Adolescent ; Attention Deficit Disorder with Hyperactivity ; diagnosis ; etiology ; therapy ; Behavior Therapy ; Central Nervous System Stimulants ; therapeutic use ; Child ; Humans ; Methylphenidate ; therapeutic use ; Young Adult

Objective: The study examines the effectiveness of a CBT treatment programme over and above that of Treatment As Usual (TAU), with children who were referred to an outpatient child psychiatric clinic for disruptive behaviour disorders in Singapore. Methods: One hundred and three children aged 8 to 12 (mean±SD=10.22±1.31) who participated in the study were assigned to either the CBT+TAU (n= 51) or TAU group (n=52). Children in both the CBT+TAU and TAU groups received a standard and typical service offered to children at the outpatient child psychiatric clinic. In addition, children in the CBT+TAU group attended the CBT treatment programme that consisted of nine 1.5 hour weekly sessions. Results: Findings from ANCOVA indicated that children in the CBT+TAU treatment group showed significantly lower levels of aggression and significantly lower levels of parental stress at posttreatment and at 3-month follow-up in comparison to the TAU group. Conclusions: Findings from the present study provided some evidence of the effects of CBT in reducing aggressive behaviour and parental stress among children with disruptive behaviour disorders. Interpretation of the findings, recommendations for future research, and implications of the present study were presented.

No abstract available.
Asia ; Child ; Child Psychiatry ; Child ; Humans

INTRODUCTIONIncidental reports collected in clinical trials suggest that amongst participants, omega-3 fatty acids derived from fish oil ('omega-3') may be difficult to blind.

MATERIALS AND METHODSWe conducted a systematic evaluation of blinding success in a 24-week trial of omega-3 versus an oil-based placebo. Within 1 week of supplement commencement (Week 1), a blinding questionnaire was completed by 131 children enrolled in a trial of omega-3 for the treatment of disruptive behaviour disorders. A version of the questionnaire was also completed by their parents at Week 1, and by the children at the end of supplement administration (Week 24).

RESULTSParticipants were unable to differentiate omega-3 from placebo, and accuracy did not improve as a function of: the confidence of guesses, reason for guesses, notice of any change, beliefs about what should change, or time. Child and parent guesses also showed high concordance.

CONCLUSIONTaken together, these data provide strong evidence that the identity of omega-3 can be blinded to participants.

Adolescent ; Attention Deficit and Disruptive Behavior Disorders ; diet therapy ; Child ; Dietary Supplements ; Fatty Acids, Omega-3 ; therapeutic use ; Female ; Humans ; Male ; Parents ; Single-Blind Method ; Surveys and Questionnaires

INTRODUCTIONSelective mutism (SM) is characterised by limited or a lack of speech in selected social settings. Recent reviews suggest that cognitive-behavioural therapy (CBT) is an effective and promising treatment approach for SM. However, there is still a lack of studies documenting the applicability of CBT for SM in diverse populations. The goal of the present study was to examine the use of a web-based CBT programme ('Meeky Mouse') among Singaporean children diagnosed with SM.

METHODSFive children with SM (one boy and four girls aged 6-11 years) participated in the 14-week 'Meeky Mouse' programme, in addition to being prescribed with an unchanged dosage of fluoxetine 10-20 mg daily. The progress made by the children throughout the course of the programme was documented by the therapist.

RESULTSPost treatment, four out of the five children demonstrated improvements in the frequency of speech during therapy sessions at home, in school and at other social situations.

CONCLUSIONFindings from the present study provide support for the use of a web-based CBT programme in improving speech and decreasing the severity of SM among affected children.

Child ; Cognitive Therapy ; methods ; Female ; Fluoxetine ; therapeutic use ; Humans ; Internet ; Male ; Mutism ; therapy ; Singapore ; Social Environment ; Speech ; Surveys and Questionnaires ; Telemedicine ; methods ; Treatment Outcome ; User-Computer Interface

INTRODUCTIONMany studies have reported various levels of association between sleep disorders and attention deficit hyperactivity disorder (ADHD). This study aims to investigate sleep disturbances in children with ADHD prior to treatment and during treatment.

MATERIALS AND METHODSThis study recruited 114 child and adolescent patients diagnosed with ADHD and 60 normal patients. Sleep disturbances are assessed using the parent-rated Child Behaviour Checklist (CBCL) questionnaire. In addition, chart reviews and semi-structured clinical interviews were conducted for 54 patients with ADHD who had been seen at the clinic since 2002 to examine the sleep disturbances they experienced during treatment over a 4-year period.

RESULTSCompared to the normal subjects, parents of children with ADHD reported that their children slept less. The summation score of the sleep items on the CBCL was also significantly higher in the ADHD group. Girls with ADHD also had more "trouble sleeping". When children with ADHD received treatment with medications, they experienced sleep-related side effects. Out of the 54 children with ADHD, 18.5% experienced sleep disturbance related to medication, with 13.0% reporting daytime somnolence and 5.5% reporting insomnia.

