Total Behavior Problem Score Research Articles

Effectiveness of a Training Program for Parents of Toddlers with or at Risk of Autism Spectrum Disorder

Purpose: This study aimed to evaluate a hospital-provided hybrid parental support program designed to help parents implement routine interventions for their toddlers under 34 months, with or at risk of autism spectrum disorder (ASD).Methods: An experimental group including 15 pairs of toddlers and their parents received eight weekly sessions, while a control group including nine pairs received no sessions. Toddlers’ joint attention, autism-related behaviors, and adaptive behaviors, as well as parenting stress and parenting efficacy, were compared between baseline and 8 weeks later. Results: The toddlers in the experimental group showed significant improvement in their joint attention scores on the Early Social Communication Scales (<i>P</i><0.01) and the Korean-Childhood Autism Rating Scale scores (<i>P</i><0.01). However, statistically significant differences were not found in the adaptive behavior composite scores of the Korean Vineland Adaptive Behavior Scales-II and total behavior problem scores of the Korean version of the Child Behavior Checklist. Parenting efficacy in the experimental group showed significant improvement (<i>P</i><0.05). Parenting stress increased in the experimental group, but the difference was not significant. Additionally, parents showed a statistically significant between-group difference in parenting efficacy (<i>P</i><0.05). Conclusion: A hospital-provided hybrid program affected the development of toddlers with ASD and parents’ implementation of interventions. It is significant that an online platform was used to provide individualized support for families to continue practicing the interventions and that the effectiveness of this program was demonstrated. This intervention can be considered as an efficient and sustainable alternative system to support toddlers with ASD and their families.

Sleep and its variability in relation to behavioral outcomes in school-age children with overweight and obesity.

This was a cross-sectional study to examine sleep and its variability in relation to behavioral outcomes in school-age children with overweight and obesity. A total of 246 school-age children with overweight or obesity were recruited between 2019 and 2021 from 10 public elementary schools in Northern Taiwan. Parents completed sleep and behavior questionnaires, with children wearing an actigraphy monitor for 7 days. Average daily sleep duration by actigraphy was 7.52 h, with 84.6% of the children having clinically significant sleep disturbance scores and 68.3% having a total behavior problem score in the clinical range. Children were categorized by median split for sleep duration and sleep duration variability. Multivariate regression analyses showed that children in the insufficient (duration)-stable (variability) sleep category had significantly higher scores for emotion problems (B = 0.94, p = 0.01), self-control problems (B = 1.61, p < 0.01), and total behavior problems (B = 3.38, p < 0.01) compared to children in the sufficient-stable sleep (reference) category. Children in the insufficient-variable sleep category had significantly higher self-control problem scores compared to children in the reference category (B = 1.03, p < 0.05). Findings from our study suggest that school-age children with overweight and obesity coexist with sleep and behavioral problems, and those who have consistently insufficient sleep are at the greatest risk for the worst behavioral outcomes. Screening for sleep habits and behavioral problems should be considered a standard practice in pediatric overweight and obesity.

Effects of parent- and child-related behavioral feeding problems in early childhood on malnutrition

ObjectiveChildren's responses to food and their caregivers during normal developmental periods are known as feeding behavior. For the healthy development of these behaviors, parent and child relationships must also be healthy. Therefore, we aimed to investigate the effect of behavioral feeding problems on primary malnutrition (PM). MethodThe Behavioral Pediatric Nutrition Assessment Scale (BPFAS) was administered to 300 malnourished and 300 control pediatric patients aged from 9 months to 4 years who were referred to our pediatric gastroenterology outpatient clinic. Pre- and posttreatment data were compared between the two groups. ResultsThere was no statistically significant difference between patients with and without malnutrition in terms of gender and age (p = 0.191, p = 0.128, respectively). Total behavioral frequency (TBF) and total behavioral problem (TBP) scores were significantly higher in the malnutrition group (p < 0.001). In the logistic regression analysis of risk factors that may affect malnutrition we found that a total TBF score of ≥85 increases the risk of developing malnutrition 3.731 times, a child TBF score of ≥62 increases it 2.644 times, and a parental TBF score of ≥21 increases it 4.82 times (p < 0.001). When anthropometric measurements and BPFAS scores of 127 PM patients who received behavioral therapy with enteral products and who attended follow-up were compared with their pretreatment data, there was a significant improvement (p < 0.05). ConclusionOur study showed that behavioral feeding problems may increase the risk of PM and that behavioral therapy together with enteral products has a positive effect on treatment. Therefore, in addition to nutritional support in patients with PM, offering behavioral feeding therapy to parents will positively affect both the child's physical development and the relationship between the parents and their child.

