Executive dysfunction as a possible mediator for the association between excessive screen time and problematic behaviors in preschoolers.

Excessive screen time in children is a growing concern for parents and healthcare providers worldwide because it frequently leads to behavioral problems. Although executive dysfunction is proposed to be one of the contributing factors to maladaptive behaviors, little is known about the link between screen time and behaviors. This study aimed to identify whether executive dysfunction contributes to the negative behaviors of children exposed to excessive screen time. A cross-sectional study was conducted on preschool-aged children from public and private schools in Chiang Mai, Thailand. The parents/guardians of each child completed the questionnaires regarding clinical characteristics and screen time use, the Behavior Rating Inventory for Executive Function-Preschool (BRIEF-P), and the Strengths and Difficulties Questionnaire (SDQ). Children with more than one hour of media exposure per day were considered to have excessive screen time. Multivariable Gaussian regression was analyzed to compare the BRIEF-P and SDQ scores between the excessive and appropriate screen time groups. Causal mediation analysis was performed to examine the effects of total screen time on increasing behavioral problems with executive functioning as a mediator. A total of 1,126 preschoolers were included in the analyses. After controlling for age, sex, socioeconomic status, and maternal education, the excessive screen time group had significantly higher BRIEF-P global executive composite score than the appropriate screen time group (mean difference of global executive composite score = 1.49, 95% CI [0.12, 2.86], and p = 0.033). Concurrently, there were significant differences in externalizing behavior subscales and SDQ total difficulties scores between the excessive and appropriate screen time groups (mean difference of total difficulties score = 0.90, 95% CI [0.29, 1.50], and p = 0.004). A significant average causal mediation effect (ACME) of screen time on behavioral problems mediated through executive functioning was ß = 0.28, 95% CI [0.13-0.44], which was more than half of the total effect (54.9%, 95% CI [37.4-100%]). The current study suggests that the increase in behavioral issues in preschoolers might be partly explained by the direct effect of excessive screen time and the mediating effect of impaired executive functioning. Our results may raise concerns about the necessity to limit screen time and monitor for executive function deficits and behavioral problems in young children with high screen time.

Association between executive function and excess weight in pre-school children.

The association between executive function and excess weight is becoming increasingly evident. However, the results of previous studies are still inconclusive, and there is a lack of evidence in early childhood. This study aims to examine the association between executive function, in terms of overall and subscales of executive function (e.g., inhibition, working memory, and shifting), and weight excess in preschoolers. A population-based cross-sectional study was conducted on children aged 2-5 years of age from public and private schools in Chiang Mai, Thailand. Participants' weights and heights were measured and classified into three weight status groups (i.e., children with normal weight, overweight, and obesity groups). Executive function was assessed using the parent-report Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P). Multivariable polynomial regression was performed to analyze the association between executive function and weight status. A total of 1,181 children were included in the study. After adjusting for confounders, impaired overall executive function significantly increased the probability of being overweight (odds ratio [OR] = 2.47; 95% confidence interval [CI] 1.33 to 4.56). A similar trend of association was also found between impaired inhibition and overweight status (OR = 2.33; 95%CI 1.11 to 4.90). Furthermore, poor working memory was associated with both overweight and obesity (OR = 1.87; 95%CI 1.09 to 3.20 and OR = 1.74; 95%CI 1.09 to 2.78, respectively). Our data suggest that deficits in executive function, particularly inhibition and working memory, are associated with weight excess in preschoolers. Early promotion of executive function may be needed at this developmental age to prevent unhealthy weight status.

Bidirectional prediction between weight status and executive function in children and adolescents: A systematic review and meta-analysis of longitudinal studies.

