A Study on the Screening of Children at Risk for Developmental Disabilities Using Facial Landmarks Derived From a Mobile-Based Application

Objective@#Early detection and intervention of developmental disabilities (DDs) are critical to improving the long-term outcomes of afflicted children. In this study, our objective was to utilize facial landmark features from mobile application to distinguish between children with DDs and typically developing (TD) children. @*Methods@#The present study recruited 89 children, including 33 diagnosed with DD, and 56 TD children. The aim was to examine the effectiveness of a deep learning classification model using facial video collected from children through mobile-based application. The study participants underwent comprehensive developmental assessments, which included the child completion of the Korean Psychoeducational Profile-Revised and caregiver completing the Korean versions of Vineland Adaptive Behavior Scale, Korean version of the Childhood Autism Rating Scale, Social Responsiveness Scale, and Child Behavior Checklist. We extracted facial landmarks from recorded videos using mobile application and performed DDs classification using long short-term memory with stratified 5-fold cross-validation. @*Results@#The classification model shows an average accuracy of 0.88 (range: 0.78–1.00), an average precision of 0.91 (range: 0.75–1.00), and an average F1-score of 0.80 (range: 0.60–1.00). Upon interpreting prediction results using SHapley Additive exPlanations (SHAP), we verified that the most crucial variable was the nodding head angle variable, with a median SHAP score of 2.6. All the top 10 contributing variables exhibited significant differences in distribution between children with DD and TD (p<0.05). @*Conclusion@#The results of this study provide evidence that facial landmarks, utilizing readily available mobile-based video data, can be used to detect DD at an early stage.

Psychoeducational Profile-Revised, Korean Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition, and the Vineland Adaptive Behavior Scale, Second Edition: Comparison of Utility for Developmental Disabilities in Preschool Children

Objectives@#This study aimed to compare the utility of the Psychoeducational Profile-Revised (PEP-R), Korean Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (K-WPPSI-IV), and Vineland Adaptive Behavior Scale, Second Edition (VABS-II) for evaluating developmental disabilities (DD) in preschool children. Additionally, we examined the correlations between the PEP-R, KWPPSI-IV, and VABS-II. @*Methods@#A total of 164 children aged 37–84 months were assessed. Children’s development was evaluated using the PEP-R, K-WPPSIIV, VABS-II, Preschool Receptive-Expressive Language Scale, and Korean Childhood Autism Rating Scale, Second Edition. @*Results@#Of the 164 children, 103 had typical development (TD) and 61 had DD. The mean of the PEP-R Developmental Quotient (DQ), K-WPPSI-IV Full-Scale Intelligence Quotient (FSIQ), and VABS-II Adaptive Behavior Composite (ABC) scores were significantly higher in the TD group than in the DD group (p<0.001). The estimated area under the curve of the PEP-R DQ, K-WPPSI-IV FSIQ, and VABS-II ABC scores was 0.953 (95% confidence interval [CI]=0.915–0.992), 0.955 (95% CI=0.914–0.996), and 0.961 (95% CI=0.932– 0.991), respectively, which did not indicate a statistically significant difference. The PEP-R DQ scores were positively correlated with the K-WPPSI-IV FSIQ (r=0.90, p<0.001) and VABS-II ABC scores (r=0.84, p<0.001). A strong correlation was observed between the KWPPSI-IV FSIQ and VABS-II ABC scores (r=0.89, p<0.001). @*Conclusion@#This study found that the PEP-R, K-WPPSI-IV, and VABS-II effectively distinguished DD from TD in preschool children, and no significant differences in utility were observed between them.

Impact of Comorbid Oppositional Defiant Disorder on the Clinical and Neuropsychological Characteristics of Korean Children With Attention-Deficit/Hyperactivity Disorder

Objective@#The aim of the present study was to investigate the influence of comorbid oppositional defiant disorder (ODD) on clinical features and neuropsychological profiles of children with attention-deficit/hyperactivity disorder (ADHD). @*Methods@#We divided the participants into three groups: the ADHD with ODD (ADHD/ODD) (n=36), ADHD without ODD (ADHDoODD) (n=307), and control groups (n=128). Parents of the participants completed the ADHD Rating Scale, Social Responsiveness Scale (SRS), Korean Personality Rating Scale for Children (K-PRC), and 10-item mania scale from the Parent General Behavior Inventory (P-GBI-10M). Neuropsychological profiles were assessed using the Advanced Test of Attention (ATA), Children’s Color Trails Test, and Stroop Color and Word Test. @*Results@#The ADHD/ODD group had more ADHD symptoms and functional impairments in relationships with teachers and peers, and self-esteem than the ADHDoODD group. The ADHD/ODD group scored higher in Social Communication (p<0.001) and Autistic Mannerisms (p<0.001) subscales of SRS, P-GBI-10M (p<0.001), and Delinquency (p<0.001) and Psychosis (p<0.001) subscales of K-PRC than the ADHDoODD group. Commission Errors (p<0.001) and Response-Time Variability (p<0.001) in Visual ATA and Commission Errors (p<0.001) in Auditory ATA were significantly higher in the ADHD/ODD group than in the ADHDoODD group. @*Conclusion@#The present study suggests that patients with ADHD with ODD experience more ADHD symptoms and neuropsychological deficits than those with ADHD without ODD. These results also imply that comorbid ODD is associated with greater social impairment and emotional dysregulation.

