Motor Skills, Heart Rate Variability, and Arterial Stiffness in Children with Autism Spectrum Disorder.

The prevalence of autism spectrum disorder (ASD) among children has been recently increasing. The severity of symptoms greatly varies between individuals with ASD, ranging from relatively mild to extremely severe. It is important to have a clearer understanding of the possible adverse consequences resulting from this disorder, such as delayed motor development, autonomic dysregulation, and arterial stiffness. Thus, the objective of this study was to investigate differences in motor skills, heart rate variability (HRV), and arterial stiffness between children with ASD and typically developing children. In this study, the school-aged children with mild symptoms of ASD (n = 17, 11.1 ± 1.0 years old) and typically developing peers (n = 15, 11.0 ± 0.5 years old) were recruited. Motor skills, HRV, and arterial stiffness were measured in these two groups. Motor skills were evaluated by the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition. Moreover, HRV was measured through a short-term recording using the Polar heart rate monitor, and arterial stiffness was assessed by non-invasive computerized oscillometry. Compared with the typically developing group, children with ASD displayed significant deficits in some areas of motor skills, including manual coordination, strength and agility, and total motor composite. Moreover, children with ASD exhibited significantly reduced HRV, including time- and frequency-domain measures. However, the results did not demonstrate any statistically significant differences in arterial stiffness between the groups. Our findings demonstrated the presence of motor skill deficits and autonomic dysregulation in children with ASD.

Developing the Occupational Therapy-Specific Mini-Clinical Evaluation Exercise (Mini-CEX) for Evaluating Interns' Clinical Skills and Attitudes in Pediatric Occupational Therapy.

IMPORTANCE: The Mini-Clinical Evaluation Exercise (Mini-CEX) is highly recommended for assessing interns' performance. OBJECTIVE: To develop a pediatric occupational therapy-specific Mini-CEX and examine its psychometrics. DESIGN: Stage 1 had a retrospective design; Stage 2 had a prospective design. SETTING: Pediatric occupational therapy unit in a hospital in Taiwan. PARTICIPANTS: Thirty-four occupational therapy interns were evaluated with the Mini-CEX (physician version), and 57 were evaluated with the occupational therapy-specific Mini-CEX. OUTCOMES AND MEASURES: The occupational therapy-specific Mini-CEX was developed with seven items on a 9-point scale categorized into three levels (unsatisfactory, satisfactory, highly satisfactory). RESULTS: In Stage 1, the frequency of Mini-CEX (physician version) items receiving a rating of not applicable ranged from 1.9% to 88.1%. In Stage 2, the frequency of occupational therapy-specific Mini-CEX items receiving a rating of not applicable ranged from 3.5% to 31.6%. With the theme of evaluation taken into consideration, the frequency of not-applicable ratings was 0% to 8.8%. For the occupational therapy-specific Mini-CEX, content validity (item-level content validity index = 1, scale-level content validity index = 1) and internal consistency (Cronbach's α = .93) were excellent. The interns' scores on the second evaluation were significantly higher than those on their first evaluation, indicating good discriminant validity. CONCLUSIONS AND RELEVANCE: The occupational therapy-specific Mini-CEX appears to be reliable and valid, and it is appropriate for evaluating interns' skills and attitudes in pediatric occupational therapy practice. What This Article Adds: The results support the development of the occupational therapy-specific Mini-CEX and its application in pediatric internship training.

Differences between Elite Male and Female Badminton Athletes Regarding Heart Rate Variability, Arterial Stiffness, and Aerobic Capacity.

