Video feedback to update negative self-perceptions in social anxiety disorder: A comparison of internet-delivered vs face-to-face cognitive therapy formats

BACKGROUND

Video feedback is a technique used in cognitive therapy for social anxiety disorder (CT-SAD) to update patients' negative self-perceptions of how they appear to others. Clients are supported to watch video of themselves engaging in social interactions. While typically undertaken in session with a therapist, this study aimed to investigate the effectiveness of remotely delivered video feedback embedded within an Internet-based cognitive therapy program (iCT-SAD).

METHODS

We examined patients' self-perceptions and social anxiety symptoms before and after video feedback in two randomised controlled trials. Study 1 compared 49 iCT-SAD participants with 47 from face-to-face CT-SAD. Study 2 was a replication using data from 38 iCT-SAD participants from Hong Kong.

RESULTS

In Study 1, ratings of self-perceptions and social anxiety showed significant reductions following video feedback, in both treatment formats. 92 % of participants in iCT-SAD, and 96 % in CT-SAD thought they looked less anxious compared to their predictions after viewing the videos. The change in self-perception ratings was larger in CT-SAD compared to iCT-SAD, but there was no evidence that the impact of video feedback on social anxiety symptoms around a week later differed between the two treatments. Study 2 replicated the iCT-SAD findings of Study 1.

LIMITATIONS

The level of therapist support in iCT-SAD videofeedback varied with clinical need and was not measured.

CONCLUSIONS

The findings indicate that video feedback can be delivered effectively online, and that its impact on social anxiety is not significantly different from in-person treatment delivery.

Can the UK AQ-10 be applicable to Chinese samples with autism spectrum disorder in Hong Kong? Cross-cultural similarities and differences

The current study aimed at testing and developing alternative short versions of autism spectrum quotient (AQ-10) (adult [self-report], adult [parent-report], adolescent, and child versions) for use in Hong Kong. First, the various versions of AQ-10 developed in the United Kingdom (the AQ-10-UK) were applied to Hong Kong Chinese samples and demonstrated satisfactory discriminative power (AUCs 0.77-0.94). Second, the Hong Kong Chinese versions of AQ-10 (AQ-10-HK) were developed, using the same methodology as in the original UK study. There were some changes in the choice of items and cut-offs. The AQ-10-HK demonstrated slightly greater discriminative power (AUCs 0.88-0.97) to that of the AQ-10-UK, but the differences in AUCs were not statistically significant. Compared to the corresponding full-length versions, both the UK and HK short forms did not seem to lose any significant discriminative power. Yet, the various versions of AQ, be they the full-length or AQ-10, appeared to consistently exhibit slightly smaller AUCs with the Hong Kong Chinese samples than with the UK samples. So, this study found both cross-cultural similarities and differences. The AQ-10-HK was recommended for local practice to maximize the advantage gained. Yet, for international multi-site research collaboration, involving the UK and HK, the original AQ-10-UK can be used for direct comparison of data.

18-month trajectories of delusional dimensions in young adults: Relationship with reasoning biases and worry

BACKGROUND

It has been argued that what differentiates delusional ideation from full-blown delusions (indicating need for care) is not the number of beliefs, but the experiential dimensions such as conviction, distress, and preoccupation. However, how these dimensions evolve over time and affect outcomes is under-researched. While delusional conviction and distress are associated with reasoning biases and worry respectively in clinical samples, how these processes predict trajectories of delusional dimensions in the general population remains unclear.

METHOD

Young adults (age 18-30) were screened for delusional ideation on the Peters et al. Delusions Inventory. Participants with at least one delusional ideation were randomly selected for a 4-wave assessment (6-month apart). Trajectories of delusional dimensions were separately identified by latent class growth analyses, then compared on baseline levels of jumping-to-conclusions bias, belief inflexibility, worry, and meta-worry.

RESULTS

The longitudinal sample consisted of 356 individuals (drawn from a community sample of 2,187). For each of the three dimensions (conviction, distress, and preoccupation), four-group linear models were identified-high stable, moderate stable, moderate decreasing, and low stable. The high stable group exhibited worse emotional and functional outcomes at 18 months than the other three groups. Worry and meta-worry predicted group differences, and notably differentiated the moderate decreasing groups from the moderate stable groups. Contrary to hypothesis, jumping-to-conclusions bias was milder in the high/moderate stable groups than the low stable group for conviction.

CONCLUSIONS

Distinct trajectories of delusional dimensions were predicted by worry and meta-worry. Differences between the decreasing and stable groups carried clinical implications. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Third-generation genome sequencing implicates medium-sized structural variants in chronic schizophrenia

Background

Schizophrenia (SCZ) is a heterogeneous psychiatric disorder, with significant contribution from genetic factors particularly for chronic cases with negative symptoms and cognitive deficits. To date, Genome Wide Association Studies (GWAS) and exome sequencing have associated SCZ with a number of single nucleotide polymorphisms (SNPs) and copy number variants (CNVs), but there is still missing heritability. Medium-sized structural variants (SVs) are difficult to detect using SNP arrays or second generation sequencing, and may account for part of the missing heritability of SCZ.

Aims and objectives

To identify SVs associated with severe chronic SCZ across the whole genome.

Study design

10 multiplex families with probands suffering from chronic SCZ with negative symptoms and cognitive deficits were recruited, with all their affected members demonstrating uni-lineal inheritance. Control subjects comprised one affected member from the affected lineage, and unaffected members from each paternal and maternal lineage.

Methods

Third generation sequencing was applied to peripheral blood samples from 10 probands and 5 unaffected controls. Bioinformatic tools were used to identify SVs from the long sequencing reads, with confirmation of findings in probands by short-read Illumina sequencing, Sanger sequencing and visual manual validation with Integrated Genome Browser.

Results

In the 10 probands, we identified and validated 88 SVs (mostly in introns and medium-sized), within 79 genes, which were absent in the 5 unaffected control subjects. These 79 genes were enriched in 20 biological pathways which were related to brain development, neuronal migration, neurogenesis, neuronal/synaptic function, learning/memory, and hearing. These identified SVs also showed evidence for enrichment of genes that are highly expressed in the adolescent striatum.

Conclusion

A substantial part of the missing heritability in SCZ may be explained by medium-sized SVs detectable only by third generation sequencing. We have identified a number of such SVs potentially conferring risk for SCZ, which implicate multiple brain-related genes and pathways. In addition to previously-identified pathways involved in SCZ such as neurodevelopment and neuronal/synaptic functioning, we also found novel evidence for enrichment in hearing-related pathways and genes expressed in the adolescent striatum.

