Table of Content

10 October 2024, Volume 32 Issue 10

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Professional Forum

Psycho-behavioral intervention for tic disorder based on neurophysioloy

CHEN Yanhui, KE Zhongling

2024, 32(10):  1045-1049.  DOI: 10.11852/zgetbjzz2024-1066

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Tic disorder(TD) is a common neurodevelopmental disorder in children, and psycho-behavioral intervention is the first-line treatment for it. This paper reviews the neurophysiological basis of psycho-behavioral intervention for TD, and discusses the psycho-behavioral intervention Methods and their effects. By integrating the latest research results, it aims to provide a scientific basis for clinical practice and a reference for future research directions.

Original Articles

Mediating role of premonitory urge on the impact of comorbidity with attention-deficit/hyperactivity disorder on tic severity in children with tic disorder

LU Yanting, CHEN Liangliang, LIU Xiumei

2024, 32(10):  1050-1054.  DOI: 10.11852/zgetbjzz2024-0214

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Objective To examine the effect of comorbidity with attention-deficit/hyperactivity disorder (ADHD) on tic severity in children with tic disorder (TD), and to explore the mediating role of premonitory urge in the association. Methods A total of 68 TD children comorbid with ADHD (TD+ADHD) and 150 children with TD were recruited from the Child Health Care/Developmental Behavior Outpatient Department of Fujian Children′s Hospital between November 2022 and October 2023. The Premonitory Urge for Tics Scale (PUTS) and the Yale Global Tic Severity Scale (YGTSS) were administered to assess premonitory urges and tic severity, respectively. Pearson correlation analysis was used to examine the associations among variables, and the PROCESS software was used to test the mediation effect. Results The TD+ADHD group scored significantly higher on the PUTS compared to the TD group (t= 2.22, P<0.05). Statistically significant differences were also found between the two groups in terms of frequency (t=2.20) and complexity (t=2.05) of motor tics, as well as intensity (t=2.19) and complexity (t=2.64) of vocal tics (P<0.05). 2) Positive correlations were found between total PUTS scores and motor tics (including number, complexity, disruptiveness, and severity of total motor tics), vocal tics, total impairment rate, and total severity of the YGTSS (r=0.170 - 0.354, P<0.05). 3) After controlling the confounding factors such as children′s age and gender, it was found that the total PUTS score mediated 25.70% of the association between comorbid ADHD and TD vocal intensity and 14.32% of the association between comorbid ADHD and TD vocal complexity. Conclusion Premonitory urge is evident in children comorbid TD and ADHD, and premonitory urge is a mediator of the effect of comorbidity with ADHD on the strength and complexity of TD vocalizations.

Association between mental health condition and quantitative electroencephalography spectral power in children with sleep disordered breathing

JIN Linglin, ZHAI Feng, WANG Guanghai, CHEN Jie

2024, 32(10):  1055-1063.  DOI: 10.11852/zgetbjzz2023-1190

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Objective To explore the associations between mental health condition and quantitative electroencephalography (qEEG) in children with sleep disordered breathing (SDB),so as to timely detect and treat the emotional complications of SDB and to ensure the healthy neuropsychological development of children with SDB. Methods From December 2020 to October 2022,an overnight polysomnography (PSG) was conducted at Shanghai Children′s Medical Center in children with SDB symptoms,meanwhile their qEEG data were collected.The parents of the subjects completed the Children′s Depression Inventory (CDI),the Spence Children′s Anxiety Scale-Parental Version (SCAS-P) or the Preschool Anxiety Scale (PAS),along with the Obstructive Sleep Apnea Questionnaire-18 (OSA-18).Two independent-sample t-test, Wilcoxon rank-sum test and χ² testand Fisher exact testwere employed to compare variables between different groups of SDB children. Finally, multiple linear regression model concerning SDB children′s mental health were built. Results A total of 105 cases of 3- to 12-year-old SDB patients were included in this study.The CDI score of school-age SDB children[6.50(3.00,9.00)] were higher than those of preschoolers [3.00(1.00,6.00)],with a statistically significant difference (Z=701.00,P=0.010).Relative δ and θ power were negatively correlated with social phobia symptoms in preschool SDB children (β=-1.06,-0.62,P＜0.05) and with interpersonal problems in school-age children (β=-3.62,-2.36,P＜0.05). Conclusions PSG is the essential test for the diagnosis of SDB,from which qEEG can be obtained.qEEG features are linked to the mental state of children with SDB,which promotes the early detection of mental health issues in children with SDB through easily accessible and accurate Methods in clinical practice.

