Child Development

Galactocele, generally occurring in young women during or after lactation, is an extremely rare cause of breast mass in infants and children, particularly in males. Here, we report a 7-year and 5-month-old boy who had a painless mass at his left breast. The hormonal blood test revealed hyperprol actinemia, caused by minimum risperidone dosage. Our purpose was to emphasize the importance of including galactocele as a differential diagnosis in children receiving risperidone presented with breast mass. Furthermore, we would like to encourage establishing a standardized follow-up guideline for pediatric patients receiving this drug.

Objective: A 1-year, group-based, treatment program with parental involvement was conducted on 115 obese youths during 2006-2011. The intervention decreased obesity severity. The current study assessed the participants' long-term weight loss and obesity-related complications. Methods: Participants were invited for a single visit. Their weights, heights, and waist circumferences were measured and compared with corresponding figures at group-based treatment program completion. Factors associated with changed percentage weight-for-height (%W/H) were assessed. Results: There were 43 subjects, including 6 participating telephonically. The median follow-up duration was 5.8 years. %W/H, BMI, and waist circumference increased significantly (p = 0.012, 0.002, and 0.003, respectively). %W/H rose for 26 participants (60.5%; failed group) but declined or stabilized for 17 (39.5%; successful group). The successful-group exercise duration and frequency were significantly higher (p = 0.006 and 0.018, respectively). Three participants had type 2 diabetes, including 1 known case, all in the failed group. Newly-found obesity-related disorders were elevated transaminases (6 participants, with 5 from the failed group), elevated blood pressure (1 failed-group participant), and dyslipidemia (one from each group). Conclusion: Only 40% of the participants maintained long-term weight reduction. Regular exercise was associated with successful weight maintenance. Obesity-related complications were common in the failed group.

E xecutive functions (EFs) are a set of skills which manage and control thinking, emotions, and behaviors in new or complicated situations to achieve set goals. 1 The development of EFs starts in early childhood and continues until 20 to 25 years of age, and the most rapid EF development is from 3 to 5 years old. 2 EFs are extremely crucial in daily life, for good health and quality of life, learning ability, and life achievement, along with proper emotional, behavioral, and social functions in children. 3-5 Impairments in EFs lead to negative impacts in many ways, including physical health problems (obesity, hypertension, diabetes mellitus, and dyslipidemia) 6-9 , mental health problems (substance dependence, attention deficit hyperactivity disorder, depression, and obsessive-compulsive disorder) 10-14 , working and learning problems (learning disability, decreased productivity, and inability to maintain a job position) 15,16 , marriage problems (difficulty in maintaining good married life) 17 as well as threats toward public security (crimes, violence, negligent behaviors, and emotional outbursts). 18,19 As previously mentioned, executive dysfunctions which are frequently seen in pediatric psychiatric patients 9,20-25 include specific learning disorders, intellectual disability, autistic spectrum disorder, anxiety disorder, depressive disorder, and ADHD. ADHD is one of the most common mental disorders affecting children. Symptoms of ADHD include difficulty paying attention, hyperactivity, and impulsive behavior. ADHD is known to impact individuals in many areas of life including academic and professional achievements, interpersonal relationships, self-esteem, and social functions. 26 In the past, impaired EFs were considered to be the cause of ADHD symptoms and its negative consequences; however, at present, there is evidence that contradicts this. Therefore, the purpose of this review is to describe

Preschool children at risk of dyslexia show inadequate progress in their preliteracy skills; they often perform poorly in the domain of phonological awareness, letter knowledge, and rapid automatized naming. As a result, they tend to fall behind academically, specifically in reading, when they enter primary school. Because time is of the essence, early intervention becomes necessary to provide the best possible preliteracy outcome. To date, there has not been a study that investigates the effectiveness of early intervention in Thai, a language that is typologically and orthographically different from those in previous studies. In this preliminary study, training materials, created with phonological awareness and letter knowledge at the core, were presented via interactive Siriraj Pre-Literacy Enhancement software. In total, 73 typically developing preschoolers, aged 60 to 66 months, were enrolled. Preliteracy skills were measured by Rama Pre-Read (RPR). At-risk children received the 11-week computer-based early intervention training. After the intervention was completed, participants' preliteracy skills were evaluated by RPR (posttest). Sixteen children (21.9%) were at risk of dyslexia. Results after training indicated that preschool atrisk children of dyslexia in Thailand show a high magnitude of improvement in preliteracy skills, across all three domains. The computer-based early intervention to promote preliteracy skills is a feasible and effective form of remediation for Thai children at risk of dyslexia.

