Behavioural and emotional problems in Malaysian children and adolescents with type 1 diabetes mellitus: A cross-sectional study in a single centre / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Type 1 diabetes mellitus (T1DM) is an autoimmune disorder that requires a lifelong treatment regimen which may affect psychosocial development.@*Objective@#To identify behavioural and emotional problems in children and adolescents with T1DM.@*Methodology@#A cross-sectional study using the Child Behaviour Check List (CBCL) was conducted among all T1DM patients receiving treatment at the Paediatric Endocrine Unit, Hospital Tunku Azizah Kuala Lumpur, Malaysia.@*Results@#Forty T1DM patients were included. The mean age of the participants was 12.4 years (SD=2.69), with 52.5% males, and 75% Malay. The average duration of illness was 4.8 years, 9 were pre-pubertal, while mean HbA1c was 9.4%. Thirty-five percent of the respondents had parent-reported internalizing problems and 17.5% had parent-reported externalizing problems. Those >12 years old had more internalizing problems (p=0.004) compared to those ≤12 years old. The differences were in the anxious/depressed syndrome subscale (p=0.001) and withdrawn/depressed syndrome subscale (p=0.015). There were no statistically significant differences in the 3 main global scores by gender, glycaemic control, duration of illness and pubertal status by univariate analysis.@*Conclusion@#T1DM patients >12 years old were at higher risk of developing psychosocial difficulties. This highlighted the benefit of screening of behavioural and emotional issues in children and adolescents with T1DM.

A cross-sectional study of behavioural disorders in children with human immunodeficiency virus / acquired immuno deficiency syndrome attending an anti-retroviral therapy centre

Background: HIV is a chronic disease which also significantly affects the behavior. This study aims at evaluating behavioral disorders in children with HIV/AIDS.Methods: This Cross-sectional study utilized the Child Behaviour Check List.Results: The overall prevalence of borderline and clinically significant behavioral problems were 69.3% (n=104). The prevalence of behavioral disorders were observed in the eight categories - anxious/depressed (borderline-7.7%, clinically significant-18.3%), withdrawn/depressed (6.7%, 18.3%), somatic problems (7.7%, 6.7%), rule-breaking behavior (7.7%, 18.3%), aggressive behavior (10.6%, 21.1%), attention problems (15.4%, 2.9%) and thought problems (9.6%, 2.9%). No social problems were observed. Internalizing problems were common in girls and externalizing problems were common in boys. As age advanced a simple linear progression in prevalence of Behavior Problems was found. There were 47.1% of Orphans in study and behavioral problems were more common in them.Conclusions: High prevalence of behavioural abnormalities warrants comprehensive management including Behavioural counselling and therapy and not just drugs for these children.

Oral midazolam reduces cortisol levels during local anaesthesia in children: a randomised controlled trial

Little is known about whether midazolam sedation can reduce salivary cortisol levels and consequently influence children’s behaviour during dental treatment. The aim of this study was to evaluate the effect of midazolam sedation on salivary cortisol and its correlation with children’s behaviour during restorative dental treatment. Eighteen healthy children, aged two to five years, were randomly assigned to two dental treatment appointments, both with physical restraint: oral midazolam 1 mg/kg (MS) and placebo (PS). An observer assessed the children’s behaviour (videos) using the Ohio State University Behavioral Rating Scale (OSUBRS). The children’s saliva was collected just after waking up, on arrival at the dental school, 25 minutes after local anaesthesia, and 25 minutes after the end of the procedure. Salivary cortisol levels were determined using the enzyme-linked immunoabsorbent assay. The data were analysed by bivariate tests and multivariate analysis of variance (5% level). Salivary cortisol levels were lower in the MS group than in the PS group at the time of anaesthesia (p = 0.004), but did not vary during the appointment within sedation (p = 0.319) or placebo (p = 0.080) groups. Children’s behaviour was negative most of the time and did not differ between MS and PS; however, the behaviour (OSUBRS) did not correlate with salivary cortisol levels. Oral midazolam is able to control salivary cortisol levels during dental treatment of pre-schoolers, which might not lead to better clinical behaviour.

Child and Behaviour: A School Based Study.

Behaviour problems in children are on the rise. Available literature speaks of variability and inadequacies of diagnostic methods, research criteria, treatment modalities and psychosocial interventions. Methods: 50 children of age 6-14 years attending government school were assessed for behaviour problems. Children were selected after appropriate randomization and subsequently assigned to Child behaviour checklist. The data thus collected was suitably interpreted using appropriate statistical tests. Results: Twenty-one (42%) children were found to be above the cut-off score. Mean CBCL score was 43.3. Most common behaviour problems in these subjects were “can not sit still, restless, hyperactive” shown by 62% of the subjects. Female children had behaviour problems like “too concerned with neatness or cleanliness”, “self conscious or easily embarrassed” and “feels she has to be perfect” where as male children had behaviour problems like. “does not feel guilty after misbehaving”, can not concentrate” and “restless”. Conclusion: The analysis of pattern of distribution of behaviour problems in the subjects revealed them to be more of externalizing ones. Female children had more of internalizing behaviour problems.