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.

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.

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.

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).

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.

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.

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.

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.

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.

Background media exposure prolongs nighttime sleep latency in Thai infants.

BACKGROUND: Less is known about the effect of screen time and sleep at a younger age on current sleep outcome in infants. Therefore, we examined whether sleep parameter at a younger age and daily exposure of electronic media could predict sleep outcomes in 12-mo-old Thai infants. METHODS: There were 208 typically developing infants enrolled since 6 mo old. Each main caregiver completed a sleep questionnaire and was interviewed for the infant's screen exposure at 6 and 12 mo of age. Nighttime sleep latency and sleep duration were calculated. Electronic media and sleep outcomes were analyzed using multiple linear regressions and path analysis. RESULTS: Longer sleep latency at age 12 mo was predicted by longer daily duration of media exposure and longer 6-mo-old sleep latency. Infants who were exposed to electronic media above the median at both ages had longer 12-mo-old nighttime sleep latency compared with those who were exposed to the screen below the median at both ages. CONCLUSION: Six-month-old nighttime sleep latency and 12-mo-old electronic media exposure could predict 12-mo-old nighttime sleep latency. Relative changes in media exposure over time can provide a better prediction of nighttime sleep latency in Thai infants than screen exposure at either time point.

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.

Increased Sleep Disturbances in Thai Children With Attention-Deficit Hyperactivity Disorder Compared With Typically Developing Children.

This study compares sleep disturbances in Thai children aged 5-12 years with attention-deficit hyperactivity disorder (ADHD) and typically developing children using the Children's Sleep Habits Questionnaire (CSHQ)-Thai version. Fifty-five children with ADHD and 110 typically developing children were enrolled. Their parents completed the CSHQ, the ADHD rating scales, and the Strengths and Difficulties Questionnaire (SDQ). Children with ADHD had significantly higher scores in all subscales of the CSHQ compared to controls. Among children with ADHD, children with higher SDQ scores (> 15) appeared to have more sleep disturbances than those with relatively lower SDQ scores. Moreover, fewer sleep-related behavioral problems were observed in the medication treated group, which is particularly new to the field and for some perhaps not unexpected clinically.

Risk factors for autism spectrum disorder in the Thai population.

UNLABELLED: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder commonly prevalent in children worldwide including Thailand. However, there are very few studies thus far addressing risk factors for ASD in Thai children. This case-control study aims to investigate whether various risk factors especially socioeconomic status, advanced parental age (age >35 years), perinatal factors, maternal autoimmune diseases, and family history of neuropsychiatric illnesses were associated with the risk of having an offspring with ASD. There were 235 children with ASD (age 8.44 ± 3.37 years) and 235 controls (age 8.39 ± 3.37 years) enrolled in this study. The risk of developing ASD in these children included advanced paternal age (adjusted odds ratio (AOR) = 3.49, 95 % confidence interval (CI) = 2.05-5.96), family history of neuropsychiatric illnesses particularly if such disorders came from the paternal side of the child's family (AOR = 2.87, 95 % CI = 1.29-6.39), and having unemployed mothers (AOR = 1.65, 95 % CI = 1.08-2.54). CONCLUSION: This study supports previous findings of Western countries where risk factors for ASD tend to occur in children whose fathers were of advanced paternal age and in the families with neuropsychiatric illnesses particularly if such disorders came from the paternal side of the child's family. WHAT IS KNOWN: • Family history of neuropsychiatric disorders and advanced paternal age are risk factors for ASD in the offspring previously identified in the studies in Europe and North America. What is New: • To our knowledge, this is the first study documenting risk factors for ASD in the Asian population. • Our study supports previous findings of Western countries where risk factors for ASD tend to occur in the families with neuropsychiatric illnesses particularly if such disorders came from the paternal side of the child's family.

Evening media exposure reduces night-time sleep.

AIM: To investigate whether evening media exposure, bedroom media use and night-time sleep duration at age 6 months are associated with night-time sleep duration in 12-month-old Thai infants. METHODS: We enrolled 208 infants in this study at 6 months of age. They were followed-up at 12 months of age. A sleep diary was used to document the infant's sleep onset and wake time at each visit. Night-time sleep duration was then calculated at both ages. Screen media exposure in the household was assessed in depth at both visits. RESULTS: Infants who were exposed to screen media in the evening at 12 months of age had a 28-min decrease in 12-month night-time sleep duration on weekdays. Moreover, infants who were exposed to screen media in the evening at age 6 months and 12 months had shorter 12-month night-time sleep duration compared with those who were not exposed to screen media after 7 pm at both ages. Night-time sleep duration at 12 months of age was also directly related to 6-month night-time sleep duration. CONCLUSION: Infants exposed to screen media in the evening at 12 months of age had decreased 12-month night-time sleep duration. To promote good sleep hygiene and optimal sleep for infants at this age, screen media exposure after 7 pm should be avoided.

Elevated background TV exposure over time increases behavioural scores of 18-month-old toddlers.

AIM: To investigate whether trends of TV exposure from age six to 18 months and adult TV programmes were associated with behavioural concerns of 18-month-old Thai toddlers. METHODS: There were 194 healthy infants recruited at age six months and followed up until 18 months of age in this present cohort. TV exposure variables were assessed by interviewing in depth at both six- and 18-month-old visits. A mother of each participant rated the child's behaviours using the Child Behaviour Checklist. RESULTS: Infants who were increasingly exposed to TV from age six to 18 months with adult programmes since six months of age had higher pervasive developmental problems and oppositional defiant behaviours scores. Exposure to adult TV programmes at age six months was also associated with emotionally reactive problems, aggression and externalising behaviours in the final regression models. CONCLUSION: To promote appropriate toddlers' behaviours at age 18 months, elevated background TV exposure over time should be discouraged. Furthermore, paediatricians should emphasise such effects of TV exposure on child behaviours with parents at health supervision visits. As such, parents will be aware of the detrimental effect of increased background TV exposure over time on their children's behaviours.

Sleep Behaviors and Sleep Problems in School-Aged Children in Thailand.

BACKGROUND: Sleep problems can have a significant effect on children behaviors, emotional and cognitive developments. However, limited information is available regarding the sleep behaviors and sleep problems of school-aged children in Thailand. The purposes of this study were to examine the prevalence of sleep problems and to describe sleep/wake pattern of Thai children. MATERIAL AND METHOD: The school-based, cross-sectional study was conducted in 5 primary public schools selected from Bangkok and three regions of Thailand. The samples were selected from the first and fourth grades of each school. The Children's Sleep Habits Questionnaire (CSHQ) was used to evaluate sleep behaviors and sleep problems. RESULTS: Grade 1 children went to bed earlier and had longer weekday sleep duration comparing with grade 4 children. Sleep duration was significantly shorter in children living in Bangkok, comparing with those living in rural areas. Mean total CSHQ score was significant higher in grade 1 children, when comparing with grade 4 children (51.30 vs. 50.18; p = 0.026). Grade 1 children scored significantly higher on bedtime resistance (10.96 vs. 10.39; p = 0.004) and sleep anxiety subscale (6.68 vs. 6.41; p = 0.022), while grade 4 children scored significantly higher on sleep-onset delay subscale (1.41 vs. 1.23; p < 0.001). Prevalence of sleep problems was highest in the category of "falling asleep while riding in car or bus" (69.5%), followed by "awakening by others in the morning" (68.5%). CONCLUSION: Sleep problems were common in Thai school-aged children. The most common sleep problems were in the domains of daytime sleepiness and bedtime resistance and anxiety.

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.