Anodal transcranial direct-current stimulation and non-verbal intelligence in autism spectrum disorder: A randomized controlled trial.

AIM: To understand the impact of anodal transcranial direct-current stimulation (tDCS) on non-verbal intelligence in high-functioning young adults with autism spectrum disorder (ASD). METHOD: Thirty individuals with ASD were randomly divided into three groups receiving 2 mA, 20 minutes daily anodal tDCS for 10 sessions. Group A received 10 sham tDCS sessions, group B five real followed by five sham sessions, and group C received 10 real tDCS sessions. The total score of non-verbal intelligence was measured using the Test of Nonverbal Intelligence, Fourth Edition. The left dorsolateral prefrontal cortex (LDLPFC) was targeted using the International 10-20 electroencephalography system, and concurrent cognitive training was avoided. RESULTS: Group C demonstrated a mean difference of 4.10 (95% confidence interval 1.41-6.79; p = 0.005) in Test of Nonverbal Intelligence scores compared with group A, with an effect size of 0.47. No significant differences were observed between groups A and B (p = 0.296), or between groups B and C (p = 0.140). INTERPRETATION: Ten sessions of anodal tDCS to the LDLPFC led to improved non-verbal intelligence among individuals with ASD. These results emphasize the potential of tDCS as a discrete method for boosting cognitive abilities in the high-functioning population with ASD. Future studies with larger groups of participants and extended observation periods are necessary to validate these findings.

Long-term effects of transcranial direct current stimulation in the treatment of autism spectrum disorder: A randomized controlled trial.

AIM: To compare the efficacy of 0, 5, and 20 sessions of transcranial direct current stimulation (tDCS) for reducing symptoms of autism spectrum disorder (ASD). METHOD: Thirty-six male children with ASD (mean age 2 years 3 months, SD 4 months, age range 1 years 6 months-2 years 11 months) were balanced and stratified by age, sex, and baseline severity of ASD, to: (1) a control group that received 20 sessions of sham tDCS; (2) a 5-session tDCS group (5-tDCS) that received 5 sessions of active tDCS followed by 15 sessions of sham tDCS; and (3) a 20-session tDCS group (20-tDCS) that received 20 sessions of active tDCS. All groups participated in the special school activity of Khon Kaen Special Education Center, Thailand. The primary outcome was autism severity as measured by the Childhood Autism Severity Scale. RESULTS: The 5-tDCS and 20-tDCS groups evidenced greater reductions in autism severity than the control group at days 5 and 14, and months 6 and 12. There were no significant differences in the outcome between the 5- and 20-tDCS groups at any time point. Within-group analysis showed clinically meaningful improvements starting at month 6 for the participants in the control group, and clinically meaningful improvements starting on day 5 in both active tDCS groups, all of which were maintained to month 12. INTERPRETATION: The 5- and 20-session tDCS seems to reduce autism severity faster than sham tDCS. These effects maintained at least for 1 year. WHAT THIS PAPER ADDS: Twenty sessions of transcranial direct current stimulation (tDCS) were not superior to five sessions. Sham tDCS with a special school activity can reduce autism severity starting at 6 months after treatment. The benefits observed for 5 and 20 sessions of tDCS last for at least 12 months.

Effectiveness of Networking of Khon Kaen University Community-Based Speech Model: Quality of Life.

Background: After surgically correcting deformities in children with cleft lip/palate (CLP), 88% still had speech disorders, resonance disorders, voice abnormalities, and unintelligibility that affected daily life. Accessibility to speech therapy in developing countries is limited. The community-Based Speech Therapy Model is one means of improving communication and quality of life. Objective: To evaluate quality of life and reflections from children, families, and speech assistants (SAs) who participated in Networking of Khon Kaen University Community-Based, Speech Therapy Model (KKUCBSM) in Mahasarakham province. Material and Method: The model was piloted from March 2014 to February 2015. The Tawanchai Quality of Life questionnaire, General Health Questionnaire (Thai GHQ-12), and open-ended question feedback were used for collecting data June to August 2015. Demographic data were reported as percentages, means, standard deviations, and content analysis of openended questions. Results: Fourteen children with cleft lip and palate (mean age 5.5 years: 7 boys, 7 girls), 14 caregivers and 6 SAs were recruited for this study. Most caregivers were parents (9 families). Their needs were dental care followed by skills to support child development and skills to improve the children's speech (score 4.64+0.497, 4.57+0.646, 4.50+0.519, respectively). The score for psychosocial satisfaction vis-a-vis facial appearance was good (3.50+0.760), but for negative result scores, they felt significantly less happy, tired, and hopeless (4.79+0.579). The anxiety score was in the normal range. As a result of interviewing about problems and obstacles before joining, caregivers reported their greatest problems arose from difficulties traveling to join the project (costs were greater than reimbursements and time was insufficient). SAs reported being overworked. Benefits from participation in the project included: children with clefts consistently accessed speech services by SAs in community, caregivers gained good experiences for daily living support and speech correction. SAs gained experiences in speech correction under supervision of Speech and language pathologists (SLPs) that could be used to help other children with speech defects and other patients besides children with clefts. Conclusion: KKUCBSM for children with CLP was not only the effective way for solving articulation defects, but also improved quality of life in children with CLP.