Cardiovascular health and aerobic capacity play crucial roles in determining the performance of athletes in the highly competitive sport of badminton. Few studies have directly compared heart rate variability (HRV), arterial stiffness, and aerobic capacity between male and female athletes, especially among badminton athletes. This study investigated sex differences in HRV, arterial stiffness, and aerobic capacity in badminton athletes. Elite badminton athletes were recruited and divided into male (n = 20, 21.0 ± 1.8 years old) and female (n = 16, 21.2 ± 2.3 years old) groups. Both groups performed an incremental treadmill running test for the evaluation of maximal oxygen consumption (V.O2max), anaerobic threshold, and time to exhaustion. They started exercising at a treadmill speed of 2.7 km/h and an inclination of 10% gradient for 3 min, and the speed and inclination were gradually increased every 3 min until they were exhausted or fatigued volitionally. HRV was examined using the Polar heart rate monitor over a period of 5 min at rest in the supine position. Subsequently, the index of arterial stiffness was examined under the same condition. Our results revealed significant differences between the male and female athletes in V.O2max (men: 60.38 ± 8.98 mL/kg/min, women: 48.13 ± 7.72 mL/kg/min, p < 0.05), anaerobic threshold (men: 41.50 ± 7.26 mL/kg/min, women: 32.51 ± 6.19 mL/kg/min, p < 0.05), time to exhaustion (men: 902.15 ± 120.15 s, women: 780.56 ± 67.63 s, p < 0.05), systolic blood pressure (men: 125.27 ± 7.76 mmHg, women: 107.16 ± 11.09 mmHg, p < 0.05), and arterial stiffness index (men: 63.56 ± 12.55, women: 53.83 ± 8.03, p < 0.05). However, no significant differences in HRV measures were observed between the two groups. These findings suggested that the male badminton athletes demonstrated significantly higher aerobic capacity than did the female athletes, but there were no significant differences in HRV measures. The female athletes exhibited superior arterial function, compared with their male counterparts.

Development of an Objective Structured Clinical Examination Station for Pediatric Occupational Therapy and an Evaluation of Its Quality.

IMPORTANCE: The Objective Structured Clinical Examination (OSCE) is a highly valued measure of students' clinical competencies in medical education. However, few studies have reported on the administration of the OSCE in pediatric occupational therapy education. OBJECTIVE: To describe the development of a pediatric occupational therapy OSCE station to evaluate students' use of a standardized assessment and examine its standard setting, failure rates, and psychometric properties. DESIGN: Prospective, cross-sectional, observational study design. SETTING: Three OSCE stations in a university clinical skills center. PARTICIPANTS: Five experienced occupational therapists, 60 examinees, 44 child standardized patients, 44 chaperones, and 15 examiners. MEASURES: The sum of the rating scale and the global performance scores were used. The rating scale measured the examinee's clinical competences in administering a standardized assessment. The 5-point global performance score was used to evaluate the examinee's whole performance. RESULTS: The OCSE station's expert validity was acceptable (item-level content validity index [CVI] = 0.8-1.0; scale-level CVI = 0.98). Passing scores according to the Angoff method (passing score = 14) and the contrasting-groups M-SD method (passing score = 13) were similar. Failure rates were high (61.7%-73.3%). Internal consistency was acceptable (Cronbach's α = .78). No significant examiner effect was found (p = .554), and interexaminer reliability was acceptable (item score = 0.58-1.00; sum of the rating scale score = 0.97; global performance score = 0.79). CONCLUSIONS AND RELEVANCE: The OSCE station for using a standardized assessment is a reliable and valid measure of students' interpersonal communication skills and assessment skills. What This Article Adds: The OSCE for education in pediatric occupational therapy is both effective and rigorous.

Aging Additively Influences Insulin- and Insulin-Like Growth Factor-1-Mediated Endothelial Dysfunction and Antioxidant Deficiency in Spontaneously Hypertensive Rats.

This study aimed to investigate the aging-related endothelial dysfunction mediated by insulin and insulin-like growth factor-1 (IGF-1) and antioxidant deficiency in hypertension. Male spontaneously hypertensive rats (SHRs) and age-matched normotensive Wistar-Kyoto rats (WKYs) were randomly divided into 24-week-old (younger) and 48-week-old (older) groups, respectively. The endothelial function was evaluated by the insulin- and IGF-1-mediated vasorelaxation of aortic rings via the organ bath system. Serum levels of nitric oxide (NO), malondialdehyde (MDA), catalase, and total antioxidant capacity (TAC) were examined. The insulin- and IGF-1-mediated vasorelaxation was significantly impaired in both 24- and 48-week-old SHRs compared with age-matched WKYs and was significantly worse in the 48-week-old SHR than the 24-week-old SHR. After pretreatments of phosphoinositide 3-kinase (PI3K) or NO synthase (NOS) inhibitors, the insulin- and IGF-1-mediated vasorelaxation became similar among four groups. The serum level of MDA was significantly increased, while the NO, catalase, and TAC were significantly reduced in the 48-week-old SHR compared with the 24-week-old SHR. This study demonstrated that the process of aging additively affected insulin- and IGF-1-mediated endothelial dysfunction in SHRs, which could be partly attributed to the reduced NO production and antioxidant deficiency.

