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.

Translation and validation of Chinese version of the problems in everyday living (PEDL) test in patients with mild cognitive impairment.

BACKGROUND: Cognitive impairment places older adults at increased risk of functional decline, injuries, and hospitalization. Assessments to determine whether older persons are still capable of meeting the cognitive challenges of everyday living are crucial to ensure their safe and independent living in the community. The present study aims to translate and validate the Chinese version of the Problems in Everyday Living (PEDL) test for use in Chinese population with mild cognitive impairment (MCI). METHODS: The cultural relevancy and content validity of the Chinese version of PEDL (C-PEDL) was evaluated by a seven-member expert panel. Forty patients with MCI and 40 cognitively healthy participants were recruited to examine the psychometric properties of C-PEDL. RESULTS: Significant differences in the C-PEDL scores were found between the patients with MCI and the cognitively healthy controls in both educated (F = 9.96, p = 0.003) and illiterate (F = 10.43, p = 0.004) populations. The C-PEDL had excellent test-retest and inter-rater reliabilities, with intraclass correlation coefficient at 0.95 and 0.99 respectively. The internal consistency of C-PEDL was acceptable with Chronbach's α at 0.69. The C-PEDL had moderate correlation with the Mini-Mental State Examination (r = 0.45, p = 0.004) and the Category Verbal Fluency Test (r = 0.40, p = 0.012), and a moderate negative Spearman's correlation with the Global Deteriorating Scale (r = -0.42, p = 0.007). CONCLUSIONS: The C-PEDL is a valid and reliable test for assessing the everyday problem-solving ability in Chinese older population with MCI.

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.

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.

Prosocial norms as a positive youth development construct: a conceptual review.

Prosocial norms like reciprocity, social responsibility, altruism, and volunteerism are ethical standards and beliefs that youth development programs often want to promote. This paper reviews evolutionary, social-cognitive, and developmental theories of prosocial development and analyzes how young people learn and adopt prosocial norms. The paper showed that very few current theories explicitly address the issue of how prosocial norms, in form of feelings of moral obligations, may be challenged by a norm of self-interest and social circumstances when prosocial acts are needed. It is necessary to develop theories which put prosocial norms as a central construct, and a new social cognitive theory of norm activation has the potential to help us understand how prosocial norms may be applied. This paper also highlights how little we know about young people perceiving and receiving prosocial norms and how influential of school policies and peer influence on the prosocial development. Lastly, while training of interpersonal competence (e.g., empathy, moral reasoning, etc.) was commonly used in the youth development, their effectiveness was not systematically evaluated. It will also be interesting to examine how computer and information technology or video games may be used in e-learning of prosocial norms.

Recognition for positive behavior as a critical youth development construct: conceptual bases and implications on youth service development.

Recognition for positive behavior is an appropriate response of the social environment to elicit desirable external behavior among the youth. Such positive responses, rendered from various social systems, include tangible and intangible reinforcements. The following theories are used to explain the importance of recognizing positive behavior: operational conditioning, observational learning, self-determination, and humanistic perspective. In the current work, culturally and socially desirable behaviors are discussed in detail with reference to Chinese adolescents. Positive behavior recognition is especially important to adolescent development because it promotes identity formation as well as cultivates moral reasoning and social perspective thinking from various social systems. The significance of recognizing positive behavior is illustrated through the support, tutorage, invitation, and subsidy provided by Hong Kong's social systems in recognition of adolescent volunteerism. The practical implications of positive behavior recognition on youth development programs are also discussed in this work.

Measurement of prosocial reasoning among Chinese adolescents.

This study attempted to develop a standardized instrument for assessment of prosocial reasoning in Chinese populations. The Prosocial Reasoning Objective Measure (PROM) was translated, and a two-stage study was conducted to evaluate the psychometric properties of the translated instrument. The content validity, cultural relevance, and reading level of the translated instrument were evaluated by an expert panel. Upon revisions according to the expert opinions, the Chinese PROM demonstrated good content validity, "good-to-very good test-retest" reliability, and internal consistency. However, only partial support to the convergent validity of the Chinese PROM was found. In the first stage of the study (n = 50), the PROM scores had high positive correlations with empathy and negative correlations with personal distress and fantasy. These results were consistent with theoretical expectations, although this is also a concern that empathy had a close-to-unity correlation with PROM score in the small sample study of stage 1. In the second stage of the study (n = 566), the relationship between PROM scores and prosocial behavior appeared to be weak. Results suggest that there were many personal, family, or social factors that were linked to prosocial behavior, and prosocial reasoning might only contribute to a small proportion of variation in prosocial behavior among adolescents.

Predictors of prosocial behavior among Chinese high school students in Hong Kong.

This study examined the correlates and predictors of prosocial behavior among Chinese adolescents in Hong Kong. A sample of 518 high school students responded to a questionnaire containing measures of antisocial and prosocial behavior, prosocial norms, pragmatic values, moral reasoning, and empathy. Preliminary analyses showed that there were gender differences in some of the measures. While correlation analyses showed that parental education, prosocial norms, pragmatic values, moral reasoning, and empathy were related to prosocial behavior, regression analyses showed that prosocial norms, pragmatic values, and empathy dimensions (personal distress and empathy) were key predictors of it. The findings are largely consistent with theoretical predictions and previous research findings, other than the negative relationship between personal distress and prosocial behavior. The study also underscores the importance of values and norms in predicting prosocial behavior, which has been largely neglected in previous studies.

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.

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.

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.

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.

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.

Secondary data analyses of conclusions drawn by the program implementers of a positive youth development program in Hong Kong.

The Tier 2 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social Programmes) is designed for adolescents with significant psychosocial needs, and its various programs are designed and implemented by social workers (program implementers) for specific student groups in different schools. Using subjective outcome evaluation data collected from the program participants (Form C) at 207 schools, the program implementers were asked to aggregate data and write down five conclusions (n = 1,035) in their evaluation reports. The conclusions stated in the evaluation reports were further analyzed via secondary data analyses in this study. Results showed that the participants regarded the Tier 2 Program as a success, and was effective in enhancing self-understanding, interpersonal skills, and self-management. They liked the experiential learning approach and activities that are novel, interesting, diversified, adventure-based, and outdoor in nature. They also liked instructors who were friendly, supportive, well-prepared, and able to bring challenges and give positive recognition. Most of the difficulties encountered in running the programs were related to time constraints, clashes with other activities, and motivation of participants. Consistent with the previous evaluation findings, the present study suggests that the Tier 2 Program was well received by the participants and that it was beneficial to the development of the program participants.

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.

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.