Table of Contents
Welcome Message-------------------------------------------------------------------------------Page 2
Organizing Committee--------------------------------------------------------------------------Page 3
ASCAPAP Committee---------------------------------------------------------------------------Page 4
ASCAPAP Contribution Award---------------------------------------------------------------Page 5
Conference Information------------------------------------------------------------------------Page 6-8
Floor Plan-------------------------------------------------------------------------------------------Page 9
Message from the creator of the conference logo and poster design----------Page 10
Time Table---------------------------------------------------------------------------------------Page 11-14
Oral Abstracts
Keynote Lecture, Special Lectures, Plenary Lectures, Research Reports, Symposiums,
Workshop, Media Theater, Social Programs
May 26th, 2023 Room A---------------------------------------------------------Page 15-18
Room B-1-------------------------------------------------------Page 18-28
Room B-2-------------------------------------------------------Page 28-37
Room C-1-------------------------------------------------------Page 38-48
Room C-2------------------------------------------------------- Page 48-58
Room K----------------------------------------------------------Page 59-67
May 27th, 2023

Room A----------------------------------------------------------Page 68-72
Room B-1-------------------------------------------------------Page 72-77
Room B-2-------------------------------------------------------Page 77-89
Room C-1-------------------------------------------------------Page 89-99
Room C-2------------------------------------------------------Page 99-109
Room K-------------------------------------------------------Page 109-118

May 28th, 2023 Room A-----------------------------------------------------Page 119-124
Room B-1---------------------------------------------------Page 124-127
Room B-2---------------------------------------------------Page 127-136
Room C-1---------------------------------------------------Page 136-146
Room C-2---------------------------------------------------Page 146-157
Room K-----------------------------------------------------Page 157-170
Calm-down Space-------------------------------------------------------------------------Page 171
Art Exhibition-------------------------------------------------------------------------------Page 172
Poster Presentations---------------------------------------------------------------------Page 173-292

1

Welcome Message
It is our true pleasure to welcome our colleagues to ASCAPAP2023 in Kyoto. It was in1990, in Kyoto when we had our first IACAPAP in Asia. Ever since then, our colleagues
from all over Asia have been debating on academic topics and exchanging opinions
specific to the situation in child adolescent psychiatry in each Asian country. The first
ASCAPAP was held in Tokyo. ASCAPAP thrived as it deepened the bonds between themembers through numerous congresses: Seoul in 1999, Taipei in 2003, Manila in 2006,
Singapore in 2008, Beijing in 2010, New Delhi in 2013, Kuala Lumpur in 2015,
Yogyakarta in 2017, and Chiang Mai in 2019. We have to acknowledge that it is the fruitof the efforts of the members of ASCAPAP and the executive committee. Under their lead,the research and practices in child adolescent psychiatry have demonstrated great
development.
This ASCAPAP in Kyoto is the 11th ASCAPAP, and we are very honored to start thisnew chapter in Japan. During the first chapter of ASCAPAP, child adolescent psychiatry
has made progress in its unique approach as it grew in accordance with the social situationin Asia. As it developed, the cooperation and interaction among the professionals went
beyond borders, and now there are many international congresses even in more specifictopics. During our journey, we acknowledge the two aspects that we should always keepin our minds to understand the mental health of child adolescence and to further develop
the support for these patients: to understand the social factors that surrounds the patient(family, friends, poverty, maltreatment, conflicts between different generations due to thedifference in their values), and to assess not only with the macro perspective as
understanding the diseases and disorders beyond borders and cultures, but also withmicro perspective as keeping eyes open for the childʼs development unique to the local
society and culture. The Congress theme, “Broadening Perspectives in Child andAdolescent Mental Health ‒ New Frontiers of Research and Practice in Asia,” invites ourcolleagues to find a new frontier in child adolescent psychiatry in Asia through discussion
as we become aware that child and adolescent mental health problems do not only arisein child and adolescent period but also has longitudinal influence on the mental disorders
in adulthood.
COVID-19 has been making a grave impact on peopleʼs health and lives. The same
impact is posed on the healthcare providers, children, the families and friends around thechildren and local societies. Under the influence of COVID-19, children are experiencing
anxiety and fear for infection, confusion from changes in their everyday life, and feelingsof loss as they miss out on their playtime and place with their local friends. Economical
damage due to the COVID-19 may have severe impacts on childrenʼs family as theirparents may become unemployed or fall into poverty. Admittedly, ASCAPAP is facing adifficult situation to have this international congress under COVID-19; however, we
believe that under such situations where children are in need of mental support that weshould gather and exchange thoughts about child adolescent psychiatry.
As it is famous for, Kyoto is the ancient capital of Japan where the capital was locatedfor 1,200 years. Surrounded by mountains, there are many temples and shrines in the
scenic land. In addition, Kyoto has a spirit of hospitality and traditional culture that has
been passed down from ancient times. At the welcome reception and social gathering,
you will experience a part of such Japanese culture. You will be able to explore the city of
Kyoto. I hope everyoneʼs stay in Kyoto become the memorable one.
Takashi Okada, MD, PhD
Congress Chair
ASCAPAP2023 in Kyoto

2Organizing Committee
Congress Chair:

Takashi Okada

Vice-Chair:Junzo Iida
Hideo Matsumoto

Adviser:

Yukiko Kano

Secretary General:

Toyosaku Ota

Organizing Committee: Hironobu Ichikawa
Junzo Iida
Machi Kakimoto
Yukiko Kano
Hideo Matsumoto
Kazuhiko Nakamura
Takashi Okada
Yoshiro Ono
Toyosaku Ota
Kazuhiko Saito
Takuya Saito
Tomoko Shimanouchi
Kiwamu Tanaka
Hosting Organization:

Japanese Society for Child and Adolescent Psychiatry
c/o Dogura& Co., Ltd., 1-8 Koyama, Nishihanaike, Kita,
Kyoto 603-8148, JAPAN.
Tel. +81-75-451-4844 Fax +81-75-441-0436
E-mail: jde07707@nifty.com

3

ASCAPAP Committee
President:

Panom Ketumarn, Thailand

Secretary General:

Yukiko Kano, Japan

Treasurer:

Yen-Nan Chiu, Taiwan

President-Elect:Takashi Okada, Japan

Past-President:

Dwijo Saputro, Indonesia
Chin Lee Toh, Malaysia
Savita Malhotra, India
Yi Zheng, PR China
Daniel Fung, Singapore

Honorary Members:

Kosuke Yamazaki, Japan
Kang-E Michael Hong, Korea
Felice Lieh Mak, Hong Kong
Wei-Tsuen Soong, Taiwan
Sze Tai Wong, Singapore
Cornelio G.Banaag, Jr, Philippines
Sadaaki Shirataki, Japan

Vice-Presidents:

Soo-Churl Cho, Korea
Yoshiro Ono, Japan
Jing Liu, PR China

Committee Members:

Portia R. Valles-Luspo, Philippines
Krystal CK Lee, Hong Kong
Mohammad S I Mullick, Bangladesh
Nattorn Pityaratstian, Thailand
Nehdi Tehrani-Doost, Iran
Bhoomikumar Jegannathan, Cambodia
Arun Raj Kunwar, Nepal
Susan Shur Fen Gau, Taiwan
Tjhin Wiguna, Indonesia

Associate Secretaries: Young-Sik Lee, Korea
Ika Widyawati, Indonesia
Editor in Chief:

Chih-Tsai Chen, Taiwan

Editors:

Aili Hashim, Malaysia
Dong Ho Song, Korea
Georgina Gozo-Oliver, Philippines

4

ASCAPAP Contribution Award
This award was proposed by Prof. Kang-E Michael Hong, M.D., Ph.D., one of the founding
members of ASCAPAP and an honorary EC member.
With the endorsement of EC members, the award will be presented to those who havecontributed to ASCAPAP, beginning with the 11th Congress of ASCAPAP (ASCAPAP 2023).
The first ASCAPAP Congress was held in Japan in 1996, followed in turn by nine Asian
countries, and the 11th Congress will again be held in Japan. This is considered to indicate thatthe society has reached a sufficient level of maturity as an academic society.
Therefore, we decided to honor those who have laid the foundation of the society and pray forthe further development of child and adolescent mental health in Asia. Among the founding
members, the first ASCAPAP Contribution Award will be presented to Prof. Kosuke Yamazaki,
who made great contributions to the establishment and development of ASCAPAP as the first
Secretary General of ASCAPAP.
Prof. Kosuke Yamazaki not only played a leading role in education, research, and clinicalpractice of child and adolescent psychiatry in Japan, with a focus on autism, but also contributed
to development of child and adolescent psychiatry in Asia and the world.
Biography of Prof. Kosuke Yamazaki
1962 graduated from School of Medicine, Hokkaido University (MD)1967 graduated from Graduate School of Medicine, Hokkaido University (PhD)
1981 Associate Professor, Department of Psychiatry, Tokai University School of Medicine
1987 Professor, Department of Psychiatry, Tokai University School of Medicine
1996 Secretary General, Asian Society for Child and Adolescent Psychiatry and Allied
Professions (ASCAPAP)
1997 President, Japanese Society for Child and Adolescent Psychiatry (-2003)
1998 Vice President, International Association for Child and Adolescent Psychiatry and Allied
Professions (IACAPAP)
2003 Professor, Institute of Educational Research, Tokai University; Principal, Tokai
University Sagami Junior & Senior High School2006 Professor, Department of Child Studies, Faculty of Human Services, Mejiro University;
Graduate School of Social Work Services, Mejiro University

5Conference Information
Congress Name:
ASCAPAP 2023 in Kyoto - The 11th Congress of The Asian Society for Child and Adolescent
Psychiatry and Allied Professions
Congress Theme:
Broadening Perspectives on Child and Adolescent Mental Health - New Frontiers of Researchand Practice in Asia
Hosting Organization:
The Japanese Society for Child and Adolescent Psychiatry
Congress Website:
https://child-adolesc.jp/ascapap2023/
Congress Venue:
Kyoto International Conference Center (ICC Kyoto)
Takaragaike, Sakyo-ku, Kyoto 606-0001 Japan
Room A, B1 B2, C-1, C-2, I, J, K, Sakura
https://www.icckyoto.or.jp/en/en/
Registration Counter:
All congress materials will be available at the congress registration located at Level 1.
Opening hours
Friday, May 26, 2023
9:00-17:00
Saturday, May 27, 2023
9:00-17:00
Sunday, May 28, 2023
9:00-16:00
Participants:
ü Mental health professionals, academics and researchers, general practitioners andpediatricians, school counsellors and allied educators
ü Community partners and service providers, policy-makers, service managers acrossgovernment and non-government sectors
ü Undergraduate and graduate students (Medicine, Psychology, Social Welfare, Education,
and Other related areas)ü Service users with lived experience and their caregivers
ü Anyone who is active in the field of child and adolescent mental healthRegistration Fee:
The registration fee of ASCAPAP 2023 isAdvanced Registration (till May 25th, 2023)*￥35,000
On-site Registration (after May 26th, 2023)*￥40,000
Accompanying Person (>18years old)#￥20,000
Undergraduate/ Graduate Student*￥20,000*Including the participation for conference program, abstract booklet, congress bag, lanyard,
welcome reception, social gathering# Including only welcome reception and social gathering. Registration of accompanying
children under 18 years is not necessary.
Payment of registration fee can be finished on registration site. Cancelation fee is 30% till
February 24, 2023 and 100% after February 25, 2023.

6

Name badges:
All participants are kindly requested to wear their name badges at all the times during thecongress including welcome reception and social gathering. Name badges for accompanying
children under 18 years are available at reception [Free of Charge].
Certificate of Attendance and Receipt:
Certificate of Attendance and Receipt are attached with name badges. These are distributedwith a congress bag.
Congress Language:
The official language of the congress is English. Simultaneous translation will not be served.
Only social programs (open to the public) are in Japanese.
Instructions for Speakers and Moderators:
All oral presentations are presented by PC projection. The PC data reception counters arelocated in each congress venue. Please be aware that there is no PC data reception room.
We prepare for the Windows PC with Microsoft PowerPoint 2013 and 2019. Please bring aPowerPoint file in USB stick memory. If you use Macintosh computers or applications except
PowerPoint, please use your PC for presentation. You are encouraged to finish PC date
reception 90 minutes (30 minutes at the session in the morning) earlier before starting yoursession.
Presentation time is counted down in the timer on the desks for speakers and moderators. The
signal terns from green to orange, and red (time over). Please strictly observe the presentation
time.
Instructions for Poster Presenters:
Poster board is 90cm x 210cm (wide x height). We will prepare the pins, and we will ask the
speaker to pin the poster on the board. All posters are located in the poster area (Room I, RoomJ and Lobby) at Level 2. Posters will be displayed from 12:00 at May 26th to 13:00 May 28th,
2023. Each author/presenter is responsible for taking and placing the poster on the assigned
panel. All posters should be hung up at 9:00-12:00 in May 26th, 2023. They should be removed
at 13:00-16:00 in May 28th, 2023.
Poster session will be used free discussion format. Presenters are requested to stand in front of
their own posters during the poster session slot below.
Poster number (Odd number): 12:00-13:00 (1 hour) May 26th, 2023
Poster number (Even number): 11:40-12:40 (1 hour) May 27th, 2023
If the assigned day is inconvenient for the presenter, it is allowed to stand on the other day.
When the presenter stands, please wear a red badge on your chest or your participation holder.
(There are red badges near the entrance of the poster area.)
Best poster award:
The organizing committee of ASCAPAP2023 will award several poster presentations in
Kyoto. Best poster award will be announced at the poster area on-site at 1pm on May 28th, andthe award winners will receive the certificate and souvenirs at the Closing Ceremony.
Lunch:
Light meal and juice will be provided at sponsored seminars in May 27th and 28th, 2023.
Please be aware that meals are not provided at sponsored seminars in May 26th, 2023.
Vegetarian menu will be served, but we cannot serve halal because of limitations in the congresshall.
Welcome Reception and Conference Party:
All participants can join the Welcome Reception and Conference Party. No additional fees arerequested.

7

Free Wi-Fi
Participants of ASCAPAP2023 are permitted to connect to ICCK_Public_WiFi (no password
required). However, the communication speed is not guaranteed. It is not suitable for videocommunication.
Prayer Room:
Prayer rooms can be found in Room 504 and 506. Compass and Prayer mat are prepared.
Sensory Room:
Sensory Room is equipped for participants with hypersensitivity to sound between Room A
and L at Level 2.
First Aid:All participants who feel sick can use First Aid at Level 2. You can call an ambulance anytime
and anywhere in Japan by dialing 119.［Free of Charge］
Sponsorship:
Sponsored seminar:

Otsuka Pharmaceutical Co., Ltd.
Janssen Pharmaceutical K.K.
Takeda Pharmaceutical Company Ltd

Advertisement:

Otsuka Pharmaceutical Co., Ltd.
Nikon Solutions Co., Ltd.
Takeda Pharmaceutical Company Ltd
Nobelpharma Co., Ltd.
Yoshitomiyakuhin Corporation

Book display:

Fukumura Shuppan Inc.

Support:This program is supported by a subsidy from Kyoto City and the Kyoto Convention & Visitors
Bureau.

8

Floor Plan

Registration (Level 1)
Venue 1-------Room A (Level 2)
Venue 2-------Room B-1 (Level 2)
Venue 3-------Room B-2 (Level 2)
Venue 4-------Room C-1 (Level 1)
Venue 5-------Room C-2 (Level 1)
Venue 6-------Room K (Level 2)
Posters --- Room I, Room J, Lobby (Level 2)
EC meeting (EC member only, May 25th, 2023)----Sakura
Welcome Reception (May 26th, 2023)---------------Sakura
Conference Party (May 27th, 2023)------------------Sakura

Prayer Rooms---Room 504 and 506 (Level 5)
Calm-down Space--- Lobby (Level2)
Art Exibition---Lobby (Level2)

9

Message from the creator of the conference logo and poster design
Mayu Aoshima , M.D.; Diector, Mental Clinic NOZOMI
Origami, the motif of this design, is one of the traditional Japanese toys and is familiar tochildren today. The shapes that can be created from a single sheet of colored paper are
infinite, and no two pieces folded by hand are the same. I pray that this year's event will bean occasion for people of all generations to connect and share their thoughts and feelings
with each other.

10

May 25th, 2023
1
Room A
520

2
Room B-1
284

3
Room B-2
180

4
Room C-1
134

5
Room C-2
134

6
Room K90

PosterRoom I, J
Lobby

Restrant
Sakura

9:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

17:00

18:00

EC meeting

19:00

20:00

21:00

BanquetOfficeRoom665

May 26th, 2023
1
Room A
520

2
Room B-1
284

3
Room B-2
180

4
Room C-1
134

5
Room C-2
134

6
Room K90

PosterRoom I, J
Lobby

Restrant
Sakura9:00

Reception

10:00
Opening Remarks
Keynote Lecture
Takashi Okada

11:00

Special Lecture 1
Daniel Fung
(Moderator: Yoshiro Ono)

Symposium 1

Symposium 2

Symposium 3

Symposium 4

Symposium 5

Moderator

Moderator

Moderator

Moderator

Moderator

Susan Shur-Fen Gau

Hidekazu Kato

Bhoomikumar Jegannathan

Shuntaro Ando

Yoshifumi Mori

Ayaka Ishii-Takahashi

Wachiraporn Arunothong

Kazumasa Kimura

Atsushi Nishida

Takanobu Suzuki

Speaker

Speaker

Speaker

Speaker

Speaker

Yu-Ju Lin

Hidekazu Kato

Puthy Pat

Ryemi Do

Yoshifumi Mori

Jung-Chi Chang

Wachiraporn Arunothong

Bhoomikumar Jegannathan

Syudo Yamasaki

Karin Kato

Yi-Ling Chien

Fransiska Kaligis

Hiroshi Tomita

Mariko Hosozawa

Takanobu Suzuki

Huey-Ling Chiang

Li-Te Chiang

Kumiko Ando

Daiki Nagaoka

Tatsuya Yamashita

Poster Putting

12:00
Sponsored Seminar 1(Otsuka)Nagahide Takahashi(Moderator: Takuya Saito)

Poster Session(odd number)

13:00

Special Lecture 2

Reserch Topics 1
Kenji Nomura

Reserch Topics 2
Hidetoshi Takahashi

Reserch Topics 3
Tomoya Hirota

Reserch Topics 4
Masatoshi Katagiri

Reserch Topics 5
Masanori Isobe

Valsamma Eapen
14:00(Moderator: Yukiko Kano)

15:00

ASCAPAP Country Reports
COVID-19 in Asia
(Moderator: Yukiko Kano)
16:00

17:00

Symposium 6

Symposium 7

Symposium 8

Moderator

Moderator

Moderator

Warren YK Ng

Junichi Fujita

Kiwamu Tanaka

Kumi Aoyama

Speaker

Symposium 9

Symposium 10

Masakage Okuno

Moderator

Masaki Kodaira

Hirokazu Kumazaki

Masatoshi Ukezono

Miki Takada

Speaker

Kaichi Yoshizaki

Speaker

SpeakerYuichiro Yoshikawa

Speaker

Yoshihiro Nakadoi

Kumi Aoyama

Toshiko Kamo

Kazunori Terada

Masatoshi Ukezono

Kota Sasaki

Masami Hanafusa

Nana Hosogane

Hirokazu Kumazaki

Kaichi Yoshizaki

Iris Chih-Tsai Chen

Kyohei Yamamoto

Ikuko Kato

Yasuhiro Kanakogi

Hiroki Furuie

Lim Choon Guan

Kazuya Asanuma

Koyuru Kurane

Naomi Matsuura

Yoshiyuki Kasahara

Symposium 11

Symposium 12

Symposium 13

Symposium 14

PosterSymposium 15

Moderator

Moderator

Moderator

Moderator

Moderator

Tomoya Hirota

Masahide Usami

Toshiko Kamo

Ayaka Ishii-Takahashi

Young Sook Kwack

Kenji J. Tsuchiya

Noa Tsujii

Nana Hosogane

Miho Kuroda

Yun Hyong Kang

Speaker

Speaker

Speaker

Speaker

Speaker

Tomoya Hirota

Masahide Usami

Miki Takada

Ayaka Ishii-Takahashi

Wan Seok Seo

Manabu Saito

Naoko Satake

Mashiro Yamaguchi

Yuka Mori

Soyoung Irene Lee

Yui Sakamoto

Jun Kobayash

Myong Sun Choe

Yearin Kim

So Hee Lee

Kenji J. Tsuchiya

Noa Tsujii

Yasuyo Minagawa

Miho Egawa

Heewoo Lee

18:00

Welcome
Reception
19:00

20:00

OfficeRoom665

May 27th, 2023
1
Room A
520

2
Room B-1
284

3
Room B-2
180

Plenary lecture 1
Susan Shur-Fen Gau(Moderator: Hirotaka
Kosaka)Plenary lecture 3
Bung-Nyun Kim
11:00

5
Room C-2
134

6
Room K
90

Reserch Topics 7
Futoshi Suzuki

Reserch Topics 8
Junichi Fujita

Reserch Topics 9
Shota Uono

PosterRoom I, J
Lobby

Restrant
SakuraOfficeRoom665

Reception

9:00

10:00

4
Room C-1
134(Moderator: Katsunaka
Mikami)

12:00

Sponsored Seminar 2(Janssen)Takuya Saito(Moderator: Yukiko Kano)

13:00

Special lecture 3

Plenary lecture 2
Gail Tripp

Reserch Topics 6
Nagahide Takahashi(Moderator: Hideki Negoro)WorkshopPlenary lecture 4
Kiwamu Tanaka(Moderator: Nami Honda)

Symposium 16

Symposium 17

Symposium 18

Moderator

Moderator

Moderator

Moderator

Tze Jui Goh

Kazuya Ono

Hitoshi Kaneko

Sowmyashree Mayur Kaku

Choon Guan Lim

Tomoko Shimanouchi

Andre Sourander

Mayur Vinaykumar Kaku

Speaker

Speaker

Speaker

Speaker

Fumio Matsuda

Sanju Silwal

Mayur Vinaykumar Kaku

Takashi Nagasawa

Masayoshi Ogura

Sowmyashree Mayur Kaku

Heejeong Yoo

Tjhin Wiguna

Kavita V Jangam

Shu-Tsen Liu

Say How Ong

Aasim Ur Rehman Ganie

Li Ting Ng, Siti Fathin Aerlisa
Binte Rosli, Xue Wei Wendy
Poh, Tai Yeow Catherine Tan,
Guan Seng Arthur Goh

PosterPoster Session(even numver)

OfficeNorbert Skokauskas

Reserch Topics 10
Katsunaka Mikami(Moderator: Masaru
Tateno)Symposium 19

14:00
Plenary lecture 5
Yukiko Kano
(Moderator: Junko Yagi)

Plenary lecture 6
Hiroshi Yamashita(Moderator: Tomoko
Shimanouchi)

15:00
Plenary lecture 7
Yoshiro Ono

16:00(Moderator: Takashi
Okada)

Reserch Topics 15
Masaru Tateno

Reserch Topics 11
Fumie Horiuchi

Plenary lecture 8
Miho Kuroda(Moderator: Naoko Inada)

Reserch Topics 16
Shuntaro Itagaki

Reserch Topics 12
Hirokazu Kumazaki

Symposium 20

Reserch Topics 13
Takahiko Inagaki

Symposium 21

Reserch Topics 14
Kazuhiko Yamamuro

Symposium 22

Moderator

Moderator

Moderator

Moderator

Susan Shur-Fen Gau

Hideki Negoro

Kiwamu Tanaka

Kazuhiko Yamamuro

Ayaka Ishii-Takahashi

Toyosaku Ota

Kazumasa Kimura

Mitsuhiro Uratani

Speaker

Speaker

Speaker

Speaker

Chia-Jui Tsai

Yuichi Onishi

Kazumasa Kimura

Kazuhiko Yamamuro

Yi-Ling Chien

Hiroki Matsuura

Junichiro Ota

Mitsuhiro Uratani

Hsing-Chang Ni

Kosuke Okazaki

Iris Chih-Tsai Chen

Kiwamu Matsuoka

Wei-Ting Ko

Masaki Taguchi

Stephen Koder

Masami Hanafusa

Symposium 23

Symposium 24

Symposium 25

PosterSymposium 26

Moderator

Moderator

Moderator

Moderator

Susan Shur-Fen Gau

Ruziana Masiran

Hidekazu Kato

Yukiko Kano

Masatoshi Ukezono

Suzy Yusna Dewi

Kristiane Siahaan

Junko Yagi

Speaker

Speaker

Speaker

Speaker

Yu-Chieh Chen

Suzy Yusna Dewi

Kusuma Minayati

Junko Yagi

Liang-Jen Wang

Ruziana Masiran

Monica Andalusia

Naomi Matsuura

Chung-Yuan Cheng

Lina Budiyanti

Rinvil Renaldi

Jiro Masuya

Yueh-Ming Tai

Rahima Dahlan

Fransiska Kaligis

Naru Fukuchi

17:00

18:00

Conference
Party
19:00

20:00

May 28th, 2023
1
Room A
520

2
Room B-1
284

3
Room B-2
180

Plenary lecture 9
Hideo Honda

Reserch Topics 17
Shiori Ogawa(Moderator: KazuhikoNakamura)

Reserch Topics 18
Hidenobu Ohta

Symposium 27
Moderator

Plenary lecture 10
Kazuhiko Nakamura
11:00(Moderator: Hideo Honda)

Media Theatre
Iris Chih-Tsai Chen,
Shu-Tsen Liu

12:00

13:00

Reserch Topics 19
Tsuyoshi Sasaki

Reserch Topics 20
Emi Furukawa

Reserch Topics 21
Atsurou Yamada

Symposium 28

Symposium 29

PosterRoom I, J
Lobby

Restrant
SakuraOfficeRoom665

Symposium 30

Tjhin Wiguna

Moderator

Moderator

Hidenobu Ohta

Andre Sourander

Keiko Yoshida

Shota Uono

Mitsuru Kikuchi

Speaker

Hiroshi Yamashita

Sayaka Yoshimura

Speaker

Shin-ichi Ishikawa

Speaker

Speaker

Toru Takumi

Tiia Ståhlberg

Arata Oiji

Ayako Kaneko

Yoshitaka Seto

Fransiska Kaligis

Naoki Horikawa

Sayaka Kawakami

Yuko Yoshimura

Tarja Korpilahti-Leino

Kenichi Yamane

Yurika Tsuji

Yoichi Minami

Arun Raj Kunwar

Hiroshi Yamashita

Shota Uono

Reserch Topics 22
Hirotaka Kosaka

PosterReserch Topics 23
Masahide Usami

Reserch Topics 24
Ayaka Ishii-Takahashi

Reserch Topics 25
Jun Egawa

OfficeSpecial lecture 4
Warren YK Ng

Symposium 31

14:00
Plenary lecture 11
Takuya Saito(Moderator: Machi
Kakimoto)
15:00

Social Program 1

Art and perspective of children
with autism spectrum disorder

Plenary lecture 12
Andre Sourander(Moderator: Hitoshi
Kaneko)Social Program 2

Closing Ceremony

Symposium 32

Symposium 33

Symposium 34

Moderator

Moderator

Moderator

Moderator

Masaru Tateno

Ryo Kimura

Yuka Egashira

Yen-Nan Chiu

Norbert Skokauskas

Masahiro Hirai

Sayuri Hayashi

Yeni Kim

Speaker

Speaker

Speaker

Speaker

Norbert Skokauskas

Ryo Kimura

Takashi Okada

Guan-Jye Seng

Akira Imamura

Masahiro Hirai

Sayuri Hayashi

Paul Wai-Ching Wong

Say How Ong

Kazunori Terada

Yuka Egashira

Sazlina Kamaralzaman

Takahiro A. Kato

Kosuke AsadaEmi Furukawa

Seokyeon Ji

Symposium 35

Symposium 36

Symposium 37

Symposium 38

Moderator

Moderator

Moderator

Moderator

Yukiko Kano

Kazuhiko Nakamura

Yushiro Yamashita

Yen-Nan Chiu

Takashi Okada

Susan Shur-Fen Gau

Gail Tripp

Wei-Tsuen Soong

Speaker

Speaker

Speaker

Speaker

Kenji J. Tsuchiya

Shizuka Shimabukuro

Disha Zaveri

Yui Sakamoto

Ryoko Shigematsu

Mei-Ni Hsiao

Nobuya Takayanagi

Emi Furukawa

Heng-Man Chen

Susan Shur-Fen Gau

Aya Kasai

Yen-Nan Chiu

Yukiko Kano
Tone, sound, music andmental health-from Kyoto to Yi Zheng
Asia
Jae Hyun Yoo
Tjhin Wiguna

17:00

6
Room K
90

Sponsored Seminar 3(Takeda)Takashi Okada, Yukiko
Kano(Moderator: Yushiro
Yamashita, Noa Tsujii)(Moderator: Takuya Saito)

16:00

5
Room C-2
134

Reception

9:00

10:00

4
Room C-1
134

Poster Removal

May 26th, 2023
Venue1 (Room A)
10:00-10:40 Opening Remarks & Keynote Lecture
Broadening Perspectives of Child and Adolescent Psychiatry Toward PostCOVID-19 era
Takashi Okada1
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
With advances in science and technology, the world has become smaller, and the means ofconnecting people have become more diverse. While this has expanded the possibilities forsocial support, it has also widened the gap between those who cannot benefit from such support
and those who can.
The novel coronavirus infection (COVID-19) was first discovered in 2019 and quickly spreadaround the world, resulting in a pandemic. The infection struck everyone equally, regardless ofwealth or status, in both East and West. However, the fatality rate of the infections varied
depending on the medical situation of the country, and the economic damage was more severe
for the socially vulnerable. These include children who have experienced traumatic experiencesin complex family environments and children who have difficulty adapting to environmental
changes due to neurodevelopmental or psychiatric disorders.
The restriction of non-essential and non-urgent outings for the purpose of infection control
narrowed the possibilities of our health care or support provision. In reality, however, we werecalled upon more than ever to save children from isolation and to provide assistance according
to their individual psychosocial situations. It was also necessary to be close to the position of thevulnerable and to powerfully communicate their need for support.
Countries have borders, sometimes leading to wars, and political, ideological or religious
conflicts. And under such circumstances, there are children with trauma, and children who
experience loss. We seek cooperation and solidarity that transcend those boundaries andconflicts. We also do not stand for the fact that the daily food that give us comfort are producedby child labor exploitation of children in distant lands. It is simply because every child in theworld deserves the freedom to be protected, to learn, and to live toward self-fulfillment.
Japan has experienced many disasters, such as the Great Hanshin Earthquake and the Great East
Japan Earthquake, and has achieved recovery by helping each other. We also know theimportance of psychological support for children who suffer more severely in suchcircumstances, and the importance of social support for children who experience difficulties
during the recovery period.
Times are shifting to post-COVID-19 era. However, it is important to provide appropriate
support to children and caregivers who are unable to keep up with the changing times. I am
convinced that it is important for us to come together to ensure that every child in the world is in
the light, and that no one is left behind.
There is no conflict of interest to disclose.
10:50-11:50 Special Lecture 1 Moderator: Yoshiro Ono
Salutogenesis for the Individual Brain
Daniel Fung1
1
Institute of Mental Health (IMH), Singapore, Singapore
Population health and its predecessor public health has been the buzzword for the last 20 years,

15

focusing largely on trying to understand health and illness across a population or group ofindividuals. Clinical medicine on the other hand focuses on the development of appropriate
treatments for identified illnesses. This is an artificial dichotomy between public healthinitiatives and clinical practice by the doctor. Brain research has moved from the grossanatomical features of the brain to its function. Previous emphasis on the brain in Western
initiatives has been to study how the typical brain functions (e.g. human connectome studies)
therefore offering insights into brain pathology. However less has been done to understandhow individual brains function in relation to achieving potential and developing illness. The
origins of health in the brain of the individual requires neuroscience research to pivot towards
understanding how the physical and social environments create risks and strengths across the
spectrum of illness and health. This can then be used to understand socio-cultural differencesin the development of evidence based interventions relevant to persons and peoples.
References
Human Connectome Project http://www.humanconnectomeproject.org/
World Health Organization; https://www.who.int/health-topics/brain-health#tab=tab_1
National Research Foundation Singapore Health and Human Potential
https://www.nrf.gov.sg/rie2025-plan/human-health-and-potential
12:00-13:00 Sponsored Seminar 1 <Otsuka Pharmaceutical Co., Ltd.>
Moderator: Takuya Saito
Prenatal inflammation and neurodevelopmental disorders
Nagahide Takahashi1, Toshiki Iwabuchi2, Tomoko Nishimura2, Kenji J. Tsuchiya2
1
Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of
Medicine, Nagoya, Japan
2
Research Center for Child Mental Development, Hamamatsu University School of Medicine,
Hamamatsu, Japan
The prevalence of neurodevelopmental disorders such as autism spectrum (ASD) and attention
deficit hyperactivity disorder (ADHD) is rapidly increasing. Although the exact causes of these
disorders are unknown, recent advances in research have revealed that both genetic andenvironmental factors contribute to the development of ASD and ADHD. In particular, it has
been noted that prenatal inflammation plays an important role in the development of ASD and
ADHD.
Here, using data from a longitudinal cohort study underway at the Research Center for Child
Mental Development, Hamamatsu University School of Medicine, we present the results ofrecent studies showing that prenatal inflammation is involved in the development of ASD and
ADHD.
Prenatal inflammation was assessed by measuring inflammatory factors using umbilical cord
blood; ASD symptoms were measured by the SRS-2 and ADHD symptoms by the ADHD-RS.
We have shown that increased prenatal leptin is a risk for ASD and increased multiple cytokines
are a risk for ADHD. We also calculated a polygenic risk score as a genetic risk for ASD and
ADHD and examined the role of gene-environment interactions in these disorders.
We believe that these findings will provide clues for future prevention methods for ASD and
ADHD.
The data presented here are from a study approved by the Ethics Committee of Hamamatsu
University School of Medicine, and written consent for the participation of infants was obtained
from each parent or guardian.
Dr. Takahashi reports receiving a speaking fee from Otsuka Pharmaceuticals. The otherpresenters have no conflicts of interest.

16

13:10-14:10 Special Lecture 2 Moderator: Yukiko Kano
Tics and Tourette: Is it time to consider Tic Spectrum Disorders?
Valsamma Eapen11Discipline of Psychiatry & Mental Health, UNSW Sydney, Sydney, Australia
Tourette Syndrome (TS), affecting 1% of school aged children is a neurodevelopmental disorderthat is often misunderstood and under-diagnosed. TS is highly heritable yet geneticallyheterogeneous. The genetic heterogeneity also links to clinical heterogeneity and this session
will trace the pathogenesis of TS from genotypes to clinical phenotypes. The commonlyoccurring co-morbidities such as ADHD and OCD will be linked to the fronto-striatal pathways
to illustrate how these neuronal circuits serve as the final common pathway in translating
genetic vulnerability to tics and related behaviours. Evidence from genetic, neuroimaging andphenomenological data sets suggest that some forms of OCD are alternative phenotypic
expressions of the putative TS gene(s) with gender dependent differences in the phenotypic
expression. Newly emerging data including neurophysiological findings suggest that the
improvement in tic symptoms with age may be the result of frontal compensatory responses,
with frontal cortices becoming more efficiently connected to the striatum and to the motor andsensorimotor cortices. Thus research exploring the neuronal circuitry in relation to sensorimotor
gating, procedural learning, and habit formation as well as its genetic underpinnings has
implications for understanding the genesis and course as well as the management. From aclinical perspective, given the significant overlap in the aetiology and clinical presentation
including course and outcome, a dimensional approach of a Tic Spectrum Disorders would
simplify the diagnostic process and most importantly reduce the stigma associated with adiagnosis of Tourette Syndrome as the management is similar whether the patient has Chronic(Motor or Vocal) Tic Disorder or Tourette Syndrome.
Conflicts of interest: Nil for this presentation
14:20-17:00 ASCAPAP Country Reports Moderator: Yukiko Kano
Child and adolescent mental health in countries and regions organizing
ASCAPAP: through COVID-19 pandemic
Over ten countries and regions organizing ASCAPAP will report on the current state of childand adolescent mental health there, focusing on the impact of COVD-19 pandemic. Among the
major impacts of COVID-19 on the lives of people around the world, the impact on child andadolescent mental health seems to be particularly significant, with school closures and otherdisruptions to their lives.
Likely, some of the problems related to child and adolescent mental health in each country andregion before COVID-19 have emerged with greater emphasis with COVID-19. Thus, there
may be issues that vary considerably from country to country and common issues throughout
Asia.
By exchanging opinions on these issues, we believe we can obtain valuable suggestions for
improving child and adolescent mental health in Asia, taking into account each country's andregion's characteristics.
Bhoomikumar Jegannathan
Caritas-CCAMH (The Center for Child and Adolescent Mental Health), Chey Chumneas
Referral Hospital, Cambodia
Jing Liu
Peking University Sixth Hospital, China

17

Phyllis Chan
Department of Psychiatry, LKS Medical Faculty, The University of Hong Kong, Hong Kong
Devashish Konar
Mental Health Care Centre, Burdwan & Kolkata, India
Tjhin WigunaChild and Adolescent Psychiatry Division, Department of Psychiatry, Faculty of Medicine
Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Indonesia
Yukiko Kano
Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo,
Japan
Aili Hanim Hashim
MYCAPS (Malaysian Child and Adolescent Psychiatry Association), Malaysia
Arun Raj Kunwar
Department of Child and Adolescent Psychiatry, Kanti Children’s Hospital, Nepal
Vanessa Kathleen B. Cainghug
St Luke’s Medical Center, Philippines
Ong Say How
Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore
Ryemi Do1, Soyeon Kim2, You Bin Lim1, Su-Jin Kim1, Hyerim Kwon1, Jong-Min Kim3, BungNyun Kim1*
1
Division of Child and Adolescent Psychiatry, Department of Neuropsychiatry, Seoul National
University Hospital, Seoul, Korea, 2Department of Psychiatry and Behavioural Neurosciences,
McMaster University, Hamilton, Canada, 3VAIV Company, Seoul, Korea
Susan Shur-Fen Gau
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
Name: Nattorn PityaratstianAffiliation: Department of Psychiatry, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand
Venue 2 (Room B-1)
10:20-11:50 Symposium 1
Longitudinal follow-up studies on neurodevelopmental disorders: Cognition andBrain Structures
Moderator 1: Susan Shur-Fen Gau (Department of Psychiatry, National Taiwan University
Hospital and College of Medicine, Taipei, Taiwan)
Moderator 2: Ayaka Ishii-Takahashi (Department of Developmental Disorders, National
Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan)
S1-1
Developmental Changes in Neuropsychological Functioning in Autism Spectrum
Disorder (ASD)18

Yu-Ju Lin1,2, Susan Shur-Fen Gau2
1
Department of Psychiatry, Far-eastern Memorial Hospital, New Taipei City, Taiwan,
2
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
ABSTRACT
Background: Attentional and neurocognitive deficits are frequently found in children with
autism spectrum disorder (ASD). Little is known about the developmental changes ofattentional and visuospatial deficits in children and adolescents with ASD, compared totypically developing controls (TDs).
Methods: We used Conners’ Continuous Performance Test (CCPT) and/or Cambridge
Neuropsychological Test Automated Battery (CANTAB) to assess a wide range ofneuropsychological functions in children (6-11 years old) and adolescents (12-18 years old)with and without ASD at baseline and 5-7 years later. Their parents received Kiddie
epidemiologic version of the schedule for affective disorders and schizophrenia (K-SADS-E)
both at baseline and follow-up. All subjects and their parents completed written informed
consent forms before receiving the tests and interviews. Age, sex, and follow-up duration werematched for children and adolescents with ASD and TDs among those who completed either
CCPT or CANTAB at both time points. Finally, 106 children with ASD, 67 TD children, 48
adolescents with ASD, and 39 TD adolescents were included for data analysis for CCPT and 24
children with ASD, 38 TD children, 45 adolescents with ASD, and 28 TD adolescents were
included for data analysis for CANTAB visuospatial tests. The paired t-test was used to compare
the differences between Time 1 and Time 2 in each subdomains of autistic and ADHD
symptoms, and CCPT/CANTAB measures. The mixed model was used to compare repeatedmeasures, estimate slope over time, and group*time interactions after adjusting for the durationof follow-up.
Results: Children and adolescents with ASD showed persistent impairments in laboratory
attentional functions and spatial (working) memory but not visual memory during the follow-up
period. Children with ASD showed greater improvement in tonic alertness/processing speed andassertive responding than TD over time. Adolescents with ASD had less improvement inresponse inhibition and signal detectability than TD over time. For spatial working memory,there were parallel developments from childhood to adolescence for the ASD and TD groups,
and a catch-up development in ASD from adolescence to adulthood. Greater improvements inneuropsychological performance (CCPT and CANTAB) were noted during childhood toadolescence than adolescence to late adolescence and young adulthood both in ASD and TD. No
linear correlation was noted between developmental changes in attention/hyperactivity
symptoms and CCPT performance.
Conclusion: Our findings suggested that there might be a deviant developmental course in thelaboratory attentional functions and delayed development of spatial (working) memory in ASD
through childhood to late adolescence.
Both authors declare no conflict of interest.
S1-2
Longitudinal Cortical Thickness Changes in Autism and Relating Autistic
Symptoms and Daily Executive Functions
Jung-Chi, Chang1,2, Yu-Chieh Chen1,2, Susan Shur-Fen Gau1,2
1
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
2
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University,
Taipei, Taiwan

19

ABSTRACT
Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with awide range of regional brain abnormalities. Although previous cross-sectional neuroimaging
studies had shown brain structure might be associated with autistic symptoms. The knowledge
regarding longitudinal changes in brain structure from adolescence to young adulthood and thetemporal relations between brain profiles and clinical features in people with ASD is still underinvestigation. This longitudinal study compared the developmental change rate of cortical
thickness between autistic people and typically developing (TD) people and their relationships
with the dynamic clinical features and daily executive functions.
Methods: We enrolled 86 participants with ASD and 82 age-, sex-, and follow-up (4.8 years on
average)-latency-matched TD participants (mean aged 14.6 years) with repeated measures atbaseline and follow-up. We used the Social Responsiveness Scale to measure the social
communication deficits and the Behavior Rating Inventory of Executive Function to assess
daily executive functions. We used surface-based morphometry to analyze the longitudinal
neuroimaging data to compare the developmental changes patterns between the ASD and TD
groups. Then, we tested the associations between the specific brain regions and autistic
symptoms and daily executive functions. The study was approved by the Ethics ResearchCommittee of the National Taiwan University Hospital, Taipei, Taiwan.
Results: With the whole brain vertex-wised analyses, seven clusters showed accelerating corticalthinning in the ASD group as compared to the TD group, including the left inferior temporal,
left rostral middle frontal, left pars orbitalis, left inferior parietal, left pars opercularis, rightrostral middle frontal, and the right middle temporal region. The cortical thinning rate in the left
inferior parietal and right pars opercularis regions negatively correlated with the change rate ofautistic traits in the ASD group. Greater thinning rates of the left inferior parietal were also
negatively associated with the change rate of daily executive functions. In addition, the corticalthinning rate in the left inferior parietal and the left pars opercularis regions during adolescence
could predict the daily executive functions and social functions in early adulthood.
Conclusion: Our results of distinct developmental changes in cortical thickness suggest that theinferior parietal and pars opercularis regions are linked to the development process of social
communication and real-world executive functions in autistic people.
Conflicts of interest: The authors have no conflicts of interest related to this work.
S1-3
The Clinical Mediators of Real-World Executive Functions in Adolescents with
Autism Spectrum Disorder
Yi-Ling Chien1, Yueh-Ming Tai2, Yen-Nan Chiu1, Wen-Che Tsai1, Susan Shur-Fen Gau1
1
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
2
Department of Psychiatry, Beitou Branch, Tri-Service General Hospital of National Defense
Medical Center, Taipei, Taiwan
ABSTRACTBACKGROUND: Psychopathologies that mediate real-world executive function deficits inindividuals with autism spectrum disorder (ASD) during the transition into young adulthood arelargely unknown. This study aimed to identify the childhood mediators for the behavioral andcognitive aspects of real-world executive function in late adolescence and young adulthood of
ASD populations.
METHODS: We followed up 289 ASD youth (aged 11.6 ± 3.8, male 82.2%) and 203 typicallydeveloped controls (TDC, 10.7 ± 2.9, 66.5%) to their ages of 16.9 ± 4.7 and 15.8 ± 3.9,
respectively. The Behavior Rating Inventory of Executive Function (BRIEF), comprising two
global scales (the Behavioral Regulation index [BRI] and the Metacognitive Index [MI]), was20

used to assess real-world executive function at Time 2. Mediators of behavioral regulations(assessed by BRI) and metacognition (assessed by MI) were explored among a wide range ofpsychopathologies, parental bonding, and attention performance by using mediation analysis.
This study was approved by the research ethics committee of National Taiwan University
Hospital, Taipei, Taiwan.
RESULTS: We found that the ASD group had lower everyday executive functions than TDC
with lower BRI, MI, and most subscales scores (large effect sizes, Cohen’s d>1.0). Several
childhood factors were significant mediators. Multiple mediation analyses revealed thatchildhood. Inattention, withdrawn behaviors, social communication deficits, and self-reported
emotion, and inattention/hyperactivity problems were significant mediators for both BRI andMI. Oppositional and aggressive behaviors were significant mediators only for BRI, while
overall school function only mediated for MI. Inattention remained a significant mediator forboth BRI and MI in multiple mediation analyses, while oppositional behaviors and peer
problems were specific mediators for BRI and MI.
CONCLUSION: Our findings suggest that several factors in late childhood may mediate theexecutive functions in daily life during late adolescence. Treating common mediators such as
inattention may improve real-world executive function in ASD individuals during the transition
into young adulthood.
The authors declared no conflict of interest.
S1-4
Longitudinal Developmental White Matter Microstructural Changes in ADHD fromChildhood to Young Adulthood
Huey-Ling Chiang1,2, Susan Shur-Fen Gau2
1
Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
2
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan.
ABSTRACT
Background: Although alterations in white matter microstructure are evident in children withattention-deficit/hyperactivity disorder (ADHD), the developmental trajectories of white matter
microstructures in ADHD remain unclear due to limited longitudinal studies. Therefore, we aim
to investigate the developmental changes of white matter tract microstructure in individuals
with ADHD compared with typically developing controls (TDC) and to explore whether thechanges correlate with clinical presentations.
Methods: This longitudinal study acquired diffusion spectrum imaging (DSI) at two timepoints.
The sample included 55 participants with ADHD and 61 TDC. The enrollment/first DSI age
ranged from 7 to 18 years, with a five-year mean follow-up time. We identified 16 participants
with remitted ADHD and 39 with persistent ADHD in the follow-up assessment. The
microstructural property of 45 major fiber tracts over the entire brain was represented by thevalues of generalized fractional anisotropy (GFA). Our primary aim was to examine the timeby-group interaction of the GFA in whole-brain white matter tracts. We also tested whether thelongitudinal changes of microstructures were associated with ADHD symptoms and attention
performance in a computerized continuous performance test. We further perform subgroup
analysis to delineate the developmental changes in participants with remitted and persistent
ADHD.
Results: Participants with ADHD showed more rapid development of GFA in 13 tracts after thefalse discovery rate correction within 45 tracts: the left arcuate fasciculus, right superior
longitudinal fasciculus (SLF) II and III, left frontal aslant tract, left cingulum (main body), left
IFOF, left FS connecting the prefrontal cortex (FS-PFC), left thalamic radiation connecting thesensorimotor cortex and auditory nerve, bilateral corticospinal tracts, and the corpus callosum21

connecting the sensorimotor cortex and the splenium. Within participants with ADHD, more
rapid GFA increases in the left cingulum and left FS-PFC were associated with slower decreases
in inattention symptoms. In all participants, more rapid GFA increases in the left cingulum andleft IFOF were associated with greater improvement in attention performance. Within these 13
tracts, we found that 12 tracts (except for SLF II) still showed significant time-by-groupinteractions in the Z-GFA between those with persistent ADHD and TDC. In contrast, only 8
tracts demonstrated significant results in those with remitted ADHD.
Conclusion: Our findings suggest atypical developmental trajectories of white matter tracts in
ADHD, characterized by normalization and possible compensatory neuroplastic processes withage from childhood to early adulthood. However, those with remitted ADHD still showeddeviant maturation in some tracts.
Conflicts of Interest: The authors declare no actual or potential conflicts of interest related tothis study.
13:00-13:40 Research Topics 1
Support for Children with Developmental Disabilities in Mongolia
Kenji Nomura1, Kana Yokoyama1, Sumino Wakabayashi2, Rie Fukumoto3, Nergui
Oyuntungalag4, Dandii Odgerel4, Hitoshi Kaneko1, Masako Nagata1
1
Psychological Support & Research Center for Human Development, Nagoya University,
Nagoya, Japan
2
Shizuoka University, Shizuoka, Japan
3
Nihon Fukushi University, Nagoya, Japan
4
Mongol National University of Education, Ulaanbaatar, Mongolia
ABSTRACT
Globally, a pressing issue in child psychiatry for at least the past 20 years has been theinadequate support systems for children with developmental disabilities. As parents in Asia gainawareness about developmental disabilities, the need for support has been increasing. To thisend, a system based on collaborations among specialists in various fields and specialized
institutions, in addition to existing medical care, is crucial. Through joint research with the
Mongolian National University of Education and the Mongolian National Medical University,
we examined the current status and issues regarding such child support in Mongolia. We
identified a lack in the methodology and human resources across all stages of the processes ofidentifying, assessing, and supporting children with developmental disabilities.
The joint research on the support for children with developmental disabilities in Mongolia has
been ongoing since 2013, and in 2016, we established the Center for Joint Support of Child
Development at the National University of Education of Mongolia as a base for research andpractical action. In this center, consultative services for children with developmental concerns
and their families were established for providing the necessary action and the promotion ofhuman resource development. Furthermore, the Mongolian version of the intelligence test forchildren was developed and standardized for the first time in 2020.
The following three activities are ongoing:
1. A training program for capable personnel for conducting intelligence tests and implementing
training programs,
2. Assessment tools for children with developmental disabilities in Mongolia and its utilizationfor epidemiological studies, and
3. A curriculum for training child psychiatrists.
Therefore, collaborating with local experts and adapting to the cultural, educational, and othernorms of the country are essential. This report explores the emergent cultural differences in thecourse of our joint supportive projects and the subsequent challenges for realizing this support.

