Associations among smartphone app-based measurements of mood, sleep and activity in bipolar disorder.

The recent popularization of smart technology presents new opportunities for continual, digital-monitoring of patient status. In this project, we used a smartphone app to track the mood, sleep, and activity levels of 159 outpatients with bipolar disorder (BD). The participants were asked to report their daily wake/sleep time and emotional status in the app, while daily activity data were automatically collected via GPS. We performed repeated-measures correlation analysis to examine possible correlations between the readouts. Mood, sleep and activity levels all showed intra-variable correlations with readings on the next day, in the next week, and in the next month. Furthermore, mood and sleep at the reference time were positively correlated with activity in subsequent weeks or months, and activity was positively correlated with mood and sleep in the same time ranges. Thus, our results were in line with previous studies, showing that mood, sleep, and activity levels are interdependent in patients with BD. With the association between mood on future activity level was most significant, and the correlations between each readout and the others were dependent on time frame. Our findings suggest our smartphone app has potential to provide an informative and reliable means for real-time tracking of BD status.

An international clinical study of ability and disability in ADHD using the WHO-ICF framework.

This is the fourth and final study designed to develop International Classification of Functioning, Disability and Health (ICF, and children and youth version, ICF-CY) core sets for attention-deficit hyperactivity disorder (ADHD). To investigate aspects of functioning and environment of individuals with ADHD as documented by the ICF-CY in clinical practice settings. An international cross-sectional multi-centre study was applied, involving nine units from eight countries: Denmark, Germany, India, Italy, Portugal, Saudi Arabia, Sweden and Taiwan. Clinicians and clinical researchers rated the functioning level of 112 children, adolescents and adults with ADHD using the extended ICF-CY checklist version 2.1a. The ratings were based on a variety of information sources, such as medical records, medical history, clinical observations, clinical questionnaires, psychometric tests and structured interviews with participants and family members. In total, 113 ICF-CY categories were identified, of which 50 were related to the activities and participation, 33 to environmental factors and 30 to body functions. The clinical study also yielded strengths related to ADHD, which included temperament and personality functions and recreation and leisure. The study findings endorse the complex nature of ADHD, as evidenced by the many functional and contextual domains impacted in ADHD. ICF-CY based tools can serve as foundation for capturing various functional profiles and environmental facilitators and barriers. The international nature of the ICF-CY makes it possible to develop user-friendly tools that can be applied globally and in multiple settings, ranging from clinical services and policy-making to education and research.

The negative attribution processes of mothers of children with attention deficit/hyperactivity disorder.

The objective of this study was to investigate the attribution processes of mothers regarding children's prosocial behaviors, inattention, and hyperactivity/impulsivity (symptoms of attention deficit/hyperactivity disorder, ADHD) using two paradigms. The first paradigm involved multidimensional attributions. The second paradigm concerned making attributions of children's identical behaviors based on information such as consensus, distinctiveness, and consistency. The participants were 64 mothers of children with ADHD (7-13 years old) and 64 mothers with typical/normal children (7-12 years old). The results showed that mothers of typical children exhibited positive attribution styles or person attributions whereas mothers of children with ADHD exhibited negative attribution styles. Mothers of children with ADHD tended to make personal attributions of children's negative behaviors (e.g., inattention and hyperactivity/impulsivity; HI) but made situational attributions of prosocial behaviors. The results of this study can be used in future studies of the effects of intervention on children with ADHD or in studies related to neurophysiology.

Inattention and development of toddlers born in preterm and with low birth weight.