Children’s and Parents’ Factors That Affect Parenting Stress in Preschool Children With Developmental Disabilities or Typical Development

Objective@#This study compared parenting stress in preschool children with developmental disabilities (DD) or typical development (TD). We also investigated children’s factors that affect parenting stress. @*Methods@#A total of 196 preschool children participated in the study (aged 54.8±9.2 months). There were 79 children with DD (59 with autism spectrum disorder, 61 with intellectual disability, 12 with language disorder) and 117 with TD. The high parenting stress and the low parenting stress groups were divided based on the Total Stress of Korean Parenting Stress Index Fourth Edition (K-PSI-4) with an 85-percentile cutoff score. Pearson’s correlation analysis was conducted to calculate the correlation between K-PSI-4 and the children’s or parents’ measures. @*Results@#The difference in parenting stress between DD and TD was significant in the Total Stress of K-PSI-4 (p<0.001). The Total Stress scale of K-PSI-4 represented a modest to strong correlation with cognitive development, adaptive functioning, social communication, and behavioral problems in children with DD. Our results showed that caregivers of children with DD reported higher parenting stress than those with TD. Parenting stress was strongly associated with cognitive development, adaptive functioning, social communication, and behavioral problems in children with DD. Among the children’s factors, especially social communication, attention problems, and aggressive behavior had association with caregivers’ higher parenting stress. @*Conclusion@#These findings suggest the need for early intervention for parenting stress in caregivers by assessing child characteristics, including social cognition, awareness, communication, and inattention and hyperactivity, in the evaluation of children with DD.

Predictors of Developmental Outcome in 4- to 6-Year-Olds With Developmental Disability

Objective@#Studies on the early trajectories of developmental disability (DD) are limited. This study aimed to evaluate the diagnostic stability and developmental trajectories of autism spectrum disorder (ASD) and intellectual disability (ID), and to determine baseline clinical characteristics that affect future diagnosis. @*Methods@#We analyzed 192 children who were referred for possible DD through retrospective chart review. Clinical diagnosis was assessed once at baseline, aged 2–4, and at follow-up, aged 4–6. The participants’ developmental profiles were measured by Psychoeducational Profile-Revised (PEP-R), Vineland Social Maturity Scale (VSMS), Beery-Buktenica Developmental Test of Visual Motor Integration (VMI), and Childhood Autism Rating Scale (CARS). @*Results@#On comparing the diagnostic change, 5% of children were no longer diagnosed as ASD, and 13% of children were no longer diagnosed as ID at follow-up. Trajectories of developmental profiles were compared between children with and without ID at follow-up, and significant time-by-group interaction were observed in PEP-R (p<0.001), VSMS (p<0.001), and VMI (p=0.003) scores, indicating that children without ID at follow-up showed significant improvement over time compared to children with ID. ASD diagnosis (p<0.001) and CARS score (p=0.007) at baseline were significantly associated with ASD at follow-up, while VSMS score (p=0.004) and VMI score (p=0.019) at baseline were significantly associated with ID at follow-up. @*Conclusion@#A subset of children lost their diagnosis at follow-up, and such diagnostic change was significantly more common in ID compared to ASD. Baseline autism symptomatology was related to ASD at follow-up, and baseline adaptive and visuo-motor function was related to ID at follow-up.

Mediating Effect of Viral Anxiety and Perceived Benefits of Physical Distancing on Adherence to Distancing Among High School Students Amid COVID-19