Effects of antenatal micronutrient supplementation regimens on adolescent emotional and behavioral problems: A 14-year follow-up of a double-blind, cluster-randomized controlled trial

Antenatal multiple micronutrient supplementation has been shown to have beneficial effects on birth outcomes and may improve child development. However, whether there is an effect of antenatal micronutrient supplementation strategies on offspring socioemotional outcomes remains unknown. We aimed to examine the effect of antenatal folic acid (FA), iron-folic acid (IFA), and multiple micronutrient (MMN) supplementation on adolescent emotional and behavioral outcomes. We conducted a double-blind, cluster-randomized trial of antenatal micronutrient supplementation in rural western China between 2002 and 2006. Pregnant females were randomized by village to receive either daily (i) 400μg FA, (ii) IFA containing 60mg iron and 400μg FA or (iii) MMN supplementation containing 30mg iron, 400μg FA plus 13 additional vitamins and minerals. A 14-year follow-up of their offspring was conducted in 2016. Adolescents were administered the locally adapted Youth Self-Report-2001 (YSR-2001) which produced internalizing, externalizing, and total behavior problem scores. We applied generalized estimating equations to assess the effect of the randomized regimens on YSR-2001 scores and explored the potential effect modification by household wealth and initial timing and duration of supplementation. A total of 1920 adolescents were included in the analysis, 1130 (58.9%) were male, and the mean (SD) age was 11.8 (0.78) years. Adolescents in IFA group had lower total (mean difference (MD):-2.89; 95% CI -5.73,-0.04) and externalizing (MD:-0.97; 95% CI -1.79,-0.15) problem scores as compared to those in FA group. There was no effect of MMN on behavior problem scores as compared to IFA and FA alone. Although, in effect modification analyses, MMN appeared to have greater beneficial effects in wealthier households than IFA and FA alone. Iron supplementation during pregnancy reduced adolescent emotional and behavioral problem scores which provides additional support for expanding coverage of iron-containing prenatal supplements in resource-limited settings. isrctn. org Identifier: ISRCTN08850194.

Dual Informants Reporting: Do we Observe Behavioral Problems in Primary School Children?

Introduction: World Health Organization states that 20% of young children have emotional and behavioral problems.&#x0D; Aims &amp; Objectives: &#x0D; 1) Identify the pattern of behavior problems among primary school students in Lahore upon dual informant report.&#x0D; 2) Measure the association of demographic variables and behavior problems in primary school students in Lahore.&#x0D; Place and duration of study: Study was conducted in Lahore and completed in one-year time.&#x0D; Material &amp; Methods: A cross-sectional study was done in eighteen public/ private primary schools of Lahore city; selected randomly from the sample frame of the schools of the selected towns. The sample size was 396, equally divided in both sectors (198 in each); three schools of each sector and town (66); and lastly 22 students from one school in a sector. Simple random sampling technique was applied to select the study subject from the sample frame. An appropriate inclusion and exclusion criterion was applied. Data collection was done on standardized Strength and Difficulties Questionnaire, using Parent and Teacher Proforma. Data was analyzed using SPSS version 23. P-Value &lt; 0.05 was taken as significant.&#x0D; Results: After exclusion, data of 369 students were analyzed for both sector school students. The frequencies for four borderline/ abnormal behavior problems-emotional; conduct; hyperactivity; and peer problems were assessed. The parent's reported frequencies were: 44.98%; 52.15%; 37.32%; and 44.02% respectively. Comparative figures reported by the teachers were: 28%; 34.69%; 28.19%; and 40.11% respectively. A statistically significant association was found between behavior problem sub-domains and socio-demographic factors in students. A weak positive Pearson correlation of 0.323was found between parent and teacher observed total behavior problem scores.&#x0D; Conclusion: According to the assessment of both informants there is a significant rise in the behavior issues in its various sub-domains in students from both sectors as compared to the last statistics of 2010.