Non-suicidal self-injurious behaviors and associations with help-seeking behaviors among Tibetan middle school students in agricultural and pastoral areas of Tibet

DING Yonggang, LI Libo, MA Zhen, ZARXI Quzha

2024, 32(10):  1064-1069.  DOI: 10.11852/zgetbjzz2024-0154

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Objective To investigate the status of non-suicidal self-injury (NSSI) among Tibetan middle school students in agricultural and pastoral areas of Tibet and its association with help-seeking behaviors, in order to provide reference for the prevention and intervention of NSSI in this demographic. Methods A self-report questionnaire survey on NSSI and help-seeking behaviors was conducted among 4 204 Tibetan middle school students in the rural and pastoral areas of Nagqu and Ali regions of Tibet from April to May 2023. Chi-square tests, t test, and Logistic regression analysis were employed to analyze the data. Results The detection rate of NSSI among Tibetan middle school students in agricultural and pastoral areas of Tibet was 33.33% (1 401/4 204), with junior high school students having a significantly higher rate of 36.00% (878/2 439) compared to 29.63% (523/1 765) for senior high school students(χ²=18.68, P<0.01). Senior high school students with NSSI had a significantly lower score on help-seeking intentions, help-seeking targets (family, teachers, friends), and help-seeking Methods (face-to-face communication, telephone conversations, WeChat/QQ) than those without NSSI (P <0.01). Logistic regression analysis revealed that female junior high school students (OR=1.46), class leaders (OR=1.28), urban students (OR=1.47), average parent-child relationships (OR=1.46), poor parent-child relationships (OR=2.01), average parenting styles (OR=1.44), poor parenting styles (OR=2.11), frequent scolding (OR=1.99), and heavy academic pressure (OR=1.42) were positively associated with the occurrence of NSSI (P<0.05). Among senior high school students, help-seeking intentions (OR=0.85), seeking help from family members (OR=0.96), and seeking help from teachers (OR=0.98) were negatively associated with the occurrence of NSSI (P<0.05). Conclusions NSSI among Tibetan secondary school students in agricultural and pastoral areas of Tibet should not be ignored, and there is a close association between NSSI and help-seeking behaviors. Tibetan secondary school students in agricultural and pastoral areas should be encouraged to proactively seek help, reduce academic stress and reprimands, and maintain good parent-child relationships and parenting styles in order to reduce the incidence of NSSI.

Sleep health status and its influencing factors among primary and secondary school students in Lanzhou City

LIANG Guiye, GONG Jian, ZHOU Yue, GONG Linlin, WANG Yanni, XUE Hongli

2024, 32(10):  1070-1075.  DOI: 10.11852/zgetbjzz2023-1178

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Objective To understand the status of sleep health among primary and secondary school students in Lanzhou City and its potential influencing factors, in order to provide a theoretical basis for improving sleep quality among students. Methods In 2021, a survey was conducted through Wenjuanxing platform among 8 934 primary and secondary school students and their parents in Lanzhou City. Sleep duration of the students was measured by self-made questionnaire. Insufficient sleep duration was defined as sleep duration less than 10, 9, 8 hours per day for primary, secondary and high school according to GB/T 17223-2012, respectively. Influencing factors were measured by Parental Bonding Instrument, Ruminative Responses Scale, and the Mobile Phone Addiction Index. Logistic regression analysis was adopted to identify factors influencing substandard sleep duration. Results Only 23.1% of students aged 10 to 15 years in Lanzhou met the standard sleep duration requirements. Heavy academic pressure (OR=1.686), overprotective parenting (OR=1.013), higher level of father′s education(ORs of vocational school, undergraduate, and postgraduate degree were 1.399, 1.731, and 2.045, respectively), symptom rumination (OR=1.016), and inefficient mobile phone dependence (OR=1.035) were identified as risk factors for inadequate sleep duration (P＜0.05). Minimal academic stress (OR=0.796), avoidance of mobile phone addiction (OR=0.951), general concern for teacher′s evaluation (OR=0.694), strong indifference to peer evaluation (OR=0.45) were protective factors(P＜0.05). Conclusions The compliance rate of sleep duration in primary and secondary school students is low in Lanzhou. Academic stress, parenting styles, father′s education level,symptom rumination,mobile phone addiction and concern for evaluations from peers or teachers have association with sleep duration.Effective measures should be implemented to increase the compliance rate of sleep duration in primary and secondary school students.