Background@#The aim of this study is to explore whether high school students’ adherence to physical distancing was associated with health beliefs, social norms, and psychological factors during the coronavirus disease 2019 (COVID-19) pandemic. @*Methods@#Overall, 300 high school students participated in this anonymous online survey conducted from October 18–24, 2021. The survey included rating scales such as attitude toward physical distancing during the pandemic, Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Patient Health Questionnaire-9 items, Satisfaction with Life Scale, and Connor Davidson Resilience Scale 2-items. @*Results@#The results revealed that perceived susceptibility or severity (β = −0.13, P = 0.038), perceived benefit (β = 0.32, P < 0.001), descriptive social norms (β = 0.10, P = 0.041), social injunctive norms (β = 0.19, P < 0.001), and SAVE-6 (β = 0.24, P < 0.001) predicted students’ adherence to physical distancing (adjusted R 2 = 0.42, F = 19.2, P < 0.001). Social injunctive norms and personal injunctive norms directly influenced adherence to physical distancing. Viral anxiety, measured by SAVE-6, mediated the association between social injunctive norms and adherence to physical distancing, and perceived benefits mediated the relationship between personal injunctive norms and adherence to physical distancing. The influence of perceived susceptibility or severity on adherence to physical distancing was entirely mediated by perceived benefits or viral anxiety. @*Conclusion@#Explaining the rationale or benefits of physical distancing may be important in increasing adherence to physical distancing among high school students.

Effect of Screen Time on Physical and Mental Health and Eating Habits During COVID-19 Lockdown in Lebanon

Objective@#This study aimed to explore whether screen time and the screen type impacted various health aspects of children, including physical activity (PA), sleep quality, and eating habits. Additionally, we investigated whether children’s eating behavior while using electronic devices affects their physical and mental health. @*Methods@#We conducted an online survey asking for screen use (duration, type, and purpose), PA, eating habits, sleep problems, and level of depression. The participants were children between the ages of 3 and 7 years, and the survey was answered by the participants’ parents from March 3 to March 20, 2021. @*Results@#A screen time of ≥2 h in children was associated with various clinical characteristics, such as body mass index (BMI), sleep problems, depression, decreased PA, and unusual eating habits. Children’s food eating behavior while using electronic devices was predicted by a total screen time ≥2 h, smartphone screen time ≥2 h, sleep problems, owning electronic devices, and eating unhealthy food. @*Conclusion@#There was an interplay among children’s PAs, eating behaviors, depression, sleep problems, and screen time in this pandemic era. Therefore, guiding children on the correct use of electronic devices and helping them eat healthy are paramount during this COVID-19 pandemic.

Efficacy of Mobile-Based Cognitive Training Program DoBrain in Preschool Children With or Without Developmental Disabilities: A Randomized, Single-Blind, Active-Controlled Trial

Objective@#Mobile-based cognitive training programs can be a viable alternative to in-person interventions, but their efficacies have not been established yet. In this study, we examined the efficacy of DoBrain, a mobile-based cognitive training program designed for children with developmental disabilities (DDs), in comparison with general educational apps named Junior Naver and Kakao Kids. @*Methods@#Children aged 34 to 77 months were recruited and randomized at a 1:1 ratio to use DoBrain or general educational apps. Each group used the assigned app on a daily basis at home for 30 minutes for 24 weeks. Parents were instructed to help the children with the app usage. A total of 166 children completed the post-test visit (DoBrain group, n=85, 55.4±8.7 months old; general educational app group, n=81, 53.7±9.9 months old). The primary outcome was cognitive development measured by Psychoeducational Profile-Revised (PEP-R), administered at baseline and at post-test. @*Results@#DoBrain had no superior effect over general educational apps on the PEP-R Developmental Quotient. When the changes before and after app usage were compared, the DoBrain group and the general educational app group both showed declines in imitation (adjusted p=0.049 and 0.022), perception (adjusted p=0.004 and <0.001), and gross motor (adjusted p=0.003 and 0.002) domains of the PEP-R. Among the DoBrain group, children with DD showed a significantly greater gain in the eye-hand coordination domain of PEP-R compared with those without DD (adjusted p=0.047). @*Conclusion@#DoBrain did not show a superior effect over general educational apps on overall cognitive development in preschool children, regardless of the presence of DD. Careful monitoring of the negative effect of mobile-based cognitive training programs is necessary.

Psychological Impact of Quarantine on Caregivers at a Children's Hospital for Contact with Case of COVID-19

Quarantine often provokes negative psychological consequences. Thus, we aimed to identify the psychological and behavioral responses and stressors of caregivers quarantined with young patients after a close contact to a coronavirus disease 2019 case at a children's hospital. More than 90% of the caregivers reported feelings of worry and nervousness, while some of them reported suicidal ideations (4.2%), and/or homicidal ideations (1.4%). Fear of infection of the patient (91.7%) and/or oneself (86.1%) were most frequently reported stressors. A multidisciplinary team including infection control team, pediatrician, psychiatrist, nursing staff and legal department provided supplies and services to reduce caregiver's psychological distress. Psychotropic medication was needed in five (6.9%), one of whom was admitted to the psychiatry department due to suicidality. Quarantine at a children's hospital makes notable psychological impacts on the caregivers and a multidisciplinary approach is required.