Disentangling the relationship of gut microbiota, functional gastrointestinal disorders and autism: a case-control study on prepubertal Chinese boys

Emerging evidence of an altered gut microbiome in autism spectrum disorder (ASD) suggests a pathomechanism through the gut-brain axis despite the inconsistent microbiome profile reported across studies. One of the knowledge gaps in the existing ASD microbiota studies is the lack of systematic exploration of the role of comorbid functional gastrointestinal disorder (FGID) in the association of ASD and altered gut microbiome. Consequently, 92 ASD and 112 age-matched typically developing (TD) boys were profiled on general psychopathology, FGID status by Rome IV classification, and gut microbiota using 16S ribosomal RNA amplicon sequencing at the V4 hypervariable region. Compared to TD, a significant decrease in the within-sample abundance of taxa was observed in ASD, regardless of FGID status. The microbiota of ASD FGID+ and ASD FGID- clustered apart from the TD groups. The microbiota of ASD FGID+ also showed qualitative differences from that of ASD FGID- and had the highest-level Firmicutes: Bacteroidetes ratio, which was paralleled by elevated levels of anxiety and overall psychopathology. The altered gastrointestinal microbiota composition in ASD appeared to be independent of comorbid FGID. Further studies should address how FGID may mediate neuropsychiatric symptoms in ASD through inflammation along the microbiota-gut-brain axis.

Youth psychopathology: Universal or culture-specific? Testing the syndrome models of youth self-report in Chinese population

PROBLEM

The debate on whether psychiatric symptoms are universal and to what extent they are affected by culture is generally divided between the universalist and relativist approaches.

METHODS

This study compared Achenbach/Rescorla's model and Weisz's model of youth self-report in 2521 Chinese adolescents (mean age = 12 years). Indigenous exploratory factor analyses were conducted to explore the factor structure of youth self-report (YSR), and the derived models were tested with confirmatory factor analysis.

FINDINGS

These analyses indicated good support of the Chinese YSR models for males and females. Further analyses revealed three syndromes, namely anxious/depressed, somatic complaints, and aggressive behaviors, which represented broad internalizing and externalizing factors. These syndromes consistently demonstrated high correlations across the different models, indicating their universal nature. Conversely, some unique factors emerged in the Chinese YSR model, such as weight concern and rule-breaking behavior, which may reflect underlying culture-bound factors.

CONCLUSIONS

Our findings support a combined perspective to the universalist and relativist approaches, which argues that some syndromes including Anxious/Depressed, Somatic Complaints, Aggressive Behavior and Attention Problems are more likely to be universal in male adolescents, while a new emerging syndrome like Weight Concern may reflect the socioeconomic, culture, and lifestyle changes that are currently emerging in China.

Common outcome, different pathways: Social information-processing deficits in autism spectrum disorder and attention-deficit/hyperactivity disorder

Social functioning is a key domain of impairment in both autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). This review adopts the social information-processing model as the theoretical framework to compare and contrast the deficits of ASD and ADHD at each of the six steps of social information-processing. Both disorders show deficits at each step, but the nature and origins of the deficits are different. Thus, while both disorders exhibit a common outcome of social impairment, the exact pathways that each disorder traverses along the six steps of social information-processing are different. For ASD, there is a social knowledge/behaviour deficit arising from difficulties in social/emotional cue detection, encoding, and interpretation, leading to problems in joining and initiating social interaction. For ADHD, there is a performance deficit incurred by disruption arising from the ADHD symptoms of inattention and hyperactivity/impulsivity, while its acquisition capacity on social knowledge is relatively intact. The inattentive, intrusive, and impulsive behaviours of ADHD unsettle social interaction. Finally, this review proposes training targets for intervention along the six steps of the social information-processing model for ASD and ADHD, as well as areas for future research in further elucidating the social impairment of the two disorders.

Longitudinal bifactor modeling of anxiety, depression and schizotypy - The role of rumination as a shared mechanism

A bifactor model with a general (p) factor reflecting shared variance and specific factors reflecting additional variance in individual symptoms has been introduced to explain common co-occurrence among anxiety, depression and schizotypy. However, longitudinal evidence is lacking and the validity of bifactor modeling is debatable. The current study aimed to examine the presence of the p factor together with specific factors in accounting for relationships between anxiety, depression and schizotypy both cross-sectionally and longitudinally, and to investigate the relationship between these factors and rumination. A validated sample of university students were surveyed on levels of anxiety, depression, schizotypy and rumination at baseline (N = 2291), one year (N = 1833) and two years (N = 1656). Models were estimated using exploratory structural equation modeling (ESEM) and compared at each time point. Longitudinal invariance of the best-fitting model was examined and all potential within- and between-factor stability pathways were tested in an SEM framework. A bifactor model with a p factor and four specific factors (representing residual information of composite anxiety and depression, cognitive-perceptual, interpersonal and disorganized schizotypy respectively) consistently outperformed a correlated-factors model. The bifactor structure appeared longitudinally stable. Within-factor stabilities were moderate, and between-factor pathways reflected a few significant interactions, mostly involving the p factor. Rumination was independently associated with p and four specific factors at each time point. Therefore, there is a p factor accounting for concurrent and sequential co-occurrence of anxiety, depression and schizotypy. Rumination explained partly the p and specific factors. Transdiagnostic interventions should target rumination.

The co-occurrence of multidimensional loneliness with depression, social anxiety and paranoia in non-clinical young adults: A latent profile analysis

INTRODUCTION

Loneliness is a negative experience arising from a mismatch between perceived and actual social relationships. Several dimensions of loneliness have been suggested, namely intimate, relational and collective loneliness. Loneliness has been linked to poorer mental health, with its co-occurrence with depression, social anxiety, and paranoia most widely reported. While expressions of these symptoms are heterogeneous across individuals in the non-clinical population, it remains unclear how these symptoms co-occur with one another and with various dimensions of loneliness. It is also of interest how trait factors such as core schemas about self/others may moderate these relationships between loneliness and co-occurring symptoms.

METHODS

A demographically diverse sample of young adults was recruited from multiple sources. The validated sample consisted of 2,089 participants (68.4% female), who completed an online survey consisting of questionnaires assessing levels of multidimensional loneliness, depression, social anxiety, paranoia, core schemas, and demographic characteristics. Latent profile analysis (LPA) was used to identify distinct profiles of loneliness and the three symptoms. Positive and negative core schemas about self and others were modeled as predictors of these profiles.