Prospective study of the stability of early diagnosis of autism spectrum disorder with positive screening results of Modified Checklist for Autism in Toddlers

GAN Kaiyan, HUANG Anqi, ZHANG Ziyi, GUAN Luyang, WANG Fei, KE Xiaoyan

2024, 32(10):  1076-1079.  DOI: 10.11852/zgetbjzz2023-1260

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Objective To analyze the consistency between the early screening Results of the Modified Checklist for Autism in Toddlers (M-CHAT) for infants and toddlers suspected of having autism spectrum disorder (ASD) and their subsequent clinical diagnosis, in order to provide reference for clinical practice and improve the early identification rate of ASD. Methods Infants and toddlers aged 16 to 30 months who first visited the Child Mental Health Research Center of Nanjing Brain Hospital between January 1st, 2017, and January 1st, 2021, were enrolled in the study. General data were collected and comprehensive assessments were completed at baseline. Between April and September 2023, telephone follow-ups were conducted to ascertain the diagnostic status of the children. The consistency between the M-CHAT screening outcomes for high-risk ASD children under 30 months and their later diagnostic follow-ups was analyzed. Results The M-CHAT showed a sensitivity of 0.937, specificity of 0.514, positive predictive value (PPV) of 0.929, negative predictive value (NPV) of 0.545, and an area under the curve (AUC) of 0.726. No statistically significant difference in the positive screening rate was observed between the two age groups of 16 - 23 months and 24 - 30 months old (83.8% vs.90.6%,χ²=2.824,P=0.113). Conclusion The M-CHAT demonstrates good screening efficacy in the early detection of ASD and exhibits a favorable diagnostic stability.

Status of screen use and its association with core symptoms in children with autism spectrum disorder

YANG Fan, LI Qinghong, LI Yiming, YANG Shunbo, LI Wei, LYU Zhihai

2024, 32(10):  1080-1084.  DOI: 10.11852/zgetbjzz2023-1076

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Objective To investigate the status quo of long-term screen use in children with autism spectrum disorder (ASD) and its correlation with core symptoms,in order to help children establish correct screen use habits. Methods A total of 136 ASD children aged 2 to 5 diagnosed from March 2022 to November 2022 were selected into this study from Longgang District Maternal and Child Health Hospital of Shenzhen City.Status of screen time in ASD children was investigated by a self-made questionnaire.The core symptoms and cognitive status ofASD children were evaluated by the Children′s Autism Rating Scale (CARS),Autistic Children′s Behavior Scale (ABC),Social Communication Scale (SCQ),and Neuropsychological Development Scale for children aged 0 - 6 years. Results Totally 62.2% (74/119) of ASD children watched TV/smartphone or tablet,79.8%(95/119)of ASD children began to use screens before the age of 2,46.2% (55/119) of ASD children had screen exposure >2h/d initially.There were significant differences in CARS score,interaction dimension score of ABC,SCQ total score and social interaction dimension score of SCQ between the screen exposure group (screen time >2h/d) and the non-screen exposure group (screen time <2h/d) (t=2.231,2.475,2.131,2.076,P<0.05).There were statistically significant differences in the scores of CARS,ABC total score,exercise dimension score of ABC,self-care ability dimension score of ABC and social interaction dimension score of SCQ of children in high-risk group (screen use time >2h/d in children <2 years old) and non-high-risk group (t=3.021,2.621,2.828,2.847,2.050,P<0.05).Linear regression analysis showed that screen exposure was positively correlated with CARS,interaction score of ABC,SCQ total score,and social interaction score of SCQ (b=1.41,3.05,2.53,1.56,P<0.05).High risk was positively correlated with CARS,ABC score and social interaction score of SCQ (b=1.53,6.17,1.27,P<0.05). Conclusions During the normalization of COVID-19,preschoolers with ASD have longer screen time.Early prolonged screen time may be associated with core symptoms of ASD.

