[Abnormal brain structure in preschool and school-aged children with autism spectrum disorder].

OBJECTIVE: To investigate the prevalence and type of abnormal brain structure in preschool and school-aged children with autism spectrum disorder (ASD). METHODS: A total of 74 252 preschool and school-aged children aged 3-12 years in Shanghai were enrolled as subjects. A questionnaire survey was performed to collect basic information, and their parents and teachers completed the Social Communication Questionnaire (SCQ) based on the children's conditions. ASD was diagnosed by specialist physicians according to the DSM-5 criteria. Brain magnetic resonance imaging (MRI) was performed according to their parents' desires. RESULTS: The overall prevalence rate of ASD was 2.59‰ (192/74 252) in the preschool and school-aged children. Brain MRI data were collected from 73 children with ASD and 185 healthy children. Among the 73 children with ASD, 40 (55%) had abnormal brain structure, and the most common types were unilateral or bilateral ventriculomegaly in 32 children (80%) and unilateral or bilateral deep frontotemporal sulci in 12 children (30%). Children with ASD showed lower white matter signal in bilateral ventricular and unilateral or bilateral deep frontotemporal sulci, compared to their normal peers (P<0.05). CONCLUSIONS: There is a high prevalence rate of abnormal brain structure in preschool and school-aged children with ASD, with major types of unilateral or bilateral ventriculomegaly and unilateral or bilateral deep frontotemporal sulci. It is speculated that abnormal brain structure might be associated with the pathogenesis of ASD, and further studies are needed to clarify the association between abnormal brain structure and symptoms in children with ASD.

Autism, Language Disorder, and Social (Pragmatic) Communication Disorder: DSM-V and Differential Diagnoses.

• Based on strong research evidence (1), the prevalence of autism spectrum disorders (ASDs) has increased over the past decade, with a 2010 prevalence of 1:68 (1.5%) in children age 8 years. • Based on some research evidence as well as consensus (3), the most recent revision of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) identifies two core dimensions for the diagnosis of ASD: social (social communication and social interaction) and nonsocial (restricted, repetitive patterns of behaviors, interests, or activities). • Based on some research evidence as well as consensus (3) (31) (32) (33) (34), DSM-V identifies social pragmatic communication disorder (SPCD) as a dissociable dimension of language and communication ability that affects how individuals use language for social exchanges. SPCD is often found in children with language impairments and children with attention-deficit/hyperactivity disorder and other genetic/neurologic conditions. • Based on strong research evidence (2) (26) (27) (28), childhood language disorders affect 7.4% of kindergarteners, and 50% to 80% of these children experience persistent language, academic, and social-emotional difficulties into their adult years, despite having normal nonverbal cognitive abilities. • Based primarily on consensus due to lack of relevant clinical studies, differential diagnosis of autism and language disorders may require a multidisciplinary evaluation that takes into account a child's overall development, including cognitive, communication, and social abilities. Monitoring the response to appropriate interventions and trajectory of development over time may improve the accuracy of diagnosis, especially in very young children.

Environmental risk factor assessment: a multilevel analysis of childhood asthma in China.

BACKGROUND: Rapid changes in socioeconomic environment and their diverse patterns in China raise a question: how socio-environmental factors affect childhood asthma in China. We performed a multilevel analysis based on a 2005 national survey to understand the association between environmental factors and asthma, and to provide insights on developing prevention strategies. METHODS: A multi-center, cross-sectional survey was conducted in 2018 school-aged children chosen from eight Chinese cities. Children of 6-13 years old were chosen randomly from schools of 39 centers in 8 cities. The multilevel analysis was made to assess both individual-level and city-level risk factors. The effect of gross domestic product (GDP) was further investigated by analysis of the factors. RESULTS: Analysis of city-level environmental factors showed that GDP [adjusted odds ratio (OR)=1.88], particulate matter with aerodynamic diameter ≤10 µm (PM10) (adjusted OR=1.37), and average humidity (adjusted OR=1.33) were strong risk factors. Further analysis of the factors decomposed GDP into two major factors, the first represented by urban construction, energy consumption, nitrogen dioxide concentration, and the second represented by health-system coverage. This suggested that the negative effects of GDP outweighed its positive effects on asthma. CONCLUSIONS: The prevalence of childhood asthma varies significantly in the eight Chinese cities. Socioenvironmental factors such as GDP, PM10 and average humidity are strong risk factors controlling individual attributes, suggesting that balance is needed between public health and economic development in China.