The objective of this study was to examine the impact of low birth weight and preterm birth on a toddler's inattention and development, including cognitive, language, motor, social-emotional and adaptive behaviors. A total of 105 toddlers enrolled for the study; they were divided into four groups: 40 full-term and normal birth weight (NBW, birth weight greater than 2500 g) toddlers, 24 moderate birth weight (MLBW, birth weight between 2499 and 1500 g) toddlers, 20 very to extremely low birth weight (V-ELBW, 12 between 1000 and 1499 g and 8 lower than 1000 g) toddlers, and 21 term toddlers who were recruited from a clinic of developmental delay as the developmental delay at risk (DDR) group. The Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III) and Disruptive Behavior Rating Scale-Toddler were used. The findings were as follows: (1) DDR group performed worst in BSID-III; (2) although there were no statistical differences among the NBW, MLBW, and V-ELBW groups in BSID-III, the lower the birth weight, the lower the average performance, especially in language, adaptive social behavior, and adaptive practical behavior; and (3) comparing the inattention score, the DDR group was the poorest, normal and V-ELBW groups were the best, and MLBW group was in the middle. In conclusion, low birth weight and preterm delivery affected children's inattention and development of language, adaptive social behavior, and adaptive practical behavior.

Cord blood levels of thyroid hormones and IGF-1 weakly correlate with breast milk levels of PBDEs in Taiwan.

In vivo studies indicate that prenatal or neonatal exposure of rodents to polybrominated diphenyl ethers (PBDEs) disrupts thyroid hormone balance, but few studies have reported an association of PBDEs and insulin-like growth factor 1 (IGF-1). The goal was to examine whether PBDEs exposure affects the levels of thyroid hormones and IGF-1 in cord blood. Study participants were healthy pregnant women recruited from the general population in central Taiwan between 2000 and 2001 and in southern Taiwan from 2007 to 2009. One-hundred-forty-nine breast milk samples (n=149), which were collected within one month after delivery, were analyzed using a high resolution gas chromatograph equipped with a high resolution mass spectrometer. The average and median levels of breast milk Σ(14)PBDEs were 5.34 and 3.38 ng/g lipid in 2000-2001 and 5.22 and 3.13 ng/g lipid in 2007-2009, respectively. In general, levels of PBDE congeners were very low in this study population and not significantly different between the years 2000-2001 and 2007-2009. Breast milk Σ(14)PBDEs were not significantly correlated with thyroid hormones and IGF-1 in cord blood. After examining multiple stepwise linear regression models with adjustment for maternal age, pre-pregnancy body mass index (BMI), parity, gestational age, and region (namely, central and southern Taiwan), we found that log of T4 in cord blood was significantly but slightly correlated with higher BDE-154 (B=0.113, p=0.017) in breast milk. The log of FT4 concentration was significantly related to a decrease in the log of BDE-99 level (B=-0.137, p=0.043) and an increase in the log of BDE-154 level (B=0.158, p=0.008). Meanwhile, the log of IGF-1 level was also significantly linked to an increase in the log of BDE-196 level (B=0.532, p=0.028) and decrease in the log of BDE-85 level (B=-0.235, p=0.018). Few epidemiological studies report an association between PBDEs exposure and IGF-1. Based on our findings, further in vivo and epidemiological studies are encouraged and needed to explore associations between PBDEs exposure and levels of thyroid hormones and IGF-1.

Neurodevelopment of infants with prenatal exposure to polybrominated diphenyl ethers.

The study aimed to examine the impact of prenatal exposure to polybrominated diphenyl ethers (PBDEs) on infant neurodevelopment. PBDEs levels in 36 cord blood samples were analyzed with a high-resolution-gas-chromatograph/high-resolution-mass-spectrometer and infant neurodevelopment was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. The mean and median of Σ(11)PBDEs were 6.63 and 4.63 ng/g lipid, respectively. As compared to the lower PBDEs group (Σ(11)PBDEs < 4.63 ng/g lipid), the higher PBDEs group (Σ(11)PBDEs > 4.63 ng/g lipid) had a significantly higher actual odds ratio (OR = 1.13, p < 0.05) of the cognition score as well as a lower odds ratio (OR = 0.904, p < 0.01) of the adaptive behavior score, suggesting that prenatal PBDEs exposure may potentially affect infant neurodevelopment.

Levels of breast milk PBDEs from southern Taiwan and their potential impact on neurodevelopment.

