Daniel Fung
Institute of Mental Health, Child and Adolescent Psychiatry, Faculty Member
Suicidality encompasses suicidal ideation, plans, and attempts. This paper aims to establish associations between suicidality and sociodemographic variables, physical disorders, and psychiatric disorders. The Singapore Mental Health Study... more
Suicidality encompasses suicidal ideation, plans, and attempts. This paper aims to establish associations between suicidality and sociodemographic variables, physical disorders, and psychiatric disorders. The Singapore Mental Health Study 2016 was a population-level epidemiological survey, which determined the prevalence of physical disorders, psychiatric disorders, and suicidality. Questionnaires were used to determine socio-demographic information. A total of 6216 respondents were interviewed. Lifetime prevalence of suicidal ideation, planning, and attempts were 7.8%, 1.6%, and 1.6%, respectively. All components of suicidality were more likely in those with major depressive disorder, bipolar disorder, generalized anxiety disorder, alcohol use disorder, and chronic pain. Suicidal ideation and attempts were more likely in those with diabetes. Age above 65, being male, and a monthly household income of ≥ SGD 10,000 were associated with a lower likelihood of suicidal ideation. These f...
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Attention Defi cit Hyperactivity Disorder (ADHD) is a modern day paradox. From its descriptions of being an untreatable moral defect,1 often associated with antisocial behaviour, to its current acceptance as a treatable neurodevelopmental... more
Attention Defi cit Hyperactivity Disorder (ADHD) is a modern day paradox. From its descriptions of being an untreatable moral defect,1 often associated with antisocial behaviour, to its current acceptance as a treatable neurodevelopmental disorder that has a lifelong impact, it is one of the most prevalent childhood psychiatric disorders. A recent meta-analysis estimated the worldwide prevalence of ADHD to be 5.29%.2 A survey of 2400 children aged 6 to 12 years in Singapore showed that 4.9% had disruptive behaviour disorders by parent ratings.3 The importance of ADHD in modern society lies in its impact on academic, social and occupational development. A burden of disease study conducted by the Ministry of Health, Singapore placed ADHD as the third highest contributor of Disability Adjusted Life Years (DALYs) in the 10 to 16 age group.4 This burden is likely to be carried into adulthood and beyond. Yet in a survey of 48 family physicians in Singapore, knowledge about ADHD was found ...
Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it is also currently being used for the treatment of other psychopathologies. In fact, cognitive bias modification has been especially... more
Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it is also currently being used for the treatment of other psychopathologies. In fact, cognitive bias modification has been especially well-investigated amongst children and adolescents. A recent review suggests some evidence for the modification of interpretative biases amongst children with neurodevelopment disorders. There have since been other studies reporting of the existence of other cognitive biases, such as emotional biases, amongst individuals with attention deficit hyperactivity disorder (ADHD). This perspective article will discuss the epidemiology of ADHD and the nature of emotional biases that are present amongst individuals with ADHD. This perspective article also reviewed some of the studies that have assessed and modified emotional biases in individuals with ADHD. A total of three studies have been identified from the published literature that provide evidence for targeting ...
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BackgroundCOVID-19 has stressed healthcare systems and workers worldwide. GPs, as first points of contact between suspected cases and the healthcare system, have assumed frontline roles in this crisis. While the prevalence of mental... more
BackgroundCOVID-19 has stressed healthcare systems and workers worldwide. GPs, as first points of contact between suspected cases and the healthcare system, have assumed frontline roles in this crisis. While the prevalence of mental health problems and illnesses arising in healthcare workers (HCWs) from tertiary care settings during the COVID-19 pandemic is well-examined,1 the impact on GPs remains understudied.AimTo describe the prevalence and predictors of anxiety, burnout, depression, and post-traumatic stress disorder (PTSD) among GPs during the COVID-19 pandemic.Design & settingSurvey of GPs operating in Singapore primary care clinics.MethodGPs completed a survey that comprised of four validated psychometric instruments. Open-ended questions asked about responders’ challenges and their envisaged support. Data were analysed with multiple logistic regression with demographic data as covariates; concepts of grounded theory were used to analyse the qualitative responses.ResultsA to...