[The association of sleep hygiene and sleep quality among school-age children].

OBJECTIVE: To study the association between sleep hygiene and sleep duration and quality among school-age children, and to explore the risk factors related to poor sleep hygiene. METHODS: Totally 2019 grade-five children were sampled by stratified cluster random sampling from 10 primary schools in Shanghai, during November and December 2009. Questionnaires were used to investigate children and their parents. Adolescent Sleep Hygiene Scale (ASHS) was used to inquiry sleep hygiene of children; Children Sleep Habits Questionnaire (CSHQ) was used to assess their sleep duration and quality; Family and Social Environment Questionnaire was used to collect demographic and socio-economic information. T-test, one-way ANOVA and multiple linear regression model were established to identify the risk factors for sleep hygiene. RESULTS: The age of subjects was (10.81 ± 0.38) years old, 49.0% (989/2019) were boys. The ASHS total score was 125.43 ± 15.17, girls with better sleep hygiene than boys (127.05 ± 14.41 vs 123.74 ± 15.75, P < 0.05). The sleep duration was (9.47 ± 0.58)h/d, children slept less than 9 h/d had lower ASHS total score than those slept 9 - 10 h/d or over 10 h/d (121.69 ± 16.09 vs 126.17 ± 14.62 vs 126.50 ± 15.36, P < 0.05). Children with poor sleep quality had worse sleep hygiene than those with good sleep quality (121.00 ± 15.84 vs 128.36 ± 13.92, P < 0.05). Children with television set in bedroom had lower ASHS total score than the others (122.40 ± 15.76 vs 126.74 ± 14.66, P < 0.05). Children from single parent family had lower ASHS total score (117.90 ± 16.80 vs 125.94 ± 14.89, P < 0.05). Children whose father had irregular sleep or wake pattern had lower ASHS total score (122.65 ± 15.30 vs 125.89 ± 14.90 vs 127.79 ± 14.71, P < 0.05). The regression model confirmed that existence of television set in children's bedroom, single-parent family and father's irregular sleep pattern were the risk factors of poor sleep hygiene. CONCLUSION: Sleep hygiene was closely associated with sleep duration and quality among school-age children. Children with television set in bedroom, male, from single parent family and whose father had irregular sleep or wake pattern had worse sleep quality.

[Comparative study of children's sleep evaluation methods].

OBJECTIVE: To compare the compliance of using Actiwatch, parent report of sleep diary and sleep questionnaire in school age children, and to further evaluate agreement rates between actigraphy, diary, and questionnaire for children's sleep patterns. METHOD: Two primary schools in Luwan District were selected and first grade students without obvious physical and mental illnesses or sleep disorders were enrolled in the study. Each student was home-monitored with an Actiwatch for 7 days, meanwhile parents were asked to complete a detailed sleep diary during the Actiwatch monitoring days. Sleep questionnaires were distributed to their parents who were asked to fill in these on the last monitoring day. RESULT: Forty-five children participated in the study, 36 children completed sleep assessments by all the three methods, and among them 20 were boys and 16 were girls. The mean age of those children was (7.26±0.42) years. The completion rate of questionnaire was 100%, of diary was 86.7% (39/45) and of Actiwatch was 93.3% (42/45). The completion rate between sleep diary and sleep questionnaire was significantly different (P<0.05). The satisfactory agreement between Actiwatch and sleep diary was reached with sleep diary overestimating weekday and weekend sleep duration by 26 minutes and 25 minutes respectively. The agreement rates between Actiwatch and questionnaire was insufficient for all variables with sleep questionnaire overestimating weekday and weekend sleep duration by 37 minutes and 38 minutes respectively. CONCLUSION: Sleep questionnaire is an easy and high compliance method for evaluating children's sleep pattern while sleep diary showed high agreement with Actiwatch. Using either of these methods for evaluating children's sleep pattern should be judged by research aim and sample size, and limitation of those methods should be considered when they are used in practice.

