Psychometric properties of the Screen for Child Anxiety Related Disorders Thai version.

BACKGROUND: Anxiety disorders are the most common psychiatric disorders among children. Because of their internalizing nature, anxiety disorders are underdiagnosed and untreated. Therefore, self-report screening tools play an important role in the early identification of these cases. This study aimed to examine the psychometric properties of the Screen for Child Anxiety Related Disorders (SCARED)-Thai version in a clinical population. METHODS: One hundred and eight participants were enrolled from patients aged 9-16 years with any psychiatric diagnosis and their parents who visited a child and adolescent psychiatric clinic in Thailand. All the parent-child pairs completed the SCARED and the Strengths and Difficulties Questionnaire (SDQ)-emotional subscale. Clinical diagnosis of an anxiety disorder was endorsed through a standard clinical interview by certified child and adolescent psychiatrists blinded to the results of the SCARED and SDQ. Internal consistency, predictive validity, and convergent validity of the screens were assessed. RESULTS: This study found that the SCARED-Thai version had very good reliability, with internal consistency (Cronbach's alpha) of 0.913 for the SCARED-Child form and 0.925 for the SCARED-Parent form. With an optimal cut-off point of 23, the SCARED-Child version significantly distinguished anxious from non-anxious young people in clinical settings with a sensitivity of 0.74 and a specificity of 0.50, while the SCARED-Parent version had a sensitivity of 0.74 and a specificity of 0.67 at the same threshold. The convergent validity between the SCARED-Thai (total) and SDQ (emotional subscale) was at a highly suitable range (r = 0.81). CONCLUSION: The SCARED-Thai version exhibited good psychometric quality for identifying young people with comorbid anxiety disorders when used in clinical settings.

Randomized Controlled Trial of Group Cognitive Behavioural Therapy for Post-Traumatic Stress Disorder in Children and Adolescents Exposed to Tsunami in Thailand.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a common and debilitating consequence of natural disaster in children and adolescents. Accumulating data show that cognitive behavioural therapy (CBT) is an effective treatment for PTSD. However, application of CBT in a large-scale disaster in a setting with limited resources, such as when the tsunami hit several Asian countries in 2004, poses a major problem. AIMS: This randomized controlled trial aimed to test for the efficacy of the modified version of CBT for children and adolescents with PSTD. METHOD: Thirty-six children (aged 10-15 years) who had been diagnosed with PSTD 4 years after the tsunami were randomly allocated to either CBT or wait list. CBT was delivered in 3-day, 2-hour-daily, group format followed by 1-month posttreatment self-monitoring and daily homework. RESULTS: Compared to the wait list, participants who received CBT demonstrated significantly greater improvement in symptoms of PTSD at 1-month follow-up, although no significant improvement was observed when the measures were done immediately posttreatment. CONCLUSIONS: Brief, group CBT is an effective treatment for PTSD in children and adolescents when delivered in conjunction with posttreatment self-monitoring and daily homework.

Concurrent validity of the Ages & Stages Questionnaires, Third Edition, Thai-version (ASQ-3 Thai) with the Denver Developmental Screening Test II (DDST-II) in developmental screening of 18, 24, and 30 months old children at Queen Sirikit National Institute of Child Health.

OBJECTIVE: To determine the concurrent validity of the Ages & Stages Questionnaires, Third Edition, Thai-version (ASQ-3 Thai) with the Denver Developmental Screening Test II (DDST-II) and agreement between them in developmental status screening in toddlers. MATERIAL AND METHOD: Children at the ages of 18, 24, and 30 months were enrolled. Each age group included 15 normal and 15 suspected cases. Participants were developmentally assessed by the DDST-II performed by a developmental pediatrician (BS). Parents of the enrolled children simultaneously completed their toddler's age-specific version of the ASQ-3 Thai questionnaire. Concurrent validity of the ASQ-3 Thai with DDST-II was determined by descriptive statistics using the cross tabulation technique. Kappa analysis was used to calculate agreement between the ASQ-3 Thai and DDST-II. RESULTS: A fair to moderate agreement (Kappa agreement = 0.338-0.606) was found between the ASQ-3 Thai and the DDST-II. Sensitivity of the ASQ-3 Thai with DDST-II at the age of 18, 24, and 30 months were 66.7%, 88.2%, and 54.5%, respectively. Specificity of the tool when compared to the DDST-II were 78.6%, 71.4% and 90.9%, respectively. CONCLUSION: This was a preliminary study of the ASQ-3 Thai version for developmental screening in clinical setting. Due to a fair to moderate agreement but low sensitivity between the ASQ-3 Thai and DDST-II, other validated tools should accompany the clinical usage of the tool. Further investigations are needed to support its usage, particularly the validation of the tool with other standardized developmental diagnostic tools.