RESULTS

Five distinct profiles were identified. Profile 1 had low levels across all symptoms and dimensions of loneliness (n = 1,273, 60.9%). Profiles 2-5 were elevated on dimensions of loneliness, and were heightened in depression (n = 189, 9.0%), social anxiety (n = 206, 9.9%), paranoia (n = 198, 9.5%), and all symptoms (n = 223, 10.7%), respectively. Relative to Profile 1, the other four profiles scored higher on negative-self (adjusted ORs = 1.36-1.49, ps < 0.001) and negative-other schemas (adjusted ORs = 1.24-1.44, ps < 0.001), and lower on positive-self (adjusted ORs = 0.82-0.85, ps < 0.001) and positive-other schemas (adjusted ORs = 0.81-0.90, ps < 0.001).

CONCLUSION

More marked intimate, relational and collective loneliness were evident across profiles that had heightened depression, social anxiety and/or paranoia, suggesting that loneliness may serve as a general risk factor for these psychopathologies. Our findings shed light on the heterogeneity of the co-occurrence of loneliness and various mental health difficulties in non-clinical young adults. Core schemas are suggested to be putative psychological mechanisms underlying their co-occurrence and even development.

School-Based Mental Health Initiative: Potentials and Challenges for Child and Adolescent Mental Health

School-based mental health support services allow children and adolescents easy access to services without requirement of traveling to clinics and hospitals. We describe a School Mental Health Support Scheme (SMHSS) piloted in Hong Kong and discuss the challenges and learnings from the experience. This conceptual paper argues that accessibility is not the only advantage of such services. Teachers are significant others in child development, alongside with families. They play a central role in impacting the children's/adolescents' needs for competence and adult attachment, while schools provide an expanded social network of peers for one's social relationship. The fulfillment of these needs has powerful implications in the mental health of the children/adolescents. Teachers can help students to develop a sense of competence with self-worth and self-identity via providing guidance and feedback, whether they be on one's strengths or weaknesses, with acceptance, tolerance and unconditional positive regard. Particularly, the latter define a form of teacher-student relationship or adult attachment that offers the children/adolescents emotional security and nourishment, protecting them from failings and adversities. Teachers can also supervise and guide their students' social development with peers at schools. A recent meta-analysis has found preliminary evidence that those school-based mental health services integrated into the teachers' routine teaching activities are more effective. Teachers, who are overworked and stressed by the schools' overemphasis on academics and grades, have yet to fully grasp their unique roles in supporting students with mental health needs. This paper ends by advocating a paradigm shift in which both the healthcare professionals and educators should forge a mutually beneficial collaboration in jointly enhancing the mental health of children/adolescents at schools.

A pilot trial of a transdiagnostic treatment for emotional disorders-a locally adapted variant of group Unified Protocol (UP) for Chinese adults

There has been increasing interest in transdiagnostic cognitive-behavioral therapy (CBT), which is more cost efficient yet yields similar effect sizes when compared to disorder-specific CBT. The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders was adapted for Hong Kong Chinese adults with common mental disorders, such as depression and anxiety. It was piloted in community settings and delivered in a group format. Thirty-one Chinese adults (female = 93.5%, mean age = 44 years) with heterogeneous anxiety and depressive disorders were recruited from a number of public-funded community mental health centers in Hong Kong to participate in a pilot trial of a locally adapted variant of UP. Treatment consisted of 14 group sessions plus one individual session. Each group included six to nine participants. The diagnostic and outcome measures included Anxiety Disorders Interview Schedule for DSM-IV, The Chinese versions of Beck Depression Inventory-Revised (C-BDI-II), Beck Anxiety Inventory (C-BAI), Positive Affect subscale of Positive and Negative Affect Scale, and Work and Social Adjustment Scale. Results indicate significant improvement across a number of outcome measures, with moderate-to-large effect sizes for measures of depression (d = 1.11), anxiety (d = 0.67), positive affect (d = 0.54), and work and social functioning (d = 0.49). Furthermore, 45.2% and 29.0% of the participants scored within the normal range of C-BDI-II and C-BAI at posttreatment, respectively, compared to 3.2% and 6.5% at pretreatment. This pilot, uncontrolled trial demonstrated potential effectiveness of a locally adapted variant of group UP for Chinese adults with common mental disorders. It achieved comparable effect sizes to those observed in western populations.

An elevated anxiety level among prepubertal autistic boys with non-treatment-seeking functional gastrointestinal disorders: A case-control study

Children with autism commonly suffer from comorbid functional gastrointestinal disorders (FGID) and anxiety. The raised prevalence of both conditions in autism suggests complex reciprocal relationships, which are seldom explored in non-treatment-seeking FGID. The relationships between subtypes of FGID and anxiety are also unclear. This study recruited boys with autism and age-matched typically developing (TD) boys, aged 4-11 years, who were not actively seeking help for gastrointestinal problems. Their parents completed the Rome IV Diagnostic Questionnaires for Pediatric FGID. Four groups of children with and without autism/FGID were identified and compared on their anxiety level using the Spence children's anxiety scale. In 69 boys with autism and 69 age-matched TD boys, FGID were identified in 22 and 16 boys, respectively. ANCOVA demonstrated a significant interaction effect of autism and FGID on anxiety (F[1, 129] = 5.43, p = 0.021), while conditional logistic regression identified an interaction effect of autism and anxiety on the odds of FGID (OR 1.038, 95% CI 1.002-1.075, p = 0.038). Explorative post hoc analysis showed higher anxiety in functional nausea and vomiting disorder (p = 0.033) and functional abdominal pain disorder (p = 0.029) among boys with autism than TD boys with the same respective subtypes of FGID. In summary, among prepubertal boys with autism, the presence of FGID that are non-treatment-seeking in nature, has a significantly stronger association with higher levels of anxiety than TD boys. The strength of association may be more prominent in subtypes of FGID. Possible pathomechanisms including the underlying microbiota spectra and inflammatory paths should be explored in future studies. LAY SUMMARY: Anxiety and gastrointestinal problems are common symptoms in autism. Given that gut health could be linked to emotions, their association in young boys with autism was studied. The presence of nausea vomiting, or abdominal pain were associated with raised anxiety among boys with autism, yet this was not observed in typically developing boys. This suggests that anxiety among autistic children could be partly explained by the presence of FGID.