Prospective, naturalistic study of open-label OROS methylphenidate treatment in Chinese school-aged children with attention-deficit/hyperactivity disorder.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders during childhood, characterized by the core symptoms of hyperactivity, impulsivity and inattention and puts great burden on children themselves, their families and the society. Osmotic release oral system methylphenidate (OROS-MPH) is a once-daily controlled-release formulation developed to overcome some of the limitations associated with immediate-release methylphenidate (IR-MPH). It has been marketed in China since 2005 but still lacks data from large-sample clinical trials on efficacy and safety profiles. The aim of this study was to evaluate the effectiveness and safety of OROS-MPH in children aged 6 to 16 years with ADHD under naturalistic clinical setting. METHODS: This 6-week, multi-center, prospective, open-label study enrolled 1447 ADHD children to once-daily OROS-MPH (18 mg, 36 mg or 54 mg) treatment. The effectiveness measures were parent-rated Inattention and Overactivity With Aggression (IOWA) Conners I/O and O/D subscales, physician-rated CGI-I and parent-rated global efficacy assessment scale. Blood pressure, pulse rate measurement, adverse events (AEs) and concomitant medications and treatment review were conducted by the investigator and were served as safety measures. RESULTS: A total of 1447 children with ADHD (mean age (9.52 ± 2.36) years) were enrolled in this trial. Totally 96.8% children received an OROS-MPH modal dose of 18 mg, 3.1% with 36 mg and 0.1% with 54 mg at the endpoint of study. The parent IOWA Conners I/O score at the end of week 2 showed statistically significant (P < 0.001) improvement with OROS-MPH (mean: 6.95 ± 2.71) versus the score at baseline (10.45 ± 2.72). The change in the parent IOWA Conners O/D subscale, CGI-I and parent-rated global efficacy assessment scale also supported the superior efficacy for OROS-MPH treatment. Fewer than half of 1447 patients (511(35.3%)) reported AEs, and the majority of the events reported were mild (68.2%). No serious adverse events were reported during the study. CONCLUSION: This open-label, naturalistic study provides further evidence of effectiveness and safety of OROS-MPH in school-aged children under routine practice.

[Follow-up study of school-age children's sleep quality in Shanghai].

OBJECTIVE: China has undergone massive socioeconomic change during the past several years, and its impact on children's sleep is still unrecognized. Shanghai, as one of typical economically fast-developing cities, was chosen as observational city in this study, which was designed to explore trends in sleep quality in Shanghai school-aged children and related high risk factors on sleep quality. METHOD: Totally 884 fifth grade school-aged students were sampled by stratified cluster random sampling method from 10 primary schools of Shanghai in 2005, then four years later in 2009, 2161 same grade students were sampled from the same schools. Chinese version of Children's Sleep Habits Questionnaire (CSHQ) was used to evaluate 8 sleep quality parameters among those children, and high risk factors on school-aged children's sleep quality were investigated as well. RESULT: The prevalence of poor sleep quality decreased from 29.2% in 2005 to 27.9% in 2009, and among 8 sleep quality parameters, bedtime resistance decreased from 33.1% to 28.7%, sleep anxiety from 50.6% to 39.8%, night waking from 25.2% to 21.5%, and parasomnia from 51.2% to 45.8%. The factors, such as heavier homework burden, longer daily computer use, bright light during sleep, cosleeping, existence of chronic disease and irregular sleep habits of parents, were associated with poor sleep quality of school-aged children after adjusting for children's age, gender, and family social-economic status. CONCLUSION: Part of sleep quality parameters improved during the past 4 years, but current situation is still tough with more than 1/4 poor sleep quality children. Helping children to develop good sleep hygiene as well as educating parents how to shape children's regular sleep habits might be effective methods to improve children's sleep quality.