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Front-line doctors are at high risk of exposure to COVID-19. The mental resilience of general practitioners and their areas of concerns and support required are important during this COVID-19 period. A total of 403 general practitioners... more
Front-line doctors are at high risk of exposure to COVID-19. The mental resilience of general practitioners and their areas of concerns and support required are important during this COVID-19 period. A total of 403 general practitioners attending a webinar on resiliency, hosted by the College of Family Physicians, Singapore, participated in the survey anonymously. Participants provided responses to questions relating to COVID-19 in the domains of Family and friends, Myself, Practice, and Community. Responses are categorized into LEARNING, FEAR, and GROWTH zones. The majority of the doctors reported to be in the GROWTH zone in relation to Family and friends (39%) and Myself (38%) as compared to Practice and Community, aOR = 4.5 (95% CI 3.4 to 5.9), p < 0.001. 34% of the participants reported being in the FEAR zone in relation to Family and friends, aOR = 8.0 (95% CI = 5.6 to 11.2), p < 0.001; at least 81% reported being in the LEARNING zone in relation to Practice and Community...
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This study aims to understand (a) the prevalence and correlates of smoking in a psychiatric population, (b) factors that encourage smoking cessation, and (c) awareness towards cessation programmes. This study captured data (n = 380)... more
This study aims to understand (a) the prevalence and correlates of smoking in a psychiatric population, (b) factors that encourage smoking cessation, and (c) awareness towards cessation programmes. This study captured data (n = 380) through a modified version of the Global Adult Tobacco Survey (GATS). A descriptive analysis of the data was performed. The prevalence of smoking was 39.5% (n = 150) and 52.3% of the smokers were dependent on nicotine. More than half of the smokers had made at least one attempt to quit in the past 12 months and 56% reported no immediate plans to quit smoking. The awareness towards institutional smoking cessation programmes was fair (44%), with 49.7% of smokers having indicated that they were willing to use the service upon referral. Smokers endorsed that increasing the cost of cigarettes, restricting availability, and increasing knowledge of health harms could encourage smoking cessation. Past smokers reported that self-determination/willpower followed b...
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Introduction: Advances in experimental psychology have led to a better understanding of automatic, unconscious processes, referred to as attentional biases. Despite the growing evidence from meta-analytical studies, we still do not... more
Introduction: Advances in experimental psychology have led to a better understanding of automatic, unconscious processes, referred to as attentional biases. Despite the growing evidence from meta-analytical studies, we still do not understand why some individuals have a greater magnitude of these biases, and why others have none. There has been little focus on elucidating individual differences and task parameters that affect the overall magnitude of the biases. In this opinion piece, we will attempt to identify these. We will then discuss both the research and clinical implications. Methods and Analysis: To identify the factors that modulated the magnitude of attentional biases across all the substance disorders (i.e., opioid use, cannabis use, and stimulant-use disorders), we performed a search using the bibliographic databases PubMed and MEDLINE. The search terminologies “attention bias” or “cognitive bias” or “approach bias” or “avoidance bias” were used when we looked for relev...
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Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, there is an increase in the number of individuals abusing opioids. The advances in experimental psychology have highlighted the need to modify... more
Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, there is an increase in the number of individuals abusing opioids. The advances in experimental psychology have highlighted the need to modify unconscious, automatic biases. These automatic, unconscious biases result in individuals having preferential attention to substance-related cues in their natural environment, thus leading to a slip or relapse back into their underlying addictive disorders. Prior studies have demonstrated not only the presence of robust attentional biases amongst individuals with opioid use disorder, even when maintained on methadone; and the effectiveness of bias modification amongst these individuals. There remains limited evaluation of attention bias modification amongst a treatment-seeking cohort of Asian individuals. The objective of this pilot is to ensure that the methods of the planned definitive randomized trial could be conducted. Methods and Analysis: A non-...