Rate of Serum Valproate Concentration Monitoring in Patients with Bipolar Disorder Type I at Srinagarind Hospital Outpatient Clinic.

Objective: Determine in the out-patient setting the rate and the purpose of serum valproate concentration monitoring during treatment with valproate, either single valproate or valproate in combination with other psychotropics in patients with bipolar disorder type I (BD-I), to determine the rate of recording valproate associated adverse effects, the rate of the follow-up and the length (days) that the patients were in the condition of full remission/recovery and symptomatic. Material and Method: The present study was a retrospective descriptive study done between January 1, 2007 and December 31, 2008. The data were from the medical records of DSM-IV-TR BD-I out-patients at Srinagarind Hospital, Khon Kaen who were treated either by single valproate or valproate in combination with other drugs for at least six weeks long. The studied variable included the annual rate and the reason that psychiatrist requested serum valproate concentration (SVC) monitoring per patient, the annual rate that psychiatrist recorded the valproate associated adverse effects, the annual rate that the patient returned to have a follow-up visit, and the length (days) that the patient was in full remission/recovery and symptomatic. Results: During the study period, of the 199 patients with BD-I, only 57 patients (28.6%) that were treated with valproate had complete records. The SVC monitoring occurred 17 times from 13 patients (22.8%). The mean SVC was 76.4 microgram/ml (SD = 31.8). The mean value +SD and range of SVC during the remission/recovery period were 75.1+17.5 µg/ml and 43.5-96.8 µg/ml, which was not significantly different from the symptomatic period, which was 77.1+39.9 µg/ml and 0.7 to 124.9 µg/ml. However, the oral dosage of valproate during the remission/recovery period (944.7+275.4 mg/day, median 1,000 mg/day) was significantly higher than during the symptomatic period (699.0+592.5 mg/day, 1,000 mg/day) (t = 2.7, df = 104 and p = 0.009). Of all the SVC monitoring, 58.8% occurred during the symptomatic period and most of the monitoring was due to the emergence of adverse effects. The causes for requesting the SVC determination were the emergence of adverse effects (29.4%), no reason specified (29.4%), and to monitor the clinical response (11.8%). The rate of valproate associated adverse effects recording was 1.1 times/person/year, which was 18.6% of the average rate of follow-up visits (6.6 times/person/year). The most frequent adverse effect was sedation. The treatment of BD-I by valproate or in combination with other psychotropics resulted in the remission/recovery period lasting 470.2 days (SD 256.8, median 517.0) while the symptomatic period lasted 176.1 days (SD 157.5, median 139.5). Conclusion: During treatment of BD-I, the rate of serum valproate concentration monitoring was very few. However, when determination was requested, the SVC was within the therapeutic range. In addition, rate of recording of valproate associated adverse effects was very low and the most frequent adverse effect was mild. The reason for monitoring the clinical response was rarely found. Valproate seems to be easily administered. The dosage can be adjusted using only clinical response and adverse effects. Therefore, valproate was effective and safe in treatment of BD-I.

Clinical outcomes of primary palatoplasty in pre-school-aged cleft palate children in Srinagarind hospital: quality of life.