Cost-efficiency assessment of 3 different pediatric first-aid training models for caregivers and teachers in Shanghai.

PURPOSE: The object of this study was to assess, in cost-effective measures, 3 different models for pediatric first-aid training among caregivers and teachers. METHODS: Quasi-experimental design was used. A stratified random sampling method was used to obtain 1282 teachers working at nurseries and kindergartens in Shanghai that consists of 18 districts and 1 county. One thousand two hundred eighty-two teachers were allocated randomly to the 3 models of training: 441 to interactive training model (group A), 441 to lecture-based training model (group B), and 400 to video instruction training model (group C). The first-aid knowledge in the 3 models was evaluated before and after the training. RESULTS: There was a statistical significance in the results of postassessment among the 3 training models. In group A, 329 (87.3%) trainees passed the course; in group B, 294 (81.7%) passed; and in group C, 262 (79.4%) passed. The total cost of group A was ¥2361 per edition, the total cost of group B was ¥1955 per edition, and the total cost of group C was ¥1064 per edition (P < 0.001). The cost per passed student was ¥151 in group A, ¥74 in group B, and ¥41 in group C (P < 0.001). CONCLUSIONS: Although interactive training model may slightly increase the rate of trainees who passed the course, the cost-effectiveness of video instruction training model is clearly superior.

[Sleep habits and sleep disturbance in school-age children of China].

OBJECTIVE: To survey the sleep habits (bedtime, wake time), sleep duration, and sleep problems in school-age children of China. METHOD: From November to December, 2005, a total of 19,299 school-age children from 55 elementary schools of 9 cities entered the study by a cross-sectional survey. A parent-administered questionnaire and the Chinese version of the Children's Sleep Habits Questionnaire were applied to investigate children's sociodemographic characteristics and sleep behaviors, respectively. RESULTS: The mean sleep duration was 9 hours and 10 minutes (9:10, SD:48 min) during the weekdays and 9:48 (SD: 63 min) during the weekends. In about 71.4% and 41.8% school-aged children the sleep duration per day did not reach the lowest criterion of 10 hours recommended by the Ministry of Education of China during weekdays and weekends, respectively. Sleep problems were common with prevalence ranging from 14.5% for sleep-disordered breathing to 75.3% for daytime sleepiness. Parasomnia (chi(2) = 13.76, P < 0.01) and sleep-disordered breathing (chi(2) = 119.83, P < 0.01) were more prevalent in boys than in girls; however, sleep anxiety was more prevalent in girls than in boys (chi(2) = 19.42, P < 0.01). Except for night waking, other types of sleep problems were significantly associated with age. CONCLUSIONS: Inadequate sleep duration and sleep problems prevail among school-age children, which indicates that children's sleep health may be a major public health concern in China.

[Internet addiction among Shanghai adolescents: prevalence and epidemiological features].

OBJECTIVE: To study the prevalence of internet use and internet addiction in adolescents of Shanghai. METHOD: From September to October 2007, a total of 5135 adolescents from 16 middle schools of 6 districts of Shanghai took part in the epidemiological study by a cross-sectional survey and 5123 adolescents finally enrolled in the study. A questionnaire of "DRM Adolescent Internet Use 52 Scale" was administrated to investigate the prevalence of internet use and internet addiction in adolescents of Shanghai. On this scale of 5-point rating, the scale includes seven parts of contents as tolerance, abstinence reaction, planning ability, self-control ability, whenness, sociability and hazard. RESULTS: The rate of internet use among the surveyed adolescents was 94.32% (4673/5123), among which the incidence rate of internet addiction was 8.78% (450/5123). Boys, senior middle-school students were more susceptible to internet addiction than girls and junior middle-school students (male scores 122.42+/-43.46, female scores 116.92+/-38.10, F=23.22, P=0.00; senior middle-school students 125.24+/-39.02, junior middle-school students 110.30+/-42.35, F=164.68, P=0.00). Students from vocational senior middle-school were most susceptible (junior middle-school students 110.30+/-42.35, ordinary senior middle-school students 122.83+/-40.99, key senior middle-school students 120.05+/-37.87, vocational senior middle-school students 133.37+/-36.84, F=34.44, P=0.00). The 2nd grade students of senior middle-school have the highest risk for internet-addiction. CONCLUSION: The prevalence of internet use and internet addiction in adolescents of Shanghai should be comparatively high in China, which indicates that great attention should be paid to the prevention and control.