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Advances in experimental psychology have provided evidence for the presence of attentional and approach biases in individuals with substance use disorders. Traditionally, reaction time tasks, such as the Stroop or the Visual Probe Task,... more
Advances in experimental psychology have provided evidence for the presence of attentional and approach biases in individuals with substance use disorders. Traditionally, reaction time tasks, such as the Stroop or the Visual Probe Task, are commonly used in the assessment of attention biases. The Visual Probe Task has been criticized for its poor reliability, and other research has highlighted that variations remain in the paradigms adopted. However, a gap remains in the published literature, as there have not been any prior studies that have reviewed stimulus timings for different substance use disorders. Such a review is pertinent, as the nature of the task might affect its effectiveness. The aim of this paper was in comparing the different methods used in the Visual Probe Task, by focusing on tasks that have been used for the most highly prevalent substance disorders—that of opiate use, cannabis use and stimulant use disorders. A total of eight published articles were identified ...
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OBJECTIVEWe report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its... more
OBJECTIVEWe report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.SETTINGA 2,000-bed tertiary-care psychiatric hospital.METHODSActive surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)-based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.RESULTSThe study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1-C3). Clu...
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Research on attentional bias modification has increased since 2014. A recent meta-analysis demonstrates evidence for bias modification for substance disorders, including alcohol and tobacco use disorders. Several pharmacological trials... more
Research on attentional bias modification has increased since 2014. A recent meta-analysis demonstrates evidence for bias modification for substance disorders, including alcohol and tobacco use disorders. Several pharmacological trials have shown that pharmacological agents can attenuate and modify such attentional bias. The pharmacological trials that have appeared to date have produced mixed results, which has clinical implications. Developments in Internet and mobile technologies have transformed how attention bias modification is currently being achieved. There remains great potential for further research that examines the efficacy of technology-aided attention bias interventions.
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To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were... more
To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were analysed. A review of services provided is also included. Adolescent mental health usage has been on an increase with a rise in the number of cases diagnosed with depression. There has also been an increase in the number of forensic cases seen in the department. There is a growing demand for adolescent mental health services. As the demands and stresses on today's youth increase, there is likely to be a continued increase in the demand for such services. The challenge in the future is to provide adolescent mental health services in cost-effective packages that will meet the needs as well as stay financially viable.
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The aims of this paper were: to study the profile of trichotillomania cases referred to a child guidance clinic in Singapore, to identify potential risk factors and to study the management and outcome of these cases. This is a... more
The aims of this paper were: to study the profile of trichotillomania cases referred to a child guidance clinic in Singapore, to identify potential risk factors and to study the management and outcome of these cases. This is a descriptive, retrospective study of all cases of trichotillomania presenting to the clinic between January 1996 and January 1998. There were 7 cases seen in a 2-year period which is less than 1% of new cases seen at the clinic. The female to male ratio was 1.33:1 with a mean age of 9.3 years. All cases met the DSM-IV criteria for trichotillomania. All 6 pulled their hair in tufts with 1 who was almost hairless. Associated problems included tics, nail-biting, anxiety and shortness of temper. Treatments included behavioural treatment, stress management, parental education and counselling as well as medications. Two improved and were discharged, with 3 still undergoing treatment and 2 defaulted follow-up. The 7 cases seen in Singapore are similar in clinical feat...
