Search Results (582)

Recently, cognitive training programs using digital content with visuoperceptual stimulation have been developed and commercialized. In particular, digital intervention content for children with attention deficit hyperactivity disorder (ADHD) has been developed as games, enhancing motivation and accessibility for the target population. Active stimulation is required to elicit positive effects on self-regulation training, including attention control and impulse inhibition, through task-based content. Common forms of stimulation include emotional stimuli, such as praise and encouragement, and economic stimuli based on a self-directed token economy system. Economic stimulation can serve as active reinforcement because the child directly engages as the primary agent within the task content. This study applied and validated a token economy intervention using digital therapeutic content in children with ADHD. Behavioral assessments were conducted using the Comprehensive Attention Test (CAT) and the Korean version of the Child Behavior Checklist (K-CBCL). The developed digital intervention content implemented a user-centered token economy based on points within the program. In the CAT Flanker Task, the experimental group (0.84 ± 0.40) showed significantly higher sensitivity factor scores than the control group (0.72 ± 0.59) after 4 weeks, with a large effect size (F = 4.76, p = 0.038, partial η² = 0.150). Additionally, the rate of change in externalizing behavior scores on the K-CBCL showed a significant difference between the two groups (t = 2.35, p = 0.026, Cohen’s d = 0.860), demonstrating greater improvement in externalizing symptoms in the experimental group than in the control group. Therefore, this study suggests that the participant-centered implementation model using token economy mechanisms in digital intervention content may serve as a novel and effective therapeutic approach for children with ADHD. Full article

The integration of AI-powered plush robots in educational and therapeutic settings for children with Autism Spectrum Disorders (ASD) necessitates a robust interdisciplinary methodology to evaluate usability, psychological impact, and therapeutic efficacy. This study proposes and applies a four-phase research framework designed to guide the development and assessment of AI-powered plush robots for social rehabilitation and education. Phase 1 involved semi-structured interviews with 13 ASD specialists to explore robot applications. Phase 2 tested initial usability with typically developing children (N = 10–15) through structured sessions. Phase 3 involved structured interaction sessions with children diagnosed with ASD (N = 6–8) to observe the robot’s potential for rehabilitation, observed by specialists and recorded on video. Finally, Phase 4 synthesized data via multidisciplinary triangulation. Results highlighted the importance of iterative, stakeholder-informed design, with experts emphasizing visual properties (color, texture), psychosocial aspects, and adjustable functions. The study identified key technical and psychological evaluation criteria, including engagement, emotional safety, and developmental alignment with ASD intervention models. Findings underscore the value of qualitative methodologies and phased testing in developing child-centered robotic tools. The research establishes a robust methodological framework and provides preliminary evidence for the potential of AI-powered plush robots to support personalized, ethically grounded interventions for children with ASD, though their therapeutic efficacy requires further longitudinal validation. This methodology bridges engineering innovation with psychological rigor, offering a template for future assistive technology research by prioritizing a rigorous, stakeholder-centered design process. Full article

Background/Objectives: Maternal vitamin supplementation (including folic acid, vitamin D, and multivitamin supplements) during pregnancy may lower the likelihood of neurodevelopmental disorders in offspring. This study examines the associations between maternal vitamin suppletion during pregnancy and morphological patterns in offsprings’ brain structure and traits of Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) in a large population-based study of child development. Methods: The study cohort included a total of 3937 children (aged 9–11) participating in the Generation R cohort in Rotterdam, the Netherlands. Maternal vitamin D and folateserum levels, multivitamin supplement use, and overall dietary quality (as assessed by the Food Frequency Questionnaire, FFQ) during pregnancy were used as predictors. T1 structural MRI scans were acquired and segmented using Freesurfer to assess brain morphometry. Cortical and subcortical brain volumes of children were separated into four independent components and used as mediators. ADHD and ASD traits, as measured by parent-completed questionnaires (Child Behavior CheckList and Social Responsiveness Scale, respectively) were used as outcome variables. Results: Results show that (1) maternal vitamin D, multivitamin supplementation, and better diet quality were associated with fewer ADHD or ASD traits in the offspring; (2) vitamin D and diet quality were associated with larger-volume childhood brain components; (3) larger-volume brain components were associated with fewer ADHD and ASD traits; (4) part of the association between dietary factors in pregnancy and offspring ADHD and ASD traits was mediated through the brain volumes of the children. Conclusions: Though all observed effect sizes were small, further population-based research should be performed to further delineate the effects of gestational multivitamin and vitamin D exposure and investigate whether this may be an avenue for preventive interventions. Full article