Neurobehavioral phenotype of Kabuki syndrome: Anxiety is a common feature.

Kabuki syndrome (KS) is a Mendelian Disorder of the Epigenetic Machinery (MDEM) caused by loss of function variants in either of two genes involved in the regulation of histone methylation, KMT2D (34–76%) or KDM6A (9–13%). Previously, representative neurobehavioral deficits of KS were recapitulated in a mouse model, emphasizing the role of KMT2D in brain development, specifically in ongoing hippocampal neurogenesis in the granule cell layer of the dentate gyrus. Interestingly, anxiety, a phenotype that has a known association with decreased hippocampal neurogenesis, has been anecdotally reported in individuals with KS. In this study, anxiety and behavior were assessed in a cohort of 60 individuals with molecularly confirmed KS and 25 unaffected biological siblings, via questionnaires (SCARED/GAS-ID and CBCL/ABCL). Participant age ranged from 4 to 43 years old, with 88.3% of participants having a pathogenic variant in KMT2D, and the rest having variants in KDM6A. In addition, data was collected on adaptive function and positive affect/quality of life in participants with KS using appropriate online surveys including ABAS-III and PROMIS Positive Affect. Survey scores were compared within the KS participants across age groups and between KS participants and their unaffected siblings. We found that children with KS have significantly higher anxiety scores and total behavior problem scores than their unaffected siblings (p = 0.0225, p < 0.0001). Moreover, a large proportion of affected individuals (22.2% of children and 60.0% of adults) surpassed the established threshold for anxiety; this may even be an underestimate given many patients are already treated for anxiety. In this sample, anxiety levels did not correlate with level of cognitive or adaptive function in any KS participants, but negatively correlated with positive affect in children with KS (p = 0.0005). These findings indicate that anxiety is a common neurobehavioral feature of KS. Providers should therefore carefully screen individuals with KS for anxiety as well as other behavioral issues in order to allow for prompt intervention. Neurobehavioral anxiety measures may also prove to be important outcome measures for clinical trials in KS.

0496 Sleep and Behavior Problems in Children with Overweight and Obesity

Abstract Introduction Limited studies have examined sleep variability in children with overweight and obesity, nor do studies focused on its relation with behavior outcomes in this high risk pediatric population. The purpose of this study was to examine sleep duration and its variability in relation to behavior outcomes in school-age children with overweight and obesity. Methods Sleep in 246 children aged 6-9 years with overweight and obesity was assessed using actigraphy for 7 days and through the parent-report Children’s Sleep Habits Questionnaire (CSHQ). Children’s behaviors were assessed using parental responses on the Behavior Assessment for Children. Children were categorized into 4 groups based on the median split of the average daily sleep duration and its variability: sufficient-stable, sufficient-variable, insufficient-stable, and insufficient-variable. General linear model (GLM) analyses were performed with the 4 sleep groups as the primary predictor variable and child behavior outcomes as the dependent variable. Results Average daily sleep duration by actigraphy was 7.52 hours, with 84.6% of the children having clinically significant CSHQ sleep disturbance scores and 68.3% having a total behavior problem score in the clinical range. In the unadjusted and adjusted GLM analysis, children in the insufficient-stable sleep duration category had significantly higher emotion problem (p &amp;lt; 0.05), self-control problem (p &amp;lt; 0.01), and total behavior problem scores (p &amp;lt; 0.01) when compared with those in the sufficient-stable sleep duration (reference) category. Children in the insufficient-variable sleep duration category had significantly higher self-control problem scores when compared with those in the reference category (p &amp;lt; 0.05). Conclusion School-age children with overweight and obesity coexist with sleep and behavior problems, with those who have persistent short sleep at the greatest risk for the worst behavior outcomes. Support (If Any) This work was supported by Ministry of Science and Technology, Taiwan, MOST 107 - 2314 - B - 002 - 025 - MY3.