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Research Interests: Primary Health Care, Evidence Based Medicine, Family Medicine, Health Care, Infertility, and 15 moreMedicine, Clinical Practice, Humans, Child, Female, Male, Christian Ministry, Alternative Medicine, Caregivers, Parents, Methylphenidate, Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, guidelines as topic, and Medical and Health Sciences
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Research Interests: Clinical Psychology, Cognitive Behavioral Therapy, Autism, Cognition, Adolescent, and 15 moreAnxiety, High Functioning Autism, Child Behavior, Humans, Child, Female, Cognitive Therapy, Cognitive behavior therapy, Child Psychiatry, Autism Spectrum Disorder, Clinical Sciences, Children and Adolescents, ANXIETY, Asperger Syndrome, and Behavioral symptoms
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It is the aim of the current research to identify some common functionalities of postnatal application, and to determine the quality of the information content of postnatal depression application using validated scales that have been... more
It is the aim of the current research to identify some common functionalities of postnatal application, and to determine the quality of the information content of postnatal depression application using validated scales that have been applied for applications in other specialties. To determine the information quality of the postnatal depression smartphone applications, the two most widely used smartphone application stores, namely Apple iTunes as well as Google Android Play store, were searched between 20May and 31 May. No participants were involved. The inclusion criteria for the application were that it must have been searchable using the keywords 'postnatal', 'pregnancy', 'perinatal', 'postpartum' and 'depression', and must be in English language. The Silberg Scale was used in the assessment of the information quality of the smartphone applications. The information quality score was the primary outcome measure. Our current results highlighte...
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OBJECTIVES: We aimed to measure the prevalence and length of the problem of pathological video gaming or Internet use, to identify risk and protective factors, to determine whether pathological gaming is a primary or secondary problem,... more
OBJECTIVES: We aimed to measure the prevalence and length of the problem of pathological video gaming or Internet use, to identify risk and protective factors, to determine whether pathological gaming is a primary or secondary problem, and to identify outcomes for individuals who become or stop being pathological gamers. METHODS: A 2-year, longitudinal, panel study was performed with a general elementary and secondary school population in Singapore, including 3034 children in grades 3 (N = 743), 4 (N = 711), 7 (N = 916), and 8 (N = 664). Several hypothesized risk and protective factors for developing or overcoming pathological gaming were measured, including weekly amount of game play, impulsivity, social competence, depression, social phobia, anxiety, and school performance. RESULTS: The prevalence of pathological gaming was similar to that in other countries (∼9%). Greater amounts of gaming, lower social competence, and greater impulsivity seemed to act as risk factors for becomin...
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Research Interests: Mental Health, Medicine, Anxiety, Humans, Child, and 15 moreFemale, Male, Checklist, Childhood Mental Health, Adult, CBCL, Educational Status, ANXIETY, Cross Sectional Studies, Behavioural Problems, Child Behavior Checklist, Child behavior disorders, Affective symptoms, Emotional problems, and Medical and Health Sciences
Background : Studies on gender differences in attention-deficit/ hyperactivity disorder (ADHD) comorbidities in the Asian populations have been limited and previous studies have shown inconclusive findings. Singapore is a city-state... more
Background : Studies on gender differences in attention-deficit/ hyperactivity disorder (ADHD) comorbidities in the Asian populations have been limited and previous studies have shown inconclusive findings. Singapore is a city-state country in Southeast Asia with a population of 5.7 million. This study examined gender differences in internalizing and externalizing problems in Singaporean children and adolescents with ADHD. The plausible social factors underlying the gender differences were discussed. Methods : A total of 773 participants (aged 6 to 18, 88% males) newly diagnosed with ADHD were recruited from the only public child and adolescent psychiatric center in Singapore. Their internalizing and externalizing problems were assessed using the Child Behavioral Checklist and Teacher’s Report Form by parents and teachers respectively. Demographics and relevant social factors were collected using parent questionnaires. Results : Females with ADHD were reported to have less delinquen...
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Stigma against mental illnesses is one of the significant obstacles faced by mental health service users and providers. It can develop at a young age and is also influenced by culture. Youths in Southeast Asian countries are... more
Stigma against mental illnesses is one of the significant obstacles faced by mental health service users and providers. It can develop at a young age and is also influenced by culture. Youths in Southeast Asian countries are under-represented in mental health research, thus this study aims to explore the dimensions of stigma and social tolerance and examine its correlates in the younger, multiethnic population of Singapore. An online survey collected data with sociodemographic questions, the Attitudes Towards Serious Mental Illness (Adolescent version) Scale, Social Tolerance Scale and an open-text question on words or phrases participants associated with the term 'mental illness'. Principal component analysis and multiple regression models were conducted to investigate the factor structure of the attitudes and social tolerance scales and their sociodemographic correlates. Participants included 940 youths aged 14-18 years old who were residing in Singapore at the time of the...