[A randomized controlled clinical trial for treatment of children with primary nocturnal enuresis].

OBJECTIVE: Applying three treatment methods for enuresis in children with primary nocturnal enuresis (PNE) in a randomized controlled clinical trial (RCT) to compare the curative effects and characteristics of the three methods. METHODS: If the parents and children consented to accept the treatment for 4 months and to keep on follow-up, the children diagnosed as primary nocturnal enuresis in the department of developmental and behavioral pediatrics in Shanghai Children's Medical Center from April 2003 to August 2004 were randomized into three groups: 52 children were in physio-psychological treatment group and were treated by utilizing the conditioning training role of alarm and other psychological and behavioral training programs; 46 children were in drug treatment group and were treated by taking DDAVP tablets orally; 40 children were in combined treatment group who were treated by applying the former two methods simultaneously. If the parents and children did not accept treatment, they were enrolled into the control group and were followed-up. Then, the curative effects of the four groups were compared statistically when the 4-month treatment was over and compared again 3 months later. RESULTS: Applying the physio-psychological treatment for 4 months, the short-term cure rate of children with enuresis was 75.0%. Three months after the end of the treatment, the long-term cure rate was 71.2%. As for drug treatment group, the short-term cure rate of children with enuresis was 47.8%, the long-term cure rate was 28.3%; As for combined treatment group, the short-term cure rate of children with enuresis was 85.0%, the long-term cure rate was 80.0%. The short-term and long-term curative effects of physio-psychological treatment group and combined treatment group were better than that of drug treatment group (P < 0.01). However, the short-term and long-term curative effects were not significantly different between physio-psychological treatment and combined treatment group (P > 0.05). Physio-psychological treatment exerts effects slowly, but showed sustained curative effects. While Drug treatment exerts effects rapidly, but the relapse rate was very high after discontinuation of the medication. CONCLUSIONS: Physio-psychological treatment and drug treatment are currently generally recognized the best ways to treat enuresis, both of them are suitable for Chinese enuresis children, both of them showed good curative effects. Physio-psychological treatment develops children's ability to control nocturnal micturition, its curative effects were better than that of the drug treatment whilst its relapse rate is lower as compared to drug treatment. So, physio-psychological treatment is more suitable for widespread use to treat PNE in China.

[Development and psychometric properties of the Chinese version of Children's Sleep Habits Questionnaire].

OBJECTIVE: To develop the Chinese version of Children's Sleep Habits Questionnaire (CSHQ) by translating and retranslating the English version of CSHQ and to examine the reliability, content validity, construct validity of the Chinese version in a general population of school-age children. METHODS: During November and December 2005, a total of 20 457 school-age children from 55 primary schools of 9 cities were recruited through cluster-stratified selection, using geographic location, economic standard, and population density as criteria. A parent-administered questionnaire and the Chinese version of CSHQ were completed to quantify sociodemographic characteristics and to characterize sleep patterns and sleep disturbances, respectively. RESULTS: The internal consistency of overall questionnaire and the eight subscales of the Chinese version of CSHQ was good (Cronbach's alpha coefficient was 0.73 and ranged from 0.42 to 0.69, respectively). The consistency between mother and father was ICCs = 0.89 for overall questionnaire and ranged from ICCs = 0.83 to ICCs = 0.92 for subscales. The test-retest reliability was ICCs = 0.85 for overall questionnaire and range from ICCs = 0.60 to ICCs = 0.88 for subscales. Factor analysis revealed a three-factor structure, which could represent bedtime behavior problems, sleep disturbance, sleep duration and daytime sleepiness, respectively, and the three factors could be used to explain 58.63% of the total variance. The factor loading was above 0.5 for the corresponding subscale. CONCLUSIONS: Reliability, content validity and construct validity of the Chinese version of CSHQ in a general population of school-age children are good. It appears to be a suitable instrument for measuring sleep patterns and screening for sleep problems in school-aged children.

