[Psychiatric issues of children and adults with autism spectrum disorders who remain undiagnosed].

Individuals of normal intelligence with autism spectrum disorders (ASD) tend to be diagnosed with ASD late in childhood or sometimes in adulthood, despite a persistent symptomatology. When such patients visit psychiatric clinics for co-occurring psychiatric symptoms, the diagnostic procedure can be challenging due to a lack of accurate developmental information and a mixed clinical presentation. The same is true for those with subthreshold autistic symptoms. Although individuals with subthreshold ASD also have social adjustment difficulties of a similar degree to those with ASD, the relative clinical significance of this population is unclear. Here, data from a large national population sample of schoolchildren were examined to determine the psychiatric needs of children with threshold and subthreshold autistic symptoms. First, autistic symptoms or traits assessed by the Social Responsiveness Scale (SRS), a quantitative behavioral measure, showed a continuous distribution in the general child population (n = 22,529), indicating no evidence of a natural gap that could differentiate children diagnosed with ASD from subthreshold or unaffected children. Second, data from 25,075 children demonstrated that having threshold autistic symptoms predicted a high psychiatric risk, as indicated by higher scores on the Strengths and Difficulties Questionnaire (SDQ; odds ratio [OR] 200.52, 95% confidence interval [CI]: 152.12-264.33), and that having subthreshold autistic symptoms indicated the same (OR 12.78, 95% CI: 11.52-14.18). Having threshold autistic symptoms predicted emotional problems (OR 20.19, 95% CI: 17.00-24.00), as did having subthreshold autistic symptoms (OR 5.90, 95% CI: 5.29-6.58). Third, among 2,250 children at a high psychiatric risk, most had threshold or subthreshold autistic symptoms (21 and 44%, respectively). These findings have important implications for the comprehensive psychiatric and developmental evaluation and treatment of this patient population, whose diagnosis and treatment are often delayed, and a further in-depth study is warranted.

Association between sleep habits/disorders and emotional/behavioral problems among Japanese children.

Actual sleep status and the association between sleep habits/disorders and emotional/behavioral problems among children in the development stage have not been fully clarified. A questionnaire survey was conducted on the sleep habits/disorders (Brief Child Sleep Questionnaire; BCSQ) and emotional/behavioral problems (Strengths and Difficulties Questionnaire; SDQ) of 87,548 children enrolled in ordinary classes in nine grade levels from the first grade of elementary school to the third grade of junior high school from December 2009 to April 2010. As school grade increased, children's bedtimes were delayed and sleep duration was reduced by 2.0 h over the nine grade levels. Based on the BCSQ, 18.3% of children were judged to have some type of sleep disorder, and about 30% to 40% of children had sleep symptoms at bedtime, during sleep, and at wake time. Multiple regression analysis showed that emotional and behavioral problems were associated with presence of any sleep symptom, longer sleep latency, and longer awake time after sleep onset, whereas total sleep time was not. Sleep symptoms at wake time were most strongly associated with emotional and behavioral problems. Status of sleep habits/disorders should be considered when interpreting emotional/behavioral problems in school-age children.

Utility of the Japanese version of the Checklist for Autism in Toddlers for predicting pervasive developmental disorders at age 2.

We evaluated the utility of the Japanese version of the Checklist for Autism in Toddlers for predicting pervasive developmental disorders (PDD) among 2-year-old children in clinical settings. Confirmed diagnosis revealed that the pass rate on four items (social interest, proto-imperative pointing, proto-declarative pointing and joint-attention) was significantly lower in 52 PDD children than in 48 non-PDD children, and if abnormal development was reported in two or more items, the sensitivity, specificity, and positive/negative predictive values for PDD diagnosis were 0.85, 0.73, and 0.77/0.81, respectively. This simple screening tool can provide valuable information to clinicians when diagnosing PDD.

Prevalence of childhood obstructive sleep apnea syndrome and its role in daytime sleepiness.