This study examined the predictability of child weight status on executive function (EF) and vice versa. We searched PubMed, CINAHL, Web of Science, and EMBASE for longitudinal studies conducted in children and adolescents on October 31, 2021. A pairwise meta-analysis was performed using a frequentist random-effects approach. The quality of all included studies was evaluated using Newcastle-Ottawa Scale and GRADE assessments. This study included 18 longitudinal studies (N = 30,101). Overall executive functioning was a significant negative predictor of child weight status (pooled beta coefficient = -0.14; 95% confidence interval [CI] [-0.22 to -0.07]; I2 = 97%). The pooled odds ratio also revealed that high EF children had a significant lower risk for developing overweight/obesity (odds ratio [OR] = 0.72; 95% CI [0.59 to 0.87]; I2 = 72%). Conversely, child weight status was a significant negative predictor of overall executive functioning (pooled beta coefficient = -0.06; 95% CI [-0.12 to -0.01]; I2 = 81%). These results suggest a bidirectional prediction between child weight status and EF. These predictabilities are low but potentially beneficial for implementation in childcare systems.

The Effects of Neurofeedback on Executive Functioning in Children With ADHD: A Meta-Analysis.

OBJECTIVE: Possible beneficial effects of neurofeedback in improving ADHD functional outcomes have been increasingly reported. This meta-analysis aimed to evaluate the relationship between neurofeedback and executive functioning in children with ADHD. METHODS: PubMed, EMBASE, EBSCO, Web of Science, and Cochrane databases were searched to identify studies reporting the effects of neurofeedback on executive functioning, including response inhibition, sustained attention, and working memory, assessed by neuropsychological tests. Only randomized controlled studies of children aged 5 to 18 years were included using a random-effects model. RESULTS: Ten studies were included. The effects of neurofeedback were not found on three domains of executive functions. A meta-regression analysis revealed a trend of numbers of neurofeedback sessions positively associated with response inhibition (p = .06). CONCLUSION: Results did not show the benefits of neurofeedback on executive functions assessed by neuropsychological tests. Future studies should focus on standard neurofeedback protocols, the intensity of intervention, and neuropsychological outcomes.

Alterations of Gut Bacteria in Hirschsprung Disease and Hirschsprung-Associated Enterocolitis.

Hirschsprung-associated enterocolitis (HAEC) is a common life-threatening complication of Hirschsprung disease (HSCR). It has been proposed that gut microbiota, which have an essential role in gut-homeostasis, are associated with HAEC. Recent studies demonstrated an increase in alpha diversity of fecal microbiota over time in HSCR mice and a decrease in diversity after surgery. In addition, clinical studies have reported a reduction in bacterial richness in HSCR children after surgery. Some studies revealed a difference in microbiota between the proximal ganglionic and distal aganglionic intestine and found a difference in bacterial character between fecal and colonic specimens. HAEC studies found an increase in Proteobacteria, especially Escherichia and Enterobacteriaceae, with a decrease in Firmicutes and Bifidobacterium in HAEC patients. However, the direction of alpha diversity in HAEC patients is still controversial. The self-comparison of microbiota in treatment periods suggested that probiotics might improve gut dysbiosis and decrease the frequency of enterocolitis, but some reported contradictory findings. This review comprehensively summarizes and discusses key findings from animal and clinical data of the distinct microbiome associated with HCSR and the association of gut dysbiosis with the development of HAEC. This information should be useful in the establishment of novel interventions to improve gut dysbiosis and prevent enterocolitis in HSCR patients.

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).

Profiles of urine and blood metabolomics in autism spectrum disorders.