Comparison of the detection rates of new media dependence and addiction among adolescents with different family social capital in the Yanbian area

JIN Guihua, CUI Wenxiang

2024, 32(10):  1085-1090.  DOI: 10.11852/zgetbjzz2024-0245

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Objective To understand the current state of new media dependency and addiction among adolescents in the Yanbian region, and to explore the association of family social capital with new media dependency and addiction, so as to provide basis for the prevention and intervention of new media dependence behaviors among adolescents. Methods A stratified cluster sampling method was employed to select 1,780 middle school students from the Yanbian region as research participants in January 2014. The survey utilized the Adolescent Pathological Internet Use Scale, the Family Capital Questionnaire, and the Chinese version of the Adolescents Cell Phone Addiction Scale.Statistical analyses were conducted using percentages and χ² tests. Results 1) The detection rates of internet dependency, internet addiction, smartphone dependency, and smartphone addiction among adolescents in Yanbian were 4.5%, 7.3%, 6.2%, and 3.7%, respectively. Dependency and addiction rates of Korean adolescents were higher than those of Han adolescents (P<0.05). 2) There were statistically significant differences in internet dependency rates across different types of parent-child relationships, frequency of parent-child communication, and parental relationships (χ²=9.24, 16.03, 9.72, P＜0.05). Significant differences in internet addiction rates were found for different types of parental relationships, frequency of parent-teacher communication, parent-child relationships, degree of parent-neighbor interaction, frequency of parent-child communication, and parental expectations regarding the educational attainment of their children(χ²=13.33, 8.16, 21.33, 14.35, 36.58, 15.89,P＜0.05). No statistically significant differences were found in the rates of smartphone dependency across different levels of family social capital (P＞0.05). However, there were statistically significant differences in smartphone addiction rates for different types of parental relationships, frequency of parent-child communication, and parent-child relationships(χ²=10.74,8.75, 10.20, P＜0.05). Conclusions Family social capital has differential impacts on adolescents′ new media dependency and addiction. Tailored intervention strategies need to be developed based on the type of problematic new media behaviors in order to effectively steer adolescents towards rational use and away from addiction.

Review

Correlation between intestinal flora and tic disorder

ZHANG Panpan, ZHAO Tingting, XIAO Xuwu

2024, 32(10):  1091-1096.  DOI: 10.11852/zgetbjzz2023-1000

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Tic disorder (TD) is a chronic neurological disorder in early childhood.Its incidence has been on the rise in recent years, and there is no specific effective treatment.With the further study of brain-gut axis interaction, more and more attention has been paid to the influence of intestinal flora on TD.On the basis of basic research and clinical trials, this paper discusses the current situation of intestinal flora and tic disorder, discusses the possible mechanism of intestinal flora changes in the pathogenesis of TD and the potential therapeutic value of microecological agents, aiming to provide some new ideas and Methods for the treatment of TD.

Role of dopamine and its receptors in tic disorder in children

QIU Jiaqi , ZHONG Xia, ZOU Shipu

2024, 32(10):  1097-1100.  DOI: 10.11852/zgetbjzz2024-0151

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Tic disorder is a childhood-onset neuropsychiatric disorder characterized by motor and/or vocal tics that commonly affect children′s physical and mental health.The pathogenesis of tic disorders may be related to abnormal neurotransmitters in the cortico-striatal-thalamic-cortical loop, especially the catecholamine neurotransmitter dopamine. This article reviews the role of dopamine and its receptors in the pathogenesis of tic disorders, in order to provide reference for clinical treatment and prevention.

Role of GABAergic system in the pathogenesis and treatment of Tourette syndrome in children

XU Ying, SHI Haishui, ZHANG Huifeng, TIAN Xiaoyu

2024, 32(10):  1101-1105.  DOI: 10.11852/zgetbjzz2024-0307

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Childhood Tourette syndrome(TS) is a chronic neuropsychiatric disorder with a prevalence of about 1% in children and adolescents. Its clinical features include sudden, involuntary twitching symptoms such as eye blinking, head shaking, and tics involving other muscles of the face, trunk, and limbs, as well as vocal tics. At present, the pathogenesis of TS is currently not clear, and there is no effective treatment for TS. γ-aminobotyric acid(GABA) is the primary inhibitory neurotransmitter in the mammalian brain. Some studies have shown that the imbalance of GABAergic system is involved in the occurrence and development of many neuropsychiatric diseases. In recent years, the role of GABAergic system in TS has gained much attention. Current research focuses on the abnormality of GABAergic metabolic pathway and the changes of GABA metabolism of intestinal flora in TS patients. However, there are no specific GABAergic drugs developed for the treatment of TS. This review provides insights into the role of the GABAergic system in the pathophysiology of TS and its potential as a novel therapeutic target.