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In recent decades, there have been concerted efforts to improve mental health services for youths alongside the challenges of rising healthcare costs and increasing demand for mental health needs. One important phenomenon is the shift... more
In recent decades, there have been concerted efforts to improve mental health services for youths alongside the challenges of rising healthcare costs and increasing demand for mental health needs. One important phenomenon is the shift from traditional clinic-based care to community-based mental health services to improve accessibility to services and provide patient-centred care. In this article, we discuss the child and adolescent community mental health efforts within the Asia-Pacific region. We also discuss Singapore's community and school-based mental health service, known as the Response, Early Intervention and Assessment in Community Mental Health (REACH). This article discusses how REACH has evolved over the years in response to the changing needs of youths in Singapore. Finally, we discuss the current challenges and future directions for youth mental health care.
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Studies investigating neurocognitive deficits in youth with conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD) are often confounded by the high rates of comorbidity between the two. Neurocognitive functioning was... more
Studies investigating neurocognitive deficits in youth with conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD) are often confounded by the high rates of comorbidity between the two. Neurocognitive functioning was examined in three diagnostic groups (ADHD only, CD only, comorbid ADHD and CD) matched by age, sex, IQ, and medication status (n=28-32 per group). No significant differences emerged between the diagnostic groups on measures of risk-taking or response inhibition. Children with CD performed better on a measure of spatial planning than those with comorbid ADHD and CD, and dimensional analyses in the full sample (n=265) revealed a small association between ADHD symptoms and poorer spatial planning. These results suggest that deficits in spatial planning may be more pronounced in individuals with ADHD, but that the neurocognitive functioning of youth with noncomorbid and comorbid CD and ADHD are largely similar.
Research Interests: Psychology, Clinical Psychology, Psychiatry, ADHD (Psychology), Cognition, and 15 moreRisk Taking, Adolescent, Medicine, Comorbidity, Neurocognitive, Humans, Child, Female, Male, Conduct Disorder, Neurocognitive development, Clinical Sciences, Spatial Behavior, Attention deficit disorder with hyperactivity, and Attention deficit hyperactivity disorder
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Research Interests: Psychology, Psychiatry, Education, Social Work, Epidemiology, and 14 moreMental Health, Mental Health Service Access, Forensic psychiatry, Singapore, Medicine, Human, Review, Child and Adolescent Psychiatry, Child Psychiatry, Community Mental Health, Prevalence, Ethnic Group, Priority Journal, and Mental Disease
Many 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... more
Many 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. This 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. Compared 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 ...
Research Interests: Psychiatry, Singapore, Medicine, Comorbidity, Insomnia, and 15 moreHumans, Child, Female, Male, Clinical Sciences, Prevalence, Optometry and Ophthalmology, CBCL, Sleep Disorder, Side Effect, Case Control Studies, Child Behavior Checklist, Child preschool, Attention deficit disorder with hyperactivity, and Attention deficit hyperactivity disorder
Research Interests: Audiology, Biology, Attention, Neurofeedback, Electroencephalography, and 14 moreBrain Computer Interface, Medicine, Multidisciplinary, Humans, Child, Stroop effect, Brain Computer Interfaces, Female, Male, PLoS one, Rating Scale, Severity of Illness Index, Attention deficit disorder with hyperactivity, and Attention deficit hyperactivity disorder
Majority of children with attention deficit hyperactivity disorder (ADHD) have significant inattentive symptoms. We developed a progressive series of activities involving brain-computer interface-based games which could train users to... more
Majority of children with attention deficit hyperactivity disorder (ADHD) have significant inattentive symptoms. We developed a progressive series of activities involving brain-computer interface-based games which could train users to improve their concentration. This pilot study investigated if the intervention could be utilized in children and if it could improve inattentive symptoms of ADHD. Ten medication-naive children aged 7 to 12 diagnosed with ADHD (combined or inattentive subtypes) received 20 sessions of therapy over a 10-week period. They were compared with age- and gendermatched controls. Both parent and teacher-rated inattentive score on the ADHD Rating Scale-IV improved more in the intervention group. A larger scale trial is warranted to further investigate the efficacy of our treatment programme in treating ADHD.