Cannabis is an herbal medicine that contains two essential cannabinoids: Cannabidiol (CBD) and Delta-9-Tetrahydrocannabinol (THC). CBD acts as an anti-inflammatory agent, helps improve sleep quality, and provides antiepileptic effects while THC has psychoactive effects and inhibits brain growth, especially in children and adolescents with developing brains. Currently, only pure CBD and CBD-enriched cannabis extracts are used in children and adolescents only for treating uncontrolled severe epilepsy. On the other hand, children and adolescents who use cannabis and cannabis products containing a large amount of THC can experience physical, mental health, and cognitive problems. Physical symptoms of cannabis use include restlessness or lethargy, abdominal pain, and severe nausea and vomiting while mental health issues are depression, anxiety, suicidal thoughts and behaviors, and severe aggressive behavior. Additionally, the use of cannabis also has negative impacts on cognitive functions and learning processes which include decreased cognitive levels, poor memory, and impaired executive functions, leading to failure in future academic and work performances. Therefore, all healthcare professionals should provide accurate information about cannabis to parents, children, and adolescents to prevent the adverse effects of cannabis use in children and adolescents after the implementation of "cannabis legalization."

This preliminary study aims to evaluate health literacy among bisexual men living with HIV. MATERIALS AND METHODS: A cross-sectional survey was conducted among 26 adult bisexual male HIV-infected patients in the HIV Clinic from October 2021 to May 2022. We applied the Thai version of the HIV-HLT to investigate health literacy among bisexual men living with HIV. RESULTS: The average age of the participants was 41.34 ± 12.41 years. 61.5% were single and 34.6% had divorced marital status. 50% had finished their bachelor degrees. Approximately half of the participants had been diagnosed with HIV infection for more than 5 years. 57.7% had adequate HIV health literacy and 26.9% had inadequate HIV health literacy, respectively. The laboratory outcome showed that 96.2% had a CD4 count of more than 200 cells/cm 3 and 76.9% had a viral load of less than 20 copies/ ml. CD4 and viral load were not associated with the level of health literacy. However, all participants had no previous history of opportunistic infections within the past 6 months. CONCLUSION: Most bisexual men living with HIV have adequate health literacy. The level of health literacy is not associated with CD4 and viral load. However, opportunistic infections within the past 6 months are not reported. Therefore, a Thai version of HIV-HLT may be applied to measure health literacy among bisexual men living with HIV and could be a potential for clinical use.

This study aims to describe the relation between media use characteristics and executive dysfunction in Thai preschoolers. Secondary data were retrieved from a cross-sectional study to compare twoThai executive functions (EFs) assessment forms. Questionnaire data from 110 caregivers of preschool children were analyzed. The research materials included a sociodemographic information form, parenting style and dimensions questionnaire, a 1-week screen time diary, and the behavior rating inventory of executive function-preschool version (BRIEF-P). Findings showed a 23.6% prevalence of executive dysfunction among Thai preschool children. Children’s media use characteristics associated with global executive dysfunction included less co-viewing time with caregivers. Shorter co-viewing time was linked to a deficiency of inhibition, emotional control, and planning and organization. Meanwhile, extended viewing of low-quality content was associated with impaired working memory. However, total screen time and setting screen time limits were not associated with executive dysfunction. Co-viewing with caregivers and limiting exposure to low-quality content must be promoted to minimize the adverse effects on EF development.

Objective: This study examined the correlation between primary caregivers' psychosocial factors and self-esteem in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Materials and Methods: A cross-sectional study involving primary caregivers and their children with ADHD, aged 8-15, was conducted from September 2022 to February 2023. The children's self-esteem was assessed using the Five-Scale Test of Self-Esteem for Children. Primary caregivers' psychosocial factors were assessed using the Attitude of Parenting Questionnaire, Parenting Style and Dimension Questionnaire, Patient Health Questionnaire-9, and Generalized Anxiety Disorder 7-item. Descriptive statistics and multivariable linear regression were used to determine the associations among variables. Results: The study included 66 pairs of children and adolescents with ADHD and their primary caregivers. The study found 53% of caregivers screened positive for depression, while 16.7% screened positive for anxiety. Almost all caregivers (90.9%) adopted an authoritative parenting. The mean self-esteem score in participants with ADHD was 39.23±8.99. Younger caregivers, those with an education level below a bachelor's degree, higher monthly income, positive screening for depression, and lower attitudes toward parenting scores were significantly associated with low self-esteem scores in their children. Conclusion: Age, education level of caregivers, and monthly family income were significantly correlated with the self-esteem of children and adolescents with ADHD. The attitudes of caregivers towards parenting and depression in caregivers also impacted self-esteem of children with ADHD under their care. Thus, strategies aimed at promoting positive caregiving attitudes, regular screening of caregivers for depression, and providing appropriate treatment are recommended to enhance self-esteem in children and adolescents with ADHD.