Cognitive impairments of children with tic disorder

LI Zhonggui, WANG Haifei, HUANG Meilin, JING Jin

2024, 32(10):  1106-1110.  DOI: 10.11852/zgetbjzz2024-0674

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Tic disorder (TD) is a chronic neurodevelopmental condition that negatively affects children′s cognition, attracting widespread academic attention. Studies indicate that children with TD commonly experience difficulties with concentration, memory, cognitive organization, task switching, and motor skills. These cognitive traits are closely linked to the severity, type, and duration of TD episodes. Furthermore, family environment and social adjustment of children with TD also play a role in their cognitive functioning. Despite the interaction of neurobiological, genetic, immune, and environmental factors, the exact mechanism remains unclear. This article provides an overview of the research progress regarding the impact of TD on children′s cognitive functions, offering insights for cognitive interventions for children with TD.

Correlation of physical activity and sedentary behavior with cognitive development of preschool children

LI Tiangeng, GUO Liang, ZENG Sai, ZHENG Gangbin

2024, 32(10):  1111-1115.  DOI: 10.11852/zgetbjzz2023-0927

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The relationship of physical activities and sedentary behavior with cognitive development of preschool children was summarized through literature review and inductive-deductive method.It is found that 180 min of physical activity per day should be accumulated, including 60 min of moderate to vigorous physical activity and 120 min of outdoor activity.A variety of types of physical activity are required, ranging from hobbies and interests to individualized designs and specific games, which should include basic motor skills as well as specialized skill acquisition.To promote better cognitive development in preschool children, the overall daily duration of sedentary behavior should be controlled, the duration of single sedentary behavior should be limited, and the daily use of recreational electronic screens should be reduced.However, sedentary behavior for learning purposes can be encouraged.Currently, these studies are relatively limited in scope, and future recommendations should focus on the combined effects of multiple physical activity and sedentary behavior types on the effect of cognitive development of preschool children so as to provide a more comprehensive scientific basis for preschool education and health.

Meta Analysis

Causal relationship between neonatalhy perbilirubinemia and tic disorder by Mendelian randomization

CUI Pengyuan, LI Guiping

2024, 32(10):  1116-1121.  DOI: 10.11852/zgetbjzz2023-1163

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Objective To explore the causal relationship between neonatal hyperbilirubinemia and tic disorder (TD) by two-sample Mendelian randomized analysis (TSMR),in order to provide insights for the mechanism research of TD. Methods Data of genome-wide association study (GWAS) was used in this study.The exposure factor was neonatal hyperbilirubinemia,and the outcome variables were TD,multiple TD and vocal TD,respectively.Through MR analysis,inverse variance weighted (inverse-variance weighted,IVW) was used as the main analysis method, MR-Egger regression and weighted median (weighted median,WM) supplementary Methods were used to analyze the potential relationship between them.Cochran Q test and MR-Egger regression intercept were used to analyze the sensitivity. Results The inverse variance weighting method,showed that there was a potential causal relationship between neonatal hyperbilirubinemia and the risk of TD(OR=1.053,95%CI:1.006 - 1.102,P=0.024),but there was no potential causal correlation with other types of TD.Sensitivity analysis showed that there was no pleiotropy and heterogeneity(P>0.05),and the result was reliable. Conclusions There is a potential causal relationship between neonatal hyperbilirubinemia and TD,but the relationship needs to be further verified by a larger sample size.

Meta-analysis of the correlation of prenatal, perinatal and environmental risk factors with childhood autism