22

The research related to this presentation has been approved by the Ethics Review Committee of
the Department of Psychology and Human Developmental Sciences, Nagoya University.
The authors declare no conflicts of interest associated with this manuscript.
13:50-15:20 Symposium 6
Keeping secrets with children
Moderator 1: Warren Y.K. Ng (American Academy of Child and Adolescent Psychiatry
President, Professor of Psychiatry at Columbia University Medical Center, USA)
Moderator 2: Kiwamu Tanaka (Hyogo Mental Health Center, Kobe, Japan)
S6-1
Issues of confidentiality with children in child and adolescent psychiatricinpatient treatment
Yoshihiro Nakadoi1, Yuichiro Fuji1, Michiyo Okada2
1
Shikoku Medical Center for Children and Adults, Zentsuji, Japan
2
Graduate School of Integrated Arts and Sciences, Kochi University, Kochi, Japan
ABSTRACTAs children grow up, they become aware of the differences in perspectives and experiences
between them and their parents, and from mid-childhood onwards, many children become awarethat the world from their point of view is different and unique from that of their parents. Theyfind that their parents do not always know what they are feeling and experiencing. They thinkthat in some cases it is better that their parents do not know that, and that they prefer to keep
secret it (Hirai, 2020).
From mid-childhood onwards, clique formation is observed among children. They are more
likely to peer with children who hang out, and to value the approval of their group over thevalues of their parents, resulting in them making up secrets and lying to their parent. Children
thrive in their relationships in which they share secrets.
Children who hang out together are considered group, and are more likely to act in ways thatemphasize the approval of the group rather than the values of their parents, resulting in themmaking up secrets and lying to their parents. It is in their relationships in which secrets areshared that children thrive.
Saito (2015) states that groups are an important facilitating factor in inpatient treatment and also
an important therapeutic structure that can sometimes be an obstructing factor. In such wards, it
is often observed that secrets are shared among children or confided in the form of consultations
from children to ward staff.
Yamazaki (2018) states that when a secret is confided, the response should be to avoid
promising in advance to keep the secret and to tell the child that if it is deemed necessary toprotect you, it may be told anyone who needs to know. However, the reality is that when a secretis suddenly confided in the context of everyday care and conversation, rather than within theframework of a fixed time and place such as a consultation or counselling session. It can be
confusing and difficult to deal with. In addition, it may be difficult to intervene, including factfinding, if the child is asked to reveal a secret about another hospitalized child or a secret sharedin a social networking service group.
Consent to medical treatment is given by the person with parental authority as part of the rightto personal custody of the child, and secrets of the child learned during treatment may in somecases need to be told to the person with parental authority. On the other hand, the Convention on
the Rights of the Child regards children under 18 years of age as "subjects with rights" andrecognizes their human rights as same as adults, in which children have the right to keep secretwhat they do not want to be known and not to have their trust and reputation damaged. The
dilemma often arises with regard to the extent to which the secrecy of the child should beprotected. In any case, if we have to tell a secret, we will have to make the greatest effort to23

obtain the child's consent.
Ethical consideration: The examples are fictitious and are combining fragmented information
under ethical considerations.
COI: No conflicts of interest to disclose
S6-2
What should we as therapists consider and deal with when a child as a patient
discloses a secret to us?
Kota Sasaki1
1
Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo,
Tokyo, Japan
ABSTRACTThe premise is that under international treaties, children are "subjects with rights" and arelegally and ethically subject to the same confidentiality as adults. One difference from adults isthat in Japan, children under the age of 18 are protected persons, and the right to custody andcontrol of property is granted to parents who have parental authority.
What is the significance of "secrecy" in the developmental process of children?
As children grow up, they become aware of differences in perspectives and experiences between
themselves and others, and come to feel that these are unique to them and, in some cases, arebetter left unknown to others, including their parents, and they come to have secrets. This isrelated to the establishment of self-identity. In other words, it is important for children to havesecrets in their development, and they need an environment in which they can have secrets withpeace of mind.
In clinical situations, it is important to consider, what it means for the child to keep a secret andwhat it means for him or her to disclosure it to the therapist.
If the content of the secret does not fall under any of the exceptions to confidentiality, thetherapist will basically respect the confidentiality, while considering the meaning of theconfidentiality and the meaning of the child's disclosure of it to the therapist and will proceed tohave a dialogue with the child about the content and take necessary action as appropriate.
On the other hand, if the content of the confidentiality is related to a potentially harmful
situation or a violation of the law, appropriate disclosure of the confidentiality is required as an
exception to ethical and legal confidentiality. In each case, it is necessary to consider whether or
not to inform the child about sharing secrets, if so, to whom, and in what way. In such cases, it
is also helpful to consider the meaning of secrecy for the child and the meaning of disclosing itto the therapist.
In the discussion, we would like to deepen the discussion by assuming specific clinicalsituations.
Ethical consideration: The examples are fictitious and are combining fragmented information
under ethical considerations.
COI: No conflicts of interest to disclose
S6-3
Clinical Management of Confidentiality: Constraints and Challenges to Keeping
Secret with Children in Taiwan
Iris, Chih-Tsai Chen1, Shih-Kai Liu2
1
Department of Child and Adolescent Psychiatry, Taoyuan Psychiatric Center, Ministry of
Health and Welfare, Taoyuan City, Taiwan

24

2

Seed of Hope Clinic, Taipei City, Taiwan

ABSTRACTA secret is defined as “hidden fact which may not be divulged”; independent of the types ofsecrets that are kept, they always “exact a price and functions as an internal stressor” (Larson &Chastain, 1990). Studies showed that keeping secrets from parents is longitudinal associatedwith physical and psychological disadvantages in adolescence, and often interferes with parental
trust, parental communication, and perceived parental supportiveness. It is, however, positively
related to adolescents’ emotional autonomy. Furthermore, vulnerable children and youths areless able to trust their relationships and need to keep their secrets in private.
Confidentiality refers to the boundaries surrounding shared secrets and to the process ofguarding those boundaries. A mental health practitioners may decide to extend the boundaries ofconfidence under different circumstances, such as assumed duties to report child abuse, underage sexual activity, teenage pregnancy, and suicidal ideation and attempt, or sharing his patient’s
notes with a supervisor or consultant if he/she feels that the patient’s treatment would be better
served, etc.
In this presentation, we will explore the constraints and challenges to providing high levels ofconfidentiality to young people, based on extensive literature review and clinical experiences in
Taiwan.
There is no one-size-fits-all answer for management under all the different circumstances.
Nevertheless, it is hoped that through the presentations of this theme, we will find it useful andwill be able to form more readily correct opinions when faced with difficult moral or personalquestions pertaining to secrecy, confidentiality, keeping promises and doing what is right inorder to foster the common good.
Ethical consideration: This is a non-clinical research and extensive literature review that does
not require ethics approval.
COI: No conflicts of interest to disclose.
S6-4
Doctor, You Have Done Us a Disservice
Lim Choon Guan1
1
Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore,
Singapore
ABSTRACTIn our clinical practice, we attend to young persons and their families.
Clinicians can get requests from parents to keep some information confidential, but such
requests may be less common from the young persons.
In keeping with the symposium theme, the author will discuss the legal and ethicalconsiderations guiding the clinician about making decisions regarding disclosure, from theperspective of a practicing child and adolescent psychiatrist in Singapore.
Ethical consideration: This presentation involves the discussion of real clinical cases in the
speaker’s practice, and the cases will be anonymous with no personal identifiers disclosed.
COI: No conflicts of interest to disclose.
15:30-17:00 Symposium 11
Is autism spectrum disorder increasing?
Moderator 1: Tomoya Hirota (Department of Psychiatry and Behavioral Sciences, University ofCalifornia San Francisco, San Francisco, USA)25

Moderator 2: Kenji J. Tsuchiya (Research Center for Child Mental Development, Hamamatsu
University School of Medicine, Hamamatsu, Japan)
S11-1
Introduction and epidemiology of autism spectrum disorder
Tomoya Hirota1
1
Department of Psychiatry and Behavioral Sciences, University of California San Francisco,
San Francisco, USA
ABSTRACTIn this presentation, the presenter will first give a brief review of the characteristics of autism
spectrum disorder (ASD), which includes diagnostic criteria in the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition, Text Revision (DSM 5-TR) and signs and symptoms
commonly described in literature. Next, the presenter will begin a discussion on what isincreasing in ASD (number vs. proportion of cases, for example). The presenter will provide
audience with epidemiological knowledge that is important for understanding the theme of this
symposium and then proceed to discuss whether or not ASD is on the rise by presenting
findings from epidemiological studies in different countries. One specific example is thechanges in the prevalence of ASD from 1 in 88 to 1 in 44 among 8-year-old children in thecatchment areas in the United States over the recent 10 years, reported by Autism andDevelopmental Disabilities Monitoring Network.
What is contributing to the increase in estimated prevalence of ASD? Is a number of new ASD
cases on the rise over time and leading to “ASD pandemic” across the world or is the increased
prevalence of ASD accounted for by different reasons? If the former is true, how genetic andenvironmental factors play roles in this change? If the latter is true, what are the contributory
factors?
Changes in diagnostic criteria, increased awareness of ASD and subsequent referrals, better
ascertainment of subpopulations who were previously overlooked, and access to better
education and services can all account for the increase in ASD. As one example, there have beenchanges in diagnostic criteria in the DSM and the International Classification of Diseases overthe last decade, broadening the concept of autism. Additionally, the sex ratio of ASD prevalence
is now considered narrower, approximately 3:1 (male: female), suggesting increased
understanding and better awareness of ASD phenotypes in females. The presenter will review
these factors and expand the discussion further to orient audience to this symposium.
S11-2
Prevalence and cumulative incidence of autism spectrum disorders in acommunity sample of preschoolers in Japan
Manabu Saito1,2, Tomoya Hirota3,4, Yui Sakamoto4
1
Department of Comprehensive Rehabilitation Science, Graduate School of Health Sciences,
Department of Clinical Psychological Science, School of Medicine, Hirosaki University,
Hirosaki, Japan
2
Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki
University, Hirosaki, Japan3
Department of Psychiatry and Behavioral Sciences, University of California San Francisco,
San Francisco, USA
4
Departments of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki,
Japan
ABSTRACTIn recent years, it has been reported that the prevalence of autism spectrum disorder (ASD) is26

increasing, but there are few research reports in Asia compared tothose in Europe and the UnitedStates. Since large-scale epidemiological studies of neurodevelopmental disorders (NDDs) inearly childhood have not been conducted in Japan, the delay in early detection is conspicuouscompared to other countries. Therefore, 10 years ago, in Hirosaki city, a middle-sized city innorthern Japan, we launched a developmental health checkup for early detection of ASD inpreschool age and started an epidemiological survey to clarify the prevalence of ASD (The
Hirosaki Five-year-old Children Developmental Health Check-up “HFC” study).
In the survey of 3,954 5-year-olds conducted between 2013 and 2016, 559 children underwent
further testing and 87 children were diagnosed with ASD according to her DSM-5 criteria.
Adjusted ASD prevalence was 3.22% and the male-to-female ratio of the crude prevalence was
2.2:1. The cumulative incidence of ASD up to 5 years of age for the total study years was 1.31%
A generalized linear model revealed no significant linear trends in 5-year cumulative incidence
over the study years.
On the other hand, according to the 2021 MEXT (Ministry of Education, Culture, Sports,
Science and Technology) survey, the number of children receiving special support in Japan has
doubled or tripled from 10 years ago. The increase in numbers is for all children with NDD,
including intellectual disabilities, and not just for ASD.
We have been diagnosing NDD in 5-year-olds for 10 years with the same method in HFC. Fromthe progress of the 10-year study, we consider whether there is a real increase in ASDs and
NDDs.
S11-3
Genetics of Autism Spectrum Disorder (ASD): Are genetic factors contributing tochanges in ASD prevalence?
Yui Sakamoto1
1
Departments of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki,
Japan
ABSTRACT
If the prevalence of Autism spectrum disorder (ASD) is on the rise due an increased number of
new incident of ASD cases, how are genetic and environmental factors contributing? In otherwords, can we explain the increase in ASD prevalence in terms of genetic and environmental
factors and possibly their interaction? In this session, the presenter will first reviewgenetics of
ASD to provide a general concept of the etiology of ASD. Secondly, the presenter will arguethe
possibility that genetics or environmental changes are contributing to the increase in ASD
prevalence.
ASD is now understood to be a complex disorder resulting from a combination of genetics andenvironment. Previous twin studies have shown that the concordance rate for ASD inmonozygotic twins is around 60-90% and the heritability is estimated to be around 40-80%.
Hundreds of genetic factors have been identified as candidates to contribute to the pathogenesis
of ASD, including genes, Copy Number Variations (CNV), and Single Nucleotide
Polymorphisms (SNP). Representative candidate genes include SHANK3, TSC2, RELN, and soon. One of the most representative CNVs is a maternal 15q11–q13 duplication found in 1–3% of
people with ASD.
Although in the past most studies have examined the genetic and environmental contributions to
the etiology of ASD separately, recent studies have begun to focus on the interaction between
genes and the environment. The interaction between genetics and environment may modify
gene expression through epigenetic processes such as changes in DNA methylation. Do
environmental risk factors increase and influence genetic factors through epigenetic processes?
If so, we may be able to understand some of the reasons why the prevalence of ASD isincreasing.

27

S11-4
Environmental contributions in the aetiology of autism spectrum disorder:
current understanding and future perspectives
Kenji J. Tsuchiya1,2, Tomoko Nishimura1,2
1
United Graduate School for Child Development, Osaka University, Kanazawa University,
Hamamatsu University School of Medicine, Chiba University, University of Fukui, Suita, Japan
2
Research Center for Child Mental Development, Hamamatsu University School of Medicine,
Hamamatsu, Japan
ABSTRACT
Literature has indicated that some non-genetic/environmental factors increase the risk for the
emergence of autism spectrum disorder (ASD). Such candidates include, for instance, advanced
parental age, maternal hypertetion and overweight during pregnancy, and maternal use ofantidepressants during pregnancy, all of which have been consistently supported in a recent
umbrella review by Kim et al. (2019). Additionally, these findings have led researchers toformulate a pathophysiological hypothesis involving maternal immunological activation (MIA),
and inflammation and immunological reactions during the prenatal period are now anticipated toplay a significant role in the aetiology.
Despite this progress, previous studies investigating the environmental contributions of ASD
have been challenged by more recent studies, which do not support earlier findings. Reasons forthe inconsistency are two-fold; one is that the more recent studies opt for covariates that havenot been considered in the literature, and the other is that nosocomial threshold for diagnosing
ASD has been changing. The former suggests that some earlier findings might have beenaccounted for by unmeasured but important confounders. The latter suggests that the more
recent parents of children with ASD perceive a higher degree of impairments.
COI disclosure: No authors reported conflict of interest to be disclosed.
Venue 3(Room B2)
10:20-11:50 Symposium 2
Overview of child and adolescent psychiatric training system and update
situation in Asian countries
Moderator 1: Hidekazu Kato (Department of Child and Adolescent Psychiatry, Nagoya
University Hospital, Nagoya, Japan)
Moderator 2: Wachiraporn Arunothong (Lampang Regional Hospital, Lampang, Thailand)
S2-1
Child and Adolescent Psychiatry Training in Japan: Current Situation andChallenges
Hidekazu Kato1
1
Department of Child and Adolescent Psychiatry, Nagoya University Hospital, Nagoya, Japan
ABSTRACTIn Japan, Japanese Medical Specialty Board was established in 2014, and the new systemstarted in 2017. However, the training system for subspecialties has not been well establishedyet. In Japan, there had been no formal system of clinical training of child and adolescentmental health, and only few institutions provide 2-3 years training programs following pediatricor psychiatric training. Many trainees had lost their way of and subsequently give up being achild and adolescent psychiatrist owing to no established pathway to this specialty. However,the situation is changing and novel formal and unified training program has just started in 2022.

28

It is certified by the medical board of specialists for mental issues of children and adolescents
which is supported by four academic societies related to youth mental health (Japanese Societyof Psychosomatic Pediatrics, Japanese Society of Pediatric Psychiatry and Neurology, The
Japanese Society for Child and Adolescent Psychiatry and Japanese Society for Adolescent
Psychiatry). A total of 82 of the training programs were established in 38 of the 47 prefectures.
Each program consists of several institutions and offers a wide range of clinical training inchildren's and adolescent's mental health. After completing three years of training in pediatrics
or psychiatry, this training program can be taken. It is unique in that both pediatricians andpsychiatrists can begin training. Pediatricians’ strength includes understanding of normal
developmental patterns, acquiring the perspective of considering syndromic disorders beingcomorbid with neurodevelopmental and psychiatric disorders, taking into account the effects ofphysical illness, and understanding the emotions of families with seriously ill or lowbirthweight infants. Psychiatrists' strengths include having a perspective that includes adults
after the child has grown up, understanding the difficulties faced by adults withneurodevelopmental disorders, understanding adolescent-onset schizophrenia and bipolar
disorder, assessing and dealing with parental personality and mental illness. This nascenttraining system needs to become a better and more specialized clinical training in children's
mental health, drawing on the respective strengths of pediatrics and psychiatry.
Author has no conflict of interest and no ethical concern to declare in preparing this presentation
because it is based on document and literature review.
S2-2
Child and adolescent psychiatry training in Thailand
Wachiraporn Arunothong11Lampang Regional Hospital, Lampang, Thailand
ABSTRACTChild and adolescent (C&A) psychiatry training in Thailand was established in 1989.
Residency and fellowship training are two available programs. For residency training,
applicants must complete medical degree. They can either apply after completing 1 to 3 year ofinternship program. Residency training is a 4- year program, with 1.5 year training in a general
psychiatric unit and 2.5 years training in a C&A psychiatric unit. Each year, residents are
required to pass an in-training examination of their institution. After completing 4 year of
training, they have to pass a C&A board examination. The C&A board examination is a national
examination and it is certified by a royal of college of psychiatrist Thailand and Thai medical
council. The examiners are from all of the training institution in Thailand. Another programin Thailand is a fellowship training program. A fellowship program is a 2 year training program.
To be entering in the fellowship program, an applicant must either complete general psychiatryor pediatric residency training. Fellows work only at a C&A psychiatric unit. Only fellows who
prior completed general psychiatry board examination can have a board examination after they
complete the program. The fellows who prior complete general pediatric board examination are
required to work under-supervision with senior C&A psychiatrist at their institute or others
institutes that have C&A supervisor for 3 more years. Then they are certified to go for board
examination. Before, completing the training, both residents and fellows are requested to do a
research on C&A psychiatry and publish or present their papers at the national conference.
Recently, there are 8 training institutions, which can accommodate 20 trainees each year. 7
institutions are in Bangkok, one in Chiangmai, northern Thailand, one in Khonkaen,northeastern Thailand, and one in Songkla, southern Thailand. There are 250 C&A psychiatristsin Thailand but majority of them are in Bangkok or central Thailand. Thailand is facing the
problem of C&A psychiatrist distribution. During Covid-19 pandemic, the training institution
faced the problems about sending residents and fellows to elective outside the institution, setting29

up a tele- lecture, conference and the most challenging is the tele-examination.
The talk will cover the history of training in Thailand, training curriculum, electives and thechallenge of conducting a training program during covid-19 pandemic.
Author has no conflict of interest and no ethical concern to declare in preparing this presentation
because it is based on document and literature review.
S2-3
Child and Adolescent Psychiatry Training in Indonesia: Current Situation andChallenges
Fransiska Kaligis1
1
Department of Psychiatry, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
ABSTRACT
There is persistent discrepancy between healthcare professionals and general population inIndonesia. While the population continues to rise, medical schools are limited and may requirealmost a decade to complete. By 2021, there are 1296 psychiatrists in Indonesia (0.5/100.000
population) and only 65 child and adolescent psychiatry subspecialists as of 2022. Despite beinga subspeciality, child & adolescent psychiatry modules are integrated in the psychiatricresidency program, medical training and Continuing Medical Education (CME) workshops. In
residency training, child and adolescent psychiatry module is given with a duration of 3-6
months. Psychiatrists are expected to be able to perform child and adolescent psychiatricexamination, handle emergency cases and perform psychotherapy as well as family therapy.
Medical students also undergo psychiatric rotation during their medical training, as generalpractitioners are expected to have the ability to screen and diagnose for conditions such as
mental retardation, ADHD and autism in accordance to the national standard. Socio-economicchanges, an increase in social problems that influence children such as the internet, violence andabuse serve as challenges in today’s climate. In addition, service facilities for child andadolescent psychiatry and mental health are limited, and community stigma around mental
health issues are still high. However, opportunities can be found in psychiatrists given
encouragement to enter child psychiatry training, collaboration with other professions,empowerment in community care, focusing on preventive measures and developing trainings/
workshops for healthcare professionals. In conclusion, child and adolescent psychiatry inIndonesia is a sub-specialty training and the number of subspecialists in Indonesia are still
small, however, challenges in shortage of resources can be minimized by improving community
care and empowering allied professions as promotion and prevention remain a key role todecrease child and adolescent mental health problems.
Author has no conflict of interest and no ethical concern to declare in preparing this presentation
because it is based on document and literature review.
S2-4
Child and adolescent psychiatry training in Taiwan
Li-Te Chiang1
1
Department of psychiatry, Taipei City Hospital Zhong-Xing branch, Taipei, Taiwan
ABSTRACTIn Taiwan, the four-year residential training in general psychiatry is followed by advanced
training in the subspecialty. This presentation is aimed to introduce the subspecialty training
course in Department of child and adolescent psychiatry in Taiwan. In 2023, around 300 child30

and adolescent psychiatrists (CAPs) provide clinical service for 4 million people under 18, and
10 to 15 new CAPs finish 12-month training program in certificated hospitals every year.
Psychiatrists who decide to specialize in this field should have a half-year training in acute ward
and another half an year in day care ward. Furthermore, psychotherapy courses and outpatient
unit training courses are also provided each week with supervision by senior psychiatrists.
Trainees who finish the training courses are expected to pass the license examination andbecome certificated CAPs. In Taiwan, although the training program is highly-standardized, thelength of training is still shorter than most of the countries. It is our future goal to extend thetraining period, and then substantially increase training time in psychotherapy, pediatricneurology, rehabilitation medicine, and clinical research.
Author has no conflict of interest and no ethical concern to declare in preparing this presentation
because it is based on document and literature review.
13:00-13:40 Research Topics 2
Acoustic startle response and its modulation in autism spectrum disorder
Hidetoshi Takahashi1,2,3
1
Department of Child and Adolescent Psychiatry, Kochi Medical School, Nankoku, Japan2
Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental
Health, National Center of Neurology and Psychiatry, Kodaira, Japan
3
Integrative Brain Imaging Center, Department of Advanced Neuroimaging, National Center of
Neurology and Psychiatry, Kodaira, Japan
ABSTRACTThe acoustic startle response (ASR) and its modulation, including prepulse inhibition (PPI), areconsidered to be well-established global neurophysiological indices for translational research inpsychiatric disorders. Sensory abnormalities have often been reported as symptoms of ASD, andauditory over-responsiveness (AOR) is the most common sensory-perceptual abnormality inindividuals with ASD. This abnormality has been reported to interrupt behavioral adaptation,and sometimes even requires therapeutic intervention.
Recently, we reported that a greater acoustic startle reﬂex magnitude in response to weak stimuli
of 65-85 dB was found in children with ASD compared to those with typical development, andthat this index was related to various clinical features, including sensory problems, autistic
traits, emotional/behavioral difficulties, and adaptive/maladaptive behaviors in ASD children.
This intensity level of acoustic stimuli is frequently experienced in everyday situations.
Comprehensive investigation of the ASR and its modulation, including the startle response to
weak startle stimuli, peak startle latency, and PPI, may contribute to an understanding of theimpairment of the neural circuitry in children with ASD and its comorbid behavioral problems.
Future studies investigating the development of sensorimotor gating in early development may
contribute to prevention of psychiatric disorders.
The ethical considerations: This study was conducted in accordance with the Helsinki
Declaration with institutional review-board approval being granted by the Research Ethics
Committee of the National Center of Neurology and Psychiatry and the research ethics
committee of the Graduate School of Education, the University of Tokyo.
Conflict of interest (COI): Department of Child and Adolescent Psychiatry, Kochi Medical
School, is a course donated by Kochi prefecture, Japan.
13:50-15:20 Symposium 7
Optimizing psychosocial intervention for gaming disorder
Moderator 1: Junichi Fujita (Yokohama City University Hospital, Yokohama, Japan)

31Moderator 2: Kumi Aoyama (Kanagawa Psychiatric Center, Yokohama, Japan)
S7-1
Gaming disorders in child and adolescent psychiatry from the perspective of
addiction treatment
Kumi Aoyama1
1
Kanagawa Psychiatric Center, Yokohama, Japan
ABSTRACT
Gaming disorder has been included in ICD-11 as a type of addictive behavior in 2022. In Japan,
health ministry team reported that there are 930,000 junior high and high school student
overusing online services from nationwide survey in 2018. During COVID-19 pandemic, a halfof elementary and junior high school student reported that they play internet games more than 2hours in average every school day. The increase in gaming behavior disorders is a concern underthese circumstances, but treatment of gaming disorder is not yet well established.
From the perspective of traditional addiction treatment in adult, motivational interviewing,
psychoeducation, detoxication, relapse prevention or connecting to self-help groups arecommonly provided. However, in children, the same treatments are not adequate or effective
because children’s addictive behavior is often connected to multiple background with ongoingdifficult circumstances related to their developmental characteristics, psychiatric symptoms, or
environmental factors. Therefore, the first step in treatment is to know why and how the child isaddicted to the substance or behavior. In most cases, improving the environment enable them tolive without relying on substances/behavior and relying on other people.
As well as other addiction, gaming disorder in children is often associated with multiple
backgrounds, including developmental disorders such as attention deficit hyperactivity disorderand autism spectrum disorder, psychiatric symptoms such as anxiety and depression, social
withdrawal, and inappropriate childcare environment. Since problematic gaming behavior
causes family conflict, family members are likely to take a negative attitude toward gaming.
However, understanding what the game has given to the child without denying may hint thebackground of the problem. The types of games that are out of control may reflect unfulfilledneeds in their real life, the timing of the loss of control may hint us the time their difficulties
maximized, and the way they play games show us the children’s strength or coping style which
guide us the road to recovery. Reassessment of their developmental characteristics, adjusting theenvironment by family psychoeducation or collaboration with school officials, should be
provided tailored to each case.
In today's world where it is not possible to abstain from the Internet, it is necessary to motivate
the individual to seek healthy Internet use through dialogue. Recovery begins with
understanding the meaning of their game and making the real world easier to live in.
There is no conflict of interest over this presentation.
S7-2
Group psychotherapy for gaming disorder in outpatient child psychiatry: A
review of four years
Masami Hanafusa1
1
Division of child and adolescent psychiatry, Osaka Psychiatric Medical Center, Hirakata, Japan
ABSTRACT
A group program has been implemented since 2019 for teenagers who have difficulty
maintaining a healthy daily life due to the Internet and games. This is the fourth year of the
program, and we have changed the contents and methods of the program over the course of thepast four years.

32The group treatment program for gaming disorder is named "CLAN; Communication, Learning
and Activity to the Next step". It has been provided twice a month for 90 minutes for both
affected children and their families. The program aims to provide an opportunity for children in
the same situation to get together, broaden their perspectives through communication and play,
and review their current lifestyle, which will lead to improve their lifestyles. The program isoperated as an outpatient group psychotherapy with the collaboration of multiple professions(physicians, nurses, and psychologists).
The first phase was conducted from June 2019 with a total of 12 sessions and 6 patients
participated. After the second phase, it became difficult to continue the program due to theoutbreak of the COVID-19. There was a significant decrease in the number of participants, but
as of January 2023, the revised program is being provided to the seventh group with newcontents and format. Since most of the participants have autistic spectrum disorder in theirbackgrounds, the program has been adjusted to the characteristics of the participants. We spend
more time on communication games than on text-based programs.
Apart from CLAN, which is a group psychotherapy for patients, we regularly hold social events
and workshops targeting parents. Reflicting high need of parent’s support, 3 to 11 parents
participated each time.
Although the number of participants in each CLAN has decreased during the COVID-19
pandemic, the number of patients with problems of dependence on the Internet and games has
not decreased among the outpatients. This may be a situation where children with suchproblems are finding it difficult to motivate them to get treatment. Therefore, we are focusing onparental support and hope that good communication within the family will improve andmotivate the children to change.
The study was approved by the Ethics Committee, and care was taken to ensure that patientswere not identified.
The presenter has no COI to disclose.
S7-3
Inpatient treatment of gaming disorder for adolescent patients
Kyohei Yamamoto1
1
Kanagawa Children's Medical Center Dept. of child and adolescent psychiatry, Yokohama,Japan
ABSTRACT
There is no set protocol for the treatment of gaming disorder, and in Japan, various treatments
such as counseling, individual or group cognitive-behavioral therapy, and camps are being
offered.
Kanagawa Psychiatric Center have opened outpatient unit specialized for treating adolescent
gaming disorder from April 2020. I introduce one case of gaming disorder who visited the unit
and was hospitalized for digital detoxication voluntary along his recovery.
Most patients in Japanese psychiatry are admitted to the hospital in one of the following forms:
voluntary hospitalization, hospitalization for medical care and protection, or involuntary
hospitalization.
The patient was taken to our hospital by his family with complains of impaired control overgaming and was day-night reversal, mood swings, non-attendance at school and social
withdrawal. After he visited our hospital several times, he realized his loss of control and family
conflict along with gaming behavior and decided to be hospitalized voluntarily. In addition todigital detoxification through the inpatient environment, a group cognitive-behavioral therapy
program and family therapy that encouraged the patient and his family to understand the issues
behind his symptoms, such as his characteristics, family environment, and social connections,were conducted, and improvement of control over gaming was observed after two months. After33

discharged from the hospital, the patient began to expand places to stay, engaging in learningand taking up a part-time job.
In the case of gaming disorder in child and adolescent care, we often experience a vicious cycle
in which family anxiety increases, negative family feelings rise, and family relationships
become agglutinative due to repeated emotional reprimanding. In such cases, hospitalization
helps distancing themselves from each other and break out the vicious cycle, which lead themto rebuild the family relationship.
There is no conflict of interest over this presentation.
S7-4
Family Support for Gaming Disorder
Kazuya Asanuma1
1
Yokohama City University Medical Center, Yokohama, Japan
ABSTRACT
While the pathology of gaming disorder is still in the research stage, there are many patients andfamilies who visit psychiatric care with complaints of difficulties related to game use. There arereports that family group therapy has improved the parent-child relationship and led to
improved Internet use in adolescent patients (Qin-Xue Liu et al. 1)). The Department of Child
Psychiatry, Yokohama City University Medical Center (CP-YCUMC) developed a grouppsychotherapy “Yokohama Boardgame and Collaboration Program (YoBoCoP)” for gaming
disorder targeting both children and their parents. It is held twice a month for 90 minutes, with
one parent and one child per family, and consists of two to four families. and about four staff
members. The first 15 minutes of the program is a lecture of psychoeducation regarding gaming
disorder, followed by boardgames such as card games, puzzle games or cooperative deduction
games adapted to participants developmental characteristics. The first course started in April
2021, with two families participating. The session once to be suspended due to the COVID-19
outbreak, but was completed in December 2021. The second course started in January 2022,with two families participating, and completed in November 2022. Online meetings were held
during outbreaks in order to maintain the group relationship.
Although there were no significant change in depression and self-esteem scales of the families
after 12 sessions due to the sample size, there were positive comments from families as follows;“I felt that children seemed to enjoy participating in the program” “we could play boardgameswith our family members at home”. There is a need increase the number of cases to evaluate
effect of YoBoCoP.
Ethical considerations: approved by our Ethical Review Committee. The utmost care is taken toprotect privacy.
No COI to disclose
Reference
1) Qin-Xue Liu, Xiao-Yi Fang, Ni Yan, Zong-Kui Zhou, Xiao-Jiao Yuan, Jing Lan, Chao-Ying
Liu(2015). Multi-family group therapy for adolescent Internet addiction: Exploring theunderlying mechanisms. Addictive Behaviors, 42, 1-8
15:30-17:00 Symposium 12Child and adolescent mental health in Japan: current status and future
perspective
Moderator 1: Masahide Usami (Department of Child and Adolescent Psychiatry, Kohnodai
Hospital, National Center for Global Health and Medicine, Ichikawa, Japan)
Moderator 2: Noa Tsujii (Department of Child Mental Health and Development, Toyama

34

University Hospital, Toyama, Japan)
S12-1
Training Program in Child and Adolescent Psychiatry in Japan
Masahide Usami1
1
Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for
Global Health and Medicine, Ichikawa, Japan
ABSTRACTJapan has several serious issues of children’s mental health. However, in Japan, there are no
official qualifications recognized by Japanese medical specialty board, and there are two
representative types of child psychiatrists: those certified by Japanese Association of Child andAdolescent Psychiatry (JASCAP) and those certified by the Board certified child mental healthmedical specialist.
JASCAP has a long history since its establishment in 1960, with 4,540 members as of April 1,
2022, of which 2,515 are psychiatrists and 430 are board-certified doctors. To become board
certified, one must be a member of the society for five years; three detailed case reports and 30
case short reports are required, but there is no written exam.
The Board certified child mental health medical specialist, which was established in 2014 by theJapanese Association of Psychiatrists and Pediatricians, and the training program for children's
mental health specialists will be launched in April 2022. In Japan, a child psychiatrist can begin
training after six years of medical school, two years of clinical training, and three years of
training in psychiatry and pediatrics. It takes an additional three years to obtain a certified childmental health medical specialist, and during the three years of training, training in
psychosomatic medicine and psychiatry as well as presentations at academic conferences are
required. The medical specialty examination consists of a written and oral examination. In otherwords, eight years of training is required after graduation from medical school. At present, there
are a total of 712 certified child mental health medical specialists.
There are a few child psychiatrists in Japan and only a few specialized hospitals. There are alsosocial issues, such as the significant increase in the number of neurodevelopmental disorders
and abused children in recent years and the increasing suicided children during COVID-19
pandemic. Japanese government has also recommended that the high waiting list for initial
medical examinations for children with developmental disabilities be improved, and Japanesecommunity need children’s mental health care system.
While consultations on children's mental health are rapidly increasing, the current state of childmental health care in Japan is that child psychiatrists and specialized medical institutions are afew. The training of child and adolescent psychiatrists is an urgent issue in Japan.
The content of the presentation is a review of previous research reports, so no particular ethicalconsiderations are required. This author has supervisory fees from Shionogi, Otsuka
Pharmaceutical, and Janssen Pharma, and lecture fees from Vertrius Pharmaceuticals andNobelpharma.
S12-2
Prevention and Intervention for Child Abuse in Japan
Naoko Satake1
1
Department of Psychiatry, Kohnodai Hospital, National Center for Global Health andMedicine, Ichikawa, Japan
ABSTRACTChild abuse is an important issue in the field of Child and Adolescent Psychiatry, and not only35

in Japan but also in many other countries many child and adolescent psychiatrists and comedical staffs are involved in various services for child abuse.
In recent years, the number of cases of child abuse in Japan has been increasing year by year. In
addition, cases of child death due to abuse are reported every year. The Government has taken
various interventions, but they have not been sufficiently effective, and the number of abuses
continues to increase.
The number of abuse cases in 2020 is 205,044, more than ten times higher than the 17,725 casesof 20 years ago in 2000. By type of abuse, psychological abuse was the largest with 121,334
cases (59.2%), followed by physical abuse, neglect, and sexual abuse and the ratio of
psychological abuse is increasing.
To reduce child abuse, the Japanese government made partial revision of the Child Welfare Act
to build a system that will provide seamless support from early detection to prevent abuse, rapid
response when abuse occurs, and independence support for abused children. Furthermore, theChildren and Family Agency, which will be established in 2023, will address a central role incollaborating with various support services for children and families, such as protection ofchildren's rights, support for expectant and nursing mothers, and child-rearing support, to builda system that can provide comprehensive support against child abuse.
In this presentation I will introduce the situation of child abuse in Japan and policies to preventchild abuse, and some cases of how child and adolescent psychiatrists and government agencies
can work together to intervene against child abuse. Furthermore, I will talk about the challengesof child abuse in Japan.
The content of the presentation is a review of previous research reports, so no particular ethicalconsiderations are required. The author declares no conflicts of interest associated with thispresentation.
S12-3
Advantages and challenges of Japanese school health system for mental healthJun Kobayashi1
1Graduate School of Health Sciences, University of the Ryukyus, Nakagami, Japan
ABSTRACTAs the importance of mental health in schools is recognized worldwide during COVID-19
pandemic, the mental school health system between Japan and other Asian countries will becompared, and discuss the future direction for promotion in Asia. The WHO Western Pacific
Office has begun to address adolescent health as a priority for the future, and a regional
conference in 2022 identified mental health as a priority for adolescent health and identified
schools as an important entry point for community health. However, in many countries, the lackof human resources to implement school health and their low mental health literacy arechallenges in implementing school health.
With the enforcement of the National School Ordinance promulgated in 1941, school nurses
were positioned as school teacher in Japan. After the World War II, the school nurse became
Yogo teacher, who played many health services in schools, However, the physical educationteacher has been in charge of health education. In recent years, the duties of Yogo teacher havebeen expanded, and in 1995, it became possible to take charge of health education. In thiscontext, neither the Yogo teacher nor the physical education teacher has taken an active role inmental health education.
Against the background of various problems related to the state of mind of students, such as thegrowing seriousness of bullying and the increasing number of students who are not attending
school, a trial program was started in 1995 to utilize school counselors, professionals outside ofschools with specialized knowledge and experience in clinical psychology, in order to address
the concerns of students and parents and to improve the counseling function in schools.

36

Although the number of placements has still not yet reached 100% now, the number ofplacements has been increasing each year.
As described above, Japan appears to have an abundance of human resources related to school
mental health, but the following challenges can also be identified. While there are many
specialists, there are no employment regulations that require ordinary teachers to be actively
involved in school health activities and health education, and there are few opportunities toreceive training for this purpose. Furthermore, opportunities for all students to learn about
mental health in teacher training schools are limited.
The content of the presentation is a review of previous research reports, so no particular ethicalconsiderations are required. The author declares no conflicts of interest associated with thispresentation.
S12-4
Pharmacotherapy for children and adolescents with attentiondeficit/hyperactivity disorder in Japan
Noa Tsujii1
1
Department of Child Mental Health and Development, Toyama University Hospital, Toyama,Japan
ABSTRACTIn Japan, the incidence of and use of medication for attention-deficit/hyperactivity disorder(ADHD) have increased over the last two decades. Nonpharmacological treatments arerecommended as first-line treatment for children, adolescents, and adults with ADHD, according
to the Japanese clinical guideline. When nonpharmacological treatments fails and ADHD
symptoms persist, pharmacological treatment is recommended as a second-line treatment. Until
now, the Pharmaceuticals and Medical Devices Agency has approved two stimulants (osmoticcontrolled release oral delivery system [OROS] methylphenidate and lisdexamfetamine) andtwo nonstimulants (atomoxetine and guanfacine) for the treatment of persons with ADHD. The
Amphetamines Control Law defines lisdexamfetamine as a stimulant raw material with thefollowing warning: “Use only if other ADHD medications are ineffective.” In comparison toother countries, the Japanese ADHD medication prescription pattern was reported to have thefollowing characteristics: (1) a lower prevalence rate of ADHD medication use for children andadolescents, (2) a higher rate of nonstimulant use for those patients, and (3) a lower daily doseof OROS methylphenidate. One reason for the differences in prescribing patterns between Japanand other countries could be the different ADHD treatment guidelines. That is, the Japaneseclinical guideline for ADHD considers both stimulants (OROS methylphenidate) andnonstimulants (atomoxetine and guanfacine) to be first-line medications. Another possibility is
explained in part by Japan’s stimulant restriction policies (OROS methylphenidate andlisdexamfetamine). These characteristics of the Japanese ADHD medication prescription pattern
may result in insufficient treatment effect, lower adherence, and a proclivity for discontinuationin the early stages. Standardized ADHD medication treatment strategies will improve the qualityof care for people caring for children and adolescents with ADHD.
The content of the presentation is a review of previous research reports, so no particular ethicalconsiderations are required. The author reports procuring personal fees from Otsuka, Shionogi,
Takeda, and Nobelpharma.

37

Venue 4 （RoomC-1）
10:20-11:50 Symposium 3
Challenges and opportunities of working with young people in prison andjuvenile justice system
Moderator 1: Bhoomikumar Jegannathan (Center for child and adolescent mental health(Caritas-CCAMH), Krŏng Ta Khmau, Cambodia)
Moderator 2: Kazumasa Kimura (Medical Corporation Shinsinkai Tama-Aoba Hospital,
Higashimurayama, Japan)
S3-1
Mental health problems and suicidal expressions among young prisoners in
Cambodia: a cross-sectional study
Puthy Pat1
1
Center for child and adolescent mental health (Caritas-CCAMH), Krŏng Ta Khmau, Cambodia
ABSTRACT
Background: Mental health and suicide problems among young people, particularly young
prisoners is a public health concern globally. Numerous studies informed that young prisoners
are one of the most vulnerable groups and are up to ten times more susceptible to mental healthproblems compared to the young people in the general population.
Aims: This is a cross-sectional study aimed to assess the level of mental health problems andsuicidal expressions and determine the associated risk factors among young prisoners in
Cambodia, a low- and middle-income post-conflict country.
Method: Three prisons were selected out of total 24 prisons in the country. 572 young maleprisoners between the ages of 15 and 24 participated. The Youth Self-Report (YSR) and theAttitude towards Suicide (ATTS) questionnaires were used to assess mental health problems andsuicidal expressions, respectively.
Results: YSR mean scores for internalizing and externalizing problems 25.97 and 18.12,
respectively; anxiety/depression 11.88, aggressive behaviours 9.97. Social problems, somatic
complaints, attention problems and rule breaking behaviour were in the range of 8.10 to 8.49.
Withdrawal depression and thought problems were 6.55 and 6.66, respectively. Young prisoners
reported significantly higher mean scores across all sub-domains of YSR compared to young
people in the schools of Cambodia (Jegannatan et al. 2011).
ATTS scores: 16.26% thought about their own death, and 12.06% expressed wish to die. Suicide
ideation, planning, and attempts were 6.83%, 1.75%, and 2.80%, respectively. All types ofsuicidal expressions were lower except suicide attempts compared to the school study in
Cambodia: 16.26% of the young prisoners reported death thoughts as opposed to 25.30% and2.80% suicide attempts compared to 0.6% in the school study (Jegannatan et al. 2011).
Mental health problems were associated with younger age, lower educational background, andshorter duration of incarceration. Prior drugs users thought about death significantly (OR 2.08,
95%CI 1.12-3.87) more than their counterparts while suicide ideation was significantly (OR0.50, 95% CI 0.26-0.98) lower among prisoners with higher education.
Conclusion: Mental health problems and suicidal expressions among young prisoners warrant
well-planned mental health services that are integrated into the current prison health system. A
contextualised intervention that considers age, education, duration of incarceration and previous
drug use may contribute to improve the mental well-being of young prisoners in Cambodia.
Ethical consideration: Ethical clearance was sought from the National Ethics Committee for
Health Research, Ministry of Health, Royal Government of Cambodia (reference no.
N33NGCHR), and the permission to conduct the study in the prisons was approved by theindividual prison authorities and the General Department of Prisons, Ministry of Interior. Bothoral and written consent were obtained from individual prisoners.

