Excessive use of electronic devices among children and adolescents is associated with musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life: a cross-sectional study.

Objective: Electronic devices have become an indispensable part of our daily lives. The frequency and duration of device use in children and adolescents have increased drastically over the years and the study of its negative musculoskeletal, visual and psychosocial health impacts is necessary. Materials and methods: This cross-sectional study aimed to evaluate the associations between electronic device use and the prevalence and severity of musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life in children and adolescents studying at primary and secondary schools. Data were collected through confidential online and paper-and-pencil questionnaires. Primary 4-5 and Secondary 1-4 students were recruited from 3 schools in Hong Kong. Demographics, frequency and duration of electronic device use, frequencies of musculoskeletal symptoms, visual symptoms, psychosocial health, and quality of life outcomes were measured. Results: 1,058 children and adolescents aged 9-17 years participated. Sixty-one percent and 78% of all students spent more than 2 h per day using electronic devices during school days and weekend/holidays, respectively. Extended electronic device use was associated with increased prevalence and severity of musculoskeletal symptoms (ρ's = 0.28-0.33, P's < 0.001), visual symptoms (ρ's = 0.33-0.35, P's < 0.001), and poorer device use-related psychosocial health (ρ's = 0.38-0.47, P's < 0.001). Secondary school students reported greater device use and severity of symptoms than primary school students. Conclusion: Excessive electronic device use was associated with increased prevalence and severity of physical and psychosocial symptoms, and such use is more prevalent in adolescents when compared to the children. The findings have important health implications for children and adolescents, suggesting that early intervention is needed to reduce the risk of developing device use-related disorders.

A randomized controlled trial of social cognition and interaction training for persons with first episode psychosis in Hong Kong.

Social cognitive impairment is a core limiting factor of functional recovery among persons with first episode psychosis (FEP). Social Cognition and Interaction Training (SCIT) is a group-based, manualized training with demonstrated evidence in improving social cognitive performance among people with schizophrenia. However, there are few studies on the effect of SCIT for people with FEP and for people in non-Western societies. This study evaluated the feasibility, acceptability and initial effectiveness of the locally-adapted SCIT in improving social cognitive functioning in Chinese people with FEP. The SCIT was delivered two sessions per week over a 10-weeks period, each session lasted for 60-90 min. A total of 72 subjects with FEP were recruited from an outpatient clinic and randomized to conventional rehabilitation ("Rehab") and experimental ("SCIT and Rehab") groups. Primary outcome measures included four social cognitive domains including emotion perception, theory-of-mind, attributional bias and jumping-to-conclusion, and secondary measures included neurocognition, social competence and quality of life. Participants were assessed at baseline, post-treatment, and 3-months post-treatment. Repeated measures ANCOVAs, with baseline scores as covariates, were used to compare the group differences in various outcomes across time. The results showed that the SCIT was well-accepted, with a satisfactory completion rate and subjective ratings of relevance in the experimental group. Moreover, treatment completers (n = 28) showed evidence of an advantage, over conventional group (n = 31), in reduced attributional bias and jumping-to-conclusions at treatment completion, lending initial support for the SCIT in Chinese people with FEP. Future research should address the limitations of this study, using more refined outcome measurements and higher treatment intensity of the SCIT.

Evaluation of an occupation-based sleep programme for people with Insomnia.

Background: Sleep problems are a health issue worldwide. Based on the Person-Environment-Occupation-Performance model, we developed an occupation-based sleep programme to promote awareness of sleep hygiene factors, promote an environment conductive to sleep, and restructure participation in daytime activities with a focus on occupational balance. Method: This study uses a non-equivalent group design to evaluate the effectiveness of an occupation-based sleep intervention among community-dwelling adults with insomnia, when compared with a treatment-as-usual (TAU) group which focused on sleep hygiene, and relaxation. Results: When compared with the TAU group (n = 20), the intervention group (n = 22) had significant improvement in sleep duration, occupational balance, and reduction in mood symptoms at both post treatment and 1-month follow up. Conclusion: The results demonstrated that an occupation-based programme is an effective treatment for insomnia disorder and demonstrated the role which occupational therapy could play in primary health care service.

