Effectiveness of behavioral parent therapy in preschool children with attention-deficit hyperactivity disorder.

The purpose of this study was to assess the effectiveness of a behavioral parent therapy (BPT) program in children with attention-deficit hyperactivity disorder (ADHD) using multidimensional evaluations, the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). Between 2001 and 2005, the parents of 21 preschool children with ADHD were divided into six groups and participated in a series of 11 BPT sessions. Before and after BPT, the parents completed the CBCL, and the teachers completed the TRF. The behavioral and emotional problems of the children showed improvement after the BPT sessions, specifically for the following categories: internalizing problems, anxious/depressed syndromes, somatic complaints, externalizing problems, rule-breaking behaviors, aggressive behaviors, social problems, thought problems, and attention problems. In the DSM-oriented scale of the CBCL, affective problems, anxiety problems, somatic problems, ADHD problems, oppositional defiant disorder problems, and conduct disorder problems showed significant improvements. On the DSM scale of the TRF, Inattention syndrome improved significantly after the BPT sessions, while other syndromes showed non-significant changes. We conclude that the BPT program significantly improved the childrens behavioral problems at home and inattention problems at school.

Apathy in late-life depression among Taiwanese patients.

BACKGROUND: Apathy is defined as lack of motivation and occurs in a variety of neuropsychological disorders. The Apathy Evaluation Scale (AES) has been shown to be valid and reliable for assessing apathy in depression but the validity and reliability of the Chinese version has never been examined. The aims of the study were to (1) evaluate the validity and reliability of the Chinese version of the AES in late-life depression and (2) evaluate the severity of apathy in late-life depression. METHODS: We translated the AES into Chinese and used a cross-sectional design to evaluate apathy in elderly subjects. Diagnostic and Statistical Manual of Mental Disorders (DSM) -IV criteria and Hamilton Depression Rating Scale (HDRS) were applied for diagnosis and assessment. Three groups of subjects were recruited including one group (n = 31) of patients with major depressive disorder with current depression, the second group (n = 30) with major depressed disorder with remission, and the third group (n = 31) of healthy controls. Convergent validity was tested using four apathy-related items from the HDRS (loss of interest, psychomotor retardation, loss of energy, and loss of insight). Multiple forms of reliability (including internal consistency, test-retest, and interrater) and discriminant validity were examined. RESULTS: We demonstrated that the internal consistency (coefficient alpha = 0.90) and test-retest reliability (p < 0.001) were satisfied. Discriminant validity of apathy severity among these three groups was significant. The convergent validity and correlation coefficients based on the four apathy-related items from the HDRS and AES were acceptable. CONCLUSION: Apathy is a distinct syndrome which may be treatable when depression is effective managed. Further application of the Chinese version of the AES to study the association of apathy with other neuropsychological symptoms is necessary.

Psychometric study of the test of variables of attention: preliminary findings on Taiwanese children with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a common mental disorder in children. Unfortunately, reliable means of measuring attention and impulsivity to help with diagnoses are scarce. The test of variables of attention (TOVA) is a computer-administered continuous performance test measuring attention and impulsivity, designed to avoid confounding arising from language processing skills or short-term memory problems. Some evidence has indicated the TOVA can be useful in diagnosing ADHD. This study examines its validity and reliability in helping diagnose Taiwanese ADHD children. The study included 31 ADHD children (24 males, seven females) from a northern Taiwan children's hospital and 30 normal controls (18 males, 12 females) from the local community. The TOVA and the Child Behavior Checklist (CBCL) were administered to all children. TOVA scores for omissions, commissions, response time, response time variability, D' and ADHD scores were analyzed. Results showed a mean internal consistency of 0.81 for all six TOVA variables across conditions, with moderate convergent and discriminant validities. Groups showed significant differences in response time variability, D' and ADHD scores, with the normal group outperforming the ADHD group. Significant group differences were also found in all CBCL subscale scores except somatic complaints. The ADHD group obtained a clinically significant score on the hyperactivity subscale of the CBCL. The findings partially support the usefulness of the TOVA in assessing attention and impulsivity problems for a Taiwanese sample. Future studies should increase the sample size, use multiple measures, and collect behavior ratings from both parents and teachers.

Acute effects of methylphenidate on performance during the Test of Variables of Attention in children with attention deficit/hyperactivity disorder.