Quality of life and happiness of the students in the disaster area: 6 years after the Tsunami at Takua Pa District, Phang Nga, Thailand.

BACKGROUND: The Tsunami disaster, which occurred on December 26, 2004 in Thailand, caused enormous damage to life, property and community. Although the tragedy occurred 6 years ago, many children and adolescents still suffer from mental health problems. OBJECTIVE: To determine the quality of life and happiness of students who live in the Tsunami disaster area 6 years after the tragedy. MATERIAL AND METHOD: A cross-sectional study was done on 648 students from three schools in Takua Pa district, Phang Nga. They had been provided with psychological or support by multidisciplinary teams from Queen Sirikit National Institute of Child Health, Siriraj Hospital and Chulalongkorn Hospital. The questionnaires consisted of 3 subsets which were self-report of general information, pediatric quality of life inventory and Thai happiness indicator. RESULTS: The student's quality of life was low 15.1%, moderate 68.7% and high 16.2%. Eighteen percent had good (27-42) score higher, 38% had a fair (27-32) score and 44% had a poor (< 27) score. Females and high school performance were associated with happiness. CONCLUSION: Disasters have long lasting effects on victims, especially in children. Although this group of children had regularly received assistance including welfare, finance, education and health advice, most had fair quality of life scores were fair and poor-is this needed. Nearly half of them had happiness level scores less than average. They still have psychosocial problems and will need long-term monitoring, support and assistance.

Association of adolescent substance use: behavioral problems and family background among school students in Tsunami affected area in southern Thailand.

OBJECTIVE: To study the prevalence of substance use and associated factors in school students in Tsunami affected areas in southern Thailand. MATERIAL AND METHOD: The study was a school-based, cross-sectional, anonymous survey that used a translated questionnaire, ESPAD-03, in 5 schools. Chi-square tests and odds ratios were used to evaluate factors associated with substance use. RESULTS: Two thousand seven hundred and sixteen students (87.8%) were enrolled in the study. Lifetime, last 12 months, and last 30 days prevalence rates of any substance use were 50.3, 33.9, and 24.8%, respectively. Lifetime, last 12 months, and last 30 days prevalence rates of alcohol use were 43.2, 30.1, and 17.5%, respectively. Lifetime and last 30 days prevalence rates of smoking were 21.7 and 12.0%. Fighting, stealing, truancy, running away, unsafe sex, and thought of self-harming were associated with alcohol and substance use. Siblings and friends with alcohol and substance use were risk factors. Close support from parents and friends were protective factors. CONCLUSION: There was a high prevalence of smoking, alcohol, and substance use among school students in Tsunami affected areas. Behavioral problems and psychosocial risk factors were associated with history of smoking, alcohol and substance use. School-based intervention in students with behavioral problems seems to be a worthwhile investment. However, longitudinal studies should be done to confirm the correlation of PTSD and substance use.

Child psychiatric consultation to pediatric inpatient services in Thailand.

Children with medical illnesses have significant levels of comorbid psychopathology. To understand the concern, and the area that needs to be addressed, the practice of child psychiatric inpatient consultation at Queen Sirikit National Institute of Child Health, Thailand was examined and appraised. Evaluation of the current practice pattern of psychiatric consultation is a crucial process in determining the next step of improving the quality of mental health care for sick children.

Post-traumatic stress disorder in children after the tsunami disaster in Thailand: a 5-year follow-up.