Early diagnosis and treatment for autism spectrum disorder (ASD) pose challenges. The current diagnostic approach for ASD is mainly clinical assessment of patient behaviors. Biomarkers-based identification of ASD would be useful for pediatricians. Currently, there is no specific treatment for ASD, and evidence for the efficacy of alternative treatments remains inconclusive. The prevalence of ASD is increasing, and it is becoming more urgent to find the pathogenesis of such disorder. Metabolomic studies have been used to deeply investigate the alteration of metabolic pathways, including those associated with ASD. Metabolomics is a promising tool for identifying potential biomarkers and possible pathogenesis of ASD. This review comprehensively summarizes and discusses the abnormal metabolic pathways in ASD children, as indicated by evidence from metabolomic studies in urine and blood. In addition, the targeted interventions that could correct the metabolomic profiles relating to the improvement of autistic behaviors in affected animals and humans have been included. The results revealed that the possible underlying pathophysiology of ASD were alterations of amino acids, reactive oxidative stress, neurotransmitters, and microbiota-gut-brain axis. The potential common pathways shared by animal and human studies related to the improvement of ASD symptoms after pharmacological interventions were mammalian-microbial co-metabolite, purine metabolism, and fatty acid oxidation. The content of this review may contribute to novel biomarkers for the early diagnosis of ASD and possible therapeutic paradigms.

Scurvy mimicking as systemic lupus erythematosus.

Scurvy is a disease caused by chronic vitamin C deficiency. The greater prevalence was found in the paediatric population with neurodevelopmental disorders such as autism spectrum disorders due to their restricted dietary intake. Our case reported a child with autism who presented with arthralgia and anaemia. Systemic lupus erythematosus was the first diagnostic impression, resulting in over investigation and delayed diagnosis of vitamin C deficiency. After the child was treated with ascorbic acid, the child's symptoms resolved. This case highlighted the importance of developmental and nutritional history taking in the paediatric population. Furthermore, parents and physicians should be concerned about nutritional status, especially in children with restrictive dietary intake.

Resilience in adolescents with thalassemia.

Adolescents with thalassemia often manifest with an increased risk of emotional and behavioral problems, as well as poor quality of life. However, some can be well-adapted and demonstrate evidence of resilience. This study aimed to explore resilience among those with thalassemia and determine the protective factors for their resilience. Sixty adolescents with thalassemia and 60 healthy adolescents as a comparison group participated in the study. Most adolescents with thalassemia demonstrated resilience. Eighty percent of them scored in the low-risk range of the SDQ total difficulties scale, and 91.7% scored in the low-risk range of the SDQ prosocial scale. The mean total difficulties scores of the thalassemia patients and the healthy controls were 11.38 and 11.27 respectively, whereas the mean prosocial scores were 7.28 and 6.65, without statistical significance. Despite the extensive demands of the illness, most adolescents with thalassemia appear to be adapted well, demonstrating evidence of resilience. Factors promoting resilience are lower BMI, less severe type of thalassemia, and younger age at the start of an iron chelator. Health care professionals who take care of adolescents with thalassemia should collaborate to improve their resilience.

Prevalence of unprotected motorcycle riding and its association with other risk behaviors among adolescents in Chiang Mai, Thailand.

OBJECTIVES: To determine the prevalence of helmet use in Chiang Mai province in Thailand and identify the association between helmet use, externalized behaviors, and other risk-taking behaviors. METHODS: A cross-sectional study was conducted using the Youth Risk Behavior Survey, Thai version. Risky motor vehicle behaviors and other risk-taking behaviors of 4,372 adolescents were measured. Behavioral problems from the Youth Self-Report were also obtained from all participants. RESULTS: A total of 2,981 adolescents (68.2%) reported motorcycle riding, of which, 36.3% reported unprotected riding. Females, younger age, attending secondary school, and those with academic underachievement were related to the unprotected riding group. Unprotected riding was significantly associated with other risky traffic behaviors and also related to other risk-taking behavior such as violence and substance use. Significantly higher behavioral problems scores were found in unprotected riding adolescents (p < 0.001). CONCLUSIONS: The prevalence of unprotected riding and other risk behaviors in Thai adolescents were high. Safety traffic riding campaigns should start in late primary school focusing on those females with poor academic achievement.

Noonan Syndrome in Thai Children.

This study describes clinical features of Noonan syndrome and gene mutations, including PTPN11, SOS1, and BRAF in the Thai population.Widely spaced eyes were the most common finding from the digital facial analysis technology used in this study.