A Study on Reliability and Validity of the Impact of Event Scale-Revised-North Korea (IES-R-NK) / 신경정신의학

OBJECTIVES: This study was conducted to translate the Impact of Event Scale-Revised (IES-R) into North Korean language and confirm its reliability and validity. METHODS: A total of 207 North Korean defectors recruited from the Call Center for North Korean Defectors participated in this study. Psychiatrists and psychiatric residents interviewed the participants individually and made psychiatric diagnosis. Subsequently, they completed the Brief Psychological State Inventory for North Korean Refugees (BPSI-NKR), the Center for Epidemiologic Studies Depression Scale-North Korea (CES-D-NK), and the Alcohol Use Disorders Identification Test-North Korea (AUDIT-NK) as well as the Impact of Event Scale-Revised-North Korea (IES-R-NK). Of the original participants, 143 subjects participated in test-retest reliability study after one week. RESULTS: The internal consistency using Cronbach's alpha was superior in both male and female from North Korea. In addition, the temporal stability was also satisfactory. A good convergent validity was clearly shown by significant correlations with BPSI-PTSD and CES-D-NK, respectively. On the other hand, IES-R-NK had no or weak correlations with AUDIT-NK and BPSI-NKR-alcohol, demonstrating its satisfactory discriminant validity. CONCLUSION: IES-R-NK might be considered as a short and valid screening tool for identification of PTSD symptoms in North Korean defectors.

Development of North Korean Version of the Composite International Diagnostic Interview / 신경정신의학

OBJECTIVES: The aim of the study was to develop a North Korean version of the Composite International Diagnostic Interview (NK-CIDI) and to evaluate the reliability and validity of NK-CIDI. METHODS: Subjects were 100 North Korean defectors, aged 18 to 65, who were recruited in a center for defectors in the National Medical Center or who were on an education curriculum in the defector settlement support center. NK-CIDI was developed based on the Korean version of CIDI considering the sociocultural background of North Korea. Inter-rater reliability, test/retest reliability, and validity of NK-CIDI were evaluated and kappa value was calculated. RESULTS: Different vocabularies and awkward expressions were adjusted, and additional explanations were supplemented for difficult phases. The target for development of NK-CIDI was early defectors who entered South Korea less than 3 months ago. Inter-rater reliability (n=30, kappa value 0.35-1.00), test/retest reliability (n=30, kappa value 0-0.86), and diagnostic validity (n=100, kappa value -0.02-0.42) were evaluated. CONCLUSION: Compared to the general population, defectors experience more psychiatric issues, and a standardized tool for diagnosis is needed. In this study, NK-CIDI was developed and the results suggest that reliability is acceptable but validity needs further verification. NK-CIDI could be utilized in future epidemiologic studies.

Association between Media Reporting and a Lower Suicide Rate in 2012 / 신경정신의학

OBJECTIVES: A recent study conducted by the Korea National Statistical Office (KNSO) reported that the suicide rate in Korea decreased in 2012. The aim of this study was to investigate the association between the decrease in suicide rate and media reporting of suicide events. METHODS: Data on suicide rates were obtained from the KNSO. Correlation between suicide rate and celebrity suicide events, number of media reports on suicide, and suicide searches was compared. Data were analyzed using Pearson's correlation coefficient. RESULTS: The number of celebrity suicide events and recognition of celebrity decreased in 2012. Pearson's correlation test showed a significant positive correlation between the monthly number of media reports on suicide and the suicide rate (daily newspaper r=0.619, p<0.001 ; broadcast r=0.393, p<0.001). The number of suicide searches showed association with celebrity suicide events. CONCLUSION: The suicide rate may be influenced by the number of media reports on suicide events. Establishing guidelines for media reporting on these events could help to decrease the suicide rates.

Overview of Suicide by Charcoal Burning and Prevention Strategies / 신경정신의학

Suicide by charcoal burning is common in Asian countries such as Hong Kong and Taiwan. Suicide by charcoal burning has recently shown a rapid increase in Korea, following a celebrity suicide, which was extensively reported by the media. Not only is suicide by charcoal burning fatal, but it also causes delayed neuropsychiatric symptoms through carbon monoxide poisoning. Risk factors associated with charcoal-burning suicide include middle age, male, divorced or unmarried, and economically active but with financial difficulties. To prevent suicide by charcoal burning, limited access to charcoal, responsible media reporting as recommended by international guidelines, and detoxification of charcoal by modifying the raw material should all be considered. In addition, suicide prevention programs should increasingly focus on suicide by charcoal burning. Relevant measures to prevent suicide by charcoal burning will be essential in order to lower the overall suicide rate in Korea.