Autism Diagnostic Interview-Revised Within DSM-5 Framework: Test of Reliability and Validity in Chinese Children

This study examines the psychometric properties of the Autism Diagnostic Interview-Revised (ADI-R) in the context of DSM-5 in a sample of Chinese children. Using re-mapped ADI-R items and algorithms matched to DSM-5 criteria, and administering to children with autism spectrum disorder (ASD) with and without intellectual disability, attention-deficit hyperactivity disorder, and typically developing, it evidenced high sensitivity and specificity. However, similar to DSM-IV algorithm, the DSM-5 algorithms were better at classifying ASD among children with intellectual disability than among those without intellectual disability. With the DSM-5's recognition of the spectrum nature of ASD, the performance of the ADI-R can be improved by having finer gradations in the ADI-R scoring and adding more items on the restricted and repetitve behavior domain.

Genetic Overlap Between Attention Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in SHANK2 Gene

Background: Recent findings indicated a high comorbidity between attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), as well as shared genetic influences on them. The latter might contribute at least partly to the former clinical scenario. This study aimed at investigating whether SHANK genes were potential pleiotropic genes to the two said disorders, underlying their genetic overlap.

Methods: This study recruited 298 boys with ADHD (including 256 family trios of 1 ADHD boy and his 2 biological parents), 134 boys with ASD, 109 boys with both ADHD and ASD, and 232 typically developing boys as community controls. They were aged between 6 and 11 years old.

Results: There was no significant difference in allele frequency of a number of single nucleotide polymorphisms (SNPs) in SHANK2/SHANK3 between the three clinical groups (ADHD, ASD, and ADHD + ASD) and between the two control groups (community controls and pseudo-controls), respectively. The three clinical groups and the two control groups were thus, respectively, combined. A comparison between the two aggregated samples identified significant evidence of disease association for three SHANK2 SNPs with both ADHD and ASD, even after multiple testing correction: rs11236616 (OR = 0.762, permuted p = 0.0376), rs7106631 (OR = 0.720, permuted p = 0.0034), and rs9888288 (OR = 0.770, permuted p = 0.0407). Comparisons among individual groups pointed to a similar trend of findings.

Conclusion:SHANK2 could be considered a potential pleiotropic gene underlying the genetic overlap between ADHD and ASD. This might contribute partly to their high comorbidity in the afflicted children.

Altered cortico-striatal functional connectivity in people with high levels of schizotypy: A longitudinal resting-state study

PURPOSE OF THE RESEARCH

Cortico-striatal functional connectivity has been implicated in the neuropathology of schizophrenia. However, the longitudinal relationship between the cortico-striatal connectivity and schizotypy remains unknown. We examined the resting-state fMRI connectivity in 27 individuals with a high level of schizotypy and 20 individuals with a low level of schizotypy at baseline and 18 months later. Correlations between changes in cortico-striatal connectivity and changes in schizotypy scores over time were examined.

PRINCIPAL RESULTS

We found both increased and decreased cortico-striatal connectivity in individuals with a high level of schizotypy at baseline. Over time, these individuals showed improvement in both the negative and positive schizotypal domains. Changes in striatal-insula connectivity were positively correlated with changes in positive schizotypy from baseline to follow-up.

MAJOR CONCLUSIONS

Our results suggested impaired cortico-striatal connectivity in individuals with a high level of schizotypy. The dysconnectivity mainly involves the dorsal striatum. The connectivity between the dorsal striatum and the insula may be a putative marker for temporal changes in positive schizotypy.

A pilot study on the effectiveness of low-intensity cognitive behavioural therapy (LiCBT) for common mental disorders in Hong Kong

BACKGROUND

To cope with the rising demand for psychological treatment, evidence-based low-intensity cognitive behavioural therapy (LiCBT) delivered by trained para-professionals was introduced internationally.

AIMS

This pilot study aimed at examining the effectiveness of LiCBT in Hong Kong.

METHOD

This study was of an uncontrolled pre- and post-treatment design, testing LiCBT at a local community mental health centre in Hong Kong. Two hundred and eighty-five Chinese adult help-seekers to the centre attended two or more sessions of LiCBT delivered by trained para-professionals. These participants also rated their depression and anxiety on the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Scale-7 (GAD-7), respectively, at pre- and post-treatment.

RESULTS

Comparison of the pre- and post-treatment PHQ-9 and GAD-7 scores of 285 participants indicated significant improvements in depression and anxiety with large effect sizes (depression: d = 0.87; anxiety: d = 0.95). For those participants reaching the clinical level of either depression and/or anxiety at pre-treatment (n = 229, 80.4%), they reported even larger effect sizes (depression: d = 1.00; anxiety: d = 1.15). The recovery rate was 55.9% with a reliable improvement rate of 63.9%. An average of 5.6 sessions was offered to the participants with each session spanning a mean of 42 minutes. The baseline clinical conditions and participants' educational level were predictive of post-treatment recovery.

CONCLUSIONS

The results supported the effectiveness and cost-efficiency of LiCBT for depression and anxiety at a Hong Kong community mental health centre. The effect sizes and the recovery and reliable improvement rates achieved were comparable to those reported from countries such as the UK and Australia.

Gastrointestinal Problems in Chinese Children with Autism Spectrum Disorder

PURPOSE

Gastrointestinal symptoms in individuals with autism spectrum disorder may constitute a subgroup with complex gut-brain interactions underlying the pathogenesis. This study examined the prevalence of gastrointestinal symptoms in a sample of Chinese children with autism spectrum disorder, as well as the factors related to them.

PARTICIPANTS AND METHODS

The participants included a clinic sample of 107 children with autism spectrum disorder and 249 gender- and age-matched typically developing community children.

RESULTS

Results found children with autism spectrum disorder to be twice as likely to suffer from gastrointestinal symptoms, reporting increased rates of constipation, abdominal migraine and aerophagia. Autism spectrum disorder diagnosis remained a significant predictor of gastrointestinal symptoms after taking into account the potential confounders that included comorbid psychopathologies, diets, and parental anxiety and depression.

CONCLUSION

Our results suggest that autism spectrum disorder with gastrointestinal symptoms may constitute a subgroup within the autism spectrum disorder population that warrants further investigation.

Worry and metacognitions as predictors of the development of anxiety and paranoia

Recent studies have shown that worry and related negative metacognitions are characteristic in generalized anxiety and paranoia respectively. However, most of these studies did not take into account common co-occurrence of anxiety and paranoia, and longitudinal modelling of the role of worry and metacognitions on the development of anxiety and paranoia is rare. The current study aimed at examining the bidirectional longitudinal relationship between anxiety and paranoia, as well as the importance of worry and metacognitions in the development of these symptoms. Our validated sample consisted of 2291 participants recruited from universities, among whom 1746 participants (76.21%) completed online questionnaires at baseline and at one year, reporting levels of anxiety, paranoia, worry, and negative metacognitions. Structural equation modeling analyses, followed by path comparisons, revealed that anxiety and paranoia mutually reinforced each other over time. Negative metacognitions, rather than worry itself, were contributive to the development of both symptoms over time. Negative metacognitions showed bi-directional relationships with anxiety over the time period assessed and showed uni-directional relationships with paranoia. Clinical implications of our findings are discussed.