In vivo studies have demonstrated that prenatal or neonatal exposure to polybrominated diphenyl ethers (PBDEs) causes developmental neurotoxicity. However, there is a lack of human data. Our hypothesis was that PBDEs would result in lower infant neurodevelopment scores. This is a post hoc analysis of previous studies. Fourteen PBDEs in 70 breast milk were analyzed using a high-resolution gas chromatograph/high-resolution mass spectrometer. Infant neurodevelopment at the age of 8-12 mo was determined using the Bayley Scales of Infants and Toddlers Development, third edition (Bayley-III). The median of Σ14 PBDEs (the sum of 14 PBDE congeners) was 2.92 ng/g lipid. The Σ14 PBDE concentrations were not correlated with Bayley-III scores on cognitive, language, motor, social-emotional, or adaptive behavior scales. A significantly inverse association between brominated diphenyl ether (BDE)-209 and the cognitive scale was found after multivariate stepwise linear regression analyses (B = -0.007, adjusted R = -0.224, p = 0.032). In contrast, the language scale was positively correlated with BDE-196 (B = 0.096, adjusted R = 0.315, p = 0.002). Our results are consistent with most in vivo studies, suggesting that prenatal or postnatal exposure to BDE-209 potentially delays the neurological development.

Effectiveness of behavioral parent therapy in preschool children with attention-deficit hyperactivity disorder.

The purpose of this study was to assess the effectiveness of a behavioral parent therapy (BPT) program in children with attention-deficit hyperactivity disorder (ADHD) using multidimensional evaluations, the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). Between 2001 and 2005, the parents of 21 preschool children with ADHD were divided into six groups and participated in a series of 11 BPT sessions. Before and after BPT, the parents completed the CBCL, and the teachers completed the TRF. The behavioral and emotional problems of the children showed improvement after the BPT sessions, specifically for the following categories: internalizing problems, anxious/depressed syndromes, somatic complaints, externalizing problems, rule-breaking behaviors, aggressive behaviors, social problems, thought problems, and attention problems. In the DSM-oriented scale of the CBCL, affective problems, anxiety problems, somatic problems, ADHD problems, oppositional defiant disorder problems, and conduct disorder problems showed significant improvements. On the DSM scale of the TRF, Inattention syndrome improved significantly after the BPT sessions, while other syndromes showed non-significant changes. We conclude that the BPT program significantly improved the childrens behavioral problems at home and inattention problems at school.

The attitude toward truth telling of cancer in Taiwan.

OBJECTIVE: This study examined a group of Taiwanese subjects at a medical university hospital regarding their attitudes toward truth telling of cancer. METHOD: Self-report survey with convenience sampling of 195 participants admitted for a 3-day comprehensive health examination in a medical university hospital in Taiwan. Three instruments used to collect the data included the Brief Psychiatric Symptom Rating Scale (BPSRS), Chinese Health Questionnaire (CHQ), and the Attitude Toward Truth Telling of Cancer List. RESULTS: Once diagnosed with cancer, 92.3% of the participants preferred being told the truth about their diagnosis and 7.7% did not. Age, education, and employment were found to differ between disclosure and nondisclosure groups. The latter group also tended to have higher depression and hostility scores on the BPSRS and higher minor psychiatric morbidity scores. A total of 62.6% of the participants preferred that doctors tell a relative the truth about their cancer diagnosis, while 37.4% preferred that doctors not tell a relative the truth. The distributions of demographic data and mental status did not significantly differ between disclosure and nondisclosure groups if a relative was to be the cancer victim. CONCLUSIONS: A majority of subjects in Taiwan would prefer to know the truth if victimized by a cancer disease, despite the supposed influence of Chinese culture. Furthermore, attitudes toward truth telling of cancer differed between relatives of patients and the patients themselves. Relatives of cancer patients were more likely to follow to the principle of beneficence, whereas the patients themselves were more likely to follow to the principle of autonomy.

Behavioral parent training for Taiwanese parents of children with attention-deficit/hyperactivity disorder.

