Huei Lin Huang

Levels of Breast Milk PBDEs From Southern Taiwan and Their Potential Impact on Neurodevelopment

In vivo studies have demonstrated that prenatal or neonatal exposure to polybrominated diphenyl ethers (PBDEs) causes developmental neurotoxicity. However, there is a lack of human data. Our hypothesis was that PBDEs would result in lower infant neurodevelopment scores. This is a post hoc analysis of previous studies. Fourteen PBDEs in 70 breast milk were analyzed using a high-resolution gas chromatograph/high-resolution mass spectrometer. Infant neurodevelopment at the age of 8–12 mo was determined using the Bayley Scales of Infants and Toddlers Development, third edition (Bayley-III). The median of Σ14 PBDEs (the sum of 14 PBDE congeners) was 2.92 ng/g lipid. The Σ14 PBDE concentrations were not correlated with Bayley-III scores on cognitive, language, motor, social-emotional, or adaptive behavior scales. A significantly inverse association between brominated diphenyl ether (BDE)-209 and the cognitive scale was found after multivariate stepwise linear regression analyses (B = −0.007, adjusted R = −0.224, p = 0.032). In contrast, the language scale was positively correlated with BDE-196 (B = 0.096, adjusted R = 0.315, p = 0.002). Our results are consistent with most in vivo studies, suggesting that prenatal or postnatal exposure to BDE-209 potentially delays the neurological development.

The attitude toward truth telling of cancer in Taiwan

OBJECTIVE This study examined a group of Taiwanese subjects at a medical university hospital regarding their attitudes toward truth telling of cancer. METHOD Self-report survey with convenience sampling of 195 participants admitted for a 3-day comprehensive health examination in a medical university hospital in Taiwan. Three instruments used to collect the data included the Brief Psychiatric Symptom Rating Scale (BPSRS), Chinese Health Questionnaire (CHQ), and the Attitude Toward Truth Telling of Cancer List. RESULTS Once diagnosed with cancer, 92.3% of the participants preferred being told the truth about their diagnosis and 7.7% did not. Age, education, and employment were found to differ between disclosure and nondisclosure groups. The latter group also tended to have higher depression and hostility scores on the BPSRS and higher minor psychiatric morbidity scores. A total of 62.6% of the participants preferred that doctors tell a relative the truth about their cancer diagnosis, while 37.4% preferred that doctors not tell a relative the truth. The distributions of demographic data and mental status did not significantly differ between disclosure and nondisclosure groups if a relative was to be the cancer victim. CONCLUSIONS A majority of subjects in Taiwan would prefer to know the truth if victimized by a cancer disease, despite the supposed influence of Chinese culture. Furthermore, attitudes toward truth telling of cancer differed between relatives of patients and the patients themselves. Relatives of cancer patients were more likely to follow to the principle of beneficence, whereas the patients themselves were more likely to follow to the principle of autonomy.

Behavioral parent training for Taiwanese parents of children with attention-deficit/hyperactivity disorder.

Abstract It has been observed that it is relatively difficult for children with attention‐deficit/hyperactivity disorder (ADHD) to follow social rules and behave in a socially desirable manner. The ADHD children in Chinese culture, which emphasizes Confucian values, might encounter even greater adjustment difficulties. The purpose of the present study is to implement a behavioral parent training program in a Confucian environment and examine its effectiveness. Twenty‐three ADHD preschoolers (age: 3–6 years) and their parents were selected to participate in the present study. Fourteen of these 23 parents completed a 10‐session parent training program. Parent ratings of ADHD/oppositional defiant disorder (ODD) symptoms and problem behaviors at home were collected at the first, fourth, sixth, seventh, and tenth sessions. Three instruments were used to evaluate treatment outcome: the Disruptive Behavior Rating Scale‐Parent Form, Child Attention Profile, and Home Situations Questionnaire. The results showed that both ADHD/ODD symptoms and home behaviors of these 14 children improved significantly after the parent training. There was also a significant decline in the severity of symptoms and problem behaviors at home with the progression of training. These findings support the effectiveness of this parent training program for parents of ADHD children in an environment of Confucianism. Limitations of the present study and future direction for research are discussed.

Cord blood levels of thyroid hormones and IGF-1 weakly correlate with breast milk levels of PBDEs in Taiwan.

In vivo studies indicate that prenatal or neonatal exposure of rodents to polybrominated diphenyl ethers (PBDEs) disrupts thyroid hormone balance, but few studies have reported an association of PBDEs and insulin-like growth factor 1 (IGF-1). The goal was to examine whether PBDEs exposure affects the levels of thyroid hormones and IGF-1 in cord blood. Study participants were healthy pregnant women recruited from the general population in central Taiwan between 2000 and 2001 and in southern Taiwan from 2007 to 2009. One-hundred-forty-nine breast milk samples (n=149), which were collected within one month after delivery, were analyzed using a high resolution gas chromatograph equipped with a high resolution mass spectrometer. The average and median levels of breast milk Σ(14)PBDEs were 5.34 and 3.38 ng/g lipid in 2000-2001 and 5.22 and 3.13 ng/g lipid in 2007-2009, respectively. In general, levels of PBDE congeners were very low in this study population and not significantly different between the years 2000-2001 and 2007-2009. Breast milk Σ(14)PBDEs were not significantly correlated with thyroid hormones and IGF-1 in cord blood. After examining multiple stepwise linear regression models with adjustment for maternal age, pre-pregnancy body mass index (BMI), parity, gestational age, and region (namely, central and southern Taiwan), we found that log of T4 in cord blood was significantly but slightly correlated with higher BDE-154 (B=0.113, p=0.017) in breast milk. The log of FT4 concentration was significantly related to a decrease in the log of BDE-99 level (B=-0.137, p=0.043) and an increase in the log of BDE-154 level (B=0.158, p=0.008). Meanwhile, the log of IGF-1 level was also significantly linked to an increase in the log of BDE-196 level (B=0.532, p=0.028) and decrease in the log of BDE-85 level (B=-0.235, p=0.018). Few epidemiological studies report an association between PBDEs exposure and IGF-1. Based on our findings, further in vivo and epidemiological studies are encouraged and needed to explore associations between PBDEs exposure and levels of thyroid hormones and IGF-1.

Applicability of BSID-II in diagnosing developmental delay at Kaohsiung area.

The purpose of this study was to investigate the applicability of BSID-II in diagnosing children with developmental delay in Kaohsuing area. Five hundred and forty-four children, all who were patients of Developmental Delay Clinic of Kaohsuing Medical University, participated in this study. The instrument of this study was the Bayley Scales of Infant Development--second edition (BSID-II), the primary value of which was in diagnosing developmental delay and planning intervention strategies. The standardization and statistical properties of BSID-II made it one of the best measures of infant development available. The findings as follows: (1) the alpha coefficients were between .95 and .99, which were higher than data on manual of BSID-II; (2) the reproducibilities, which were different with each examiner, were between .9503 and .9633, that were good enough to be a developmental scale; (3) Standard Errors of Measurement were between 2.8589 and 3.8206. It was a restricted sample so that these also were lower than the data on manual of BSID-II. This evidence shows BSID-II is a highly reliable instrument of developmental assessment at Kaohsuing area. A special norm for developmentally delayed children and quality control of examiners are suggested.

Inattention and development of toddlers born in preterm and with low birth weight

The objective of this study was to examine the impact of low birth weight and preterm birth on a toddlers inattention and development, including cognitive, language, motor, social–emotional and adaptive behaviors. A total of 105 toddlers enrolled for the study; they were divided into four groups: 40 full‐term and normal birth weight (NBW, birth weight greater than 2500 g) toddlers, 24 moderate birth weight (MLBW, birth weight between 2499 and 1500 g) toddlers, 20 very to extremely low birth weight (V‐ELBW, 12 between 1000 and 1499 g and 8 lower than 1000 g) toddlers, and 21 term toddlers who were recruited from a clinic of developmental delay as the developmental delay at risk (DDR) group. The Bayley Scales of Infant and Toddler Development—Third Edition (BSID‐III) and Disruptive Behavior Rating Scale—Toddler were used. The findings were as follows: (1) DDR group performed worst in BSID‐III; (2) although there were no statistical differences among the NBW, MLBW, and V‐ELBW groups in BSID‐III, the lower the birth weight, the lower the average performance, especially in language, adaptive social behavior, and adaptive practical behavior; and (3) comparing the inattention score, the DDR group was the poorest, normal and V‐ELBW groups were the best, and MLBW group was in the middle. In conclusion, low birth weight and preterm delivery affected childrens inattention and development of language, adaptive social behavior, and adaptive practical behavior.

Concurrent Validity of the Scale for Screening of Developmental Delay

This study establishes the concurrent validity of the Screening Scale of Developmental Delay II (SSDD-II) with the Bayley Scale of Infant Development II (BSID-II). Three hundred and seventy-nine children referred by pediatricians at the Clinic of Developmental Delay at the Kaohsiung Medical University-Medical Center were tested using the SSDD-II, and about 1 week to 1 month later, they were tested again using the BSID-II. The results indicate that (1) the SSDD-II score increased as age increased, fitting the principle of developmental sequence. (2) The raw scores of the Mental and Motor scales of the BSID-II significantly correlated with the five subscales of the SSDD-II. (3) The three facet scale scores (language, cognitive and motor) of the BSID-II also significantly correlated with the five subscales of the SSDD-II. The SSDD-II has a high concurrent validity, and is a convenient scale to use to screen children for developmental delay in clinical practice in Taiwan.

Effectiveness of behavioral parent therapy in preschool children with attention-deficit hyperactivity disorder.

The purpose of this study was to assess the effectiveness of a behavioral parent therapy (BPT) program in children with attention‐deficit hyperactivity disorder (ADHD) using multidimensional evaluations, the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). Between 2001 and 2005, the parents of 21 preschool children with ADHD were divided into six groups and participated in a series of 11 BPT sessions. Before and after BPT, the parents completed the CBCL, and the teachers completed the TRF. The behavioral and emotional problems of the children showed improvement after the BPT sessions, specifically for the following categories: internalizing problems, anxious/depressed syndromes, somatic complaints, externalizing problems, rule‐breaking behaviors, aggressive behaviors, social problems, thought problems, and attention problems. In the DSM‐oriented scale of the CBCL, affective problems, anxiety problems, somatic problems, ADHD problems, oppositional defiant disorder problems, and conduct disorder problems showed significant improvements. On the DSM scale of the TRF, Inattention syndrome improved significantly after the BPT sessions, while other syndromes showed non‐significant changes. We conclude that the BPT program significantly improved the childrens behavioral problems at home and inattention problems at school.

The negative attribution processes of mothers of children with attention deficit/hyperactivity disorder

The objective of this study was to investigate the attribution processes of mothers regarding childrens prosocial behaviors, inattention, and hyperactivity/impulsivity (symptoms of attention deficit/hyperactivity disorder, ADHD) using two paradigms. The first paradigm involved multidimensional attributions. The second paradigm concerned making attributions of childrens identical behaviors based on information such as consensus, distinctiveness, and consistency. The participants were 64 mothers of children with ADHD (7-13 years old) and 64 mothers with typical/normal children (7-12 years old). The results showed that mothers of typical children exhibited positive attribution styles or person attributions whereas mothers of children with ADHD exhibited negative attribution styles. Mothers of children with ADHD tended to make personal attributions of childrens negative behaviors (e.g., inattention and hyperactivity/impulsivity; HI) but made situational attributions of prosocial behaviors. The results of this study can be used in future studies of the effects of intervention on children with ADHD or in studies related to neurophysiology.

Meta-Analysis of Counseling and Psychotherapy Outcome Studies in Taiwan

This study applied the meta-analysis method to investigate the effectiveness of counseling and psychotherapy. It began with a systematic search of the literature through computer search and previous narrative reviews to locate counseling and psychotherapy outcome studies conducted in Taiwan between January 1971 and August 2000. Salient characteristics of each study were recorded systematically. These study characteristics included type of therapy, type of target problem, therapist experience, and type of outcome measure, among others. In total, 257 studies, which yielded 302 effect sizes, were examined, in which clients who received psychotherapy or counseling were compared with controls. Results demonstrated that the overall mean effect of counseling and psychotherapy was positive and significant. Further categorical model testing indicated that most coded study characteristics were significantly related to effect sizes.