Parental Preconception and Prenatal Environmental Exposures and Child Neurobehavioral Outcomes

BACKGROUND AND AIM: There are limited studies quantifying the effects of paternal and maternal preconception environmental exposures on children’s health. The Preconception Environmental exposure And Childhood health Effects (PEACE) Study includes children (age 6-13 years) who were born to couples in the Environment and Reproductive Health (EARTH) Study and aims to determine the extent to which maternal and paternal preconception phthalate exposures are associated with neurobehavioral outcomes. METHODS: The PEACE study began in 2019 and is ongoing. A total of 478 eligible children (includes multiples) were born to 451 mothers who participated in the EARTH study (2005-2017). Study staff collected multiple maternal and paternal preconception urine samples before pregnancy and prenatal maternal urine samples during each trimester of pregnancy. We quantified 10 urinary phthalate metabolites in these samples. Children’s behavior, executive function, and reciprocal social behaviors are being assessed via parent-report using the Behavior Assessment System for Children-3 (BASC-3), Behavior Rating Inventory of Executive Function (BRIEF), and Social Responsiveness Scale-2 (SRS-2), respectively. Trained staff collected additional information about diet, sleep, physical activity, product use, and COVID-19 stress. RESULTS:As of March 2021, we enrolled 95 mothers, 57 fathers, and 120 children in the PEACE Study who completed visits either in person or virtually. Of children who completed the study, 64 (53%) were boys and 97 (81%) were White. Mean BASC-3 total behavior problem scores were 48.7 (SD: 7.6). Ten percent of children had scores indicative of being at-risk for behavioral problems (T-score60). Average BRIEF and SRS-2 scores were 48.2 (SD: 9.5) and 46.9 (SD:6.1), respectively. CONCLUSIONS:The PEACE Study will provide new information about the potential impact of parental preconception environmental chemical exposures on children’s health. In addition, the PEACE study will be able to leverage the rich data repository that includes parental chemical, built environment, and dietary exposures. KEYWORDS: Children's environmental health, Neurodevelopmental outcomes, Phthalates, Male, Chemical exposures, Endocrine disrupting chemicals, Female

Behavioural and emotional disturbances associated with sleep-disordered breathing symptomatology in children with Down's syndrome.

Down's syndrome (DS) predisposes to sleep-disordered breathing (SDB). In children with DS, behavioural and emotional disturbances secondary to SDB are often assumed to result from cognitive impairment alone. Our aim was to explore the relationship of behavioural and emotional disturbances with SDB in a population of children with DS. A modified sleep questionnaire, Epworth Sleepiness Scale (ESS), Paediatric ESS and the short form of the developmental behaviour checklist (DBC-P24) were sent to 261 carers of children aged 4 to 15years with DS in 2012. Of 120 participants, 25% had probable SDB. In children with probable SDB compared to those without nocturnal symptoms, the total behaviour problem score (TBPS) was significantly higher (20.3±8.6/48 vs. 12±7.5/48; P=0.002) as was the PaedESS (7.7±5.6/24 vs. 2.8±3.5/24; P=0.002). For every increase in frequency of choking attacks, snoring and night awakenings, the TBPS increased by 1.37, 1.28 and 1.75 points, respectively, indicating worsening behaviour. The TBPS was found to decrease by 1.31 points for every hour more of self-reported sleep duration (r=-0.25, P=0.017). SDB symptoms and shorter self-reported sleep duration are highly prevalent among children with DS and are independently associated with worsening behaviour using the TBPS.

Longitudinal association between environmental tobacco smoke exposure and behavioral problems in children from ages 5 to 9

Few studies have assessed the cumulative effects of exposure to environmental tobacco smoke (ETS11Environmental tobacco smoke.) in relation to children's neurobehavioral problems over time. We assessed the longitudinal associations between ETS exposure at age 5 and behavioral problems at ages 5, 7, and 9 using the Ewha Birth and Growth Cohort, in Seoul, Korea. Children with available urinary cotinine levels at age 5 and one or more behavioral problem scores measured with the Korean Version of Child Behavior Checklist (CBCL22Child behavior checklist.) at age 5, 7, and 9 were included in the study. Those whose mothers smoked during pregnancy were excluded, and a total of 179 children were included in the analysis. A linear mixed-model analysis using a REPEATED statement was conducted to assess whether ETS exposure was associated with the total, internalizing, and externalizing behavioral problem scores of the CBCL. The group with higher levels of cotinine showed continuously higher total and external behavioral problem scores from ages 5 to 9, which was seen after adjusting for preterm birth, father's education level, and television watching time. In addition, the difference in the total and external behavioral problem scores between the higher and lower cotinine groups at age 5 was statistically significant after a Bonferroni correction (p = 0.02 and 0.04, respectively), even though the fixed effect of cotinine level was almost but not statistically significant (p = 0.07 and 0.08, respectively). The results of this longitudinal cohort study provide evidence regarding the negative effects of ETS exposure in early childhood and their behavioral problems over time. This study supports the strengthening of anti-smoking policies used in educational interventions for parents, in order to reduce early ETS exposure in children.