LI Shuai, HUANG Qijun, XIA Yu, LIU Zhenhuan

2024, 32(10):  1122-1127.  DOI: 10.11852/zgetbjzz2023-1172

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Objective To assess the association of maternal and environmental factors with the risk of autism in children, thereby informing strategies for prevention and early intervention. Methods A comprehensive search was conducted for case-control studies in both Chinese and English, utilizing databases including Wanfang, VIP, CNKI, and PubMed.The quality of the retrieved literature was rigorously assessed, and relevant risk factors were extracted for analysis.Statistical evaluation was performed using Review Manager 5.3, focusing on odds ratios (OR) and 95% confidence intervals (CI) as primary measures. Results Fifteen articles, encompassing a total of 1 758 cases in the observation group and 7 848 healthy children in the control group from six countries, were included in the final analysis.The Results indicated significant associations between autism and several factors, including paternal age over 35 years old (OR=2.60, 95%CI:1.58 - 4.61), maternal emotional disorders during pregnancy (anxiety, depression, stress) (OR=3.06, 95%CI:2.23 - 4.20), maternal smoking (active and passive) during pregnancy (OR=3.57, 95%CI:2.68 - 4.75), paternal introversion (OR=2.55, 95%CI:1.35 - 4.78), history of maternal induced abortion (OR=3.76, 95% CI:2.54 - 5.57), and maternal occupational exposure to toxins (OR=2.24, 95%CI:1.35 - 3.70).Additional significant associations were observed with maternal pregnancy-related diseases (hypertension, diabetes, hypothyroidism, etc.) (OR=2.47, 95%CI:1.22 - 4.98), maternal exposure to ionizing radiation (including frequent computer use) during the first six months of pregnancy (OR=2.35, 95%CI:1.39 - 3.98), family history of mental illness (OR=8.26, 95%CI:2.90 - 23.50), and maternal use of certain medications (anti-infective drugs, hormones) (OR=5.24, 95%CI:2.50 - 10.96). Conclusions The findings suggest a complex interplay of genetic, environmental and maternal health factors in the etiology of childhood autism.Early identification and mitigation of these risk factors, alongside vigilant monitoring during pregnancy, are imperative for reducing the incidence of autism and improving child health outcomes.

Clinical Research

Construction of a risk prediction scoring system for tic disorders in Chinese children based on Meta-analysis and external validation

JIANG Yanlin, WANG Junhong, LI Jialin, ZHAI Rui, JIANG Xiulei

2024, 32(10):  1128-1134.  DOI: 10.11852/zgetbjzz2023-1189

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Objective To construct a risk prediction scoring model for tic disorders (TD) in Chinese children using a two-stage approach:Meta-analysis for updated prevalence and risk factors followed by external validation, in order to establish an appropriate predicting model for TD in Chinese children. Methods An extensive search in Chinese and international databases (CNKI, Wanfang, VIP, PubMed, Embase, Web of Science) was conducted to identify observational studies on TD prevalence and risk factors in Chinese children published before October 2022.Meta-analysis in R yielded updated prevalence estimates and pooled odds ratios (ORs) for risk factors.A risk prediction model was developed using Logistic regression based on these findings.A total of 644 children (TD patients and healthy controls) from Dongzhimen Hospital, Beijing, from October 2022 to June 2023 were recruited for model validation.Predictive performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC) and clinical utility via decision curve analysis. Results Finally 34 studies were included in this Meta-analysis, encompassing 9 955 patients.The overall prevalence of TD in Chinese children diagnosed using DSM-IV criteria was 1.22% (95%CI:0.79% - 1.86%).After filtering, eight risk factors were incorporated into the model, including psychiatric abnormality during pregnancy (OR=2.50, 95%CI:1.78 - 3.52), other perinatal factors (OR=3.05, 95%CI:2.21 - 4.21), recurrent respiratory infections (OR=2.51, 95%CI:2.12 - 2.97), family history of TD (OR=4.86, 95%CI:2.98 - 7.93), corporal punishment (OR=2.78, 95%CI:1.73 - 4.47), poor dietary habits (OR=2.27, 95%CI:1.50 - 3.42), excessive screen time (OR=2.29, 95%CI:1.91-2.73), and single-parent/left-behind child/family disharmony (OR=2.44, 95%CI:1.53 - 3.89).The model score ranged from 0 to 80, with an AUC of 0.726 (95%CI:0.675 - 0.776).The optimal cutoff was 11 points, yielding 65.4% sensitivity and 70% specificity.The model demonstrated significant clinical net benefit within a 10% - 40% probability threshold. Conclusions This TD risk prediction scoring system based on Meta-analysis shows promising performance as a clinical assessment tool.However, further validation and refinement are warranted.