Translation and validation of the Reaction to Impairment and Disability Inventory for Chinese population in Hong Kong.

PURPOSE: This study translated the reaction to impairment and disability inventory (RIDI) to Chinese and validated it for use in Hong Kong. METHODS: We conducted an instrument validation of the Chinese RIDI, with a sample of 244 persons with CID. The research questionnaire collected demographic information, illness-related variables, the Chinese version of RIDI (C-RIDI), and measures of resilience and well-being. We examined the factor structure, internal consistency, convergent validity, and criterion-related validity of the C-RIDI. RESULTS: The C-RIDI has good content validity and no major changes to the translated items were needed for the use in Hong Kong. For factor structure, we replicated the results of Livneh et al. The C-RIDI has two second-order factors of adaptive and nonadaptive scales, which interact with the two denial subscales. Internal consistency of the subscales is satisfactory except for the three-item denial subscales. Correlations of the C-RIDI subscales with illness-related variables, resilience, and mental well-being are consistent with our hypotheses and provide support for the convergent and criterion-related validity of the scale. CONCLUSIONS: The C-RIDI has satisfactory psychometric properties. The study results support its internal consistency, convergent validity, criterion-related validity, and factorial validity.IMPLICATIONS FOR REHABILITATIONEmotional adjustment to chronic illness and disability is a key determinant of illness self-management, mental well-being, and quality of life.The study translated the reaction to impairment and disability inventory into Chinese and conducted a psychometric evaluation of the translated instrument.The Chinese RIDI had a similar second-order factor structure as in the validation studies of the English version, and result of this confirmatory factor analysis support the theory underlying the design of the RIDI.The Chinese RIDI had satisfactory convergent and criterion-related validity and internal consistency, and is ready for application in rehabilitation practice and research in the Chinese context.

Cognitive and Emotional Appraisal of Motivational Interviewing Statements: An Event-Related Potential Study.

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC, n = 15) or readiness stage of the change group (RD, n = 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r = 0.607-0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing.

Problematic Use of Internet-Related Activities and Perceived Weight Stigma in Schoolchildren: A Longitudinal Study Across Different Epidemic Periods of COVID-19 in China.

Background: Social distancing and school suspension due to the coronavirus pandemic (COVID-19) may have a negative impact on children's behavior and well-being. Problematic smartphone use (PSU), problematic social media use (PSMU) and perceived weight stigma (PWS) are particularly important issues for children, yet we have a poor understanding of how these may have been affected by lockdowns and physical isolation resulting from COVID-19. This research aimed to understand how these psychosocial and behavioral variables may be associated with psychological distress, and how these associations may have changed during the COVID-19 pandemic. Methods: A total of 489 children completed a three-wave longitudinal study from January 2020 to June 2020. The first wave was conducted before the COVID-19 outbreak. The second wave was conducted during the outbreak. The third wave was conducted during post-COVID-19 lockdown. Questionnaires measured psychological distress, PSU, PSMU, and PWS. Results: PSU, PSMU, PWS and psychological distress were all significantly associated with each other. PSU was significantly higher during outbreak. PWS was significantly higher before outbreak. We found an increased association between PSMU and PWS across three waves in all three models. The association between PSU and depression/anxiety decreased across three waves; however, association between PSMU and depression/anxiety increased across three waves. Conclusions: COVID-19 initiated school suspension and associated lockdowns appear to have exacerbated PSU and depression among children. However, PWS was reduced during this period. Children should use smartphones and social media safely and cautiously, and be aware of the potential exposure to weight stigmatization.

The Effectiveness of a School-Based Social Cognitive Intervention on the Social Participation of Chinese Children with Autism.