Background/Objectives: The primary aim of this study was to describe all cases of fetal hemivertebrae diagnosed prenatally at the Hospital Clínico Universitario de Salamanca over the last 15 years. Additionally, the presence of associated malformations was assessed, pregnancy outcomes were evaluated, and child development results were analyzed in affected cases. Methods: We undertook a prospective observational analysis of all cases (N = 10) of prenatally diagnosed hemivertebrae at our hospital between 2007 and 2022. Postnatal follow-up was performed through telephone interviews and reviewing medical records. Results: Most cases were diagnosed during the second-trimester ultrasound, with the lumbar region being the most frequently affected site (60%). Multiple hemivertebrae were detected in 4 of 10 cases. One case of Marfan syndrome and two cases of VACTERL association (vertebral defects, anal atresia, tracheoesophageal fistula, renal dysplasia, and limb abnormalities) were documented. Six cases presented with additional malformations. Cases involving multiple hemivertebrae (40%) were more likely to be associated with other anomalies and poorer prognoses, while isolated single hemivertebra showed favorable outcomes, with normal development during childhood. Vaginal delivery occurred in six cases, while cesarean sections were performed for standard obstetric indications unrelated to the hemivertebra diagnosis. Conclusions: Prenatal diagnosis of hemivertebra is achievable and holds critical neonatal and postnatal relevance. Hemivertebrae are often linked to additional disorders, including genetic syndromes, and carry significant prognostic implications depending on the associated anomalies and the extent of vertebral involvement. Full article

Background/Objectives: In haematology, a wide range of blood disorders are hereditary. The thalassaemias are hereditary anaemias characterised by a high burden of disease at the public health level, challenging the resources of many health systems. This review focuses on thalassaemias for which many countries have developed screening and prevention programmes. To manage this heavy burden, two approaches were introduced over the years. The first one focused on reducing the annual affected births consequent to appropriate non-directive genetic counselling, offering to the parents the chance to make an informed choice concerning their reproductive lives. The second approach was related to the development of curative treatments such as haematopoietic stem cell transplantation (HSCT) in the early years, with continued ongoing efforts for improvements, followed by successful advances in gene-based holistic cures in more recent years. Genetic counselling is a vital component in successful prevention, aiming at informing individuals who are found to be carriers and couples who are both carriers with a 25% risk at every pregnancy of having an affected child in the case of recessive, Mendelian inheritance. The issues are many, and that may have to be discussed, highlighting the level of skills which a genetic counsellor is expected to possess and utilise appropriately in every counselling session. The concern is that such trained and skilled professionals are few in number and not well integrated into the multidisciplinary groups addressing the control of these complex disorders. It is our experience that for blood disorders, counselling is rarely in the hands of qualified scientists. It is our firm belief that it is necessary to incorporate genetic counselling as an integral part of haematology services. Methods: To investigate current practices we have drawn on the experience of existing programmes, as well as published literature. Results: Currently, in almost all haemoglobinopathy prevention programmes, counselling is offered by the clinicians in charge of clinical care or, in some settings, by the nurse of the clinic or the screening laboratory scientist. Conclusions: The Thalassaemia International Federation suggests and is in the process of developing special training in counselling as part of haematology training, as well as professional development modules for those already in practice. Considering the complexity of the issues that must be discussed, a multidisciplinary approach to counselling should be considered where possible. Full article

Background/Objectives: Autism spectrum disorder (ASD) is characterized by qualitative difficulties in interaction and communication, as well as hyper- or hypo-responsivity to sensory input, which can substantially challenge the formation of mother-child attachment. This study aimed to identify attachment levels among mothers of preschool-aged children with ASD and to delineate the attachment processes associated with those levels, with the goal of developing a grounded theory explaining these processes. Methods: A two-step study using methodological triangulation was conducted. In the first quantitative study, the attachment level of 64 mothers of children with ASD, under the age of 7 years in Korea, were measured. And 12 were selected for a second study using the grounded theory method of Strauss & Corbin. Results: A significant attachment difference (t = 4.39, p < 0.001) was found in the pregnancy plan. The core attachment category in mothers of pre-school children with ASD was identified as “keep on going with closing the distance”. Eight stages and four types were found in their attachment process. Conclusions: The results of this suggest that it is necessary to develop a personalized intervention strategy and to provide proper nursing by considering the attachment process and type of mothers of children with ASD. Full article