The Mediation of Maternal Occupational Skillfulness on Maternal Education and Chinese Preschoolers' Behavior

There is growing evidence supporting the individual associations of maternal occupation and maternal education with children's behavioral outcomes. However, few studies have linked these factors together in a mediation model. The current study is the first to examine the mediating effect of maternal occupational skillfulness on the relationship between the length of maternal education and preschool children's behavioral outcomes in the Chinese context. To assess children's behavior, parents and teachers of 286 preschoolers from the China Jintan Cohort Study completed the Child Behavior Checklist (CBCL) and Caregiver-Teacher Report Form (C-TRF), respectively. Sociodemographic information, such as maternal occupational skillfulness and education level, was also collected. Using PROCESS and kappa statistics, maternal occupational skillfulness was found to mediate the effect of length of maternal education on both internalizing and externalizing behaviors of preschoolers, as rated by parents but not on behaviors as rated by teachers. Such findings can provide insight for counseling psychologists or family therapists in providing mothers, particularly those in low-skill jobs, appropriate advice and strategies for handling job-related stress. Mother-child relationships would consequently improve, which could then minimize the development of children's internalizing and externalizing behaviors. Furthermore, teachers could identify at-risk children and provide early intervention. Our findings also offer insight for policy makers to consider legislation providing financial assistance from the government to low-income mothers. Future replication studies should be conducted in other countries so as to determine whether similar results can be obtained.

The Hong Kong Survey on the Epidemiology of Trauma Exposure and Posttraumatic Stress Disorder

This study examined the epidemiology of trauma exposure (TE) and posttraumatic stress disorder (PTSD) among community-dwelling Chinese adults in Hong Kong. Multistage stratification sampling design was used, and 5,377 participants were included. In Phase 1, TE, probable PTSD (p-PTSD), and psychiatric comorbid conditions were examined. In Phase 2, the Structured Clinical Interview for the DSM-IV (SCID-I) was used to determine the weighted diagnostic prevalence of lifetime full PTSD. Disability level and health service utilization were studied. The findings showed that the weighted prevalence of TE was 64.8%, and increased to 88.7% when indirect TE types were included, with transportation accidents (50.8%) reported as the most common TE. The prevalence of current p-PTSD among participants with TE was 2.9%. Results of logistic regression suggested that nine specific trauma types were significantly associated with p-PTSD; among this group, severe human suffering, sexual assault, unwanted or uncomfortable sexual experience, captivity, and sudden and violent death carried the greatest risks for developing PTSD, odds ratio (OR) = 2.32-2.69. The occurrence of p-PTSD was associated with more mental health burdens, including (a) sixfold higher rates for any past-week common mental disorder, OR = 28.4, (b) more mental health service utilization, p < .001, (c) poorer mental health indexes in level of symptomatology, suicide ideation and functioning, p < .001, and (d) more disability, ps < .001-p = .014. The associations found among TE, PTSD, and health service utilization suggest that both TE and PTSD should be considered public health concerns.

Prevalence of Anxiety Disorders in Hong Kong Chinese Children With ADHD

OBJECTIVE

This study examined the prevalence and correlates of anxiety disorders in Chinese children with ADHD.

METHOD

Overall, 120 children with ADHD aged 6 to 12 years were recruited, and the parent version of computerized Diagnostic Interview Schedule for Children-Version 4 was administrated to their primary caretakers.

RESULTS

The prevalence rate of anxiety disorders was 27.5%, which is consistent with the reports of previous Asian and Western studies. Among the children with ADHD and anxiety disorders, more than 50% of them also had comorbid oppositional defiant disorder or conduct disorder (ODD/CD), which yielded an adjusted odds ratio of 3.0 in multivariable analysis for anxiety disorder, with comorbid ODD/CD. In addition, anxiety disorders were positively associated with inattention symptoms in children with both disorders.

CONCLUSION

Clinicians should perform screening and careful assessment for anxiety symptoms in children with ADHD, particularly those suffering from comorbid ODD/CD.

Cultural Values and Choice of Strategic Move in Therapy

A Chinese woman (Mrs. L) suffering from lowbackpain was referred for psychological consultation. Subsequent investigation linked her back pain to a chronology of life events, including premarital sex, desertion, arranged marriage, and miscarriage. The therapist chose a strategic move that reframed her problems in terms of Chinese familism. Eventually, low back pain was alleviated, contingent upon an improved marital relationship and the birth of a baby boy. The case of Mrs. L highlighted the interplay between psychotherapy and cultural considerations. However, warnings were served against noncritical acceptance of broad generalization and cultural relativism.

Use of the extended Strengths and Difficulties Questionnaire (SDQ) to predict psychiatric caseness in Hong Kong

The extended Strengths and Difficulties Questionnaire (SDQ) provides information on problem behaviours and impairment measures. Western studies found impairment measures to be as good as symptom scores in predicting clinical caseness. The high levels of comorbidities among child psychiatric disorders also meant that disorders not specifically captured by the questionnaire could be identified. This study examines its applicability among Chinese school children in Hong Kong. Results found that impairment measures were more predictive of clinical status than were symptom scores. Children with low symptom but high impairment ratings had profiles that were intermediate between the low symptom low impairment and high symptom low impairment groups. The extended SDQ is useful in identifying children who might otherwise be missed if symptom scores alone were used in screening. The acceptance of child psychiatric care in Hong Kong is a multi-step process that depends on how symptoms are perceived.

Validation of the Chinese strengths and weaknesses of ADHD-symptoms and normal-behaviors questionnaire in Hong Kong

OBJECTIVE

Unlike rating scales that focus on the severity of ADHD symptoms, the Strengths and Weaknesses of ADHD-symptoms and normal-behaviors (SWAN) rating scale is phrased in neutral or positive terms for carers to compare the index child's behaviors with that of their peers. This study explores its psychometric properties when applied to Chinese children in Hong Kong.

METHOD

Ratings from the Chinese SWAN scale collected from parents and teachers of a community sample of 3,722 6- to 12-year-old students recruited by stratified random sampling were compared with 247 clinic children with a diagnosis of ADHD. Reliability, validity, factor structure, and cutoff scores were calculated.

RESULTS

Favorable psychometrics and a two-factor structure identical to the original were reproduced. Cutoff scores were supported by satisfactory sensitivities and specificities.