38

COI: All research team members/authors declared no conflict of interest.
S3-2
Challenges in giving voice to marginalize young people in prison setting,Cambodia, a post-conflict country
Bhoomikumar Jegannathan1
1Center for child and adolescent mental health (Caritas-CCAMH), Krŏng Ta Khmau, Cambodia
ABSTRACT
Background: Globally, there are challenges in engaging with and enabling the participation of
marginalized young people in research. There are methodological and practical issues faced
when conducting studies with young people who experience marginalization such as young
prisoners. The mental health of offenders in prisons and other penal institutions pose significant
challenges in treatments and rehabilitation due to differences in social situations and context. It
is important to understand the challenges in involving marginalized young people in researchsetting, particularly young prisoners to explore mental health challenges and voice theiropinions and suggestions to bring prison reform and integrate mental health services into theprison health system.
Aims: Compare the research experiences from four diverse settings involving marginalized
young people in the following countries: urban communities in North India, rural northern
Sweden, rural schools in Zambia and young prisoners in Cambodia to inform youth research in
the field of global public health.
Method: Qualitative studies were conducted to give voice to the marginalized young people inIndia, Sweden and Zambia, and a mixed-methods study in Cambodia to examine the mental
health challenges among young prisoners and access to psychosocial care within the prison
setting. Youth Self-report and Attitude Toward Suicide questionnaires for quantitative study andfocus group discussions (FGDs) for qualitative.
Results: Developing trusting relationships with participating young people, the value of researchmethods, flattening power relations between young people and researchers were highlighted in
the four countries study to maximize youth participation. In Cambodia, the quantitative study
reported high prevalence of mental health problems and suicides compared to the general
population. Overcrowding, multifaceted experiences, socio-economic support, and previous
involvement of drug abuse influenced mental health and well-being. The practices of rituals andtraditional healing helped them to cope.
Conclusion: Marginalized young people’s participation in research may contribute to prison
reform addressing issues of overcrowding and integrating mental health services into the current
prison health system, particularly in the context of mistrust between the authorities to overcome
the barriers. This informs future youth research in the field of global public health with thefocus on conducting participatory research among marginalized young people and being
responsive to their needs, wishes and initiatives, open to new ways of planning intervention inconstrictive setting such as prison.
Ethical consideration: Ethical clearance was sought from the National Ethics Committee for
Health Research, Ministry of Health, Royal Government of Cambodia (reference no.
N33NGCHR), and the permission to conduct the study in the prisons was approved by theindividual prison authorities and the General Department of Prisons, Ministry of Interior. Bothoral and written consent were obtained from individual prisoners.
COI: All research team members/authors declared no conflict of interest.
S3-3
Two different institutional treatment systems for juvenile delinquents with mental

39

disorders in Japan
Hiroshi Tomita1
1
Abashiri Prison, Hokkaido home school, Abashiri, Japan
ABSTRACTJapan has two different systems for treating juvenile delinquents. These two systems are very
different in nature.One is a juvenile training school, a correctional institution under thejurisdiction of the Ministry of Justice, and the other is a child welfare institution under thejurisdiction of the Ministry of Health, Labour and Welfare, a child self-reliance support facility.
The first premise is that the proportion of juvenile delinquents in Japan is very small in relation
to the population. Perhaps because of the small number of juvenile delinquents, the proportionof delinquents admitted to institutions with mental disorders, especially developmental andattachment disorders, is very high.
In a juvenile training school, these young people receive systematic cognitive-behaviouraltherapy. During their stay in a juvenile training school, juveniles spend their time in delinquency
rehabilitation programmes. In principle, private conversation is prohibited in the institution,
except during group work sessions.
On the other hand, in a children's self-reliance support facility, milieu therapy in the therapeuticcommunity is the mainstay of treatment.In children's self-reliance support facilities that use acouple's dormitory system, married couples live in a dormitory with the juvenile delinquents.
The maximum capacity is about 10 children. If the couple has biological children, they also livewith them. In other words, in the dormitory, the staff literally “live” with the boys. In themornings, the boys attend classes at the school set up on the premises. In the afternoons, theboys spend most of their time working and exercising. In the dormitories, a regular daily routine
is maintained. The boys can talk freely with each other in the dormitories, even about private
matters. As these are children with developmental and attachment problems, interpersonal
problems are likely to arise. However, the staff are of the opinion that the problems are a goodtraining ground for their interpersonal skills.
Thus, the treatment systems of the two institutions are very different. This section focuses on thetype of treatment and education the boys receive at the child self-reliance support facility, asystem that is unique in the world.
Ethical consideration: This research is a non-clinical research that does not require ethics
approval.
COI: No conflicts of interest
S3-4
The future of juvenile delinquents/young prisoners - The prejudiced survey'
blocking against rehabilitation of offenders
Kumiko Ando1
1
Department of Neuropsychiatry, St.Marianna University School of Medicine, Kawasaki, Japan
ABSTRACTThe current Juvenile Law of Japan was enacted in 1948 and has undergone a series of revisions
since then. The basic philosophy is based on the beliefs of Parens Patriae, and the key objectives
are to provide correctional education and to adjust the environment for the sound upbringing ofjuvenile delinquents.
In Japan, following the lead of other countries, the age of adulthood was lowered from 20 to 18
in April 2022. As a result, 18-19 year olds are treated as adults in civil law, but in criminal law,they continue to be subject to the Juvenile Law as "specified juveniles. However, the expansionof the number of cases referred to prosecutors and the disclosure of their real names to the40

public may have some impact on their reintegration into society.
When we look at changes in juveniles themselves, we find that the number of juvenile
delinquency cases has been consistently decreasing since 2004, and that the number of juvenile
delinquency cases is now one-half that of 1983, when the number of delinquency cases peaked.
As a child psychiatrist, I used to work at a juvenile reformatory and am still involved in thetreatment of juveniles there. For example, in the past, juvenile delinquents tended to express
their defiance of adults in outward aggressive behavior such as verbally abusive and physicalviolence. In recent years, however, juvenile delinquents have shifted to passive-aggressive
behaviors, such as self-mutilation and refusal to eat, instead of violent behaviors. Such changes
can be confirmed by comparing paintings.
With these changes in Japanese law and society, as well as in the juveniles themselves, whatkind of support is needed to help juvenile delinquents reintegrate into society?
We will discuss the reintegration of juvenile delinquents into society, based on the results of astigma survey toward forensic patients with mental disorders among 2,000 people in the general
population.
Ethical consideration: Regarding the stigma survey, ethics approval of the ethics committee of
St. Marianna University School of Medicine.
COI: The authors have no conflicts of interest directly relevant to the content of thispresentation.
13:00-13:40 Research Topics 3
Clinical implications of Longitudinal Research in Child and Adolescent Mental
Health: Are We Doing Good?
Tomoya Hirota1
1
Department of Psychiatry and Behavioral Sciences, University of California San Francisco,
San Francisco, USA
ABSTRACT“Doctor, will my child grow out of this problem?” “Doc, is my daughter going to feel happy if
we help her now?”
Clinicians in child and adolescent mental health often experience these simple but challenging
questions from caregivers of the patients/clients. Can we answer these questions? We believethat mental health problems, symptoms, and conditions that emerge in childhood will diminish
over time. We also believe that interventions/treatments we provide can change a child’s
prognosis in the field of child and adolescent mental health. However, to what degree are weconvinced in sharing these opinions with the patients and their families? To support our beliefs,
we need data.
Scientific findings can augment our empirical views in clinical practice. Cross-sectional
research in which data is collected only once can help us understand what variables areassociated at one time point. However, this method does not address clinical questions above. In
contrast, longitudinal study designs take multiple waves of data collection and can allow for
examining continuity (vs. discontinuity) of child and adolescent psychopathology, patterns ofcontinuity, factors predicting certain future psychopathologies, and effects of interventions andtreatment on future mental health outcomes.
This presentation will summarize existing research findings from longitudinal studies to argue
clinical implications of these findings on psychopathologies and treatment effects. To enhance
the audience's understanding of study findings, analytical methods commonly employed inlongitudinal studies will also be presented. The discussion will then focus on what are yet to beunderstood from the findings of the existing studies. For instance, what is the ultimate goal ofour daily practice and therapeutic interventions? Is it to alleviate the current painful condition oris it to improve the quality of youth’s life in the future? Do our current interventions have a41

preventive aspect?
13:50-15:20 Symposium 8
Implementation and Dissemination of Parent-Child Interaction Therapy (PCIT) in
Japan
Moderator 1: Masaki Kodaira (Department of Child and Adolescent Mental Health, Aiiku
Clinic, Tokyo, Japan)
Moderator 2: Miki Takada (1) National Center of Neurology and Psychiatry National Institute of
Mental Health, Department of Developmental Disorders, Kodaira, Japan, 2) Chiba University,
Graduate School of Medical and Pharmaceutical Science, Department of Frontier Medicine andPharmacy, Chiba, Japan)
S8-1
Implementation and Effectiveness of PCIT in Japan
Toshiko Kamo1,2
1
Wakamatsucho Mental and Skin Clinic, Tokyo, Japan
2
Japan PCIT Training Center, Tokyo, Japan
ABSTRACTParent-Child Interaction Therapy (PCIT) is a psychotherapy based on play therapy and behavior
therapy that aims to improve the quality of parent-child interaction and facilitate recovery forparents (caregivers) struggling with their child's emotional or behavioral problems or parenting
difficulties. It was developed by Eyberg et al. in the 1970s in the United States. The treatment
program consists of two stages: Child-Directed Interaction (CDI) in the first half, where thechild takes the lead in play to improve the parent-child relationship, and Parent-DirectedInteraction (PDI) in the second half, where the parent takes the lead and conducts discipline.
The essential evaluation measures used are the Eyberg Child Behavior Checklist (ECBI) and the
Dyadic Parent-Child Interaction Coding System (DPICS). The theoretical background includes
behavioral science, attachment theory, parenting style research by Baumrind, and social learningtheory.
PCIT's most significant feature is live coaching, and it is based on robust evidence. It has spreadworldwide beyond language barriers, including Australia, Germany, Switzerland, Norway,
Korea, Hong Kong, Taiwan and Japan.
PCIT was introduced to Japan in 2008, and since 2010, the developers, Eyberg and PCIT
International, have provided direct training. Since the beginning of the training program using
Japanese texts in 2015, the dissemination of PCIT has particularly progressed, andapproximately 600 people have taken the initial workshop, with approximately 100 receiving
certification as therapists or trainers from PCIT International. Participants include clinicalpsychologists, clinical developmental psychologists, child psychiatrists, pediatricians,
psychiatrists, nurses, social workers, and others, and their fields of work are diverse, includingchild abuse, domestic violence, developmental disorders, and more, as well. In addition to theannual conference, which attracts participants from all over Japan, activities by local
associations are also becoming more active.
A retrospective cohort study was conducted in January 2020 in multiple facilities, analyzing 192
cases from 21 institutions, with an effect size of 1.85 and a completion rate of 69%, confirmingthat having a co-therapy system and super-vision led to better outcomes. PCIT is positioned as aparticularly crucial psychotherapy for Japan, which is experiencing a declining birthrate andaging population, as it includes both interventions for a child's problematic behavior and support
for caregivers.
COI: The presenter receives salary and honorarium from Japan PCIT Training Center, andcopyright income from Shogakukan and Chiba Test Center.

42

S8-2
Parent-Child Interaction Therapy (PCIT) in Child Psychiatry Clinical PracticeNana Hosogane1, Nozomi Kihara1,2, Yurika Tagami1,2
1
Department of Child and Adolescent Mental Health, Aiiku Clinic, Maternal and Child HealthCenter, Tokyo, Japan2
Department of Medical Welfare, Aiiku Clinic, Tokyo, Japan
ABSTRACT
Aiiku Clinic is a Maternal and Child Health Center in Tokyo and focuses on outpatient clinic
services for women, newborns and children. The Department of Child and Adolescent Mental
Health provides child psychiatry services for children from infancy to school age.
Approximately two-thirds of the children’s diagnoses at first visits are developmental disorders
such as autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD).
Many developmental disorders require long-term support and caregivers are generally underhigh stress, particularly because of the long duration and high intensity of the children’s
behavior problems often including significant disruptive behaviors (Anastopoulos, 1993;
Angold, 1998). The younger the child is, the greater the impact of the immediate family
environment has on the child, and providing support for caregivers is important for improving
the child’s prognosis.
Parent-Child Interaction Therapy (PCIT) is an evidence-based behavioral parent training
treatment for children aged 2 to 7 and their parents (Eyberg, 1988). PCIT is efficacious intreating children with disruptive behavior disorders by enhancing the quality of parent-childrelationships and the improvement has been shown to last up to 3-6 years after treatment (Hood& Eyberg, 2003). We would like to report on the implementation of PCIT in our Clinic anddiscuss the efficacy and benefits in child psychiatry clinical practice.
The implementation of PCIT in child psychiatry clinical practice can be beneficial in improving
disruptive symptoms of children with developmental disorders and also improving and/or
preventing comorbidities. PCIT is also reported to decrease parenting stress in caregivers ofchildren with developmental disorders.
Another advantage of PCIT is the educational aspect. During PCIT, multiple clinicians work
together and provide coaching from behind the one-way mirror. In this way, clinicians may
work together as a team and share ideas and information of clinical assessments and show how
to approach children and caregivers.
PCIT is an intensive treatment intervention and cannot be implemented to all cases with
developmental disorders. We would like to explore ways in which PCIT can be implemented
more efficiently in the future.
The contents of this presentation have been approved by the Ethics Committee of Aiiku
Research Institute.
The presenters have no conflicts of interest directly relevant to the content of this presentation.
S8-3
Implementation of Parent-Child Interaction Therapy within foster care
Ikuko Kato1
1
Saitama City Comprehensiive Center for Children and Family, Saitama, Japan
ABSTRACTIn Japan, the increase in the number of cases of child abuse has led to the need for further
strengthening of measures to prevent child abuse, as well as to strengthen support for caregivers
and to expand both the quantity and quality of social care for abused children and others. In
Japan, approximately 90% of children in need of social foster care are currently placed

43

institutions. In order to ensure that children are nurtured in a healthy environment, bothmentally and physically, it is necessary to promote foster care in an environment closer to home,
and a comprehensive foster care support system is being developed. In practice, however, foster
parents face considerable difficulties in fostering children in the child welfare system. Many ofthese difficulties are in dealing with children's significant behavioral problems, which can cause
foster parents to lose confidence in their foster care. Children in foster care often have a historyof abuse and neglect, experience high Adverse Childhood Experiences (ACE)scores, exhibit
externalizing behaviors, and are at risk for developing future psychological complications.
Foster parents often lack the training and support necessary to manage their children's
externalizing behaviors, which contribute to parenting stress and are high predictors ofplacement change in foster care. Although foster parents receive pre-service training before
registering or being entrusted with a child, the content of this training varies by region and often
does not include sufficient training in parenting skills, among other things, which prevents themfrom providing the gold standard, evidence-based interventions to address children's behavioral
problems. Parent-Child Interaction Therapy (PCIT) is an established, empirically supported
treatment for children's disruptive behavior. We have been actively promoting PCIT as a foster
care support program since 2019 to support foster parents to manage their children's behavior
and improve their parenting skills. To date, in several cases, the program has been shown to beeffective in improving children's behavior problems and reducing foster parents' sense ofdifficulty in fostering their children. In this symposium, we report on the effectiveness andlimitations of the application of PCIT to the field of child welfare, including our own
experiences.
Presenter has no conflict of interest relevant to this presentation.

S8-4
PCIT for preterm infants in Jichi Medical University and our role in social
problems related to preterm infants
Koyuru Kurane1, Yukifumi Monden1, Miyuki Matrano1, Kei Wakabayashi1
1Jichi Medical University, Department of Pediatrics, Shimotsuke, Japan
ABSTRACTThe number of preterm infants is increasing worldwide, with a reported prevalence of 5–18%.
Preterm infants tend to experience more externalizing behavioral problems during their growthand development, and parents experience stress related to child rearing. In turn, parental stressincreases the externalizing problem behaviors of preterm infants. Therefore, childcare problems
resulting from externalizing problem behaviors remain. This is a societal issue for preterm
infants and their parents. However, no evidence-based treatments are available for theexternalizing problem behaviors of preterm infants. Yukifumi Monden has established a PCIT
laboratory and co-authors are the members. To identify treatments for preterm infants withexternalizing problem behaviors, we conducted several studies to analyze the clinical questions(1) to (4) as follows:(1) Although a standardized quantitative index of externalizing problematic behavior, called the
Eyberg Child Behavior Inventory (ECBI), is available in the U.S., standardization has not beenaccomplished in Japan. To quantify externalizing problem behaviors, we validated thestandardization of ECBI in Japan with the instruction of Toshiko Kamo and Fumie Ito.
(2) Few studies have been conducted in Japan on the effectiveness of treatment for externalizing
problem behaviors in preterm infants. Jichi Medical University has implemented parent-childinteraction therapy (PCIT), which improves children's externalizing problem behaviors andparents' child rearing styles. Therefore, we used the standardized ECBI as an effectiveness scale
to verify the effectiveness of PCIT for preterm infants.
(3) Internet-based support was necessary during the COVID-19 pandemic. In the U.S., several

44

studies have examined the effectiveness of Internet-based PCIT before the COVID-19
pandemic. However, in Japan, Internet-based PCIT spread after the pandemic, and few reports
have examined the effectiveness of Internet-based PCIT. With the support of Toshiko Kamo, We
established Japan's first PCIT-certified therapist training undergraduate course at Jichi Medical
University. By building a support network using teletherapy, we verified the effectiveness ofInternet-based PCIT for preterm infants.
(4) We lack to treat externalizing problem behaviors in preterm infants under 2 years of age,which is not an original indication for PCIT. Few studies have been conducted worldwide on theeffectiveness of PCIT for toddlers (PCIT-T) for externalizing problem behaviors in preterm
infants under 30 months of age. Therefore, we conducted PCIT-T on preterm infants to examine
the effectiveness of this treatment for externalizing problem behaviors.
Written consent was obtained from all participants. The study was approved by the Ethics
Committees of Jichi Medical University.
In relation to this presentation, the presenter has no conflict of interest that needed to bedisclosed.
15:30-17:00 Symposium 13
Does the Difference in Language and Culture Alter the Efficacy of EvidenceBased Parent Training Treatments in Japan?
Moderator 1: Toshiko Kamo (1) Wakamatsucho Mental and Skin Clinic, Tokyo, Japan, 2) Japan
PCIT Training Center, Tokyo, Japan)
Moderator 2: Nana Hosogane (Aiiku Clinic, Tokyo, Japan)
S13-1
Language and cultural differences in PCIT –Insights from clinical practices and
PCIT attrition studies–
Miki Takada1,2
1National Center of Neurology and Psychiatry National Institute of Mental Health, Departmentof Developmental Disorders, Kodaira, Japan
2
Chiba University, Graduate School of Medical and Pharmaceutical Science, Department ofFrontier Medicine and Pharmacy, Chiba, Japan
ABSTRACTParent-child interaction therapy (PCIT) is a behavioral parent-child psychotherapy that has been
widely demonstrated to be highly effective in reducing child's disruptive behaviors andimproving parents' parenting skills. Despite the language difference, with the same protocol in
multiple languages (originally written in English), its procedure has been used with a wide
range of populations across multiple countries and ethnicities, and has shown impressive
efficacy rates. Moreover, PCIT has demonstrated long-lasting effect for those who complete thetreatment that it is crucial for caregiver-child dyads to complete the treatment to obtain the best
outcome.
However, PCIT treatment responsiveness and attrition vary due to a variety of cultural andpsychosocial factors. The systematic review has illustrated that heterogeneous countries like theUnited States have varied completion rates (from around 30% to 80%), while homogeneous
countries like Taiwan and the Netherland have much more consistent and lower rates (around30-40%).
The differences in completion rates may be due to the difficulty of creating a strong "rapport"
between the therapist and the dyad especially when cultural backgrounds and native languages
are different. In more homogenous countries, it is easier for the therapist to understand andrelate to the clients due to their shared culture and language. However, in heterogeneous
countries, it can be more difficult for the therapist to bridge the gap between their own cultural

45

background and that of the client even when they speak the same language.
As Japan transitions to a more multicultural and heterogeneous society, with more immigrants
from both Asia and the West (recently from Ukraine), it is getting more critical that Japanese
therapists adjust their approaches to accommodate the different cultural contexts of their clients.
While PCIT has been utilized its well-established methodology to every client, especially whentherapists are in the treatment with multicultural background, the process which appeared to be
auxiliary becomes the important process of developing the relationship with clients. Thus, it isimportant that therapists take into account the different cultural contexts and make adjustments
to their cultural norms by properly considering each unique cultures, so that the dyads are able
to feel connected to the therapist and receive the most benefit from the treatment by completingthe treatment. Insights from the systematic review and the experiences of conducting PCIT withmultilingual and multicultural families in Japan will be discussed.
The author has no conflict of interest.
S13-2
Japanese mother-child interaction in Dyadic Parent-Child Interaction Coding
System (DPICS)
Masahiro Yamaguchi1
1
Department of Educational Collaboration, Osaka Kyouiku University, Kashiwara, Japan
ABSTRACT
Dyadic Parent-Child Interaction Coding System (DPICS) is a technique for assessing the qualityof parent-child interactions based on observations in Parent-Child Interaction Therapy (PCIT).
DPICS is a method that primarily relies on language; it allows for maintaining objectivity when
specialists of different professions conduct evaluations. Studies utilizing the DPICS havedemonstrated that interactions between caregivers and young children with behavioral issues
frequently involve criticism, instruction, and ineffective commands (Robinson & Eyberg, 1981;
Webster-Stratton, 1985).
However, it is widely acknowledged that there are distinctions in parent-child interactions basedon culture. For instance, American mothers are more likely than French and Japanese mothers toengage in activities such as describing, pointing to, naming, or describing object features that
foster their children's visual and tactile exploration of their surroundings (Bornstein & TamisLeMonda, 1991). Furthermore, Japanese mother-child interactions are characterized by a strong
sense of attachment and amae, a Japanese concept of dependence on another person (Rothbaum
et al., 2016). Some studies have found that Japanese mothers tend to be more controlling andless responsive than their American counterparts (Fogel et al., 1988; Trommsdorff &Friedlmeier, 1993) while perceiving their children differently than American mothers (Senzaki
et al., 2021). Since DPICS was developed in the United States, American culture may haveinfluenced its coding rules and characteristics. It is hypothesized that variations in cultural
backgrounds affect parent-child conflicts and children's behavioral issues (Garcia et al., 2017).
Therefore, cultural influences must be considered when utilizing DPICS to assess parent-childinteractions and evaluate the effectiveness of PCIT properly. Furthermore, utilizing the DPICS
coding rules for assessing parent-child interactions would enable evaluations of the effects of
PCIT in familial settings with diverse cultural backgrounds.
PCIT is gradually gaining popularity in Japan, and the DPICS has been employed to gauge theeffects of this intervention (Hosogane et al., 2018). However, PCIT and DPICS have only
recently been introduced in Japan (Kamo, 2010), and standardized data on the DPICS ofJapanese remains limited.
In this presentation, we will present the findings of an exploratory study of parent-childinteraction patterns among Japanese mothers using DPICS. Specifically, we will present data forJapanese mothers and their children using the clinical version of DPICS and compare results

46

from Western countries. Additionally, we will introduce the characteristics of mother-infantinteractional patterns in DPICS.
The research was conducted without any commercial or financial relationships that could beconstrued as a potential conflict of interest.
S13-3
The practical approach of Parent-Child Interaction Therapy throughDevelopmental-Behavioral Pediatrics in the United States
Myong Sun Choe1, Emma Girard2
1
Early Intervention Program, Golden Gate Regional Center, San Francisco, USA
2
University of California Riverside School of Medicine, Riverside, USA
ABSTRACTParent-Child Interaction Therapy (PCIT) has been proven to be highly effective in young
children aged from 3 to 7 years with externalizing behavior problems. However, not all families
benefit from PCIT for various reasons. In particular, language used and ethnic culture of thefamily as well as the implicit biases from the society surrounding could become barriers for
immigrant families. Inter-generational cultural and language gaps within the direct- andextended-family may add another layer of challenges on its effectiveness. As such, it isimperative for the PCIT therapists to understand the family’s cultural view to tailor its approach
while preserving generalizability to both minority and non-minority ethnic immigrants.
In this presentation, the practical approach of PCIT to the children and families emigrated to theUnited States (U.S.) with different background, cultures and languages will be presented. Fourchildren (aged 3 to 4 years) and their families were consulted to a developmental-behavioral
pediatrician, who provides PCIT, from different institutions and programs in the U.S.;
developmental-behavioral pediatricians from a tertiary university hospital, the U.S. Federal
funded Early Intervention Program, and community-based parenting groups. Each family
experienced its own unique challenges in language barrier between the PCIT provider and afamily member (either child or one parent), language barrier within the family members, ethnic
culture and religion of the family, a stigmatized view of neurodevelopmental disorders,socioeconomic barrier, as well as psychosocial background and traumatic experiences that led
the families to relocate to the U.S.
An approach of personalizing treatment was used while keeping fidelity/adaptation balance.
During the pre-assessment, the therapist tried to identify factors associated with treatment
engagement and response in each family. In each step of the PCIT, even it was a small step,
motivational interviewing-based intervention and subsequent shared decisions making with thefamily helped to effectively proceed the therapeutic course across multiple ethnic minority
families.
The evidence has generally suggested that ethnic minority families are less likely to engage inbehavior parent training and show poorer outcomes. Our practical approach applied to thefamilies living in the U.S. with different ethnic backgrounds may provide some hints to the
PCIT providers in Japan when they serve increasingly diverse set of clients with bicultural andmultiethnic backgrounds.
There is no conflict of interest (COI).
S13-4
Difference between Japan and Western countries in parent-infant interaction andsocio-cognitive development

47

Yasuyo Minagawa1
1
Department of Psychology, Keio University, Yokohama, Japan
ABSTRACTThe literature on developmental psychology including social and language development
consists mainly of studies conducted in Western countries. Although such Western-culture-basedknowledge seems to be the norm, researchers in this field have realized that the developmental
trajectory might differ depending on culture and language. Particularly, Japanese infants seem tolag behind Western infants in socio-cognitive development. In this talk, I will first show someexamples of such differences in social and language development found in our studies as well asother previous ones. These examples include 1) development of Theory of Mind (ToM)
measured by the false belief and perspective taking tasks, and 2) phoneme and vocabularyacquisition. Then, I will discuss possible causes of the developmental lag from the perspectiveof parent-infant interaction. One dominant cause would be the weakness of perceptual saliencyof the stimuli, namely social and linguistic signals, under the Japanese social environment. For
instance, the amplitude of facial expressions (movement) and the frequency of eye-contact arelower in Japanese culture. This affects the infant’s perception and what parts of the face they
focus on as cues to understand others’ emotional state, intention as well as linguistic soundcategory. Such social stimuli during parent-infant interaction impact on infant’s development.
Another possible cause would be the difference in the use of words to express one’s emotions orstates of mind (mental state terms). It has been reported that the use of mental state terms
positively affects the development of ToM. Japanese culture is less prone to express one’s
emotional state, so there may be fewer mental state terms provided by caregivers to children,which may eventually result in delayed ToM development. Additionally, I will show an example
of possible bias about gender-specificity that Japanese mothers may unconsciously have for
their parenting. It seems that Japanese mothers tend to prefer gender-typical behaviors of theirchildren. This was found from maternal behaviors during mother-child free play using gendertypical and non-gender-typical toys. After summarizing these studies, I will discuss what theideal form of parent-infant interaction in Japan is and how to achieve it, by referring to PCIT
(Parent-Child Interaction Therapy) and our intervention trials.
The author declares no competing interest to disclose.
Venue 5 (RoomC-2)
10:20-11:50 Symposium 4
Epidemiological study on adolescent mental healthModerator 1: Shuntaro Ando (The University of Tokyo, Tokyo, Japan)
Moderator 2: Atsushi Nishida (Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan)
S4-1
Mental health of adolescents during COVID-19 in South Korea: a social media big
data analysis
Ryemi Do1, Soyeon Kim2, You Bin Lim1, Su-Jin Kim1, Hyerim Kwon1, Jong-Min Kim3, BungNyun Kim1
1
Division of Child and Adolescent Psychiatry, Department of Neuropsychiatry, Seoul National
University Hospital, Seoul, Korea
2
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton,
Canada3
VAIV Company, Seoul, South Korea

48

ABSTRACT
Since the Coronavirus disease 2019 (COVID-19), public safety measures, including social
distancing and school closures, have been implemented, precipitating psychological difficulties
and heightened online activities for adolescents. This study investigated adolescents' perceptionof the psychological impact of the COVID-19 pandemic and their coping strategies through asocial media big data analysis. Through examining genuine discourse on mental health problem
shared by adolescents on social media, this study suggests effective ways to provide support foradolescents during the pandemic.
The data were gathered from social media platforms such as online communities, Twitter, andpersonal blogs of South Korea from January, 2019, to October, 2021. The 12,520,250 texts were
included. The focus keywords and associated words were analyzed by text mining, natural
language processing, and a language dictionary. The whole data included in this study isvoluntarily and openly shared online posts with no personally identifiable information. Ethicalapproval was not required for these reasons.
Various mental health difficulties such as self-harm, sleep, and attention problems intensified
during the pandemic. Korean adolescents seem to perceive psychiatric drugs and caffeinatedbeverages as strategies to cope with sleep and attention problems. Korean adolescents may copewith self-harm by talking to their peers. Clinicians, parents, and educators should work
collaboratively to provide developmentally appropriate coping strategies to address mental
health difficulties for adolescents during the pandemic. For instance, 1) intervention programs
that support healthy relationships with parents and peers and 2) psycho-education about the
optimal management of sleep, attention problems, and self-harm seem important to guideadolescents more efficiently.
Conflict of Interest
The research was conducted without any commercial or financial relationships that could beconstrued as a potential conflict of interest. The author who belonged to social media big datacompany collected and analyzed the social media data according to other authors’ designs andideas.
S4-2
Tokyo TEEN Cohort Study: An adolescent population-based birth cohort study inTokyo
Syudo Yamasaki1, Daniel Stanyon1, Satoshi Yamaguchi1, Kaori Endo1, Mitsuhiro Miyashita1,
Shuntaro Ando1,2, Mariko Hiraiwa-Hasegawa3, Kiyoto Kasai2, Atsushi Nishida1
1Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical
Science, Tokyo, Japan2
Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo,
Tokyo, Japan3
School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies),
Kanagawa, Japan
ABSTRACT
Adolescent is a distinct period of biological, psychological, and social development.
Adolescents experience dramatic changes to their physical and mental status, often accompanied
by feelings of instability. Many life-long mental disorders first appear during adolescence,
which if unaddressed may have serious ramifications for quality of life and incur substantialsocial and economic costs. In addition, over the past decade, the prevalence of depression andsuicidality has increased among adolescents globally. To comprehensively investigate
developmental processes and to find critical targets for intervention to promote adolescentmental health, we have launched the Tokyo TEEN Cohort, a large prospective population-based
birth cohort study.

49

Launched in 2012, Tokyo TEEN Cohort study is conducted in three municipalities in the Tokyo
metropolitan area. We recruited over 3000 10-year-old children born between 2002 and 2004,
and their caregivers. We have collected information on adolescents’ mental health and related
factors through four waves of data collection at 2-year intervals (10, 12, 14 and 16 years of age)with a high participant retention rate (83% over six years). Tokyo TEEN Cohort study wasapproved by the ethics committees of the Tokyo Metropolitan Institute of Medical Science, The
University of Tokyo, and The Graduate University for Advanced Studies.
Using longitudinal data spanning four time points allows us to disentangle complex relations
among many factors influencing adolescent mental health. In particular, we can inferprospective (nearly causal) relationships among these factors dividing within-person andbetween-person effects using statistical modeling. We will introduce the details of Tokyo TEEN
Cohort study and will present the results of the Random Intercept Cross-Lagged Panel Model(RI-CLPM), which allows us to test within-person prospective associations. We will further
discuss future research for finding targets for prevention and intervention to promote positiveadolescent mental health.
Conflict of Interest: None
S4-3
Adolescent depression: the impact of the COVID-19 pandemic and help-seeking
among the vulnerable population
Mariko Hosozawa1
1
Institute for Global Health Policy Research, Bureau of International Health Cooperation,
National Center for Global Health and Medicine, Tokyo, Japan
ABSTRACT
Adolescence is a vulnerable period for experiencing mental health problems, including
depression. Furthermore, there is an increasing concern that adolescent mental health,particularly depressive symptoms, has worsened during the COVID-19 pandemic. Using datafrom the Tokyo Teen Cohort study, we present results from two studies regarding depressive
symptoms of adolescents in the general population. All procedures involving human participants
for the Tokyo Teen Cohort study were approved by the institutional review boards of Tokyo
Metropolitan Institute of Medical Science, SOKENDAI, and the University of Tokyo.
The first study examined the potential impact of the pandemic by comparing depressive
symptoms among 16-year-olds surveyed before (February 2019-February 2020) or during(March 2020-September 2021) the pandemic while accounting for expected age-and-sex-relatedchanges based on age 10, 12 and 14 surveys. Variations by sex, household income, andpandemic phase (early, middle, and late) were examined. We found that depressive symptoms
increased by 0.80 points (95%CI 0.28–1.31) during the pandemic. This increase varied by sex
and pandemic phase; compared to pre-pandemic, depressive symptoms increased among boys
during the pandemic (0.97, 0.15–1.79), which enlarged over time, whereas, in girls, there was an
initial decrease followed by an increase that was within the expected age-related change.
The second study focuses on a vulnerable population: adolescents with high autistic traits in thegeneral population, who are known to be at higher risk for experiencing depression. We
examined the role of help-seeking intentions in reducing their subsequent depressive symptoms.
We found that adolescents with high autistic traits were more likely not to have help-seeking
intentions at age 12 (40% vs 27%), which partially explained their greater depressive symptoms
at age 14.
We will further discuss approaches to support adolescents' mental health in the post-COVID-19
era based on the results of these studies.
Conflict of Interest: None

50

S4-4
Being Praised for Prosocial Behaviors Longitudinally Reduces Depressive
Symptoms in Early Adolescents
Daiki Nagaoka1, Nanami Tomoshige2, Shuntaro Ando1, Masaya Morita1, Tomoki Kiyono1, Sho
Kanata2, Shinya Fujikawa1, Kaori Endo3, Syudo Yamasaki3, Masato Fukuda4, Atsushi Nishida3,
Mariko Hiraiwa-Hasegawa5, Kiyoto Kasai1
1
The Department of Neuropsychiatry, The University of Tokyo, Tokyo, Japan
2
The Department of Neuropsychiatry, Teikyo University School Medicine, Tokyo, Japan
3
Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical
Science, Tokyo, Japan
4
Department of Psychiatry and Neuroscience, Gunma University Graduate School, Maebashi,Japan
5School of Advanced Sciences, SOKENDAI (The Graduate University for Advanced Studies),
Hayama, Japan
ABSTRACT
Background: Depression is highly prevalent and causes a heavy burden in adolescent life. Being
praised for prosocial behavior might be a preventive factor because both being praised andprosocial behavior are protective against depression. Here, we investigated the longitudinal
relationship between being praised for prosocial behavior and depressive symptoms inadolescents.
Methods: In Tokyo Teen Cohort study (TTC), an ongoing prospective population-based cohort
study, we collected 3,171 adolescents' data on self-reported experiences of being praised for
prosocial behavior, depressive symptoms, and caregiver-evaluated prosocial behavior. Ten-yearold children were asked to freely describe answers to the question “What are you praised for?”.
Only children who clearly answered that they were praised for their prosocial behavior were
designated the “prosocial praise group.” The degree of depression at ages 10 and 12 wasmeasured with the Short Mood and Feelings Questionnaire (SMFQ), a self-report questionnaire
about depression. Objective prosocial behavior of the 10 year-old children was assessed by theStrength and Difficulty Questionnaire (SDQ). Multiple linear regression analysis was performed
using the SMFQ score at age 12 as the objective variable and being praised for prosocial
behavior as the main explanatory variable, and the SMFQ score at age 10 and the objective
prosocial behavior at age 10 were included as confounders.
Results: 845 (28.1%) children answered that they were praised for prosocial behavior.
Depressive symptoms (SMFQ scores) in the “prosocial praise group” were significantly lower
than those in the other group both at age 10 (4.3 ± 4.4 vs. 4.9 ± 4.6, p < 0.001) and at age 12(3.4 ± 4.2 vs. 4.0 ± 4.6, p < 0.01). In the single regression analysis, the children who reported
being praised for prosocial behavior at age 10 had significantly lower depressive symptoms at
age 12 (partial regression variable: −0.57, 95% confidence interval (CI) [−0.96, −0.17]). This
association remained significant after adjusting for confounders, including baseline depressive
symptoms (partial regression variable: −0.44, 95% CI [−0.80, −0.08]). Prosocial behavior alone
was not associated with depressive symptoms.
Conclusions: Being praised for prosocial behavior rather than objective prosocial behavior at 10
years of age predicted lower depressive symptoms 2 years later. Praise for adolescents’ prosocial
behavior can be encouraged to prevent depression.
TTC has been approved by the ethics committees of the institutions. There is no COI todisclose.
13:00-13:40 Research Topics 4
Support and Future Perspectives for Children with Gifted in Japan51

Masatoshi Katagiri1
1
Hokkaido University of Education Asahikawa Campus, Asahikawa, Japan
ABSTRACTIn recent years, the Ministry of education, culture, sports, science and technology in Japan has
been discussing how to support children with specific abilities (talents) such as giftedness.
However, in the field of education, we often hear comments such as "I don't know how to deal
with the highly intelligent children", "I don't know how it differs from developmental
disabilities", and "I don't know how to support them in regular classes".
In this Research Topics, I will talk about the support and future perspectives for gifted children
in Japan. First, I will review the characteristics of children with gifted. Especially, the conceptof "Overexcitabilities" is a theory that has greatly influenced our understanding of children andadults with gifted. This presentation will also talk about the characteristics of overexcitabilities,
which seem to occur in five different areas and some examples. Then I will explain about the
support for gifted children in Japan. In Japan, support for gifted children is limited to 2E (twice
exceptional) children with developmental disabilities. In this presentation, we will show somecases. Finally, I will consider what kind of support is possible and what is needed now andconsider future support for gifted children in Japan.
In the ethical considerations for this presentation, we report some very short cases where theperson is not identified. Other cases will be reported with prior permission. The speaker declares
no conflicts of interest (COI) in relation to this presentation.
13:50-15:20 Symposium 9
Towards an AI Agent System Promoting the Computational Development ofSocial Emotional Skills for Individuals with Autism Spectrum Disorder
Moderator 1: Masakage Okuno (Mikuni-hill Hospital, Sakai, Japan)
Moderator 2: Hirokazu Kumazaki (Department of Future Psychiatric Medicine, Graduate schoolof Biomedical Sciences, Nagasaki University, Nagasaki, Japan)
S9-1
Development of robotic communication environment toward supporting
cognitive development of mentalizing
Yuichiro Yoshikawa1
1
Department of Systems Innovation, Graduate school of Engineering Science, Osaka University,
Toyonaka, Japan
ABSTRACTDue to the recent decline in the birthrate and the difficulty of direct interaction due to the spreadof COVID-19 infection, there is concern about the lack of opportunities for dialogue, which isthe foundation for the development of "mentalizing," the ability to discover and reason about
the mental states of others that is originally developed in a group setting, and the creation of a
dialogue environment that supports mentalizing is an urgent need. On the other hand, researchrecognizing the effectiveness of learning with humanoid robots has been active. Especially,
humanoid robots, that is robots in human form, are expected to become communication partners
that give the feeling of dealing with people (presence) while ensuring the ease of talking to themby not having to face them directly, and are therefore expected to be applied to medical care
support.
We have developed a small humanoid robot called CommU (Communication Unity) that has
relatively big eyes and a cute appearance to be a friend of individuals with certain weaknesses
such as individuals with Autism Spectrum Disorders and children. Our former studies using
tele-operating system to control this robot have shown its possibilities to be a partner of52

conversation, with which children or adolescent with ASD learn gaze following (Kumazaki etal. 2018) and consult about their daily problems (Shimaya et al. 2019). In addition, wedeveloped an interactive robot system with a mental state projection function that supports theability to discover and reason about the mental states of others (mentalizing), and confirmed its
effectiveness in supporting the understanding of the emotions and attention of dialogue partners
in a psychological experiment with elementary school students. In this presentation, theprogress of research and development on the robotic communication environment with ease oftalk will be given.
S9-2
Towards an AI Agent System Promoting the Computational Development ofSocial Emotional Skills
Kazunori Terada1
1
Gifu University, Faculty of Engineering, Gifu, Japan
ABSTRACT
We are developing a system that enables children, including children with developmental
disabilities, to acquire computational social-emotional skills through social interaction with AI
agents. Computational social-emotional skills are the ability to read the minds of others andrelationships with others, which are essentially invisible, and to construct plus-sum relationships
based on computation. Plus-sum relationships contribute to the realization of a well-being
society by distributing resources and tasks according to the various intrinsic values of eachindividual, rather than competing over a few values such as monetary value or social status.
Social-emotional skills have been contrasted with cognitive skills, which can be measured by
IQ, and has been called non-cognitive skills that is difficult to objectively measure and quantify.
However, research on social intelligence, which has been developed in various fields such as
game theory, evolutionary psychology, social psychology, cognitive science, and artificial
intelligence, has clarified and demonstrated the computational model of the ability to readothers' minds and the optimization of social relationships. We believe that it is important formembers of society to have social-emotional skills, which is a hybrid of mathematical andmoral competence, as well as STEM competence. In this presentation, we will introduce an AI
agent system that promotes the computational development of social emotional skills ofchildren, including children with developmental disabilities.
S9-3
The utility of android robot for intervention for children with autism spectrum
disordersHirokazu Kumazaki1
1
Department of Future Psychiatric Medicine, Graduate school of Biomedical Sciences, Nagasaki
University, Nagasaki, Japan
ABSTRACT
Autism Spectrum Disorders (ASD) is a neurodevelopmental disorder that affects the ability of
an individual to communicate and understand social cues throughout their lifespan. Recent rapid
technological advances have enabled robots to fulfill a variety of human-like functions, leading
researchers to use such technology for the development and subsequent validation of robotic
interventions for children with ASD. Indeed, some investigators have argued that recent robotic
applications could be effectively harnessed to provide innovative clinical treatments for children
with ASD, as many children with ASD have been shown to demonstrate a higher degree of task
engagement when interacting with robots as compared with human adults. In fact, growing

53

anecdotal evidence indicates that the use of robots may provide unique opportunities forassisting children with ASD. Although a variety of robots have been proposed as possible
therapeutic tools for interventions with children with ASD, the physical appearances ofhumanoid robots currently used in therapy with these patients is highly varied. Accordingly,
robot developers and therapists are interested in identifying the optimal appearance for robots
used in interventions. The ultimate goal of robot-assisted ASD therapy is the generalization ofsocial skills obtained in the robot sessions to subsequent interactions with humans. For thispurpose, robots that are more human-like may be advantageous compared with mechanicalrobots. A Lab android ST is a female type of android robot with an appearance similar to that ofa real person. Its artificial body has the same proportions, facial features, hair color, andhairstyle as a human. At first sight and from a distance it is difficult to distinguish this android
robot from a live human adult. In this presentation, I am going to introduce the utility of android
robot for intervention for children with ASD.
S9-4
The developmental origins of sense of justice
Yasuhiro Kanakogi1
1
Graduate School of Human Sciences, Osaka University, Suita, Japan
ABSTRACTIn this talk, I will present two studies that investigated infant morality, especially a sense ofjustice. First, I will introduce the study that revealed preverbal infants affirm third-party
interventions that protect victims from aggressors (Kanakogi et al., 2017). After watchingaggressive interactions involving a third-party agent who either interfered or did not, 6-monthold infants preferred the former. Subsequent experiments confirmed the psychological processes
underlying such choices. These findings shed light upon the developmental trajectory ofperceiving and understanding protective third-party interventions.
Second, I will introduce the study that investigating the developmental origins of how to behave
towards antisocial others, in other words, third-party punishment for antisocial others (Kanakogi
et al., 2022). After familiarized with a gaze contingent association between a look for the agentsand subsequent punitive event, we compared the looking tendency for the agents before andafter when they watch aggressive interactions between aggressor and victim. As a result,preverbal infants seem to punish antisocial others; infants increase the selective looks to punish
the aggressor. Additional three control experiments exclude the low-level perceptualinterpretations. These findings suggest that the disposition to do third-party punishment for
antisocial others emerge in early infancy. Finally, based on these findings, I will discuss thepossibility that admiration for justice and disposition to do such action may be engraved inpreverbal infant’s mind.
S9-5
Robot Acceptance Process and Learning Effects of a Socially Interactive Robotin Classroom Participation
Naomi Matsuura1,2
1
Faculty of Education, Mie University, Tsu, Japan
2
Elementary School attached to the Mie University of Education, Tsu, Japan
ABSTRACTIn this study, a socially interactive robot remotely operated by multiple operators was installed
in an elementary school classroom to investigate how students' impressions of the robot changed
and how it affected their school life.