Background: Pediatric sepsis, a life-threatening condition, often progresses to septic shock. However, microbiological and clinical profiles between pediatric sepsis patients with and without septic shock remain underexplored. Methods: This retrospective cohort study included 1200 pediatric sepsis patients (Phoenix Sepsis Score ≥ 2) from the Children’s Hospital of Chongqing Medical University between June 2018 and June 2023. Pediatric sepsis patients with septic shock were diagnosed based on the Phoenix Cardiovascular Score being ≥1. Clinical data and pathogens were taken from the electronic medical records and analyzed. Univariate and multivariable logistic regressions were conducted to identify the risk factors for septic shock. Results: Septic shock patients had longer hospital stays (14.8 vs. 12.0 days, p = 0.003) and higher mortality (17.4% vs. 4.7%, p < 0.001) when compared to non-septic-shock patients. Among these two groups, the pathogen prevalence revealed that bacterial pathogens dominated (48.9%), followed by viruses (10.3%). Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus remained the predominant pathogens; Pseudomonas aeruginosa and Mycoplasma pneumoniae were also increased. Combination antibiotic therapy was most frequent in patients with viral and fungal sepsis (79% and 86.5%, respectively). Patients with fungal sepsis had significantly longer hospital stays than those with viral sepsis (20.74 vs. 12.97 days, p = 0.017). Multivariable analysis identified that elevated lactate (OR = 1.49, 95% CI = 1.29–1.75) and pulmonary infection (OR = 2.25, 95% CI = 1.35–3.73) were independent risk factors for septic shock. Conclusions: Children with septic shock had higher mortality and prolonged hospitalization, with distinct microbiological profiles when compared with patients in the non-septic-shock group. Elevated lactate and presence of pulmonary infection are independent risk factors for septic shock. Early recognition of high-risk patients and tailored antimicrobial strategies are critical for improving outcomes. Full article

Introduction: Secure infant/child–caregiver attachment is crucial for the development of social and emotional functioning and can affect long-term outcomes, such as adult relationships, but it may also be influenced by prenatal and early childhood risk factors. Children with a history of prenatal alcohol exposure (PAE) have a complex spectrum of strengths and difficulties and often have the additional risk of early life adversity. There is some evidence that children with PAE are at increased risk of insecure attachment, but it is unclear whether this is consistent or why it is the case. No published review has focused on the relationship between PAE and attachment. Methods: A systematic search of seven academic databases using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines was undertaken by two reviewers to identify primary studies that have focused on the relationship between PAE and attachment. Quality assessments were undertaken using the Quality of Observational Cohort and Cross-Sectional Studies tool, and the report was written following the PRISMA-ScR checklist. Results: A total of 4199 records were returned from the database searches. A total of 11 studies (eight peer-reviewed papers and three dissertations), published between 1987 and 2021, met the criteria. Five studies showed that PAE was related to insecure or disorganised attachment, two of which showed that infant irritability and caregiver–infant interaction mediated this relationship. The other six studies found no significant relationship between PAE and attachment. Conclusions: This scoping review demonstrates that there is a dearth of published research on this topic, and none that takes advantage of more recent understanding of the relationship between adverse childhood experiences and neurodevelopmental disorders. There is some evidence that PAE may impact the attachment relationship via caregiver–infant interaction and infant irritability, but further studies, including those that assess the additional impact of early life adversity, are needed. Full article

Alcohol consumption during pregnancy and lactation remains a significant global issue. Preventive policies have proven insufficient, and consumption rates remain high, mainly due to a lack of awareness, the misconception that only high alcohol intake harms the fetus, inconsistent medical advice, and pre-existing alcohol use disorders. Alcohol consumption is linked to child harm during critical stages of development. Using a recently published model of fetal alcohol spectrum disorder (FASD) developed by our group, we analyzed brain changes in mothers who consumed alcohol during pregnancy and lactation and the behavioral consequences at the emotional-cognitive level and in caring for their offspring. We also considered the previous drinking history, using the paradigm of voluntary pre-gestational alcohol consumption. In addition, from gestational day 7 (GD7) until the day of sacrifice, mothers received a 3 g/kg dose of alcohol every 12 h via gavage. Our findings revealed deficiencies in maternal care, anxiety and depressive-like behavior, and aversive stimulus learning disturbances. These were associated with changes in gene targets linked to stress-axis regulation, reward circuits, and neuroplasticity. Additionally, we observed increased microgliosis and astrogliosis, indicating neuroinflammation in brain regions involved in cognition and emotional states’ regulation. Full article