This study attempted to determine the acute effects of methylphenidate (MPH) on cognitive performance using the Test of Variables of Attention (TOVA) in children with attention deficit/hyperactivity disorder (ADHD). The study subjects comprised 57 children diagnosed with ADHD aged 6-13 years. Diagnoses of ADHD and other comorbid psychiatric disorders were based on Diagnostic and Statistical Manual of Mental Disorders-fourth edition criteria following a standard interview with the Schedule for Affective Disorder and Schizophrenia for School-Age Children, epidemiologic version. The subjects' performance on the TOVA was compared before and 1 h after administration of MPH. After administration of MPH, commission scores, response time and ADHD scores improved significantly, however, there were no significant changes in omission scores, response time variability or response sensitivity. The authors concluded that administration of one dose of MPH (0.5-1.0 mg/kg) produced more effects on impulsivity than on attention deficiency in children with ADHD, and that the second half section of the TOVA could be more sensitive than the first half in determining the acute effects of MPH therapy in children with ADHD. However, the effects of different MPH doses on the TOVA results need further investigation.

Mobile information and communication in the hospital outpatient service.

OBJECTIVES: Most healthcare providers provide mobile service for their medical staff; however, few healthcare providers provide mobile service as part of their outpatient service. The mobile outpatient service system (MOSS) focuses on illness treatment, illness prevention and patient relation management for outpatient service users. Initiated in a local hospital in Taiwan, the MOSS pilot project was developed to improve outpatient service quality and pursue higher patient safety. METHOD: This study focuses on the development of the MOSS. The workflow, architecture and target users of the MOSS are delineated. In addition, there were two surveys conducted as part of this study. After a focus group of medical staff identified areas in which outpatient services might be improved by the MOSS, the first survey was administered to outpatients to confirm the focus group's intuitions. The second administration of the survey explored outpatient satisfaction after they used the MOSS service. RESULTS: With regard to outpatient attitudes, about 93% of participants agreed that the mobile outpatient service improved outpatient service quality. In the area of outpatient satisfaction, about 89% of participants indicated they were satisfied with the mobile outpatient service. DISCUSSION/CONCLUSION: Supported by our study finding, we propose that more diverse mobile outpatient services can be provided in the future.

Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital.

OBJECTIVE: The outbreak of severe acute respiratory syndrome (SARS) in 2003 resulted in 346 probable SARS cases and 37 deaths in Taiwan. This descriptive study, which was conducted from May to June 2003, intended to identify staff stress and coping strategies among a SARS team of nursing staff during the outbreak. METHOD: Twenty-six female nurses of the SARS team completed a questionnaire about their experiences serving in the SARS team. RESULTS: SARS had both positive and negative psychological impacts on the nurses. While worrying about infecting their families and colleagues, nurses were able to cope with the situation through various means. Additional findings include the need for more psychiatric staff to provide flexible and continuous service, the importance of meetings to improve teamwork and reduce conflict between doctors and nurses and the useful discovery that video cell phones provided needed reassurance from afar to the worried families of the nurses. CONCLUSION: This study reinforces the importance and benefits of psychiatric services for SARS team members in reducing their secondary traumatization. It is hoped that the results will enhance our knowledge on the needs of frontline health care workers and support the planning of better psychiatric services in future epidemics.

Using mobile technology to improve healthcare service quality.

Improving healthcare service quality for illness of treatment, illness prevention and patient service is difficult for most hospitals because the hospitals are lack adequate resources and labor. In order to provide better healthcare service quality for patients, mobile technology can be used to manage healthcare in a way that provides the optimal healthcare service for patients. Pursuing utilization of mobile technology for better patient service, Taipei Medical University Municipal W. F. Teaching Hospital has implemented a mobile healthcare service (m-HS) system to increase healthcare service quality. The m-HS system improves the quality of medical care as well as healthcare service. The m-HS is a multi-functional healthcare management agent, meets the mobile tendency of the present society. This study seeks to discuss the m-HS architecture and workflow processes. We believe the m-HS does have the potential to improve healthcare service quality. Finally, the conclusions and suggestions for the m-HS are given.

Sleep disorders in Taiwanese children with attention deficit/hyperactivity disorder.

To assess obstructive sleep apnea syndrome (OSAS) and periodic limb movement disorder (PLMD) in children with attention deficit/hyperactivity disorder (ADHD) compared with a control group. The ADHD was diagnosed based on Diagnostic and Statistical Manual, version IV (DSM-IV) criteria on successively seen elementary school children aged 6-12 years referred to a psychiatric clinic for suspected ADHD. A standardized interview (Kiddie-SADS-E), parents and teacher questionnaires, neuropsychological testing, and nocturnal polysomnography were completed for each child. Eighty-eight children (77 boys) with ADHD and 27 controls were involved in the study. Fifty children with ADHD (56.8%) had an apnea-hypopnea index (AHI) >1 event h(-1) and 17 (19.3%) had an AHI >5 event h(-1). Nine children (10.2%) had a periodic limb movement index (PLMI) >5 events h(-1). There is one child with AHI >1 and none with a PLMI > 5 in the control group. In the test of variables of attention (TOVA), the response time was significantly worse in ADHD with sleep disorders than those without them. The child behavior checklist (CBCL) showed a significant difference between groups in the hyperactivity subscale. The diagnostic criteria for ADHD based on DSM-IV do not differentiate between children with or without sleep disorders. Evaluation of sleep disorders should be considered before starting drug treatment for ADHD.