54

The subjects were 96 students in the fifth grade of an elementary school attached to the Facultyof Education, Mie University. There are three fifth-grade classes, and the interactive robot"Sota" was placed in the classroom of one of the classes, while the other two classes were not.
We investigated how the children's impressions of the robot changed and what kind of influence
the robot had on them as they interacted with the robot and its remote operators during recess
and in class. We also compared the changes in the impression of the robot between the classes inwhich the robot was installed and those in which it was not, and analyzed the relationshipbetween these factors by comparing them using a questionnaire.
The tele-operator monitored the classroom through a camera and microphone installed behind
the robot and participated in classroom activities. The teleoperator could control the direction of
the robot's gaze, and the robot looked toward the speaker or toward the teacher together with thechildren. During the class, the robot answered the teacher's questions and talked to the children.
During recess, the teacher acted as if she were asking the students individually about the state of
the class and their understanding of the lesson through chatting with them.
After the interaction with the robot, the children in the experimental group felt more
comfortable with the robot than the children in the control group, and their impression of therobot changed to that of being polite and methodical. Some of the children felt uncomfortablewith the voice change that occurred when the remote operator switched, but their stress andnegative impression of the robot decreased.
15:30-17:00 Symposium 14
Medical support for Parents of children with neurodevelopmental disorders inhealthcare facilities
Moderator 1: Ayaka Ishii-Takahashi (Department of Developmental Disorders National Instituteof Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan)
Moderator 2: Miho Kuroda (Department of Psychology, Teikyo University, Tokyo, Japan)
S14-1
Behavioral parent training for Attention deficit hyperactivity disorder
Ayaka Ishii-Takahashi1
1Department of Developmental Disorders National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACT
Behavioral parent training (BPT) for attention-deficit/hyperactivity disorder (ADHD) is a
training centered on psychoeducation and behavior therapy for parents. It has been reported in
the 2011 Cochrane Review to improve behavioral problems in children and child-related stressin parents. It is recommended in most treatment guidelines in the West, to be the first line oftreatment over medication for preschoolers under 6 years of age. In primary school aged
children, the American Academy of Pediatrics strongly recommends a combination of BPT andmedication. However, in Japan, the healthcare facilities that can provide BPT for ADHD arelimited. We had been conducting a randomized controlled trial to detect a biomarker that showsthe efficacy of BPT with the use of neuroimaging. We also examined child-related stress inparents and behavioral problems in children pre and post intervention. Furthermore, we had
been conducting child attachment interviews (CAI) as well as obtaining brain images using
magnetic resonance imaging to examine the effects of BPT and its effect on the attachment
patterns of children with ADHD. Moreover, barriers to implementing BPT or the facilitating
factors for its implementation in Japan was explored. In recent years with the proliferation of
implementation research, the obstacles and facilitating factors at various levels when
implementing an intervention program in the field can be evaluated with the Consolidated
Framework for Implementation Research (CFIR). We used the CFIR to identify barriers to
implement BPT for parents of children with ADHD in Japanese healthcare facilities. We had

55

also been developing a practitioner training program to implement BPT for parents of children
with ADHD. Based on the findings, we will be able to establish a practitioner training programand a supervision system, aiming to materialize the implementation of BPT as a treatment forchildren with ADHD at healthcare facilities in Japan. It is a pioneering work globally, toconduct research evaluating the effects of BPT using CAI, social support, and MRI . If thisstudy can promote the implementation of BPT as effective treatment for ADHD in Japan, it will
help improve the long-term prognosis of children with ADHD. As ADHD is the most prevalentchildhood psychiatric disorder, this may make a significant medical and economical
contribution.
S14-2
Current Situation and Measures for Japanese Children with Developmental
Disabilities in Singapore
Yuka Mori1
1
The Japanese Association Clinic, Singapore
ABSTRACTIn recent years, as globalization continues to advance, the number of people from Japan who are
posted overseas or immigrating to other countries has been increasing. Singapore, in particular,
has a large number of expatriates with their families, because of its safety, political stability,
adequate living infrastructure, and high level of education. The large number of expatriates with
their families also results in a large number of children with developmental disabilities. These
children are more likely to experience the stress and adjustment problems related to overseas
migration, and are more likely to experience problems such as non-attendance at school andbehavioral disorders. Although the support for these Japanese children with developmental
disabilities in Singapore is better than in other countries, there are still many restrictions on the
support they can receive due to language barriers. For example, Japanese elementary schools in
Singapore have well-developed support classes, and these children are rather well supported.
However, junior high schools did not have support classes, which caused problems for thesechildren, who were unable to continue on to higher education even though they were still in the
middle of their compulsory education period in Japan. As a result of the efforts of those
involved over the years to establish support classes in Japanese junior high schools, theestablishment of such classes will be decided in the next school year, and the problem ofstudents being unable to go on to higher education is expected to be solved. In addition, when it
comes to educational therapy in Japanese, the number of facilities and therapists who canprovide such support is limited. However, compared to Japan, Japanese-language educational
therapy is not publicly funded, so it seems that children who would have difficulty receiving
educational therapy in Japan are more likely to receive support. Our clinic has been providing
speech therapy and educational therapy for a long time, and this time Behavioral parent training(BPT) was conducted for such parents who immigrated from Japan to Singapore to care forchildren with neurodevelopmental disabilities such as autism spectrum disorder (ASD) andattention-deficit/hyperactivity disorder (ADHD). In addition to presenting a discussion of theresults of pre- and post-effectiveness assessments, we will also report on the current situation
surrounding Japanese children with developmental disabilities in Singapore.
S14-3
Effects of an Online Parents Training Program on Challenging Behaviors inChildren with Autism Spectrum Disorders in Korea
Yearin Kim1
1
Seoul National University Hospital, Soomin Jang, Seoul National University Boramae Medical

56

Center, Seoul, South Korea
ABSTRACTParent training is an essential part of quality programming for children with Autism Spectrum
Disorder (ASD) (Douglas et al.,2017). However, unfortunately, limited research exists exploring
online parents training approaches and not all parents have been able to reap the benefits of thisprogress because of extensive time commitment required or imbalance in the geographicaldistribution of service providers (McGarry et al., 2020). During the COVID-19 pandemic, thedevelopment of emergency remote education programs for children with ASD and their parents
became a requirement. The purpose of this study is to investigate and examine the effects of the
Supportive, Technological, Effective, Online Parents Training (STEP-O) program for threechildren with ASD in Korea and their challenging behaviors using a multiple baseline acrossparticipants to demonstrate experimental control. The STEP-O program, combining behavior
skills training (BST), task direction, contingent reinforcement, and fading resulted in positive
outcomes for participants. According to Park, Turnbull & Park (2011), Korean parents are more
likely than others to be silent, prefer listening and following professionals’ opinions without
disagreeing or asking questions since asking questions could be seen as a challenge to anotherperson’s knowledge. During the study, parents were trained via online, and BST was used,which involves instructions, modeling, rehearsal, and feedback, to train parents to implement a
strategy to support their children with ASD and, had an opportunity to become active
participants, ask questions, and engaged in self-reflection. Parents recorded videos every day to
get feedback and training was happened once a week for an hour session. The result
documented: (1) a clear pattern of improvement in the child’s response during the day, (2)decrease in problem behavior following the intervention, (3) increase the interactional behaviors
of parents and children, (4) decrease in parental stress, and (5) positive behaviors weremaintained at follow-up. Although this was a small sample size, this early investigation offers
promise for delivering this combined intervention approach effectively online for parents ofchildren with ASD in Korea. Training small groups of parents in an online format may be afeasible, efficient service delivery method. Limitations and future research directions will be
discussed.
S14-4
Total healthcare for Mothers in gynecological practice: focusing on the
menstruation-associated symptoms
Miho Egawa1
1
Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine,
Kyoto, Japan
ABSTRACTAs a gynecologist, I have been practicing holistic medicine for women with psychosomatic
disorders, including premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD),
prevailing widely with various symptoms ranging in degree, from mild to severe. Our institute,a tertiary hospital, receives patient referrals with strong psychological symptoms, difficult totreat at primary care gynecology clinics and hospitals. A number of cases of PMS/PMDD, fromadolescence to perimenopause, did not improve with standard treatments such as oral
contraceptives or selective serotonin reuptake inhibitors, or the patients did not tolerate thesetreatments. As the trusting doctor-patient relationship grew gradually, it became evident that nota few of these women were raising a child with ASD and/or ADHD. Therefore, I became
interested in and felt responsible for the total healthcare of mothers caring for children withneurodevelopmental disorders.
The daily life focus of these mothers is usually not themselves but their developmentallychallenged children. As their day is consumed by their children’s activities, disabilities, and57

hypersensitivities, they are exhausted and unable to afford any time for themselves.
Additionally, they often compare themselves with mothers of normally developing children andfeel guilty, inadequate, and lonely, thus lowering their self-esteem. Although they typicallyconsult many professionals for their children and even learn “parental training”, it seems thatthey receive little guidance on how to cope with their own suffering. Women with strong senseof responsibilities are often quietly on the verge of falling into a psychiatric disorder. Since
these mothers can hardly find adequate words and phrases to describe their own difficulties andcomplications, they have few resources available for help.
However, gynecologists could be by their side. If these mothers notice they might have PMS or
menopausal disorder, they may seek the help of a gynecologist. Whether they have a psychiatricdiagnosis or not, the hormonal and nutritional approach based on the medical evaluation of theirmenstrual conditions and nutrient deficiencies, especially iron deficiency, can be a major
catalyst toward self-compassion and improved mental and physical health. While it isappropriate to consult a gynecologist or general physician individually, it is more desirable tobuild a comprehensive supportive system for these mothers. Mothers should be happy andhealthy not just for themselves but also for the sake of their children's happiness and healthy
development, as the mother might be the most important environmental factor and the greatest
social negotiator for the child.
Venue 6 (Room K)
10:20-11:50 Symposium 5
A psychotherapy to cure childhood trauma called Brainspotting (BSP)
Moderator 1: Yoshifumi Mori (Department of Integrated Neuroanatomy & Neuroimaging,
Graduate School of Medicine, Kyoto University, Kyoto, Japan)
Moderator 2: Takanobu Suzuki (Faculty of Letters, Arts and Sciences, Waseda University,
Tokyo, Japan)
S5-1
Quantitative Insight into Dissociation
Yoshifumi Mori1
1
Department of Integrated Neuroanatomy & Neuroimaging, Graduate School of Medicine,
Kyoto University, Kyoto, Japan
ABSTRACT
Despite its long history that dates back to the ancient Greek, when Hippocrates termed somatic
syndrome disorder as hysteria, the phenomenon ‘dissociation’ has been introduced into modern
medicine only in these several centuries after the ‘witch-hunting’ medieval era. Studies on
dissociation is the more important since it assumes different appearances ranging fromdepersonalisation in psychiatry to functional neurological symptoms in daily clinical practicelike psychogenic weakness and chronic pain. With all these common somatoform symptoms,
much has been remaining an open question, indeed, even today like its prevalence,
pathophysiology, and objective diagnosis as well as therapy with so strong evidence as otherpsychiatric diseases have obtained. So it is with aetiology; the debate has been buoyant between
early trauma and fantasy proneness. More people would agree with trauma theory; some would
insist that there still exist cases where the patients have no trauma history. These backgrounds
inclined us to study pathophysiology and neural basis of dissociation.
In my talk I will discuss the two topics: questionnaire survey and neuroimaging study. Bothresearches were approved by the ethical committee of Kyoto University. The former study,
where psychiatric patients without any limiting criteria to specific disease were asked to fill in
psychometric scales for childhood trauma, dissociation, neurodevelopmental trait, fantasy
proneness, and personality, was intended for an insight into psychopathology that might underlie

58dissociation proneness. My speech will refer to the model of how personality might affectinduction of childhood trauma and/or fantasy proneness into dissociation. The results haveanother social significance in that unignorable scores in questionnaires would encourage
clinicians to take care about clients’ trauma and dissociation that have been often overlooked- to
avoid misdiagnose dissociative disorder as other ones like schizophrenia, bipolar disorder, orborderline personality disorder.
The latter part of my talk will focus on neural machinery that might explain dissociation, though
it is quite tough to tell whether the results reflect both or either state or trait of dissociation. We
recruited subjects randomly from the participants in the questionnaire study mentioned above
and obtained magnetic resonance image (MRI) and MR spectroscopy (MRS). The results partly
had correlation with the dissociation scale and so we are thinking of asking for collaboration to
add to sample size.
I have no conflict of interest to disclose.
S5-2
Developmental disorders and chronic pain
Karin Kato1
1
Patient Safety Unit, Kyoto University Hospital, Kyoto, Japan
ABSTRACT
Chronic pain is a common disease that occurs in 20% of the world's population, but do you
know the definition of ‘Pain?’ ‘Pain’ is defined as “An unpleasant sensory and emotional
experience associated with, or resembling that associated with, actual or potential tissue
damage” by International Association for the Study of Pain (IASP). In other words, ‘emotion’ isdeeply involved in the definition of pain. ‘Presenteeism’ is a term used to describe a situation inwhich an employee comes to work but is unable to do his or her job due to physical discomfort
such as ‘tiredness’ or ‘pain in some part of the body,’ resulting in a reduction in performance(i.e., if a job that normally takes two hours takes four hours, that amount is a loss). In recent
years, however, it has become clear that this ‘presenteeism’ is even greater than the cost of‘absenteeism’ (absent and sick leave). Medical and pharmaceutical costs account for 25% of
total costs, while absenteeism accounts for 11%, and presenteeism 64%. Chronic pain is thus asocial problem, but the prevalence of developmental disorders in chronic pain patients is high.
In 146 patients aged 8-17 years seen in pain clinics, 20 (13.7%) had ASD and 29 (19.9%)
exceeded the cutoff for ADHD. Chronic pain is often related to childhood trauma, poverty,
educational disparities, and other upbringing and childhood adversity experiences. There are
two types of patients: those who are unable to cope well with their pain and whose pain isexacerbated by overactivity, and those who, conversely, become extremely immobile and unable
to engage in social activities due to fear of pain. ADHD is well known to cause sleep
disturbance, and sleep disturbance and pain exacerbation are involved, and from this aspect,
ADHD may also be a pain-enhancing factor. In addition, there are many pain-related
medications that require careful handling (anticonvulsants, antidepressants, opioids), which canlead to unintentional abuse due to lack of understanding of how to take them correctly. Chronic
pain requires patients to come to terms with their pain, but ADHD patients with low stress
tolerance may seek "zero pain" and endlessly seek medications that do not relieve their pain.
This presentation will discuss the current status of developmental disorders and chronic pain as
described above.
I have no conflict of interest to disclose. Our study is approved by the ethical committee of
Kyoto University Hospital.

59

S5-3
Brief introduction of Brainspotting (BSP)
Takanobu Suzuki1
1
Faculty of Letters, Arts and Sciences, Waseda University, Tokyo, Japan
ABSTRACT
Adverse childhood experiences (ACE) can cause trauma in children. ACE impacts the course ofdevelopment, which can lead to severe dysfunctions in adult life. Brainspotting (BSP), a
clinically informed and validated psychotherapy, can address such early traumas in bothchildren and adults. BSP is considered one of the somatic approaches that is explained as “abrain and body-informed relational therapy.” Aiming at processing unprocessed information
about trauma, BSP claims to have two mutual features that are critical for the resolution of
trauma. Firstly, BSP acknowledges the complexity and uniqueness of each patient or client as“unknowable” and guides the therapist to “assume nothing.” With this phenomenologicalprinciple, BSP helps a therapist build a safe environment within the patient or client that allows
the therapist to initiate the work of trauma. A safe internal environment is indispensable toaddress one of the symptoms of trauma, avoidance, and to start working on trauma. The attuned
presence of a therapist who carefully attends to what’s happening at the moment is thefoundation of building a safe environment. Secondly, BSP facilitates focused attention on thetrauma by identifying a relevant eye position. A relevant eye position, called a “brain spot,” ishypothesized as a sign of brain activities in subcortical areas associated with trauma. It ishypothesized that bodily information that needs to be processed for the full resolution of trauma
cannot be accessed without focused attention on it. Identifying and maintaining the brain spot is
posited to enable the therapist to find and hold the brain activities in subcortical areas, such as
the brainstem and upper spine, associated with the trauma. Besides these two features, BSP, likeother trauma approaches, has multiple tools for a therapist to use to meet the complexity anduniqueness of each patient or client. Patients and clients with early traumas, especially, tend todemonstrate vulnerability to stress generated by psychotherapeutic interventions and are unable
to process many traumas by themselves. To address this vulnerability, a BSP therapist canengage in resourceful interventions during processing trauma with tools that involve eye
movements, including one-eye brainspotting and z-axis brainspotting. Also, a BSP therapist can
include an ongoing resource in the process by identifying a “resource spot” with which thepatient or client can tolerate physiological, emotional, and cognitive activities associated withprocessing trauma.
I have no conflict of interest to disclose.
S5-4
A case Study of BSP for Children in our Department
Tatsuya Yamashita1
1Department of Pediatrics, Gifu Municipal Hospital, Outpatient Mental Health Clinic forChildren and Adolescents, Gifu, Japan
ABSTRACT
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), the first choice in trauma treatment
for children, includes Brainspotting (BSP), Somatic Experiencing (SE), and Ego State Therapy(EST) as well as Eye Movement Desensitization and Reprocessing (EMDR) with accumulating
evidence. Of these all we make a choice depending on the characteristics and reactions of thepatients. In the outpatient mental health clinic for children and adolescents, a pediatrician
provides the patients at the age of 1 to early 20s with mainly maladaptive behaviors such as
truancy and psychosomatic disorders- sometimes anxiety disorders and PTSD- with60

psychotherapy within the framework of one hour per patient. Mothers may also be treated.
First, we show 20 patients with trauma treated by BSP (3 males and 17 females; 15.5 years old
in average), some accompanying EMDR, SE, EST or others. 7 manifested adjustment disorder;
3, social anxiety disorder; 3, PTSD. In my opinion, EMDR is easy due to its clear protocol
though attention should be paid to dyscoordination and complex PTSD; BSP is readily applied
to patients and children with poor eye movement skills because of its various modifications; SE
is easy to use in patients who can verbalize bodily sensations because the load can be easilyadjusted; and EST is potential when doing parts work on patients with dissociative disorders andpatients with conflicts.
Then, we focus on one case with good response to BSP. The 12-year-old girl with no family
history complains headache and dizziness. At 11 she was diagnosed with orthostatic
dysregulation disorder by her previous physician and drug treatment worked. Her headache wasthen worsened when she was insulted repeated by her schoolteacher at 12, followed by anxiety
and panic attacks on her attempts to go to school. We treated her with BSP because her historyof rotatory dizziness during EMDR. SUDS showed 8/10 for anxiety about going to school andshe expressed a sensation of wanting to move her lower extremities. Eye position was identified
as lower left on Inside Window. To improve her sense of security, we asked her to draw animage representative of the problems, anxiety, and physical sensation on a sticky note, followed
by Focused Mindfulness with her gaze on the note. Laughter then occurred intermittently, andafter 7-8 minutes of continuation, the above physical sensations dissipated and SUDS eventually
were reduced to 4/10. Her perception of the teacher changed into forgiving. This case is one
where drawing images related to trauma facilitated safe practice of BSP.
This report has an approval from the hospital and the family. I have no COI to declare.
13:00-13:40 Research Topics 5
Brain Reward System of Anorexia Nervosa
Masanori Isobe1
1
Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan
ABSTRACT
Anorexia nervosa (AN) is a well-known psychiatric disorder characterized by abnormal eating
attitudes and resulting low body weight, where the core symptoms include the desire to thinness
and the fear of obesity. The etiology and mechanisms of onset and maintenance are still
unknown, and no biologically based treatment has yet been established. It has been suggested
that the onset and maintenance of the disease may involve abnormalities in the brain reward
system that could explain its clinical features. In this presentation, I will outline current topics
related to the brain reward system as a model for the onset and maintenance of AN.
In recent years, psycho-biological findings that disturbances in the brain reward system are
involved in the persistence of AN symptoms have been accumulating. In activity based anorexia(ABA) mice, a promising mouse model of AN, a background imbalance in the neural circuitryof the reward system has been suggested. Findings of structural brain imaging also suggest thatstructural changes related to the reward system may be involved in the pathogenesis of AN.
Similarly, functional MRI studies have reported that AN patients exhibit characteristic brain
activity in the reward system circuitry in response to the presentation of potentially rewarding
stimuli, such as food, body image, and stimuli related to food intake restriction andhyperactivity. Furthermore, AN patients, as well as patients with mood and anxiety disorders,
are known to show inadequate responses to many events that are inherently perceived as
rewarding, such as food and social interaction. In contrast, brain activity increases in response to
AN-related stimulus presentations such as dietary restriction and excessive exercise. In addition
to decreased responses to rewarding stimuli, increased responses to punishing stimuli have also
been noted. AN patients show rewarding responses to stimuli associated with weight-loss

61

behaviors and thinness, but strong aversions to weight gain, social situations, and economic
loss. These responses are easily influenced by the context of the situation, and clarifying what
information and stimuli AN patients perceive as reward or punishment will not only provide
important insights into the mechanisms of symptom maintenance, but will also be suggestive formore effective support.
The pathophysiological hypothesis of AN through the reward system will be shared, and thepossibility of the reward system in the brain as a potential therapeutic target will be mentioned.
The content of the presentation is a review of previous researches, thus no particular ethicalconsiderations are required.
COI: Nothing to declare
13:50-15:20 Symposium 10
The research of social facilitation to promote the performance in rodents
Moderator 1: Masatoshi Ukezono (Department of Developmental Disorders, National Instituteof Mental Health National Center of Neurology and Psychiatry, Kodaira, Japan)
Moderator 2: Kaichi Yoshizaki (Aichi Developmental Disability Center, Kasugai, Japan)
S10-1
The effect of lesion in the anterior cingulate cortex on social facilitation in rat
Masatoshi Ukezono1, Yuji Takano2, Hiroki Furuie3, Yuko Nakatake3, Yuka Shirakawa4, Sayuri
Hayashi1, Yuka Egashira1, Shota Uono1, Miki Takada1,5, Takashi Okada1
1
Department of Developmental Disorders, National Institute of Mental Health National Centerof Neurology and Psychiatry, Kodaira, Japan
2
School of Psychological Sciences, University of Human Environments, Matsuyama, Japan3
Department of Neuropsychopharmacology National Institute of Mental Health National Centerof Neurology and Psychiatry, Kodaira, Japan
4
Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan
5
Department of Frontier Medicine and Pharmacy, Graduate School of Medical andPharmaceutical Sciences, Chiba University, Chiba, Japan
ABSTRACTSocial facilitation refers to performing tasks more efficiently with other individuals. Previous
research has classified social facilitation into two categories: audience effect and co-action
effect. Atypical or dysfunctional social facilitation has been reported in patients with autism
spectrum disorder. However, the neural basis of social facilitation and its relationship with
autism has not been actively explored. Understanding social functions in rats with lesions in theanterior cingulate cortex (ACC) can help elucidate the neural mechanisms of social facilitation.
Therefore, this study examined the audience and co-action effects of drinking and eating
behavior in rats with ACC lesions. This study used two adjacent transparent boxes for the
behavior test. Constraints were investigated under three conditions: empty, presence of otherindividuals (audience effect), and other individuals engaged in the same task (co-action effect).
Rats were split into sham control and lesion groups. Rats in the lesion group were electricallylesioned in the ACC. Rats in the sham control group received scalp incisions and burr holes
under anesthesia, as in the lesion group, but an electrode was not inserted. After surgery, eachgroup was allowed one week to recover before the behavioral test was conducted. The results
demonstrated that the effect of ACC lesions was not facilitated by the audience effect.
Intriguingly, water and pasta consumption was facilitated by the co-action effect. These results
suggest that the two types of social facilitation may be mediated by different neural bases. The
audience effect may be related to the theory of mind derived from neural processing involving
the ACC.

62

Animal experiments were conducted in compliance with the Guidelines for the Care and Use ofLaboratory Animals and approved by the National Center of Neurology and Psychiatry Animal
Care and Use Committee. The authors declare no conflict of interest.
S10-2
Social facilitation of voluntary exercise in mouse
Kaichi Yoshizaki1
1Aichi Department of Disease Model, Institute for Developmental Research, Aichi
Developmental Disability Center, Kasugai, Japan
ABSTRACTSocial facilitation is a psychological phenomenon that an individual’s performance improves infrequency and intensity due to mere presence of other individuals, and impaired social
facilitation was reported in autism spectrum disorder (ASD) children. To understandpathophysigology of ASD focused on social facilitation, we previously developed a novel
breeding home cage with running wheel for social facilitation, which is not required forparticular learning processes, and reported that voluntary exercise of more social C57BL/6J
mice was significantly increased in the presence of conspecific observer mouse compared tothat in the absence of observer mouse, while the presence of conspecific observer mouse does
not affect voluntary exercise of less social BALB/cCrSlc mice. These suggest that social
facilitation was observed in motor performance of more social C57BL/6 J mice, but not that ofless social BALB/cCrSlc mice. However, it is not clear how more social C57BL/6J mouseacquires social facilitation, while less social BALB/cCrSlc mouse does not. In this symposium,
we share results of our latest behavioral analyses using both more social C57BL/6 J mice andless social BALB/cCrSlc mice and discuss how social facilitation is developed and modified.
S10-3
Social facilitation of feeding behavior in a schizophrenia rat model
Hiroki Furuie1, Masatoshi Ukezono2, Takashi Okada2, Mitsuhiko Yamada1
1
Department of Neuropsychopharmacology, National Institute of Mental Health, National
Center of Neurology and Psychiatry, Kodaira, Japan2
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACT
Schizophrenia is a disabling disease characterized by positive and negative symptoms, as wellas cognitive deficits. Social impairment is a core symptom of the disease that prevents patientsfrom reintegration into society. The ability to control one’s behavior in social situations isessential for adaptation to society. Social facilitation, in which behavior is promoted by thepresence of others, is an example of behavior control in social situations. Recently, it has beensuggested that this ability is disrupted in schizophrenia. The N-methyl-D-aspartate (NMDA)
receptor, an ionotropic glutamate receptor subtype, is essential for postnatal brain development.
Since neonatal blockade of NMDA receptors causes various behavioral abnormalities, including
social deficits, animals neonatally treated with an NMDA receptor antagonist are considered
useful models for studies regarding schizophrenia. However, the effect of neonatal NMDA
receptor blockade on social facilitation is unclear. Therefore, we investigated the effect of
neonatal treatment with MK-801, an antagonist of NMDA receptors, on the feeding behavior ofrats in the presence of other individual rats. On postnatal days 7 through 20, male Wistar rats
were treated with 0.4 mg/kg MK-801 or saline twice daily. In adulthood, the feeding behavior ofthese rats was investigated in the presence or absence of other rats in competitive and63noncompetitive situations. As a result, rats neonatally treated with saline showed social
facilitation of feeding behavior both in competitive and noncompetitive situations. On the other
hand, in noncompetitive situations, MK-801-treated rats did not show social facilitation leading
to an increase in food intake when feeding with another rat. In addition, MK-801-treated rats
showed a significant decrease in food intake when they ate with another rat in a competitive
situation. These results suggest that a neonatal blockade of NMDA receptors impairs the ability
to control one’s own behavior in social situations.
Animal experiments were conducted in compliance with the Guidelines for the Care and Use ofLaboratory Animals and approved by the National Center of Neurology and Psychiatry Animal
Care and Use Committee. The authors declare no conflict of interest.
S10-4
Evaluation of changes in autonomic nervous system activity and maternal andfetal heart rate similarity during fetal period in mouse models of autism based on
DOHaD theory
Yoshiyuki Kasahara1,2, Chihiro Yoshida1, Namareq Widatalla2, Masatoshi Ukezono3, Erika Ida1,
Ryoma Ito1, Yuta Momono1, Ken Ishikawa1, Yoshitaka Kimura1,2, Masatoshi Saito1,2
1
Tohoku University Graduate School of Medicine, Sendai, Japan
2
Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan3
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACT
Autism spectrum disorder (ASD) is characterized by impaired social communication, repetitive
behavior, and restricted interests. The risk of ASD is strongly associated with the prenatal
period; for example, maternal valproic acid (VPA) administration, maternal immune activation,
and a high-fat diet during pregnancy increase the risk of ASD. Developmental Origins of Healthand Disease (DOHaD) is a concept that entails that exposure to certain factors present during
the prenatal period can cause long-term adverse effects. Developmental disorders, including
ASD, have also been associated with DOHaD. Patients with ASD often show an alteration in theautonomic nervous system. Therefore, we evaluated the autonomic activities in the fetal periodof mouse models of ASD. The assessment of the autonomic activities was performed bymeasuring fetal electrocardiography. Interestingly, the ASD model mice had altered autonomic
activities during the fetal stage. This indicates that neurodevelopmental deficits may be
expressed from the fetal period, which may be one of the fetal pathophysiologies of ASD.
Furthermore, social facilitation and social behavior were impaired in ASD model mice
generated by fetal VPA administration. Investigating how abnormal fetal autonomic activity
may contribute to future behavioral changes will be very important.
On the other hand, one of the symptoms of ASD is inability to interact well with others. To
examine the interaction between mother and fetus, the similarity of heartrates between motherand fetus was evaluated because the only other individual for the fetus is the mother.
Subsequently, the similarity of heartrates between mother and fetus was significantly reduced in
ASD mouse models.
In summary, in the fetuses of ASD model mice. there were changes in autonomic nervous
activity reflecting impaired neurodevelopment and decreased similarity between maternal andfetal heartrates, reflecting impaired interaction with others. This may be a new aspect of ASD
pathophysiology, as well as a potential for very early diagnosis of ASD from the fetal stage.
Animal experiments were conducted in compliance with the Guidelines for the Care and Use ofLaboratory Animals and approved by the Tohoku university and Use Committee. The authors
declare no conflict of interest.

6415:30-17:00 Symposium 15
The impact of COVID-19 Pandemic on Mental Health of Children and AdolescentsModerator 1: Young Sook Kwack (College of Medicine, Jeju University, Jeju, Republic ofKorea)
Moderator 2: Yun Hyong Kang (Doctor's psychiatric Clinic, Republic of Korea)
S15-1
Emergency Department visiting youth with suicide thoughts or behaviors during
COVID-19 Pandemic
Wan Seok Seo1
1
Department of Psychiatry, Yeungnam University Hospital, Daegu, Republic of Korea
ABSTRACTReports of how youths visit the ED for suicide-related behavior (SRB) during the pandemic areinconsistent. In an analysis using Kaiser Permanente Northern California, the number of youths
who visited the ED for SRB did not increase significantly after the pandemic. There was also no
significant increase of suicide deaths among Japanese adolescents between 2018 and 2020.
However, SRB increased in February-April 2020, at the beginning of the pandemic in the US.
South Korea's teenage suicide deaths and suicide rates per 100,000 population, continue toincrease in 2020 and 2021 compared to 2019.
SRB during COVID-19 pandemic differs by gender. Suicide attempts and mental healthsymptoms after the pandemic increased at a higher rate in females. In the statistics from the US
CDC for 2019 and 2021, the number of visits to the ED for suicide attempts among youths
increased by 50.6% for women, while for men it increased only by 3.7%.
Many youths who had never received psychiatric treatment in the past visited the ED for SRB,
and several reasons can be inferred for this. Many youths with mental problems received
counseling from community bases such as schools, religions, and other institutions before the
COVID-19 pandemic. They were unable to get these services during the pandemic, which may
have exacerbated their psychiatric symptoms and suicidal ideation. Next, it is possible thatpatients who newly developed psychiatric symptoms during the pandemic did not receive
proper treatment in the early stages. Youths who were not properly cared for the psychiatric
symptoms attempted suicide and visited the ED.
Social, economic, and health-related stress after COVID-19 pandemic has had a significant
negative impact on the lives of youth. Actively implemented shelter-in-place orders, and social
distancing policies in the early phase of the pandemic were useful in preventing the spread of
COVID-19, but may have negative effects on controlling mental health or SRB. These policies
negatively affected the family economy, increased anxiety about their health and future in youth,
and increased conflict with their families. Increased family, school, and community-related
stress has exacerbated mental health problems in youth and increased suicidal thoughts and
SRB. In conclusion, the COVID-19 pandemic has worsened the mental health of some groupsof child and adolescents. Continuous research is needed on the effects of the COVID-19
pandemic on the mental health of adolescents.
This report was exempt from institutional review board evaluation. The author declares noconflicts of interest.
S15-2
Technology-Facilitated Sexual Violence Victimization in Children andAdolescents during the COVID-19 Pandemic
Soyoung Irene Lee1
1
Department of Psychiatry, College of Medicine, Soonchunhyang University, Republic of Korea

65

ABSTRACT
Online sexual violence includes grooming, live streaming and the consumption of child sexual
abuse material for sexual purposes. And these violence often leads to offline coercion or
extortion of children and adolescents. According to the Korean Ministry of Gender Quality andFamily, Technology-Facilitated Sexual Violence (TFSV) victimization has been increased
recently. Specifically, the Digital Sexual Crime Victim Support Center, that provide
comprehensive support services for victims of digital sexual crimes such as illegal
photographing or filming and dissemination, has presented 5 times increased number of victims
based on the visits of the center during 2019 and 2022. The proportion of children andadolescents among the visitors indicated an apparent increase (8.4% in 2019; 21.3% in 2021).
Evidence suggest more younger children than ever before have been introduced to digitalplatforms. And long-term school closures have increased children’s unsupervised screen time. In
addition, the lockdown of social welfare systems including child protection systems did notwork properly.
Although it has not been confirmed that there were increases in the technology-facilitated childsexual exploitation and abuse during the pandemic yet, available country-level data will bepresented in this session. In addition, necessity of the fight against online sexual violenceagainst children and adolescents will be proposed and discussed.
S15-3
Text-based Crisis Intervention for Teen Suicide Prevention
So Hee Lee1
1
Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
ABSTRACT
Since 2009, suicide has been the most common cause of death among adolescents in Korea. To
address this problem, the Ministry of Education started text-based crisis intervention service forteens in 2018 as one of the nation action plans for suicide prevention.
Adolescents can initiate the counselling services at any time through social networks.
Interpersonal conflicts, school concerns, and family struggles represent the major subjects ofmessages. Records indicate that mental health problems and suicidal thoughts have increased
since the COVID-19 outbreak.
The number of cases peaked in the summer before the COVID-19 pandemic, but the curve of
the monthly case numbers became flatter since the COVID-19 than before. Overall, text
message counseling was sought most frequently on Wednesdays. In 2022, however, counselingwas sought most often on Fridays. Evening hours were the busiest for the counseling center, butwith counseling around midnight to before dawn gradually increasing; the cases between the
two-time demarcations are similar now. Texts from elementary students have decreased, but
texts from high school students and individuals in their early 20s are on the rise.
In cases of impending suicide, the counselor responds by calling the police, rescue service or
guardians and continues counseling until the caller is safe. This service has saved many people
from dangerous situations including self-mutilation, family violence, sexual crimes, and runningaway prompted by mental illness. After the Seoul Halloween crowd crush, the indirect trauma
experienced from exposure to unfiltered videos and the grief over accident victims were dealt
with by text interventions.
A limitation of text-based crisis intervention is it reliance on texting. However, it might be oneof the critical and effective service for suicide prevention among teens. This service is especiallyhelpful for teens who need psychological support or who are in dangerous situations at night. To
guarantee that those in need receive appropriate help, counselors are trained mental healthexperts with opportunities for further education.
This report was exempt from institutional review board evaluation. The author declares no66

conflicts of interest.
S15-4
Case Intervention for High-Risk Students with Mental Health Problems throughSchool Visit Projects in Seoul
Heewoo, Lee1
1
Department of Psychiatry, SMC-Seoul Medical Center, Seoul, Republic of Korea
ABSTRACT
Korea's mental health specialist's school visit project started in 2016 as one of the School-Based
Mental Health strategies. Based on 17 metropolitan and provincial offices of education in
Korea, mental health experts from the Center for Mental Health Specialist School Visit Support
Project visit schools in person and conduct in-depth evaluations of students, guardians, andhomeroom teachers requested by the schools. Establish an intervention strategy for each student
through a multidisciplinary expert case meeting at the base center. If necessary, they directly
conduct short-term case intervention or provide mental health services, focusing on students
experiencing mental health difficulties in connection with local institutions for children andadolescents, including pediatric psychiatrists, so that mental health services can be provided in
an integrated manner.
The main targets of this project are students in mental health crises who are not linked to
specialized institutions, students who are linked to specialized institutions but face the risk of
discontinuing treatment, and students in mental health crises in areas without access to medical
help.
The project was first launched between 2016 and 2018 and then expanded to 17 base centers in
2021. This project not only intervenes in mental health problems such as depression, anxiety,and suicide-related behaviors but also intervenes in various mental health-related crises such as
child abuse and connects necessary resources.
The Seoul Base Center was divided into four districts in 2021. A team consisting of child andadolescent psychiatrists, clinical psychologists, and mental health specialists from four
university hospitals and public hospitals each make a request to the Seoul Metropolitan Officeof Education from schools in their respective regions. In addition, mental health experts fromthe responsible base team visit schools, conduct in-depth interviews with students andinterviews with guardians and teachers, and then establish individual intervention plans. As of2022, this 4 center supported about 370 people in Seoul, and the connection rate withspecialized institutions is about 66.4% as of 2021. ADHD was the main problem for elementary
school students, and depression and anxiety were the main problems for middle and high school
students. Both parents and teachers evaluated that this project improved students' emotional andbehavioral issues and made them aware of the importance of child and adolescent mental healthmanagement.
In this regard, I will explain the effects of the Mental Health Specialist School Visit Support
Program and some cases and consider future expansion plans.

67

May 27th, 2023
Venue 1 (Room A)
9:10-10:10 Plenary Lecture 1 Moderator: Hirotaka Kosaka
Characterizing Autism and ADHD by Image Endophenotypes, Genetic Image, andMetagenomic profiles
Susan Shur-Fen Gau1
1
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
Autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) areclinically and genetically heterogeneous neurodevelopmental disorders with an unknown
pathogenetic mechanism and a lack of effective early detection and treatment for ASD. This
presentation has three parts as follows.
First, we characterized ASD and ADHD based on image endophenotype (sibling design),
genetic images, longitudinal studies, and metagenomic profiles (ASD only) as compared totypically developing controls (TDC). Comparing the neuropsychological, neuroanatomy, whitematter (WM) tracts microstructural properties, and intrinsic functional connectivity (iFC)among ASD probands, unaffected siblings, and TDC, results suggest that verbal and spatial
working memory, atypical neuroanatomy and iFC surrounding the MCC, several white-matter
tracts related to social communication and interactions with aberrant integrity, maybe potential
endophenotypic markers for ASD. Our longitudinal neuropsychological data showed that
despite significant improvement in attention and most executive functions with time except
cognitive flexibility and inhibition control, ASD still suffered from impaired focused attention,
cognitive flexibility, executive functions, and visual memory than TDC at follow-up. Ourlongitudinal iFC results suggest a clinically meaningful relationship between the atypicaldevelopment of frontoparietal structural connections and the dynamics of the ASD phenotype
through early adulthood. Moreover, our longitudinal whole-brain structural results provide
evidence to support the atypically developmentally increasing fractional anisotropy of several
WM tracts in ASD than TDC during follow-up using the normative model and altered withinand between-cortical changes of the regions relating to the social and language networks
predicting improving ASD phenotype across a crucial developmental phase. Finally, regarding
metagenomic profiles among ASD, unaffected siblings, and TDC, our results support the gutmicrobiome-metabolomics-brain-behavior axis in ASD and identify a few microbiomes
potentially affecting treating ASD. These findings highlight several potential markers searchingfor the etiologies and future outcomes of ASD. The ADHD and ASD genetic images, as well as
ADHD endophenotype and longitudinal image studies, will also be presented.
Second, the whole-brain white matter tract deviation and idiosyncrasy from normative
development were compared between ASD, ADHD, and their unaffected siblings.
Third, we tested the neurodevelopmental model of schizophrenia. Again, we found individual
deviation and idiosyncrasy similarity from the normative model of whole-brain white matter
tracts and shared brain-cognition covariation with ADHD and ASD.
Conflicts of Interest: The authors declare no actual or potential conflicts of interest related tothis study.
All the studies from National Taiwan University Hospital (NTUH), Taipei, Taiwan, presented in
the lecture, have been approved by the NTUH Research Ethics Committee before study
implementation.
10:20-11:20 Plenary Lecture 3 Moderator: Katsunaka Mikami
New System & New Hope for ASD treatment in South Korea

68

Bung-Nyun Kim1
1
Division of Child & Adolescent Psychiatry, Department of Psychiatry, Seoul National
University Hospital and College of Medicine, Seoul National University, Seoul, Republic ofKorea
In Korea, a new support law for people with developmental disabilities, including those with
autism and intellectual disabilities, was created in 2014 and published in 2015. A new
rehabilitation system, legal support system, and community based integrated support system forpeople with autism was started and developed for 8 years until 2022. In addition to this,
hospital-centered treatment for problematic behaviors began to be systematically created anddeveloped from 2016 till now.
In addition, new treatment system within university hospitals for people with developmental
disabilities that can promote and support the use of medical care by people with developmental
disabilities is being developed centering on base national university hospitals and major
hospitals in each region. In addition to this, efforts are being made to create a new system totrain professional therapists who can deal with behavioral problems, and a national level autism
early diagnosis-early treatment system is being established.
Seoul National University Hospital and the College of Medicine play a key role in supporting
the nationwide expansion of the regional base hospitals and behavioral development promotion
center for people with autism, training therapists, and creating and distributing effective
behavior programs. Seoul National University Hospital has been assigned the role of the Central
Support Group for Developmental Disorders, and is carrying out activities to develop autism
treatment clinical guidelines, develop and distribute new treatments, establish multidisciplinary
therapist training programs, and resolve social prejudice.
National Autism R&D projects, which aims to innovatively develop new diagnostic assessmenttreatment-rehabilitation methods to improve the core problems of autism, that is, - emotionalrecognition/exchange - ability to form social relationships – control to repetitive/limited
interests and stereotyped behaviors - verbal and non-verbal communication skills. In 2025, theresults of the new project are expected to be introduced into education and medical settings, andoutputs that can be utilized by families with autism are expected.
Seoul National University Hospital and College of Medicine have leading roles to develop
digital therapeutics and to develop big data-based AI diagnosis platform and electronic
medicine-based CNS modulations. SNU and SNUH are also leading clinical applications of new
digital devices and the development of microbiome-based health functional foods andtreatments. It is expected that the introduction of this innovative- newly organized national
medical-welfare system and the development of a diagnostic & treatment tools that integrates
the new IT-BI-CT will make a new breakthrough in the treatment of core features of autism anddevelopmental disorders by 2030.
11:40-12:40 Sponsored Seminar 2 <Janssen Pharmaceutical K.K.>
Moderator: Yukiko Kano
Key Similarities and Differences Across Current International Clinical Guidelinesof Attention Deficit Hyperactivity Disorder (ADHD)
Takuya Saito1
1
Department of child and adolescent psychiatry, Hokkaido University Hospital, Sapporo, Japan
Attention deficit hyperactivity disorder (ADHD) is a common condition with a high societal
burden presenting to child and adolescent mental health, pediatric, and primary care services.
Interventions to address core ADHD symptoms and co-occurring problems are a high priority
for healthcare and society more widely. While much research has reported on the benefits andadverse effects of different interventions for ADHD, these individual research reports and thereviews, meta-analyses and guidelines summarizing their findings are sometimes inconsistent69

and difficult to interpret. In this session the current evidence and identified several
methodological issues and gaps will be summarized for clinicians to consider when evaluating
the evidence and making treatment decisions. These include understanding potential impact ofbias such as inadequate blinding and selection bias on study outcomes; the relative lack of highquality data comparing different treatments and assessing long-term effectiveness, adverse
effects and safety for both pharmacological and non-pharmacological treatments. In this session
key similarities and differences will be presented across current international clinical guidelinesand discuss the reasons for divergence where these occur. The integration of these different
perspective into a framework for person/family-centered evidence-based practice approach tocare that aims to achieve optimal outcomes that prioritize individual strengths and impairments
will be discussed, as well as the personal treatment targets of children and their families.
I have no financial relationships to disclose.
12:50-13:50 Special Lecture 3 Moderator: Masaru Tateno
Sustainable Child and Adolescent Mental Health Practice and Research
Norbert Skokauskas1
1
Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child
Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
There is a growing public health crisis as increasing numbers of children and adolescents arefacing mental health challenges.
While some of these increases have been attributed to COVID-19 pandemic, increasing
prevalence started earlier and likely correlated with many factors, including social media,
climate change, and global economical instability. There is a wide gap between digital healthresources, policies, and their implementation in the provision of high-quality health care.
This division is especially evident when considering services for children and adolescents withmental disorders.
There is need for innovative approaches to address challenges in providing high quality andquantity of children and adolescents mental health services (CAMHS), including optimizing
digital technology and applying principles of personalized medicine to improve clinicaldecision-making.
No ethical conflict.
14:00-15:00 Plenary Lecture 5 Moderator: Junko Yagi
Tourette syndrome: Comprehensive understanding, treatment and support alonglife stages
Yukiko Kano1,2
1
Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo,
Tokyo, Japan2
Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan
Tourette syndrome (TS) is a chronic tic disorder with both motor and vocal tics. Sensory
phenomena, including premonitory urges that precede tics, are of interest because they cause
distress in patients with TS and may be useful in intervention for tics. A variety ofneuropsychiatric disorders are often comorbid in TS, of which attention-deficit/hyperactivity
disorder (ADHD) and obsessive-compulsive disorder (OCD) are the most common.
TS is classified by the ICD-11 as neurodevelopmental disorders as well as obsessive-70

compulsive or related disorders. Most patients with TS have compulsivity even if it does notmeet the diagnostic criteria for OCD. Although coprolalia and echolalia, described as cardinal
symptoms in the original article by Gilles de la Tourette, are not present in many cases currently,
the tendency common to these symptoms, i.e., the more one thinks one should not do, the more
one does, is often observed, causing distress and impairment of life to the patients. It is
important to have a comprehensive understanding of patients with TS, including thecharacteristics described above.
It is also important to consider life stages in understanding patients with TS. Around the age of
10, tics are more likely to be a concern than before as the patients become more self-conscious
along with development of metacognition. On the other hand, it is noted that the severity of tics
peaks between the ages of 10 and 12, increasing the likelihood that tics actually have a greater
impact on feeling and life of the patients. It is desirable to prepare the patients to cope with tics
by forming a basic sense of security by this time, and to ensure that the presence of tics during
this period does not impair the patients' self-esteem.
Cognitive behavioral therapy/behavioral therapy, including Comprehensive Behavioral
Intervention for Tics (CBIT), has been shown to be effective to tics, and if that effect isinsufficient, pharmacotherapy, mainly antipsychotics and α2-adrenergic agonists, may beconsidered. Consideration of comorbidities in treatment of TS is necessary because of theirfrequency and impact. It is important to have the perspective of helping patients with TS
understand and accept themselves with tics and move toward a better life in that state, without
seeking reduction or disappearance of tics only.
15:10-16:10 Plenary Lecture 7 Moderator: Takashi Okada
Mental health and well-being of children and adolescents in child welfare
systems: the roles of child and adolescent mental health professionals working
for child welfare
Yoshiro Ono1
1
Wakayama Prefecture Mental Health and Welfare Center, Wakayama, Japan
Health is a core element of child welfare, and psychiatric care is expected to plays a very
important role, along with pediatric care, in achieving the objectives of child welfare. On theother hand, health is ultimately the pursuit of wellbeing, as the WHO Constitution states "healthis a state of complete physical, mental and social well-being and not merely the absence ofdisease or infirmity." Thus, there is a growing interest in well-being for children and theirfamilies in the field of child welfare as well.
Recently, with the popularization of child and adolescent mental health, children's emotionaland behavioral problems are increasingly tended to be explained as mental illnesses. As a result,the prevalence of mental disorders among children in general has become very high, all over theworld including Japan. In the field of child welfare, as child abuse and neglect have become acentral issue in child welfare, the prevalence of mental illness among children in child welfare
systems has increased, and child and adolescent mental health is becoming more important thanever before.
It is reasonable to expect that the commitment of child psychiatrists will enhance child welfare
expertise and provide more effective support to children and families. Now, the role of childpsychiatrists has become an integral part of child welfare from prevention, early detection,intervention, and care of child abuse and neglect, to judicial decisions related to childprotection. At the same time, however, it is important to note that diagnoses of mental illnesses
will inevitably lead to an increase in more specific psychiatric treatment, especiallypsychopharmacological therapy. Indeed, it has been known that psychotropic medication forchildren in child welfare systems is quite common.
While it is true that diagnoses may be rational in determining care plans, they are not powerfulenough by themselves to lead to the best support and to the well-being of the child. Well-being71

cannot be achieved without a secure and trusted human relationships, even if the care planseems scientific. Although psychiatric involvement will be required more and more in the
future, we must always consider what the diagnosis is for and who it is for, but only in order tocontribute to the child's well-being.
This presentation is a non-clinical and literature study.
The author has no conflict of interest directly relevant to the context of this presentation.
16:20-17:00 Research Topics 15
Current Clinical Practice for Gender Incongruence in Childhood andAdolescence in Japan
Masaru Tateno1,2
1
Tokiwa Child Development Center, Tokiwa Hospital, Sapporo, Japan
2
Child Mental Health Clinic, Department of Neuropsychiatry, Sapporo Medical University,
Sapporo, Japan
ABSTRACT
Increasing attention has been paid to transgender and gender diverse children and adolescents
over the past decade in Japan. Gender identity disorder (GID) of ICD-10 was considered a smallpart of the transgender population. Recently, GID was replaced with Gender Incongruencewhich is listed in “Conditions relating to sexual health” of ICD-11. That is, Gender
Incongruence of ICD-11 is no longer part of the chapter on Mental Disorders. Previous studies
have estimated that about 1% of all people identify with a different gender than that assigned tothem at birth. A national survey of schools by the Ministry of Education, Culture, Sports,
Science and Technology of Japan reported that at least 606 students in primary, junior-high andhigh school were aware of their gender incongruence, and about 60% of them received someform of special treatment at school. Our survey of child and adolescent psychiatrists in Japanrevealed that about 60% of the subjects had seen children and adolescents with genderincongruence, and two-thirds of them had seen cases with gender identity-related concerns. In
Japan, in general, junior high school students are required to wear school uniforms based on
their assigned gender, typically a skirt for girls and trousers for boys. They are also requested toobey school regulations related to length of hair, though the strictness is highly dependent on theparticular school. These school rules often annoy gender dysphoric students and could be thecause of subsequent school refusal. As reported in the DSM-5 textbook, Japan is one of only
two countries whose emergence rate of trans-male is higher than trans-female, along with
Poland. In Japan, statistical reports from specialized clinics for gender have demonstrated thattrans-female is dominant in childhood while the rate of trans-male is higher in adolescence andolder ages. Many of the transgender cases also have co-morbid psychiatric conditions such as
depression and anxiety as revealed by our study. In the Gender Identity Disorder Special Act ofJapan, it is specified that when transgender people wish to change their gender on the family
registry, their gonads must be absent or non-functioning, and their genitalia should resemble thegender to which they transition. Although transgender people sometimes seek help at
specialized clinics for gender-related issues, the number relative to the need is insufficient inJapan. Thus, the role of child and adolescent psychiatrists will be expanding to support children
and adolescents with gender incongruence.
Venue 2 (Room B-1)
9:10-10:10 Plenary Lecture 2 Moderator: Hideki Negoro
Altered Motivational Processing in ADHD: Implications for Behavioral
Management and Cultural Considerations

72

Gail Tripp1
1
Okinawa Institute of Science and Technology Graduate University (OIST), Human
Developmental Neurobiology Unit, Okinawa, Japan
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disordercharacterized by elevated levels of inattention, overactivity and impulsivity. These symptoms
negatively impact the educational and social development of affected children and placesignificant burden on their families and communities. Despite extensive research the etiology ofADHD remains elusive. Altered processing of motivationally significant stimuli has been
hypothesized to contribute to symptoms of ADHD; a core deficit linking underlying
neurobiological disturbances to behavioral symptoms of inattention, hyperactivity andimpulsivity. A biological explanation for altered reinforcement sensitivity will be discussed.
Here we present evidence that children with ADHD differ from typically developing children in
their behavioral responses to both positive reinforcement and punishment. This includes astronger preference for immediate reward, difficulty waiting for reward, increased sensitivity torecent rewards, decreased sensitivity to changing reinforcement contingencies, and faster
extinction of previously learned responses. Imaging research shows reduced BOLD activation
to reward predicting cues and increased activation to reward delivery in young adults with
ADHD. The sensitivity of children with ADHD to punishment has received less theoretical andexperimental attention. None-the-less there is research indicating that children with ADHD
show increased sensitivity to punishment, an effect that appears cumulative with repeatedexposure.
The implications of these findings for the behavior of children with ADHD and for the
implementation of behavioral management techniques, i.e., the use of antecedent andconsequent strategies is discussed. To date available parenting programs do not specificallyaddress altered reinforcement sensitivity in ADHD. We offer recommendations for translatingknowledge from empirical studies into improved behavioral management for ADHD.
We also consider the importance of culture in the interpretation of altered reinforcement
sensitivity in children with ADHD, including risks this may pose for affected children. This
includes consideration of the use of praise and punishment across cultures, reflecting on theneed to adapt behavioral approaches and/or their delivery to ensure their effective
implementation across diverse populations.
Presenter cited research was approved by the following ethics committees: Otago Ethics
Committee/Southern Regional Ethics Committee (NZ), the OIST Graduate University Human
Subjects Research Review Committee (Japan); the University of Massachusetts Dartmouth
Institutional Review Board (US), the Institute of Psychiatry of the Federal University of Rio deJaneiro (Brazil) and the D’Or Institute for Research and Education; and the Social and Societal
Ethics Committee, Faculty of Psychology and Educational Sciences at the KU Leuven(Belgium).
10:20-11:20 Plenary Lecture 4 Moderator: Nami Honda
Between the observable and the sensible in the clinic of child and adolescent
psychiatry-trauma and resilienceKiwamu Tanaka1
1
Hyogo Mental Health Center, Kobe, Japan
Child and adolescent psychiatry has many facets and requires an interdisciplinary andmultifaceted approach. For the clinician, in order to solve one child's problems, the child's
situation is viewed from a comprehensive perspective of biological, psychological, andsociological factors and examined and resolved from a dynamic process using knowledge fromsymptomatology, pathology, pharmacology, neuropsychology, developmental psychology,sociology, pedagogy, and other fields. The solution is based on a dynamic process. However, in73

actual clinical practice, we sometimes fail to find the factors of psychopathology at that timeand understand them after many years. Even if the factors are clear, the patient may refuse toapproach the problem. The clinician may be able to sense the subtle signs of the invisible or theunobservable and prevent the development or manifestation of psychopathology.
Many effective diagnostic and treatment tools have been developed and have been of great
benefit in child trauma clinical practice. However, children with attachment issues and children
who are tormented by shame and guilt may deny verbalizing their trauma or even be unaware of
their trauma. These children may express their psychopathology in a variety of other-harming,
self-injurious, and illegal behaviors. Their trauma is invisible from the outside. That is why
clinicians must be aware of it and intuitively feel it.
We sometimes find a child with a genetic predisposition to schizophrenia who has been truant orwithdrawn from school, and in his paintings, we find the child's psychiatric crisis. Although thechild does not show any symptoms of schizophrenia, the clinician must be aware of thepsychological danger. The clinician then works on therapy for the ambiguity, and often it is overa long period of time, and in a sense, it could be said that resilience is fostered in thattherapeutic relationship.
We all have childhoods, but we tend to forget how we felt and saw then. The secret of a child's
mind is that "it is only with the heart that one can see rightly; what is essential is invisible to theeye."(Antoine de Saint-Exupéry)
Through several cases, I would like to consider psychological treatment in child and adolescent
psychiatry.
The cases presented are either consented for presentation or fictitious cases. There are no
conflicts of interest related to this presentation.
12:50-13:30 Research Topics 10
Impact of microbiota on individuals with autism spectrum disorder
Katsunaka Mikami1
1
Department of Psychiatry, Tokai University School of Medicine, Isehara, Japan
ABSTRACTThe gut microbiota plays an extremely important role in the organism. The formation of the gut
microbiota commences immediately after birth, and the prototype of the subsequent gut
microbiota is formed within the first week of life, leading to the formation of the gut microbiota
that will have a significant impact on the gut microbiota in adulthood. Children with ASD are
more likely to have gastrointestinal symptoms such as constipation, diarrhea, and repeatedconstipation and diarrhea. Compared to typically developing children, children with ASD have acharacteristic intestinal microbiota. It has also been suggested that gastrointestinal symptoms
correlate with core symptoms of ASD. Experiments using mice have accumulated evidence thatthe gut microbiota influences mental activity and behavior during early development, as well as
ASD symptoms. In recent years, probiotics and prebiotics as well as fecal microbiotatransplantation (FMT) into the intestinal tract, have attracted attention as therapeuticinterventions for the core symptoms of ASD. Therapeutic intervention for the gut microbiota of
ASD may provide relief of both gastrointestinal and ASD symptoms, and relief of these two
symptoms may lead to a reduction in social dysfunction. Currently, however, therapeuticinterventions for the gut microbiota in ASD have not been recommended as a treatment for thecore symptoms of ASD due to a lack of the studies on double-blind, placebo-controlled trials. In
addition, the safety of FMT needs to be carefully assessed, since it requires close examination of
the content microorganisms of the human gut microbiota and verification of the long-term
prognosis of the transplant. The establishment of these interventions as treatments remains to beevaluated for efficacy and safety in future clinical studies. This presentation reviews thecharacteristics of the gut microbiota in ASD, focusing on potential therapeutic interventions forthe gut microbiota that have been actively attempted in recent years.