This study evaluates the efficacy of a school-based social cognitive intervention for children with autism. Seventy-four children and adolescents were taught visually scaffolded, theory of mind-based social skills program. Using a mixed-methods approach, children's social competence was assessed at pre-test and post-test. Compared to a waitlist control group, children in the intervention group demonstrated significantly greater gains on theory-of-mind and social skill measures. Focus groups and interviews were conducted to explore parents' views and generalization of children's social skills across settings. Children's social participation exhibited improvement in home, community, and school settings. The study findings offer promising evidence for a cost-effective program and support of the school-based social skills intervention for children with ASD in Hong Kong context.

Evaluation of a computer-assisted cognitive remediation program for young people with psychosis: A pilot study.

BACKGROUND: People with psychosis have a range of neuropsychological impairments that impact their functional abilities and rehabilitation outcomes. We designed a Computer-Assisted Cognitive Remediation (CACR) program to help young people with psychosis to restore their cognitive function. The program combines the drill-and-practice approach and the strategic approach to remediation, with sixteen sessions of computerized cognitive training, two sessions of psychoeducation, and four session of coaching on applying cognitive skills to daily life. METHOD: This was a randomized, single-blind, controlled study in which the outcomes of the CACR program were compared with outcomes of a treatment-as-usual (TAU) control group. Pre-intervention and post-intervention measures were compared. RESULTS: When compared with the control group, the intervention group had significant increases in their MCCB neurocognitive composite scores, and specifically in the areas of verbal learning and speed of processing at posttest. They also had significant increases in their secondary outcome measures of mental well-being and perceived occupational competence. There were no significant differences in functional status between the two groups at post-test. CONCLUSIONS: The CACR program was effective in improving overall cognitive function and in the specific domains of verbal learning, speed of processing, and effect sizes were small. Participants also experienced positive changes in mental well-being and perceived competence.

Horticultural Therapy Program for People with Mental Illness: A Mixed-Method Evaluation.

BACKGROUND: Horticultural therapy (HT) has long been used in the rehabilitation of people with mental illness, but many HT programs are not standardized, and there have been few evaluation studies. AIMS: This study evaluated the process and outcomes of a standardized horticultural program using a mixed methodology, i.e., systematic integration ("mixing") of quantitative and qualitative data within a study. METHODS: Participants who have mental illnesses were assigned to a treatment (HT) and a comparison group (n = 41 for each group). The process and outcomes of the program, including stress and anxiety, engagement and participation, affect changes, mental well-being, and social exchange, were obtained using self-completed questionnaires, observational ratings of participants during the group, as well as through a focus group. RESULTS: The study results supported the proposal HT is effective in increasing mental well-being, engagement, and the sense of meaningfulness and accomplishment of participants. Many participants reported a reduction in stress and anxiety in the focus group, but positive changes in affect were not fully observed during the group process or captured by quantitative measures. The participants also did not report increases in the social exchange over the HT sessions. CONCLUSION: The evidence supports that HT is effective in increasing mental well-being, engagement in meaningful activities, but did not result in significant affect changes during therapy, or increase social exchanges among people with mental illness.

Psychometric Properties of Sensory Processing and Self-Regulation Checklist (SPSRC).

BACKGROUND: Some children may encounter difficulties in processing sensory stimuli, which may affect their ability to participate in activities of daily living. Self-regulation abilities may also affect children on how to process different sensory experiences. The Sensory Processing and Self-Regulation Checklist (SPSRC) was developed as a single, parent-reported instrument for the examination of sensory processing and self-regulation difficulties in children. AIMS: This study is aimed at evaluating the psychometric properties of the SPSRC and examine the patterns of self-regulation and sensory processing in children with and without autism spectrum disorder (ASD). METHODS AND PROCEDURES: The contents of the SPSRC were validated by a group of experts, and a field test was subsequently conducted to examine the reliability and validity of this instrument in a sample of 997 typically developing children and 78 children with ASD. OUTCOMES AND RESULTS: The results of the validation and field test analyses suggest that the SPSRC exhibits high internal consistency, good intrarater reliability, and a valid ability to measure and discriminate sensory processing and self-regulation in children aged 3-8 years with and without ASD. CONCLUSIONS AND IMPLICATIONS: The current results supported the reliability and validity of SPSRC to assess a child's sensory processing and self-regulation performance in activities of daily living. The study findings warrant further investigation to compare the performance of the SPSRC with laboratory-based tests, as this would better elucidate sensory responsivity in children with sensory modulation disorders from both clinical and research perspectives.