A social skills training program for preschool children with attention-deficit/hyperactivity disorder.

Many children with Attention-deficit/hyperactivity disorder (ADHD) have difficulties in regulating their emotions and maintaining good peer relations. It is important for children with ADHD to receive interventions as early as possible so that their social and emotional development can be achieved. Some social skills training programs for school-ages children with ADHD in Taiwan have shown positive results. However, such programs have not been applied to preschool children with ADHD yet and its applicability needs to be explored. In this report, we describe the clinical experience of conducting social skills training with 8 boys with ADHD (aged 4 to 6 years) and their parents. Eight weekly training sessions were conducted. Each session included a joint parent-child social skills training group (1 hour) and a parent group (40 minutes). After the training, most parents (75%) reported improvements in their children's behaviors. Clinical implications and limitations of this study are discussed.

Behavioral parent training for Taiwanese parents of children with attention-deficit/hyperactivity disorder.

It has been observed that it is relatively difficult for children with attention-deficit/hyperactivity disorder (ADHD) to follow social rules and behave in a socially desirable manner. The ADHD children in Chinese culture, which emphasizes Confucian values, might encounter even greater adjustment difficulties. The purpose of the present study is to implement a behavioral parent training program in a Confucian environment and examine its effectiveness. Twenty-three ADHD preschoolers (age: 3-6 years) and their parents were selected to participate in the present study. Fourteen of these 23 parents completed a 10-session parent training program. Parent ratings of ADHD/oppositional defiant disorder (ODD) symptoms and problem behaviors at home were collected at the first, fourth, sixth, seventh, and tenth sessions. Three instruments were used to evaluate treatment outcome: the Disruptive Behavior Rating Scale-Parent Form, Child Attention Profile, and Home Situations Questionnaire. The results showed that both ADHD/ODD symptoms and home behaviors of these 14 children improved significantly after the parent training. There was also a significant decline in the severity of symptoms and problem behaviors at home with the progression of training. These findings support the effectiveness of this parent training program for parents of ADHD children in an environment of Confucianism. Limitations of the present study and future direction for research are discussed.

Psychosocial adjustment among pediatric cancer patients and their parents.

Children with cancer face both physical and psychosocial challenges. However, there is not enough empirical evidence in Taiwan regarding how they and their families cope with their illness. The purpose of the present study was to explore the psychosocial impact of cancer on target children and their families as well as the degree of depression experienced by these children. Twenty-four pediatric cancer patients, aged 8 through 17 years, completed the Chinese version of Children Depression Inventory (CDI). Both these patients and 18 parents completed questionnaires about their psychosocial adjustment since the diagnosis of cancer. The results showed: (i) patients did not perceive significant changes in their psychosocial adjustment, whereas parents indicated significantly lower mood of patients and a slight decrease in the number of friends; (ii) both parents and siblings showed positive adjustment; and (iii) there was neither significant difference on the CDI scores between the pediatric cancer patients and a normative group, nor significant relationships between patients' CDI scores and demographic characteristics of both patients and their parents, parenting attitudes, as well as variables related to the illness. Lastly, the results are discussed in terms of issues of methodology and instruments. Possible direction for further investigations is suggested.

A family-based association study of attention-deficit hyperactivity disorder and dopamine D2 receptor TaqI A alleles.

BACKGROUND: Over the past 5 years, considerable progress has been made in the identification of polymorphic variation within monoamine system genes that are associated with the attention-deficit hyperactivity disorder (ADHD) phenotype. In this study, we investigated the association of the dopamine D2 receptor (DAD2) TaqI A and ADHD in a Taiwanese sample. METHODS: The sample consisted of 98 children with ADHD and 154 of their parents. ADHD cases were ascertained from the Child Psychiatric Clinics at Chang Gung Memorial Hospital in the Taipei area, Taiwan. A diagnosis of ADHD was made following clinical interviews plus completion of a standard maternal interview and Conner's revised rating scales by a parent and teacher. Association of DRD2 TaqI A polymorphism in this sample was investigated using a haplotype-based haplotype relative-risk method. RESULTS: Among our subjects, there was no significant difference in transmission rates between DRD2 TaqI A1 and A2 alleles. CONCLUSION: The results of this study do not support DRD2 playing a major role in Taiwanese children with ADHD.