Research Interests: Psychology, ADHD, Attention, Singapore, Brain Computer Interface, and 15 moreMedicine, Brain, Humans, Child, Female, Feasibility Studies, Male, Child Psychiatry, Electroencephalogram, Rating Scale, Computer User Interface Design, Time Factors, Pilot Projects, Attention deficit disorder with hyperactivity, and Attention deficit hyperactivity disorder
Selective 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... more
Selective 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. Five 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. Post 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. Findings from the presen...
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To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit... more
To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. CFAs supported the tested syndrome models ...
Research Interests: Epidemiology, International, Adolescent, Medicine, Ethnopsychology, and 15 moreGeneralization, Child Behavior, Cultural Differences, Faculty, Interviews, Humans, Child, Child Psychopathology, Child and Adolescent Psychiatry, Incidence, Confirmatory, Internationality, Dimensions, Behavioral symptoms, and Medical and Health Sciences
The goals of the present study were to: (i) examine similarities and differences in behavioral/emotional problems manifested by children with autism spectrum disorder (ASD) and those with anxiety disorder (ANX); (ii) test the ability of... more
The goals of the present study were to: (i) examine similarities and differences in behavioral/emotional problems manifested by children with autism spectrum disorder (ASD) and those with anxiety disorder (ANX); (ii) test the ability of each of the eight child behavioral checklist (CBCL) and teacher report form (TRF) syndrome scales to differentiate the ASD group from the ANX group; and (iii) test the ability of an ASD scale derived by Ooi et al. to differentiate the ASD group from the ANX group. Archival CBCL and TRF data from 180 children between 4 and 18 years of age (119 males, 61 females) diagnosed with ASD (n = 86) or ANX (n = 94) at an outpatient child psychiatric clinic in Singapore were analyzed. The ASD group scored significantly higher on Social Problems and Attention Problems but significantly lower on Anxious/Depressed and Somatic Complaints than the ANX group. The groups did not show significant differences on Withdrawn/Depressed and Thought Problems. Both the CBCL and...
Research Interests: Clinical Psychology, Anxiety Disorders, Autism, Attention, Adolescent, and 15 moreAnxiety, Emotions, Child Behavior, Humans, Child, Female, Differential Diagnosis, Autism Spectrum Disorder, Clinical Sciences, Analysis of Variance, CBCL, ANXIETY, Anxiety Disorder, Child Behavior Checklist, and Child preschool
OBJECTIVE. Birth parameters have been hypothesized to have an influence on IQ. However, studies within the range of normal birth size have been sparse. With this study we examined the associations between birth length, birth weight, head... more
OBJECTIVE. Birth parameters have been hypothesized to have an influence on IQ. However, studies within the range of normal birth size have been sparse. With this study we examined the associations between birth length, birth weight, head circumference, and gestational age within the normal birth size range in relation to childhood IQ in Asian children. METHODS. A cohort of 1979 of 2913 Asian children aged 7 to 9 years, recruited from 3 schools in Singapore, were followed yearly from 1999 onward. Birth parameters were recorded by health personnel. Childhood IQ was measured with the Raven's Standard Progressive Matrices at ages 8 to 12. RESULTS. The mean IQ score across the sample (n = 1645) was 114.2. After controlling for multiple confounders for every 1-cm increment in birth length, 1 kg in birth weight, or 1 cm in head circumference, there was a corresponding increase in IQ of 0.49 points (P for trend < .001), 2.19 points (P for trend = .007) and .62 points (P for trend = ....