CONCLUSIONOur study showed that there was an increased frequency of sleep disturbances in children with ADHD prior to treatment with medications. The children in our study appeared to sleep less. A significant proportion also experienced sleep disturbance during treatment with medication, of which daytime somnolence and insomnia were the most commonly reported problems. Future research in this area is needed to further examine the range of sleep disorders in ADHD children locally.

Attention Deficit Disorder with Hyperactivity ; epidemiology ; Child ; Child, Preschool ; Comorbidity ; Disorders of Excessive Somnolence ; epidemiology ; Female ; Humans ; Male ; Prevalence ; Singapore ; Sleep Initiation and Maintenance Disorders ; epidemiology ; Sleep Wake Disorders ; epidemiology

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Attention Deficit Disorder with Hyperactivity ; diagnosis ; drug therapy ; therapy ; Caregivers ; Child ; Evidence-Based Medicine ; Humans ; Methylphenidate ; therapeutic use ; Parents ; Psychiatry ; methods ; standards ; Singapore ; Societies, Medical

INTRODUCTION: Family history of psychopathology is a risk factor for mood and anxiety disorders in children, but little is known about rates of parental psychopathology among treatment-seeking youth with affective disorders in the Asia Pacific region. This study examined patterns of emotional and behavioural problems in parents of clinically-referred youth in Singapore. We hypothesised that parents would have higher rates of affective disorders compared to the Singapore national prevalence rate of 12%. MATERIALS AND METHODS: In this cross-sectional study, 47 families were recruited from affective disorders and community-based psychiatry programmes run by a tertiary child psychiatry clinic. All children had a confirmed primary clinical diagnosis of depression or an anxiety disorder. Parents completed the Mini International Neuropsychiatric Interview (MINI) to assess for lifetime mood and anxiety disorders. They also completed the Adult Self Report (ASR) and Adult Behavior Checklist (ABCL) to assess current internalising and externalising symptoms. RESULTS: Consistent with our hypothesis, 38.5% of mothers and 10.5% of fathers reported a lifetime mood and anxiety disorder. Nearly 1/3 of mothers had clinical/subclinical scores on current internalising and externalising problems. A similar pattern was found for internalising problems among fathers, with a slightly lower rate of clinical/subclinical externalising problems. CONCLUSION Our findings are consistent with previous overseas studies showing elevated rates of affective disorders among parents - particularly mothers - of children seeking outpatient psychiatric care. Routine screening in this population may help to close the current treatment gap for adults with mood and anxiety disorders.
Adult ; Anxiety Disorders ; diagnosis ; epidemiology ; psychology ; Child ; Cross-Sectional Studies ; Family Health ; statistics & numerical data ; Female ; Humans ; Male ; Mood Disorders ; diagnosis ; epidemiology ; psychology ; Parent-Child Relations ; Parenting ; psychology ; Parents ; psychology ; Psychiatric Status Rating Scales ; Psychopathology ; Singapore ; epidemiology

OBJECTIVES: To study the early clinical efficacy of combined therapy of stage 4 neuroblastoma. METHODS: A retrospective analysis was performed on the medical data and follow-up data of 14 children with stage 4 neuroblastoma who were diagnosed in Hong Kong University-Shenzhen Hospital from January 2016 to June 2021. RESULTS: The median age of onset was 3 years and 7.5 months in these 14 children. Among these children, 9 had positive results of bone marrow biopsy, 4 had N-Myc gene amplification, 13 had an increase in neuron-specific enolase, and 7 had an increase in vanilmandelic acid in urine. Based on the results of pathological examination, differentiated type was observed in 6 children, undifferentiated type in one child, mixed type, in one child and poorly differentiated type in 6 children. Of all the children, 10 received chemotherapy with the N7 regimen (including 2 children receiving arsenic trioxide in addition) and 4 received chemotherapy with the Rapid COJEC regimen. Thirteen children underwent surgery, 14 received hematopoietic stem cell transplantation, and 10 received radiotherapy. A total of 8 children received Ch14.18/CHO immunotherapy, among whom 1 child discontinued due to anaphylactic shock during immunotherapy, and the other 7 children completed Ch14.18/CHO treatment without serious adverse events, among whom 1 child was treated with Lu177 Dotatate 3 times after recurrence and is still undergoing chemotherapy at present. The median follow-up time was 45 months for all the 14 children. Four children experienced recurrence within 2 years, and the 2-year overall survival rate was 100%; 4 children experienced recurrence within 3 years, and 7 achieved disease-free survival within 3 years. CONCLUSIONS Multidisciplinary combined therapy is recommended for children with stage 4 neuroblastoma and can help them achieve better survival and prognosis.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Child ; Child, Preschool ; Combined Modality Therapy ; Humans ; Infant ; Neuroblastoma/drug therapy* ; Positron-Emission Tomography ; Radionuclide Imaging ; Retrospective Studies ; Treatment Outcome