The association of externalizing and internalizing problems with indicators of intelligence in a sample of at-risk children

To date, a substantial body of research exists suggesting an association between indicators of intelligence and various deleterious outcomes, including externalizing and internalizing behavioral problems. Much of this research, however, has focused on samples drawn from the general population, thus it remains less clear how (and if) intelligence relates to problem behaviors in samples of highly at-risk individuals. The current study seeks to contribute to this knowledge base by examining the associations between intelligence and internalizing, externalizing, and total scores on the Child Behavioral Checklist in a sample of approximately 2500 highly disadvantaged respondents considered by Child Protective Services as at-risk for abuse or neglect. While the two measures of intelligence performed differently, there emerged some association between overall lower IQ and higher total behavioral problem scores. There was some evidence that low IQ also predicted higher internalizing scores, but this relationship varied greatly by measure and model. Results, limitations, and implications of the current study are discussed.

Maternal acetaminophen use during pregnancy and childhood behavioural problems: Discrepancies between mother- and teacher-reported outcomes.

Maternal acetaminophen use during pregnancy is common and has been associated with childhood behavioural problems among offspring, specifically hyperactivity and conduct problems. Assessments of child behaviour in many previous studies have relied on maternal or parent report. Acknowledging that results of behavioural assessments vary between informants, we examined the association between maternal acetaminophen use during pregnancy and behaviour problems in childhood based on mother- and teacher-report. A longitudinal study of 560 mother-child pairs with data on illnesses and medication use during pregnancy and neurodevelopmental assessments during childhood was conducted. Acetaminophen use during pregnancy was captured using a standardised maternal interview, completed 1year after delivery on average. Measures of childhood (6-12years of age) behaviour were obtained via mother- and teacher-report, using the Child Behaviour Checklist and Teacher Report Form. Linear and log-binomial models were used to calculate adjusted mean differences (MD) and risk ratios (RR), respectively and 95% confidence intervals (CI) for internalising, externalising, and total behaviour problems comparing acetaminophen users to non-users. Stabilized inverse probability weights were used to account for loss to follow-up, and adjustments for indication were made. Approximately 60% (n=354) of women reported use of acetaminophen during pregnancy. Acetaminophen use during pregnancy was associated with an increase in total behaviour problem score and risk of clinical behaviour problems according to mother report (MD 2.2, 95% CI 0.3, 4.1 and RR 1.93, 95% CI 0.99, 3.76) but not according to teacher report. Weighting to account for participation did not alter results, while adjustment for indications of acetaminophen use greatly attenuated the associations with mother-reported total behaviour problem score and risk of clinical behaviour problems (MD 0.1, 95% CI -2.1, 2.3 and RR 1.31, 95% CI 0.67, 2.58). Acetaminophen use during pregnancy was weakly associated with mother-reported behaviour problems and not associated with teacher-reported problems.

Behavioural and emotional issues among primary school pupils with congenital colour vision deficiency in the Federal Territory of Kuala Lumpur, Malaysia: A case-control study

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.

Behavioural and emotional issues among primary school pupils with congenital colour vision deficiency in the Federal Territory of Kuala Lumpur, Malaysia: A case-control study.

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.

Concurrence of the strengths and difficulties questionnaire and developmental behaviour checklist among children with an intellectual disability.