[Early intervention for children with language developmental delay].

OBJECTIVE: To explore the mode of intervention for children with language developmental delay under the current condition of China. METHOD: The study population consisted of a cross-sectional convenience sample of 206 children, ages 13 - 24 months, from six communities of Qingpu in Shanghai. Parents were asked to complete detailed questionnaires about their child's spontaneous use of vocabularies. Fourteen children with vocabularies less than 5 percentile of every age group were identified as having language developmental delay. During the 12-month intervention, developmental pediatricians did the developmental assessment for every child and set goals of intervention for everybody according to their language abilities and family situation. Then kindergarten teachers who got the training in language therapy carried out the intervention. Gesell development scale was used for developmental assessment before and after the intervention. RESULTS: The developmental quotient (DQ) in areas of language and personal-social behavior was elevated significantly after 12 months of intervention (P < 0.01). The developmental quotient (DQ) in the area of adaptive behavior was also elevated (P < 0.05). There was an obvious catching up effect in both areas of language and personal-social behavior. Increased developmental age in both areas was (18.0 +/- 5.3) months and (16.2 +/- 5.9) months, respectively. The language ability of 71.4% samples was in the normal range at the end. CONCLUSIONS: The mode of medical and educational cooperation to give early intervention for children with language developmental delay is feasible. It can significantly improve the abilities in language and communication of children 1 - 2 years of age.

[Logistic regression analysis of influential factors on auditory receptive and auditory expressive language development in 2-year old child].

OBJECTIVE: To identify the influential factors on auditory receptive and auditory expressive language development and to provide clues to avoid language delay. METHODS: A questionnaire was conducted among the caregivers of 2794 2-year old healthy children selected by cluster sampling in subdistricts with middle economic level from randomly selected 8 districts of Shanghai by using the "Early language milestone scale". Logistic regression analysis was used to find out the related factors. RESULTS: Five of the 24 items were the risk factors for the expressive language development: seldom practicing speaking (OR = 3.0257), reading quietly (OR = 2.0704), being male (OR = 1.7778), watching TV without discussing (OR = 1.4424), beginning to read after the age of 1.5 years (OR = 1.1576 - 2.0115). Eleven of the 24 items were the risk factors for the receptive language development: father's physical labor occupation (OR = 17.0238), seldom practicing speaking (OR = 2.8410), living in city (OR = 2.0125), reading quietly (OR = 1.7039), watching TV for more than 2 hours a day (OR = 1.6551), watching TV without discussing (OR = 1.5344), lack of communication between children and caregiver (OR = 1.1892), mother's bad education (OR = 1.1870), being male (OR = 1.6722), seldom playing with other children n (OR = 1.1671), beginning to read after the aged of 1.5 years (OR = 1.0435 - 2.0228). CONCLUSION: There are different factors related to 2-year-old children's receptive and expressive language development. Avoiding the risk factors and providing rich language environment would help prevent and intervene the language delay in early life.

[Development of children's self-regulation competence and its relationship with behavioral problems].

