Validation of the Chinese Version of the Autism Diagnostic Interview-Revised in Autism Spectrum Disorder.

BACKGROUND: The Autism Diagnostic Interview-Revised (ADI-R) is an essential semi-structured diagnostic tool for autism spectrum disorder (ASD). This study aims to validate the Chinese version of the ADI-R in Taiwan. METHODS: The Chinese version of the ADI-R was translated and back-translated by professional translators and was approved by the original authors. A group of child psychiatrists and psychologists corrected medical terminology for the final version. Then, a total of 74 participants with ASD (male, 59, 79.73%) and 33 control participants without ASD (male, 16, 48.48%) were recruited. All participants were between 3 years 4 months to 41 years old (mean: 14.63 ± 7.93 years). Exploratory factor analysis (EFA) was used to measure the factor structure. RESULTS: Cronbach's α showed good to excellent internal consistency (0.78-0.98) over the three core symptom domains of the Chinese version of the ADI-R. Pearson's correlation analysis revealed very high test-retest reliability (Pearson's correlation coefficients ranging from 0.95 to 0.99). EFA supported three categories of factors. For correct diagnosis of ASD, the Chinese version of the ADI-R had high sensitivity (97.30%), specificity (100%), positive predictive value (PPV) (100%), and negative predictive value (NPV) (94.29%). All domains also showed excellent area under the curves (0.991-1), sensitivity (94.59-98.65%), specificity (96.97-100%), Youden index (94.59-98.65%), PPV (97.78-100%), NPV (89.19-100%), positive likelihood ratio (32.55-33.00%) and negative likelihood ratio (0.00-0.05) after statistical examination. CONCLUSION: The Chinese version of the ADI-R is a reliable and valid diagnostic tool for the diagnosis of ASD in Clinical settings in Taiwan.

Remission in children and adolescents diagnosed with attention-deficit/hyperactivity disorder via an effective and tolerable titration scheme for osmotic release oral system methylphenidate.

OBJECTIVES: The purpose of this study was to identify the optimal dose of osmotic release oral system methylphenidate (OROS-MPH) using a dosage forced-titration scheme to achieve symptomatic remission in children with attention- deficit/hyperactivity disorder (ADHD). We also evaluated the efficacy and safety of, and patient and parent satisfaction with, the change in therapy from immediate-release methylphenidate (IR-MPH) to OROS-MPH over 10 weeks. METHOD: We recruited 521 children and adolescents aged 6-18 years with an American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnosis of ADHD, who had received IR-MPH treatments (<70 mg/day) for at least 1 month. The treatment, switched from IR-MPH to OROS-MPH according to a conversion scheme, started with a 6-week forced-titration phase of OROS-MPH to achieve symptomatic remission (defined as a score of 0 or 1 for each of the first 18 ADHD items in the Chinese version of the Swanson, Nolan, and Pelham, Version IV [SNAP-IV]), followed by a 4-week maintenance phase. The global ADHD severity and drug side effects of the participants were evaluated. Parents completed the ratings scales for the ADHD-related symptoms. Patient and parent satisfaction for the OROS-MPH treatment was also assessed. RESULTS: Among the 439 participants with ADHD who completed the trial, 290 participants (66.1%) achieved symptomatic remission. The mean dose of OROS-MPH among participants in remission was 36.7 mg (1.08 mg/kg) per day. Increased efficacy, superior satisfaction, and safety equivalent to that of IR-MPH were demonstrated in intra-individual comparisons from the baseline to the end of study. Determinants for remission included less severe ADHD symptoms (SNAP-IV score < 40), no family history of ADHD, and an appropriate dosage of medication according to the patient's weight. CONCLUSIONS: The findings suggest remission as a treatment goal for ADHD therapy by providing an optimal dosage of medication for children and adolescents with ADHD through using an effective and tolerable forced-titration scheme.