Twelve-Week Protocatechuic Acid Administration Improves Insulin-Induced and Insulin-Like Growth Factor-1-Induced Vasorelaxation and Antioxidant Activities in Aging Spontaneously Hypertensive Rats.

Protocatechuic acid (PCA), a strong antioxidant, has been reported for its cardiovascular-protective effects. This study aimed to investigate the effects of PCA administration on vascular endothelial function, mediated by insulin and insulin-like growth factor-1 (IGF-1), and antioxidant activities in aging hypertension. Thirty-six-week-old male aging spontaneously hypertensive rats were randomly divided into vehicle control (SHR) and PCA (SHR+PCA) groups, while age-matched Wistar⁻Kyoto rats (WKY) served as the normotensive vehicle control group. The oral PCA (200 mg/kg/day) was administered daily for a total of 12 weeks. When the rats reached the age of 48 weeks, the rat aortas were isolated for the evaluation of vascular reactivity and Western blotting. Also, nitric oxide (NO) production and antioxidant activities were examined among the three groups. The results showed that, when compared with the SHR group, the insulin-induced and IGF-1-induced vasorelaxation were significantly improved in the SHR+PCA group. There was no significant difference in the endothelium-denuded vessels among the three groups. After the pre-incubation of phosphatidylinositol 3-kinase (PI3K) or NO synthase (NOS) inhibitors, the vasorelaxation was abolished and comparable among the three groups. The protein levels of insulin receptors, IGF-1 receptors, phospho-protein kinase B (p-Akt)/Akt, and phospho-endothelial NOS (p-eNOS)/eNOS in aortic tissues were significantly enhanced in the SHR+PCA group when compared with the SHR group. Moreover, significant improvements of nitrate/nitrite concentration and antioxidant activities, including superoxide dismutase, catalase, and total antioxidants, were also found in the SHR+PCA group. In conclusion, the 12 weeks of PCA administration remarkably improved the endothelium-dependent vasorelaxation induced by insulin and IGF-1 in aging hypertension through enhancing the PI3K⁻NOS⁻NO pathway. Furthermore, the enhanced antioxidant activities partly contributed to the improved vasorelaxation.

The Construct of the Schizophrenia Quality of Life Scale Revision 4 for the Population of Taiwan.

This study examines the factor structure of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) for inpatients with schizophrenia in a psychiatric hospital in southern Taiwan. All the participants (n = 100) filled out the SQLS-R4, Mini Mental Status Examination (MMSE), and Brief Psychiatric Rating Scale (BPRS) under the supervision of one experienced occupational therapist. Using confirmatory factor analysis, we first determined that a 29-item model was more satisfactory than the original 33-item model based on the findings of better fit indices for the 29-item model. We then found that a three-correlated-factor structure was best for the SQLS-R4 after four models (namely, two-correlated-factor, three-correlated-factor, seven-correlated-factor, and second-order models) had been compared. In addition, the three constructs (psychosocial, physical, and vitality) were moderately to highly correlated with the constructs of the World Health Organization Quality of Life- (WHOQOL-) BREF (r = -0.38 to -0.69), except for one low correlation between the vitality construct of the SQLS-R4 and the psychological construct of the WHOQOL-BREF (r = -0.26). We tentatively conclude that the SQLS-R4 with a three-correlated-factor structure is a valid and reliable instrument for examining the quality of life of people with schizophrenia.

Comparing two schizophrenia-specific quality of life instruments in institutionalized people with schizophrenia.