OBJECTIVE: To study the development of self-regulation competence and its relationship with behavioral problems in Chinese children with the method of questionnaire assessment. METHODS: The subjects of the study consisted of 18 to 36 months old toddlers and 3 to 6 years old children. Self-regulation competence in this study included effortful control and self-regulation development. Effortful control is the concept described in Rothbart theory. Attentional focus and inhibitory control were two components in effortful control, which mainly reflect the positive control of emotion and behavior. The Early Childhood Behavior Questionnaire (ECBQ) and Children's Behavior Questionnaire (CBQ) were adopted to assess the attentional focus and inhibitory control of effortful control and impulsivity in children at different ages. Achenbach's Children Behavioral Checklist was used to measure behavioral problems in three to five years old children. RESULTS: Totally 114 18 to 36 months old toddlers and 443 3 to 6 years old children were enrolled in data analysis. (1) The internal consistency of attentional focus in ECBQ and CBQ, alpha (Cronbach) value was respectively 0.89 and 0.75. The internal consistency of inhibitory control, alpha value was respectively 0.84 and 0.78. The alpha value of self-regulation development was respectively 0.84 and 0.94. (2) In 18 to 36 months old toddlers, there was no significant difference between genders in effortful control and self-regulation development. In 3 to 6 years old children, the score of girls' effortful control was higher than the score of boys' effortful control, the scores of girls' self-regulation development factor except regulation motion were significantly higher than boys (t = 4.27 and 11.14, P < 0.05 or P < 0.01). (3) The self-regulation competence including attentional focus, inhibitory control and all the factors in self-regulation development was significantly higher with age in three to six years old children (F = 2.9-10.16, P < 0.05 or P < 0.01). Children in this period already had some regulation skills. The development of regulation competence and regulation skill was not on the same step. Some were fast and some were slow. (4) The scores of attention focus and inhibitory control had significantly positive correlation with the general score of self-regulation development, the coefficient of partial correlation analysis was 0.52 and 0.64, respectively (P < 0.001). (5) The impulsivity had no significant correlation with self-regulation competence in 18 to 36 months old toddlers. The scores of impulsivity and behavioral problems scores had significantly negative correlation with attentional focus, inhibitory control and self-regulation development in 3-to-6 years old children. The coefficients were at low level, none was beyond -0.30 (P < 0.001). CONCLUSIONS: Effortful control or self-regulation had sex differences, girls had higher competence than boys, except motivation of self-regulation. But such sex differences did not show significant difference in children younger than three years of age in this study. This phenomenon is consistent with the development of self-regulation reported by Kopp. Child self-regulation competence increases with age. Generally speaking, the lower self-regulation competent, the higher impulsivity and behavioral problems, but the correlation was at a low level. For assessment and prediction of occurrence of behavioral problems, self-regulation competence should be combined with the other influential factors.

[Clinical characteristics and speech therapy of lingua-apical articulation disorder].

OBJECTIVE: To explore the clinical characteristics and speech therapy of 62 children with lingua-apical articulation disorder. METHODS: Peabody Picture Vocabulary Test (PPVT), Gesell development scales (Gesell), Wechsler Intelligence Scale for Preschool Children (WPPSI) and speech test were performed for 62 children at the ages of 3 to 8 years with lingua-apical articulation disorder. PPVT was used to measure receptive vocabulary skills. GESELL and WPPSI were utilized to represent cognitive and non-verbal ability. The speech test was adopted to assess the speech development. The children received speech therapy and auxiliary oral-motor functional training once or twice a week. Firstly the target sound was identified according to the speech development milestone, then the method of speech localization was used to clarify the correct articulation placement and manner. It was needed to change food character and administer oral-motor functional training for children with oral motor dysfunction. RESULTS: The 62 cases with the apical articulation disorder were classified into four groups. The combined pattern of the articulation disorder was the most common (40 cases, 64.5%), the next was apico-dental disorder (15 cases, 24.2%). The third was palatal disorder (4 cases, 6.5%) and the last one was the linguo-alveolar disorder (3 cases, 4.8%). The substitution errors of velar were the most common (95.2%), the next was omission errors (30.6%) and the last was absence of aspiration (12.9%). Oral motor dysfunction was found in some children with problems such as disordered joint movement of tongue and head, unstable jaw, weak tongue strength and poor coordination of tongue movement. Some children had feeding problems such as preference of eating soft food, keeping food in mouths, eating slowly, and poor chewing. After 5 to 18 times of therapy, the effective rate of speech therapy reached 82.3%. CONCLUSION: The lingua-apical articulation disorders can be classified into four groups. The combined pattern of the articulation errors is the most common one. Most of the apical sounds are replaced by velar sounds. The speech localization method is very useful in the therapy of apical articulation disorder. For children with feeding problems and oral motor dysfunction, it is needed to improve food texture and administer oral motor skill training.