74The content of the presentation is a review of previous research reports, so no particular ethicalconsiderations are required.
Funding: This presentation has no financial support to disclose.
Conflicts of Interests (over the three years): Katsunaka Mikami has received a Grant-in-Aid for
Scientific Research (C) (Number 22K07624) and financial support from Otsuka PharmaceuticalCo., Ltd., and Shionogi & Co., Ltd.; honoraria from Miyarisan Pharmaceutical Co., Otsuka
Pharmaceutical Co., Ltd., Shionogi & Co., Ltd., Sumitomo Pharma Co., Ltd., and Takeda
Pharmaceutical Co., Ltd.; and a consulting fee from Otsuka Pharmaceutical Co., Ltd., Shionogi& Co., Ltd., and Viatris.
14:00-15:00 Plenary Lecture 6 Moderator: Tomoko Shimanouchi
The significance of attachment theory in child psychiatry practice - a Life courseand Affiliative Neuroscience perspectiveHiroshi Yamashita1
1Department of Child Psychiatry Kyushu University Hospital, Fukuoka, JapanThe extension of attachment theory, supported by empirical research, has had a strong influenceon philosophy and paradigm formation and policy decisions in a wide range of disciplines,
including social welfare, maternal and child health, paediatric and psychiatric care, as aconceptual framework underlying the social sciences. This lecture will review recent findings ofattachment theory that will be used in the future clinical practice of child psychiatry.
(1) Locating the concept of Relational disorder in the practice parameter of child psychiatry:
Relationships development over the life course - the process of bond formation and its
difficulties - is an important perspective from which to read clinical problems involving
multiple disciplines from a cross-cutting perspective. The RDoC (Research Domain Criteria)with a neurobiological etiological perspective has positioned Attachment and Affiliation as acomponent of the research domain on the neural circuits of the social system. Children's
emotional and behavioural problems have a latent structure of internalisation - disinhibition
externalisation - oppositional externalisation, while the dynamic developmental process of
attachment behaviour (approach - exploration and inhibition - disinhibition) provides aclinically explanatory model of this two-dimensional structure. As corresponding diagnostic
concepts, DSM5 and ICD11 have placed Reactive attachment disorder and Disinhibited social
engagement disorder under stress-related disorders.
(2) Inclusion of environmental diversity in Attachment theory:
Attachment research has introduced diverse socio-cultural environmental perspectives. While
the mainstream of institutional and foster care research in Europe and the USA has used
developmental psychopathology, which uses longitudinal data to identify developmental
pathways, Rutter et al. pointed out the heterogeneity contained in a wide range of phenomenon
that have been understood in an integrated manner under the concept of attachment. It isnecessary to rethink the process of attachment formation as an adaptive survival strategy,
especially in the context of various crisis situations that threaten safety, i.e. Adverse Childhood
Experiences (ACEs).
(3) Evolution of attachment theory and comprehensive intervention models:
New attachment theories based on evolutionary biological frameworks, such as life history
theory, go beyond the traditional stress-vulnerability=deficit model to offer a comprehensive
intervention approach to the mental health problems in caregiving and affiliation. An approachbased on attachment and adaptive strategies underpins Higher Order Intervention that ensurespositive relationship enhancement as an available scaffold. Approaches that foster and restore
mentalising functions as common elements that enhance the effectiveness of therapeuticinterventions for interpersonal violence, such as bullying and abuse.
The author has no financial conflict of interest to disclose concerning the presentation.

75

15:10-16:10 Plenary Lecture 8 Moderator: Naoko Inada
Current Status and Challenges of Early Detection and Intervention for Toddlers
with ASD in Japan
Miho Kuroda1
1
Department of Psychology, College of Human Sciences, Denenchofu-Gakuen University,
Tokyo, Japan
After World War II, Japan started the community based well-baby health checkups for toddlersof 18 and 36 months old. And The service use has reached to over 90%. There the Japaneseversion of M-CHAT (Modified Checklist for Autism in Toddlers), translated and validated by
the National Center of Neurology and Psychiatry and others, is used for the first screening
assessment to detect autism spectrum disorder (ASD) in early childhood. And there are tools
for secondary screening assessment including the Japanese original test battery called PARS-TR(Parent-interview ASD Rating Scale Text Revision). We also use such tools for diagnostic
assessment as the Japanese version of ADOS-2 (Autism Diagnostic Observation ScheduleSecond Edition) and ADI-R (Autism Diagnostic Interview-Revised). Though they have enabled
early detection, the medical institutions/clinics utilizing the ADOS-2 and the ADI-R are still
limited in number. The challenge for us is to disseminate these assessment tools in the medical
institutions where the children are referred to.
“The Naturalistic Developmental Behavioral Interventions” such as ESDM (Early Start Denver
Model) and JASPER(Joint Attention、Symbolic Play, Engagement, and Regulation) are theprograms which were developed in U.S. and are found effective for toddlers with ASD, arebeing introduced in Japan. They promote interpersonal communication skills in the naturalcontext of play. The challenge here is few psychologists can implement these interventions. I
would like to report the results of the JASPER effectiveness research conducted in Japan.
The parent training and parent programs are becoming popular to support families. The COVID19 has led to the use of Internet-based programs, whose effectiveness is being verified. In Japan,
local development-led support centers have long been responsible for supporting children with
developmental disabilities. Since 2011, child development support offices have been establishedto provide community-based practical support. Unfortunately, the level and quality of support
varies widely from one center to another. Another cultural issue is that many Japanese parents
do not seek for diagnosis of developmental disabilities in early childhood, and many
pediatricians also are hesitant to diagnose them, leaving some children without support.
In this lecture I will discuss the results of our research on the efficacy of interventional
programs in the Japanese context and on the Internet-based parent programs, the social systemfor early detection and support, and its challenges and future in Japan.
There is no COI for this presentation. All the research here I refer to have been approved by therelevant ethics committees.
16:20-17:00 Research Topics 16
Mental Health Care for Children after the Great East Japan Earthquake andNuclear Power Plant Accident: Fukushima Health Management Survey
Shuntaro Itagaki1,2, Hirooki Yabe1,2, Masaharu Maeda2, Tetsuya Ohira2, Seiji Yasumura2, Kenji
Kamiya2, and The Team for Mental Health and Lifestyle Survey2
1
Department of Neuropsychiatry, Fukushima Medical University School of Medicine,
Fukushima, Japan
2
Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima
Medical University, Fukushima, Japan
ABSTRACTThe Great East Japan Earthquake (GEJE) and subsequent nuclear power plant (NPP). accident,

76which occurred in 2011, had longitudinal effects on the lives of the residents of Fukushima
Prefecture, specifically children. Soon after the disaster, Fukushima Prefecture launched the
Fukushima Health Management Survey to investigate the long-term low-dose radiation
exposure caused by the accident. Fukushima Medical University took the lead in planning andimplementing this survey. This survey aims to monitor the mental health status of those who
evacuated following the NPP accident (Yabe et al., 2014). The eligible population was residents
living in one of the 13 eligible municipalities and hotspots associated with high levels ofradiation. We sent a questionnaire containing the Strengths and Difficulties Questionnaire(SDQ) to parents/guardians of children. After collecting questionnaire responses, support wasprovided for children with high SDQ scores.
To identify those requiring support, survey respondents with SDQ scores of 16 or higher were
defined as having a high risk for mental health issues. We reported that the proportion of people
in the mental health high-risk group was higher than the general population of Japan (Mashiko
et al., 2017). We also reported that regular exercise is important for maintaining children’s
mental health after a disaster (Itagaki et al., 2017). Regarding sleep habits, we reported thatshorter sleep time was associated with a higher risk of mental health issues in 4–6-year-olds;
however, oversleeping was associated with a high risk of mental health in 7–15-year-olds(Itagaki et al., 2018). In addition to these single-year survey reports, follow-up studies havebeen conducted annually. We reported the trajectories of peer relationship problems andemotional symptoms in children and examined potential risks and protective factors over the 5
years following the GEJE. For peer relationship problems, male sex, experiencing the NPP
explosion and lack of exercise habits were associated with the severe trajectory group. For
emotional symptoms, experiencing the NPP explosion, experiencing the tsunami disaster, and alack of exercise habits were associated with the severe trajectory group (Itagaki, 2021). Basedon these published papers, we will report the results of support provided and research completed
in the 10 years since the earthquake, and discuss future issues.
This study was conducted in accordance with the Declaration of Helsinki, and the protocol wasapproved by the Ethics Committee of the School of Medicine of Fukushima Medical University(No. 1316, No. 2148, No. 2020-239).
Conflict of interest: none declared.
Venue 3 (Room B-2)
9:10-9:50 Research Topics 6
Polygenic risk model approach for neurodevelopmental disorders using
longitudinal birth cohort
Nagahide Takahashi1,3, Tomoko Nishimura2,3, Akemi Okumura2,3, Toshiki Iwabuchi2,3, Shafiur
Md Rhaman2,3, Kenji J. Tsuchiya2,31
Department of Child and Adolescent Psychiatry, Nagaoya University Graduate School of
Medicine, Nagoya, Japan
2
Research Center for Child Mental Development, Hamamatsu University School of Medicine,
Hamamatsu, Japan
3
United Graduate School of Child Development, Hamamatsu University School of Medicine,
Hamamatsu, Japan
ABSTRACTThe prevalence of neurodevelopmental disorders such as autism spectrum (ASD) and attention
deficit hyperactivity disorder (ADHD) is rapidly increasing. Although the exact causes of these
disorders are unknown, recent advances in research have revealed that both genetic andenvironmental factors contribute to the development of ASD and ADHD.
Tsuchiya et al. planned and began recruiting for the Hamamatsu Mother and Child Cohort (HBC

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Study) in 2007. The purpose of this cohort is to examine neurodevelopmental trajectories
through frequent face-to-face monitoring to identify early signs of neurodevelopmental
disorders and to enable early intervention for neurodevelopmental disorders in the future.
Previously, Nishimura and colleagues found that children's neurodevelopmental trajectories fall
into five groups and that trajectory classes are associated with later diagnosis of ASD(Nishimura, Int J Epidemiol. 2016). In addition, Aoyagi and colleagues found that thedevelopment of postpartum depression was associated with the development of expressive
language (Aoyagi, Peer J. 2019).
The presenter joined the HBC team in 2020 and began to examine genetic influences onneurodevelopmental disorders, as well as gene-environment interactions, utilizing genetic datawith Dr. Tsuchiya and his team.
First, they found that polygenic risk scores for ASD were associated with ASD traits in thegeneral population, and that delays in gross motor skills and recessive language skills could beearly makers of ASD (Takahashi, JAMA Network Open, 2020). Next, he showed that ADHD
and narcolepsy are genetically correlated and may explain the excessive daytime sleepinessoften observed in ADHD subjects (Takahashi, Trans Psychiat. 2021).
More recently, we have shown that delayed sleep onset increases ADHD symptoms only insubjects at low genetic risk for ADHD and reported the importance of proper assessment of
sleep habits for an accurate diagnosis of ADHD (Takahashi, Okumura, JAMA Network Open2022). It has also been shown that body birth weight (<2500 g) and genetic risk for ADHD
mutually increase the risk of developing ADHD (Rahman, BMC Medicine. 2022.)
Although the case-control studies that have been conducted have been very innovative, thesealone cannot clarify the interaction between genes and the environment. In this presentation, we
will present our recent data showing gene-environment interactions, obtained using longitudinalcohorts from the general population, and suggest how genetic data should be used in clinicalpractice in the field of child and adolescent psychiatry.
The data presented here are from a study approved by the Ethics Committee of Hamamatsu
University School of Medicine, and written consent for the participation of infants was obtained
from each parent or guardian.
All presenters have no conflicts of interest.
10:00-11:30 Workshop
Making Changes one step at a time: A Clinical Workshop Series on Intervention
Programmes for Children and AdolescentsModerator 1: Tze Jui, Goh (Department of Developmental Psychiatry, Institute of Mental
Health, Singapore, Singapore)
Moderator 2: Choon Guan, Lim (Department of Developmental Psychiatry, Institute of Mental
Health, Singapore, Singapore)
W-1
Dealing with Feelings©: Emotional Regulation Skills Programme for Children andAdolescents with Autism Spectrum Disorder
Li Ting, Ng1, Tze Jui, Goh1
1
Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
ABSTRACT
There is a high rate of psychiatric co-morbidities such as anxiety disorders, anger management
problems and depression in children and adolescents with Autism Spectrum Disorders (Weiss,2014). They often present with difficulties in recognizing and understanding emotions inthemselves and others, and also use fewer or less effective strategies to regulate emotions thantheir neuro-typical counterparts (Jahromi, Meek & Ober-Reynolds, 2012).

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Cognitive behavioural therapy (CBT) has been widely used in the treatment of anxiety disorders
in children and adolescents with ASD. We conducted a Randomized Controlled Trial (RCT) on
a CBT emotional regulation programme with children and adolescents with ASD in 2005. Since
the successful completion of the RCT, the programme has been revised and implemented ingroup settings as well as be used individually in psychotherapy sessions for children andadolescents with ASD attending the outpatient clinic. In addition, training of the programme
was also conducted with psychologists, school counselors, special needs officers (supporting
students with special needs in mainstream school) as well as para-professionals working withchildren and adolescents with a range of conditions. The programme is not only suitable forchildren and adolescents with neurodevelopmental conditions, but can also be used to build
emotional literacy in children with no clinical diagnosis.
We provide an overview of the programme, with a focus on the modifications and strategies
specific to meet the needs of individuals with ASD, such as structured teaching, social problemsolving strategies, and experiential activities to engage the children. We also discuss
implementation considerations of the programme from lessons learnt over the years.
W-2
Teaching Emotional Regulation Skills to students with Intellectual Disability in
the Special Education School Setting
Siti Fathin Aerlisa, Binte Rosli1, Tze Jui, Goh1
1
Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
ABSTRACT
Following the successful completion of a Cognitive Behavioural Therapy (CBT) randomized
controlled trial and implementation of the programme to teach emotional regulation skills tochildren and adolescents with Autism Spectrum Disorder (Sung et al, 2011; Goh et al., 2017),
we adapted the programme for children and adolescents who presents with intellectual
disability. There is a scarcity of intervention programmes developed for the intellectual disabled(ID) community. The needs of the ID community are often over-looked, from physical services
to programmes addressing their socio-development and emotional literacy skills. Yet, there is ahigh rate of emotion-related issues such as anxiety and behavioural issues associated withdysregulation in children and adolescents with ID.
We conducted a pilot trial of the adapted programme with students with a diagnosis of Autism
Spectrum Disorder (ASD) and/or intellectual disability (IQ < 70) from two special education
schools in Singapore. Results indicated that participants were reported to display improvementsin their communication skills. Anxiety related symptoms reduced, although the difference was
not significant.
In this workshop, we present the emotional regulation skills programme, with a focus on theadaptations made to accommodate the cognitive and language abilities of the students with ID.
In particular, we discuss the necessary considerations in conducting a CBT-based programme toteach emotional literacy and emotional skills in the special needs population.
W-3
Anger Management Programme for Children with ADHD: “Taking the GRRR Out
from Anger” and “Regnatales©”Xue Wei Wendy, Poh1, Yi Ren, Tan1, Nikki, Lim-Ashworth1, Tze Jui, Goh1, Choon Guan, Lim1
1
Institute of Mental Health, Department of Developmental Psychiatry, Singapore, Singapore
ABSTRACTChildren with Attention Deficit Hyperactivity Disorder (ADHD) often presents with emotional

79

regulation difficulties in view of their underlying impulsivity and poor executive control. It isalso not uncommon for children with ADHD to experience challenges in regulating theiremotions and thoughts. These emotional dysregulation and anger issues can contributesignificantly to psychosocial burden in these children such as getting into conflicts with peers.
Studies have shown that behavioural intervention can be effective in addressing anger issues in
ADHD by helping the child learn coping strategies.
“Taking the GRRR Out from Anger” aims to teach children with ADHD coping techniques foranger control and conflict management in a group setting. Various coping strategies are
introduced through interactive and hands-on activities. Participants are also encouraged topractise the skills in session.
This anger management programme was also developed into Regnatales©: a series of gamebased mobile applications to enhance the learning experience for children. With the rapid
advancement in media technology, the delivery of knowledge and building of skills throughinteractive mobile games has demonstrated potential in implementation in child mental healthwork. A quantitative pilot trial provided evidence to support Regnatales© as a feasible anger
management intervention for children with ADHD. Results indicated high levels of enjoyment
and playability based on child reports. Child participants also reported lower reactive aggression
scores, felt that they have acquired skills in anger management, were motivated to apply theseskills in their daily lives, and were also confident that they can manage their anger better.
W-4
Classroom Behaviours Skills (CBS) Programme: Supporting children in ADHD in
the classroom
Tai Yeow Catherine, Tan1, Tze Jui, Goh1, Choon Guan, Lim1
1
Institute of Mental Health, Department of Developmental Psychiatry, Singapore, Singapore
ABSTRACTChildren with ADHD present with behavioural issues in multiple settings, such as in school andat home. Often times, they need to be taught specifically to be able to meet the learning andsocial demands in school. The Classroom Behaviours Skills (CBS) programme is an 8-weekgroup intervention, developed to teach children with ADHD important skills to help them adapt
to the school settings. It involves skills-training for children, and a parallel caregiver component
to encourage skills generalisation and support for caregivers.
Following the successful implementation of the programme, we conducted a pilot clinical trial
to elucidate the effectiveness of the programme. Thirty-eight children with ADHD, aged
between 6 to 8 years (M = 7.08, SD = 0.59) and their parents were enrolled in a treatment (n =20) and control (n =18) group. Pre and post comparison analyses indicated that parents from thetreatment group reported a greater reduction in ADHD symptoms in their child on the ADHD
Rating Scale (ARS) compared to the control group, F(1,37) = 10.91, p = .002]. Improvementson the behavioural outcomes on the Child Behaviour Checklist (CBCL) and parenting stress on
the Parenting Stress Index – Short Form (PSI-SF) were also noted for children in the treatmentgroup. The results provide preliminary evidence for the effectiveness of the CBS programme in
reducing ADHD symptoms and improving behaviours in children with ADHD, with benefits
extended to their caregivers. An evidence-based, multi-prong approach towards remediating theimpact of ADHD on the children and their caregivers is recommended.
W-5
Mentally LIT: A Mental Health Literacy Curriculum in Singapore
Guan Sheng Arthur, Goh1
1
Institute of Mental Health, Department of Developmental Psychiatry, Singapore, Singapore

80

ABSTRACT
About 1 in 7 people in Singapore has experienced a mental health disorder at some point in theirlife. However, factors such as stigma and lack of knowledge prevents some individuals fromseeking professional help. Early identification of mental health disorder symptoms andintervention has been reported to be effective in mitigating the impact of the conditions, which
is fundamental to effect more positive outcomes in the domains of physical, mental and social
well-being, as well as improve quality of life for these individuals.
The Mentally LIT program curriculum is a localized adaptation of the mental health literacy
program in Canada. It is focused on the adolescents, with aims to increase the knowledge andunderstanding of mental health and mental illnesses in the young individuals. This is done
through a series of classroom based learning and interactive activities that leads to theunderstanding of what mental health is, how to obtain and maintain good mental health, andunderstanding the various symptomatology of mental illnesses and their treatments. At the endof the Mentally LIT curriculum, individuals would be informed of facts related to mental health,translating to an increase in their mental health literacy, as well as experience a reduction instigma towards mental illnesses. This in turn, may increase the likelihood of them seeking help
should they experience mental health symptoms, or support others when they are able torecognize the symptoms in their peers.
An evaluation of the efficacy of the Mentally Lit program is currently on-going. We sharehighlights and aims of the program and preliminary findings of the evaluation.
12:50-13:30 Research Topics 11
Sleep in children with neurodevelopmental disorders: how do we address?
Fumie Horiuchi1,21Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
2
Center for Child Health, Behavior and Development, Ehime University Hospital, Toon, Japan
ABSTRACT
Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attentiondeficit/hyperactivity disorder (ADHD) include a wide range of neuro-psychiatric conditions
presented during infancy or childhood. Children with NDDs frequently suffer from sleep
disturbances, with a higher prevalence than the general populations (ASD: 64-93%, ADHD:2575%, typically developing children:3.7%).
In recent years, sleep disorders in NDDs have become a field of greater interest, andunderstanding features of sleep patterns is crucial to set up target treatments. Among the cooccurring conditions associated with ASD or ADHD, sleep disturbances often arise before theonset of ASD or ADHD core symptoms. The most prevalent caregiver-perceived sleep problems
in infancy were “waking overnight”. Sleep problems caregivers perceived from early to middle
childhood were declined, although “difficulty falling asleep” still impacted between ages 6 and11 years. Clinicians should assess sleep disorders in children with NDDs accurately, howevervalidated Japanese screening questionnaires are not enough. The intervention for sleep problems
in children with NDDs should be approached in a stepwise fashion; the first-line intervention
being sleep hygiene education, the second-line being the use of specific behavioral strategies,
and the third line being the use of sleep medications. Especially, the use of melatonin to improve
sleep onset times for individuals with ASD had the most empirical support, but still does notmeet clinical recommendation standards.
I would like to offer a general picture of sleep disturbances in children with NDDs, and present
our data, and future direction would be shown in the sleep research related to NDDs.
I have no financial relationships to disclose. Studies were approved by the Institutional Review
Board of Ehime University Graduate School of Medicine. Participants and their parents
provided informed assent and consent.

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13:40-15:10 Symposium 19
Neuroimage studies on neurodevelopmental disorders
Moderator 1: Susan Shur-Fen Gau (Department of Psychiatry, National Taiwan University
Hospital and College of Medicine, Taipei, Taiwan)
Moderator 2: Ayaka Ishii-Takahashi (Department of Developmental Disorders, National
Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan)
S19-1
Correlation of Altered Neural Substrates with Emotion Dysregulation in Children
and Adolescents with ADHD
Chia-Jui Tsai1,2,3, Hsiang-Yuan Lin4,5, Isaac Wen-Yih Tseng6, Susan Shur-Fen Gau3,71
Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
2College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
3
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University,
Taipei, Taiwan
4
Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute,and Adult Neurodevelopmental and Geriatric Psychiatry Division, Centre for Addiction and
Mental Health, Toronto, Canada
5
Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto,
Canada6
Institute of Medical Device and Imaging, National Taiwan University College of Medicine,
Taipei, Taiwan
7
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
ABSTRACT
Background: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood-onset
neurodevelopmental disorder with clinical heterogeneity. Co-occurring emotion dysregulation(ED) is noted in 40–70% of ADHD individuals across studies, leading to more severe ADHD
symptoms and worse outcomes longitudinally. Several brain regions and networks withvolumetric or functional abnormalities in ADHD are also implicated in emotion regulation.
However, there is a lack of study comparing the patterns of neural substrate changes
underpinning ED between ADHD individuals and typically developing controls (TDC).
Methods: The brain imaging data of 140 children and adolescents with ADHD and 140 TDC,
aged 7 to 18 years old, were included. ED severity was estimated based on the dysregulation
profile of the Child Behavior Checklist (CBCL-DP). We investigated whether ADHD and TDC
had distinct neural correlates underpinning ED by using the following MRI methods: voxelbased morphometry (VBM) for regional brain volume, diffusion spectrum imaging (DSI) for
white matter (WM) tract microstructural integrity, and resting-state functional MRI (rsfMRI) for
intrinsic functional connectivity (iFC) analyses. This study was approved by the Research
Ethics Committee at National Taiwan University Hospital, Taipei, Taiwan, before
implementation.
Results: First, the VBM analysis revealed significant group-by-ED interactions between ADHD
and TDC in the left DLPFC volume. ADHD had decreased grey matter volume, while TDC had
increased grey matter volume of the left DLPFC that correlated with ED severity. DSI analyses
revealed that the microstructural integrity of 19 WM tracts, which were linked to affective
processing, sensory processing and integration, and cognitive control circuitry, were positively
correlated with ED severity in the TDC group but negatively correlated with ED severity in the
ADHD group. Also, in rsfMRI analysis, the iFC of the default-mode network (DMN) withangular gyrus had different patterns with ED severity between ADHD and TDC. A positive
correlation between the iFC strength and ED severity in the ADHD group while a negative
correlation in the TDC group was detected. The positive correlation between iFC strength of
DMN and ED severity in ADHD may be engaged in more mind wandering and thus hamper the82

ability of mindfulness-based emotion regulation.
Conclusion: We found ADHD and TDC exhibited different trends of GM volume, WM integrity
and iFC change underpinning ED. These neural substrates might be essential correlates of ED in
ADHD. Besides, individuals with ADHD might have distinct neural mechanisms whileregulating their emotions. Thus, it is worthwhile to take ADHD-specific interventions for their
ED problems.
Conflict of interest: The authors declare that they have no known competing financial interests
or personal relationships that could have appeared to influence the work reported in this paper.
Ethics: The work described in this abstract was carried out in accordance with the Declarationof Helsinki for experiments involving humans and had been approved by the Research Ethics
Committee at National Taiwan University Hospital, Taipei, Taiwan, before implementation(approval number: 200903062R and 201204071RIC; ClinicalTrials.gov number NCT00916851
and NCT01682915).
S19-2
Neural Substrate of Sensory-Social Correlation in Autism
Yi-Ling Chien1, Susan Shur-Fen Gau1
1
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
ABSTRACT
Backgrounds: Sensory symptoms are common in individuals with autism spectrum disorder(ASD) and are associated with social deficits in ASD. Sensory sensitivity can impact selective
attention to social stimuli, decoding intentions, social reciprocity, and adherence to social normsof behavior. Whether and how sensory symptoms mediate social symptoms and social brain
networks during development is unclear. This study aims to investigate how sensory symptoms
mediate social deficits and the development of social brain networks in a longitudinal ASD
sample.
Methods: This study recruited 248 individuals with ASD and 120 typically developing controls(TDC). These participants were followed for six years on average. Social deficits were
measured by the Social Responsiveness Scale (SRS), while sensory items in the SRS and Short
Sensory Profile evaluated sensory symptoms. All participants underwent head MRI at two time
points. We used single and multiple mediation analyses to examine whether sensory symptoms
can mediate social development.
Results: We found that sensory symptoms were significantly correlated with social deficits ateach cross-sectional time point. Besides, we found that sensory symptoms at either Time 1 orTime 2 significantly mediate social deficits from Time 1 to Time 2. In neuroimage analysis, we
also found that sensory symptoms may mediate the changes in the social brain networks fromTime 1 to Time 2.
Conclusion: Our findings suggested that sensory symptoms may mediate the changes in social
deficits behaviorally and in the social brain network. Clinical intervention may potentially help
the training on social functioning.
This study was approved by the research ethics committee of the National Taiwan University
Hospital. The authors declared no conflict of interest.
S19-3
Application of Theta Burst Stimulation in Autism Spectrum Disorder
Hsing-Chang Ni1
1
Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital at Linkou,

83

Taoyuan, Taiwan
ABSTRACT
Background: Theta burst stimulation (TBS), a modified repetitive transcranial magnetic
stimulation (rTMS), had a compatible therapeutic effect with rTMS in treatment-resistantdepression. With lower stimulatory intensity, fewer stimulatory pulses, and less stimulatory timethan traditional rTMS, TBS is more feasible in treating patients with autism spectrum disorder(ASD). Three brain regions have been proposed to be the targets with therapeutic potential intreating ASD, including the dorsolateral prefrontal cortex (DLPFC), posterior superior temporalsulcus (pSTS), and right inferior frontal gyrus (IFG).
Methods: In the past nine years, we did a series of randomized, blinded, sham-controlled studies
to validate TBS's feasibility and therapeutic potential on these brain regions in children,
adolescents, and adults with ASD. First, we applied intermittent TBS twice weekly for 8 weeks
over bilateral pSTS in children and adolescents with ASD (8-18 years old; Active group, n=40,
Sham group, n=38). Second, we applied continuous TBS twice per week for 8 weeks over theleft DLPFC in individuals with ASD (8-30 years old; Active group, n=30, Sham group, n=30).
Third, we applied intermittent TBS twice per week for 8 weeks over the right IFG in individuals
with ASD (8-30 years old; Active group, n=30, Sham group, n=30). All our studies had been
approved by the Research Ethics Committee at Chang Gung Medical Foundation- Institutional
Review Board (CGMF-IRB 200705065R, 104-9413A, 201802246A0 and 201900713A0)
before study implementation.
Results: Overall, we found TBS over DLPFC, right IFG and pSTS was feasible and tolerable inbeing applied in ASD. Because of the high heterogeneity in ASD, not all ASD individuals
responded to TBS. First, we found longer TBS (8 weeks >4 weeks) over the pSTS might havetherapeutic potential on social communication deficits and repetitive behaviors. Second, we
found TBS over the right IFG might have benefits on emotion regulation. Third, we did not findthe therapeutic effect of TBS over the left DLPFC on emotion regulation or core symptoms of
ASD. Several baseline characteristics might modify the therapeutic response of TBS.
Conclusion: Our work supported the feasibility and therapeutic potential of TBS in treating
ASD. However, because of the high heterogeneity in ASD, the best or individualized TBS
protocol should be investigated and developed for each patient with ASD in the future.
The authors declare no conflicts of interest related to this work.
S19-4
Comparing the Brain Structural Alterations between Autism and Schizophrenia
Wei-Ting Ko1,2, Yi-Ling Chien1,3, Susan Shur-Fen Gau1,2,3
1
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
2
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University,
Taipei, Taiwan
3
Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
ABSTRACT
Background: Autism (ASD) and schizophrenia (SCZ) are common neuropsychiatric disorders
with brain structure alteration. The autistic traits and schizotypal traits shows a significant
positive correlation, and similar social-cognitive impairment is shared between ASD and SCZ.
Comparing the brain structure of ASD or SCZ to normal controls in separate studies revealed
several consistent white matter alterations but diverse results in grey matter. This phenomenon
might reflect a similar social cognitive impairment but diverse in the existence of psychosisfeatures. This study demonstrated a single-site magnetic resonance imaging work to compare
the brain structure of ASD and SSD comprehensively for examining that ASD and SCZ have
convergent white matter alterations but divergent grey matter alterations.

84

Methods: This study was approved by the Research Ethics Committee of the National Taiwan
University Hospital, complying with the Helsinki Declaration of 1975, as revised in 2008. We
recruited 84 patients with autism, 79 patients with schizophrenias, and 108 healthy controls.
Acquiring T1-weighted image and diffusion spectrum imaging on a 3T MRI system. For quality
control, T-1 weighted images were checked visually, and diffusion images were checked bysignal-noise ratio (SNR). We used voxel-based morphometry (VBM) to estimate the grey mattervolume by Statistical Parametric Mapping 12 with cat12 toolbox and applied both whole brain
and region of interest (ROIs) approaches. We used tract-based automatic analysis (TBAA) toconstruct the white matter fiber tracts and to calculate the generalized fractional anisotropy(GFA) value of 76 fiber tracts.
Results: The whole brain and multiple ROIs’ grey matters, including right precuneus gyrus,bilateral parahippocampal gyrus, bilateral fusiform gyrus, bilateral hippocampus, bilateralanterior/middle cingulate gyrus, bilateral frontal operculum, bilateral anterior/posterior insula,bilateral superior/inferior temporal gyrus, and bilateral pallidum, significantly differed between
the ASD and SCZ groups. Among the 76 white matter fiber tracts, only bilateral fornix, frontal
aslant tract, and thalamic radiation of auditory nerve were significantly different between ASD
and SCZ. Autistic patients had lower GFA values in the left arcuate fasciculus, corpus callosumof supplementary motor area, and corpus callosum of superior and middle temporal gyrus thanhealthy controls. Schizophrenic patients had lower GFA values in the left superior longitudinalfasciculus, left uncinate fasciculus, left inferior fronto-occipital fasciculus, and posterior
thalamic radiation than HC. Still, there were no differences between SSD and ASD.
Conclusion: Our results suggested that autistic patients and schizophrenic patients may have
convergent white matter alterations but divergent grey matter alterations.
Conflicts of Interest: All the authors declare no conflicts of interest regarding this work.
15:20-16:50 Symposium 23
Application of Artificial Intelligence in Biological Studies on Neurodevelopmental
DisordersModerator 1: Susan Shur-Fen Gau (Department of Psychiatry, National Taiwan University
Hospital and College of Medicine, Taipei, Taiwan)
Moderator 2: Masatoshi Ukezono (Department of Developmental Disorders, National Instituteof Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan)
S23-1
Metagenomic Profiles in Children with Autism Spectrum Disorder and Their
Unaffected Siblings
Yu- Chieh Chen1,2, Susan Shur-Fen Gau1
1
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
2
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University,
Taipei, Taiwan
ABSTRACT
Background: Due to the high prevalence (1% in Taiwan), long-lasting impairment, and a lack ofeffective detection, prevention, and treatment, autism spectrum disorder (ASD) has beenprioritized for brain research. The gut-brain axis is suggested to be altered in psychiatricdisorders, including ASD, using animal models. The highly inheritable factors run through ASD
families; hence, we used the unaffected sibling (unSIB) and typically developing control (TDC)
design to compare the clinical, gut microbiome, metabolome, and neuroimaging data between
these two groups to figure out the differences between ASD and unSIB shared similar genetic
variants.

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Methods: We assessed 242 ASD youth (M:F=214:28, age=15.32±4.52), 102 unSIB (M:F=61:41,
age=14.51±6.21) and 80 TDC (M:F=63:17, age=15.67±3.21) with psychiatric interviews (ADIR, ADOS, K-SADS-E), autistic symptoms (SRS), gut microbiota (16s metagenome sequencing)and untargeted metabolomic profiling. We conducted metagenome analysis and applied a linear
mixed effect model for statistical analysis to connect the microbiota and behavioral assessments
done via QIIME2 and R, with the significance level being the FDR-corrected q value <0.05. The
National Taiwan University Hospital Research Ethics Committee, Taipei, Taiwan, approved thisstudy before we conducted this study.
Results: ASD had the highest weighted Unifrac distance of beta-diversity than unSIB and TDC.
The protein processing and transcription factors were upregulated in ASD but downregulated in
unSIB. Second, we observed the microbiotas community composition changes (i.e.,
Lachnospiraceae and Eggerthellaceae) and cellular processing were positively correlated to the
SRS scores, the higher relative abundance of Ruminococcaceae, Fusobacteriaceae, andEnterobacteriaceae were associated with worse school function and peer relationships in ASD
than TDC. Third, the concentration of pyroglutamatic acid, 2’-Deonyguanosin 5’monophosphate, N-Acetylserine, glycine, glutamatic acid, sphingosine, guanidoacetic acid,allocholic acid and butanone were positively correlated to relative abundance of certain
microbiotas in both ASD and unSIB. We identified the downregulation of ubiquinone
biosynthesis in unSIB than ASD. Fourth, we also observed the cortical thickness alternation of
the frontal lobe areas correlated to microbial community diversity and guanidoacetic acidconcentration level changes positively in the ASD group and negatively in the unSIB group.
Conclusion: Our preliminary findings support the gut-microbiome-metabolomics-brain axis andthe feasibility of establishing brain-behavior relationships, microbiomes-behavioral phenotype
relationship, and microbiomes-metabolomics-brain axis. We also identified a few microbiomesthat potentially affect treating ASD based on the highly diverse patterns of microbiota
composition in unSIB providing new insight to indicate further that the probiotic’s usage should
vary in individuals with ASD.
The authors declared no conflict of interest.
S23-2
MicroRNAs Serve as Biomarkers of ADHD and Promote the Differentiation of
Neuronal Cells
Liang-Jen Wang1, Ho-Chang Kuo2,3, Wen-Jiun Chou1, Sheng-Yu Lee4,5, Sung-Chou Li6
1
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospitaland Chang Gung University College of Medicine, Kaohsiung, Taiwan
2
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung
University College of Medicine, Kaohsiung, Taiwan
3
Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
4Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
5Department of Psychiatry, College of Medicine, Graduate Institute of Medicine, School of
Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
6
Center for Mitochondrial Research and Medicine and Genomics and Proteomics Core
Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital andChang Gung University College of Medicine, Kaohsiung, Taiwan
ABSTRACT
Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly heritableneurodevelopmental disorder. MicroRNAs (miRNAs) involve RNA silencing and the posttranscriptional regulation of gene expression, and miRNAs may play an important role inneurodevelopment. The series of studies was to identify potential miRNAs biomarkers and thenuse these biomarkers to establish a diagnostic panel for ADHD. Furthermore, whether the86expression levels of miRNAs are associated with the differentiation of neuron cells and thedevelopment of brain structures was also investigated.
Methods and Results: Our research protocol was approved by the Institutional Review Board(IRB) at Chang Gung Memorial Hospital in Taiwan. We obtained written informed consent of
all the participants in accordance with the Declaration of Helsinki.
First, we identified 13 candidate miRNAs in total white blood cells (WBCs) with the nextgeneration sequencing (NGS) technique (Illumina). The ΔCt values of these miRNAs in a
Training Set (68 ADHD patients and 54 controls) were integrated to create a biomarker modelusing the support vector machines (SVM) algorithm, which demonstrated good validity indifferentiating ADHD patients from control subjects (AUC: 0.94, p < 0.001). Total WBC
samples were further collected from a Testing Set (145 patients and 83 controls), followed by
RNA extraction and qPCR assays. The SVM prediction model applying the ΔCt values ofmiRNAs demonstrated good validity in discriminating ADHD from controls (sensitivity: 96%;
specificity: 94.2%).
Second, we assessed 30 drug-naïve patients with ADHD and 25 healthy controls with a single
session of 3.0-T whole-brain structural MRI scanning. In the ADHD group, the gray matter(GM) volume of the cingulate gyrus and left fusiform gyrus was negatively correlated with theΔCt values of miR-30e-5p, miR-140-3p. The GM volume of the left fusiform gyrus was
negatively correlated to ADHD behavioral symptoms. Using structural equation modeling, we
observed that the effect of miR-140-3p on hyperactivity/impulsivity symptoms was mediated by
the left fusiform gyrus.
Finally, we conducted an in vitro study (neuron HCN-2 cells) to examine whether miRNAs
affected neurodevelopment (the differentiation of neuronal cells). The in vitro cell model
revealed that miR-140-3p and miR-126-5p promoted the differentiation of HCN-2 cells byenhancing the length of neurons and the number of junctions.
Conclusion: The overall findings suggest that the expression levels of miRNAs have thepotential to serve as biomarkers for ADHD and further participate in the pathophysiology ofADHD. The possible biological mechanisms of these biomarker miRNAs in ADHD
pathophysiology were also clarified.
Conflict of Interest Statement: The authors declare that the research was conducted in theabsence of any commercial or financial relationships that could be construed as a potential
conflict of interest.
S23-3
Utilizing Machine Learning to Forecast ADHD: From Symptomatology,
Neuropsychology to Brain Structure
Chung-Yuan Cheng1,2, Susan Shur-Fen Gau2
1
Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei,
Taiwan2
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
ABSTRACTIntroduction: Attention-deficit hyperactivity disorder (ADHD) is a common
neurodevelopmental disorder that affects 3-10% of the population, leading to long-term
neuropsychological and social dysfunction. Research shows that 65% of children with ADHD
continue to exhibit symptoms and impairments as adults, with an estimated adult ADHD
prevalence at 2-5%. Various tools and methods have been developed to assess ADHD. This
study aims to identify ADHD from different perspectives by combining behavioral rating scales,
neuropsychological tests, and structural and functional neuroimaging with artificial intelligence
techniques.