Clinical health professionals may have difficulties to select appropriate schizophrenia-specific Quality of life (QoL) instruments because of the limited information regarding their psychometric properties. Two widely used schizophrenia-specific QoL instruments (Schizophrenia Quality of Life Scale Revision 4 [SQLS-R4] and Lancashire Quality of Life Profile [LQOLP]) were compared in institutionalized people with schizophrenia, and useful recommendations for clinical health professionals were provided. Participants (n = 100) filled out the two instruments twice. Test-retest reliability, internal consistency, and confirmatory factor analyses (CFAs) were conducted. Both SQLS-R4 domains (r = 0.573-0.731) and LQOLP domains (r = 0.303-0.778) had good test-retest reliability. However, the objective QoL domains in the LQOLP showed lower internal consistency (α = 0.219-0.617) than its subjective QoL domains (α = 0.532-0.947) and the SQLS-R4 domains (α = 0.768-0.939). The CFAs with two correlated underlying instruments constructs and two correlated underlying QoL traits (viz., Physical and Psychosocial QoL) performed the best data-model fit (CFI = 0.990, RMSEA = 0.039, SRMR = 0.039), which supported the validity of both instruments. Although both SQLS-R4 and LQOLP were valid and reliable, using SQLS-R4 on institutionalized people seemed to be more psychometrically solid than using the LQOLP.

Using children as standardized patients in OSCE in pediatric occupational therapy.

BACKGROUND: Objective structured clinical examinations (OSCEs) have been administered in physical and psychiatric occupational therapy (OT) education, but not in pediatric OT education. The objectives were to examine the satisfaction and the influences of OSCE in pediatric OT on all participants. METHODS: The OSCE contained evaluation, intervention, and parent education stations. Sixty examinees, 44 child standardized patients (SPs), 44 chaperones, three playroom managers, 14 OSCE assistants, and 15 examiners participated in the OSCE. An OSCE video and three playrooms were prepared for child SPs. RESULTS: Ninety percent of the child SPs liked taking part in the OSCE and 75-85% expressed interest in participating in an OSCE the following year. Their parents appreciated the chaperones accompanying their children and giving them a memorable day. 88.3% of the examinees thought that the OSCE was helpful for their upcoming clinical training. 73.3% preferred the OSCE over the written exam. 60-93.4% considered the implementation appropriate. Most of the examiners thought that the content (80-100%) and the implementation (93.3-100%) were appropriate. Many chaperones reported having valuable experiences. CONCLUSIONS: It is practical using child SPs in OSCE in pediatric OT. The OSCE was beneficial to all participants. It is recommended that OSCEs be included in pediatric OT education.

Improvement of Acetylcholine-Induced Vasodilation by Acute Exercise in Ovariectomized Hypertensive Rats.

Postmenopause is associated with the development of cardiovascular disease, such as hypertension. However, limited information is available regarding effects of exercise on cardiovascular responses and its underlying mechanisms in the simultaneous postmenopausal and hypertensive status. We aimed to investigate whether acute exercise could enhance vasodilation mediated by acetylcholine (ACh) and sodium nitroprusside (SNP) in ovariectomized hypertensive rats. The fifteen-week-old female spontaneously hypertensive rats (SHR) were bilaterally ovariectomized, at the age of twenty-four weeks, and randomly divided into sedentary (SHR-O) and acute exercise (SHR-OE) groups. Age-matched WKY rats were used as the normotensive control group. The SHR-OE group ran on a motor-driven treadmill at a speed of 24 m/min for one hour in a moderate-intensity program. Following a single bout of exercise, rat aortas were isolated for the evaluation of the endothelium-dependent (ACh-induced) and endothelium-independent (SNP-induced) vasodilation by the organ bath system. Also, the serum levels of oxidative stress and antioxidant activities, including malondialdehyde (MDA), superoxide dismutase (SOD), and catalase, were measured after acute exercise among the three groups. We found that acute exercise significantly enhanced the ACh-induced vasodilation, but not the SNP-induced vasodilation, in ovariectomized hypertensive rats. This increased vasodilation was eliminated after the inhibition of nitric oxide synthase (NOS). Also, the activities of SOD and catalase were significantly increased after acute exercise, whereas the level of MDA was comparable among the three groups. These results indicated that acute exercise improved the endothelium-dependent vasodilating response to ACh through the NOS-related pathway in ovariectomized hypertensive rats, which might be associated with increased serum antioxidant activities.

Long-term treadmill training ameliorates endothelium-dependent vasorelaxation mediated by insulin and insulin-like growth factor-1 in hypertension.