Effects of repetitive transcranial magnetic stimulation (rTMS) on craving and substance consumption in patients with substance dependence: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Repetitive transcranial magnetic stimulation (rTMS) is increasingly used as an intervention for treating substance dependence. We aimed to assess evidence of the anti-craving and consumption-reducing effects of rTMS in patients with alcohol, nicotine and illicit drug dependence. METHODS: A systematic review and meta-analysis of 26 randomized controlled trials (RCTs) published from January 2000 to October 2018 that investigated the effects of rTMS on craving and substance consumption in patients with nicotine, alcohol and illicit drug dependence (n = 748). Craving, measured using self-reported questionnaires or visual analog scale, and substance consumption, measured using self-report substance intake or number of addiction relapse cases, were considered as primary and secondary outcomes, respectively. Substance type, study design and rTMS parameters were used as the independent factors in the meta-regression. RESULTS: Results showed that excitatory rTMS of the left dorsolateral pre-frontal cortex (DLPFC) significantly reduced craving [Hedges' g = -0.62; 95% confidence interval (CI) = -0.89 to -0.35; P < 0.0001], compared with sham stimulation. Moreover, meta-regression revealed a significant positive association between the total number of stimulation pulses and effect size among studies using excitatory left DLPFC stimulation (P = 0.01). Effects of other rTMS protocols on craving were not significant. However, when examining substance consumption, excitatory rTMS of the left DLPFC and excitatory deep TMS (dTMS) of the bilateral DLPFC and insula revealed significant consumption-reducing effects, compared with sham stimulation. CONCLUSION: Excitatory repetitive transcranial magnetic stimulation of the dorsolateral pre-frontal cortex appears to have an acute effect on reducing craving and substance consumption in patients with substance dependence. The anti-craving effect may be associated with stimulation dose.

Self-Harm and Suicide Among Children and Adolescents in Hong Kong: A Review of Prevalence, Risk Factors, and Prevention Strategies.

This paper reviews the prevalence, risk factors, and effectiveness of prevention programs for self-harm and suicide among children and adolescents in Hong Kong. Youth suicide rates declined gradually over the past two decades, but it is alarming to see that self-harm, suicidal thoughts, and attempts are quite common among junior secondary students. Local studies identify psychopathology (especially depression) and family relationship issues as the most common risk factors of suicide and self-harm, and impulsive control issues are an additional factor contributing to self-harm. In the second part, this paper reviews the evidence for six types of universal and selective prevention strategies identified from local and overseas literature: (1) restriction of access to means of suicide; (2) guidelines for responsible media reporting of suicides; (3) provision of quality mental healthcare to at-risk populations; (4) school-based screening and prevention programs; (5) online prevention, monitoring, and support programs; and (6) life skills training programs. Research evidence supports that the provision of high-quality mental health services to at-risk populations and some school-based prevention programs (awareness and screening, and gatekeeper training) are effective in suicide prevention. Further research efforts are needed to verify the impact of the other four strategies. Practitioners could make better use of new prevention programs through the internet and instant messaging platforms, which have the potential to alter attitude toward suicide and self-harm as well as promoting help seeking behavior among young people.

An evaluation of the TEACCH approach for teaching functional skills to adults with autism spectrum disorders and intellectual disabilities.