CONCLUSION

The SWAN scale is a reliable and valid instrument for the assessment of ADHD symptoms in Chinese children in Hong Kong.

Mother's environmental tobacco smoke exposure during pregnancy and externalizing behavior problems in children

BACKGROUND

While the impact of active maternal smoking during pregnancy on child health has been well investigated, the association between maternal passive smoking, or environmental tobacco smoke (ETS), or second-hand smoke, and behavioral development of offspring is less clear. This study examines the association between maternal ETS exposure during pregnancy and child behavior problems.

METHODS

Cross-sectional data of 646 mother-child pairs from the Jintan China Cohort Study were used in the analyses. Mother's exposure to tobacco smoking at home, the workplace, and other places during pregnancy (for the determination of maternal ETS exposure) and children's behaviors (via Child Behavior Checklist) were assessed when the children were 5-6 years old. Logistic regression models were constructed to examine associations between maternal exposure to ETS during pregnancy and internalizing and externalizing behavior problems, adjusting for potential cofounders including child sex and parental characteristics.

RESULTS

37% of mothers reported ETS during pregnancy. Children of mothers exposed to ETS during pregnancy had higher scores for externalizing and total behavior problems, with 25% of children whose mothers were exposed to ETS compared to 16% of children of unexposed mothers. After adjusting for potential confounders, ETS exposure was associated with a higher risk of externalizing behavior problems in offspring of exposed mothers (OR=2.08, 95% confidence interval [CI] 1.27-3.43). Analysis after multiple imputations and sensitivity analysis further verified the association, but no dose-response relationship was found. ETS exposure, however, was not associated with internalizing or total behavior problems.

CONCLUSION

This study suggests that maternal ETS exposure during pregnancy may impact child behavioral development, particularly externalizing behaviors.

Behavioral/Emotional Problems of Preschoolers: Caregiver/Teacher Reports From 15 Societies

This study tested societal effects on caregiver/teacher ratings of behavioral/emotional problems for 10,521 preschoolers from 15 societies. Many societies had problem scale scores within a relatively narrow range, despite differences in language, culture, and other characteristics. The small age and gender effects were quite similar across societies. The rank orders of mean item ratings were similar across diverse societies. For 7,380 children from 13 societies, ratings were also obtained from a parent. In all 13 societies, mean Total Problems scores derived from parent ratings were significantly higher than mean Total Problems scores derived from caregiver/teacher ratings, although the size of the difference varied somewhat across societies. Mean cross-informant agreement for problem scale scores varied across societies. Societies were very similar with respect to which problem items, on average, received high versus low ratings from parents and caregivers/teachers. Within every society, cross-informant agreement for item ratings varied widely across children. In most respects, results were quite similar across 15 very diverse societies.

International comparisons of behavioral and emotional problems in preschool children: parents' reports from 24 societies

International comparisons were conducted of preschool children's behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½-5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders-oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3-12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0-198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes < 1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies.

The application of the preschool Child Behavior Checklist and the caregiver-teacher report form to Mainland Chinese children: syndrome structure, gender differences, country effects, and inter-informant agreement

Preschool children have long been a neglected population in the study of psychopathology. The Achenbach System of Empirically Based Assessment (ASEBA), which includes the Child Behavior Checklist/1.5-5 (CBCL/1.5-5) and the Caregiver-Teacher Report Form (C-TRF), constitutes the few available measures to assess preschoolers with an empirically derived taxonomy of preschool psychopathology. However, the utility of the measures and their taxonomy of preschool psychopathology to the Chinese is largely unknown and has not been studied. The present study aimed at testing the cross-cultural factorial validity of the CBCL/1.5-5 and C-TRF, as well as the applicability of the taxonomy of preschool psychopathology they embody, to Mainland Chinese preschoolers. Country effects between our Chinese sample and the original U.S. sample, gender differences, and cross-informant agreement between teachers and parents were also to be examined. A Chinese version of the CBCL/1.5-5 and C-TRF was completed by parents and teachers respectively on 876 preschoolers in Mainland China. Confirmatory factor analysis (CFA) confirmed the original, U.S.-derived second order, multi-factor model best fit the Chinese preschool data of the CBCL/1.5-5 and C-TRF. Rates of total behavior problems in Chinese preschoolers were largely similar to those in American preschoolers. Specifically, Chinese preschoolers scored higher on internalizing problems while American preschoolers scored higher on externalizing problems. Chinese preschool boys had significantly higher rates of externalizing problems than Chinese preschool girls. Cross-informant agreement between Chinese teachers and parents was relatively low compared to agreement in the original U.S. sample. Results support the generalizability of the taxonomic structure of preschool psychopathology derived in the U.S. to the Chinese, as well as the applicability of the Chinese version of the CBCL/1.5-5 and C-TRF.

Validation of the Chinese version of the strengths and difficulties questionnaire in Hong Kong

BACKGROUND

The strengths and difficulties questionnaire (SDQ) is now one of the most commonly used instruments for screening child psychiatric morbidities. Psychometric studies in the West affirm its reliability and validity, but similar studies are scarce among non-Western populations. This is an important gap because cultural differences can influence how children's behaviours are perceived and rated. This study explores the psychometric properties of the Chinese version of the SDQ among children in Hong Kong.

METHOD

The SDQ was translated into Chinese. A community sample of 3,722 students between 6 and 12 years were recruited by stratified random sampling from across the whole of Hong Kong. Comparison group consisted of 494 consecutive children attending a general child psychiatric clinic. SDQ and basic socio-demographic data were collected from parents and teachers. Reliability was determined by internal consistency and test-retest stability. Validity was assessed by the questionnaire's ability to discriminate between community and clinic samples, and ROC curves. Cutoff scores and their sensitivity, specificity, positive predictive value and negative predictive value were calculated.

RESULTS

Our results confirm the questionnaire's reliability and validity. The total difficulties scale and hyperactivity subscale are potentially the most useful in discriminating between community and clinic children. The emotional subscale was relatively weaker, especially with respect to teachers' ratings. Of note also is that our normative scores are significantly higher than those reported in the West, highlighting once again the importance of examining a questionnaire's cultural applicability.

CONCLUSION

Our data support the use of the Chinese version of the SDQ, especially the total difficulties scale, as a screening instrument for psychiatric morbidities among children in Hong Kong.

Preschool psychopathology reported by parents in 23 societies: testing the seven-syndrome model of the child behavior checklist for ages 1.5-5

OBJECTIVE

To test the fit of a seven-syndrome model to ratings of preschoolers' problems by parents in very diverse societies.

METHOD

Parents of 19,106 children 18 to 71 months of age from 23 societies in Asia, Australasia, Europe, the Middle East, and South America completed the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). Confirmatory factor analyses were used to test the seven-syndrome model separately for each society.

RESULTS

The primary model fit index, the root mean square error of approximation (RMSEA), indicated acceptable to good fit for each society. Although a six-syndrome model combining the Emotionally Reactive and Anxious/Depressed syndromes also fit the data for nine societies, it fit less well than the seven-syndrome model for seven of the nine societies. Other fit indices yielded less consistent results than the RMSEA.

CONCLUSIONS

The seven-syndrome model provides one way to capture patterns of children's problems that are manifested in ratings by parents from many societies. Clinicians working with preschoolers from these societies can thus assess and describe parents' ratings of behavioral, emotional, and social problems in terms of the seven syndromes. The results illustrate possibilities for culture-general taxonomic constructs of preschool psychopathology. Problems not captured by the CBCL/1.5-5 may form additional syndromes, and other syndrome models may also fit the data.

Validation of the Chinese version of the strengths and difficulties questionnaire in Hong Kong

BACKGROUND

The strengths and difficulties questionnaire (SDQ) is now one of the most commonly used instruments for screening child psychiatric morbidities. Psychometric studies in the West affirm its reliability and validity, but similar studies are scarce among non-Western populations. This is an important gap because cultural differences can influence how children's behaviours are perceived and rated. This study explores the psychometric properties of the Chinese version of the SDQ among children in Hong Kong.

METHOD

The SDQ was translated into Chinese. A community sample of 3,722 students between 6 and 12 years were recruited by stratified random sampling from across the whole of Hong Kong. Comparison group consisted of 494 consecutive children attending a general child psychiatric clinic. SDQ and basic socio-demographic data were collected from parents and teachers. Reliability was determined by internal consistency and test-retest stability. Validity was assessed by the questionnaire's ability to discriminate between community and clinic samples, and ROC curves. Cutoff scores and their sensitivity, specificity, positive predictive value and negative predictive value were calculated.

RESULTS

Our results confirm the questionnaire's reliability and validity. The total difficulties scale and hyperactivity subscale are potentially the most useful in discriminating between community and clinic children. The emotional subscale was relatively weaker, especially with respect to teachers' ratings. Of note also is that our normative scores are significantly higher than those reported in the West, highlighting once again the importance of examining a questionnaire's cultural applicability.

CONCLUSION

Our data support the use of the Chinese version of the SDQ, especially the total difficulties scale, as a screening instrument for psychiatric morbidities among children in Hong Kong.

The application of the preschool Child Behavior Checklist and the caregiver-teacher report form to Mainland Chinese children: syndrome structure, gender differences, country effects, and inter-informant agreement

Preschool children have long been a neglected population in the study of psychopathology. The Achenbach System of Empirically Based Assessment (ASEBA), which includes the Child Behavior Checklist/1.5-5 (CBCL/1.5-5) and the Caregiver-Teacher Report Form (C-TRF), constitutes the few available measures to assess preschoolers with an empirically derived taxonomy of preschool psychopathology. However, the utility of the measures and their taxonomy of preschool psychopathology to the Chinese is largely unknown and has not been studied. The present study aimed at testing the cross-cultural factorial validity of the CBCL/1.5-5 and C-TRF, as well as the applicability of the taxonomy of preschool psychopathology they embody, to Mainland Chinese preschoolers. Country effects between our Chinese sample and the original U.S. sample, gender differences, and cross-informant agreement between teachers and parents were also to be examined. A Chinese version of the CBCL/1.5-5 and C-TRF was completed by parents and teachers respectively on 876 preschoolers in Mainland China. Confirmatory factor analysis (CFA) confirmed the original, U.S.-derived second order, multi-factor model best fit the Chinese preschool data of the CBCL/1.5-5 and C-TRF. Rates of total behavior problems in Chinese preschoolers were largely similar to those in American preschoolers. Specifically, Chinese preschoolers scored higher on internalizing problems while American preschoolers scored higher on externalizing problems. Chinese preschool boys had significantly higher rates of externalizing problems than Chinese preschool girls. Cross-informant agreement between Chinese teachers and parents was relatively low compared to agreement in the original U.S. sample. Results support the generalizability of the taxonomic structure of preschool psychopathology derived in the U.S. to the Chinese, as well as the applicability of the Chinese version of the CBCL/1.5-5 and C-TRF.

Factors accounting for youth suicide attempt in Hong Kong: a model building

This study aimed at proposing and testing a conceptual model of youth suicide attempt. We proposed a model that began with family factors such as a history of physical abuse and parental divorce/separation. Family relationship, presence of psychopathology, life stressors, and suicide ideation were postulated as mediators, leading to youth suicide attempt. The stepwise entry of the risk factors to a logistic regression model defined their proximity as related to suicide attempt. Path analysis further refined our proposed model of youth suicide attempt. Our originally proposed model was largely confirmed. The main revision was dropping parental divorce/separation as a risk factor in the model due to lack of significant contribution when examined alongside with other risk factors. This model was cross-validated by gender. This study moved research on youth suicide from identification of individual risk factors to model building, integrating separate findings of the past studies.

Anxiety symptoms in Chinese and German adolescents: their relationship with early learning experiences, perfectionism, and learning motivation

The main aim of this study was to compare the frequency and correlates of DSM-IV anxiety disorder symptoms among non-referred adolescents in Germany and in Hong Kong. A total of 1,022 adolescents (594 from Germany and 428 from Hong Kong) between the ages of 12 and 17 years were investigated. Results showed that adolescents in Hong Kong reported significantly higher levels of anxiety symptoms than adolescents in Germany. Anxiety symptoms showed different correlates in different cultures. Specifically, academic motivational goals to compete to get good grades and to be rewarded for their performance correlated significantly with anxiety symptoms in Hong Kong. In Germany, anxiety symptoms correlated significantly with reinforcement received for anxiety-related problems (i.e., instrumental learning) and with parental verbal transmission about the danger of anxiety (i.e., informational learning). The findings underscore the importance of cultural factors on adolescent's anxiety.

Age-related grey matter volume correlates of response inhibition and shifting in attention-deficit hyperactivity disorder

BACKGROUND

Children with attention-deficit hyperactivity disorder (ADHD) have difficulties with executive function and impulse control which may improve with age.

AIMS

To map the brain correlates of executive function in ADHD and determine age-related changes in reaction times and brain volumes.

METHOD

Attention-deficit hyperactivity disorder and control groups were compared on the change task measures of response inhibition (stop signal reaction time, SSRT) and shifting (change response reaction time, CRRT). Voxel-wise magnetic resonance imaging (MRI) correlations of reaction times and grey matter volume were determined, along with bivariate correlations of reaction times, brain volumes and age.

RESULTS

Individuals in the ADHD group had longer SSRTs and CRRTs. Anterior cingulate, striatal and medial temporal volumes highly correlated with SSRT. Striatal and cerebellar volumes strongly correlated with CRRT. Older children had faster reaction times and larger regional brain volumes. In controls, orbitofrontal, medial temporal and cerebellar volumes correlated with CRRT but not SSRT. Neither reaction times nor regional brain volumes were strongly age-dependent.

CONCLUSIONS

Our evidence supports delayed brain maturation in ADHD and implies that some features of ADHD improve with age.

Test-retest reliability and criterion validity of the Chinese version of CBCL, TRF, and YSR

BACKGROUND

Psychometric properties of the Chinese version of CBCL, TRF, and YSR were understudied. This study aimed at examining their test-retest reliability and criterion validity.

METHODS

Three Chinese community and clinic samples were recruited in Hong Kong. The parents, teachers, and youths respectively completed the CBCL, TRF, and YSR.

RESULTS

The Chinese CBCL, TRF, and YSR were test-retest reliable and valid. However, there was score/case attenuation at retest. CBCL and TRF appeared to screen externalizing and ADHD problems better, while YSR screened internalizing problems better.

CONCLUSIONS

Clinicians should be cautious about score/case attenuation at retest while using CBCL, TRF, and YSR to chart patients' progress. They should also recognize their different strengths in screening various disorders.

The test-retest reliability and screening efficiency of DISC Predictive Scales-version 4.32 (DPS-4.32) with Chinese children/youths

INTRODUCTION

The DISC Predictive Scales-4.32 (DPS-4.32) were short-forms of the Diagnostic Interview Schedule for Children-IV (DISC-IV).

METHOD

The psychometric properties of DPS-4.32 were tested on two Chinese samples: a clinic sample of 83 children/youths, and a community sample of 541 youths.

RESULTS

Both Parent and Youth DPS-4.32 exhibited good-to-excellent test-retest reliability. Their screening efficiency was examined respectively against DSM-IV diagnoses of the full-length Parent and Youth DISC-IV. Results indicated large AUCs (Area under Receiver-Operating Characteristic Curve), as well as high sensitivity, specificity, and negative predictive values, supporting the capability of DPS-4.32 to differentiate cases from noncases.

CONCLUSION

DPS-4.32 held promise as efficient short-forms of DISC-IV, screening DSM-IV diagnoses. They were also applicable to the Chinese population, demonstrating their cross-cultural applicability.

Dopamine receptor D4 (DRD4) gene in Han Chinese children with attention-deficit/hyperactivity disorder (ADHD): increased prevalence of the 2-repeat allele

There is an increased prevalence of the 7-repeat (7R) allele of the dopamine receptor D4 (DRD4) gene in attention-deficit/hyperactivity disorder (ADHD). However, the population prevalence of the 7R allele varies considerably across ethnicity and is very low in Asians. To test whether this 7R allele/ADHD association still held in a Chinese clinical sample, 32 Han Chinese children with a confirmed ADHD diagnosis and normal IQ who were methylphenidate-responders were genotyped. None of them had a DRD4 7R allele. Instead, we observed a significantly increased prevalence of the 2-repeat (2R) allele in this clinical sample (33%) compared to ethnically-matched controls (20%) (chi(2)(1d.f.) = 5.90, P = 0.015). This approximately 1.65-fold increase of the 2R allele in our probands is close to the observed increase of the 7R allele in European-ancestry ADHD children. Recent genetic studies have indicated that the 2R allele in Asians is likely derived from the 7R allele. Further, available biochemical data indicate that both the 2R and 7R protein have blunted responses to dopamine compared to the 4R protein. Based on these results, we propose that the observed increased prevalence of the 2R allele in our Han Chinese ADHD probands is still consistent with the 7R allele hypothesis of ADHD in European-ancestry children. Recent studies have suggested that any variant from the conserved ancestral 4R allele might potentially alter biochemistry/phenotype. We hypothesize that an increased frequency of any non-4R allele may define the association of the DRD4 gene with ADHD that holds across ethnicity. The present findings, however, obtained with a small ADHD sample size, should be replicated.

Comparisons of problems reported by youths from seven countries

OBJECTIVE

This study compared ratings for self-reported behavioral and emotional problems in adolescents from seven countries.

METHOD

Youth Self-Report scores were analyzed for 7,137 adolescents ages 11-18 years from general population samples from Australia, China, Israel, Jamaica, the Netherlands, Turkey, and the United States.

RESULTS

Comparisons of problems scores yielded small to medium effect sizes for cross-cultural variations. Youths from China and Jamaica had the highest and youths from Israel and Turkey had the lowest mean total problems scores. With cross-cultural consistency, girls scored higher for internalizing and lower for externalizing than boys. Cross-cultural correlations were high among the mean item scores.

CONCLUSIONS

Empirically based assessment provided a robust method for assessing and comparing adolescents' self-reported problems. Self-reports thus supplemented empirically based assessments of parent-reported problems and offered a cost-effective way of identifying problems for which adolescents from diverse cultural backgrounds may need help.

PERCEIVED PARENTAL FAVORITISM AND SUICIDAL IDEATION IN HONG KONG ADOLESCENTS

Chinese adolescents from Hong Kong (N = 317) participated in a study of the relationship between perceived parental favoritism in terms of affection and control, and suicidal ideation. Correlation analyses showed that adolescents who believed that children in their families were treated differently in terms of affection and control by their mothers and fathers reported greater suicidal ideation; whether they personally were the favored or nonfavored children made no difference. Stepwise multiple regression analysis identified perceived differential maternal affection as the best predictor of suicidal ideation.

PERCEIVED PARENTAL CHILD REARING AND SUICIDAL IDEATION IN CHINESE ADOLESCENTS

Three hundred and sixty-five Chinese adolescent boys and girls participated in a study of the relationship between perceived maternal and paternal warmth and control in child rearing, and suicidal ideation. Results of correlation and stepwise multiple regression analyses of data generated by the Parental Acceptance-Rejection Questionnaire, the Autonomy-Control Scale, and the Scale for Suicide Ideation showed that Chinese adolescents who experienced their mothers as less warm and affectionate tended to suffer from greater suicidal ideation, with girls generally reporting higher levels of ideation than boys.