when compared with PHEU children. The standard ART PHIV group demonstrated lower typical developmental pattern than both the early ART PHIV group and the PHEU group (57% vs. 77% vs. 82% respectively). Non-attendance at nursery school was associated with changes in ELC score during study participation (adjusted coefficient -3.8; 95% CI -6.1 to -1.6, p = 0.001). CONCLUSIONS: Preschool children with HIV who initiated ART in the first three months of life had a similar rate of GDI as PHEU children. Lack of nursery school attendance predicted poor developmental trajectory outcomes among PHIV children.

Investigation of epigenetic regulatory networks associated with autism spectrum disorder (ASD) by integrated global LINE-1 methylation and gene expression profiling analyses.

BACKGROUND: The exact cause and mechanisms underlying the pathobiology of autism spectrum disorder (ASD) remain unclear. Dysregulation of long interspersed element-1 (LINE-1) has been reported in the brains of ASD-like mutant mice and ASD brain tissues. However, the role and methylation of LINE-1 in individuals with ASD remain unclear. In this study, we aimed to investigate whether LINE-1 insertion is associated with differentially expressed genes (DEGs) and to assess LINE-1 methylation in ASD. METHODS: To identify DEGs associated with LINE-1 in ASD, we reanalyzed previously published transcriptome profiles and overlapped them with the list of LINE-1-containing genes from the TranspoGene database. An Ingenuity Pathway Analysis (IPA) of DEGs associated with LINE-1 insertion was conducted. DNA methylation of LINE-1 was assessed via combined bisulfite restriction analysis (COBRA) of lymphoblastoid cell lines from ASD individuals and unaffected individuals, and the methylation levels were correlated with the expression levels of LINE-1 and two LINE-1-inserted DEGs, C1orf27 and ARMC8. RESULTS: We found that LINE-1 insertion was significantly associated with DEGs in ASD. The IPA showed that LINE-1-inserted DEGs were associated with ASD-related mechanisms, including sex hormone receptor signaling and axon guidance signaling. Moreover, we observed that the LINE-1 methylation level was significantly reduced in lymphoblastoid cell lines from ASD individuals with severe language impairment and was inversely correlated with the transcript level. The methylation level of LINE-1 was also correlated with the expression of the LINE-1-inserted DEG C1orf27 but not ARMC8. CONCLUSIONS: In ASD individuals with severe language impairment, LINE-1 methylation was reduced and correlated with the expression levels of LINE-1 and the LINE-1-inserted DEG C1orf27. Our findings highlight the association of LINE-1 with DEGs in ASD blood samples and warrant further investigation. The molecular mechanisms of LINE-1 and the effects of its methylation in ASD pathobiology deserve further study.

Integrated genome-wide Alu methylation and transcriptome profiling analyses reveal novel epigenetic regulatory networks associated with autism spectrum disorder.

Background: Alu elements are a group of repetitive elements that can influence gene expression through CpG residues and transcription factor binding. Altered gene expression and methylation profiles have been reported in various tissues and cell lines from individuals with autism spectrum disorder (ASD). However, the role of Alu elements in ASD remains unclear. We thus investigated whether Alu elements are associated with altered gene expression profiles in ASD. Methods: We obtained five blood-based gene expression profiles from the Gene Expression Omnibus database and human Alu-inserted gene lists from the TranspoGene database. Differentially expressed genes (DEGs) in ASD were identified from each study and overlapped with the human Alu-inserted genes. The biological functions and networks of Alu-inserted DEGs were then predicted by Ingenuity Pathway Analysis (IPA). A combined bisulfite restriction analysis of lymphoblastoid cell lines (LCLs) derived from 36 ASD and 20 sex- and age-matched unaffected individuals was performed to assess the global DNA methylation levels within Alu elements, and the Alu expression levels were determined by quantitative RT-PCR. Results: In ASD blood or blood-derived cells, 320 Alu-inserted genes were reproducibly differentially expressed. Biological function and pathway analysis showed that these genes were significantly associated with neurodevelopmental disorders and neurological functions involved in ASD etiology. Interestingly, estrogen receptor and androgen signaling pathways implicated in the sex bias of ASD, as well as IL-6 signaling and neuroinflammation signaling pathways, were also highlighted. Alu methylation was not significantly different between the ASD and sex- and age-matched control groups. However, significantly altered Alu methylation patterns were observed in ASD cases sub-grouped based on Autism Diagnostic Interview-Revised scores compared with matched controls. Quantitative RT-PCR analysis of Alu expression also showed significant differences between ASD subgroups. Interestingly, Alu expression was correlated with methylation status in one phenotypic ASD subgroup. Conclusion: Alu methylation and expression were altered in LCLs from ASD subgroups. Our findings highlight the association of Alu elements with gene dysregulation in ASD blood samples and warrant further investigation. Moreover, the classification of ASD individuals into subgroups based on phenotypes may be beneficial and could provide insights into the still unknown etiology and the underlying mechanisms of ASD.

