Wen-Jiun Chou

Behavioral problems and parenting style among Taiwanese children with autism and their siblings

Aims:  The purpose of the present study was to investigate the behavioral problems and parenting style among children with autism and their siblings in an ethnic Chinese population.

Psychometric properties of the Chinese version of the Autism Spectrum Quotient (AQ)

The Autism Spectrum Quotient (AQ) has been widely used for measuring autistic characteristics in parents of children with autism spectrum disorders (ASD). Nonetheless, its psychometric validity is yet to be justified. This study tested the factor structure of the AQ by means of principal component analysis and confirmatory factor analysis using, for the first time, data from 4192 Taiwanese parents (1208 with ASD children and 2984 with typically developing children). Results yielded a 35-item, 5-dimensional factor solution that had favorable psychometric characteristics (RMSEA = .054; NNFI = .962; CFI = .969) than any of the previously-published AQ factor solutions. Subscales of this new AQ-Chinese model were statistically and semantically coherent, namely: Socialness, Mindreading, Patterns, Attention to Details and Attention Switching. The psychometric properties of the AQ-Chinese did not change between clinic-based and community-based data suggesting good fitting for a continuum of autistic expression. Furthermore, the considerable overlap between the AQ-Chinese and the AQ factor structures derived previously using student samples indicated consistency in the manifestation of the autistic profile across different cultures and age groups. Group differences in the AQ-Chinese scores were in line with previous studies, i.e. males generally scored radically higher than females except in Attention to Details. Interestingly, mothers of ASD children reported lower total AQ scores than community mothers yet no significant group difference for the fathers. Important research and clinical implications pertinent to parents with children with ASD and the utility of the AQ were drawn.

The association of Internet addiction symptoms with anxiety, depression and self-esteem among adolescents with attention-deficit/hyperactivity disorder.

BACKGROUND The aims of this study were to examine the associations of the severity of Internet addiction symptoms with various dimensions of anxiety (physical anxiety symptoms, harm avoidance, social anxiety, and separation/panic) and depression symptoms (depressed affect, somatic symptoms, interpersonal problems, and positive affect) and self-esteem among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan. METHOD A total of 287 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. Their severity of Internet addiction symptoms was assessed using the Chen Internet Addiction Scale. Anxiety and depression symptoms and self-esteem were assessed using the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T), the Center for Epidemiological Studies Depression Scale (CES-D), and the Rosenberg Self-Esteem Scale (RSES), respectively. The association between the severity of Internet addiction symptoms and anxiety and depression symptoms and self-esteem were examined using multiple regression analyses. RESULTS The results indicated that higher physical symptoms and lower harm avoidance scores on the MASC-T, higher somatic discomfort/retarded activity scores on the CES-D, and lower self-esteem scores on the RSES were significantly associated with more severe Internet addiction symptoms. CONCLUSIONS Prevention and intervention programs for Internet addiction in adolescents with ADHD should take anxiety, depression, and self-esteem into consideration.

Better efficacy for the osmotic release oral system methylphenidate among poor adherents to immediate‐release methylphenidate in the three ADHD subtypes

Aims:  To determine factors for switching to osmotic release oral system methylphenidate (OROS‐MPH) among poor adherents to immediate‐release methylphenidate (IR‐MPH); and to compare the efficacy of OROS‐MPH on the three attention‐deficit/hyperactivity disorder (ADHD) subtypes in a multi‐site prospective observational study in Taiwan.

Multi-dimensional correlates of Internet addiction symptoms in adolescents with attention-deficit/hyperactivity disorder.

This study examined the associations of the severity of Internet addiction symptoms with reinforcement sensitivity, family factors, Internet activities, and attention-deficit/hyperactivity disorder (ADHD) symptoms among adolescents in Taiwan diagnosed with ADHD. A total of 287 adolescents diagnosed with ADHD and aged between 11 and 18 years participated in this study. Their levels of Internet addiction symptoms, ADHD symptoms, reinforcement sensitivity, family factors, and various Internet activities in which the participants engaged were assessed. The correlates of the severities of Internet addiction symptoms were determined using multiple regression analyses. The results indicated that low satisfaction with family relationships was the strongest factor predicting severe Internet addiction symptoms, followed by using instant messaging, watching movies, high Behavioral Approach System (BAS) fun seeking, and high Behavioral Inhibition System scores. Meanwhile, low paternal occupational SES, low BAS drive, and online gaming were also significantly associated with severe Internet addiction symptoms. Multiple factors are significantly associated with the severity of Internet addiction symptoms among adolescents with ADHD. Clinicians, educational professionals, and parents of adolescents with ADHD should monitor the Internet use of adolescents who exhibit the factors identified in this study.

Cyberbullying among male adolescents with attention-deficit/hyperactivity disorder: Prevalence, correlates, and association with poor mental health status

The aims of this study were to examine the prevalence rates and multilevel correlates of cyberbullying victims and perpetrators among male adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan. The relationships between cyberbullying involvement and depression, anxiety, and suicidality were also examined. The experiences of cyberbullying victimization and perpetration in 251 male adolescents with ADHD were assessed. Logistic regression analysis was used to examine the correlates of cyberbullying victims and perpetrators. The relationships between cyberbullying involvement and depression, anxiety, and suicidality were examined using multiple regression analysis. A total of 48 (19.1%) and 36 (14.3%) participants reported that they were cyberbullying victims or perpetrators, respectively. Those who had increased age and a higher parental occupational socioeconomic status, and reported more severe traditional passive bullying victimization were more likely to be cyberbullying victims. Those who had increased age and combined-type ADHD, and reported lower BAS reward responsiveness, more severe Internet addiction and more severe traditional passive bullying perpetration were more likely to be cyberbullying perpetrators. Cyberbullying victims reported more severe depression and suicidality than those who were not cyberbullying victims. A high proportion of male adolescents with ADHD are involved in cyberbullying. Clinicians, educational professionals, and parents of adolescents should monitor the possibility of cyberbullying involvement among male adolescents with ADHD who exhibit the cyberbullying correlates identified in this study.

Genome-wide analysis of copy number variations identifies PARK2 as a candidate gene for autism spectrum disorder

BackgroundAutism spectrum disorder (ASD) is an early-onset neurodevelopmental disorder with complex genetic underpinning in its etiology. Copy number variations (CNVs) as one of the genetic factors associated with ASD have been addressed in recent genome-wide association studies (GWAS). However, the significance of CNV has not been well investigated in non-Caucasian ASD population.MethodsTo identify the pathogenic CNVs responsible for ASD in Han Chinese, we performed a segment-based GWAS of CNV in 335 ASD cases and 1093 healthy controls using Affymetrix single nucleotide polymorphism (SNP) array by focusing on case-specific CNVs. PARK2 was one of the important genes with several case-specific regions overlapped on it. The findings were validated in the initial screen sample set and replicated in another sample set by real-time quantitative PCR (qPCR).ResultsA total of six CNVs at 6q26 that spanned different exons of PARK2 were identified. The PARK2 expression level was down-regulated at exon-dependent manner in cases with either deletion or duplication. The result revealed that the gene function might be disrupted by exonic deletion and duplication. We also observed that the ASD case with exonic duplication demonstrated a more severe interference of PARK2 expression and the clinical feature than the ones with deletion at the exons 2–4 of the PARK2 gene.ConclusionsOur finding provides evidence to support that CNVs affecting PARK2 function might contribute to genetic etiology of a proportion of cases with ASD. The intriguing results of this work warrant further study on characterizing the functional impact of various exonic CNVs on the PARK2 gene.Trial registrationClinicalTrials.gov NCT00494754

Maternal mental health and child development in Asian immigrant mothers in Taiwan.

BACKGROUND/PURPOSE Marriages between Taiwanese men and immigrant women are common in Southern Taiwan. However, little is known about the adjustment of these women to life in Taiwan and their childrens development as a result of cross-national marriage. This study evaluated the psychological status and adjustment of the foreign-born mothers in Taiwan, and assessed the influence of their immigrant motherhood on child development. METHODS Ninety-four immigrant mothers (41 Chinese, 37 Vietnamese, and 16 Southeast Asian women) and their 104 children born in Taiwan were enrolled in this study. Information was obtained by a clinical interview for medical history and sociodemographics, and five standardized self-administered questionnaires for maternal general mental health, maternal depression, maternal cognitive functioning, home environment, and child development. RESULTS Chinese mothers were significantly more educated and less likely to marry via referral agencies than mothers from Vietnam and other countries in Southeast Asia. Husbands of Chinese mothers significantly better educated, less likely to have physical illnesses, and were closer in age to their wives than husbands in the other two groups. Immigrant mothers had high rates of psychological distress (70%) and marked depression (24%). Longer residency in Taiwan predicted a higher likelihood of maternal depression, especially in the Southeast Asian mothers. Chinese mothers had the highest degree of cognitive functioning and provided a better home environment for their children. Childhood developmental delay was predicted by older child age and parental marriage via referral agencies. CONCLUSION This study highlights the need to give continuous psychosocial support to immigrant mothers and to identify early developmental delays among their children.

Effects of Cognitive-Behavioral Therapy on Improving Anxiety Symptoms, Behavioral Problems and Parenting Stress in Taiwanese Children with Anxiety Disorders and Their Mothers

The aims of this intervention study were to examine the effects of individual cognitive-behavioral therapy (CBT) based on the modified Coping Cat Program on improving anxiety symptoms and behavioral problems in Taiwanese children with anxiety disorders and parenting stress perceived by their mothers. A total of 24 children with anxiety disorders in the treatment group completed the 17-session individual CBT based on the modified Coping Cat Program, and 26 children in the control group received the treatment as usual intervention. The Taiwanese version of the MASC (MASC-T), the Child Behavior Checklist for Ages 6–18 (CBCL/6-18) and the Chinese version of the Parenting Stress Index (C-PSI) were applied to assess the severities of anxiety symptoms, behavioral problems and parenting stress, respectively. The effects of CBT on improving anxiety symptoms, behavioral problems and parenting stress were examined by using linear mixed-effect model with maximum likelihood estimation. The results indicated that the CBT significantly improved the severities of MASC-T Physical Symptoms and Social Anxiety subscales, CBCL/6-18 DSM-oriented Anxiety Problem subscale, and C-PSI Child domains Mood and Adaptability subscales. Individual CBT based on the modified Coping Cat Program can potentially improve anxiety symptoms in Taiwanese children with anxiety disorders and some child domains of parenting stress perceived by their mothers.

Chromosomal abnormalities in patients with autism spectrum disorders from Taiwan.

Autism spectrum disorders (ASD) are childhood‐onset neurodevelopmental disorders characterized by verbal communication impairments, social reciprocity deficits, and the presence of restricted interests and stereotyped behaviors. Genetic factors contribute to the incidence of ASD evidently. However, the genetic spectrum of ASD is highly heterogeneous. Chromosomal abnormalities contribute significantly to the genetic deficits of syndromic and non‐syndromic ASD. In this study, we conducted karyotyping analysis in a sample of 500 patients (447 males, 53 females) with ASD from Taiwan, the largest cohort in Asia, to the best of our knowledge. We found three patients having sex chromosome aneuploidy, including two cases of 47, XXY and one case of 47, XYY. In addition, we detected a novel reciprocal chromosomal translocation between long arms of chromosomes 4 and 14, designated t(4;14)(q31.3;q24.1), in a patient with Aspergers disorder. This translocation was inherited from his unaffected father, suggesting it might not be pathogenic or it needs further hits to become pathogenic. In line with other studies, our study revealed that subjects with sex chromosomal aneuploidy are liable to neurodevelopmental disorders, including ASD, and conventional karyotyping analysis is still a useful tool in detecting chromosomal translocation in patients with ASD, given that array‐based comparative genomic hybridization technology can provide better resolution in detecting copy number variations of genomic DNA.