Dysfunction of insulin and insulin-like growth factor-1 (IGF-1) is associated with the pathophysiology of hypertension. The influence of long-term exercise on vascular dysfunction caused by hypertension remains unclear. We investigated whether long-term treadmill training improved insulin- and IGF-1-mediated vasorelaxation in hypertensive rats. Eight-week-old male spontaneously hypertensive rats (SHR) were randomly divided into sedentary and exercise (SHR-EX) groups. The SHR-EX group was trained on a treadmill for 60 min/day, 5 days/wk, for 8 wk. Wistar-Kyoto rats (WKY) were used as the normal control group. After training, aortic insulin- and IGF-1-mediated vasorelaxation was evaluated in organ baths. Additionally, the roles of phosphatidylinositol 3-kinase (PI3K), nitric oxide synthase (NOS), and aortic protein expression were examined in the three groups. Compared with sedentary SHR and WKY groups, insulin- and IGF-1-mediated vasorelaxation was significantly enhanced to a nearly normal level in the SHR-EX group. After endothelial denudation, blunted and comparable vasorelaxation was found among the three groups. Pretreatment with selective PI3K and NOS inhibitors attenuated insulin- and IGF-1-mediated vasorelaxation, and no significant difference was found among the three groups after the pretreatment. The aortic protein levels of the insulin receptor (IR), IGF-1 receptor (IGF-1R), insulin receptor substrate-1 (IRS-1), and endothelial NOS (eNOS) were also significantly increased in the SHR-EX group compared with the other two groups. These results suggested that treadmill training elicited the amelioration of endothelium-dependent insulin/IGF-1-mediated vasorelaxation partly via the increased activation of PI3K and NOS, as well as the enhancement of protein levels of IR, IGF-1R, IRS-1, and eNOS, in hypertension.

Validity of sensory systems as distinct constructs.

This study investigated the validity of sensory systems as distinct measurable constructs as part of a larger project examining Ayres's theory of sensory integration. Confirmatory factor analysis (CFA) was conducted to test whether sensory questionnaire items represent distinct sensory system constructs. Data were obtained from clinical records of two age groups, 2- to 5-yr-olds (n = 231) and 6- to 10-yr-olds (n = 223). With each group, we tested several CFA models for goodness of fit with the data. The accepted model was identical for each group and indicated that tactile, vestibular-proprioceptive, visual, and auditory systems form distinct, valid factors that are not age dependent. In contrast, alternative models that grouped items according to sensory processing problems (e.g., over- or underresponsiveness within or across sensory systems) did not yield valid factors. Results indicate that distinct sensory system constructs can be measured validly using questionnaire data.

Psychometric evaluation of the Short Form 36 Health Survey (SF-36) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) for patients with schizophrenia.

Quality-of-life (QoL) instruments measure the overall health status of people with schizophrenia, for whom the activities of daily life are often difficult. However, information on the psychometric properties of scores from the Short Form 36 Health Survey (SF-36) and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF), 2 commonly used generic QoL instruments in this population, is limited. Thus, we used a multitrait-multimethod analysis plus confirmatory factor analysis (CFA) to examine their psychometric properties. To test the reliability of their scores, we used methods of absolute reliability (standard error of measurement [SEM] and smallest real difference [SRD]) and relative reliability (i.e., intraclass correlation coefficient [ICC]). We recruited 100 patients with schizophrenia from a psychiatric hospital in southern Taiwan. All participants filled out the SF-36 and the WHOQOL-BREF at baseline and 2 weeks later. The participants' QoL scores were lower than those of the Taiwan general population (ps < .01), and CFA indicated that the constructs of QoL scores for the SF-36 (comparative fit index [CFI] = .918; incremental fit index [IFI] = .919; Tucker-Lewis index [TLI] = .885) and the WHOQOL-BREF (CFI = .967; IFI = .967; TLI = .900) were acceptable. The SEM and SRD analyses suggested that the total scores of the SF-36 (SEM% = 10.03%; SRD% = 27.80%) and of the WHOQOL-BREF (SEM% = 5.55%; SRD% = 15.40%) were reliable. Also, our results demonstrated that the WHOQOL-BREF scores were more reliable and valid than the SF-36 scores for assessing people with schizophrenia. The scores of both questionnaires were valid and reliable and detected different aspects of QOL in the population with schizophrenia.

Balance in children with attention deficit hyperactivity disorder-combined type.