Research Interests: Pediatrics, Intelligence, Singapore, Medicine, Birth Weight, and 15 moreCephalometry, Humans, Child, Female, Male, Newborn Infant, Health surveys, Gestational Age, Body Height, Reference Values, Cohort Studies, Statistics as Topic, Psychology and Cognitive Sciences, Medical and Health Sciences, and Infant Premature
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Research Interests: Cognitive Science, Developmental Psychology, Child Clinical Psychology, Child Behavior, Humans, and 15 moreCorrelation, Effect size, Female, Clinical, Male, Checklist, Cross cultural studies, International Comparison, Internal Consistency, Age Factors, Child Behavior Checklist, Child preschool, Child behavior disorders, Affective symptoms, and Diagnostic and Statistical Manual
We tested the ability of the 2001 CBCL syndromes to discriminate among 86 children with Autism Spectrum Disorder (ASD), 117 children with Attention Deficit Hyperactivity Disorder-Inattentive type, 426 children with Attention Deficit... more
We tested the ability of the 2001 CBCL syndromes to discriminate among 86 children with Autism Spectrum Disorder (ASD), 117 children with Attention Deficit Hyperactivity Disorder-Inattentive type, 426 children with Attention Deficit Hyperactivity Disorder-Hyperactive-Impulsive or Combined type, 200 clinically referred children who did not receive a diagnosis, and 436 typically-developing children in a community sample. The Withdrawn/Depressed, Social Problems, and Thought Problems syndromes significantly discriminated the ASD group from the four other groups. An ASD scale, constructed from nine CBCL items, demonstrated moderate to high sensitivity (68 to 78%) and specificity (73 to 92%). Consistent with previous research, findings from this study provide strong support for the CBCL as a screening tool for ASD.
Research Interests: Clinical Psychology, Education, Autism, Adolescent, Child Behavior, and 15 moreHumans, Child, Female, Male, Checklist, Differential Diagnosis, Autism Spectrum Disorder, CBCL, High Sensitivity, Impulsive behavior, Child Behavior Checklist, Child preschool, Attention deficit disorder with hyperactivity, Attention deficit hyperactivity disorder, and mass Screening
Research Interests: Psychology, Clinical Psychology, Developmental Psychology, Depression, Culture, and 15 moreSingapore, Medicine, Multidisciplinary, Humans, Child, Negative Affect, Female, Male, Questionnaires, Medicine as Culture, Asian Continental Ancestry Group, Conceptualization, Self Esteem, Severity of Illness Index, and Cognitive dysfunction
This study examined the criterion validity of the Child Behavior Checklist (CBCL) and... more
This study examined the criterion validity of the Child Behavior Checklist (CBCL) and Teacher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Report Form (TRF) problem scales and items in demographically-matched Singapore samples of referred and non-referred children (840 in each sample for the CBCL and 447 in each sample for the TRF). Internal consistency estimates for both the CBCL and TRF scales were good. Almost all CBCL and TRF problem scales and items significantly discriminated between referred and non-referred children, with referred children scoring higher, as expected. The largest referral status effects were on attention problems scales and their associated items, with the TRF having larger effects than the CBCL. Effect sizes for demographic variables such as age, gender, ethnicity and SES were much smaller than effect sizes for referral status, across both the CBCL and TRF forms and at both the scale and item levels. These findings suggest that teachers can be effective partners in identifying children who need mental health services and those who do not.
Research Interests: Psychology, Psychometrics, Personality Assessment, Singapore, Faculty, and 15 moreHumans, Child, Test Validity, Effect size, Female, Male, Clinical Sciences, CBCL, Reproducibility of Results, Reference Values, Child Behavior Checklist, Child behavior disorders, Paediatrics and reproductive medicine, Referral and consultation, and Referral
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International comparisons were conducted of preschool children's behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½–5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores... more
International comparisons were conducted of preschool children's behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½–5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders–oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3–12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0–198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes < 1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies.