Positive mother-child interactions and parenting styles were associated with lower screen time in early childhood.

AIM: This study examined long-term associations between mother-child interactions and parenting styles and electronic screen time. METHODS: We studied 280 healthy children (53.2% girls) enrolled at a mean age of 36 ± 0.4 months from February 2015 to September 2016. The study included retrospective data on 267 children who had been recruited from medical facilities in Thailand at 6 months of age. Mother-child interaction, parenting styles and screen time were assessed at various ages and path analyses were performed to elucidate the directionality and relationships between the variables. RESULTS: Increased mother-child interaction at 18 months of age was positively associated with less screen time at 2 and 3 years of age. Likewise, nurturing authoritative parenting at 3 years of age was directly related to lower media exposure at 4 years. The total screen time at younger ages had positive direct relationships with relaxed permissive and strict authoritarian parenting styles, but negative direct relationships with nurturing authoritative parenting in subsequent years. CONCLUSION: Early mother-child interaction and nurturing authoritative parenting were associated with subsequent decreased screen time, while media exposure at the age of two was related to relaxed permissive and strict authoritarian parenting at 3 years of age.

Background media exposure prolongs nighttime sleep latency in Thai infants.

BACKGROUND: Less is known about the effect of screen time and sleep at a younger age on current sleep outcome in infants. Therefore, we examined whether sleep parameter at a younger age and daily exposure of electronic media could predict sleep outcomes in 12-mo-old Thai infants. METHODS: There were 208 typically developing infants enrolled since 6 mo old. Each main caregiver completed a sleep questionnaire and was interviewed for the infant's screen exposure at 6 and 12 mo of age. Nighttime sleep latency and sleep duration were calculated. Electronic media and sleep outcomes were analyzed using multiple linear regressions and path analysis. RESULTS: Longer sleep latency at age 12 mo was predicted by longer daily duration of media exposure and longer 6-mo-old sleep latency. Infants who were exposed to electronic media above the median at both ages had longer 12-mo-old nighttime sleep latency compared with those who were exposed to the screen below the median at both ages. CONCLUSION: Six-month-old nighttime sleep latency and 12-mo-old electronic media exposure could predict 12-mo-old nighttime sleep latency. Relative changes in media exposure over time can provide a better prediction of nighttime sleep latency in Thai infants than screen exposure at either time point.

Two-Step Screening of the Modified Checklist for Autism in Toddlers in Thai Children with Language Delay and Typically Developing Children.

This study aimed to validate the use of two-step Modified Checklist for Autism in Toddlers (M-CHAT) screening adapted for a Thai population. Our participants included both high-risk children with language delay (N = 109) and low-risk children with typical development (N = 732). Compared with the critical scoring criteria, the total scoring method (failing ≥3 items) yielded the highest sensitivity of 90.7 %; specificity was 99.7 %, positive predictive value 96.1 %, and negative predictive value 99.4 %. The two-step M-CHAT screening is a promising instrument that can be utilized to detect ASD in Thai children in both primary and clinical settings. Moreover, socio-cultural context should be considered when adopting the use and interpretation of the M-CHAT for each country.

Increased Sleep Disturbances in Thai Children With Attention-Deficit Hyperactivity Disorder Compared With Typically Developing Children.

This study compares sleep disturbances in Thai children aged 5-12 years with attention-deficit hyperactivity disorder (ADHD) and typically developing children using the Children's Sleep Habits Questionnaire (CSHQ)-Thai version. Fifty-five children with ADHD and 110 typically developing children were enrolled. Their parents completed the CSHQ, the ADHD rating scales, and the Strengths and Difficulties Questionnaire (SDQ). Children with ADHD had significantly higher scores in all subscales of the CSHQ compared to controls. Among children with ADHD, children with higher SDQ scores (> 15) appeared to have more sleep disturbances than those with relatively lower SDQ scores. Moreover, fewer sleep-related behavioral problems were observed in the medication treated group, which is particularly new to the field and for some perhaps not unexpected clinically.

Low-glycemic index diet may improve insulin sensitivity in obese children.

BACKGROUND: A low-glycemic index (GI) diet may be beneficial for weight management due to its effect on insulin metabolism and satiety. METHODS: Obese children aged 9-16 y were randomly assigned either a low-GI diet or a low-fat diet (control group) for 6 mo. Body composition changes were measured by dual-energy X-ray absorptiometry and bioelectrical impedance analysis. Insulin sensitivity was measured by fasting plasma glucose and insulin. RESULTS: Fifty-two participants completed the study (mean age: 12.0 ± 2.0 y, 35 boys); both groups showed significantly decreased BMI z-score but similar changes in fat and fat-free mass. The low-GI group demonstrated a significant decline in fasting plasma insulin (22.2 ± 14.3 to 13.7 ± 10.9 mU/l; P = 0.004) and homeostatic model of assessment-insulin resistance (4.8 ± 3.3 to 2.9 ± 2.3; P = 0.007), whereas the control group did not. However, general linear model showed no significant difference in insulin resistance between groups after adjusting for baseline levels, suggesting that the greater reduction in insulin resistance in the low-GI group may be explained by higher baseline values. CONCLUSION: Despite subtle effects on body composition, a low-GI diet may improve insulin sensitivity in obese children with high baseline insulin. A bigger study in obese children with insulin resistance could be worthwhile to confirm our findings.

Elevated background TV exposure over time increases behavioural scores of 18-month-old toddlers.

AIM: To investigate whether trends of TV exposure from age six to 18 months and adult TV programmes were associated with behavioural concerns of 18-month-old Thai toddlers. METHODS: There were 194 healthy infants recruited at age six months and followed up until 18 months of age in this present cohort. TV exposure variables were assessed by interviewing in depth at both six- and 18-month-old visits. A mother of each participant rated the child's behaviours using the Child Behaviour Checklist. RESULTS: Infants who were increasingly exposed to TV from age six to 18 months with adult programmes since six months of age had higher pervasive developmental problems and oppositional defiant behaviours scores. Exposure to adult TV programmes at age six months was also associated with emotionally reactive problems, aggression and externalising behaviours in the final regression models. CONCLUSION: To promote appropriate toddlers' behaviours at age 18 months, elevated background TV exposure over time should be discouraged. Furthermore, paediatricians should emphasise such effects of TV exposure on child behaviours with parents at health supervision visits. As such, parents will be aware of the detrimental effect of increased background TV exposure over time on their children's behaviours.

Sleep Behaviors and Sleep Problems in School-Aged Children in Thailand.

BACKGROUND: Sleep problems can have a significant effect on children behaviors, emotional and cognitive developments. However, limited information is available regarding the sleep behaviors and sleep problems of school-aged children in Thailand. The purposes of this study were to examine the prevalence of sleep problems and to describe sleep/wake pattern of Thai children. MATERIAL AND METHOD: The school-based, cross-sectional study was conducted in 5 primary public schools selected from Bangkok and three regions of Thailand. The samples were selected from the first and fourth grades of each school. The Children's Sleep Habits Questionnaire (CSHQ) was used to evaluate sleep behaviors and sleep problems. RESULTS: Grade 1 children went to bed earlier and had longer weekday sleep duration comparing with grade 4 children. Sleep duration was significantly shorter in children living in Bangkok, comparing with those living in rural areas. Mean total CSHQ score was significant higher in grade 1 children, when comparing with grade 4 children (51.30 vs. 50.18; p = 0.026). Grade 1 children scored significantly higher on bedtime resistance (10.96 vs. 10.39; p = 0.004) and sleep anxiety subscale (6.68 vs. 6.41; p = 0.022), while grade 4 children scored significantly higher on sleep-onset delay subscale (1.41 vs. 1.23; p < 0.001). Prevalence of sleep problems was highest in the category of "falling asleep while riding in car or bus" (69.5%), followed by "awakening by others in the morning" (68.5%). CONCLUSION: Sleep problems were common in Thai school-aged children. The most common sleep problems were in the domains of daytime sleepiness and bedtime resistance and anxiety.

Evening media exposure reduces night-time sleep.

AIM: To investigate whether evening media exposure, bedroom media use and night-time sleep duration at age 6 months are associated with night-time sleep duration in 12-month-old Thai infants. METHODS: We enrolled 208 infants in this study at 6 months of age. They were followed-up at 12 months of age. A sleep diary was used to document the infant's sleep onset and wake time at each visit. Night-time sleep duration was then calculated at both ages. Screen media exposure in the household was assessed in depth at both visits. RESULTS: Infants who were exposed to screen media in the evening at 12 months of age had a 28-min decrease in 12-month night-time sleep duration on weekdays. Moreover, infants who were exposed to screen media in the evening at age 6 months and 12 months had shorter 12-month night-time sleep duration compared with those who were not exposed to screen media after 7 pm at both ages. Night-time sleep duration at 12 months of age was also directly related to 6-month night-time sleep duration. CONCLUSION: Infants exposed to screen media in the evening at 12 months of age had decreased 12-month night-time sleep duration. To promote good sleep hygiene and optimal sleep for infants at this age, screen media exposure after 7 pm should be avoided.

Comparison of television viewing between children with autism spectrum disorder and controls.

AIM: To examine the pattern and extent of television viewing in children with autism spectrum disorder (ASD) compared with typically developing controls and those with delayed language development (DLD). METHODS: Fifty-four individuals with ASD (mean age 2.56 ± 0.66 years) and 84 controls (mean age 2.43 ± 0.81 years) were enrolled. Fifty-six individuals with DLD, who had language developmental levels similar to those with ASD, were enrolled in our previous study. Main outcome measures included onset and frequency of television viewing, in addition to the type of programme and whether a caregiver cowatched television. RESULTS: Those with ASD began to watch television significantly earlier than controls (6.44 ± 6.35 vs. 12.41 ± 6.00 months of age, p ≤ 0.0001*) and spent more time watching television than those with DLD (4.60 ± 1.91 vs. 3.05 ± 1.90 h/day, p ≤ 0.0001*) and controls (4.60 ± 1.91 vs. 2.06 ± 1.21 h/day, p ≤ 0.0001*). Those with ASD appeared to watch more adult programmes than normal controls, and they were less likely to watch television with caregivers than both control groups. CONCLUSION: There is an earlier onset and higher frequency of television viewing in autistic children compared with children with typical development.

Television viewing associates with delayed language development.

AIM: To identify impact of television viewing on language development. METHODS: The case-control study included 56 new patients with language delay and 110 normal children, aged 15-48 months. Language delay was diagnosed by reviewing language milestones and Denver-II. Television viewing variables and child/parental characteristics between both groups were interviewed. The data were analyzed by ANOVA and chi-square test. Adjusted odds ratios and 95% confidence intervals were calculated from multivariate logistic regression model. RESULTS: Forty-six boys and 10 girls; mean [+/-SD] age, 2.11+/-0.47 years of the case group and 59 boys and 51 girls; mean [+/-SD] age, 2.23+/-0.80 years of the control group were enrolled. Children who had language delay usually started watching television earlier at age 7.22+/-5.52 months vs. 11.92+/-5.86 months, p-value<0.001 and also spent more time watching television than normal children (3.05+/-1.90 h/day vs. 1.85+/-1.18 h/day; p-value<0.001). Children who started watching television at<12 months of age and watched television>2 h/day were approximately six times more likely to have language delays. CONCLUSIONS: There is a relationship between early onset and high frequency of TV viewing and language delay.