The balance ability in children with attention deficit hyperactivity disorder-combined type (ADHD-C) has not been fully examined, particularly dynamic sitting balance. Moreover, the findings of some published studies are contradictory. We examined the static and dynamic sitting balance ability in 20 children with ADHD-C (mean age: 9 years 3 months; 18 boys, 2 girls) and 20 age-, sex-, height-, weight-, and IQ-matched healthy and typically developing controls (mean age: 9 years 2 months; 18 boys, 2 girls). The balance subtests of the Movement Assessment Battery for Children (MABC) and the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) were used to compare the two groups, and a mechanical horseback riding test was recorded using a motion-capture system. Compared with the controls, children with ADHD-C had less-consistent patterns of movement, more deviation of movement area, and less-effective balance strategies during mechanical horseback riding. In addition, their performance on the balance subtests of the MABC and BOTMP were not as well as those of the controls. Our findings suggest that balance ability skill levels in children with ADHD-C were generally not as high as those of the controls in various aspects, including static and dynamic balance.

Child-rated versus parent-rated quality of life of community-based obese children across gender and grade.

BACKGROUND: Quality of life (QoL), which can be examined using self-reports or parental reports, might help healthcare providers understand obese children's subjective well-being in several domains of life. Community-based obese children report their QoL lower than their parents do. However, the differences between child- and parent-reported QoL have neither been tested across gender and grade nor analyzed by item. This study probed the relationship between obesity and QoL item scores in children, and compared child-reported with parent-reported QoL stratified by gender and grade. METHODS: One hundred eighty-seven dyads of 8- to 12-year-old children (60 obese, 127 normal-weight) and their parents were recruited. QoL was assessed using both child- and parent-reported Pediatric Quality of Life Inventory 4.0 (PedsQL) questionnaires. RESULTS: Regression analyses showed specific difficulties with physical and emotional QoL in third- and fourth-grade obese boys (ß = 0.278-0.620), and specific problems with social functioning in fifth- and sixth-grade obese girls (ß = 0.337-0.411). Moreover, parents seemed unaware of the specific difficulties that their children faced (ß = 0.274-0.435). CONCLUSIONS: Obese children seemed to have their difficulties from third to fifth grade, respectively, and their parents seemed unaware of them. Thus, parents need to be more aware of specific difficulties related to childhood obesity.

Objective measurement of weekly physical activity and sensory modulation problems in children with attention deficit hyperactivity disorder.

This study aimed to objectively compare the daily physical activity (PA), as indicated by moderate-to-vigorous physical activity (MVPA) during a week and metabolic equivalents (METs) per minute, between children with attention deficit hyperactivity disorder (ADHD) and typically developing children. Moreover, sensory modulation problems were examined using behavioral and physiological measures. Twenty boys with ADHD (mean age 8.64 ± 2.57 years), and 20 matched typically developing boys (mean age 9.10 ± 1.79 years) participated in our study. Each child wore a PA monitor for 14 h a day, seven days a week. All participants' parents were asked to fill out daily activity logs for their children. The problems of sensory modulation were detected using sensory profile (SP) questionnaires and Sensory Challenge Protocol that measured electrodermal response (EDR) to repeated sensory stimulation. Compared with the controls, the children with ADHD had a generally higher level of PA (1.48 ± 0.10 vs. 1.60 ± 0.12 METs/min; p=001), and tended to spend more time in MVPA on weekdays (35.71%) and the weekend (57.14%). However, when analyzing hourly recorded PA, the group differences were obvious only for certain hours. Our data suggested that children with ADHD were more hyperactive in structure-free than structured settings. The ADHD group showed their sensory modulation problems on the SP but not on the EDR. We found some correlations between sensory modulation problems and hyperactivity in children with ADHD.

Lower exercise capacity in children with asymptomatic atrial septal defect associated with circulatory impairment.