87

Methods: The study included 676 children with ADHD and 374 typically developing controls,
aged 6-18 years old, with IQ greater than 80. Participants were assessed through psychiatricclinical interviews using the Chinese version of the Kiddie epidemiologic version of the
Schedule for Affective Disorders and Schizophrenia, behavioral rating scales,
neuropsychological tests, and MRI assessments. We used the first 18 questions of the SNAP-IV
ADHD rating scale with both parent and teacher versions to measure ADHD core symptoms.
We used the 13 tasks of the Cambridge Neuropsychological Test Automated Batteries(CANTAB) for a wide range of neuropsychological functions. We used FreeSurfer analyzing T1
brain imaging to obtain the cortical thickness of each of the 148 regions in total in the left andright hemispheres. The whole data was divided into training and testing groups using a 7:3 ratio,
and machine learning methods such as support vector machine, random forest, xgboost,LightGBM, catboost, etc., and deep learning (deep neuron network, DNN) were used forclassification and feature selection. The study was conducted in accordance with ethicalguidelines, with the approvals by the Research Ethics Committee of National Taiwan University
Hospital.
Results: A self-designed DNN model achieved an area under the curve (AUC) of 0.92 on thetesting set in the behavioral rating scale, and feature importance analysis further reduced thenumber of questions that machine learning could accurately identify ADHD. In
neuropsychological tests, using specific combinations of tests led to a better classification of
ADHD (AUC = 0.8) than using complete CANTAB test data (AUC = 0.75). In brain imaging
data, using the first 20 important regions for classification improved the testing set AUC to 0.9.
Conclusion: This study successfully used machine learning and deep learning to differentiate
ADHD from non-ADHD through behavioral rating scales, neuropsychological tests, and brain
imaging and found several important features in these three data sets to further improve theaccuracy of machine predictions.
The authors declared no conflict of interest.
S23-4
Natural Language Processing in Assisting Autism Diagnoses through the
Present Illness in Mandarin
Yueh-Ming Tai1, Chung-Yuan Cheng2, Susan Shur-Fen Gau2
1
Beitou Branch Tri-Service General Hospital, Taiwan
2
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
ABSTRACT
Background: Very few studies have used artificial intelligence to identify features of traditional
Chinese psychiatric medical records. The authors attempt to use Chinese medical records totrain a natural language processing (NLP) biphasic transformer model (BERT) to identify theirestablished psychiatry diagnoses, including autistic spectrum disorder (ASD). We thencompared their performances.
Methods: This study collected 22,355 (belonging to 13,204 cases) traditional Chinese electronic
medical records from the psychiatric emergency department of a military psychiatric centerfrom 2004 to 2019 and their diagnosis by clinicians at that time. The present illness section wasused as a corpus, and six clinical diagnoses, namely, schizophrenia (SCZ), major depressive
disorder (MDD), personality disorder (PD), adjustment disorder (ADJ), manic episode(MANIA), Substance Use Disorder (SUD) and ASD were used as the training and predicting
target diagnoses. The preprocessing and bidirectional converter model (BERT) and deeplearning model with convolutional neural network (CNN) layer were performed with thetraining set (80% of the total sample). Finally, the test set (another 20% of the total samples)
was used to test the trained models. We also compared the area under the curve (AUC) of the88receiver operating characteristic curve of diagnoses identification between different models(using the DeLong test). The institutional review board at the Tri-Service General Hospital,
National Defense Medical Center in Taipei, Taiwan, approved the study before study
implementation.
Results: After using the NLP model (BERT+CNN) to complete the training based on the
training set (n=14,824), the accuracy rate of identifying the six diagnoses in the test set(n=3,666) could reach more than 80% overall. The best performance models were the models
for SCZ and MDD. Both AUCs were above 0.95 and the sensitivity and specificity at the
optimal cut-off points were above 87%. The worst one was the model for ASD (AUC=0.604).
This distinguished inferior performance of a model of ASD might result from the relatively
lower prevalence (16%) and implicit symptoms presented in the context of history, especially in
Chinese.
Conclusion: This work demonstrated the feasibility of using deep learning artificial intelligence
technology to assist in diagnosing psychiatric disorders (e.g., schizophrenia and depression) in
the clinical setting using Traditional Chinese medical records. But, this work is not yet feasible
for some other diseases, namely ASD and personality disorders. Further fine-tuned training andadvanced algorithm for modeling are still needed.
The authors declared no conflict of interest related to this work.
Venue 4 (Room C-1)
9:10-9:50 Research Topics 7
Evidence-Based Child and Adolescent Psychiatry from Central Japan
Futoshi Suzuki1,2
1
Department of Child and Adolescent Psychiatry, Kamibayashi Memorial Hospital, Ichinomiya,Japan
2
Research Center for Child Mental Development, University of Fukui, Yoshida-gun, Japan
ABSTRACT
Aichi Prefecture is located in the center of Japan and has the highest rate of international
marriages between Japanese men and foreign women among the 47 prefectures in Japan, second
only to Gifu Prefecture, and the highest rate of foreign children in elementary schools. The
Kamibayashi Memorial Hospital, where I work, is a psychiatric hospital located on the borderof Aichi and Gifu prefectures. Children and adolescents from diverse backgrounds visit the“Aomushi” (Young Worms) outpatient clinic for child and adolescent psychiatry at this hospital.
Like most child and adolescent psychiatric outpatient clinics in Japan, Aomushi is a lowresource setting, but our staff uses questionnaires, structured interviews, and information
technology to support children, adolescents, and their parents.
This research topic begins with an introduction to my clinical practice at Aomushi, where I
work. My clinical practice is supported by the Japanese universal health insurance system,
which only allows me to see patients for short periods of time. I will use examples to illustrate
how I treat neurodevelopmental disorders, functional somatic syndrome, anxiety disorders,
depressive disorders, eating disorders, conduct disorder, and borderline personality disorder
within this context. I and Dr. Toshihiko Nagata have published two Japanese translated
psychotherapy manuals, such as interpersonal psychotherapy for depressed adolescents (IPT-A)
and family based treatment for adolescent anorexia nervosa (FBT-AN) and participated in thedissemination of evidence-supported psychotherapies. Although the validity of categorical
psychiatric diagnoses is inadequate, they remain useful and reliable tools for bringing
medication and evidence-supported psychotherapy to children and adolescents as early as
possible.
In the second half of this presentation, I will present Japanese-language questionnaires that are89

easy to assess psychopathology in a low-resource setting and a structured diagnostic interview.
The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present andLifetime version (K-SADS-PL) is the most widely used semi-structured interview for children
and adolescents. I and my colleagues translated the K-SADS-PL for DSM-5 into Japanese andvalidated it. Asian language versions of each questionnaire and K-SADS-PL are introduced
concisely for clinicians interested in international collaboration. The use of well-validated andwidely disseminated assessment tools by Japanese clinicians facilitates inter-professional
collaboration within institutions, facilitates inter-institutional collaboration and multi-center
research within Japan, and enables international collaboration. The results of such researchwould be returned to users of child and adolescent psychiatric services.
This work was supported by JSPS KAKENHI Grant Number 19K03280.
10:00-11:30 Symposium 16
The Role of Inpatient Treatment and Future Prospects
Moderator 1: Kazuya Ono (Department of Neuropsychiatry, St.Marianna University school of
medicine, Kawasaki, Japan)
Moderator 2: Tomoko Shimanouchi (Department of Neuropsychiatry, St.Marianna University
school of medicine, Kawasaki, Japan)
S16-1
Dynamics of Treating Child and Adolescent Inpatients - Inpatient Treatment at aChild and Adolescent Ward Fumio Matsuda1
1
Matsuda Hospital, Hiroshima, Japan
ABSTRACTThe treatment of children and adolescents hospitalized at a child and adolescent ward iscertainly “an ordeal and a challenge” to the staff at the Matsuda Hospital. In this presentation, I
would like to introduce our 29-year experience as well as discuss our inpatient treatment forchildren and adolescents. We started a child and adolescent ward with 18 beds at Matsuda
Hospital in May 1994 to provide inpatient treatment to children and adolescents. Matsuda
Hospital, located in Hiroshima Prefecture is a small-scale psychiatric hospital with 110 beds
opened in 1953.
When we established the child and adolescent ward, more than 40 years had passed since thefoundation of the hospital. Our long experience in treating hospitalized patients in a private
psychiatric hospital forced us to build a control-oriented environment that was quite different
from the routine in order to protect patients.
Now, we have two child and adolescent wards with 43 beds. And we practice dynamic
psychiatry. I introduce years of progress which we challenged.
Ethical information: This presentation is a non-clinical study
COI: None
S16-2
Inpatient Treatment in Japan: Current status and future directions
Takashi Nagasawa1
1
Department of Child and Adolescent Psychiatry, Tokyo Metropolitan Children's Medical
Center, Tokyo, Japan90

ABSTRACTAs of December 2022, Japanese Council of Child and Adolescent Mental Institution has 38
member institutions, and according to the Council's statistics (2020), 2,936 children per year
receive inpatient treatment in specialized wards. In Japan, however, there are many areas where
specialized wards do not exist and inpatient treatment is not available.
I would like to introduce our hospital and the current situation in Tokyo. Tokyo Metropolitan
Children's Medical Center is located in Fuchu City, Tokyo, and is a general pediatric hospitalwith 561 beds. Of these, 202 are psychiatric beds (7 wards). Compared to other specialized
institutions in Japan, it has some distinctive features. First, there are several specialized wards,
such as a school-aged children's ward where younger children are admitted, and a specialized
autism ward where children with severe behavioral disorders are treated. The hospital also
provides liaison and consultation psychiatry to children hospitalized for physical illnesses. It isalso accredited as a training institution for Board certified child mental health medical
specialists and plays a central role in Japan as a training institution for child psychiatrists. As aresult of the COVID-19 pandemic, there has been an increase in visits and hospitalizations foreating disorders. While many medical institutions in Japan provide long-term inpatient
treatment, our hospital has provided relatively short-term inpatient treatment. In the wake of thethe COVID-19 pandemic, the length of hospitalization has become even shorter.
Recently, the number of inpatient treatment institutions has been increasing in Tokyo. Our
hospital has a long history of over 70 years, followed by the opening of a child psychiatric ward
at one hospital in 2012 and the opening of several specialized wards since 2020. A network
between specialized wards was considered necessary, and a collaborative network ML between
wards started in 2022. A network has been started in which each medical institution reports thecurrent situation to each other and exchanges information.
There are many issues in child psychiatric inpatient treatment in Japan, including regional
differences. In regions where specialized wards are lacking, the expansion of specialized wards
is expected. In regions where there are multiple specialized wards, a network system thatenables smooth cooperation among them by taking advantage of their strengths should beestablished. Furthermore, there is a need to standardize and improve the quality of inpatientcare.
Ethical information: This presentation is non-clinical.
COI: None
S16-3
Inpatient treatment of children and adolescents in the general psychiatry ward
Heejeong Yoo1
1
Seoul National University College of Medicine, Seoul National Bundang Hosptal, Seoul,
Republic of Korea
ABSTRACTThe objective of this presentation is to share inpatient treatments for children and adolescents insmall general psychiatric wards, focusing on the following: 1) indications for inpatient treatment
based on diagnostic groups as well as inter-diagnostic and problem-centered perspectives, 2)
basic principles of inpatient treatments, 3) the essential elements required for inpatient care, and4) specific interventions for children and adolescents.
The inpatient unit at Seoul National University Bundang Hospital is composed of 15 closed and26 general wards. While children and adolescents are admitted with the adult population, there
is a strong necessity to implement an ecologically valid and developmentally appropriate
inpatient care strategy to ensure that they benefit from the treatments. The principles we areapplying are: 1) a multi-disciplinary approach with a team of clinical psychologists, nurses, andsocial workers, 2) maintaining daily rhythms and routines by applying daily living rules and91

schooling programs (“mini-school”), and 3) reinforcing positive, prosocial behaviors using an
individualized token system based on behavioral interventions.
The main problems admitted children and adolescents manifest are suicidal attempts, nonsuicidal self-injury, or impulsive and aggressive behavior. Therefore, the individual
psychotherapeutic approach is essential alongside crisis intervention and pharmacologicaltherapy. We implement dialectic behavior therapy tailored for individual clinical issues to thosewith mood disorders and self-injurious behaviors. Deficits in social cognition and skills often
exist as one of the underlying predispositions for maladaptive behaviors, especially with anger
management and aggressiveness. Hence, we extract basic elements using outpatient intervention
programs such as The Program for the Education and Enrichment of Relational Skills (PEERS®)
and implement them in the context of individual social skills training. These approaches will
be introduced in the presentation and discussed in the application of outpatient treatment
programs in inpatient units.
Ethical information: This presentation is non-clinical.
COI: None
S16-4
Acute child and adolescent psychiatric inpatient care in Taiwan: current status,
challenges, and child protection issues
Shu-Tsen Liu1, Shih-Kai Liu2, Iris, Chih-Tsai Chen3
1
Division of Child and Adolescent Psychiatry & Division of Developmental and Behavioral
Pediatrics, China Medical University Children’s Hospital, Taichung, Taiwan
2
Seed of Hope Clinic, Taipei City. Taiwan
3
Department of Child and Adolescent Psychiatry, Taoyuan Psychiatric Center, Ministry of
Health and Welfare, Taoyuan City, Taiwan
ABSTRACT
Currently in Taiwan, the need for acute child and adolescent psychiatric inpatient services isincreasing. The reasons for admission of children and adolescents to an acute psychiatric ward
have become diverse and complex--not just severe mental illness, but also severe behavioral oremotional concerns (e.g., suicide/self-harm attempts, aggression). A growing number of children
and adolescents involved with child protection systems due to maltreatment have severe
emotional/behavioral problems as well as multiple psychiatric diagnoses, hindering theirplacement/schooling stability and increasing their utilization of psychiatric emergency andinpatient services. Research has shown that maltreated children and adolescents in childprotection services have an increased number of psychiatric hospitalizations, longer stay, andhigher rates of involuntary admission, multiple psychotropic medications, and use of restraint
than their non-maltreated inpatient peers. Providing developmentally appropriate, traumainformed, and safe acute child and adolescent psychiatric inpatient care is important but
challenging. We need new thinking in the functions of child and adolescent psychiatrichospitalization with developing interventions to address the complicated needs of child andadolescent psychiatric inpatients.
In Taiwan, we have 290 child and adolescent psychiatrists, 158 registered acute child andadolescent psychiatric inpatient beds, and 358 child and adolescent day-care beds that include
psychiatric rehabilitation for adolescents and early intervention for preschoolers with
developmental delay. Most child and adolescent psychiatric inpatient beds in Taiwan are not in award designed to fit the needs of children and adolescents. In this presentation, I will review thecurrent resource for child and adolescent psychiatric inpatients in Taiwan, the need for staff
training to avoid inappropriate use of restraint and psychotropic medications with theunderlying concepts that they need to rely on such strategies to manage “misbehaviors” of childand adolescent inpatients, and the emerging child protection issues in acute psychiatric wards

92

(e.g., being sexually abused by other psychiatric inpatients). Finally, I will explore somepromising attempts in Taiwan and the future directions: how we could transform and expand thefunctions of settings to provide psychiatric care that addresses mental health and childprotection issues, such as the ongoing residency programs for youths in foster care with severe
mental health issues; how we can empower child and adolescent psychiatric inpatients with theskills to handle their emotions; how we could collaborate with parents, schools, and foster-caresystems to prepare a better future for child and adolescent patients after they leave acute
psychiatric wards.
We don’t have conflicts to disclose. This presentation is non-clinical.
12:50-13:30 Research Topics 12
Humanoid robot intervention for individuals with autism spectrum disorders
Hirokazu Kumazaki1
1
Department of Future Psychiatric Medicine, Graduate school of Biomedical Sciences, Nagasaki
University, Nagasaki, Japan
ABSTRACT
Autism spectrum disorders (ASD) is a developmental disability that leads to significant social,communication, and behavioral challenges. Individuals with ASD face lifelong challenges.
Therapeutic and educational approaches benefit only a small percent of individuals with ASD.
The latest progress of humanoid robotics is remarkable. With rapid advances in technology,
humanoid robots are being designed to function in a variety of ways. As increasing anecdotal
evidence suggests, robots may offer many unique opportunities for helping individuals with
ASD. Individuals with ASD often achieve a higher degree of task engagement through theinteraction with robots than through the interactions with human trainees. The type and form ofrobots to be used for such interactions have been meticulously considered. Simple robots andanimal robots are acceptable because of their simplicity and the ease of interesting and engaging
interactions. Android robots have the benefit of the potential of generalization into daily life tosome extent. Considering the affinity between robots and users is important to draw out the
maximum potential of robotic interventions. Factors such as the appearance, biological motion,
clothes, hairstyle, and disposition of robots are important. Many factors of a user such as age,sex, and intelligence quotient may also affect their affinity toward the robot. The potential endusers of this technology are unaware or unconvinced of the potential roles robots could play inautism spectrum disorder interventions. If trainers have extensive experience in using robots,
they can identify many potential roles of robots based on their experience. To date, only a few
studies have been conducted in the field of robotics for providing assistance to individuals with
ASD, and further studies are needed to realize an optimal robot for this purpose. In this lecture,
I am going to provide a review of the current status of humanoid robot intervention for
individuals with ASD.
13:40-15:10 Symposium 20
Various issues in clinical practice associated with neurodevelopmental disorders
Moderator 1: Hideki Negoro (Shigisan Hospital, Heartland Shigisan, Ikoma-gun, Japan)
Moderator 2: Toyosaku Ota (Department of Human Development, Nara Medical University,
Kashihara, Japan)
S20-1
Suicidal behavior of individuals with autism spectrum disorder in adolescence
Yuichi Onishi1, Keitaro Kimoto1, Katsunaka Mikami1

93

1

Department of Psychiatry, Tokai University School of Medicine, Isehara, Japan

ABSTRACT
Neurodevelopmental disorders associated with suicidal behavior (suicide ideation, suicide
attempts, and suicide deaths) are autism spectrum disorder (ASD) and attentiondeficit/hyperactivity disorder (ADHD). In contrast to suicide research on individuals with
ADHD, which has been accumulating since the 1980s, individuals with ASD have been thesubject of suicide research since 2000. Observational studies of suicidal behavior in individuals
with ASD have accumulated remarkably in recent years, and their clinical features are becoming
increasingly clear. A recent systematic review of children, adolescents, and adults found asignificant association between individuals with ASD and suicidal behavior across all age
groups. In a systematic review focused on young people aged 25 years or younger, the incidenceof suicidal ideation in individuals with ASD was 25%, that of suicide attempts was 8%, and thatof completed suicide was less than 1%. While the rate of suicide attempts decreases with age
and age is a protective factor in the general population, the higher risk of suicide attempts acrossage groups remains the same for individuals with ASD from childhood to age 25. In addition,compared with young people in the general population, adolescents with ASD are thought tohave a higher frequency of suicidal ideation and suicide attempts. Therefore, clinicians treating
adolescents with ASD should always be aware of the risk of suicide attempts. The presentation
at this symposium will review suicidal behaviors in youth with ASD.
The content of the presentation is a review of previous research reports, so no particular ethicalconsiderations are required.
Funding: This presentation has no financial support to disclose.
Conflicts of Interests (over the three years): Yuichi Onishi has received honoraria from Takeda
Pharmaceutical Co., Ltd. Keitaro Kimoto has received financial support and honoraria from
Otsuka Pharmaceutical Co., Ltd., and Shionogi & Co., Ltd.; honoraria from Sumitomo
Dainippon Pharma Co., Ltd., Takeda Pharma Co., Ltd, and Viatris Inc. Katsunaka Mikami has
received a Grant-in-Aid for Scientific Research (C) (Number 22K07624) and financial support
from Otsuka Pharmaceutical Co., Ltd., and Shionogi & Co., Ltd.; honoraria from Miyarisan
Pharmaceutical Co., Otsuka Pharmaceutical Co., Ltd., Shionogi & Co., Ltd., Sumitomo PharmaCo., Ltd., and Takeda Pharmaceutical Co., Ltd.; and a consulting fee from Otsuka
Pharmaceutical Co., Ltd., Shionogi & Co., Ltd., and Viatris.
S20-2
Neurodevelopmental disorders in School Refusal Behavior
Hiroki Matsuura1
1
Department of neuropsychiatry, Wakayama Medical University, Wakayama, Japan
ABSTRACT
School refusal behavior（SRB）is defined as child-motivated refusal to attend school and/or
difficulties remaining in class for an entire day. Approximately 28–35% of children have everrefused to attend school, with estimates up to 53% in autism spectrum disorder (ASD). Children
with ASD or attention-deficit/hyperactivity disorder (ADHD) are at particular risk for school
absenteeism, extended disengagement, and dropout. Kurita et al reported that SRB issignificantly more common in students with ASD compared with typically developing students.
In Japan, Suzuki reported that 36% was diagnosed as pervasive developmental disorder (PDD),
7% was diagnosed as ADHD, 9% was diagnosed as PDD+ADHD among children who absent
from school more than 30days. At a glance, children in SRB seems to be healthy in home, butthey are struggling and their health-related Quality of Life (HRQOL) is lower than we thought.
Our research group researched the HRQOL in SRB. A total of 175 young people (aged 8–18
years old) who visited our medical centers and outpatient clinics participated in the study. This

94

comprised the SRB group (n = 70) and an age- and sex-matched control group (n = 105).
Information about any psychiatric diagnosis was collected from medical records, HRQOL wasmeasured using the J-KIDSCREEN-52, SRB was assessed using the School Refusal Assessment
Scale-Revised for Japanese Attendance at School, self-esteem was measured using the
Rosenberg Self-Esteem Scale, children’s mental health status was measured using the Strengths
and Difficulties Questionnaire. We performed between-group comparisons and multiple
regression analysis. The SRB had a significantly lower HRQOL than the control group inseveral of the J-KIDSCREEN-52 dimensions. In the SRB group, 35.7% had chronic disease and35.7% of their parents had health problems and were receiving treatment. The multiple
regression analysis revealed that, within the SRB group, a psychiatric diagnosis was associatedwith a lower HRQOL. However, this was not the case for a diagnosis of ASD. Self-esteem
positively affected HRQOL in six dimensions of the J-KIDSCREEN-52 within the SRB group.
Consequently, our research indicated that the support enhancing self-esteem could be used toincrease HRQOL in young people with SRB. Previous study suggested that in support ofneurodevelopmental disorders, developing self-esteem is important. Developing self-esteem isuseful for SRB with neurodevelopmental disorders also.
Our study was approved by the Institutional Review Board at the Nara Medical University andNara Prefecture General Medical Center.
The author reports no conflicts of interest in this work.
S20-3
Neurodevelopmental Disorders and Maltreatments
Kosuke Okazaki1
1
Department of Psychiatry, Nara Medical University, Kashihara, Japan
ABSTRACTThe neurodevelopmental disorders, e.g., autism spectrum disorder (ASD) and attentiondeficit/hyperactivity disorder, are a group of conditions with onset in the developmental period.
Neurodevelopmental disorders are characterized by core symptoms such as impairments insocial and communicative functions, the presence of restricted interests and repetitive behavior,inattention, hyperactivity, and impulsivity. Children with neurodevelopmental disorders may be
more vulnerable to experiencing trauma because of their difficulties with social interaction,communication, or regulation of emotions. They may also be more likely to have difficulty
recognizing and coping with traumatic events.
Maltreatment, which includes physical, sexual, and emotional maltreatment, as well as neglect,
can have a particularly negative impact on children with neurodevelopmental disorders. These
children may be more likely to experience maltreatment, and the consequences of maltreatment
can be more severe for them. Maltreatment can lead to a range of negative outcomes, including
an increased risk of developing additional mental health problems, such as anxiety, depression,and post-traumatic stress disorder.
Furthermore, it is known that children raised in a neglect-like environment for an extended
period during childhood are more likely to exhibit symptoms similar to neurodevelopmental
disorders, such as ASD-like symptoms, disinhibited interpersonal interactions, inattentive
symptoms, and hyperactivity symptoms. Previous studies have reported that traumatic
experiences such as maltreatment affect brain function in children with and without
neurodevelopmental disorders, and they negatively impact adulthood. Okazaki et al. (2020)
reported that the experience of childhood maltreatment could affect brain function in patientswith an ASD in adulthood, and preventing the experience of maltreatment in children withneurodevelopmental disorders is an urgent issue. On the other hand, children withneurodevelopmental disorders may have difficulty communicating their experiences ofmaltreatment to others due to communication problems. In addition, it is difficult to distinguish95

symptoms of neurodevelopmental disorders from those caused by maltreatment, which may
delay support for the maltreatment of children with neurodevelopmental disorders. Therefore, it
is important for caregivers and mental health professionals to be aware of the relationshipbetween neurodevelopmental disorders and trauma, and to provide appropriate support andinterventions for children who have experienced maltreatment.
Our research in this presentation was approved by the Institutional Review Board of Nara
Medical University. The author has no financial conflicts of interest disclose concerning thepresentation.
S20-4
Relationship between neurodevelopmental disorders and psychosomatic
disorders
Masaki Taguchi1
1
Department of Pediatrics, Nara Prefectural Seiwa Medical Center, Ikoma-gun, Japan
ABSTRACT
Psychosomatic disorders are defined as physical diseases in which psychological and social
factors have a significant influence on the onset and course of the disease. I work in thepediatric department of a general hospital and have experienced that patients with characteristicsof neurodevelopmental disorders, especially ASD, are prone to develop psychosomatic
disorders and are difficult to treat. I consider the risk factors for psychosomatic disorders to be
the intensity of stress and the vulnerability of the patient. I also consider the protective factors of
psychosomatic disorders to be the supportive environment and the resilience of the patient. In
terms of risk and protective factors, I would like to lay out why patients withneurodevelopmental disorders are at high risk for developing psychosomatic disorders. Patientswith neurodevelopmental disorders also tend to have irregular lifestyles, which can also
exacerbate psychosomatic disorders. Therefore, it is more important to provide lifestyle
guidance that includes parents. In Japan, psychosomatic disorders are more often seen bypediatricians than by child psychiatrists because of their physical symptoms. However,pediatricians without systematic training in psychosomatic disorders often struggle to treat
them. Therefore, appropriate interventions may not be made and symptoms may worsen or
secondary psychiatric disorders may develop. Undiagnosed neurodevelopmental disorders areoften suspected in the wake of psychosomatic disorders. We need to be more aware of therelationship between neurodevelopmental disorders and psychosomatic disorders.
In this presentation, care has been taken to ensure that patients are not identified.
The auther have no COI to disclose.
15:20-16:50 Symposium 24
Mental Health of Children and Youth In Malaysia and Indonesia: The Experiences andInterventions During the Pandemic and Post-pandemic Times
Moderator 1: Ruziana Masiran (Universiti Putra Malaysia & Hospital Pengajar Universiti Putra
Malaysia, Serdang, Malaysia)
Moderator 2: Suzy Yusna Dewi (University of Pembangunan Nasional Veteran Jakarta &Soeharto Heerdjan Mental Hospital, Jakarta, Indonesia)
S24-1
Perception of Students in the Transitional Phase of Distance Learning during thePandemic In Java, Indonesia

96Suzy Yusna Dewi1,2
1Faculty of Medicine, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, Indonesia
2
Soeharto Heerdjan Mental Health Hospital, West Jakarta, Jakarta, Indonesia
ABSTRACTDuring the pandemic, new policies have been implemented to minimize the spread of Covid-19.
One of them is to temporarily stop all activities of educational institutions. Distance learning is
an alternative presented by the government so that the teaching and learning process continues
Distance learning methods have both positive and negative impacts. This study aims to look atstudents' perceptions of distance learning during the COVID-19 pandemic. This research is anobservational descriptive study using a cross-sectional method with 384 freshmen college
student respondents on the Island of Java. Ethical approval (KH.03.02/2.4/6115/2022) was
received from Soeharto Heerdjan Mental Hospital. The results obtained are students' perceptionsof their difficulties communicating with lecturers while undergoing distance learning, thedifficulty of understanding material, experiencing boredom, experiencing interpersonalcommunication problems, being disturbed by the home environment when learning from a
distance, worrying about academic education being late, experiencing changes in routine,
miscommunication between lecturers and students often occurs, students feel that they open
social media more often, and students feel that they have not experienced an increase in
expenses during distance learning. From the results of this study, it is hoped that there will be anevaluation of more effective learning methods for the transitional period as well as input forpolicymakers.
I certify that there is no actual or potential conflict of interest in connection with thispresentation.
S24-2
Transferability of a Foreign Evidence-Based Parenting Program to the Malaysian
Population During the Pandemic
Ruziana Masiran1,2, Normala Ibrahim1,2, Hamidin Awang1,2, Lim Poh Ying3
1
Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia,
Serdang, Selangor, Malaysia
2
Department of Psychiatry, Hospital Pengajar Universiti Putra Malaysia, Serdang, Selangor,
Malaysia3
Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra
Malaysia, Serdang, Malaysia
ABSTRACTIntroduction: Despite the clear role of parenting programs in managing behavior problems inchildren, their implementation in countries with limited resources has been challenging.
Furthermore, programs from foreign countries may not be suitable for local parents. This study
examined whether the Incredible Years School Age Basic parenting program (IYSAB) program
was transferrable, and hence effective to improve children’s behavior problems and parenting
stress, for Malaysian population. Methods: Mothers of 70 six to twelve-year-old children
diagnosed with behavioural problems in the pediatrics and child and adolescent psychiatry
clinics in Klang Valley, Malaysia participated in the study and were randomly assigned to either
IYSAB or wait-list control groups. The severity of children’s behavior problems and levels of
parenting stress were parent-rated using self-administered questionnaires. The IYSAB program
was conducted weekly for 14 weeks with a few modifications to meet the public health control
requirement during the pandemic. The generalized estimating equation was used to analyze thedata. Ethical approval was granted by the Research Ethics Committee of Universiti Putra
Malaysia (JKEUPM-2021-163) and the Medical Research and Ethics Committee (MREC),

97

Ministry of Health Malaysia (NMRR-19-107-45772). Results: Children of mothers in the
IYSAB group significantly improved their behaviors as compared to those in the control groupat baseline, at two weeks (B = -4.20, 95 % CI: −6.68, −1.72, p = 0.001) and 12 weeks postprogram completion(B = -3.51, 95 % CI:-6.37, −0.66, p = 0.016). Mothers who participated in
the IYSAB experienced significantly lowered parenting stress only 12 weeks after the program
ended (B = -5.03, 95 % CI: 9.16, −0.90, p = 0.017). The IYSAB was well-accepted by theparticipants. Conclusion: A modified, established foreign parenting program was transferrable
and acceptable to the local Malaysian population. However, the impact of COVID-instigatedpsychological distress may play a role in the study outcomes.
I certify that there is no actual or potential conflict of interest in connection with thispresentation.
S24-3
Effect of online distance learning in the COVID era on adolescent emotional
dysregulation : A case report
Lina Budiyanti11West Java Mental Hospital Bandung, Bandung, Indonesia
ABSTRACTIntroduction: To prevent the spread of COVID-19 during the pandemic, the Indonesian
government adopted a policy to carry out online distance learning for students from theelementary to tertiary levels. In addition to the various benefits that can be drawn from thisdistance learning policy, negative impacts were often found in daily clinical practice. Emotional
dysregulation disorder is commonly found among children and adolescents as an indirect resultof distance learning. Method: This is a case report of an inpatient in a mental hospital in WestJava province in Indonesia. Informed consent was provided by patient’s parents. Result: A 15
year-old teenage girl was diagnosed with emotional dysregulation disorder after experiencing
online distance learning. To abide by the distance learning, she was given leeway by her parents
to access the internet for learning. However, as time went by, the time spent accessing theinternet became longer, and parents could no longer limit it. Since then the patient rarelyinteracted with friends or other people around her and became very emotionally sensitive. If her
wishes were not fulfilled, she would get angry, behave rudely and break things at home. She
often skipped school and even threatened to hurt herself whenever she felt angry or
disappointed. She then received psychopharmacotherapy and family counselling to improveparenting. Conclusion: Online distance learning during the COVID-19 pandemic has
undoubtedly increased the access to internet use. In children with particular vulnerabilities,
online distance learning is related to the occurrence of emotional dysregulation problems.
I certify that there is no actual or potential conflict of interest in connection with thispresentation.
S24-4
Impact of Pandemic COVID-19 on the Referral Patterns for Child and Adolescent
Mental Health Service in Selangor, Malaysia
Rahima Dahlan1,2, Chern Choong Thum2, Tan Kit Aun1,2, Ruziana Masiran1,2, Ahmad Azwal
Rusidi2
1
Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia,
Serdang, Selangor, Malaysia
2
Department of Psychiatry, Hospital Pengajar Universiti Putra Malaysia, Serdang, Selangor,

98

Malaysia
ABSTRACTThe 2019 global coronavirus pandemic (COVID -19) has entered its third wave. Government
restrictions continue, with unknown physical and mental health consequences. The pandemic
has changed the clinical picture and the number of clinical referrals of children and adolescentswith mental health problems and has impacted care in Malaysia. This presentation examines
how and why referrals to the Child and Adolescent Mental Health Service (CAMHS) at
Hospital Pengajar Universiti Putra Malaysia, Selangor, Malaysia, changed during the pandemic.
Data on referrals and hospitalizations to CAMHS were collected retrospectively from electronic
records for both the year 2020 and the subsequent year 2022. Because this was an observational
study, informed consent was not required. Referrals to CAMHS increased steadily over themonths following a brief decline in 2020. The possible reasons for these observations are
discussed.
I certify that there is no actual or potential conflict of interest in connection with thispresentation.
Venue 5 (Room C-2)
9:10-9:50 Research Topics 8
Effectiveness of mental health education for school teachers in Japan
Junichi Fujita1
1
Department of child psychiatry, Yokohama city university hospital, Yokohama, Japan
ABSTRACT
Background: Young people with mental disorders, many are less likely to seek help, and mostgo untreated. Psychiatric illness in Asian society has been stigmatized, which can be a barrier tomedical or social support. Recently, various efforts to reduce stigmatization have been
implemented, such as mental health education for students in schools. However, Japaneseteachers still have insufficient knowledge of mental health.
Method: In response to social needs, we have conducted meetings called “The Association for
Cooperation between Medicine and Education (AC-ME) Project” two or three times annuallyfrom 2016 to 2018 in Yokohama City University to consider collaboration between medicine
and education, with the aim of providing mental health education programs to teachers. In linewith the mental health needs of the schools identified during the meeting, we developed mental
health education programs for teachers in four areas: self-injury/suicide, behavioral problems
with developmental disabilities, school absenteeism, and violence. We conducted study aimed toevaluate the effectiveness of a mental health educational program for high-school teachers to
improve knowledge of students’ mental health.
Results: The acceptability of the program was favorable. The analysis revealed improvement inmental health knowledge. Especially, knowledge improvement about suicidal behaviors
continued after 1 year.
Conclusion: The results indicated that the program may improve educators’ knowledge after
intervention especially concerning suicidal behaviors. Based on this result, we are currently
implementing an educational program for junior high and high school teachers in Japan that
focuses on suicide prevention.
We report that there are no potential conflicts of interests related to this study.

99

10:00-11:30 Symposium 17
The impact of threats on child and adolescent mental health: Covid-19 pandemic,
natural disasters, and Ukraine war
Moderator 1: Hitoshi Kaneko (Nagoya University, Japan)
Moderator 2: Andre Sourander (University of Turku, Finland)
S17-1
Mental health of adolescents after Russian invasion of southeastern Ukraine in2014
Sanju Silwal1,2, Andre Sourander1,2,3, Olga Osokina4,5, Tatiana Bohdanova4, Matthew Hodes6,
Norbert Skokauskas7
1
Research Centre for Child Psychiatry, University of Turku, Turku, Finland
2
INVEST Research Flagship Center, University of Turku, Turku, Finland
3
Turku University Hospital, Turku, Finland
4
Donetsk National Medical University, Kramatorsk, Ukraine
5
Kyiv Medical University, Kyiv, Ukraine
6
Imperial College London, United Kingdom
7
Regional Centre for Child and Youth Mental Health and Child Welfare, IPH, Norwegian
University of Science and Technology, Trondheim, Norway
ABSTRACT
Very limited evidence is available on the psychological impact of Ukraine war on adolescents.
We aimed to compare war experiences, mental health, suicidality and self-harm of adolescentsliving in war-torn, Donetsk region and peaceful Kirovograd region, more than 2 years after
Russia first invaded Ukraine in 2014. This is a cross-sectional study including 2,766 students
from age range 11-17 years. The data was collected from September 2016 to January 2017. Selfreported tools were used to measure post-traumatic stress disorder (PTSD), depression, anxiety,suicidality and self-harm. Binary and multinomial logistic regression models were used to
examine the association between mental health outcomes and regions. Odds ratios (OR) wereused to estimate the strength of the associations and 95% conﬁdence intervals (CI) were
calculated. P values of <0.05 were considered statistically significant. War trauma, daily stressand suicidality were higher in adolescents in the Donetsk region. They reported significantly
increased risks for PTSD (OR 4.11, 95% CI 2.37-7.13), moderately severe/severe depression(OR 2.65, 95% CI 1.79-3.92) and severe anxiety (OR 3.10, 95% CI 1.83-5.27). Adolescents inthe Donetsk region had three-fold increased risk for suicidal ideation only, OR 2.92 (95% CI
2.23-3.82), about two-fold increased risk for suicidal ideation and self-harm, OR 1.71 (95% CI
1.21-2.40) and two-fold increased risk for suicidal attempts, OR 2.11 (95% CI 1.48-3.00).
Exposure to high number of war events increased the risk of suicidal ideation, 1-2 war events,(OR 1.96, 95% CI 1.42-2.71) and 3 war events, (OR 2.03, 95% CI 1.43-2.88). Traumatic
events were strongly associated with psychological distress and suicidality in adolescents living
in a war-torn region. These findings provided insight on the psychological impact of war in acountry which is experiencing Russian invasion since February 2022. The study can help toestimate and address the long-term impact of the current war on adolescent’s mental health andwell-being. Ethical approval was obtained from the Ethical Committee for Medical Research
Ethics of Donetsk National Medical University. Informed consent was obtained from parents
and adolescents. The participants were told that their participation is voluntary, anonymity of
responses and possibility for psychological consultation for adolescents in need.
The authors declare no conflict of interest.
S17-2
Impact of the COVID-19 Pandemic on Middle School Students of Local Cities in100

JapanMasayoshi Ogura1
1
Naruto University of Education, Naruto, Japan
ABSTRACTThe COVID-19 pandemic and the ensuing social restrictions caused major disruptions in the
lives of children and adolescents. In Japan, all elementary, junior high, and senior high schools
were temporarily closed from March 2, 2020, and face-to-face classes did not commence until
the end of May of the same year in the areas facing severe infection situations. After the
resumption of face-to-face classes, schools shortened the summer vacation and canceled or
reduced events such as athletic meets and field trips to compensate for the loss of learning
during the school closures. However, certain aspects of school life cannot be said to have beenreturned to normal as yet, such as the continued wearing of masks and the continued restrictionof some activities. Another major change during the same period was the promotion ofInformation and Communication Technology (ICT) in schools under the policy of the GIGA
(Global and Innovation Gateway for All) school concept. These changes are thought to have hada significant impact on children's mental health.
The Ministry of Education, Culture, Sports, Science and Technology (MEXT) conducts anannual survey on various issues regarding student guidance for children, and the increase inschool non-attendance has drawn particular attention. Specifically, the number of elementaryand junior high school students in a state of non-attendance was 17,688 in FY2020, but itreached 21,536 in FY2021, a record high. However, as the number has been increasing for the
past nine years, the school life changes due to the COVID-19 pandemic cannot be attributed to afactor in truancy, but from my perspective, I have had the impression of them being related inno small degree.
In this presentation, we provide the results of 1) a review of studies on the impact of the
COVID-19 pandemic on children's mental health in Japan, and 2) our analysis of changes over a
10-year period by comparing a survey of eighth graders conducted by the authors across local
cities in Japan in 2011 with a survey of eighth graders and their teachers conducted in 2023 in
the same schools as in 2011. We then discuss our findings regarding the impact of the COVID19 pandemic on junior high school students in Japan.
The authors have obtained approval from the Research Ethics Committee of the Graduate
School of Education and Development, Nagoya University, for the surveys conducted in 2011
and 2023. There is no COI to disclose.
S17-3
Screen time and its associated mental health problems among adolescents: A
pre- and peri-COVID-19 pandemic comparative study in Indonesia
Tjhin Wiguna1, Belinda Julivia Murtani1, Gina Anindyajati1, Fransiska Kaligis1, Raden Irawati
Ismail1, Kusuma Minayati1, Enjeline Hanafi1, Kanya Paramastri2
1
Department of Psychiatry, Faculty of Medicine Universitas Indonesia – dr. Cipto
Mangunkusumo General Hospital, Jakarta, Indonesia
2
Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
ABSTRACT
Objective: Screen time is defined as the time spent engaging with visual screen-based
technologies such as televisions, computers/laptops, videogames, smart phones, tablets/iPads,
and handheld electronic or gaming devices with the exception of auditory activities such as
talking on the phone or listening to music. The rapid outbreak of COVID-19 has led tosignificant changes in daily life due to social distancing and stay-at-home policies, which have101

affected adolescents’ routines. As they are asked to study from home through online learningand stay at home, they have much less contact with their peers Consequently, the COVID-19
pandemic is assumed to have critically influenced adolescents’ mental well-being, especiallyregarding the increase in screen time. Hence, this study aimed to identify whether there wereany differences between pre- and peri-COVID-19 pandemic screen time among adolescents, andthe mental health problems that associated with the usage of screen time.
Method: This cross-sectional study compared the pre- and peri-COVID-19 pandemic screen
time, emotional, conduct, and prosocial problems of adolescents in Indonesia. This study waspart of a community mental health survey during COVID-19 pandemic in Indonesia. Both preand peri-COVID-19 pandemic data were collected using a crowdsourcing method that is widely
applied these days because of the proliferation of the Internet. Target participants wereadolescents aged 11-17 years old and having secondary- or senior-high school background. The
pre-COVID-19 pandemic data were collected from June to August 2018. During this period,
there were 447 participants who participated in the study; however, only 290 completed thesurvey to meet the study criteria, and were included in the analysis. The peri-COVID-19
pandemic data were collected from August 21 to October 10, 2020; during this period, there
were 743 participants that filled out the online questionnaire, but only 390 data fully matchedwith the pre-COVID-19 pandemic data and were included in the analysis. Modified YouthScreen Time Survey and Strength and Difficulties Questionnaire were used to measure screen
time and mental health problems. Data was analysed by using SPSS version 21 for Mac. The
protocol of this study has been approved by the Ethic Committee was approved by theIndonesian Ethic Committee of the Faculty of Medicine Universitas on April 2020.
Results: The proportion of adolescents that watched television for more than 4 hours was higher
during COVID-19 pandemic (28.1% vs.19.9%, p>0.05). A similar finding was found in personal
computer use (37.9% vs. 23%, p<0.05). Total screen time during COVID-19 among adolescentswas dominated in the ≥ 10 hours in both groups (63.9% vs. 51.4%, p<0.05). The total average
screen time per day among adolescents in the peri-COVID-19 pandemic study was higher
compared to the pre-COVID-19 pandemic study [832.95(623.585) vs. 808.57(675.83), p>0.05].
Adolescents used higher screen time for television and personal computer during COVID-19
pandemic. Television screen time ≥10 hours were potential risk for having conduct problem(OR=8.58, 95% Cl=2.90 – 25.42). Using personal computer for more than 10 hours also
increased risk for having emotional problem (OR=4.28, 95% CI=1.44 – 12.73).
Conclusion: This study found that screen time during peri-COVID-19 pandemic increased andpossibly being risks for having mental health problems among adolescents. Community mental
health promotion and prevention towards adolescent health and mental wellbeing related toscreen time should be re-arranged systematically during COVID-19 pandemic.
Declaration: The authors did not have any conflict of interest of this presentation
S17-4
COVID-19 Pandemic Effects on Singapore Children and Adolescents: What local
studies tell us?
Say How Ong1
1
Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
ABSTRACTThe COVID-19 pandemic is known to have an universal negative impact on child andadolescent mental health and wellbeing, with reported increased rates of anxiety, depression andemergency room visits for self-harm behaviours, amongst other mental disorders. Several
studies have also attempted to study the mechanisms and risk factors that caused theseobservations. Two local studies conducted in Singapore children and adolescents are discussed.
Confinement measures such as lockdowns, have led to the closure of schools and consequent102

disruptions to school and social routines. Loneliness, uncertainty about the future and stressfrom social isolation during this period can increase levels of depression and anxiety amongchildren and adolescents.
Results from one study showed that the increase in children’s mental health problems from prepandemic to pre-lockdown was partially explained by a decrease in time spent outdoors, anincrease in their conflict with fathers, and an increase in their mothers’ mental health problems,with the last factor being the only significant mediator when all three factors were consideredsimultaneously.
In another qualitative study, adolescents reported more academic-related than social-related
stress. Benefits and challenges of home-based remote learning were experienced acrossstudents. The students coped with stress during the pandemic through disengagement (fromproblems), taking active steps (to problem-solve and de-stress) and turning to others (for help).
As multiple personal and familial factors may undermine mental wellbeing of children andadolescents, mental health of adult caregivers and academic-related stress could be especiallysignificant during the pandemic and should be considered as areas of focus in family and schoolsupport services.
Disclosure: I have no competing personal or financial conflict of interest.
12:50-13:30 Research Topics 13
The Importance of International Interactions: Why and How We Should
Participate
Takahiko Inagaki1,2
1Adolescent Mental Health Service, Biwako Hospital, Otsu, Japan2
Department of Psychiatry, Shiga University of Medical Science, Otsu, Japan
ABSTRACT
Non-native English speakers face difficulties while engaging in international interactions
because of language barriers.
For example, most Japanese mental health professionals have limited opportunities to speak
English during their daily lives or clinical and research activities. Most psychiatrists can read
and write English but cannot competently speak the language. Many Japanese psychiatricpractitioners register for the IACAPAP and WPA congresses. However, visitors to such seminars
rarely observe Japanese professionals conversing with their international counterparts; instead,they tend to interact with other Japanese speakers. The Japanese participants’ lack of significant
engagement at international symposia is worrisome.
Special incentives and methodologies are required to mitigate hesitation resulting from language
barriers. In this lecture, I would like to share my motivations for international exchanges and themethodology used to attain my inspiration.
1: Why Do I Participate in International Interactions?
My first international interaction occurred on a visit to England. Excellent guidelines exist in
many countries around the world, including Japan. However, compliance with the guidelines is
extremely low in Japan. I was eager to find out what would transpire with superior complianceas the prevailing circumstances cannot improve without understanding the desired ideal.
2: How Do I Engage in International Interactions?
2-1. English Skills
Despite taking English lessons before departing for England, my knowledge of the language
was inadequate. To overcome language barriers, one must unhesitatingly and repeatedly ask
questions to grasp what is said and restate what one has apprehended until it is understood by
the other party.
2-2. Communicate with People from Other Nations in Connection with the CongressFirst, one should make friends and be respectful to others while communicating. Conversation

103

can be initiated by asking questions about the person’s presentation. One should also exchange
name cards after the lecture and send an email that evening.
Next, a symposium can be organized as scholarly conventions request research-based
information and reviews of known findings.
Finally, one should consider it an honor and accept requests to collaborate with international
projects.
3. The Outcomes of My International Interactions
I enact several roles in the IACAPAP. I chair a project to translate a textbook into Japanese,
where I serve as an associate editor of version 1.0 and an editorial board member of version 2.0.
I also chair the child and adolescent mental health services network in my region. I use theexperience from international interchanges to run and improve the network.
13:40-15:10 Symposium 21
Informed consent and related ethical issues in childhood and adolescence
Moderator 1: Kiwamu Tanaka (Hyogo Mental Health Center, Kobe, Japan)
Moderator 2: Kazumasa Kimura (Medical corporation Shinshinkai Tama-Aoba Hospital,
Higashimurayama, Japan)
S21-1
Title Informed consent/assent in childhood and adolescence and issues related
to parental authority in Japan
Kazumasa Kimura1
1
Medical corporation Shinshinkai Tama-Aoba Hospital, Higashimurayama, Japan
ABSTRACTIn recent years, the JSCAP ethics committee has considered the issues of informed consent andassent in child and adolescent psychiatry. We conducted a questionnaire study in 2016 to
identify the age from which a child is able to think critically and found that those aged 13 to 15
years are able to provide consent at approximately the same level as adolescents aged 16 to 20
years. Conflict arises when a competent child or adolescent agrees to a medical procedure whena person with parental authority disagrees. The government has stated with respect to parental
authority since medieval times. This culture affects the modern Civil Code and its present
iteration. When disagreement arises between a competent minor and a person with parental
authority, the issue is not brought before a court as it is Europe and North America. To act on thedecision of a competent minor without respecting parental authority is not a simple matter.
However, in the revised Civil Code, a person with parental authority must seek a benefit for thechild. Japanese culture should absorb the concept of consent “being in the best interests” ofchildren and adolescents.
Ethical consideration: Regarding the questionnaire study in 2016, ethics approval by The ethics
committee of Tokyo Metropolitan Children’s Medical Center
COI: No conflicts of interest to disclose.
S21-2
The Law Related to Mental Health and Welfare of the Person with Mental Disorderand Child’s Rights in Japan
Junichiro Ota1
1
Mental Health and Welfare Center of Okayama-City, Okayama, Japan
ABSTRACTThe Law Related to the Mental Health and Welfare of Persons with a Mental Disorder104

(LMHW) basically does not distinguish between adults and children. This law was establishedin terms of the due process of the law regarding involuntary hospitalization. Therefore,
corresponding ages are required. Involuntary hospitalization with the agreement of one family
member peculiar to Japan in the LMHW should be abolished. It should be specified in the lawthat only the national or local government can decide on involuntary hospitalization. The rightof self-determination by children who are capable of providing consent for treatment should bespecified in the law. In cases in which a child judged as being incapable of providing consent is
to be involuntarily hospitalized, informed consent should still be sought from the child. Properand careful explanations and the development of a support system should be required tofacilitate a child’s expression of their own opinions. The roles of an advocate including a personwith parental authority for the rights of the child must be clarified.
Ethical consideration: This research is non-clinical research that does not require ethics
approval.
COI: No conflicts of interest to disclose.
S21-3
Informed Consent in Psychiatric Care of Minority in Taiwan: Issues andChallenges
Iris, Chih-Tsai Chen1
1
Department of Child and Adolescent Psychiatry, Taoyuan Psychiatric Center, Ministry of
Health and Welfare, Taoyuan City, Taiwan
ABSTRACTOn January 6, 2019, the “Patient Right to Autonomy Act” was formally implemented in Taiwan,
it is Asia’s first specialized legislation that offers complete protection of the patient’s right toautonomy. With increasing awareness of patient rights and autonomy, informed consent inpsychiatric care of minority in Taiwan became a further challenge to medical professionals,
especially the child psychiatrists. Issues such as “Who is to make decision? Patients, parents or
the professionals?”; “Is the child/adolescent with mental illness competent in decision making”?
or “What is the best-interest judgment for the client?” are more frequently encountered in ourdaily practices.
A survey of practitioners’ perspectives on informed consent of psychiatric treatments andinterventions in clinical practices for minority in Taiwan was performed. Most childpsychiatrists acknowledge the importance of informed consent to child and adolescent patientsin the treatments and interventions of child psychiatric diseases and with the opinions that age is
not the only consideration. 57.1% of them believed that the medical autonomy could be carriedout regardless of age, as long as the minorities are “competent”. The issues will be discussed
further based on extensive literature review and clinical experiences in Taiwan.
Ethical consideration: Regarding the survey, it is the anonymous online survey under ethicalconsiderations.
COI: No conflicts of interest to disclose.
S21-4
Informed Consent: Gender Dysphoria and the Mature Minor in Australian Law
Stephen Koder1
1South Eastern Sydney Local Health District, Sydney, Australia
ABSTRACTDr Koder is a child and adolescent psychiatrist based in Sydney, Australia. He works in public

105

community outpatient teams in the eastern suburbs of Sydney and has a subspeciality expertisein the assessment and management of gender incongruence and dysphoria in children and youth.
Because of the small numbers of child psychiatrists in this field, he sees patients and families
from all over Sydney and sometimes further afield.
His talk will give an outline of the Australian Federal and State laws bearing upon this area of
medical practice. He will summarise the changes in interpretation of the law over the last
decade. Dr Koder will then present an outline for the systematic assessment of capacity of thechild/adolescent to give informed consent to the major gender affirming medical and surgicalinterventions. Its development stems from a case determined in the House of Lords (England) in1985.
While based on British case law, this model can be easily modified to suit different jurisdictions
and medical procedures.
Ethical consideration: This presentation is under ethical consideration.
COI: No conflicts of interest to disclose
15:20-16:50 Symposium 25
Various Cases in Child and Adolescent Psychiatry Related to Cultures inIndonesia
Moderator 1: Hidekazu Kato (Department of Child and Adolescent Psychiatry, Nagoya
University Hospital, Nagoya, Japan)
Moderator 2: Kristiane Siahaan (Universitas Indonesia Hospital, Depok West Java, Indonesia)
S25-1
Factors Related to Mother-Infant Bonding in Indonesia
Kusuma Minayati1
1Child and Adolescent Psychiatry Division, Department of Psychiatry, Cipto Mangunkusumo
National Referral Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
ABSTRACT
Background: Mother-infant bonding is an important factor that supports socio-emotional
development of the infant. Therefore, every family member should acknowledge Mother-infantbonding process, especially when extended family structures and co-parenting are common, as
in Indonesia.
Method: One-hundred-sixty-eight mothers who had 0-36 months infants participated in thiscross-sectional study. The Indonesian version of mother-infant bonding scale and a sociodemographic questionnaire were administered to all mothers willingly joined the study bysigning the informed consent form. Logistic regression analysis was applied to identify thesocio-demographic factors that had any association with the mother-infant bonding scale. We
have no conflicts of interest to disclose.
Results: The study showed that 13.1% of the participants were categorized as having amoderate-to-high level of impaired mother-infant bonding. Logistic regression analysis showedthat vaginal or normal delivery mode was 4.07 (95% CI [1.27, 13.09]) times more likely to
exhibit low levels of impaired mother-infant bonding compared to a cesarean section. The
model explained 18.6% (Nagelkerke R2) of the variance in impaired mother-infant bonding andaccurately classified 86.9% of cases.
Conclusion: The findings support prior studies that have been conducted in several studies.
Psychoeducation on supporting mother-infant bonding may consist of several topics, including
the advantages of vaginal delivery mode and the importance of family support. It may bedelivered in the early adulthood period or marriage preparation and, hopefully, basic knowledge
during those periods may help strengthen the understanding of mother-infant dyad issues among
all family members.