Naturalistic exploration of the effect of osmotic release oral system-methylphenidate on remission rate and functional improvement in Taiwanese children with attention-deficit-hyperactivity disorder.

AIM: To determine the differences in the remission rate, recovery rate, functional improvement, and treatment adherence related to treatment with short-acting immediate-release methylphenidate (IR-MPH) and long-acting osmotic-release oral system-methylphenidate (OROS-MPH) in a naturalistic setting among Taiwanese children with attention-deficit-hyperactivity disorder (ADHD). METHODS: A total of 757 children with ADHD, aged 6-18 years, was evaluated using the following in order determine functional improvement and treatment adherence: the Chinese version of the Swanson, Nolan, and Pelham, version IV scale (SNAP-IV-C), Clinical Global Impression-ADHD-Severity (CGI-S) to measure remission and recovery rates, the Chinese version of the Social Adjustment Inventory for Children and Adolescents (CSAICA), and caregiver's satisfaction rate, treatment adherence, and frequency of adverse effects. RESULTS: According to the SNAP-IV-C scores, the remission rate was 30.72%, and the recovery rate was 16.38%. Compared to short-acting IR-MPH, OROS-MPH was associated with greater functional improvement and treatment adherence among children with ADHD. CONCLUSION: OROS-MPH treatment at the adequate dosage can achieve higher remission and recovery rates, produce greater functional improvement, and result in better treatment adherence than IR-MPH treatment.

Body weight statuses and their sociodemographic correlates among adolescents in southern Taiwan: results using two sets of cutoff references.

PURPOSE: To examine the differences in the prevalence of overweight and obesity based on the cutoff references established by the International Obesity Task Force (IOTF) and the Working Group on Obesity in China (WGOC), the prevalence of underweight on the IOTF reference, and the sociodemographic correlates of body weight statuses in Taiwanese adolescents. METHODS: Overweight and obesity in 10,371 Taiwanese adolescents were determined by the IOTF and WGOC cutoff references for body mass index (BMI). Underweight was determined by the IOTF. The prevalence of overweight and obesity using the IOTF standard were compared to those using the WGOC standard. Associations of body weight statuses with gender, age, residential status, and parental education level were also examined. RESULTS: Using the IOTF standard, 3.4% were underweight, 15.2% were overweight, and 6.1% obese, whereas 14.1% were considered overweight and 8.7% were obese by the WGOC standard. For both genders, more adolescents were classified as overweight by the IOTF standard and as obese by the WGOC standard. Although females were more likely to be underweight than males, males were more likely to be overweight or obese than females. For both genders, although older age increased the risk of being underweight, younger age increased the risk of being overweight or obese. For males, living in urban areas was associated with being overweight, and low paternal education level was associated with being obese. CONCLUSIONS: The prevalence of overweight and obesity may differ depending on the reference standard consulted. Paternal education level and urbanicity were associated with gender differences in the proportion of adolescents who were overweight or obese.

The relationships between body mass index and television viewing, internet use and cellular phone use: the moderating effects of socio-demographic characteristics and exercise.

OBJECTIVE: This study aimed to examine the relationships between body mass index (BMI) and television viewing, Internet use and cellular phone use and the moderators for these relationships in adolescents. METHOD: The relationship between BMI and the time spent on three kinds of sedentary activities and the moderators for these relationships were analyzed among 9,278 Taiwanese adolescents. The different relationships between BMI and various Internet and cellular phone-related activities were analyzed. RESULTS: High television viewing and high Internet use were associated with increased BMI in adolescents. Exercising had a moderating effect on the relationship between BMI and television viewing. Several Internet and cellular phone-related activities were associated with increased BMI. DISCUSSION: The results support the relationships between adolescent BMI and television viewing and Internet use. The moderating effect of exercise and various Internet and cellular phone-related activities should be considered when developing intervention strategies for overweight adolescents.

The associations between aggressive behaviors and internet addiction and online activities in adolescents.

PURPOSE: To evaluate (a) the association between Internet addiction and aggressive behaviors, as well as the moderating effects of gender, school, and depression on this association; and (b) to evaluate the association between Internet activities and aggressive behaviors. METHODS: A total of 9405 adolescents were recruited into this study and completed the questionnaires. Their aggressive behaviors, with or without Internet addiction, Internet activities, demographic data, with or without depression, self-esteem, family function, and the watching of violent TV were assessed. RESULTS: The results demonstrated that after controlling for the effects of shared associated factors and watching violent TV programs, adolescents with Internet addiction were more likely to have aggressive behaviors during the previous year. The association was more significant among adolescents in junior high schools than in senior high/vocational schools. Online chatting, adult sex Web viewing, online gaming, online gambling, and Bulletin Board System were all associated with aggressive behaviors. CONCLUSIONS: The results suggest that preventive programs for aggressive behaviors should pay attention to Internet addiction among adolescents. Also, intervention to prevent the effects of Internet addiction on aggressive behaviors should be conducted as early as possible.

Relationship between psychosocial adjustment and executive function in patients with bipolar disorder and schizophrenia in remission: the mediating and moderating effects of insight.

OBJECTIVES: The aims of this study were to examine the relationships between executive function and psychosocial adjustment, and the mediating and moderating effects of insight on the association between executive function and psychosocial adjustment in patients with bipolar disorder and schizophrenia in clinical remission. METHODS: The level of psychosocial adjustment was assessed in 96 subjects with bipolar disorder and 96 subjects with schizophrenia who were in remitted state. The association between executive function and psychosocial adjustment and the mediating and moderating effects of insight were examined by multiple regression analysis models and the Goodman test. RESULTS: The results indicated that executive function had direct effect on psychosocial adjustment in both subjects with bipolar disorder and schizophrenia. However, the mediating effect of insight on the association between executive function and psychosocial adjustment was only found in subjects with schizophrenia, but not in subjects with bipolar disorder. No moderating effect of insight on the association between executive function and psychosocial adjustment was found in subjects with schizophrenia or bipolar disorder. CONCLUSIONS: The results of this study indicated that executive function has an important role in psychosocial adjustment in both patients with bipolar disorder and schizophrenia. Meanwhile, insight has a different role in the association between executive function and psychosocial adjustment between patients with bipolar disorder and schizophrenia.

Concern over weight and dieting in Taiwanese adolescents: correlations of gender, age, weight, and multidimensional characteristics.

The aims of this study were to compare the levels of concern over weight and dieting (COWD) among adolescents with different body weight status, gender, and age, and to examine the associations of COWD with multidimensional characteristics. Nine thousand eighty-seven adolescents completed the questionnaires. The levels of COWD were compared among the groups with different body weight status, gender, and age. The correlates of COWD in gender- and age-specified groups were examined. The results indicated that the levels of COWD varied across the groups of adolescents with different body weight status, gender, and age. Being overweight or obese, depression, and low self-esteem were associated with high COWD in all gender- and age-specified groups. A variety of socio-demographic, personal, family, peer, and school characteristics were also associated with high COWD in adolescents with specified gender and age. Gender- and age-specified intervention programs targeting adolescents with the correlates of high COWD should be considered.

Suicide and its association with individual, family, peer, and school factors in an adolescent population in southern Taiwan.

A representative sample of 10,233 adolescent students was recruited to examine the rate of suicidal attempt and its correlates in the adolescents living in southern Taiwan. Five questions from the Kiddie Schedule for Affective Disorders and Schizophrenia (Kiddie-SADS-E) were used to inquire about the participants' suicidality. The associations between suicidal attempt and multidimensional factors were examined by using logistic regression analysis: 9.1% of the participants reported a suicidal attempt in the preceding year. Female gender, low self-esteem, weekly alcohol use, illicit drugs use, depression, high family conflict, low maternal education level, poor family function, low connectedness to school, low rank, poor feeling in peer group, and drop out from school were associated with adolescent suicidal attempt. The rate of suicidal attempt was found to be high in Taiwanese adolescents, and multidimensional factors were correlated to adolescent suicidal attempt.

Symptoms of problematic cellular phone use, functional impairment and its association with depression among adolescents in Southern Taiwan.

The aims of this study were: (1) to examine the prevalence of symptoms of problematic cellular phone use (CPU); (2) to examine the associations between the symptoms of problematic CPU, functional impairment caused by CPU and the characteristics of CPU; (3) to establish the optimal cut-off point of the number of symptoms for functional impairment caused by CPU; and (4) to examine the association between problematic CPU and depression in adolescents. A total of 10,191 adolescent students in Southern Taiwan were recruited into this study. Participants' self-reported symptoms of problematic CPU and functional impairments caused by CPU were collected. The associations of symptoms of problematic CPU with functional impairments and with the characteristics of CPU were examined. The cut-off point of the number of symptoms for functional impairment was also determined. The association between problematic CPU and depression was examined by logistic regression analysis. The results indicated that the symptoms of problematic CPU were prevalent in adolescents. The adolescents who had any one of the symptoms of problematic CPU were more likely to report at least one dimension of functional impairment caused by CPU, called more on cellular phones, sent more text messages, or spent more time and higher fees on CPU. Having four or more symptoms of problematic CPU had the highest potential to differentiate between the adolescents with and without functional impairment caused by CPU. Adolescents who had significant depression were more likely to have four or more symptoms of problematic CPU. The results of this study may provide a basis for detecting symptoms of problematic CPU in adolescents.

Depression and its association with self-esteem, family, peer and school factors in a population of 9586 adolescents in southern Taiwan.

AIMS: The aim of the present study was to gain insight into the prevalence of depression and its association with self-esteem, family, peer and school factors in a large-scale representative Taiwanese adolescent population. METHODS: A total of 12,210 adolescent students were recruited into the present study. Subjects with a score >28 on the Center for Epidemiological Studies' Depression Scale were defined as having significant depression; the Rosenberg Self-Esteem Scale, Adolescent Family and Social Life Questionnaire and Family C-APGAR Index were applied to assess subjects' self-esteem, family, peer and school factors. The association between depression and correlates were examined on t-test and chi(2) test. The significant factors were further included in logistic regression analysis. RESULTS: Among 9586 participants (response rate: 86.3%), the prevalence of depression was 12.3%. The risk factors associated with depression in univariate analysis included female gender, older age, residency in urban areas, lower self-esteem, disruptive parental marriage, low family income, family conflict, poorer family function, less satisfaction with peer relationships, less connectedness to school, and poor academic performance. After adjusting the effects of sex, age and location, only subjects with lower self-esteem, higher family conflict, poorer family function, lower rank and decreased satisfaction in their peer group, and less connectedness to school were prone to depression on logistic regression. CONCLUSION: The prevalence of depression is high in Taiwanese adolescents, and the multiple factors of family, peer, school and individuals are associated with adolescent depression. The factors identified in the present study may be helpful when designing and implementing preventive intervention programs.

Insight into alcohol-related problems and its associations with severity of alcohol consumption, mental health status, race, and level of acculturation in southern Taiwanese indigenous people with alcoholism.

OBJECTIVE: While not well known in the West, Taiwan has a substantial indigenous population, and this population has rapidly developed alcohol problems. This study examined the level of insight into alcohol-related problems and its associations with the severity of alcohol consumption, mental health status, race, and the level of acculturation among indigenous populations with alcohol problems in southern Taiwan. METHODS: A total of 332 indigenes, whose total Alcohol Use Disorders Identification Test (AUDIT) score was equal to 8 or higher, were interviewed. The associations between the level of insight into alcohol-related problems and the severity of alcohol drinking on the AUDIT, mental health status on the Chinese Health Questionnaire-12 (>or= 4 vs. < 4), race (Bunun vs. non-Bunun), and the level of acculturation on the Taiwan Aboriginal Acculturation Scale were examined using logistic regression models. RESULTS: The results of this study found that 72.6% of the participants had poor insight into alcohol-related problems and no participant had good insight. Participants who had more severe alcohol drinking or poor mental health were more likely to have a higher level of insight into alcohol-related problems. Participants who were non-Bunun were also more likely to have a higher level of insight into alcohol-related problems, but the level of acculturation was not associated with the level of insight into alcohol-related problems. CONCLUSIONS: These findings suggest that most alcoholic indigenes in southern Taiwan have poor insight into their own alcohol-related problems. Cultural specific interventions targeting and improving the indigenes' insight into alcohol-related problems are needed.

Quality of life and its association with insight, adverse effects of medication and use of atypical antipsychotics in patients with bipolar disorder and schizophrenia in remission.

OBJECTIVE: The present study aimed: (i) to compare the level of quality of life (QOL) among subjects with bipolar disorder (BD) and schizophrenia who were in remission and healthy control subjects and (ii) to examine the association of QOL with insight, adverse effects of medication and use of atypical antipsychotics among subjects with BD and schizophrenia who were in remission by controlling other confounding factors. METHODS: The QOL on the four domains of the World Health Organization Questionnaire on Quality of Life: Short Form - Taiwan version (WHOQOL-BREF) were compared between 96 subjects with BD in remission, 96 subjects with schizophrenia in remission and 106 healthy control subjects. The association between the four QOL domains and subjects' insight, adverse effects of medication and use of atypical antipsychotics were examined using multiple regression analyses in the subjects with BD and schizophrenia in remission. RESULTS: The results demonstrated that the subjects with BD in remission had similarly poor levels of QOL in all four domains as those subjects with schizophrenia in remission, and both subjects with BD and schizophrenia had poorer QOL than those in the control group. For both subjects with BD and schizophrenia in remission, insight was negatively associated with QOL on the physical domain, and adverse effects of medication were negatively associated with QOL on the physical and environment domains. Use of atypical antipsychotics was not associated with QOL, but subjects with BD receiving olanzapine perceived better psychological QOL than those receiving risperidone and better psychological and social relationship QOL than those receiving no atypical antipsychotic. CONCLUSIONS: The results of the present study indicate that subjects with BD are dissatisfied with their QOL, even when they are in a remitted state. Clinicians must consider the negative influences of insight and adverse effects of medication on QOL of patients with BD and schizophrenia in remission.

Suicidality and its association with insight and neurocognition in taiwanese patients with bipolar I disorder in remission.

The aims of this study were to examine the relationships between suicidality, insight, and neurocognition in patients with bipolar I disorder who were in a remitted state. Using the Violence and Suicide Assessment Scale, we evaluated 96 patients with bipolar I disorder in remission to determine their suicidal ideations and attempts over the previous year. We also evaluated their level of insight by using the Schedule of Assessment of Insight (SAI) and its expanded version (SAI-E), as well as their neurocognitive function by a series of neurocognitive function tests. Insight and neurocognitive functions of bipolar subjects who had and who had no suicidal ideations or attempts over the previous year were compared. The results indicated that the remitted bipolar subjects who had suicidal ideations or attempts over the previous year had higher insight scores on all 3 SAI dimensions and on the SAI-E compared with those who had no suicidal ideations or attempts. However, no difference in any neurocognitive function was found between the 2 groups of remitted bipolar subjects. The results of this study suggest clinicians need to be particularly alert to the potential for suicide in bipolar patients with a high level of insight.

Relationship between insight and neurocognition in patients with bipolar I disorder in remission.

The aim of this study was to examine the relationships between insight and neurocognition in a population of patients with bipolar I disorder who were in a remitted state. Using the Schedule of Assessment of Insight (SAI) and its expanded version, we evaluated 96 patients with bipolar I disorder in remission to determine their level of insight. We also evaluated their neurocognitive function included in the domains of executive function, attention, and memory. The associations between insight and neurocognitive function were examined by using the stepwise multiple regression analysis to control the confounding effects of sociodemographic and clinical factors. The results indicated that by controlling the confounding effects of other factors, executive function was positively associated with the SAI dimensions of awareness of illness and relabeling of phenomena, and the total expanded version of the SAI in remitted bipolar patients. The results of this study indicated that the relationships vary between different dimensions of insight and domains of neurocognitive function in remitted bipolar patients.

Comparisons of substance use disorders and correlates between aboriginal and non-aboriginal adolescents living in a mountain region in southern Taiwan.

The purposes of this study were to examine the differences in prevalence of lifetime substance use disorders (SUDs), age at initial substance use, and knowledge and attitudes toward substance use between aboriginal and non-aboriginal adolescents living in a mountain region of southern Taiwan, and to separately examine the correlates of SUDs among the two groups. A total of 251 aboriginal and 79 non-aboriginal adolescents were recruited into this study. The results revealed that although the prevalence of SUDs was high in both aboriginal and non-aboriginal adolescents, no difference in the prevalence of SUDs between the two groups was found. Attitudes toward substance use and several dimensions of peer influence were associated with SUDs in both aboriginal and non-aboriginal adolescents. However, there were different socio-demographic and family correlates with SUDs in aboriginal and non-aboriginal adolescents, and an association between characteristics of personality and SUDs was found only in aboriginal adolescents. Those who devise strategies to prevent adolescent substance use may consider the differences in the correlates of SUDs between aboriginal and non-aboriginal adolescents.

Psychopathology of aboriginal and non-aboriginal adolescents living in the mountainous region of southern Taiwan.

The aim of this study was to examine the hypothesis that Taiwanese aboriginal adolescents feature more severe psychopathology than non-aboriginal adolescents who live in the same mountainous region of southern Taiwan, and to test the hypothesis by controlling other individual and environ-mental factors. In this study, a total of 251 aboriginal and 79 non-aboriginal Taiwanese adolescents were enrolled. Their psychopathology was measured by the Symptom Checklist-90-Revised Scale; demographic and family characteristics, and their affinity with their peer group and with their school were also assessed. The results of the multiple regression analysis revealed that aboriginal adolescents feature more severe psychopathology than non-aboriginal adolescents, and indicated that females and adolescents perceiving higher levels of family conflict and lower family support were more likely to experience more severe psychopathology than those perceiving the contrary. Those who devise strategies to improve the mental health of adolescents living in impoverished regions must take into consideration their ethnicity, gender, and family context when devising such treatment strategies.

Relationships among mental health status, social context, and demographic characteristics in Taiwanese aboriginal adolescents: a structural equation model.

The purposes of this study were to examine the relationships among mental health status, demographic characteristics, and social contexts, including family conflict and support, connectedness to school, and affiliation with peers who exhibit delinquent behavior and who use substances, among Taiwanese aboriginal adolescents. A total of 251 aboriginal junior high school students in an isolated mountainous area of southern Taiwan were recruited, and the relationships among mental health status, demographic characteristics, and social contexts among them were examined using a structural equation model (SEM). The SEM revealed that family conflict and support had direct influences on mental health status and connectedness to school. Family conflict had a direct relationship with affiliation with peers who use substances, and family conflict and support were both indirectly linked with affiliation with peers who exhibit delinquent behavior and who used substances; these were mediated by a poor mental health status. Female and older age were directly linked with a poor mental health status and were indirectly linked with a greater number of peers who exhibit delinquent behavior and who use substances via the poor mental health status. Disruptive parenting was directly linked with affiliation with peers who use substances. The authors suggest that those who devise strategies to improve aboriginal adolescents' mental health and discourage substance use should take these relationships among mental health, demographic characteristics, and social contexts into account.