It has been observed that it is relatively difficult for children with attention-deficit/hyperactivity disorder (ADHD) to follow social rules and behave in a socially desirable manner. The ADHD children in Chinese culture, which emphasizes Confucian values, might encounter even greater adjustment difficulties. The purpose of the present study is to implement a behavioral parent training program in a Confucian environment and examine its effectiveness. Twenty-three ADHD preschoolers (age: 3-6 years) and their parents were selected to participate in the present study. Fourteen of these 23 parents completed a 10-session parent training program. Parent ratings of ADHD/oppositional defiant disorder (ODD) symptoms and problem behaviors at home were collected at the first, fourth, sixth, seventh, and tenth sessions. Three instruments were used to evaluate treatment outcome: the Disruptive Behavior Rating Scale-Parent Form, Child Attention Profile, and Home Situations Questionnaire. The results showed that both ADHD/ODD symptoms and home behaviors of these 14 children improved significantly after the parent training. There was also a significant decline in the severity of symptoms and problem behaviors at home with the progression of training. These findings support the effectiveness of this parent training program for parents of ADHD children in an environment of Confucianism. Limitations of the present study and future direction for research are discussed.

Asperger's syndrome and aberrant neurofunctional organization--a case report.

Asperger's Syndrome(AS) is a severe developmental disorder characterized primarily by marked and sustained difficulties in social interaction and unusual patterns of circumscribed interests and behavioral peculiarities. AS differs from autism primarily in that there is no general delay or retardation in language. A 3. 5 year-old boy with AS was referred for psychological assessment and treatment. When the boy was 23 months old, he was assessed with Bayley Scales of Infant Development (2nd ed.). Both MDI and PDI were within normal limits. After the referral, this boy was assessed with WPPSI-R and then prescribed 5 weekly intervention sessions consisting of communication skills training. At a one week's follow-up the boy was reassessed with Leiter-R. The results of WPPSI-R and Leiter-R showed the boy was in the normal intelligence range. From the second session to the fifth session, the boy's mother recorded 526 of his utterances. According to the analysis of these speech data, the language development for this boy was at Stage V, which indicated that his language development was in the superior range for his age. After 5 intervention sessions, the improvements in the child's communication skills were such that no further sessions were warranted. This boy might represent a case of aberrant neurofunctional organization. He has defects in perceptual organization but has good pattern recognition, which is based on features. It is theorized that his excellent verbal ability competed with the perceptual organization, so that he compensated for perceptual organization with verbal ability. An intervention designed to inhibit verbal compensation and facilitate configural processing is recommended.

Meta-analysis of counseling and psychotherapy outcome studies in Taiwan.

This study applied the meta-analysis method to investigate the effectiveness of counseling and psychotherapy. It began with a systematic search of the literature through computer search and previous narrative reviews to locate counseling and psychotherapy outcome studies conducted in Taiwan between January 1971 and August 2000. Salient characteristics of each study were recorded systematically. These study characteristics included type of therapy, type of target problem, therapist experience, and type of outcome measure, among others. In total, 257 studies, which yielded 302 effect sizes, were examined, in which clients who received psychotherapy or counseling were compared with controls. Results demonstrated that the overall mean effect of counseling and psychotherapy was positive and significant. Further categorical model testing indicated that most coded study characteristics were significantly related to effect sizes.

Concurrent validity of the scale for screening of developmental delay.

This study establishes the concurrent validity of the Screening Scale of Developmental Delay II (SSDD-II) with the Bayley Scale of Infant Development II (BSID-II). Three hundred and seventy-nine children referred by pediatricians at the Clinic of Developmental Delay at the Kaohsiung Medical University-Medical Center were tested using the SSDD-II, and about 1 week to 1 month later, they were tested again using the BSID-II. The results indicate that (1) the SSDD-II score increased as age increased, fitting the principle of developmental sequence. (2) The raw scores of the Mental and Motor scales of the BSID-II significantly correlated with the five subscales of the SSDD-II. (3) The three facet scale scores (language, cognitive and motor) of the BSID-II also significantly correlated with the five subscales of the SSDD-II. The SSDD-II has a high concurrent validity, and is a convenient scale to use to screen children for developmental delay in clinical practice in Taiwan.