The Strengths and Difficulties Questionnaire (SDQ) is widely used to measure emotional and behavioural problems in typically developing young people, although there is some evidence that it may also be suitable for children with intellectual disability (ID). The Developmental Behaviour Checklist - Parent version (DBC-P) is a measure of emotional and behavioural problems that was specifically designed for children and adolescents with an ID. The DBC-P cut-off has high agreement with clinical diagnosis. The aim of this study was to estimate the relationship between DBC-P and SDQ scores in a sample of children with ID. Parents of 83 young people with ID aged 4-17years completed the parent versions of the SDQ and the DBC-P. We evaluated the concurrent validity of the SDQ and DBC-P total scores, and the agreement between the DBC-P cut-off and the SDQ cut-offs for 'borderline' and 'abnormal' behaviour. The SDQ total difficulties score correlated well with the DBC-P total behaviour problem score. Agreement between the SDQ borderline cut-off and the DBC-P cut-off for abnormality was high (83%), but was lower for the SDQ abnormal cut-off (75%). Positive agreement between the DBC-P and the SDQ borderline cut-off was also high, with the SDQ borderline cut-off identifying 86% of those who met the DBC-P criterion. Negative agreement was weaker, with the SDQ borderline cut-off identifying only 79% of the participants who did not meet the DBC-P cut-off. The SDQ borderline cut-off has some validity as a measure of overall levels of behavioural and emotional problems in young people with ID, and may be useful in epidemiological studies that include participants with and without ID. However, where it is important to focus on behavioural profiles in children with ID, a specialised ID instrument with established psychometric properties, such as the DBC-P, may provide more reliable and valid information.

Reduced gamma-aminobutyric acid is associated with emotional and behavioral problems in Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is characterized by infantile hypotonia, hypogonadism, small hands and feet, distinct facial features and usually intellectual impairment. The disorder is associated with severe behavioral disturbances which include hyperphagia leading to morbid obesity, temper outbursts, skin-picking, and compulsive behaviors. While the brain mechanisms that underpin these disturbances are unknown these behaviors suggest a lack of inhibition and thus gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter may be implicated. In the present study, we investigated in vivo brain GABA and its relationship with emotion and behavior in individuals with PWS. Single voxel proton magnetic resonance spectroscopy (1H-MRS) was performed on 15 individuals with PWS and 15 age- and gender-matched typically developing controls. GABA levels were measured in the parieto-occipital lobe. All other metabolite levels (N-acetyl aspartate, myo-Inositol, glutathione, glutamate, and glutamine + glutamate) were measured in the anterior cingulate cortex (ACC). GABA levels were significantly lower in the participants with PWS who had clinically significant emotional and behavioral problems relative to typically developing control participants and participants with PWS who did not have emotional and behavioral problems within the clinically significant range. GABA levels were negatively correlated with total behavioral problem scores as well as temper outbursts, skin-picking, depression, social relating difficulties, and a tendency to be self-absorbed. Our data suggests that alterations of the GABAergic system may play an important role in aspects of the pathophysiology of PWS. Pathological mechanism found in PWS may be relevant to understanding the control of similar behaviors in the general population. © 2016 Wiley Periodicals, Inc.

Emotional and behavioral characteristics of childhood depression

This study aimed to determine whether there were any differences between the behavioral and emotional problems of depressed children in clinical setting and their healthy peers without chronic medical illnesses or psychiatric disorders. The study was carried out in a child and adolescent psychiatry department of Karadeniz Technical University, Faculty of Medicine, between the dates of 03 March 2013 and 03 March 2014. Forty two children, ranging from 7 to 12 years, diagnosed with major depression, were choosen as study sample. Child Depression Inventory (CDI) was used to evaluate the severity of depression and the behavioral problems of children were evaluated with Child Behavior Checklist for Ages 6-18 (CBCL 6/18). According to the CBCL 6/18, the internalizing, externalizing and total behavior problem scores were found significantly higher (respectively p<0.001; p<0.001; p<0.001) in the study group. The internalizing and total behavior problems were significantly higher in girls, but there was no significant difference in externalizing behavior in both genders. In addition, 57.1% of the study group (n=24) had suicidal ideation and 19% (n=8) showed self-injurious behavior. Suicidal ideation was increasing with child’s depression severity but not related with behavioral problems. In addition, self-injurious was significantly associated with rule-breaking behavior, aggresive behavior and externalizing behavior problem subscales, but not associated with suicidal ideation or depression severity. Consequently, children diagnosed with major depressive disorder ( MDD) had significantly higher behavior problems than their healthy peers. The results suggest that externalizing behavior problems could be a part of childhood depression regardless of gender differences. Besides, the results suggest that self harming behavior in depressive children may not always be related with depression severity. Impulsivity and high comorbidity rates may be additional contributions to this behavior. Lastly, children are at the risk of suicide as adolescent and should be examined carefully.