This study aims to describe the relation between media use characteristics and executive dysfunction in Thai preschoolers. Secondary data were retrieved from a cross-sectional study to compare two Thai executive functions (EFs) assessment forms. Questionnaire data from 110 caregivers of preschool children were analyzed. The research materials included a sociodemographic information form, parenting style and dimensions questionnaire, a 1-week screen time diary, and the behavior rating inventory of executive function-preschool version (BRIEF-P). Findings showed a 23.6% prevalence of executive dysfunction among Thai preschool children. Children's media use characteristics associated with global executive dysfunction included less co-viewing time with caregivers. Shorter co-viewing time was linked to a deficiency of inhibition, emotional control, and planning and organization. Meanwhile, extended viewing of low-quality content was associated with impaired working memory. However, to...

This study aimed to investigate the prevalence of at-risk of dyslexia and its risk factors in Thai preschoolers. Our results found a relatively high prevalence of at-risk of dyslexia preschoolers (22.14%). Family socioeconomic status, family history of learning difficulties, and the child's language development were risk factors for this condition.

Objective: Psychological comorbidity in children with enuresis is common and its screening is recommended. A brief validated screening instrument is needed for a busy medical practice. This study focused on the development of the Thai Behavioral and Emotional Screening Tool for children with Enuresis (TBEST-E) and aimed to examine its psychometric properties. Materials and Methods: Using the Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE) as a template, the 15-item with a yes/no answer format of the TBEST-E was developed for the screening of emotional problems (7 items), attention and hyperactivity/impulsivity problems (3 items each), and oppositional defiant symptoms (2 items). The parents of the children with enuresis completed the TBEST-E and the behavioral rating scale "Thai Youth Checklist" (TYC). The optimal cutoff for further assessment, the sensitivity, and the specificity the TBEST-E were identified using receiver operating characteristic (ROC) curves. Results: After an adaptation following comments from three child psychiatrists, the TBEST-E showed a content validity of 0.9, an internal consistency of 0.71. A total of 33 children with enuresis (median age = 9, interquartile range = 6.5-11 years) were recruited. Further assessment was indicated when one of the following occurred; at least 3 emotional problems; 3 attention problems; or 2 hyperactivity/impulsivity together with 2 oppositional defiant symptoms. The overall sensitivity and specificity were 0.88 and 0.71 respectively with the accuracy of 0.84 (95% CI = 0.68-0.95). Conclusion: The TBEST-E is time-efficient and has acceptable psychometric properties in early detection of common psychological problems in children with enuresis.

Objective: This study aimed to determine the average age at diagnosis and the characteristics associated with the age of children at the diagnosis of autism spectrum disorder (ASD) at Sawanpracharak Hospital. Materials and Methods: A retrospective cross-sectional study was conducted from May 2023 to July 2023. Data were collected from the medical patient files of all children diagnosed with ASD between 2020 to 2022. Descriptive analysis was used to examine the characteristics of the children and their caregivers, and the children's age at diagnosis. Factors associated with the age at diagnosis were assessed by chi-square test analysis. Results: In total, 100 patient records with complete information were collected. The average age at the diagnosis of ASD was 4.57± 1.61 years old, with 60% of the patients diagnosed after four years of age. Social communication deficit symptoms, including non-response to name and lack of pointing out objects of interest, were significantly associated with an early ASD diagnosis (p-value = 0.023 and 0.002, respectively). Being a firstborn child and the presence of delayed development were found to delay the diagnosis of ASD meaning it occurred at a later age (p-value = 0.002 and 0.019, respectively). However, sex, the caregiver's education, and socioeconomic status were not related to the age at diagnosis. Conclusion: Most children with ASD who received treatment at Sawanpracharak Hospital were diagnosed late. Being a firstborn child, poor response to name being called, lack of pointing out objects of interest, and delayed development were related to the age of the children at ASD diagnosis. Differences in diagnostic age based on sociodemographic and clinical characteristics indicate the need for coordinated measures for the early detection of ASD.