BACKGROUND: Cleft lips and cleft palates are common congenital anomalies, which affects facial appearance, speech, hearing, teeth alignment and other structures. Craniofacial anomalies and speech disorders are crucial problems in the preschool-aged children (5-6 years old), when they start attending school and become more engaged in the community. This condition, which differentiates them from other students, can lead to teasing or mocking which can cause low-self esteem, an inferiority complex, andfoster bad relationships with friends. Missing class in order to receive treatment and other additional care can affect a student's learning, development and overall-quality of life. OBJECTIVE: The purpose of this research was to study the quality of life in preschool-aged cleftpalate children and satisfaction with their level of speech. MATERIAL AND METHOD: This was a retrospective, descriptive study. The data were collected by reviewing medical records of patients with cleft lip and cleft palate aged 5-6 years old who underwent operation and treatment with the Tawanchai Center at Srinagarind Hospital. There were 39patients in this study. Data collection was conducted for 5 months (June to October 2013). The research instruments were: (1) General Demographic Questionnaire, (2) Quality of Life Questionnaire with 5 Domains, and (3) the Satisfaction of Speech Questionnaire. The descriptive statistics, percentages and the standard deviation were analyzed in the present study. RESULTS: The findings revealedfamily information pertaining to CLP treatment and the impact it has on consumption, speech training, hearing test, development, dental treatment, communication skills, participation, referral treatment as well as the quality ofcoordinationfor advanced treatment. The present study revealed that all ofthe aforementioned criteria were met at a high level. Moreover the child's sickness had only a moderate impact on family life. In conclusion, the overall satisfaction was at a very high level. CONCLUSION: It was concluded that the collaboration of the Tawanchai Cleft Center and the government, as well as with private and non-governmental organizations was exceptional, particularly in regard to providing proper and continuous treatment for patients with cleft lips and/or cleft palate. The findings reflect a good quality of life in the pre-schooled children with cleft lip and cleft palate that received treatment from the Tawanchai Cleft Center at Srinagarind Hospital. Furthermore, the study showed that the problems associated with the condition, only affected the family's lives at a minimal level.

Development outcomes of Thai children with cleft lip/palate at 5-years-old.

OBJECTIVE: To measure the development outcomes among Thai children with non-syndromic cleft lip and/or palate (CLP) treated at the Tawanchai Center 5 years after birth. MATERIAL AND METHOD: Using a developmental screening test, Thai children with CLP were followed-up at the center. RESULTS: Nearly two-thirds (62.5%) of 24 Thai children with CLP had delayed development. Eight of the children had more than one delayed category and 13 both "delayed" and "caution". Delayed language, personal, social and fine motor skills occurred in 54.2%, 20.8% (5/24) and 20.8% (5/24) of cases, respectively. CONCLUSION: An understanding of the incidence of the different types of delays will help our center to improve our treatment standards and place more emphasis on psychosocial and development outcomes.

Tawanchai Cleft Center quality of life outcomes: one of studies of patients with cleft lip and palate in Thailand and the Asia Pacific Region.

BACKGROUND: The needs and quality of life (QOL) of children with cleft lip and palate (CLP) after being processed through the healthcare system are important in order to understand how to improve the standards of care. The Tawanchai Cleft Center of Thailand in collaboration with Cleft Lip and Palate Care Center of the Asia Pacific Region, conducted a number of studies on various aspects of treatment outcomes as an indication of its performance. This paper presents the outcome effects on QOL. OBJECTIVE: To determine (a) the QOL of children with CLP in Northeast Thailand registered and followed-up at the Tawanchai Centre, (b) their ongoing care needs and (c) the mental health of their parents when the children reach 5 years of age. MATERIAL AND METHOD: Using the Need, Satisfaction, QOL and GHQ-12 questionnaires, the authors evaluated 36 five-year-old children with CLP, living in Northeast Thailand, registered at birth for treatment at the Tawanchai Cleft Center. RESULTS: The aspects most needing attention were: dental, speech therapy and local healthcare service. The QOL was low in the economic, child relationships and psychological domains. The parents need more training on how to raise children with CLP most appropriately. According to the GHQ-12, none of the families identified any mental problems. CONCLUSION: Children with CLP at five years of age under the care of the Tawanchai Cleft Center by their own self-assessment have satisfactory outcomes in most domains. Notwithstanding, there is need to improve parent training and access to dental care, speech therapy and local healthcare services.

Epidemiology of assault-related hospitalizations in Thailand in the fiscal year 2010: comparison between with and without psychiatric disorder.

BACKGROUND: Assault is a leading cause of injury and death; however little is known regarding the psychiatric epidemiology of assault-related hospitalizations (ARH) in Thailand. OBJECTIVE: To analyze the epidemiological data of ARH in Thailand for the fiscal year 2010 and to compare the epidemiology of ARH between with and without psychiatric disorder MATERIAL AND METHOD: The data analyzed were from the annual reports for the fiscal year 2010 (October 1, 2009-September 30, 2010), on every kind of hospitalization reimbursed by the Universal Health Coverage System, the Social Welfare System, and the Civil Servant Medical Benefits Scheme, altogether provided medical coverage for more than 96% of the Thai population. The information on ARH (X85-Y09: ICD-10 version for 2010) and comorbid psychiatric disorder(s) (F00-F99) were extracted. Number of in-patient hospitalizations by sex, age, geographical region, month, hospital charges, length of hospital stay (LOS) and mortality rate (MR) were analyzed. Frequencies (percentages) of ARH and subgroups were reported. RESULTS: The national ARH care cost was 0.98% of the overall national in-patient care expenses (88,964 million Baht). The rate of ARH was 0.72 of every 100 hospitalizations or 7.74 incidents/100,000 general population. Assaults leading to hospitalizations frequently occurred among males (80.86%); in 25-39 year-olds (35.60%), 40-59 year-olds (22.85%); by sharp object (29.44%), blunt object (24.40%) and bodily force (23.71%); in the Central (39.48%) and Northeast region (31.16%). There was a tri-modal monthly peak distribution: April (11.12%), December (9.45%) and October (8.90%). A minority i.e. 0.4% (male to female ratio of 4.22:1) of ARH had a concomitant psychiatric disorder(s): the most frequent being 'mental and behavioral disorders due to psychoactive substance use' (66.54%) followed by 'schizophrenia, schizotypal and delusional disorders' (14.230%). The MR of ARH with and without concomitant psychiatric disorder was 1.03% and 0.30%, respectively. The LOS of overall ARH was 5.15 +/- 12.41 days, min-max was 1-568 days and the mode was 1 day. The LOS of ARH with/without psychiatric disorder was 5.2 +/- 12.4 vs. 3.7 +/- 7.5 days. The expenses paid for ARH with/without psychiatric disorder was 75,811,383.40 Baht vs. 791,214,659.90 Baht. CONCLUSION: Assault accounted for 0.72 hospitalization of every 100 hospitalizations and 7.74 times/100,000 population. A fraction (0.04%) of ARH had concomitant psychiatric disorder(s): most frequently psychoactive substance use disorders followed by schizophrenia and related psychosis.

Epidemiology of mental and behavioral disorders among the elderly: based on data of hospitalized patients in Thailand 2010.

BACKGROUND: To date, only small, selected groups of elderly hospitalized with mental and behavioral disorders (EHMBD) have been studied. Since no national epidemiological studies have been published, the recent advent of universal healthcare in Thailand makes doing such a study timely for improving the medical curricula and service provision. OBJECTIVE: To analyze the epidemiology of the EHMBD in the year 2010 of Thailand. MATERIAL AND METHOD: The data analyzed were gathered from Medical Expense Reimbursement forms submitted for the fiscal year 2010. The particular focus of this research was on elderly inpatient aged 60 years and over with ICD-10 (for 2010) diagnosis: F00-F99 Mental and Behavioral Disorders. The authors extracted and analyzed the number of in-patient department (IPD) admissions, psychiatric diagnoses, length of hospital stays, hospital charges and mortality rate. Data were analyzed using SPSS 17 for Windows. RESULTS: In 2010, EHMBD accounted for 11,418 admissions which was 1.56 admission per 1000 elderly people or 13.9% of overall admission (19 years and over). Of the 11,418 admission, 44 died (0.39%). The mean in-patient charges/admission in Thai Baht (SD) for the EHMBD with any F00-F99 diagnosis was 12,896 (51,659). The average range of stay was 8.3 +/- 22.2 days. The leading diagnosed clusters of behavioral and mental disorders were organic mental disorders (F00-F09: 23.8%), neurotic, stress-related and somatoform disorders (F40-F48: 21.1%); and mental and behavioral disorders due to use of alcohol (F10: 20.3%). Alcohol use disorders among the elderly resulted in four times more men being hospitalized than women. Regarding the F30-F39 cluster mood (affective) disorders, the prevalence of depressive episodes increased with age and bipolar affective disorder decreased with age. CONCLUSION: The prevalence of hospitalization among the elderly with mental and behavioral disorders was about one-eighth that of all admission of adult from 19 years old. Death was an uncommon result. The most common psychiatric diagnoses were organic mental disorders, neurotic, stress-related and somatoform disorders and mental and behavioral disorders due to use of alcohol.

Brain laterality evaluated by F-18 fluorodeoxyglucose positron emission computed tomography in autism spectrum disorders.

Background and rationale: Autism spectrum disorder (ASD) is a neuropsychiatric disorder that has no curative treatment. Little is known about the brain laterality in patients with ASD. F-18 fluorodeoxyglucose positron emission computed tomography (F-18 FDG PET/CT) is a neuroimaging technique that is suitable for ASD owing to its ability to detect whole brain functional abnormalities in a short time and is feasible in ASD patients. The purpose of this study was to evaluate brain laterality using F-18 FDG PET/CT in patients with high-functioning ASD. Materials and methods: This case-control study recruited eight ASD patients who met the DSM-5 criteria, the recorded data of eight controls matched for age, sex, and handedness were also enrolled. The resting state of brain glucose metabolism in the regions of interest (ROIs) was analyzed using the Q.Brain software. Brain glucose metabolism and laterality index in each ROI of ASD patients were compared with those of the controls. The pattern of brain metabolism was analyzed using visual analysis and is reported in the data description. Results: The ASD group's overall brain glucose metabolism was lower than that of the control group in both the left and right hemispheres, with mean differences of 1.54 and 1.21, respectively. We found statistically lower mean glucose metabolism for ASD patients than controls in the left prefrontal lateral (Z = 1.96, p = 0.049). The left laterality index was found in nine ROIs for ASD and 11 ROIs for the control. The left laterality index in the ASD group was significantly lower than that in the control group in the prefrontal lateral (Z = 2.52, p = 0.012), precuneus (Z = 2.10, p = 0.036), and parietal inferior (Z = 1.96, p = 0.049) regions. Conclusion: Individuals with ASD have lower brain glucose metabolism than control. In addition, the number of ROIs for left laterality index in the ASD group was lower than control. Left laterality defects may be one of the causes of ASD. This knowledge can be useful in the treatment of ASD by increasing the left-brain metabolism. This trial was registered in the Thai Clinical Trials Registry (TCTR20210705005).

Validity and reliability study of the Thai version of WHO Schedules for Clinical Assessment in Neuropsychiatry: Eating Disorders Section.

OBJECTIVE: To determine the validity and reliability of the Thai version of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Version 2.1, Eating Disorders Section MATERIAL AND METHOD: The SCAN interview version 2.1 Eating Disorders Section (section 9) was translated into Thai. The content validity of the translation was verified by comparing the back-translation to the English original. Whenever inconsistencies were encountered, the Thai version was adapted so that it correctly conveyed the meaning of the original English version. The revised Thai version was then field-tested in four regions (Suanprung Psychiatric Hospital, Jitavejkhonkaen Hospital, Srithanya Hospital and Suansaranrom Psychiatric Hospital, each place comprised 20 volunteers) for comprehensibility of the relatively technical language. Re-edition of the Thai version was made in accordance with suggestions from the field trial. The reliability study was done between October 2005 and September 2008 in which 30 persons (4 males; 26 females) were recruited. Fifteen persons (1 males and 14 females) were eating disorders patients (4 anorexia nervosa and 11 bulimia nervosa patients) and the other 15 (3 males and 12 females) were normal. The number of years of formal education varied widely and occupations were diverse. Subjects were interviewed using SCAN eating disorders section by a psychiatrist competent in using the Thai version of SCAN. The interviews were recorded on video so that the material could be re-rated. RESULTS: Regarding validity of WHO SCAN eating disorders section, based on the response from Thai subjects and consultations with competent psychiatrists, the content validity was established. Regarding the reliability study, the time taken to interview an eating disorder patient averaged 23.80 +/- 5.15 minutes (range, 18.35-34.26) versus 17.27 +/- 4.05 minutes (range, 9.07-22.37) for a normal subject. The mean of inter-rater reliability (kappa) of the eating disorder section was 0.73, standard error (SE) = 0.02, 95% confident interval (CI = 0.68-0.77). Seventy-eight point five percent of the items in the section had a substantial kappa. The mean of intra-rater reliabilities was 0.76, SE = 0.03, 95% CI = 0.70-0.82. Sixty-eight point four percent and 31.58% of the items had a substantial and almost perfect kappa respectively. CONCLUSION: The Thai version of the Eating Disorders Sections of SCAN version 2.1 proved to be a valid and reliable tool for assessing eating disorders among Thai speakers.

Validity and reliability of the Rosenberg Self-Esteem Scale-Thai version as compared to the Self-Esteem Visual Analog Scale.

OBJECTIVE: To compare the validity and reliability of the Thai version of the Rosenberg Self-Esteem Scale with the Self-Esteem Visual Analog Scale. MATERIAL AND METHOD: The Rosenberg Self-Esteem Scale was translated into Thai and its content-validity checked by bacA translation. The reliability of the Rosenberg Self-Esteem Scale compared with the Self-Esteem Visual Analog Scale was ther tested between February and March 2008 on 270 volunteers, including 135 patients with psychiatric illness and 135 normal volunteers. The authors analyzed the internal consistency and factor structure of the Rosenberg Self-Esteem Scale-Thai version and the correlation between it and the Visual Analog Scale. RESULTS: The Cronbach's Alpha for the Rosenberg Self-Esteem scale-Thai version was 0.849 and the Pearson's correlation between it and the Self-Esteem Visual Analog Scale 0.618 (p = 0.01). Two factors, viz, the positively and negatively framea items, from the Rosenberg Self-Esteem Scale-Thai version accounted for 44.04% and 12.10% of the variance, respectively. CONCLUSION: The Rosenberg Self-Esteem Scale-Thai version has acceptable reliability. The Self-Esteem Visual Analog Scale provides an effective measure of self-esteem.

A qualitative study of health-related quality of life and psychosocial adjustments of Thai adolescents with repaired cleft lips and palates.

OBJECTIVE: The purposes of the present study were (1) to study the meaning of Health-Related Quality of Life (HRQoL) from the insider's perspective and (2) to explore the relevant psychosocial adjustments involved in the HRQoL of Thai 12-to-17-year-old adolescents with repaired cleft lip and cleft palate (CLP). MATERIAL AND METHOD: The study included a sample of 18 adolescents with non-syndromic repaired CLP and 6 parents of these adolescents. The participants were recruited from an orthodontic clinic in the Faculty of Dentistry, Mahidol University, and all were in-depth interviewed. RESULTS: HRQoL can be categorized into four domains: physical symptoms,functional limitations, emotional well-being and social well-being. In the affected group they were striking differences in psychological assets, psychosocial resources and socioeconomic disparities. The majority of these participants were well-adjusted and able to cope with the adversities they experienced as a result of their conditions; hence it was noted that, participants with consistent support from parents,friends and professionals were likely to have a positive health status and satisfaction with treatment. CONCLUSION: These findings have important implications in measuring a multidimensional HRQoL construct, and will enhance issues regarding adaptation strategies which have an impact on HRQoL of adolescents with CLP.

Development of improved cleft lip/palate face models for teaching parents of children with cleft lip/palate.

OBJECTIVE: The objective of this study was to improve and evaluate cleft lip/palate face models to give support information to the parents whose children have cleft lip/palate. MATERIAL AND METHOD: Cleft lip/palate face models are made from a mold of about the same size as a child'head using rubber, wood and silicone and can be separated into parts to match the severity of the disease. The authors surveyed two representative samples of new candidate parents whose children had cleft lip/palate (10 in a pilot study then 30 in the larger study) and five nurses (who had taken care of the cleft lip/palate patients). The questionnaire was designed by the researchers and it had a Cronbach's reliability of a = 0.72. RESULTS: The result of the pilot evaluation revealed that the overall satisfaction score was high but the color of the models was not realistic so the satisfaction score was medium. After improvements of the colour and the post-surgical scar, the qualification and satisfaction scores were high (average 4.2). CONCLUSION: The authors present an improved cleft lip/palate face models for educational use to parents of children with cleft lip/palate. The models had an overall good level of satisfaction. Using face models to give information helped parents to know and understand about the condition, treatments, caregiving and scheduling age-determined visits for treatments.

Development and reliability of the THAICLEFT Quality of Life Questionnaire for children with cleft lip/palate and families.

OBJECTIVE: The objective of this study was to develop and test the reliability of the THAICLEFT Quality of Life (QoL) questionnaire for families of children coping with the problems associated with cleft lip/palate (CLP). MATERIAL AND METHOD: After reviewing the literature on QoL measurements, the THAICLEFT QoL questionnaire was developed. The 27 families registered with the Tawanchai CLP service registry completed the questionnaire. RESULTS: The Cronbach's alpha, i.e., the internal consistency and reliability, of 24 Quality of Life questionnaires was calculated. Values > 0.7 are considered acceptable and the value of the THAICLEFT QoL questionnaire was 0.861. CONCLUSION: Using the THAICLEFT QoL questionnaire can help the healthcare provider to support parents and understand whether they are able to care for the patients and their psycho-economic needs.

Brain Metabolite Changes After Anodal Transcranial Direct Current Stimulation in Autism Spectrum Disorder.

OBJECTIVES: Previous research has provided evidence that transcranial direct current stimulation (tDCS) can reduce severity of autism spectrum disorder (ASD); however, the exact mechanism of this effect is still unknown. Magnetic resonance spectroscopy has demonstrated low levels of brain metabolites in the anterior cingulate cortex (ACC), amygdala, and left dorsolateral prefrontal cortex (DLPFC) in individuals with ASD. The aim of this study was to investigate the effects of anodal tDCS on social functioning of individuals with ASD, as measured by the social subscale of the Autism Treatment Evaluation Checklist (ATEC), through correlations between pretreatment and posttreatment concentrations of brain metabolites in the areas of interest (DLPFC, ACC, amygdala, and locus coeruleus) and scores on the ATEC social subscale. METHODS: Ten participants with ASD were administered 1 mA anodal tDCS to the left DLPFC for 20 min over five consecutive days. Measures of the ATEC social subscale and the concentrations of brain metabolites were performed before and immediately after the treatment. RESULTS: The results showed a significant decrease between pretreatment and immediately posttreatment in the ATEC social subscale scores, significant increases in N-acetylaspartate (NAA)/creatine (Cr) and myoinositol (mI)/Cr concentrations, and a decrease in choline (Cho)/Cr concentrations in the left DLPFC and locus coeruleus after tDCS treatment. Significant associations between decreased ATEC social subscale scores and changed concentrations in NAA/Cr, Cho/Cr, and mI/Cr in the locus coeruleus were positive. CONCLUSION: Findings suggest that beneficial effects of tDCS in ASD may be due to changes in neuronal and glia cell activity and synaptogenesis in the brain network of individuals with ASD. Further studies with larger sample sizes and control groups are warranted.

The short-term effects of transcranial direct current stimulation on electroencephalography in children with autism: a randomized crossover controlled trial.

Abnormal synaptic maturation and connectivity are possible etiologies of autism. Previous studies showed significantly less alpha activity in autism than normal children. Therefore, we studied the effects of anodal tDCS on peak alpha frequency (PAF) related to autism treatment evaluation checklist (ATEC). Twenty male children with autism were randomly assigned in a crossover design to receive a single session of both active and sham tDCS stimulation (11 mA) over F3 (left dorsolateral prefrontal cortex). Pre- to postsession changes in a measure of cortical activity impacted by tDCS (PAF) and ATEC were compared between groups. We also examined the associations between pre- and postsession changes in the PAF and ATEC. The results show significant pre- to postsession improvements in two domains of ATEC (social and health/behavior domains) following active tDCS, relative to sham treatment. PAF also significantly increased at the stimulation site, and an increase in PAF was significantly associated with improvements in the two domains of ATEC impacted by tDCS. The findings suggest that a single session of anodal tDCS over the F3 may have clinical benefits in children with autism and that those benefits may be related to an increase in PAF.

Effect of anodal transcranial direct current stimulation on autism: a randomized double-blind crossover trial.

The aim of this study was to evaluate the Childhood Autism Rating Scale (CARS), Autism Treatment Evaluation Checklist (ATEC), and Children's Global Assessment Scale (CGAS) after anodal transcranial direct current stimulation (tDCS) in individuals with autism. Twenty patients with autism received 5 consecutive days of both sham and active tDCS stimulation (1 mA) in a randomized double-blind crossover trial over the left dorsolateral prefrontal cortex (F3) for 20 minutes in different orders. Measures of CARS, ATEC, and CGAS were administered before treatment and at 7 days posttreatment. The result showed statistical decrease in CARS score (P < 0.001). ATEC total was decreased from 67.25 to 58 (P < 0.001). CGAS was increased at 7 days posttreatment (P = 0.042). Our study suggests that anodal tDCS over the F3 may be a useful clinical tool in autism.