BACKGROUND: The Treatment & Education of Autistic and Communication Related Handicapped Children (TEACCH) approach has been widely adopted around the world, but most previous studies focus on applying it to teaching children with autism spectrum disorders (ASD) who have high functioning or without intellectual disabilities. AIMS: This study evaluated the application and effectiveness of a TEACCH approach in teaching functional skills to young adults with ASD who have mild to moderate intellectual disabilities. METHODS AND PROCEDURES: The study employed an experimental design which compared the training goal attainment of an experimental (n = 32) and a comparison (n = 31) group. We administered the TEACCH Transitional Assessment Profile (TTAP) to identify suitable areas of training and devised three individualized training goals for each participant using the goal attainment scaling (GAS) methodology. The experimental group participated in a standardized, individualized, 20-session training program based on the TEACCH approach, on top of their regular training in day activity centers. RESULTS: All the participants showed improvements in functional skills over the baseline, mid-program, and post-program assessments (F = 146.66, p < .001). The experimental group had significantly larger improvement in the GAS scores than the comparison group (F = 15.40, p < .001). There were no significant changes between the pre- and post-program TTAP scores of both groups. CONCLUSIONS AND IMPLICATIONS: The TEACCH approach is effective in teaching specific functional skills to young adults with ASD and mild to moderate intellectual disabilities. The clinical and research implications of the study are discussed.

Vocational evaluation and vocational guidance for young people with a history of drug abuse.

BACKGROUND: Young people recovering from drug addiction often face challenges in returning to the job market and in maintaining their jobs. Many of them feel they have no choice but to do entry-level work, and they are often unsure about their work ability and vocational choice. OBJECTIVE: In collaboration with a youth outreach service, this study aims to provide a package of vocational assessment, guidance, and support for these clients. METHODS: Using a strength-based case management framework, we conducted a comprehensive vocational evaluation for each participant (N = 17), which covered self-perception of abilities, work and occupational interests, work readiness, work-related self-efficacy, and work aptitudes. We presented assessment results to each client and provided guidance on their education, training, or vocational choice. RESULTS: The results of aptitude tests indicate that most participants can cope with an entry-level job. Many participants are strong in jobs that require quick decision-making, sorting, assembly, and clerical tasks, but many are weak in fine manual dexterity and eye-hand-foot coordination. Many participants preferred jobs that are creative, indefinite, and autonomous in nature. CONCLUSION: Longer-term vocational counseling and coaching is needed to help clients make vocational choices and extend their job tenure. Many clients will also need training in job seeking and job maintenance skills.

Chinese version of the Recovery Self-Assessment scale: psychometric evidence from Rasch analysis and reliability estimates.

BACKGROUND: The Recovery Self-Assessment (RSA) is a popular and well-validated instrument for assessing recovery-oriented service around the world. AIMS: This study aims to develop a Chinese version of the RSA, which assesses the recovery orientation of hospital-based mental health services. METHODS: We conducted forward and backward translations of the RSA and modify the translated Chinese based on comments by content experts. We recruited 350 people with mental illnesses who regularly attend hospital and community mental health services. The participants completed the Chinese Recovery Self-Assessment Service User version (CRSA-SU) and convergent measures on hope and mental well-being. RESULTS: The Rasch analysis supported five of the six factors in the instrument and suggests that the "Life Goal" factor could be further split into two factors. We identified three misfit items (items 6, 12 and 17) that could be considered for removal. Both the internal consistency and test-retest reliability are between satisfactory and very good within each subscale, with the exception of the Choice subscale. The seven subscales had low positive correlations with measures of hope and mental well-being, which supported the convergent validity of CRSA-SU. CONCLUSIONS: The results supported the factor structure, reliability and validity of the CRSA-SU.

Developmental skills between kindergarten children with handwriting difficulties in Chinese and/or English.