Background: While attention deficit/hyperactivity disorder (ADHD) is characterized by neurodevelopmental heterogeneity, the influence of familial structural factors—particularly parental age and skipped-generation caregiving—on comorbidity patterns remains insufficiently studied. This study examined the associations between parent–child age gaps, skipped-generation family structures, and psychiatric comorbidities in children with ADHD. Methods: Data came from Taiwan’s NHIRD (2009–2013), including 79,163 ADHD cases and 395,815 matched controls. Key variables included maternal and paternal age at childbirth and grandparent-paid insurance premiums as a proxy for skipped-generation caregiving. Conditional logistic regression was used to estimate odds ratios (ORs) for 20 psychiatric and developmental comorbidities. Results: Children with ADHD exhibited significantly higher odds of various comorbidities, including oppositional defiant disorder (OR = 147.05, 95% CI = 101.0–214.1), somatoform disorder (OR = 25.78, 95% CI = 7.96–83.46), anxiety disorder (OR = 24.49, 95% CI = 17.9–33.5), emotional disturbances during childhood and adolescence (OR = 13.99, 95% CI = 9.15–21.4), and autism spectrum disorder (OR = 8.07, 95% CI = 6.63–9.82). Advanced maternal age (>35 years) was associated with increased odds of autism spectrum disorder (OR = 1.47, 95% CI: 1.29–1.67) and speech/language delay (OR = 1.33, 95% CI: 1.17–1.52), whereas younger maternal age (≤25 years) was linked to higher odds of anxiety disorder (OR = 1.23, 95% CI: 1.13–1.33) and adjustment reaction (OR = 1.41, 95% CI: 0.95–2.11). Maternal age under 20 years showed the highest odds for bipolar disorder (OR = 2.01, 95% CI: 1.04–3.88). For paternal age, older age (>35 years) was associated with increased odds of autism (OR = 1.14, 95% CI: 1.04–1.26) and speech/language delay (OR = 1.15, 95% CI: 1.04–1.27), whereas paternal age ≤20 years was strongly linked to bipolar disorder (OR = 3.58, 95% CI: 1.54–8.32) and anxiety (OR = 1.39, 95% CI: 1.01–1.93). Children from skipped-generation families—defined as grandparent-paid insurance premiums without parental cohabitation—had significantly higher odds of bipolar disorder (OR = 2.88, 95% CI: 1.36–6.11), personality disorder (OR = 9.23, 95% CI: 2.23–38.20), adjustment reaction (OR = 2.23, 95% CI: 1.39–3.59), and emotional disturbances during childhood/adolescence (OR = 1.69, 95% CI: 1.13–2.54). Conclusions: Both extremes of parental age and skipped-generation caregiving are linked to specific associations with certain psychiatric comorbidity patterns in children with ADHD. These findings highlight the importance of integrating family structure into diagnostic assessments and treatment planning and support the development of targeted early interventions. Full article

Background/Objectives: The assessment of motor development in early ages is considered fundamental for the early identification of alarm signs that indicate the possibility of a child suffering from a developmental disorder. To this end, it is necessary to use reliable evaluation tools that have been specifically validated in the target population. The main aim of the current review was to examine the existing motor development assessment tools validated in Spanish populations of children aged 0–18 months. Methods: A systematic review was carried out following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) declaration criteria, and it was registered in PROSPERO. A bibliographic search was conducted in the PubMed, Scopus, Web of Science, and Cochrane databases, using terms related to motor development, assessment tools, and validation. The COSMIN verification list was employed to evaluate the quality of the included scales, and the QUADAS-2 instrument was used to analyse the quality of the included studies. Results: A total of 7 studies were included in the review, all of which were validation studies of motor development assessment tools in Spanish populations of children aged 0–18 months. Moreover, they all show heterogeneity with respect to their characteristics, such as target population, sample size, and metric properties. Conclusions: The present systematic review provides relevant information about the characteristics and methodological quality of motor development assessment tools validated in Spanish populations. There are currently very few of these evaluation tools, as well as limitations in regard to theories that support them, their metric properties, and the methodological quality of their validation studies. Therefore, we confirm the need for validating updated motor development tools to improve the detection, prognosis, and evaluation of children with developmental disorders or at risk of suffering from them. Full article