Sleep disturbance in Mowat-Wilson syndrome.

Mowat-Wilson syndrome (MWS) is a multiple congenital anomaly syndrome caused by a heterozygous mutation or deletion of the ZEB2 gene. It is characterized by a distinctive facial appearance in association with intellectual disability (ID) and variable other features including agenesis of the corpus callosum, seizures, congenital heart defects, microcephaly, short stature, hypotonia, and Hirschsprung disease. The current study investigated sleep disturbance in people with MWS. In a series of unstructured interviews focused on development and behaviors in MWS, family members frequently reported sleep disturbance, particularly early-morning waking and frequent night waking. The Sleep Disturbance Scale for Children (SDSC) was therefore administered to a sample of 35 individuals with MWS, along with the Developmental Behaviour Checklist (DBC) to measure behavioral and emotional disturbance. A high level of sleep disturbance was found in the MWS sample, with 53% scoring in the borderline range and 44% in the clinical disorder range for at least one subscale of the SDSC. Scores were highest for the Sleep-wake transition disorders subscale, with 91% of participants reaching at least the borderline disorder range. A significant positive association was found between total scores on the SDSC and the DBC Total Behaviour Problem Score. These results suggest that sleep disorders should be screened for in people with MWS, and where appropriate, referrals to sleep specialists made for management of sleep problems.

정신보건시스템 내에서의 아동청소년 기능평가척도 개발을 위한 예비연구

Objectives：The aim of this study was to develop an assessment tool for measurement of children’s functioning in the mental health service. We conducted a preliminary study to develop a sensitive and inclusive scale focused on the functional changes of children rather than just focusing on their symptoms or screening. Methods：The Child and Adolescent Functional Assessment Scale and the Korean-Child Behavior Checklist (K-CBCL) were both administered to 134 parents of children with emotional or behavioral problems who participated in the Aizone program and also to 186 parents of elementary school children in the Seoul metropolitan area as a control group. SPSS version 12.0 was used for statistical analysis. Results：Most of the reliability coefficients were over 0.70 except those of the conduct behavior items, which showed rela tively high internal consistency. The corrected item-total correlations ranged from .411 to .758, except those of conduct behavior items and special measure items. In a concurrent validity test with K-CBCL, the total behavior problem score of K-CBCL was highly correlated with the total score of the Child and Adolescent Functional Assesment Scale (r=.610). For the construct validity, confirmatory factor analysis was performed for each of four areas, including behavior (at home/school), achievement, peer re lationship, and emotion. Conclusion：The results showed that the scale was statistically reliable and valid, except for conduct behavior items. This study was conducted only for parents with elementary children. An adolescents group should be included in future studies.

Sex and Age Differences in Psychiatric Disorders among Children and Adolescents: High-Risk Students Study.

ObjectiveThe aims of the present study are to investigate the rate of the psychiatric disorders in psychiatrically high-risk children and adolescents and to examine sex and age differences in the diagnosis of psychiatric disorders.MethodsThe participants included students aged 6-16 from the 27 elementary and the 45 middle schools in Busan, Korea. We screened psychopathology using the Korean version of Child Behavior Checklist (K-CBCL) or the Youth Self Report (K-YSR). A total of 2,912 students were selected as high-risk students on the basis of cut-off scores (T-score ≥60) for a total behavior problem score of K-CBCL/K-YSR. Of these high-risk students, 1,985 students participated in and completed individual diagnostic interviews. Psychiatric diagnosis was assessed using a Korean version of the Kiddie-Schedule for Affective Disorders and Schizophrenia. Multivariate logistic regression analysis was conducted to examine sex and age differences of psychiatric diagnosis.ResultsBased on sex, boys were more likely to have ADHD and girls were more likely to have depression. Based on age, children were more likely to have ADHD and adolescents were more likely to have affective disorder, conduct disorder, psychotic disorder, and anxiety disorders except separation anxiety disorder.ConclusionThis is the largest study to conduct face-to-face interviews with subjects and parent(s) among Korean studies in this field. The present study revealed significant differences across sex and age among specific psychiatric disorders in children and adolescents. Future population-based studies will be required to ascertain the sex- and age-related differences of psychiat prevalence.