Possible links between gut-microbiota and attention-deficit/hyperactivity disorders in children and adolescents.

An association between gut-microbiota and several neuropsychiatric conditions including autism, depression, anxiety, schizophrenia, and attention-deficit/hyperactivity disorder (ADHD) has been observed. Despite being the most prevalent neurodevelopmental disorders in children and adolescents worldwide, the etiology and curative approaches to treatment of ADHD remain unclear. There is a probability that gut-microbiota may contribute to ADHD via bidirectional communication between the gut and brain, a system known as the "gut-brain axis". Although a mechanistic link in the gut-brain axis in ADHD has been proposed, there is still a lack of information about the correlation of the microbiome profile with the mechanisms involved. The objective of this review was to summarize the diversity of the gut-microbiota and taxonomic profiles in children and adolescents with ADHD. In this review, we have provided an overview of the association between ADHD and gut-microbiota. The evidence pertinent to potentially distinctive gut-microbiota in children and adolescents with ADHD is also discussed and compared to that of their non-ADHD peers. Finally, the implications and future directions for investigation into the gut microbiome in ADHD patients are proposed.

Emotional and behavioral problems among sexual minority youth in Thailand.

BACKGROUND: Sexual minority youth (SMY) had more risk behaviors and mental health problems than heterosexual youth. Relatively little research has differentiated among lesbian/gay, bisexual, and questioning (LGBQ) youth. OBJECTIVE: To examine the differences in emotional and behavioral problems between LGBQ youth in the city of Northern Thailand. METHODS: Data were from a school-based, cross-sectional study of grade 7-12 students in secondary and vocational schools. Five hundred and forty-three students who identified themselves as LGBQ and 3829 heterosexual peers completed the Youth Self-Report (YSR). RESULTS: Of 12.4% of LGBQ participants, 4.1% identified themselves as lesbian/gay, 4.8% as bisexual, and 3.5% were unsure. SMY had significantly higher scores in internalizing problems (16.84 VS 13.99, 95% confidence interval [CI] 1.94-3.77, P < 0.001), externalizing problems (15.23 VS 13.51, 95% CI 0.97-2.45, P < 0.001), and total behavioral scores (55.26 VS 47.16, 95% CI 5.55-10.63, P < 0.001) than their heterosexual peers. In sexual minority subgroup analyses, all syndrome subscales were highest in the bisexual group followed by the lesbian/gay group, and the questioning group, respectively. CONCLUSION: LGBQ high school students had greater psychosocial problems than their heterosexual counterparts. Bisexual students were at the greatest risks of emotional and behavioral problems. Pediatricians and school mental health providers should be aware of emotional and behavioral problems among LGBQ students.

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.

Health-Related Quality of Life in Adolescents with Thalassemia.

Children and adolescents with thalassemia suffer from chronicity of the disease and its treatment, including transfusion dependence and complications of iron overload. This study aimed to assess the health-related quality of life of adolescents with thalassemia compared with healthy controls. Sixty-four adolescents with thalassemia aged 13 to18 years and their parents were enrolled in this cross-sectional study, as well as their age- and gender-matched those of the healthy controls (64 participants and their parents). The Pediatric Quality of Life Inventory 4.0 Scales (PedsQL 4.0) self-report form was administered to the adolescents in both groups. Parents were also asked to complete the PedsQL 4.0, parent proxy-report form. The self-reported total, psychosocial, and school functioning scores of the thalassemia patients were significantly lower than those of the healthy controls (p = 0.03, 0.04, and <0.001, respectively). The parent-reported psychosocial and school functioning scores of the thalassemia group were also significantly lower than those of the controls (p = 0.03 and 0.003, respectively). Among adolescents with thalassemia, the serum ferritin level and comorbidity were the only variables associated with quality of life scores. This study showed that thalassemia negatively affected quality of life. For a better quality of life, thalassemia patients should be monitored for serum ferritin levels and treated for comorbidity as part of their comprehensive health care.