Childhood trauma has been associated with criminal behaviour and a variety of psychopathologies. Furthermore, it is known that emotional dysregulation (ED) predicts anxiety and depression and can be a product of traumatic experiences. In order to develop effective interventions for offenders’ rehabilitation and prevent recidivism, it is essential to fully understand their mental health and its relation with previous child trauma experiences and ED. This study involved a sample of 100 male inmates incarcerated in seven different prisons in the northern region of Portugal. The following measures were used: the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the International Trauma Questionnaire (ITQ), the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire (PHQ-9), and the Difficulties in Emotional Regulation Scale (DERS). Our findings suggest that individuals who experienced physical and sexual abuse are more likely to perpetrate violent crimes and that ED increases anxiety and depressive symptoms in individuals with traumatic symptoms. In conclusion, it is imperative to provide psychological support to this population, and interventions need to be adapted according to trauma exposure. Full article

Objectives. The aim of this study was to examine screen media use and the development and alteration of pre-existing mental health problems over the first year of the COVID-19 pandemic in a clinical sample of children and adolescents. Methods. A survey was conducted with over 650 parents of patients referred to child and adolescent psychiatry. Results. A worsening of the main mental health problem during the first year of the pandemic was reported more often (38%) by parents than an improvement (25%), a tendency even more pronounced for comorbid/secondary problems (worsening in 48%, improvement in 16% of cases). Girls in general, but especially between 14 and 18 years, more often showed a persistent deterioration of mental problems than boys. A negative impact of screen media use on their child’s mental health was reported most frequently by parents of a child affected by depression (50%), with acute crisis (52%), eating disorders (45%), and conduct disorder/aggression (40%). Patients with multiple/comorbid mental health problems presented significantly higher mean screen media times (5.53 h/day) than patients with a single mental problem (3.97 h/day), and their parents more frequently reported increased concerns about their child’s media use since the pandemic. Critical periods such as the lockdown or the “second wave” outbreak were characterized by higher media consumption in all patients, but with higher peaks in patients with multiple mental health problems. Conclusions. Particularly vulnerable patients, i.e., those with multiple mental problems and adolescent girls, have become more vulnerable in the course of the pandemic. From the perspective of most parents, screen media use has contributed to this development. Full article

Background: Food addiction is a new clinical entity that is beginning to be linked to obesity and eating disorders. The present study aims to investigate the association between the risk of food addiction in children and the presence of obesity. It also explores the relationship between food addiction, the development of eating disorders, and body image dissatisfaction. Material and methods: A matched case-control study was conducted in a Spanish pediatric population (cases have obesity, and controls have normal weight). The main outcome measures were evaluation of food addiction (S-YFAS-C), child feeding attitudes (ChEAT), and evaluation of body image (CDRS). Additionally, sociodemographic and anthropometric data were gathered. Results: A total of 62 children were evaluated (31 cases with age 11 ± 0.7 years and BMI Z-score 2.89 ± 1.33; 31 controls with age 10.7 ± 0.8 years and BMI Z-score −0.05 ± 0.52). For all items on the S-YFAS-C scale, significant differences were observed between the two groups (∧ = 0.252, p = 0.002). Food addiction was diagnosed in 32.3% of cases (2.06 ± 1.7 symptoms) and 22.6% of controls (1.61 ± 1.6 symptoms), although no statistically significant differences were observed between groups. A statistically significant correlation exists between all the scores of the scales studied in the children. Conclusions: Children with obesity have a higher number of food addiction symptoms compared to those with normal weight. In general, as food addiction scores increase, higher scores are observed for the risk of developing eating disorders and body image dissatisfaction. Full article

Technological innovation in immersive virtual reality is fostering the development of novel psychotherapeutic interventions in mental health, particularly benefiting populations with limited access to specialized services. This pilot study explores the feasibility, tolerability, and therapeutic potential of an immersive virtual reality-based psychotherapeutic intervention for adolescents and young people with eating disorders in a rural setting. A quasi-experimental pre-test/post-test design was used, with a control group (n = 5) and an experimental group (n = 5), applying weekly immersive virtual reality sessions focused on body perception and food exposure. Preliminary results showed good acceptance and a low incidence of cybersickness. However, a reduction in anxiety levels was observed in the experimental group after immersive virtual reality exposure, particularly in trait anxiety, suggesting a potential effect of the intervention on emotional regulation. While these changes were not statistically significant, the direction and magnitude of the effect warrant further investigation. Changes in body mass index were also noted during the intervention. The remotely guided sessions, conducted via fifth-generation mobile network connectivity, demonstrated technical feasibility and encouraging clinical outcomes, even in geographically isolated or underserved areas. These findings support the use of immersive VR as a complementary tool in the early stages of treatment for eating disorders, contributing to improved body perception and emotional self-regulation. This work not only reinforces the applicability of immersive technology in real-world clinical practice but also opens new avenues for the development of personalized, accessible, and emotionally meaningful interventions in child and adolescent mental health. Full article