AIM: This study aimed to examine the differences in developmental skills between children with and without handwriting difficulties in their last year of kindergarten education. METHODS: Standardised tests on handwriting performance and developmental skills were administered to 20 typically developing children, 21 children with handwriting difficulties in Chinese and 23 children with handwriting difficulties in both Chinese and English. We used one-way MANOVA, univariate ANOVA and post hoc comparisons, to compare the developmental skills between children with and without handwriting difficulties. Multiple regression analysis was used to identify the significant predictors of developmental skills for Chinese and English handwriting performance. RESULTS: Higher proportion of children faced handwriting difficulties in Chinese than in English. Their major problem in Chinese handwriting was on stroke formation, while the results did not indicate the key factor leading to English handwriting difficulties. The results also showed that children with handwriting difficulties had significantly poorer visual motor integration, some aspects of visual perception and fine motor skills than typically developing children. Reading skills were not a key factor contributing to handwriting performance. In addition, visual and fine motor integration and spatial relationship were the significant predictors of Chinese and English handwriting performance, which accounted for 39.7 and 43.6% of the variance respectively. CONCLUSION: First, the results suggested that more resources should be devoted to coaching children to learn Chinese than English handwriting. Second, besides direct repetitive practice on handwriting, there is a need to incorporate learning activities to facilitate the development of visual motor skills, visual perception, and fine motor skills as a preparation for learning to write or in improving handwriting performance among kindergarten children.

Occupational Therapy Practice in Sleep Management: A Review of Conceptual Models and Research Evidence.

The effectiveness of sleep intervention developed by occupational therapists was reviewed, and a conceptual framework for organizing the developing practice of sleep management in occupational therapy was proposed in this paper. Evidence-based articles on sleep management practice in occupational therapy from 2007 to 2017 were retrieved. Four types of effective sleep management intervention were identified from the literature, including the use of assistive devices/equipment, activities, cognitive behavioral therapy for insomnia, and lifestyle intervention, and the use of assistive device was the most popular intervention. Applying the Person-Environment-Occupation Performance (PEOP) framework, we developed a conceptual framework for organizing occupational therapy practice in sleep management. The future development of occupation-based sleep intervention could focus on strategies to (1) minimize the influence of bodily function on sleep, (2) promote environment conducive to sleep, and (3) restructure daytime activity with a focus on occupational balance.

Outcome Evaluation of a Short-Term Hospitalization and Community Support Program for People Who Abuse Ketamine.

Ketamine is a popular recreational drug among young people in Hong Kong. Long-term abuse of ketamine can lead to acute urological and medical issues, which often require immediate care at emergency rooms. Many patients require short-term hospitalization for medical management. This opens a brief time window, within which mental health professionals could engage young people who abuses ketamine in psychosocial, functional, and lifestyle interventions. The Crisis Accommodation Program (CAP) is a short-term hospitalization and community support program that addresses the health care needs of young people who abuse ketamine. During short-term hospitalization, the patient participates in a range of cognitive and psychosocial assessments, motivational interviewing, emotions management, and lifestyle re-design interventions. Upon discharge, social work professionals of non-government agencies continue to work with the patients on their action plans in the community. This evaluation study uses a quasi-experimental non-equivalent group design, in which the outcomes of the treatment group (n = 84) are compared with a comparison group (n = 34) who have a history of ketamine abuse but who have not joined the treatment program. The results confirm that the treatment group showed significant increases in motivation for treatment, reduction in drug use, improvement in cognitive screening tests, healthy lifestyle scores, and self-efficacy in avoidance of drugs over 13 weeks. When compared with the comparison group, the treatment group had significant decreases in anxiety and treatment needs and had moved from pre-contemplation to the contemplation or preparation stage. However, there were no significant changes in outcome measures covering lifestyle or self-efficacy in drug avoidance. Overall, the CAP is effective in reducing drug use, anxiety, and helping patients to move from pre-contemplation to the contemplation or preparation stage of change. The study results suggest that health care professionals can successfully engage young people who abuse ketamine to participate in a package of psychosocial interventions, motivational interviewing, and lifestyle re-design during their hospital stay for management of urological problems. The CAP also highlights the importance of collaboration between hospitals and community social services in the management of addiction.