BACKGROUND: Children may suffer from post-traumatic stress disorder after disaster. There was a severe tsunami following an undersea earthquake off the Sumatra coast of Indonesia. There were 20,000 children in 6 southwestern provinces of Thailand who were possibly affected. OBJECTIVE: To study the prevalence of post-traumatic stress disorder (PTSD) in Thai students in the area affected by the December 26th, 2004 tsunami disaster, Thailand. MATERIAL AND METHOD: One thousand six hundred and fifteen surviving students from two schools in Takua Pa district located in Phang-nga Province, Thailand participated in this longitudinal study. Screening was done by using Pediatric Symptom Checklists part II (PSC-II), Childhood Depressive Intervention (CDI) and the Revised Child Impact of Events Scales (CRIES 8). PTSD was diagnosed by child and adolescent psychiatrists by using criteria of DSM-IV. The intervention included psychological first aid, psycho-education, cognitive-behavioral therapy, medication in severe cases, group support for students, parents and teachers which was done, beginning at 10 days after the tsunami disaster. Data were analyzed by using SPSS version 12.0. RESULTS: The prevalence rates of PTSD in the students facing the tsunami disaster in the study group were 573, 46.1, 31.6, 7.6, 4.5, 3.9 and 2.7% at 6 weeks, 6 months, 1 year, 2 years, 3 years, 4 years and 5 years after the disaster, respectively. Female to male ratio was 1.7: 1. The peak age was 9-10 years old. The top five on the list of symptoms in PTSD were distress with cue, intrusive thought, functioning impairment, startled response, terrified and hyper vigilance. Seven cases (3.1%) were diagnosed partial PTSD, still exhibited a wide range of PTSD symptoms but did not fulfill the DSM-IV diagnostic criteria. The top five on the list of symptoms in partial PTSD were avoiding thought/feelings, terrified, avoiding place/activities, distress with cue and startled response. CONCLUSION: The prevalence of PTSD among tsunami victims was 57.3% at 6 weeks after the disaster. It declined sharply at 2 years after the event. Despite receiving financial, rehabilitation and mental health support, 2.7% of the victims continued to suffer from PTSD 5 years after the disaster.

Concurrent treatment of steroid-related mood and psychotic symptoms with risperidone.

Corticosteroid treatment is an important therapeutic modality for many pediatric medical conditions including acute lymphoblastic leukemia. However, steroid-induced behavioral and mood abnormalities are common and potentially disabling adverse effects that have been widely reported in the pediatric literature. From this case series, we report the efficacy of risperidone in 3 children with acute lymphoblastic leukemia who developed steroid-related mood and psychotic symptoms during treatment with prednisone and dexamethasone. Risperidone is an effective short-term pharmacologic agent for controlling steroid-related psychiatric adverse effects when cessation or dose reduction of steroid therapy is not an option.

Assessment of psychopathological consequences in children at 3 years after tsunami disaster.

BACKGROUND: At 1 year after the Tsunami disaster, 30% of students in two high risk schools at Takuapa district of Phang Nga Province still suffered from post traumatic stress disorder (PTSD). The number ofpatients was sharply declined after 18 months. The psychological consequences in children who diagnosed PTSD after the event were reinvestigated again at 3 years, as there were reports of significant comorbidity and continuing of subsyndromal post traumatic stress symptoms in children suffered from other disasters. OBJECTIVE: To assess psychological outcomes and factors contributed at 3-year follow up time in children diagnosed PTSD at 1-year after the Tsunami disaster MATERIAL AND METHOD: There were 45 students who were diagnosed PTSD at 1-year after the disaster At 3-year follow up time, clinical interview for psychiatric diagnosis was done by psychiatrists. RESULTS: 11.1% of students who had been diagnosed as PTSD at 1-year after Tsunami still had chronic PTSD and 15% had either depressive disorder or anxiety disorder 25% of students completely recovered from mental disorders. Nearly 50% ofstudents were categorized in partial remission or subsyndromal PTSD group. Factors which influenced long-term outcomes were prior history of trauma and severe physical injury from the disaster. CONCLUSION: Although the point prevalence of PTSD in children affected by Tsunami was declined overtime, a significant number of students still suffer from post traumatic stress symptoms, depressive disorder or anxiety disorder which need psychological intervention.