106

S25-2
Validity and Reliability Test of Center for Epidemiologic Studies Depression –Revised (CESD-R) Instrument Indonesian Version in Cipto Mangunkusumo
Hospital
Monica Andalusia1, Fransiska Kaligis2, Tjhin Wiguna2, Noorhana SW2
1Child and Adolescent Psychiatry Division, Department of Psychiatry, Duren Sawit General
Hospital, Jakarta, Indonesia
2Child and Adolescent Psychiatry Division, Department of Psychiatry University of Indonesia—
Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
ABSTRACT
Background: Symptoms and diagnosis depression is one of the causes of many impairment anddisability among adolescents. Adolescents in inpatient care may be consulted for psychiatricproblems, including depression. A screening instrument should be used upon a specificpopulation to detect expected disorders. Currently, there is no screening instruments to early
detect depression among adolescence that could be used by other departments in a hospital.
Methods: Validity and reliability test were done to CESD-R, Indonesian version. This
instrument has been tested upon the general population, resulting in good validity and reliability.
A hundred adolescent patients in RSUPNCM were recruited in the study to self-rate thequestionnaire. All participants must fill out the consent form before the interview started.
Interview using MINI Kid was done to test criterion validity. Internal consistency and test-retest
reliability were assessed to determine the instrument’s reliability with using SPSS 20.00
version. Twenty people were re-tested in the next 2-4 weeks to assess reliability. We have noconflicts of interest to disclose.
Result: The median age of this study’s subject was 13.5 years old, the oldest age was 18 years
old. The sample had a varied education, elementary school (30%), junior high school (39%),and senior high school (31%). 68% of the sample had general medical comorbidity, withsystemic lupus erythematosus as the most prevalent comorbidity. CESD-R in this study had a
median score of 11.71. The optimal cut-off was ≥9 with the Youden’s indexes of 0.671. With the
AUC curve of 0.92 (95%CI: 0.86-0.97), this instrument had a sensitivity of 93.9%, specificity
73.1%, positive likelihood ratio 3.5, and negative likelihood ratio 0.08. CESD-R had a
Cronbach’s Alpha of 0.88 (95%CI: 0,84 – 0,91) and test-retest result of 0.91.
Conclusion: The Indonesian version of CESD-R showed satisfactory validity and reliability todetect depression among adolescence that was treated in RSCM. CESD-R in adolescence had alower cut-off than a general population.
S25-3
The Comparison Effects of Risperidone and Aripiprazole on Irritability Symptoms
and Serotonin Levels in Children with Autism Spectrum Disorder
Rinvil Renaldi1, Rohmatyah Suaib1, Saidah Syamsuddin1, Andi Alfian Zainuddin2
1
Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
2
Department of Public Health and Community Medicine, Hasanuddin University, Makassar,
Indonesia
ABSTRACT
Background: Autism Spectrum Disorder (ASD) is a behavioral syndrome that includes
impairment in social interactions, communication difficulties and restricted patterns of interests
and activities. 68% of children with ASD exhibit symptoms of irritability which is the term
often used to describe destructive behavior, such as verbal and physical aggression, and self-107harm. Early detection using serotonin as biomarker and intervention using Risperidone andAripiprazole as approved drugs to treat the irritability symptoms would related with better
prognosis. Several research groups have attempted to find a clinical correlation between
irritability and hyper-serotonin. However, the study results remains inconsistencies.
Objective: To compare the effectiveness of Risperidone and Aripiprazole on irritability
symptoms and serotonin levels in children with ASD.
Method: We recruited ASD patients which met the criterion of DSM-5, age 5-17 years, andAbberant Behavior Checklist - Irritability (ABC-I) Score beyond 18. Using simple random
sampling, the patients were grouped into group which was given mono therapy Risperidone andAripiprazole in therapeutic range dose until the amount of minimum subject each groups (12subjects) was met. We calculated the ABC-I Score at baseline, the fourth, and the eight weeks
during therapeutic phase. Serotonin Level was examined at the baseline and the eighth weeks.
Result: There was a significant decrease in the ABC-I Score after patients given Risperidone
and Aripiprazole (p <0.001) but there was no significant change on The Serotonin level. The
Change of ABC-I Score was significant in Aripiprazole group after eight weeks. Moreover, thesignificant difference between the decrease of ABC-I Score was found between the forth and theeight weeks after using Aripiprazole compare to Risperidone with p<0.05. There was nocorrelation between The decrease of ABC-I Score and Serotonin level in both groups.
Conclusion: Risperidone and Aripiprazole were effectively reduced the irritability symptoms in
ASD patients. Moreover, Aripiprazole was more effective after eight weeks of treatment.
However, there was no significant change in The Serotonin level after given both agents. Besideit, there was no significant correlation between the improvement of irritability symptoms andserotonin level in ASD patients.
Conflict of interest: The authors declare no conflict of interest.
S25-4
Parenting in Children with Mental Health Problems in Indonesia
Fransiska Kaligis1, Kusuma Minayati1, R.Irawati Ismail1, Tjhin Wiguna1
1
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Faculty of Medicine,
Universitas Indonesia, Jakarta, Indonesia
ABSTRACT
For parents who have children with mental health disorders (e.g.: autism spectrum
disorder/ASD, intellectual disability), parenting can pose a difficult challenge. In ASD,
parenting is mostly affected by the child’s lack of adaptability, acceptability, anddemandingness. One study from Netherland reported that children with ASD received lessauthoritative parenting in comparison with non-clinical children.1 Moreover, in Asian countries
which are predominantly collectivistic (in contrast with the individualistic Western countries),
having a child with mental disorders and lack of knowledge could invoke parent’s feelings ofshame and stigmatization from the community, thus their children might end up being isolated.
One study from Taiwan reported that children with ASD in Taiwan were objected to more
overprotection and authoritarian parenting style from their parents compared to normallydeveloping children, while one small study in Indonesia showed that children with intellectual
disability had predominantly permissive parenting style. However, compared to Westerncountries, research on parenting in children with mental disorders are relatively scarce in Asia,
even less Indonesia. Available researches in Indonesia only included small number of samples.
Given the stark cultural and environmental difference between Asia and Western countries, it isnecessary to further examine the parenting styles of children with mental disorders, especially inIndonesia. The presentation will share and discuss the result of this study.
Author has no conflict of interest and all subjects involved in the study gave their informed108consent before participated in the study.
Venue 6 (Room K)
9:10-9:50 Research Topics 9
Atypical social cognition in autism spectrum disorder
Shota Uono1
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACT
Autism spectrum disorder (ASD) is a neurodevelopmental disorder diagnosed by persistent
deficits in social communication and restricted interests and repetitive behaviors. I have been
conducting research to elucidate the psychological and neural mechanisms underlying
impairments in social communication. First, using behavioral experiments, we have examined
whether problems exist in the automatic aspects of joint attention and facial expression
recognition, which play important roles in the development of theory of mind and empathy.
These studies showed the atypicality in reflexive orienting attention to eye gaze, mimicking
facial expressions, perceiving dynamic facial expressions as more exaggerated forms, andintegrating information of gaze and facial expressions. These results suggest that ASD
individuals have problems with automatic and nonconscious processing of social stimuli, which
inhibits smooth communication with others. Second, using a similar experimental paradigm, we
examined what neural bases are involved in these phenomena. We identified the spatiotemporal
structure of neural activity involved in gaze and facial expression processing in typicallydeveloping individuals and patients with intractable epilepsy, and compared neural correlates inindividuals with and without ASD based on this information. Taken together, these studies
indicate that the subcortical amygdala and temporal-frontal cortical networks play an importantrole in gaze and facial expression processing and that functional connectivity between theseregions are atypical in individuals with ASD. The amygdala activity in response to social stimuli
may alter the development of cortical networks. Further, I will present recent advances in the
study of social cognition in ASD and the role of atypical sensory processing on the developmentof social cognition.
Ethical consideration: All procedures were in accordance with the guidelines of the Declarationof Helsinki 1964 and its later amendments. The experimental procedure was approved by the
local ethics committee, and written informed consent was obtained from all participants.
COI: The author declared no conflict of interest.
10:00-11:30 Symposium 18
Role of Yoga in Child and Adolescent Mental Health – Broadening the integrative
approach
Moderator 1: Sowmyashree Mayur Kaku (Center for Advanced Research and Excellence inAutism and Developmental Disorders (CAREADD), St. John’s Medical College Hospital andResearch Institute, Bengaluru, India)
Moderator 2: Mayur Vinaykumar Kaku (Department of Neurosurgery and Department of Yoga,
PES Medical College and Research Center & YENRI (YogaEnvironment Neuroscience
Research Institute) trust, India)
IRB approval/individual consent was taken as required. All the four authors declare that wehave no conflicts of interest to disclose.

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S18-1
Yoga in Child and Adolescent Mental Health – The Why and The How
Mayur Vinaykumar Kaku1,2
1
Department of Neurosurgery and Department of Yoga, PES Medical College and ResearchCenter, Kuppam, India
2
YENRI (Yoga Environment Neuroscience Research Institute) trust, Bengaluru, India
ABSTRACT
Yoga and meditation is known to be associated with immense benefits for children andadolescents. The principles of Yoga are timeless and they have preventive as well as therapeuticvalue in managing both body and mind related disorders in a holistic manner across the ages.
Yoga can help in positive neuroplasticity and significantly improve memory, communication,
language and executive functions in children. It also contributes to better mood, decreased
anxiety, better self-awareness and concentration.
This presentation will include demonstration of practices that can be used in parental
interventions and support. These practices can help them learn to become calm, manage stress,
induce compassion, and positively support their child through the process of healing. We will
share our experience with demonstration of simple yoga, relaxation techniques, and practices
that can be used by practitioners even in primary health settings for CAMH. This will include
movement and breathing exercises that help establish mind-body coordination along with selfintrospection, bringing the modern research evidence and ancient scriptural references together.
We will present our work done in the community with adolescents who were diagnosed with
anxiety, depression, suicidality, ADHD, gadget addiction, etc.
S18-2
Yoga in Child and Adolescent Mental Health – The psychosocial impact
Sowmyashree Mayur Kaku1
1
Center for Advanced Research and Excellence in Autism and Developmental Disorders(CAREADD), St. John’s Medical College Hospital and Research Institute, Bengaluru, India
ABSTRACTIn this presentation, we will describe case vignettes from a consultation-liaison CAMH point ofview. This will include examples of children with neurological disorders, ADHD, school refusal,
internet addiction, gender dysphoria, anxiety disorder and depression. Yoga has also helped
manage children with ASD and related developmental disorders and those with visual
impairment.
Children with chronic illnesses, and families of children and adolescents with chronic
neurological and psychiatric disorders are enormously benefited from the practice of yoga. In
CAMH practice, yoga has been tried for children with ADHD, ASD, speech and language
disorders, depression, anxiety and other mood disorders, and early onset schizophrenia. Yoga
has also been as an intervention in those with immune disorders. Children and adolescents arealso benefited from enhanced self-regulation practices and mindfulness for better relaxation.
Yogic interventions for managing stress and facilitating well-being in children also improveschild’s positive behaviors due to improvement in perceived wellbeing. When practiced sincechildhood, yoga can impact physical health which also bolsters positive epigenetic changes andcan potentially improve long term prognosis in CAMH. Introducing a mandatory yoga session
regularly in school can also broadly benefit school mental health systems, and in particularimprove resilience, mood and self-regulation of children at schools. Group interventions are
more effective when implemented in schools and in yoga schools for children and adolescentsand work effectively as support groups too.

110

S18-3
Grief among children: Indications for yoga interventions
Kavita V Jangam1
1
Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences,
Bengaluru, India
ABSTRACT
When the death of a significant one occurs during childhood or adolescence, the child may failto adequately mourn and later in life may present with symptoms of depression or inability toform close relationships during the adult years. Defining grief and loss is very difficult because
a sense of loss is very personal and idiosyncratic. Therefore, children’s grief differs from that of
adults, especially younger children. Children tend to grieve for shorter periods of time thanadults. Children’s reactions to loss can be different – it differs from child to child. The recent
Covid – 19 pandemic has led to the death of the parents of many young children. Owing to thecircumstances around the pandemic as well as the sudden and traumatic death of parents,
children have developed significant grief reactions such as depression, emotional disturbances,anger and aggression, school refusal, and technology addiction etc. In this session, two casestudies will be presented to discuss the complicated grief reactions of the children seen for grieftherapy and the need for integrated interventions, including yoga interventions. Both thechildren seen for grief therapy had lost their parent due to Covid-19 complications. Children had
developed significantly complicated grief reactions such as school refusal, episodes ofaggression and irritability, sad mood, reduced interest in social interactions, death wishes andaddiction to video games. In view of significant depression, children were given
pharmacotherapy and grief interventions were initiated. Improvement in mood and functioning
was reported; however, brief episodes of aggression triggered by memories of the deceased
parent were still observed. At this point, the need for other integrative interventions, such as
yoga was felt. The research related to yoga-based grief interventions has reported significant
benefits in terms of reduction in stress and exhaustion and distraction from the pain of grieving.
Moreover, yoga can provide children safe space to express their thoughts and process difficult
emotions by being aware of them. In addition to this, yoga will help children to improve on theirself care, mastery over emotions and routine and also develop healthy relationships around them
(Woodyard, 2011).
S18-4
Stress and Emotional Functions of Parents of Children with Psychiatric
Disorders: Yoga as Solution Strategy
Aasim Ur Rehman Ganie1, Kavita V Jangam1
1
Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences,
Bengaluru, India
ABSTRACT
Families of children with psychiatric disorders are found to have more stressful living and spentmuch time in caring them. These families not only have struggle with stressful situations, buthave huge financial bearings, face huge emotional pressures, are surrounded by feelings ofshame and guilt. In addition to these challenges, these families or parents experience of negative
effects, difficulty in accepting the child’s psychiatric conditions, poor interpersonal andpsychological well-being and develop significant physical health issues. It is well noted thatpsychological well-being of children are parents are well connected and in multiple ways.
Families who face difficulties in coping with depressive and anxiety symptoms due to constantcaring of children with psychiatric disorders often report difficulty in providing quality care ton

111children. Such factors also make families or parents potentially impaired to be supportive
caregivers to children. While numerous studies have reported that parents of children withpsychiatric disorders experience higher levels of stress and elevated emotions issues, very few
studies are there studied the mind-body relationship in overcoming the challenges. Whereas,some of the stressors of families associated with psychiatric conditions of children are
unavoidable, by effective mind-body intervention such as Yoga can influence and be effective in
addressing the emotions pressures and stress of families. The application of Yogic techniques
helps families or parents of children to utilize cognitive and behavioural efforts during stressful
events to manage themselves with an emphasis on self-realization. This presentation aims topresent the relationship of parental emotional issues and their challenges due to mental illness inchildren. Based on our clinical and research experience, we will highlight the role of yoga as anactive and solution-oriented coping strategy in addressing the emotional issues in parents.
12:50-13:30 Research Topics 14
Pathophysiology and exploration of possible future treatment approaches formaltreatment in mice
Kazuhiko Yamamuro1
1
Department of Psychiatry, Nara Medical University, Kashihara, Japan
ABSTRACT
Juvenile social isolation reduces sociability in adulthood, but the neural circuit mechanisms arepoorly understood. We found that, in male mice, 2 weeks of social isolation immediately thefollowing weaning leads to a failure to activate medial prefrontal cortex (mPFC) neurons
projecting to the posterior paraventricular thalamus (pPVT) during social exposure inadulthood. Chemogenetic or optogenetic suppression of mPFC->pPVT activity in adulthood
was sufficient to induce sociability deficits without affecting anxiety-related behaviors or
preference toward rewarding food. Juvenile isolation led to both reduced excitability of mPFC>pPVT neurons and increased inhibitory input drive from low-threshold spiking somatostatininterneurons in adulthood, suggesting a circuit mechanism underlying sociability deficits.
Moreover, we identify a specific activation pattern of parvalbumin-positive interneurons (PVIs)
in mPFC before an active bout, or a bout initiated by the focal mouse, but not during a passive
bout when a stimulus mouse explores mice. Optogenetic and chemogenetic manipulation
reveals that brief mPFC-PVI activation triggers an active social approach to promote sociability.
Juvenile social isolation decouples mPFC-PVI activation from subsequent active social
approaches by freezing the functional maturation process of mPFC-PVIs during the juvenile-toadult transition. Based on these findings, optogenetic stimulation of mPFC->pPVT neurons inadulthood could rescue the sociability deficits caused by juvenile isolation, and chemogenetic
activating mPFC-PVI activity in the adult animal mitigates juvenile isolation-induced social
deficits. However, since these technologies cannot be adapted to humans, neuromodulation,
which can be adapted to humans, is attracting attention. Therefore, the therapeutic application ofrepetitive transcranial stimulation therapy (rTMS) is currently attracting attention, but its
mechanism of action remains unclear. Deep brain stimulation (DBS) was used to stimulate themPFC in a localized manner in mice, as rTMS affects the entire brain. The mice were subjected
to DBS (20 min/day for 6 days) for social behavior (3-chamber task, AR-LABO), fear memory(fear conditioning), and depressive symptoms (tail suspension test). Next, we examined theeffects of DBS on the local neuronal circuitry of the mPFC using the whole-cell patch clamp
technique. These results indicate that neuromodulation improves various psychiatric symptoms
in humans, and it is expected to be applied to clinical practice in the future.
The author declares no conflicts of interest associated with this manuscript.

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13:40-15:10 Symposium 22
Effects of child abuse on children: From basic research to functional brain
imaging and clinical practiceModerator 1: Kazuhiko Yamamuro (Department of Psychiatry, Nara Medical University,
Kashihara, Japan)
Moderator 2: Mitsuhiro Uratani (Department of Psychiatry, Nara Medical University,
Kashihara, Japan)
S22-1
Impact of the prefrontal cortex neural circuit due to childhood adversity
experience
Kazuhiko Yamamuro1
1
Department of Psychiatry, Nara Medical University, Kashihara, Japan
ABSTRACTSocial isolation, especially in childhood, adversely affects adult brain function and social
behavior in rodents and humans. Children placed in foster care at an early age and sociallydisadvantaged in institutional care environments are known to have improved functional
outcomes compared to children who have never been placed in foster care or are placed in foster
care at a later age. In mice, juvenile social isolation (jSI; juvenile social isolation) during thefirst two weeks after weaning (21 to 35 days of age) is known to lead to reduced social behavior
in adulthood, suggesting that this is a sensitive period for establishing social behavior. Several
studies in humans and rodents have shown that the medial prefrontal cortex (mPFC; medial
prefrontal cortex) is an essential region of the brain network that regulates social behavior. Our
previous study found that L5/6 pyramidal cells projecting to the subcortical area of the mPFC
are vulnerable to social isolation in juveniles and that adult pyramidal cell activity is attenuatedin jSI. In addition, previous genetics and transcriptome studies have shown that many risk genes
for autism spectrum disorders and schizophrenia are highly expressed in mPFC L5/6 pyramidalcells, and mouse studies have shown that the function of subcortical projecting mPFC pyramidalcells (L5/6) is impaired in mouse models of autism spectrum disorders. Our study found that
mPFC projecting pyramidal cells (L5/6), which project to the subcortical region, arefunctionally abnormal in a mouse model of autism spectrum disorder. Our study found that theparaventricular nucleus of the thalamus (PVT) is a candidate subcortical region that projects
from mPFC pyramidal cells (L5/6) and is related to social behavior. Considering that this region
projects various reward-related areas such as the nucleus accumbens, striatum internus, andcentral nucleus of the amygdala, the mPFC→PVT neural circuit is suitable for top-down control
of brain networks. We have identified a neural circuit (mPFC→PVT) that requires juvenilesocial experience for appropriate social behavior in adulthood. In this talk, I will focus on thefunctional and behavioral roles of the mPFC→PVT neural circuit and its development injuvenile social experience. Today, in clinical practice, the potential of neuromodulation fordevelopmental disorders has been suggested. Therefore, we have examined the effects ofneuromodulation in various models, including this jSI, and we would like to discuss the resultson that day.
The author declares no conflicts of interest associated with this presentation.
S22-2
Effects of adverse childhood experiences on event-related potentials (ERPs)
Mitsuhiro Uratani1
1
Department of Psychiatry, Nara Medical University, Kashihara, Japan113

ABSTRACT
Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood(0-17 years). For example, traumatic events include childhood maltreatment and dysfunctionalfamilies. In Japan, the epidemiology of ACEs has not been studied, but ACEs are considered tobe common. Previous studies have shown that ACEs are more likely to be experienced byneurodevelopmental children than by typically developing (TD) children. Stress from ACEs cannegatively affect brain structure and function, causing psychiatric disorders such as
posttraumatic stress disorder (PTSD). In this session, we focused on event-related potentials(ERPs) to investigate the effects of ACEs on brain function. ERPs are commonly used as a noninvasive physiological measure of cognitive dysfunction. ERPs are available to probe
information processing (IP) in real time because they can assess different phases of IP in thehuman brain. Studies have shown that individuals who have experienced ACEs have altered
ERP responses. The most well-studied component is P300 of the late cognitive component in
ERPs. Some previous studies reported that patients with PTSD showed reduced amplitudes ofP300 to trauma-neutral stimuli. In contrast, most findings have shown that patients with PTSD
have enhanced P300 amplitudes in response to trauma-relevant stimuli. Mismatch negativity(MMN) which is considered to reflect an automatic cerebral discrimination process is affectedby PTSD. Also, N100 and P 200 are the mid-latency range of IP which are gating of redundant
information. These two components are affected by PTSD, but results have been inconsistent.
And our group showed that the impact of experiencing child maltreatment on ERPs in
adulthood differs between TD individuals and those with autism spectrum disorder (ASD). In
this session, I will review the evidence on the impact of ACEs in ERPs. In addition, I will
present our group’s studies that examined differences in the impact of child maltreatment on
ASD in ERPs.
The author declares no conflicts of interest associated with this presentation.
S22-3
The review of brain changes after exposure to adverse childhood experiences
Kiwamu Matsuoka1,2
1
Department of Psychiatry, Nara Medical University, Kashihara, Japan2
Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum
Life and Medical Science Directorate, National Institutes for Quantum Science and Technology,
Chiba, Japan
ABSTRACTThe 2022 report of the world health organization (WHO) said that about three in four children
aged 2-4 years suffered physical punishment and/or psychological violence and that one in five
women and one in thirteen men had been sexually abused as a child aged 0-17 years. It is
generally known that health problems are observed more commonly in people that have earlylife stress. Recent studies reported that adverse childhood experiences (ACEs) were at higher
risk of incident mental disorders. In line with the previous study that subjects with autism
spectrum disorder (ASD) have an increased risk of ACEs compared to typically developing(TD) children, exposure to ACEs is associated with adult ASD psychological comorbidities,
such as posttraumatic stress disorder (PTSD). The occurrence of intrusive event reexperiencing,the characteristic of PTSD, often causes social dysfunction in subjects with ASD. However, its
pathological basis remains unclear. Given growing evidence suggesting that ACEs introduced
brain structural changes, we currently examined the associations of brain gray matter volume
and white matter microstructures with ACE severity in subjects with ASD. The volumetry anddiffusional tensor imaging (DTI) revealed that the subjects with ASD exposed to severe ACEs
exhibited less volume in the precuneus and higher radial diffusivity (RD) of DTI parameter in
the anterior thalamic radiation (ATR) than those exposed to mild ACEs and TD participants.

114

Moreover, the severity of intrusive reexperiencing was associated with reduced gray mattervolume in the precuneus in subjects with ASD. These findings suggest that exposure to ACEs is
associated with atrophy in the precuneus and microstructural changes in the frontal lobe-related
white matter. The precuneus might have a critical role in intrusive reexperiencing in adults with
ASD. We believe that a satisfactory environment and support in childhood promote better neuraldevelopment, resulting in decreased psychiatric comorbidities in ASD. In this symposium, I will
review the evidence of brain structural and functional changes after exposure to ACEs inimaging studies. I will also present our findings on the association between brain structuralchanges and ACEs in subjects with ASD.
The author declares no conflicts of interest associated with this presentation.
S22-4
Inpatient Treatment of Abused Children in the Children's Unit
Masami Hanafusa1
1
Division of child and adolescent psychiatry, Osaka Psychiatric Medical Center, Hirakata, Japan
ABSTRACTThe child psychiatric ward of our hospital has a 50-bed closed ward specializing in inpatient
psychiatric treatment of children. These are divided into a children's unit (25 beds) for preschool
to elementary school-age children and an adolescent unit (25 beds) mainly for teenagers.
We reported on the background of patients recently admitted to the children's unit, particularly
the inpatient treatment of abused children. There were 145 patients admitted to the Children's
Unit between April 1, 2018, and March 31, 2022. The average age of the patients was 9.47 (412) years, 99 boys and 46 girls. The average length of hospitalization was 158.6 days but varied
greatly from 3 to 667 days.
We organized patient information and assigned an ACE score to each patient admitted to theChildren's Unit; ACE scores were 0 for 25 (17%), 1 for 31 (21%), 2 for 26 (18%), 3 for 22(15%), 4 for 27 (19%), 5 for 7 (5%), 6 for 2 (1%) 7 in 5 patients (3%).
Patients with higher ACE scores were more likely to have emotional dysregulation and violent
problems, and the higher the score, the more extended the hospital stay. In addition to
medication, various intensive treatment modalities were used, including psychologist-led playtherapy, Trauma-Focused Cognitive Behavioral Therapy, and Parent-Child Interaction Therapy
with caregivers in some cases. The Ethics Committee approved the study, and care was taken to
ensure that patients were not identified.
The author declares no conflicts of interest associated with this presentation.
15:20-16:50 Symposium 26
The Impact of the Great East Japan Earthquake and Tsunami on Children's
Development and Mental Health: Findings from the Michinoku Children's Cohort
Study
Moderator 1: Yukiko Kano (Department of Child Neuropsychiatry, Graduate School of
Medicine, The University of Tokyo, Tokyo, Japan)
Moderator 2: Junko Yagi (Department of Neuropsychiatry, School of medicine, Iwate Medical
University, Morioka, Japan)
S26-1
How to support children born after the disaster and their families: Overview andprogress of the Michinoku Children's Cohort Study after Great East Japan
Earthquake in 2011115

Junko Yagi1,2
1
Department of Neuropsychiatry, School of Medicine, Iwate Medical University, Morioka,
Japan
2
Iwate Children’s Mental Health Care Center, Shiwa-gun, Japan
ABSTRACT
There are various reports on the effects of early life stress (ELS) on later development. Twelve
years have passed since the Great East Japan Earthquake occurred in 2011 that brought
devastating damage to the affected region. The impact can still be observed in various aspects,
such as economic problems and mental health of the people living there.
In 2015, we initiated the Michinoku Children's Cohort study after the Great East Japan
Earthquake (“MiCCa” GEJE study), a longitudinal study focusing on the developmental,
behavioral and emotional problems of children born in the affected areas during the year
immediately following the Great East Japan Earthquake, as well as the mental health of theirparents, and have continued tracking their changes over time to date. The 223 children
participating in the study did not directly experience the earthquake but spent their infancy
immediately after birth in the severely affected areas of Iwate, Miyagi, and Fukushima
prefectures, which was concerned to have had various effects on their developmental andbehavioral problems years later. In fact, the results of the baseline survey conducted in 2016,
five years after the disaster, highlighted delays in children's intellectual and lexicaldevelopment, behavioral problems in the clinical area, and serious mental health problems
among parents (Yagi et al., 2022). We have provided assessment-based support and intervention
to high-need children and their parents, with regular follow-up. At the beginning of the study,
there were concerns about developmental delays and persistent mental health problems, but thefact that those issues have recovered and even improved as social capital has been fostered gives
us hope and hints on how to provide post-disaster support to children born just after theearthquake and their families.
We report on the effects of spending childhood in disaster-affected areas on children's
development and their mental health. In addition, changes in children’s mental health andlifestyle in the areas due to the prolonged impact of Covid-19 will be reported.
S26-2
Results of a Comprehensive Assessment and Longitudinal Follow-up Study ofChildren Born After the Great East Japan Earthquake and their Parents
Naomi Matsuura1,2
1
Faculty of Education, Mie University, Tsu, Japan
2
Elementary School attached to the Faculty of Education, Mie University, Tsu, Japan
ABSTRACTThe Great East Japan Earthquake of 2011 was a natural disaster that had a profound impact not
only on Japan but also on the world. The massive tremors, tsunamis, and fires in eastern Japancaused 22,312 deaths and missing persons in 12 prefectures, mainly in the Tohoku region. At thesame time, a series of nuclear power plant accidents caused by the tsunami in Fukushima
Prefecture resulted in great loss of life for local residents.
In 2013, after the disaster, this study conducted a comprehensive survey of children born in thesevere disaster area and their parents. Specifically, the survey covered children's intelligence,
behavioral and emotional problems, parents' mental health issues, the extent of earthquake
damage, and economic conditions. Data from the six years since the survey was conducted havenow been accumulated, allowing for a groundbreaking analysis as a longitudinal study, and wereport the results.
Since 2013, we have been using the K6 (anxiety scale), BDI II (depression scale), and IESR
(trauma scale) to assess the mental health of parents, and the BDI scale divides parents into four116

groups: healthy, mild, moderate, and severe. and mild groups showed no significant change,
while the moderate and severe groups showed improvement. Parents who were concerned about
their children's developmental problems or whose children had significant behavioral andemotional problems tended to have less complete or persistent mental health problems.
This study is a longitudinal study that simultaneously conducts an investigation and anintervention, and can present extremely valuable data. It could be a useful resource in the eventof a severe disaster in Japan in the future.
S26-3
The Evidence from a Longitudinal Study: MiCCaGEJE-Study Focusing on
Cognitive development, Behavior, Emotions among children Born After the Great
East Japan Earthquake
Jiro Masuya1,21Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
2
Fukushima Children’s Mental Health Care Center, Fukushima, Japan
ABSTRACTThe Michinoku Children's Cohort Study after the Great East Japan Earthquake (MiCCa GEJE
Study), which has been conducted since 2016, focuses on the developmental, behavioral, andemotional problems of children born in the affected areas after the 2011 GEJE and thepsychological and social problems of their caregivers. the MiCCa GEJE Study The MiCCa
GEJE study has continuously observed changes in children and their caregivers over time.
Analyses to date have yielded noteworthy results related to the mental development andbehavior of children born in the affected areas after the GEJE.
Results from the 2016 baseline survey showed partial delays in cognitive development andbehavioral problems in children born after the GEJE in the affected areas. We therefore
provided support to children and their mothers in the heavily affected areas. Subsequent
research also revealed that the percentage of children exhibiting autistic traits was significantly
higher in the heavily affected areas. We also found a significant association between caregivers'
mental health and interpersonal styles and children's behavioral and developmental problems.
Parents were asked to annually rate their own children's behavioral and emotional problems
using the CBCL, and an analysis of CBCL scores assessed five times between 2016 and 2021
showed that when examining changes in CBCL scores for children in the healthy and clinicalgroups on caregivers' K6 scores in 2016, the CBCL scores for children rated in the clinicalgroup The CBCL scores of children of caregivers rated as the clinical group were consistently
significantly higher than those of children in the healthy group. In contrast, over time, CBCL
scores improved significantly for both groups, indicating that children's behavior and emotions
were improving; similar trends were observed for BDI and IESR scores assessed in 2016. Inother words, the results suggest that children of parents who had poor mental health status as of2016 were more likely to exhibit some problems than children of parents who did not. Thesefindings suggest that support for both caregivers and children is needed in psychological support
after a major disaster.
S26-4
How should we support the parents in the affected communities following theGreat East Japan Earthquake in 2011?
Naru Fukuchi1,21Department of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan
2
Miyagi Disaster Mental Health Care Center, Sendai, Japan117

ABSTRACTThe Michinoku Children’s Cohort study after the Great East Japan Earthquake (MiCCa GEJE
study), which has been conducted since 2016, is focused on the developmental, behavioral, andemotional problems of children who were born in the affected areas immediately following the
GEJE in 2011. In the MiCCa GEJE study, we have continued observing the changes in children
and their parents over time, conducted several analyses, and found notable results associatedwith the mental health of the parents.
First, by analyzing structural equation models at the baseline, we found a strong correlation
between the two latent variables, “parent’s mental health” and “children’s behavioral andemotional problems”. Second, by using a two-way analysis of variance (ANOVA), we
demonstrated that parents who lost their loved ones in the GEJE displayed worse depressive
symptoms in 2021 compared with those who did not. Third, Ward’s method of cluster analysis
showed that parents who experienced traumatic events before the GEJE had worse traumatic
symptoms compared with other groups. Finally, by using a two-way ANOVA, we showed thatchildren whose parents were diagnosed with a mental illness by the Mini-International
Neuropsychiatric Interview at the baseline have remained associated with worse behavioral
problems in 2021 compared with those whose parents were not diagnosed.
Our results demonstrated that parents who experienced the loss of loved ones in the GEJE andtraumatic events before the GEJE may be at high-risk and have difficulties in their child-rearing.
Furthermore, their children may develop behavioral and emotional problems and need more
specific support. Since other studies found that strong social capital helped parents' mental
health in the aftermath of the disaster in Japan, it is effective for such vulnerable families toconnect to their communities.
We, three child psychiatrists, visited the affected communities in our regions and set up social
gatherings for the parents in the MiCCa study, named as MiCCa’s Caravan. We provided tips forparent training programs and had time to interact with parents. It may be possible to help
parents with severe difficulties through these social gatherings and bring them to the usual life.

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May 28th, 2023
Venue 1 (Room A)
9:10-10:10 Plenary Lecture 9 Moderator: Kazuhiko Nakamura
A System-Model of Community Care for Autistic Individuals: From Clinical
Practice to Research
Hideo Honda1,2
1
Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of
Medicine, Matsumoto, Japan
2
Mental Health Clinic for Children, Shinshu University Hospital, Matsumoto, JapanThe speaker and colleagues developed a system model for early detection and intervention ofchildren with neurodevelopmental disorders in Kohoku Ward, Yokohama in the 1990s (Honda& Shimizu, 2002). In this model, all children suspected as having autism during health checkups
in the community were referred to a specific regional center for diagnosis and earlyintervention. This provided favorable conditions for an all-inclusive survey with little bias. By
applying this model, we were able to thoroughly identify autistic children in this area at the 18month health checkup, link them to early intervention, and follow them into adulthood whileproviding medical, educational, and welfare support. This clinical practice has enabled highquality research from an epidemiological perspective.
We reported the first cumulative incidence data of autism, demonstrating that autistic children
without intellectual disability existed in far greater numbers than was believed at the time
(Honda et al, 1996). Then we conducted an epidemiological study of autism spectrum disorders(ASD) in 31,426 children born in the area between 1988 and 1996 and identified 278 autistic
children diagnosed before 7 years old (Honda, Shimizu, & Rutter, 2005). After all these
individuals were over 20 years of age, we conducted a follow-up study (Yokohama Longitudinal
ASD Birth Cohort Study; Y-LABiC Study) and have constructed a large-scale epidemiological
database (Iwasa, Shimizu, Sasayama et al, 2022). Cooperation was obtained from 170 (61.2%),of whom 113 had received regular medical care and consultation by a psychiatrist or clinicalpsychologist, beginning in early childhood and continuing through the time of the survey. Longterm prognosis for ASD was not as unfavorable as has been previously reported. This was
mainly due to the study design that thoroughly followed up on the participants identified in arigorous incidence study of ASD. The Y-LABiC database, derived from our steady
accumulation of practice, will provide a great deal of information on the prognosis of children
with ASD, which was ascertained in an all-inclusive survey with little bias.
Recently, epidemiological studies have been conducted in several regions in Japan, including
ours in Okaya City (Sasayama et al, 2021). Good community care system will contribute toimproving the level of health and medical care, welfare, and education for autistic children, as
well as research on ASD.
Ethical considerations: This plenary lecture is a review of previously published studies and does
not include new data that deal with personal information or intervention studies.
COI: None
10:20-11:20 Plenary Lecture 10 Moderator: Hideo Honda
Biological and epidemiological studies of neurodevelopmental disorders
Kazuhiko Nakamura1
1
Department of Neuropsychiatry, Hirosaki University Graduate School of Medicine, Hirosaki,
Japan

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PET (positron emission tomography) study; Autism Spectrum Disorder (ASD) is one of
neurodevelopmental disorders. We used PET to focus on neurotransmitter alterations andmicroglial activation in the autistic brain. We indicated that gross abnormalities in both
serotonin transporter and dopamine transporter systems. We also indicated that a deficit incholinergic innervations of the fusiform gyrus, which may be related to not only current but also
childhood impairment of social functioning. Furthermore, we showed excessive microglial
activation in multiple brain regions. Attention-Deficit/Hyperactivity Disorder (ADHD) is highly
prevalent neurodevelopmental disorder. We used PET to focus on dopamine system andmicroglial activation in the ADHD brain. We showed decreased D1 receptor in the anterior
cingulate cortex and increased activated microglial in the dorsolateral prefrontal cortex andorbitofrontal cortex.
Genomic study; the etiology of ASD is complicated due to its multifactorial nature, and both
genetic factors and environmental factors. It has been suggested that approximately 50-60% of
ASD etiologies are caused by genetic factors. Copy number variation (CNV) is one ofchromosomal abnormalities that contribute to an increased risk of ASD. We conducted CNV
analysis using genomic DNA from Japanese children. We showed four ASD-related CNVs:
deletion at 12p11.1, duplications at 4q13.2, 8p23.1 and 18q12.3. Specifically, the odds ratio ofduplication at 18q12.3 was highest among the 4 CNVs (odds ratio, 8.13).
Epidemiological studies: whether there is a true increase in ASD frequency or not remains
unclear. We estimated the prevalence and cumulative incidence of ASD in Japan. We indicatedthat adjusted ASD prevalence was 3.22%. The male to female ratio of the crude prevalence was
2.2:1. The cumulative incidence of ASD up to 5 years of age for the total study years was
1.31%. A generalized linear model revealed no significant linear trends in 5-year cumulative
incidence over the study years. Only 11.5% of children had ASD alone; the remaining 88.5%
were found to have at least one co-existing neurodevelopmental disorders.
We examined whether school social capital mediates the association between ASD traits anddepression in a general population sample. We indicated that ASD traits were associated withdepression among adolescents, and that this association is partly mediated by school social
capital. We also examined whether neurodevelopmental traits predicted certain internet
addiction. We indicated that ADS traits predicted the persisting internet addiction pattern andthat inattention traits predicted the persisting and converting (from non-internet addiction tointernet addiction status) patterns.
The ethics committees approved these studies. The authors have no conflicts of interest.
11:30-12:30 Sponsored Seminar 3 <Takeda Pharmaceutical Company Ltd>
What is the appropriate diagnosis and treatment of ADHD based on the updated
Japanese guidelines?
Moderator 1: Yushiro Yamashita (Department of Pediatrics and Child Health, Kurume
University School of Medicine, Fukuoka, Japan)
Moderator 2: Noa Tsujii (Department of Child Mental Health and Development, Toyama
University Hospital, Toyama, Japan)
SS 3-1
Diagnosis of ADHD
Yukiko Kano1,2
1
Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo,
Tokyo, Japan2
Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, JapanThe Guideline for Diagnosis and Treatment of ADHD in Japan, first published in 2003 and now
in its fifth revision in 2022, are designed to ensure appropriate diagnosis, evaluation, treatment,120

and support for multidisciplinary people involved in treatment and support of individuals with
ADHD under 18 years old.
In this presentation, the main points of diagnosis and assessment in this latest guideline aredescribed.
Although DSM-5 is used to diagnose ADHD, it is not enough to follow the operational criteria
only. For diagnosis and assessment leading to appropriate treatment and support, it is important
to extract a clinical picture of the whole individual with ADHD from developmental history,
family history, current medical history, and various medical and psychological tests.
While differentiation from various psychiatric disorders is necessary in diagnosis of ADHD, avariety of psychiatric disorders are comorbid with ADHD. In particular, differentiation andcomorbidity between ADHD and autism spectrum disorder (ASD) is an important issue. It is
desirable to carefully and rigorously determine whether inattention, hyperactivity, impulsivity,and interpersonal problems are caused by comorbidity of the two disorders or can be explainedby one of them.
It is important to remember that ADHD-like symptoms can be caused by a wide range ofattachment dysfunction as well as reactive attachment disorder (RAD) and disinhibited social
engagement disorder (DSED) and should be differentiated, and that ADHD is a risk factor forencountering attachment dysfunction also.
The guideline divides comorbidities into eight disorder groups: behavioral disorders, emotional
disorders, nervous habits, neurodevelopmental disorders (including tic disorders), RAD and
DSED (including broader attachment dysfunction), sleep-wake disorders, personality disorders,and game and Internet addiction. Comorbidities can also be divided into primary comorbidities,
which are based on innate disposition of the individual, and secondary comorbidities, which
result from interaction of dispositional and environmental factors. Primary comorbidities consistof nervous habits, neurodevelopmental disorders, and large portion of sleep-wake disorders.
The importance of synthesizing cross-sectional and longitudinal assessments to understand thewhole individual with ADHD is emphasized in the guideline.
SS 3-2
Pharmacotherapy for Children With ADHD: Based on Treatment Guidelines inJapan
Takashi Okada1
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
Attention-deficit hyperactivity disorder (ADHD) is marked by an ongoing pattern of inattention
and/or hyperactivity that interferes with functioning or development. It is often comorbid withother neurodevelopmental disorders (ex. autism spectrum disorders) or psychiatric disorders(ex. mood disorders or anxiety disorders). Maladaptation to daily life may lead to secondary
disorders such as low self-esteem and worsening of internalizing/externalizing symptoms.
Therefore, the treatment for ADHD is aimed to minimize ADHD symptoms and their
dysfunctions, and to prevent secondary psychosocial disturbances.
Neuropsychological or neuroimaging studies revealed that children with ADHD have
impairments in executive functions, reward system, time perception, and low activations inrelated brain regions. Pharmacological interventions improve these brain functions by inhibiting
reuptake of these neurotransmitters, promoting neurotransmitters release in synaptic cleft, or
activating alpha 2A receptors.
In Japan, there are four pharmacological agents which are available for ADHD: OROS(osmotic
release oral system)-methylphenidate (MPH), atomoxetine hydrochloride (ATX), guanfacinehydrochloride extended-release (GFR), and lisdexamphetamine dimesylate (LDX). Three agents(MPH, ATX, GFR) can be given to children or adults, but LDX should be tried only forchildren.