Objective: Burnout syndrome causes chronic fatigue, loss of motivation, despair, decreased work performance, and depression. Clinical medical students risk developing burnout syndrome due to long-term learning pressure, responsibilities for patient care and night shifts. This study aimed to examine the factors associated with burnout syndrome among clinical medical students at Chonburi Hospital. Material and Methods: A cross-sectional study was conducted from July 2022 and January 2023. Data were collected using the Maslach Burnout Inventory General Survey among 106 medical students. Descriptive statistics, chi-square, ANOVA, and the independent t-test were used to investigate the association among variables. Results: Severe burnout syndrome was not found among clinical medical students. High emotional exhaustion was the most common burnout symptom among these medical students (53.8%). While 27.3% had high depersonalization, no medical students had low personal accomplishment. The factor related to high emotional exhaustion was 4 th-year medical students. At the same time, the factors associated with high depersonalization were fourth-year medical students, males, and low accumulated grade point averages (GPAX). Conclusion: The prevalence of severe burnout was not found among clinical medical students at Chonburi Hospital. However, males, fourth-year medical students, and low GPAX were risk factors for burnout symptoms. Therefore, screening, monitoring, and providing help to these at-risk medical students to reduce their chances of severe burnout should be encouraged.

Abnormal swallowing in children is common in pediatric practice, especially in the children with neurological or developmental disorder. The symptoms include frequent choking or coughing during swallowing. In addition, there may be dyspnea caused by airway obstruction, aspiration, and recurrent pneumonia. The healthcare providers who care for children with suspected swallowing problems need to understand the child's age-related eating development and normal swallowing processes. A thorough history taking, including symptoms, age-appropriate diet, and feeding posture, is essential. A child suspected of having a swallowing problem requires a thorough physical examination, especially the oral cavity, and observing symptoms while eating. Additional investigations such as videofluoroscopic swallowing study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES) may be performed where the cause of swallowing problems cannot be determined through history and physical examination. Besides treating the cause of swallowing problems in children, adjusting the texture of diet and eating posture is a necessary additional treatment to reduce complications that may arise if aspiration occurs again.

To identify risk factors affecting developmental delays in early childhood in Lampang Province to develop monitoring processes and promote age-appropriate development for children at risk of developmental delays. Methods: This retrospective case-control study collected data from the medical patient files of children with developmental delays whom developmental and behavioral pediatricians diagnosed and typically developing children born at the same time as children with developmental delays in Lampang Hospital, from 2 months to 5 years of age, from 1 January 2020 to 31 December 2021. Biological risk factors affecting developmental delay were identified by using multivariate risk difference regression analysis. Results: A total of 447 children were recruited for this study, divided into 149 children with developmental delays and 298 with typical development. Among children with delayed development, 57% have delayed language development. After risk difference regression analysis, the biological risk factors that were significantly associated with delayed development included males, history of birth asphyxia, microcephaly, more than five hospitalization days in the neonatal intensive care unit, hearing loss, malnutrition, twin pregnancy, maternal anemia, and maternal chorioamnionitis. Conclusion: Biological risk factors that affect developmental delays in children include maternal illness and malnutrition during pregnancy, perinatal complications, and children's illness and nutritional status. Certain risk factors can be monitored and prevented to reduce developmental delays in early childhood. In addition, recognizing the risk factors for developmental delays can lead healthcare providers and parents to closely monitor developmental problems and promote the development of children with these risk factors from birth.

Objective: This study examined the correlation between primary caregivers' psychosocial factors and self-esteem in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Materials and Methods: A cross-sectional study involving primary caregivers and their children with ADHD, aged 8-15, was conducted from September 2022 to February 2023. The children's self-esteem was assessed using the Five-Scale Test of Self-Esteem for Children. Primary caregivers' psychosocial factors were assessed using the Attitude of Parenting Questionnaire, Parenting Style and Dimension Questionnaire, Patient Health Questionnaire-9, and Generalized Anxiety Disorder 7-item. Descriptive statistics and multivariable linear regression were used to determine the associations among variables. Results: The study included 66 pairs of children and adolescents with ADHD and their primary caregivers. The study found 53% of caregivers screened positive for depression, while 16.7% screened positive for anxiety. Almost all caregivers (90.9%) adopted an authoritative parenting. The mean self-esteem score in participants with ADHD was 39.23±8.99. Younger caregivers, those with an education level below a bachelor's degree, higher monthly income, positive screening for depression, and lower attitudes toward parenting scores were significantly associated with low self-esteem scores in their children. Conclusion: Age, education level of caregivers, and monthly family income were significantly correlated with the self-esteem of children and adolescents with ADHD. The attitudes of caregivers towards parenting and depression in caregivers also impacted self-esteem of children with ADHD under their care. Thus, strategies aimed at promoting positive caregiving attitudes, regular screening of caregivers for depression, and providing appropriate treatment are recommended to enhance self-esteem in children and adolescents with ADHD.