OBJECTIVES: To investigate childhood obstructive sleep apnea syndrome (OSAS) and its role in daytime sleepiness among school-age children. METHODS: A questionnaire survey was conducted with 25,211 children aged 6-15 (mean, 10.39) years attending 148 elementary and 71 middle schools in 10 prefectures across Japan and their parents. Questions concerned 4 sleep habit items (bedtime, sleep onset latency, wake time after sleep onset, wake-up time) and 4 sleep disorder items (loud snoring, snorts/gasps, breathing pauses, seems very sleepy in the daytime). Total sleep time (TST) was calculated with sleep habits. Severe possible OSAS (p-OSAS) was defined as having loud snoring, snorts and gasps, or breathing pauses "frequently" (≥ 5 times per week), and mild p-OSAS was rated as having any of these "sometimes" (2-4 times per week). Severe daytime sleepiness was defined as seeming very sleepy "frequently" and mild daytime sleepiness as seeming very sleepy "sometimes". RESULTS: Mean prevalence of mild to severe p-OSAS and severe p-OSAS in children across all grade levels was 9.5% and 1.6%, respectively. p-OSAS was particularly prevalent in children at lower elementary levels, decreasing with advancing grade levels. Prevalence of mild and severe daytime sleepiness was 6.1% and 0.9%, respectively, among all children (7.0%). Prevalence of daytime sleepiness increased with advancing grade levels, particularly in middle-school level. Average TST was 8.4 ± 2.2 h in both elementary and middle-school levels, and decreased as grades advanced, particularly in middle-school levels. Multivariate logistic regression analysis showed that middle-school level, TST < 8 h, and p-OSAS were independent factors for daytime sleepiness. Strong correlations were found between severe daytime sleepiness and severe p-OSAS or TST < 6 h, and between daytime sleepiness and loud snoring or breathing pauses. CONCLUSION: p-OSAS may be an independent factor influencing daytime sleepiness in school-age children. Loud snoring and breathing pauses could be clinical markers for children with severe daytime sleepiness.

Somatic and depressive symptoms in female Japanese and American students: a preliminary investigation.

The present study examined the relationship between common somatic symptoms and depression in samples of Japanese and American college students. Fifty Japanese and 44 American women completed the Beck Depression Inventory (BDI) and rated 56 somatic-distress items for 7 days. Japanese had higher levels of somatic distress than Americans. ANOVA of somatic distress by BDI-level revealed that the High BDI Japanese group reported 26 somatic symptoms (including stomach ache, dizziness, and shoulder pain) with significantly higher means when compared with the low BDI group. High BDI Americans had a significantly higher mean for joint pain compared to the Low BDI group. The importance of the body in transcultural psychiatry is explored, and implications for primary and mental health care are discussed.

Benefits of negative thinking and negative affect: analyses of answers to an open-ended question by Japanese undergraduates.

What are the benefits of negative thinking and negative affect? Although previous studies in evolutionary psychology, social psychology, and clinical psychology have clarified the question, there has been no definitive study asking people directly about the perceived benefits. In the present study, 119 Japanese undergraduates were asked how they recognized the benefits of negative thinking and negative affect. Their answers were analyzed qualitatively. The answers were arranged into 30 smaller categories and 12 superordinate ones. The benefits were divided into "benefits to the self" and "benefits to interpersonal relations". Finally, the conditions necessary for the negative thinking and negative affect being benign, and possible cultural differences, were discussed.

Association between delayed bedtime and sleep-related problems among community-dwelling 2-year-old children in Japan.

BACKGROUND: Although delayed sleep timing causes many socio-psycho-biological problems such as sleep loss, excessive daytime sleepiness, obesity, and impaired daytime neurocognitive performance in adults, there are insufficient data showing the clinical significance of a 'night owl lifestyle' in early life. This study examined the association between habitual delayed bedtime and sleep-related problems among community-dwelling 2-year-old children in Japan. METHODS: Parents/caregivers of 708 community-dwelling 2-year-old children in Nishitokyo City, Tokyo, participated in the study. The participants answered a questionnaire to evaluate their child's sleep habits and sleep-related problems for the past 1 month. RESULTS: Of the 425 children for whom complete data were collected, 90 (21.2%) went to bed at 22:00 or later. Children with delayed bedtime showed significantly more irregular bedtime, delayed wake time, shorter total sleep time, and difficulty in initiating and terminating sleep. Although this relationship indicated the presence of sleep debt in children with delayed bedtime, sleep onset latency did not differ between children with earlier bedtime and those with delayed bedtime. Rather, delayed bedtime was significantly associated with bedtime resistance and problems in the morning even when adjusting for nighttime and daytime sleep time. CONCLUSIONS: Even in 2-year-old children, delayed bedtime was associated with various sleep-related problems. The causal factors may include diminished homeostatic sleep drive due to prolonged daytime nap as well as diurnal preference (morning or night type) regulated by the biological clock.

