Daniel Fung

The Influence of Birth Size on Intelligence in Healthy Children

OBJECTIVE. Birth parameters have been hypothesized to have an influence on IQ. However, studies within the range of normal birth size have been sparse. With this study we examined the associations between birth length, birth weight, head circumference, and gestational age within the normal birth size range in relation to childhood IQ in Asian children. METHODS. A cohort of 1979 of 2913 Asian children aged 7 to 9 years, recruited from 3 schools in Singapore, were followed yearly from 1999 onward. Birth parameters were recorded by health personnel. Childhood IQ was measured with the Ravens Standard Progressive Matrices at ages 8 to 12. RESULTS. The mean IQ score across the sample (n = 1645) was 114.2. After controlling for multiple confounders for every 1-cm increment in birth length, 1 kg in birth weight, or 1 cm in head circumference, there was a corresponding increase in IQ of 0.49 points (P for trend < .001), 2.19 points (P for trend = .007) and .62 points (P for trend = .003), respectively. These associations persisted even after exclusion of premature children and children with extreme weights and head circumferences. CONCLUSIONS. Longer birth length, higher birth weight, or larger head circumferences within the normal birth size range are associated with higher IQ scores in Asian children. Our results suggest that antenatal factors reflected in altered rates of growth but within the normative range of pregnancy experiences play a role in generating cognitive potential. This has implications for targeting early intervention and preventative programs.

Influence of Birth Weight on Internalizing Traits Modulated by Serotonergic Genes

OBJECTIVE: Fetal growth predicts childhood behavioral problems associated with brain serotonergic systems. We hypothesized that allelic variations in genes involved in serotonergic function would moderate associations between birth weight (BW) and internalizing traits in childhood. METHODS: The Child Behavior Checklist was administered to 545 healthy Singaporean children at 8 to 12 years. BW, corrected for gestational age, and candidate single-nucleotide polymorphisms (SNPs) in the TPH2, HTR2A, and SCL6A4 genes were investigated. RESULTS: There was no significant main effect of BW on internalizing T scores (F = 1.08; P = .36). After multiple corrections, significant main effects on internalizing T scores were found for HTR2A rs2296972 (adjusted: F = 2.85; P = .019) and HTR2A rs6313 (adjusted: F = 5.91; P = .0002). Significant interactions were found between BW and SNPs for the TPH2 gene (rs2171363: P = .008; rs7305115: P = .007) and the HTR2A gene (rs2770304: P = .001; rs6313: P = .026) for internalizing T scores. The CC genotype of TPH2 rs2171363, GG genotype of TPH2 rs7305115, CC genotype of HTR2A rs2770304, and CC genotype of HTR2A rs6313 were associated with reduced internalizing scores for children born in the quartile above the midpoint. No significant main effects or interactions were found for SCL6A4 SNPs. CONCLUSIONS: These findings suggest that sequence variations in genes involved in serotonergic functions modulate relationships between BW and internalizing traits and might be candidates for plasticity mechanisms that determine individual differences in responses to environmental influences over the course of development.

Intrinsic Affective Network Is Impaired in Children with Attention-Deficit/Hyperactivity Disorder

Deficits in impulsivity and affect dysregulation are key features of attention-deficit/hyperactivity disorder (ADHD) besides impairing levels of hyperactivity and/or inattention. However, the neural substrates underlying these traits are relatively under-investigated. In this study, we use resting-state functional magnetic resonance imaging to test the hypothesis of diminished functional integration within the affective/limbic network (which includes the amygdala, hippocampus, subgenual cingulate cortex, orbitofrontal cortex and nucleus accumbens) of children with ADHD, which is associated with their behavioral measures of emotional control deficits. Resting state-fMRI data were obtained from 12 healthy control subjects and 15 children with ADHD, all who had a minimum one-month washout period for medications and supplements. Children with ADHD demonstrated less integrated affective network, evidenced by increased bilateral amygdalar and decreased left orbitofrontal connectivity within the affective network compared to healthy controls. The hyper-connectivity at the left amygdalar within the affective network was associated with increased aggressiveness and conduct problems, as well as decline in functioning in children with ADHD. Similar findings in affective network dysconnectivity were replicated in a subset of children with ADHD three months later. Our findings of divergent changes in amygdala and orbitofrontal intrinsic connectivity support the hypothesis of an impaired functional integration within the affective network in childhood ADHD. Larger prospective studies of the intrinsic affective network in ADHD are required, which may provide further insight on the biological mechanisms of emotional control deficits observed in ADHD.

Self-reported depression and anxiety symptoms in school-aged Singaporean children

Few studies have examined anxiety and depression experiences of primary (middle) school‐aged children from ethnically diverse backgrounds, and most have relied on parents or others as informants. The present study aimed to investigate self‐reported anxiety and depression symptoms in Singaporean primary school‐aged children. Age, gender, and ethnic differences and interactions were explored as well as similarities and differences between Singaporean children and US norms.

Brain-computer-interface-based intervention re-normalizes brain functional network topology in children with attention deficit/hyperactivity disorder

A brain-computer-interface (BCI)-based attention training game system has shown promise for treating attention deficit/hyperactivity disorder (ADHD) children with inattentive symptoms. However, little is known about brain network organizational changes underlying behavior improvement following BCI-based training. To cover this gap, we aimed to examine the topological alterations of large-scale brain functional networks induced by the 8-week BCI-based attention intervention in ADHD boys using resting-state functional magnetic resonance imaging method. Compared to the non-intervention (ADHD-NI) group, the intervention group (ADHD-I) showed greater reduction of inattention symptoms accompanied with differential brain network reorganizations after training. Specifically, the ADHD-NI group had increased functional connectivity (FC) within the salience/ventral attention network (SVN) and increased FC between task-positive networks (including the SVN, dorsal attention (DAN), somatomotor, and executive control network) and subcortical regions; in contrast ADHD-I group did not have this pattern. In parallel, ADHD-I group had reduced degree centrality and clustering coefficient as well as increased closeness in task-positive and the default mode networks (prefrontal regions) after the training. More importantly, these reduced local functional processing mainly in the SVN were associated with less inattentive/internalizing problems after 8-week BCI-based intervention across ADHD patients. Our findings suggest that the BCI-based attention training facilitates behavioral improvement in ADHD children by reorganizing brain functional network from more regular to more random configurations, particularly renormalizing salience network processing. Future long-term longitudinal neuroimaging studies are needed to develop the BCI-based intervention approach to promote brain maturation in ADHD.

Neurocognitive characteristics of youth with noncomorbid and comorbid forms of conduct disorder and attention deficit hyperactivity disorder

OBJECTIVE Studies investigating neurocognitive deficits in youth with conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD) are often confounded by the high rates of comorbidity between the two. METHOD Neurocognitive functioning was examined in three diagnostic groups (ADHD only, CD only, comorbid ADHD and CD) matched by age, sex, IQ, and medication status (n=28-32 per group). RESULTS No significant differences emerged between the diagnostic groups on measures of risk-taking or response inhibition. Children with CD performed better on a measure of spatial planning than those with comorbid ADHD and CD, and dimensional analyses in the full sample (n=265) revealed a small association between ADHD symptoms and poorer spatial planning. CONCLUSION These results suggest that deficits in spatial planning may be more pronounced in individuals with ADHD, but that the neurocognitive functioning of youth with noncomorbid and comorbid CD and ADHD are largely similar.

Child Community Mental Health Services in Asia Pacific and Singapore’s REACH Model

In recent decades, there have been concerted efforts to improve mental health services for youths alongside the challenges of rising healthcare costs and increasing demand for mental health needs. One important phenomenon is the shift from traditional clinic-based care to community-based mental health services to improve accessibility to services and provide patient-centred care. In this article, we discuss the child and adolescent community mental health efforts within the Asia-Pacific region. We also discuss Singapore’s community and school-based mental health service, known as the Response, Early Intervention and Assessment in Community Mental Health (REACH). This article discusses how REACH has evolved over the years in response to the changing needs of youths in Singapore. Finally, we discuss the current challenges and future directions for youth mental health care.

Understanding player perceptions of RegnaTales, a mobile game for teaching social problem solving skills

Research on the use of serious games to support child and adolescent mental health interventions is in its early stages. Work is needed to provide evidence of the applicability and effectiveness of using such games in teaching children skills needed to overcome their behavioral and emotional problems. The present study adds to the knowledge in this area through the development and evaluation of RegnaTales, a mobile game for teaching social problem solving skills among children. The study examined the playability and usability of the mobile game among 12 children (mean age = 9.58; SD = 1.78) from international schools in Basel. Results showed that 76% of participants found the game fun and 58% would play it again. Our findings further highlight the potential of serious games in teaching skills needed to address anger feelings and provide support for its use in child and adolescent mental health interventions.

Brain-computer interface and its applications in cognitive training

We investigated the use of Brain-Computer Interface (BCI) in cognitive training. We developed a BCI to quantify a persons attention level. Based on this algorithm, a feedforward mechanism is then used to build gaming interfaces for cognitive training. Several clinical trials have been conducted and significant improvement has been achieved in both children with ADHD and elderly with cognitive decline. Pivotal trials to demonstrate the efficacy of cognitive training are under way in both children and elderly subjects.

Validity of the Children's Yale-Brown Obsessive Compulsive Scale in Singaporean Children

Abstract Aim: This study examined validity of the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and its clinical utility as an assessment tool in a Singapore clinical sample. It also examined correlates between the CY-BOCS and other measures of psychological impairment, anxiety and depression. Sample: A parent—child paired sample of 58 children/ adolescents (8–18 years old) diagnosed with OCD and 60 of their parents were recruited from the Child Guidance Clinic. All children and adolescents had a principal diagnosis of OCD according to DSM-IV-TR criteria. Instruments: The CY-BOCS, the Child Behaviour Checklist, the Computerised Diagnostic Interview Schedule for children were completed by the parents. The Multidimensional Anxiety Scale fir children and the Asian Children Depression Scale were administered to the children. In addition, the Clinical Global Impression-Severity Scale was completed by the clinician. Results: Results showed that the CY-BOCS demonstrated good convergent validity with a measure of global psychological impairment, and reasonable divergent validity with measures of anxiety and depression. The obsession and compulsion severity scales of the CY-BOCS demonstrated good to excellent internal reliability and showed strongly positive and statistically significant correlations with relevant variables in conceptually correct directions. The CY-BOCS is a clinically useful tool for assessment of the degree of impairment and stress in Singaporean child and adolescent patients diagnosed as sufferingfrom Obsessive Compulsive Disorder.