The exercise capacity and limitation in children with asymptomatic atrial septal defect (ASD) have not been explored thoroughly. The aim of our study was to examine the influence of asymptomatic ASD on exercise capacity in children. Fifty children with asymptomatic ASD who had undergone medical interventions at least 4 years ago and fifty normal children were recruited in this study. The exercise capacity was assessed by the symptom-limited exercise test through the Bruce treadmill protocol. The pulmonary function was also evaluated by the spirometry. Circulatory and ventilatory impairments were respectively reflected by chronotropic incompetence (CI) and ventilatory limitation as measured by the exercise test and spirometry. Eleven (22%) of children with ASD failed to reach the age-predicted peak heart rate during the exercise test. Also, children with ASD had significantly lower oxygen consumption at anaerobic threshold and peak exercise (P < 0.01). The rate of circulatory impairment was significantly higher in children with ASD (P < 0.01). However, the pulmonary function and ventilatory limitation were comparable between these two groups. Within the ASD group, children with CI had significantly worse peak oxygen consumption than their peers without CI (P < 0.01). Our study examined a larger population sample and confirmed that children with asymptomatic ASD, who had previously undergone medical interventions, had significantly worse exercise capacity than normal children. This difference in exercise capacity was mainly related to circulatory impairment. Our findings support the concerns of exercise limitation in ASD children.

Measurement equivalence across child self-reports and parent-proxy reports in the Chinese version of the pediatric quality of life inventory version 4.0.

An important assumption for comparing children's quality of life (QoL) between children's and parents' perceptions is that measurement equivalence/invariance (ME/I) exists. The ME/I across the child- and parent-reported Chinese PedsQL was examined, and the latent means between child self-reports and parent-proxy reports were compared. Third-grade to sixth-grade children (n = 519) and their parents (n = 270) respectively completed the child- and parent-reported PedsQL. Seventy-eight parents completed parent-proxy reports twice. Full ME/I across child and parent reports was found in first- and second-order factor loadings. Partial ME/I was supported in item intercepts and item residual variances. The latent means of child self-reports and of parent-proxy reports were not significantly different, which suggested interchangeability between child- and parent-reported PedsQL. The ME/I results support the use of PedsQL scores to compare children's and parents' perceptions of children's QoL.

Self-rated and parent-rated quality of life (QoL) for community-based obese and overweight children.

AIMS: To determine the effects of being obese or overweight on quality of life (QoL) of children from a community-based sample and to compare their self-ratings of QoL with their parents' ratings for their children's QoL. METHODS: Dyads of 8- to 12-year-old children [60 obese, 34 overweight and 127 normal weight (N = 221)] and their parents or caregivers were recruited from southern Taiwan. QoL was assessed by both parent proxy ratings and child self-ratings using the Pediatric Quality of Life Inventory (PedsQL) questionnaire. RESULTS: Obese children reported significantly lower QoL than did their normal-weight counterparts (83 ± 15 vs. 88 ± 10; p = 0.04). Obese children rated their QoL lower than did their parents in all (Cohen's d = -0.38 to -0.22) but the school domain. Overweight children's and normal-weight children's self-reported QoL was not significantly different, nor were they different from parent-reported QoL. CONCLUSIONS: Community-based obese children reported a lower QoL than did normal-weight children; however, their parents seemed unaware of their children's decreased QoL. Caution is required when using only parent proxy reports to assess the QoL of obese children. More effort is needed in Taiwan to improve parents' understanding of their obese children's QoL.

Psychometric properties and gender invariance of the Chinese version of the self-report Pediatric Quality of Life Inventory version 4.0: short form is acceptable.

PURPOSE: To evaluate the psychometric properties and gender invariance of the Chinese version of the Pediatric Quality of Life Inventory (PedsQL) for 8- to 12-year-olds. METHODS: Psychometric testing and confirmatory factor analysis (CFA) were used with a convenience sample of 8- to 12-year-old children (n = 479) for PedsQL full and short forms. RESULTS: The internal consistency reliability was satisfactory for all subscales and total scores (Cronbach's α = 0.73-0.90), except for the school subscale (0.68 [full form], 0.62 [short form]). Test-retest reliability was 0.67-0.84. Convergent validity was supported by the correlation between the Children's Depression Inventory and PedsQL psychosocial subscale (r = -0.69). Construct validity determined using CFA showed a better model fit in the short form (RMSEA = 0.06) than in the full form (RMSEA = 0.08). Measurement invariance across gender determined using nested CFA models showed that all absolute ΔRMSEA values were <0.01. CONCLUSIONS: The Chinese version of the PedsQL is a relatively reliable and valid instrument, and the PedsQL short form showed a better construct validity than did the full form. Measurement across gender was invariant; therefore, the comparisons of quality of life between boys and girls were appropriate.