Normative data and psychometric properties of the strengths and difficulties questionnaire among Japanese school-aged children.

BACKGROUND: Although child mental health problems are among the most important worldwide issues, development of culturally acceptable mental health services to serve the clinical needs of children and their families is especially lacking in regions outside Europe and North America. The Strengths and Difficulties Questionnaire (SDQ), which was developed in the United Kingdom and is now one of the most widely used measurement tools for screening child psychiatric symptoms, has been translated into Japanese, but culturally calibrated norms for Japanese schoolchildren have yet to be established. To this end, we examined the applicability of the Japanese versions of the parent and teacher SDQs by establishing norms and extending validation of its psychometric properties to a large nationwide sample, as well as to a smaller clinical sample. METHODS: The Japanese versions of the SDQ were completed by parents and teachers of schoolchildren aged 7 to 15 years attending mainstream classes in primary or secondary schools in Japan. Data were analyzed to describe the population distribution and gender/age effects by informant, cut-off scores according to banding, factor structure, cross-scale correlations, and internal consistency for 24,519 parent ratings and 7,977 teacher ratings from a large nationwide sample. Inter-rater and test-retest reliabilities and convergent and divergent validities were confirmed for a smaller validation sample (total n = 128) consisting of a clinical sample with any mental disorder and community children without any diagnoses. RESULTS: Means, standard deviations, and banding of normative data for this Japanese child population were obtained. Gender/age effects were significant for both parent and teacher ratings. The original five-factor structure was replicated, and strong cross-scale correlations and internal reliability were shown across all SDQ subscales for this population. Inter-rater agreement was satisfactory, test-retest reliability was excellent, and convergent and divergent validities were satisfactory for the validation sample, with some differences between informants. CONCLUSIONS: This study provides evidence that the Japanese version of the SDQ is a useful instrument for parents and teachers as well as for research purposes. Our findings also emphasize the importance of establishing culturally calibrated norms and boundaries for the instrument's use.

Utility of teacher-report assessments of autistic severity in Japanese school children.

Recent studies suggest that many children with milder autism spectrum disorder (ASD) are undiagnosed, untreated, and being educated in mainstream classes without support and that school teachers might be the best persons to identify a child's social deviance. At present, only a few screening measures using teacher ratings of ASD have been validated. The aim of this study was to examine the utility of teacher ratings on the Social Responsiveness Scale (SRS), a quantitative measure of ASD. We recruited 130 participants aged 4 to 17 years from local schools or local pediatric outpatient clinics specializing in neurodevelopmental disorders that included 70 children with ASD. We found that the teacher-report SRS can be reliably and validly applied to children as a screening tool or for other research purposes, and it also has cross-cultural comparability. Although parent-teacher agreement was satisfactory overall, a discrepancy existed for children with ASD, especially for girls with ASD. To improve sensitivity in children at higher risk, especially girls, we cannot overstate the importance of using standardized norms specific to gender, informant, and culture.

A CROSS-CULTURAL STUDY OF THE EXPERIENTIAL STRUCTURE OF EMOTIONS OF DISTRESS: PRELIMINARY FINDINGS IN A SAMPLE OF FEMALE JAPANESE AND AMERICAN COLLEGE STUDENTS.

Negative emotions such as anger, sadness and fear are universal; however, there is cultural variability in the ways that specific emotions cluster together. This Experience Sampling Method study collected daily life emotions of distress for 44 American and 50 Japanese college students. These women reported their experiences of 37 distresses once a day for seven days. Cluster Analysis revealed that Americans had upset, depression, hostility and dependency clusters. The Japanese had depression, sad/angry, gloomy, hate and interpersonal clusters. Cultural analysis of idioms of distress and clinical implications are discussed.

The association between negative self-descriptions and depressive symptomology: does culture make a difference?

Research findings that depressed Americans endorse more negative self-related adjectives than controls may be related to a shared self-enhancement cultural frame. This study examines the relationship between negative core self-descriptors and depressive symptoms in 79 Japanese and 50 American women. Americans had more positive self-descriptions and core self-descriptors; however, there were no cultural group differences in number of negative self-descriptors or core self-descriptors. There was a significant correlation between negative core self-descriptor and Beck Depression Inventory (BDI) for Americans only, explaining 10.6% of the BDI variance. Analysis of variance revealed that there was significant BDI group differences for American negative core self-descriptor only. Theoretical possibilities are discussed.