Efficacy of EEG biofeedback combined with methylphenidate hydrochloride in the treatment of childhood attention deficit hyperactivity disorder and its effect on cerebral blood flow and serum cortisol level

ZHANG Liwen, QIN Xing, LI Juan, SONG Zixia, WU Weiwei

2024, 32(10):  1135-1139.  DOI: 10.11852/zgetbjzz2023-0599

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Objective To explore the efficacy of EEG biofeedback(EF)combined with methylphenidate hydrochloride in the treatment of children with attention deficit hyperactivity disorder (ADHD) and its effects on cerebral blood flow and serum cortisol (COR) levels. Methods A total of 120 children with ADHD admitted to Nanchong Central Hospital from January 2020 to December 2022 were enrolled in this study, and were randomly divided into control group (n=60) and observation group (n=60) according to the random number table method. The control group was treated with methylphenidate hydrochloride tablets, while the observation group was treated with EFadditionally. Both groups were treated for 15 consecutive weeks. The clinical efficacy, scores of Chinese version of Swanson Nolan and Pelham Version Ⅳ Scale (SNAP-Ⅳ) and Questionnaire-Children with Difficulties (QCD), cerebral blood flow velocity [left middle artery (MCA-L), left anterior artery (ACA-L), left posterior artery (PCA-L)] and serum COR level before and after treatment were compared between the two groups. Results The total effective rate of the observation group was significantly higher than that of the control group (93.33% vs. 78.33%, χ²=5.551,P<0.05). After treatment, the scores of attention deficit (1.13±0.25 vs. 1.28±0.22), hyperactivity-impulsion (1.47±0.32 vs. 1.61±0.29) and oppositional defiance (0.96±0.17 vs. 1.12±0.17) in SNAP-Ⅳ in the observation group were significantly lower than those in the control group (t=3.489, 2.511, 5.155, P<0.05). After treatment, the QCD score (42.86±3.15 vs. 41.32±2.96), cerebral blood flow velocity [MCA-L:(58.63±3.11)cm/s vs. (57.04±4.78)cm/s; ACA-L:(49.57±3.97)cm/s vs. (48.24±3.21)cm/s; PCA-L:(39.74±3.82)cm/s vs. (38.05±4.0)cm/s] and serum COR level [(317.84±29.76)nmol/L vs. (283.92±30.54)nmol/L] in the observation group were significantly higher than those in the control group (t=2.760, 2.160, 2.018, 2.354, 6.162,P<0.05). Conclusions EF combined with methylphenidate hydrochloride is effective in the treatment of ADHD in children. It can significantly improve the core symptoms and social function of ADHD children. Improving cerebral blood flow velocity and serum COR level may be the mechanism of its efficacy.

Psychological and behavioral problems and the influencing factors of children with beta-thalassemia major

HUANG Xiuping, LU Qingmei, SHANG Xiufen, LUO Yanni, CHEN Yuke, HUANG Lianchun

2024, 32(10):  1140-1144.  DOI: 10.11852/zgetbjzz2024-0119

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Objective To investigate psychological and behavioral problems in children and adolescents with severe beta-thalassemia major (β-TM), and to analyze their influencing factors, so as to provide basis for targeted interventions to promote the psychological and behavioral health of β-TM patients. Methods A convenience sampling method was used to select 146 pediatric and adolescent patients with β-TM from the pediatrics department a tertiary general hospital in the border region of Guangxi, Yunnan, and Guizhou provinces between August 2022 and February 2023. Data were collected using a demographic questionnaire, the Conners′ Parent Symptom Questionnaire, the Simplified Coping Style Questionnaire, and the Parental Feeding Style Scale. Multivariate Logistic regression analysis was used to identify factors influencing the psychological and behavioral problems of these patients. Results Among the 146 β-TM patients, the total score of psychological and behavioral problems was 17.08 ± 13.62, with a detection rate of 39.0%. Multivariate Logistic regression analysis showed that protective factors of psychological and behavioral problems in β-TM children included age (13 -18 years old), parental education level of high school or above(senior high school/vocational school,college andabove), and emotionally warm parenting style(OR=0.778,0.730,0.802,0.703), while the risk factors included heavy economic burden due to the disease, migrant family status, negative coping styles of parents, and overprotective parenting style (P＜0.05). Gender, being an only child, and regular iron chelation therapy were not significantly associated with the occurrence of psychological and behavioral problems (P>0.05). Conclusion Psychological and behavioral problems are prominent among β-TM patients and are closely related to patient age, family structure, and parental education levels. Targeted interventions should be implemented to improve the psychological and behavioral health of these patients.

