Validity and Reliability Study of the Chinese (Traditional) Version of the Devereux Early Childhood Assessment for Toddlers (DECA-T).

BACKGROUND: The Devereux Early Childhood Assessment for Toddlers (DECA-T), which is one of the few standardized, norm-referenced behavioral rating scales related to young children's mental health, resilience, and social-emotional development, was developed for toddlers aged between 18 and 36 months. OBJECTIVE: The aim of this study was to test the clinimetric properties of the Chinese (Traditional) version of the DECA-T (C-DECA-T) using a classical test theory analysis and an item response theory analysis. METHODS: Seventy-five community-based toddlers aged from 18 to 36 months and 50 clinic-based participants recruited in hospitals in northern Taiwan participated in this study. Social-emotional competence was assessed by the C-DECA-T and children's behavior problems were rated via the Child Behavior Checklist 1.5 to 5 (CBCL/1.5-5). Homogeneity of the C-DECA-T was assessed by Mokken analysis; sensitivity and specificity were assessed via receiver operating characteristic curve. RESULTS: The results showed the C-DECA-T demonstrated good test-retest reliability (r=0.8) and high internal consistency (Cronbach's alpha = 0.94). Inter-rater reliability between father and mother was fair (ICC = 0.46). Convergent validity of the CBCL/1.5-5 total behavior problems (r=-0.26) demonstrated acceptable psychometric performance. The overall measure of the sampling adequacy of the C-DECA-T assessed by principal component analysis was 0.93. Mokken scale analysis showed the 36-items of the C- DECA-T formed a weak unidimensional scale (Hs =0.35), supporting its construct validity. The area under curve of the C-DECA-T in prediction of social-emotional disturbance was 0.70. The optimal cutoff of the Total Protective Factor score of the C-DECA-T was a T score of 40.1 (T40.1), with a sensitivity of 95% and a specificity of 68%. Item 2 ("show affection for a familiar adult") and item 33 ("calm herself/himself") provide a good amount of information for the assessment of social-emotional strength and needs of a toddler in clinical practice. CONCLUSION: The C-DECA-T showed good psychometric properties. Our findings of high internal consistency of the three subscales and total score of the C-DECA-T suggest symptom manifestation of social-emotional competence and needs in Taiwanese toddlers is not culturally different from American toddlers. The clinimetric properties of the C-DECA-T examined by a classical test theory analysis approach and an item response theory analysis approach suggest that the C-DECA-T is a reliable and valid instrument for measuring social-emotional strength and needs in the population in Taiwan.

Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. AIMS: To investigate the MPH usage and the risk of suicide attempt among ADHD youths. METHODS: We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. OUTCOME AND RESULTS: Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). CONCLUSIONS AND IMPLICATIONS: We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. WHAT THIS PAPER ADDS: This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance.

Assessment of brain functional connectome alternations and correlation with depression and anxiety in major depressive disorders.

Major depressive disorder (MDD) is highly prevalent, recurrent, and associated with functional impairment, morbidity, and mortality. Herein, we aimed to identify disruptions in functional connectomics among subjects with MDD by using resting-state functional magnetic resonance imaging (rs-fMRI). Sixteen subjects with MDD and thirty health controls completed resting-state fMRI scans and clinical assessments (e.g., Hamilton Depression Rating Scale (HAMD) and Hospital Anxiety and Depression Scale (HADS)). We found higher amplitude of low frequency fluctuations (ALFF) bilaterally in the hippocampus and amygdala among MDD subjects when compared to healthy controls. Using graph theoretical analysis, we found decreased clustering coefficient, local efficiency, and transitivity in the MDD patients. Our findings suggest a potential biomarker for differentiating individuals with MDD from individuals without MDD.

Assessment of abnormal brain structures and networks in major depressive disorder using morphometric and connectome analyses.

BACKGROUND: It is hypothesized that the phenomenology of major depressive disorder (MDD) is subserved by disturbances in the structure and function of brain circuits; however, findings of structural abnormalities using MRI have been inconsistent. Generalized q-sampling imaging (GQI) methodology provides an opportunity to assess the functional integrity of white matter tracts in implicated circuits. METHODS: The study population was comprised of 16 outpatients with MDD (mean age 44.81±2.2 years) and 30 age- and gender-matched healthy controls (mean age 45.03±1.88 years). We excluded participants with any other primary mental disorder, substance use disorder, or any neurological illnesses. We used T1-weighted 3D MRI with voxel-based morphometry (VBM) and vertex-wise shape analysis, and GQI with voxel-based statistical analysis (VBA), graph theoretical analysis (GTA) and network-based statistical (NBS) analysis to evaluate brain structure and connectivity abnormalities in MDD compared to healthy controls correlates with clinical measures of depressive symptom severity, Hamilton Depression Rating Scale 17-item (HAMD) and Hospital Anxiety and Depression Scale (HADS). RESULTS: Using VBM and vertex-wise shape analyses, we found significant volumetric decreases in the hippocampus and amygdala among subjects with MDD (p<0.001). Using GQI, we found decreases in diffusion anisotropy in the superior longitudinal fasciculus and increases in diffusion probability distribution in the frontal lobe among subjects with MDD (p<0.01). In GTA and NBS analyses, we found several disruptions in connectivity among subjects with MDD, particularly in the frontal lobes (p<0.05). In addition, structural alterations were correlated with depressive symptom severity (p<0.01). LIMITATIONS: Small sample size; the cross-sectional design did not allow us to observe treatment effects in the MDD participants. CONCLUSIONS: Our results provide further evidence indicating that MDD may be conceptualized as a brain disorder with abnormal circuit structure and connectivity.