Pattern of video game use in children with attention-deficit-hyperactivity disorder and typical development.

BACKGROUND: Video game playing is a favorite leisure activity among children worldwide. Individuals with attention-deficit-hyperactivity disorder (ADHD) often lack self-control, making them at risk for substance abuse and game addiction. There are conflicting results, however, between studies on the pattern of video gaming and game addiction between those with ADHD and healthy controls. We therefore compared the pattern of video game use and game addiction between Thai children with ADHD and healthy controls. METHODS: A total of 80 participants with ADHD (median age, 9.5 years) and 102 controls (median age, 10 years) were recruited in this study. ADHD was diagnosed by a developmental pediatrician. Each control subject's teacher completed the ADHD questionnaire to ensure that they did not have the diagnosis of ADHD. Pattern of video game use and Game Addiction Screening Test (GAST) were completed by participants' parents. RESULTS: More than half of the children with and without ADHD spent >2 h/day playing video games rather than engaging in other age-appropriate leisure activities, particularly on weekends. Participants with ADHD, however, had a higher rate of compulsive video game use than controls (37.5% vs 11.8%, P < 0.001). CONCLUSIONS: Although video game playing was relatively prevalent in children regardless of ADHD status, those with ADHD had a higher rate of problematic video game use than controls. The pattern of leisure activities including video game use should be assessed during health supervision visits. As such, those at risk for game addiction could be identified early, resulting in appropriate intervention.

Media use and psychosocial adjustment in children and adolescents.

AIMS: Currently, television and new forms of media are readily available to children and adolescents in their daily lives. Excessive use of media can lead to negative physical and psychosocial health effects. This study aimed to describe children's media use, including media multitasking, as well as the associations between media use and their psychosocial adjustment. METHODS: This study recruited 339 participants aged 10-15 years from an international school. The children and their care givers were asked to complete the Strengths and Difficulties Questionnaire independently to evaluate the psychosocial problems of the children. RESULTS: The mean age of the study participants was 12.4 ± 1.5 years, who were recruited from grades 5 to 9. Multitasking media use was reported in 59.3% of participants. The average total media exposure time was 7.0 h/day. The behavioural problem scores from self-reports were greater with increased media use time. After adjusting for confounding variables, the school report and sleep problems were among the factors associated with the total behavioural problem scores from the multiple linear regression analysis (P = 0.001 and <0.001, respectively), whereas age and average total media exposure time were significantly associated with the prosocial behaviour scores reported by the children (P = 0.004 and 0.02, respectively). Multitasking media use was not significantly associated with the total difficulties scores or the prosocial behaviour scores in this study. CONCLUSION: Increased media use time was significantly associated with decreased prosocial behaviour scores in children in this study. This can provide important information to parents regarding media use in children.

Screen viewing time and externalising problems in pre-school children in Northern Thailand.

OBJECTIVES: There are increasing reports of younger children accessing media and screen. This study aims to describe screen use in pre-school children and its association with externalising problems. METHODS: A cross-sectional study of pre-schoolers aged two to five years was conducted. Their caregivers were asked to provide data regarding screen use by their children and themselves. The Child Behaviour Checklist (CBCL) was completed by caregivers to assess their child's behaviour. RESULTS: Participants included 200 caregivers of pre-school children. There were 47% of pre-schoolers who had used at least three types of media. When comparing the 0-1, >1 to 2, and >2 hours per day of screen viewing time groups, the children who had experienced more screen time also had significantly more background media and their caregivers had more screen time (p < 0.001). The externalising problem scores increased with more screen viewing time, although the relationship was not statistically significant. However, age and gender of the child were factors associated with externalising problems from the multiple linear regression analysis (p = 0.03). CONCLUSION: Pre-schoolers with more screen viewing time did not have a significantly greater externalising problem score than those with less screen time. A longitudinal study with a larger sample size would provide more information.