Pregnancy outcome of the fetus with omphalocele deformity

TENG Yunfei, DUAN Zhao, ZHANG Tingting, WANG Huiping, QI Yanhua, GUO Linqiong, LI Xiaopeng

2024, 32(10):  1145-1148.  DOI: 10.11852/zgetbjzz2023-1323

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Objective To analyze the pregnancy outcome of the fetus with omphalocele, so as to provide reference for clinical diagnosis, treatment and prognosis of the disease. Methods The data of 44 cases of fetal omphalocele diagnosed prenatal in two large Grade A hospitals in Xi′an were retrospectively analyzed. According to the size of the fetal omphalocele at birth, children were divided into two groups: omphalocele ≤5cm group (n=21) and omphalocele >5cm group(n=23) (50% - 75% of the liver was in the capsule). Data on pregnant women′s age, time of delivery, mode of delivery, whether there were other malformations, gestational weeks at delivery, birth weight of newborns, adverse neonatal outcomes, neonatal sex, neonatal hospitalization time, neonatal fasting time, whether there were pregnancy complications during pregnancy, and long-term follow-up of neonatal development were collected and analyzed. Results There was no significant difference between the two groups in age, gestational age, time of delivery, mode of delivery, complications during pregnancy, birth weight and newborn sex (P>0.05). Compared with the omphalocele ≤5cm group, the hospital stay and fasting time of neonates in the omphalocele >5cm group were longer, and the incidence of adverse outcomes was higher, with statistical significance (t=3.054,0.918,χ²=5.750,P<0.05). In the long-term follow-up, there were no significant differences in postoperative feeding difficulties, motor function, cognition, weight development, height development, behavior and the rate of second operation between the two groups (P>0.05). Conclusions Most newborns with omphalocele ≤5cm have a good prognosis. Attention should be paid to fetal health examination, and regular ultrasound should be performed during pregnancy to observe the development of fetal umbilical cord, and effective prevention and control measures should be taken to diagnose the malformation of omphalocele.

Appropriate Technology

Multidimensional executive function deficits in children with attention deficit hyperactivity disorder assessed by Cambridge Neuropsychological Test Automated Battery

DONG Chao, ZHANG Linlin, ZHONG Yunyu, LIU Yun, LIU Juan, WANG Peng, WANG Yufeng, YANG Binrang, WU Zhaomin, LI Ying

2024, 32(10):  1149-1154.  DOI: 10.11852/zgetbjzz2024-0355

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Objective To explore the validity of Cambridge Neuropsychological Test Automated Battery (CANTAB) in detecting executive function deficits in children with attention deficit hyperactivity disorder (ADHD), and to analyze the correlation among ADHD symptoms, intellectual level and executive function deficits. Methods A total of 441 children with ADHD in Children′s Care and Mental Health Center, Shenzhen Children′s Hospital were selected into this study from September 2017 toSeptember 2020, meanwhile 85 healthy children were enrolled as controls. All children were assessed using the continuous performance task, processing speed task, response inhibition task, and spatial working memory task from the CANTAB. The severity of ADHD symptoms was evaluated using the ADHD Symptom Rating Scale (parent version), behavioral problems in children with ADHD were assessed using the Conners′ Rating Scales, ana Covariance analysis was used to compare differences in executive function measures between the ADHD group and the control group. Partial correlation analysis was used to examine the correlations of the severity of ADHD symptoms with IQ indices and CANTAB measures. Mediation models were built to explore causal relationships among these measures. Results Compared with the control group, children with ADHD performed worse in all executive function domains, except for the RVPPFA (F= 4.46 - 25.90, P <0.05). There were no significant correlations between the ADHD core symptom severity and the executive function deficits (r: -0.017 - 0.13, P>0.05). However, IQ was significantly associated with executive function performances (r=-0.36 - 0.24, P <0.05). IQ served as an effective mediating factor for executive function impairments in children with ADHD(P<0.05). Conclusions CANTAB is a valid tool for detecting executive function deficits in children with ADHD. The executive function in ADHD children is affected by their IQ.

Case Report

Case report and literarure review of aldosterone synthase deficiency caused by CYP11B2 gene mutation

He Xiumei, Cao Wenqi, WU Honglin, Zhou Qifeng, HE Xiyu

2024, 32(10):  1155-1160.  DOI: 10.11852/zgetbjzz2023-1070

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