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The latest treatment guideline was published in the last year. It is emphasized that anti-ADHD
drug should be added in individuals with moderate or more severe impairments in daily life
even if sufficient psychosocial treatments has been administered. Clinicians should select one ofthree agents (MPH, ATX, GFR), and in non-responsive cases for the first drug, treatment should
be changed to another agent among these drugs. In non-responsive cases to more two agents,
clinicians can choice LDX or combined therapy with two drugs. In addition, this guideline puts
emphasis on the importance to reconsider the diagnosis and the understanding of children
including psychosocial aspects. The Japanese guideline also explains that it is essential todiagnose children with ADHD and autism spectrum disorders.
The treatment guideline should be published according to the previous studies and expert
consensus. However, the guidelines all over the world are quite different. One of the reasons isthat the expected outcomes and concerns may be different. Clinicians should choice treatment
options after the good communications with the children and their care-givers (i.e. shareddecision making).
There is no conflict of interest (COI) regarding this lecture.
12:50-13:50 Special Lecture 4 Moderator: Takuya Saito
Sounding the Alarm for Children’s Mental Health in the USA
Warren Y.K. Ng1
1
American Academy of Child and Adolescent Psychiatry President, Professor of Psychiatry atColumbia University Medical Center, USA
American Academy of Child and Adolescent Psychiatry in partnership with other organizations
declared a national state of emergency in child and adolescent mental health in October 2021
and reaffirmed in 2022. The COVID-19 pandemic exacerbated the silent pandemic that had
been worsening over previous decades due to underinvestment in child and adolescent serving
systems. One in five children and adolescents have a behavioral health disorders with suicide
already the second leading cause of death for youth 10-24 years of age. The COVID-19
pandemic exacerbated the risk factors known as the social determinants of mental health,including family mental health and substance use issues, adverse childhood experiences, racialdisparities, social isolation, trauma, food and housing insecurity, economic stress, and poverty.
Not all children and adolescents were equally impacted, with children of color
disproportionately affected as well as other groups of marginalized youth including sexual
minority youth, justice and child welfare involved, and those impacted by poverty,
discrimination, violence, trauma, and dislocation. During the COVID-19 pandemic, there was24-31% percentage increase in behavioral health issues in emergency departments. There wasa 51% increase in adolescent females with suspected suicidal behaviors compared to before thepandemic. Adolescent females were arriving to emergency departments presenting withincreased behavioral health disorder severity, complexity and comorbidities. There has also been
a 65% increase in overdose deaths for youth aged 10-19 years of age. Child and adolescent
psychiatrists and our national organization are committed to responding with strategies inclusiveof racial/ethnic minoritized, underserved, LGBTQ, justice-involved, child welfare-involved, anddisabled youth. Working in partnership with government, communities and professionalorganizations, child and adolescent psychiatrists have contributed to strategies such as
integrated mental health services with pediatric providers, enhanced school based mental health,and coordinated crisis response services. Child and adolescent psychiatrists play a key role
within systems of care. They provide expert mental health expertise and knowledge to help
develop systems promoting health, wellbeing, resilience and development. There has been some
progress in enhancing mental health services, but more needs to be done to address the current
crisis and prevent the next wave. Clinical care transformation needs to focus on health equity
and diversifying the workforce. Advocacy continues to be critical in building coalition with122

youth, families and communities to lift up the youth voice. These partnerships continue to helptransform our systems of care to serve all youth, families and communities with health equity
and justice.
14:00-15:00 Plenary Lecture 11 Moderator: Machi Kakimoto
Neurodevelopmental disorders and suicide
Takuya Saito1
1
Department of child and adolescent psychiatry, Hokkaido University Hospital, Sapporo, Japan
Suicide is one of the leading causes of death among children/adolescents. Despite ambitious
national goals to reduce suicide rates, risk continues to rise unabated at all ages and across all
demographic groups. When primary prevention is used, it is typically applied after significant
risk has accrued and affected children/adolescents are entrenched in risk-maintaining
environments. Scalable prevention programs are needed in which children and adolescent are
identified at younger ages based on malleable vulnerability traits. Impulsivity is one candidate
trait. However, impulsivity alone confers only modest increases in suicide risk, and isremarkably resistant to enduring change across the lifespan. It is therefore an insufficientindicator of vulnerability and an inefficient prevention target. At the same time, it cannot beignored given its strong influence on suicide in contexts of additional vulnerability and risk.
Neurodevelopmental disorders such as Attention deficit hyperactivity disorder (ADHD) andAutism spectrum disorder (ASD), particularly when combined with comorbid conditions suchas depression and conduct disorder, can confer up to a 10-fold increase in risk for suicide
according to some studies. It thus is an important player in the suicide risk picture and inconsiderations regarding prevention. However, neurodevelopmental disorders are multifactorialconstruct and the elements of neurodevelopmental disorders that contribute to suicide risk areunclear. Important possibilities are impulsivity and the associated idea of reward discounting,poor executive functioning or inattention, and overactivity, poor communication skills andirritability. Although many acknowledge the importance of Biological Vulnerability x
Environmental Risk interactions in emerging psychopathology, interactions among biologicalsystems--some of which vary by sex-may be equally important to consider and target as we seek
to improve prediction of suicide risk and strive for more effective. Given the scope of the crisis,
identifying the youth most at risk and effectively intervening is a critical yet unrealized goal.
Complicating the problem, risk is conveyed via an interacting set of cultural, familial,biological, and child-level characteristics whose relationships are not yet fully understood. The
current talk will focus on Neurodevelopmental disorders, suicide, and child development toconsider the multiple factors contributing to risk for mood problems and suicidality among
youth.
15:10-16:10 Plenary Lecture 12 Moderator: Hitoshi Kaneko
Population Based Study of Efficacy and Implementation of Digital and Phone
Assisted Parent Training Intervention for Preschool Children with Disruptive
Behavioral Problems
Andre Sourander1
1
Turku University, Child Psychiatry, Turku, Finland
Background/Objective: Parent training is the most effective approach to the psychosocial
treatment of disruptive behavioral problems in childhood, and there is mounting evidence fromrandomized controlled trials (RCTs) that such initiatives reduce problems and improveparenting skills The barriers to receiving parent training include the lack of trained staff that can
provide interventions; the stigma related to receiving mental health treatment; and the123difficulties of accessing and engaging in treatment in terms of costs, time, and location.
Method: Technology-based parent training programs can offer many benefits over traditional
interventions, such as higher fidelity, greater accessibility, convenience, and reduced time andcosts. We previously reported the 24-month follow-up study of RCT to provide an interactive
Web-based parent training program with supplementary weekly phone coaching, the Strongest
Families Smart Website (SFSW), using a population-based screening procedure. The study
showed that the intervention resulted in significant reductions in the level of disruptive behavior
problems among 4-year-old children and improved parenting skills.
Results: In this study, we implemented our aforementioned RCT study in primary health caresettings to see how it would work in the real world. The first aim of this study was to compare
certain child and family characteristics of the RCT intervention group with those of the first 882
families who received treatment during the primary care implementation phase. Both groups
were based on population-based screening of 4-year-old children with high levels of disruptive
behavior.
16:30-17:00 Closing Ceremony (including ceremony for best poster awards)
Venue 2 (Room B-1)
9:10-9:50 Research Topics 17
Support for children with foreign backgrounds who have developmental
disorders ~Toward establishing inclusive multicultural society~
Shiori Ogawa1, Osamu Takahashi2
1
Department of Psychology, Faculty of Education and Psychology, Nihon Fukushi University,
Nagoya, Japan2
Toyota Municipal Child Development Center, Toyota, Japan
ABSTRACT
Enhancing support for children with foreign backgrounds who have developmental disorders
requires a multifaceted approach that addresses the unique needs of these children and theirfamilies.
Early identification and assessment: It is important to identify developmental disorders early inorder to provide timely interventions and support. This can be done through screenings andassessments that are culturally and linguistically appropriate, and that take into account thechild's unique background and experiences.
Tailored interventions: Once a developmental disorder has been identified, it is necessary toprovide interventions that are tailored to the child's specific needs and that take into account thechild's cultural background.
Collaboration with families: Families play a critical role in supporting children with
developmental disorders, so it is important to involve them in all aspects of the child's care. Thiscan include providing information and support to families in a language and format that they
can understand, and involving families in the child's treatment plan.
Language support: Children who are not fluent in Japanese may have difficulty communicating
and understanding information related to their condition, so it's important to provide language
support such as translation and interpretation services, and to make full use of non-verbal
communication along with visual support such as picture cards.
Access to information and resources: Families of children with developmental disorders may
have a hard time navigating the complex healthcare system, so it's essential to provide themwith information and resources that will help them understand the diagnosis, treatment options
and where to find the best services, not to mention municipal health checkups for infants offered
free of charge.

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Inclusion and support in education: Children with developmental disorders may require
specialized educational supports, such as individualized education programs (IEPs), and special
education services, so we need to ensure that they are receiving the necessary support to succeedin school. Measures should be taken at school and local communities to prevent them frombeing isolated, enabling them to mingle and cherishing each other’s individuality.
Children with developmental disabilities who have roots in foreign countries face the "barriersand difficulties of living in a different culture" that children with foreign roots generally face, in
addition to the "barriers and difficulties of having a disability”.
In this session, I would like to discuss the goal of support and how to work toward the solution
by examining the current situation surrounding these children and their families in Japan.
10:00-12:30 Media TheatreChildren under Difficult Circumstances
Iris Chih-Tsai Chen1, Shu-Tsen Liu2
1
Department of Child and Adolescent Psychiatry, Taoyuan Psychiatric Center, Ministry of
Health and Welfare, Taoyuan City, Taiwan
2
Division of Child and Adolescent Psychiatry & Division of Developmental and Behavioral
Pediatrics, China Medical University Children’s Hospital, Taichung, Taiwan
ABSTRACT
Numerous empirical studies show that adverse childhood experiences can profoundly affectpeople’s lives. However, it is not unusual for children today in the world to struggle throughtheir childhood due to innate factors such as gender, race, vulnerabilities and special needs, andthe influences of political and social environments.
This media theatre session aims to disclose the life of children under difficult circumstancesfrom the perspective of multiple cultural contexts in Taiwan. From the children’s voices, we
could have a better understanding of what they are suffering.
We will present 2 films that describe children’s lives under various difficult circumstances, “TheSilent Forest” and “Invisible Children”; scheduled to run for about 120 minutes and will befollowed by a 30-minute discussion chaired by two child psychiatrists, Iris, Chih-Tsai Chen and
Shu-Tsen Liu.
The Silent Forest (https://www.youtube.com/watch?v=NZQ9at8jRBE) is a 105-minute 2020
film based on a true story directed by Chen-Nien Ko and with a screenplay by Chen-Nien Ko
and Pin Chun Lin. The story is based on the 2018 book, “Silence Island” by Chao-Ju Chen, arecord of the “institutional abuse” event. This event happened in a special education school forchildren and young people with hearing impairments. There were more than 100 cases of"student to student", as well as cases of "teacher-to-student" sexual assaults and harassment
during 2004-2012. The victimized children could not hear or speak out, so they could only
choose to remain silent; but overwhelmed by fear, becoming passive accomplices in silence....
Invisible Children (https://www.youtube.com/watch?v=WdUtGn6r_mg&t=15s) is a 9 minutesof 2021 film directed by Liu Chun-Yu. The film tells the story of a child who has lived a lonely
life with no identity and unable to go to school, for her mother is a lost-contact migrant worker.
We hope that through different points of view; we could deepen our understanding of children
under difficult circumstances and in different situations, and thus inform better practices tofacilitate their quality of life and mental well-being.
Conflict of Interest: No conflicts of interest to disclose.
Ethical considerations: “The Silent Forest” is classified into the category of Parental Guidance12 rate ("PG-12"): not suitable for viewing by children under the age of twelve; and “Invisible
Children” is classified into category of General rate ("G"): suitable for watching by generalaudiences according to Television Programs Classification Handling Regulations by the125National Communications Commission of Taiwan. Both films had been authorized to play in
ASCAPAP 2023 in Kyoto, free of charge.
14:30-15:30 Social Program 1 (Open to the public, in Japanese) [Free of charge]
Moderator: Motomi Toichi (Department of Human Health Sciences Graduate School of
Medicine, Kyoto University, Kyoto Japan)
Art and perspective of children with autism spectrum disorder
Shiro Matsui1
1
Department of Fine Arts (Sculpture), Kyoto City University of Arts, Kyoto, Japan
Reconsidering human cognition from its origins is one of the important themes of media art. In
this exhibition, Prof. Shiro Matsui, a world-renowned artist in the field of media art, will exhibit
or install works containing topological structures of various sizes as devices to change our wayof perceiving and localizing the external world through the unusual experiences of unexpected
localization of e.g. sound source.
In recent years, it has been suggested that the cognitive style of autism spectrum disorders,among other developmental disorders, is closely related to the primitive perceptions andsensations that media art seeks to uncover. Matsui’s lecture is expected to uncover thesimilarities between early cognitive development and primitive-like cognitive processing seen
in youth with autism spectrum disorder. [Free of charge]
You can see the exhibitions and biography in the following website:
https://www.shiromatsui.com/

His work is exhibited in front of the Room B1 and stairs between the 1st and 2nd floors during
the ASCAPAP 2023.
15:30-16:30 Social Program 2 (Open to the public, in Japanese) [Free of charge]
Moderator: Motomi Toichi (Department of Human Health Sciences Graduate School of
Medicine, Kyoto University, Kyoto Japan)
Tone, sound, music and mental health-from Kyoto to Asia
Performer: Eri Chichibu
Composer, Arranger, Pianist/Keyboardist, living in Sendai, JapanThe final session in room B1 is a live performance by Ms. Eri Chichibu, a young Japanesecomposer. After studying Education and Psychology at Tohoku University in Japan, Ms.
Chichibu studied music (Jazz Composition/Flim Scoring/Video Game Scoring) at Berklee
College of Music, a prestigious jazz education institution in Boston, in the US. Her works has
been internationally recognized and have awarded by ISJAC (2020 Owen Prize), ASCAP (2020& 2019 Herb Alpert Young Jazz Composers Award) and more organizations. In 2022, she has
released her 1st album “Crossing Reality,” and the album got the “Tohoku Block Award” at the2022 CD Shop Award.
In this session, works from the album “Crossing Reality” will be performed by her large
ensemble. Along with the live performance, talk session will also be held. The professional126

artists and composers on the floor will join. Through discussing the relationship between her
musical originality (timbre, acoustics and harmony) and the theme of her composition (thevarious states of mind/consciousness), we will dig into the unique characteristics of Ms.
Chichibu’s music. [Free of charge]
Ms. Chichibu’s biography (in Japanese) and her official YouTube channel is in the following
QR codes (You can listen to songs from her album “Crossing Reality”).

biography

YouTube channel

Venue 3 (Room B-2)
9:10-9:50 Research Topics 18
Does preterm birth affect sleep development and symptoms related todevelopmental disorders?
Hidenobu Ohta1,2,3
1
Department of Occupational Therapy, Graduate School of Medicine, Akita University, Akita,Japan
2
Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of
Neurology and Psychiatry, Kodaira, Japan3
Department of Psychiatry, Asai Hospital, Chiba, Japan
ABSTRACT
Autism Spectrum Disorder (ASD) has been on the rise in recent years with a high incidence rateof nearly 2%. Moreover, the incident rate of ASD in prematurely-born children has beenreported to be at least two times higher than that of full-term-born children, suggesting thatperinatal environments related to preterm births may contribute to an increase in the incidenceof ASD in prematurely-born children.
Some researchers have reported a relationship between sleep disturbances and the severity ofthe properties of behavioral problems, which can be symptoms of developmental disorders such
as ASD and ADHD. To have an insight into how preterm birth affects postnatal sleep
development of children and to examine whether sleep properties can be used as markers todetect developmental disorders among prematurely-born children, we studied the sleep
properties of preterm infants using a sleep accelerometer (i.e. Actigraphy), which is convenient
to use and can be used during sleep at home. Through these studies, we investigated therelationship between the sleep properties and mental development of prematurely-born toddlersof approximately 1.5 years of age.
Ref.
1. Nakagawa M, et al., Sci Rep. 2021;11:3028. doi: 10.1038/s41598-021-81970-6.
2. Ando A, et al., Sci Rep. 2021;11:15921. doi: 10.1038/s41598-021-95495-5.
3. Asaka Y, et al., Sci Rep. 2022;12:20032. doi: 10.1038/s41598-022-24338-8.
The authors declare that the research was conducted with no commercial or financial
relationship that could be construed as a potential competing interest or conflict of interest. The
Ethics Committees of the research institutes approved the methods and procedures, all of whichwere performed in accordance with the Declaration of Helsinki.

12710:00-11:30 Symposium 27
Developmental Disorders and Sleep Problems
Moderator 1: Hidenobu Ohta (Department of Occupational Therapy, Graduate School of
Medicine, Akita University, Akita, Japan)
Moderator 2: Mitsuru Kikuchi (Department of Psychiatry & Behavioral Science, Faculty of
Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University,
Kanazawa, Japan)
S27-1
Brain Science of Neurodevelopmental Disorders
Toru Takumi1
1
Department of Physiology and Cell Biology, Kobe University School of Medicine, Kobe, Japan
ABSTRACT
Autism Spectrum Disorder (ASD), a neurodevelopmental disorder, has been on the rise in recent
years, with a high incidence rate of nearly 2%, and is a burden on a society suffering from adeclining birth rate. ASD is considered a brain development disorder and, compared to othermental disorders, the genetic contribution is known to be high. As many as a thousand ASD risk
genes and copy number variations (CNVs) on the order of a hundred have now been reported to
be involved in its causation; one of the most frequent CNVs is known to be the humanchromosome 15q11-13 duplication. We generated mice with a 6.3 Mb duplication of mouse
chromosome 7c, a region homologous to human chromosome 15q11-13, using a Cre-loxP-based
chromosome engineering approach. This mouse model of autism satisfies not only thephenotypic validity of exhibiting autistic-like behavior but also the construct validity of having
the same chromosomal abnormality as humans. In addition, synaptic and serotonin
abnormalities were found in this mouse. The mouse is expected to serve as an artificial foundermouse for forward genetics of neurodevelopmental disorders and as a model for drug discovery.
In addition, I would like to discuss the relationship between sleep-wake rhythm abnormalities
that are frequently found in neurodevelopmental disorders.
The author declares that the research was conducted with no commercial or financial
relationship that could be construed as a potential competing interest or conflict of interest. The
Ethics Committee of Kobe University approved the methods and procedures.
S27-2
Sleep problems and cognitive development in preterm toddlers
Yoshitaka Seto1, Akiko Ando1, Kazutoshi Cho1, Hidenobu Ohta2
1
Maternity and Perinatal Care Center, Hokkaido University Hospital, Sapporo, Japan2
Department of Occupational Therapy, Akita University Graduate School of Medicine, Akita,
Japan
ABSTRACT
Our recent study on full-term toddlers demonstrated that daytime nap properties affect the
distribution ratio between nap and nighttime sleep duration in total sleep time but does notaffect the overall total amount of daily sleep time itself. However, there is still no clear scientificconsensus as to whether the ratio between naps and nighttime sleep or just the daily total sleep
duration itself is more important for healthy child development. In the current study, to gain ananswer to this question, we examined the relationship between the sleep properties and thecognitive development of toddlers born prematurely using actigraphy and the Kyoto scale ofpsychological development (KSPD) test. 101 premature toddlers of approximately 1.5 years ofage were recruited for the study. Actigraphy units were attached to their waist with an adjustable

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elastic belt for 7 consecutive days and a child sleep diary was completed by their parents. In the
study, we found no significant correlation between either nap or nighttime sleep duration andcognitive development of the preterm toddlers. In contrast, we found that stable daily wake time
was significantly associated with better cognitive development, suggesting that sleep regulation
may contribute to the brain maturation of preterm toddlers.
The authors declare that the research was conducted with no commercial or financial
relationship that could be construed as a potential competing interest or conflict of interest. The
Ethics Committee of Hokkaidio University and Akita University approved the methods andprocedures, all of which were performed in accordance with the Declaration of Helsinki.
S27-3
Sleep problems and cognitive development in children with autism spectrum
disorderYuko Yoshimura1,2, Takashi Ikeda2, Yusuke Mitani3, Nobushige Naito4, Hidenobu Ohta5,
Mitsuru Kikuchi2,41Institute of Human and Social Science, Kanazawa University, Kanazawa, Japan
2
Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan3
Department of Pediatrics, Kanazawa University, Kanazawa, Japan
4
Institute of Medical, Pharmaceutical and Health Sciences, Department of Psychiatry &Behavioral Science Kanazawa University, Kanazawa, Japan
5
Department of Occupational Therapy, Akita University Graduate School of Medicine, Akita,
Japan
ABSTRACT
Sleep problems have been frequently reported in children with autism spectrum disorder (ASD)(Humphreys JS et al., 2014; Ikeuchi et al., 2019). Some studies have reported a relationshipbetween sleep problems and the severity of social communication impairment, stereotyped
behavior, and anxiety symptoms, which are symptoms of ASD (Hayashi, 2007; Johnson et al.,2015). It is necessary to evaluate the quality of sleep more objectively to understand thesymptoms and developmental aspects of children with ASD, and to support them by preparing
an appropriate environment. On the other hand, due to the difficulty of measuring sleep data
objectively in the sleep environment of daily life, the relationship between sleep characteristics
and development in children with ASD is still unclear. We are investigating the relationshipbetween sleep characteristics and development in children with ASD by using a sleep
accelerometer (i.e. Actigraphy), which is convenient to use and can be used during sleep athome.
We compared the time course of nocturnal body movements between 17 children with ASD and
17 Typically Developing (TD) children (Naito et al., 2019). Body movements during night sleep
for three days were measured by an actigraphy. It was found that the amount of body movementfor 2 to 3 hours after the onset of sleep was significantly higher in children with ASD.
Furthermore, increased body movement during sleep was associated with lower social
performance in children with ASD. The result that children with ASD show more body
movement during sleep than TD children during the period 2 to 3 hours after falling asleep may
suggest that children with ASD either sleep lightly or are easily awakened during this period.
Furthermore, recent studies have reported the risk of developmental disorders in children whoare born weighing less than 2500g and/or before 37 weeks of pregnancy. Our study on sleep
characteristics in preterm toddlers also suggests a relationship between low nighttime sleep
quality and high daytime activity (Asaka et al., 2022). Through some collaborative research, we
are investigating the relationship between sleep and cognitive development in preterm children.
Based on these studies, we would like to discuss the common neural mechanisms underlying
sleep development and cognitive development in children with developmental disorders.

129

The authors declare that the research was conducted with no commercial or financial
relationship that could be construed as a potential competing interest or conflict of interest. The
Ethics Committee of Kanazawa University Hospital approved the methods and procedures, allof which were performed in accordance with the Declaration of Helsinki.
S27-4
Large-scale sleep analysis in youth and neurodevelopmental disorders
Yoichi Minami1, Akifumi Kishi1, Hiroki Ueda1
1
Department of Systems Pharmacology, Graduate School of Medicine, The University of Tokyo,
Tokyo, Japan
ABSTRACTWith the launch of the ERATO Ueda Biological Timing Project in October 2020, our laboratory
started the “Sleep Health Checkup.” This sleep health checkup became possible because of therapid development and widespread use of wearable devices making sleep measurement morepractical.
We developed an algorithm to determine sleep and wake from acceleration data from young
adults. Simultaneous measurement of biological signals from polysomnograms and wristband
accelerometers was performed throughout the night, and it was confirmed that the algorithm(ACCEL) determined sleep and wake with good accuracy, sensitivity, and specificity (Ode,Katori, Shi et al. iScience, 2022). Using ACCEL, the acceleration data of approximately
100,000 adults registered in the UK Biobank were analyzed and sleep patterns were successfully
extracted. We also succeeded in classifying the sleep patterns of 100,000 people into 16 clusters(Katori, Shi et al., PNAS, 2022).
Further, we launched the "Children's Sleep Health Checkup” project in October 2022 to measure
sleep using a wristband accelerometer for school-aged children. The Children's Sleep Health
Checkup is an activity to encourage children to get better sleep. On the research side, the projectis a large-scale measurement of sleep in developing children. In addition, as a collaboration withProfessor Mitsuhiro Kato of Showa University, we are also analyzing the sleep of children with
developmental disorders. At this conference, we will present the current status of our ongoingproject to measure children's sleep.
The authors declare that the research was conducted with no commercial or financial
relationship that could be construed as a potential competing interest or conflict of interest. The
Ethics Committee of the University of Tokyo approved the methods and procedures, all ofwhich were performed in accordance with the Declaration of Helsinki.
12:30-13:10 Research Topics 22
Neuroimaging for social and sensory dysfunctions in adults with autism
spectrum disorders
Hirotaka Kosaka1
1
Department of Neuropsychiatry, University of Fukui, Fukui, Japan
ABSTRACT
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by
impairments in socialization, communication, and range of interests. Furthermore, theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) added sensory
abnormalities as a core symptom to the diagnostic criteria for ASD. The overall ASD prevalenceis 2.3% (one in 44) (Maenner et al., MMWR Surveill Summ, 2021), and it is not an uncommon
psychiatric disorder. It often causes functional impairments and social adjustment problems.

130However, the neurological basis is unknown. We have conducted neuroimaging researches withcollaborators in adolescents/adults with high-functioning ASD, and I will introduce our "social
brain" and “sensory characteristics” researches for ASD. These studies were approved by the
ethics committee of the University of Fukui and conducted in accordance with the ethicalstandards of the Declaration of Helsinki. I declare no competing interests.
Regarding the brain structure, we explored gray matter volume using voxel-based morphometry
in young male adults with ASD compared to normal male control subjects (Kosaka et al.,NeuroImage, 2010). ASD group showed significantly less gray matter volume in the rightinferior frontal gyrus, which is part of the mirror neuron system, results in impaired social
interaction, one of the core symptoms of ASD. We also researched social brain functions inyoung male adults with ASD during emotional face recognition (Ishitobi et al., Res Autism
Spectr Disord, 2011), self-face processing (Morita et al., Social Neurosci, 2012), self-relevant
processing (Komeda et al., SCAN, 2015), eye-contact and joint attention (Tanabe et al., Front
Hum Neurosci, 2012), and resting state (Jung et al., Mol Autism, 2014). These results suggestthat it is not dysfunction of a specific region, but rather aberrant functions of some regions, aswell as differences of the network between each region. Next, we investigated the association
between brain morphological changes and sensory characteristics using FreeSurfer (Habata etal., Transl Psy, 2021). There was a significant positive correlation between visual sensory
sensitivity scores and the right lingual cortical thickness. These findings suggest that brain
morphological changes may trigger sensory symptoms in adults with ASD. In addition, I will
introduce clinical researches in progress regarding pain and tactile sensation for ASD. Finally, I
would like to consider the seemingly unrelated relationship between social functioning andsensory characteristics.
13:20-14:50 Symposium 31
Digital Mental Health in Child and Adolescent Psychiatry
Moderator 1: Masaru Tateno (Tokiwa Child Development Center, Tokiwa Hospital, & Child
Mental Health Clinic, Department of Neuropsychiatry, Sapporo Medical University, School of
Medicine, Sapporo, Japan)
Moderator 2: Norbert Skokauskas (Department of Mental Health, Regional Centre for Child andYouth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of
Science and Technology (NTNU), Trondheim, Norway)
S31-1
Individualized Digital Decision Assist System (IDDEAS) from Norway
Norbert Skokauskas1
1
Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child
Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU),
Trondheim, Norway
ABSTRACT
Patient electronic health records (EHRs) are readily available to practitioners but rarely provide
adequate insight into complex clinical situations intrinsic to psychiatric care, including how best
to address newly developed biological frameworks for disorders, emerging methods forphenotyping symptoms, and identifying syndromes. A CDSS (clinical decision support system)
can offer evidence-based guidance by using practice parameters, standardized guidelines,
evolving scientific literature, and/or datasets compiled from actual experience, assembled in ascalable informatics framework. Essentially, a CDSS accesses large amounts of information andthen uses algorithms for matching patient conditions and phenotypic patterns to the most
relevant recommendations, so as to provide the most pertinent information and alternative
actions, at each step in the clinical decision-making process. The Individualized Digital
Decision Assist System (IDDEAS) is a new CDSS for child and adolescent mental health131

services in Norway. IDDEAS aims to increase service efficiency by making collected uniquehealth data sets work for patients by supporting clinicians decisions and improve quality ofservices by bringing evidenced-based expertise directly to the examination room.
S31-2
Training Experts in Child and Adolescent Psychiatry Using an Online
Conferencing System and e-Learning
Akira Imamura1,2, Naoki Yamamoto2, Ryoichiro Iwanaga1, Goro Tanaka1, Hirokazu Kumazaki3
1
Department of Occupational Therapy, Division of Health Sciences, Institute of Biomedical
Sciences, Nagasaki University, Nagasaki, Japan
2
Child and Adolescent Psychiatry Community Partnership Center, Nagasaki University
Hospital, Nagasaki, Japan3
Department of Future Psychiatric Medicine, Graduate School of Biomedical Sciences,
Nagasaki University, Nagasaki, Japan
ABSTRACT“Nagasaki University Hospital Child and Adolescent Psychiatry Community PartnershipCenter” was established in October 2015 for the purpose of training specialists who treat
children's minds and for regional cooperation in Nagasaki Prefecture. Nagasaki Prefecture islocated in the westernmost part of Japan, and includes 594 remote islands (including 72
inhabited islands) as well as remote areas other than remote islands.
In order to develop human resources and promote regional cooperation in such an environment,
we have been delivering online child psychiatry courses (online workshops and online lectures)using an online conferencing system since April 2016, long before the COVID-19 pandemic.
Doctors who have taken the online child psychiatry course and passed the case report will becertified as "Nagasaki prefecture children's mental support doctors". Currently, 49 doctors are
certified, and the number of hospitals that treat children with mental disorders in Nagasaki
Prefecture is gradually increasing. In addition, the number of doctors who work at childconsultation centers as mental support doctors for children is increasing.
Since 2020, we have been conducting online consultations as follow-up training for children's
mental support doctors. This is to enable the support doctors to support and treat children by
conducting online consultations with expert doctors for cases that the support doctors consider
difficult to treat. We are also planning a project to provide online coaching using avatar robots
for young doctors working on remote islands.
Another institution within Nagasaki University,” Nagasaki University Child mental Health Careand Education Center” has been conducting lectures using e-learning as a "Professional
Practical Skills Development Program" since 2017. This program aims to develop specialists
not only in the medical field but also in the fields of education and welfare. The program
currently has over 600 participants annually. This program also has participants from remoteislands and remote areas, and it is useful for the development of support for children’s minds inthe region.
We will present a report of our daily activities as described above, along with a discussion of theliterature.
S31-3
Telepsychiatry and its impact on therapeutic alliance during COVID-19
Say How Ong1
1
Department of Developmental Psychiatry, Institute of Mental Health, Singapore

132

ABSTRACTThe COVID-19 pandemic has expedited the adoption of telepsychiatry in Singapore.
Teleconsultations in the child psychiatric outpatient clinics started in 2020 with the purpose ofproviding ongoing clinical care and as an appropriate infection control measure. To date after
COVID-19 has become endemic, it continues to be offered to all suitable patients. Patient
selection for telepsychiatry will be presented and the difference in therapeutic alliance between
patients who had and those who had not received telepsychiatry would be examined anddiscussed in this symposium.
S31-4
Intervention for school refusal and hikikomori, severe social withdrawal, using
robots and Metaverse
Takahiro A. Kato1
1
Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University,
Fukuoka, Japan
ABSTRACTHikikomori is a pathological condition of social withdrawal for 6 months or more, and thenumber of hikikomori is estimated to be more than one million in Japan (Kato et al. World
Psychiatry 2018 & 2020). Among youth, hikikomori has been observed as school refusal.
Evidence-based intervention strategies for hikikomori and school refusal have not been wellestablished, and prolonged social isolation is a risk factors for a variety of mental disorders.
Persons with hikikomori and school refusal hesitate to communicate with others in-person, but
majority of them like to use internet via smartphones or laptop computers. Thus, we hypothesizethat non-human interventions using internet would be novel therapeutic strategy for sufferers
with hikikomori condition. In this symposium, we will introduce novel therapeutic approaches
using non-human communication robots and metaverse in Kyushu University Hospital andaffiliated hikikomori support canters, Fukuoka, Japan.
15:00-16:30 Symposium 35
Tourette syndrome and related disorders in Asia
Moderator 1: Yukiko Kano (Department of Child Neuropsychiatry, Graduate School of
Medicine, The University of Tokyo, Tokyo, Japan)
Moderator 2: Takashi Okada (Department of Developmental Disorders, National Institute of
Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan)
S35-1
Impact of comorbidities and sex on quality of life in children and adolescentswith Tourette syndrome
Yukiko Kano1,2, Maiko Nonaka2,3, Natsumi Kikuchi2,4, Mayu Fujiwara2, Akane Tokunaga2,3, Yu
Hamamoto1,2
1
Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo,
Tokyo, Japan2
Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan
3
Graduate School of Education, The University of Tokyo, Tokyo, Japan
4
Faculty of Human Studies, Shirayuri University, Chofu, Japan
ABSTRACT
Tourette syndrome (TS) is a chronic tic disorder with both motor and vocal tics, andcharacterized by frequent comorbidities such as attention-deficit/hyperactivity disorder (ADHD)

133

and obsessive-compulsive disorder (OCD). TS is included in neurodevelopmental disorders,which have been suggested to be more frequent in females than previously thought and manifest
slightly differently according to sex.
In this presentation, we aim to examine the relationship between tics, comorbidities and sex andtheir impact on quality of life (QOL) in patients with TS based on recent previous studies andour own survey in Japan.
In our survey in TS, tics, comorbidities, QOL, and mental health were assessed byquestionnaires in individuals with TS visiting four hospitals or members of Tourette Syndrome
Association of Japan from October 2019 to June 2020. The participants of this study were aged
18 years or younger. Tics and comorbid symptoms were assessed by parent-rated Tic Symptom
Self-report (TSSR) and Child behavior checklist (CBCL). QOL and mental health in theparticipants aged from 13 to 18 years were assessed by self-rated Gilles de la TouretteSyndrome-Quality of Life Scale (GTS-QOL) and General Health Questionnaire-28 (GHQ-28).
Sixty-seven participants assessed by CBCL were involved. In all the participants,
Anxious/Depressed in CBCL had a significant trend to be more frequent in females than inmales. In 13 aged from 6 to 12, Anxious/Depressed and Aggressive Behavior in CBCL had asignificant trend to be more frequent in females than in males. A multiple regression analysis
was performed with GTS-QOL and GHQ-28 as the dependent variables and TSSR, satisfactionof tic control, and CBCL as the independent variables, and significant relationship was foundbetween GTS-QOL, severity of motor tics, satisfaction of tic control and Internalizing Problems
as well as GHQ-28 and Internalizing Problems.
The accumulated findings to date indicate that comorbidities, particularly ADHD and/or OCD,
significantly affect QOL in children and adolescents with TS. When comorbidities were
examined in Japanese patients with TS using behavioral problems ascertained by CBCL,
internalizing problems were significantly associated with QOL, similar to previous studies.
Several studies suggest that female patients with TS have a lower frequency of ADHD and are
more prone to severe tics, especially in adulthood, but data on sex differences have not yet been
sufficiently established. Japanese patients with TS tended to be more anxious/depressed infemales than in males, suggesting that it is important to combine comorbidities and sex infurther examining QOL.
S35-2
The Prevalence and Comorbidity of Tic Disorders and Obsessive-Compulsive
Disorder in Chinese School Students Aged 6-16
Yi Zheng1, Yonghua Cui2
1
Department of Psychiatry, Beijing Anding Hospital, Capital Medical University, Beijing, China
2
Department of Psychiatry, Beijing Children’s Hospital, Capital Medical University, Beijing,
China
ABSTRACT
Obsessive-compulsive disorder (OCD) and tic disorders (TDs) are closely related andconsidered to etiologically overlap. Both disorders are characterized by repetitive behaviors. TD
and OCD often co-occur. The high comorbidity between OCD and TD individuals suggests that
we also need to pay more attention to the homogeneity and heterogeneity between TS and OCD.
A two-stage epidemiological study of psychiatric point prevalence was conducted. We used themultistage cluster stratified random sampling strategy to assess five provinces of China. The
Child Behavior Checklist was used to identify behavioral problems among the enrolled students
in the first stage. The results from the Mini-International Neuropsychiatric Interview forChildren and Adolescents and evaluations from two psychiatrists based on the Diagnostic andStatistical Manual-IV were used to make a diagnosis. Point weighted prevalence for TD and
OCD was estimated.
In the first stage, 73,992 participants aged 6-16 years old were selected. The prevalence rates of134

OCD and TDs were 1.37% (95% CI: 1.28-1.45) and 2.46% (95% CI: 2.35-2.57), respectively.
The prevalence of OCD was found to be higher in girls (p< 0.001) and higher in boys withtransient tic disorder (TTD) (p< 0.001) and Tourette's syndrome (TS) (p< 0.001). The mostcommon comorbidity of TS was OCD (40.73%), and for OCD, it was TS (11.36%).
Our study is the first nationwide survey on the prevalence of TD (2.46%) and OCD (1.37%) in
school students aged 6-16 years old in China. The high comorbidity between OCD and TD
individuals suggested overlap based on the prevalence dimensions, which might be influenced
by age and sex. This result suggested that we also need to pay more attention to thehomogeneity and heterogeneity between TS and OCD.
S35-3
Tourette and Chronic Tic Disorders: Results From Multimodal Brain Imaging
Studies in Korea
Jae Hyun Yoo1, IN-HYANG KIM2, Soo-Min Jang3, Woo-Seok Choi3, Yu-Bin Lim3, Bung-Nyun
Kim3, 4
1
Psychiatry, The Catholic University of Korea, Seoul St.Mary's Hospital, Seoul, Korea
2
Psychiatry, Hanyang University Medical Center, Seoul, Korea
3
Psychiatry, Seoul National University Hospital, Seoul, Korea
4
College of Medicine, Seoul National University, Seoul, Korea
ABSTRACTIntroduction: Tic and tourette disorders are neurodevelopmental disorders that develop in earlychildhood. Literature suggested tic symptoms are associated with widespread structural changes
including cortico–striatal–thalamocortical pathway and ascending cortical inputs. Still, methods
and sample size have varied widely across imaging studies, findings from stuructural imaging
have not been converged yet in tic disorder.
In the current study, we aimed to find neural correlates of tic disorder by exploring subcorticalmorphologic changes and associated anatomical connectivity findings.
Methods: Current study recruited 62 subjects with chronic tic disorder and 62 age-matched
controls. To reveal collective alterations alongside subcortical structures and white matter, wesequentially analyzed multimodal imaging data. Using FIRST of FSL, comparison ofmorphologic alteration has been conducted using high-resolution T1-weighted images. Hence,
regions with significant change inputted as seed mask for diffusion tractography by mrtrix3.
Results: The shape of subcortical structure among participant with tic disorder showedsignificant shrinkage in posterodorsal facet of right amygdala (p=0.017), ventromedial facet ofright putamen (corrected p=0.029), posterior and lateral facet right pallidum (corrected
p=0.041), inferior and lateral facet of right thalamus (corrected p=0.030) and posterodorsal facetof left thalamus (corrected p =0.029). Seed based tractography revealed that tic group showed
reduced connectivity between right thalamus-right inferior insula (p=0.001), right thalamusright posterior lateral fissure (p=0.043), and right putamen-right inferior insula (p=0.037). In
contrast, connectivity between right putamen-right orbital area (p=0.028), and right pallidumright caudate (p=0.013) was stronger in tic group than that of control group.
Discussion: Current study highlighted that children with chronic tic disorder had morphologicalchanges across several subcortical regions including thalamus, putamen, pallidum andamygdala. In addition, cortical connectivity network from such regions are also wellcorresponded to neural correlates of genesis, premonitory urge, and suppression of tic.
S35-4
Case report on Indonesian Computer-based game intervention for children with
Tourette’s Syndrome (TS): A focus on executive function stimulation

135

Tjhin Wiguna1
1
Child and Adolescent Psyhchiatry Division, Department of Psychiatr, Faculty of Medicine
Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
ABSTRACT
Objective: Tourette syndrome (TS) is a developmental neuropsychiatric childhood-onset
disorder characterized by involuntary and premonitory urge-driven motor and vocal tics. Several
studies reported significant executive functions impairments in TS patients, and it was
speculated that some young TS patients show reorganization of prefrontal areas with consequent
increased executive functions ability enabling remission of TS symptoms. Indonesian computerbased game intervention was developed several years ago, and it showed a good effect on
improving executive function. Therefore, this presentation aimed to present three TS/tic disordercases and using the Indonesian-computer based game approach as an adjunct and main
alternative intervention.
Method: This was a case study that generated from the child and adolescent psychiatry
outpatient clinic and did not count into the research study. Therefore, it have not had any ethicalclearance yet. The first case is a six years old boy with ADHD and tic disorder, after several
weeks with immediate-release Methylphenidate Hydrochloride, the tics severity become more
prominent and parents was reluctant to continue psychostimulant medication. The second caseis a eleven years old boy with TS. The medication was antipsychotic second generation and it
induced sleepiness. The third case was an eight years old boy with TS that was treated by using
second generation-antipsychotic but the symptoms did not remit significantly. The whole threecases were treated by using Indonesian computer-based game intervention as an adjunctive
therapy or main intervention. Results were analyzed case by case and discussion was madequalitatively.
Results: The three cases intervened by Indonesian computer-based game stimulation once, twiceor three times in a week. One case was also treated by low dose of second generation
antipsychotic. After seven to ten times of stimulation, the tics symptoms decreased quite
significant. Parents reported that their child academic achievements improved, behavior andemotional expression was much more controllable, and there were not any others side effects orcomplaints.
Conclusion: This case report showed that Indonesia computer-based game therapy may become
an adjunct alternative intervention that conjunctively given with medication or may be also
given solely without any medication to reduce TS/tic disorder. This study raised a question
whether Indonesian computer-based game therapy may improve executive function in children
with ADHD and TS/tic disorder, and as a final result it help them to control their own behavior
and emotional expression. Further study need to be proposed in order to answer this question.
I don't have any conflict of interest of this presentation.
Venue 4 (Room C-1)
9:10-9:50 Research Topics 19
Ifenprodil tartrate treatment of adolescents with post-traumatic stress disorder:
A double-blind, placebo-controlled trial
Tsuyoshi Sasaki1,2, Kenji Hashimoto3, Tomihisa Niitsu4, Yutaka Hosoda2, Yasunori Oda2, Yuki
Shiko4, Yoshihito Ozawa4, Yohei Kawasaki4, Nobuhisa Kanahara3, Akihiro Shiina3, Tasuku
Hashimoto2, Takaaki Suzuki5, Takeshi Sugawara6, Hideki Hanaoka4, Masaomi Iyo1,2,3
1
Department of Child Psychiatry, Chiba University Hospital, Chiba, Japan2
Department of Psychiatry, Graduate School of Medicine, Chiba University, Chiba, Japan
3
Chiba University Center for Forensic Mental Health, Chiba, Japan
4
Clinical Research Center, Chiba University Hospital, Chiba, Japan

136

5
6

Division of Pharmacy, Chiba University Hospital, Chiba, Japan
Translational Research and Development Center, Chiba University Hospital, Chiba, Japan

ABSTRACT
Background: Several lines of evidence suggest that glutamatergic neurotransmission via the Nmethyl-D-aspartate (NMDA) receptor plays a role in certain behavioral manifestations common
to Post-Traumatic Stress Disorder (PTSD). Ifenprodil tartrate is a neuroprotective agent thatbinds to the GluN2B subunit of the NMDA receptor. The aim of this study is to confirm whether
ifenprodil tartrate is effective in the adolescent PTSD patients. Methods: This is a randomized,
double-blind, placebo-controlled trial. Ten adolescent (13 to 18 years old) PTSD patients wererandomized into two arms: placebo (n = 4), 40 mg/day ifenprodil tartrate (n = 6) for 4 weeks.
All of the patients were assessed by IES-R-J (Primary outcome measure), TSCC-J, CDRS-R,
DSRS-C-J and CGI-I. Results: A comparison of baseline IES-R-J total scores and 4-week endpoint scores showed a mild trend of improvement (p = 0.0895) and the difference score was 9.314. A comparison of baseline scores and 2-week intermediate-point scores showed that IESR-J hyperarousal subscores and TSCC-J subscores (dissociation sub- scores, sexual concerns
subscores) improved significantly. A comparison of baseline TSCC-J sexual concerns subscoresand 4-week end-point scores improved significantly.
Conclusions: Our study may prove to be an short-term effective alternative safe treatment foradolescent patients with PTSD.
Ethics statement: This study was performed in accord with the Declaration of Helsinki II. The
Institutional Review Board of Chiba University Hospital approved the study protocol (approval
no. G25013). After receiving a full explanation of the study as well as any potential risks andbenefits, all subjects (person him/herself and legally acceptable representative) provided written
informed consent for participation in the study.
Trial registration: We registered this trial on the official database of clinical research(ClinicalTrials.gov) as NCT01835093 on July 11, 2013 and on the UMIN clinical trial registryas UMIN000011720 on September 11, 2013.
COI: Tsuyoshi Sasaki reports grants and personal fees from Otsuka and Shionogi, personal feesfrom Janssen, Kyowa, Yoshitomi, Eli Lilly, Novartis, Takeda, Shire, Meiji, Sumitomo Pharma,
Nobel Pharma and Towa outside the study.
https://doi.org/10.1016/j.psychres.2022.114486
10:00-11:30 Symposium 28
Early child mental health interventions
Moderator 1: Tjhin Wiguna (Faculty of Medicine, Department of Psychiatry, University ofIndonesia, Indonesia)
Moderator 2: Andre Sourander (Department of Clinical Science/Faculty of Medicine, Universityof Turku, Finland)
S28-1
The rationale and practical skills of a school-based universal prevention program
Shin-ichi Ishikawa1, Kohei Matsubara1, Kohei Kishida1, Noriko Hida1
1
Department of Psychology, Doshisha University, Kyoto, Japan
ABSTRACTA school-based universal psychological intervention is one of the avenues to prevent andpromote child and adolescent mental health. The workshop will provide the rationale andpractical skills of a school-based universal prevention program, called the Universal Unified
Prevention Program for Diverse Disorders (Up2-D2; Ishikawa et al., 2019), based on cognitive
behavioral and positive psychological interventions. First, current evidence and theoretical137

background of school-based psychosocial programs for anxiety and depression in children will
be provided. Second, the components in the Up2-D2 will be explained referring materials forteachers and students as well as actual classroom management. Participants will learn the basic
knowledge and skills regarding school-based universal prevention programs for mental health.
The studies in this presentation were conducted with the approval of the Institutional Review
Board of the authors’ university (17002, 201904, 202012, 22003) and Ethics Committee of the
National Center of Neurology and Psychiatry (A2016-035). The authors declare no conflict ofinterest.
S28-2
The Translation and Cultural Adaptation Process of a School-Based Mental
Health Intervention on Emotional Awareness in Children Living in Finland
Tiia Ståhlberg1,2,3, Yuko Mori1,2, Lotta Lehti1,2, Sonja Gilbert1,2
1
Research Centre for Child Psychiatry, Department of Clinical Medicine, University of Turku,
Turku, Finland
2
INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical
Medicine, Faculty of Medicine, University of Turku, Turku, Finland3
Department of Child Psychiatry, Turku University Hospital, Turku, Finland
ABSTRACT
Cultural adaptation process (CAP) of evidence-based interventions is critical to delivering anintervention to a new population. The aim of this presentation is to describe the CAP of the
Universal Unified Prevention Program for Diverse Disorders (Up2d2) program developed inJapan, to Finnish elementary school context. First, a CAP working group, including twobilingual translators, a linguist, mental health researchers, psychiatrists, and cognitive
behavioural therapy (CBT) specialists, was established. Japanese researchers and two Finnish
education specialists were consulted throughout the process. Second, the program contents weretranslated into Finnish and adapted to local culture, teaching and school system. The aim
throughout the CAP was to balance between three factors: (1) fidelity and spirit of the original
program, (2) appropriateness to the Finnish culture, school and teaching system and (3)preserving the integrity of the CBT core content. Contextual modifications were documented.
The feasibility of the Finnish ‘Let´s learn about emotions’ version of the program will be
examined in a pilot study in 36 classes from February to May 2023. Let´s learn about emotions
will be delivered to 4th graders at primary schools in the city of Hyvinkää, Finland.
Research ethics were followed in the cultural adaptation process, being faithful for the original
program but also considering ethical approach of Finnish children. Ethical approval for thefeasibility study of the program was granted by The Ethics Committee for Human Sciences at
the University of Turku, Health Care Division (8/2023). The authors declare no conflict ofinterest.
S28-3
Online Mental Health Strengthening Module to Build Resilience and Overcome
Stress for Transitional Age Medical Students in Indonesia
Fransiska Kaligis1, Tjhin Wiguna1
1
Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo
General Hospital, Jakarta, Indonesia

138

ABSTRACTFirst-year college students are prone to stress due to changes in biological, psychological, andenvironmental situations they encounter. To overcome those challenges, college students need toincrease their resilience. Currently, there is no module for improving resilience amongtransitional age youth in Indonesia. A mixed method research is used in this study. Qualitative
research is carried out at the module development stage by conducting in-depth interviews withstudents, and a Delphi survey with experts. The module effectiveness test on resilience ismeasured by the Connor-Davidson Resilience Scale (CD-RISC) questionnaire, knowledge andattitudes towards mental health, Perceived Stress Scale (PSS), and Depression Anxiety Stress
Scale (DASS). The presentation will share and discuss the result of this study.
The study has got ethical approval from ethical committee of the Faculty of Medicine
Universitas Indonesia number ND-701/UN2.F1/ETIK/PPM.00.02/2021. Authors declare no
conflict of interest.
S28-4
Stronger Together – randomized controlled trial of a population-based iCBT intervention for antenatal depression
Terja Ristkari1,2, Tarja Korpilahti-Leino1,2
1
Research Centre for Child Psychiatry, Department of Clinical Medicine, University of Turku,
Turku, Finland
2
INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical
Medicine, Faculty of Medicine, University of Turku, Turku, Finland
ABSTRACT
Untreated antenatal depression is associated with postpartum depression and severe childoutcomes, e.g. emotional and behavioral problems and difficulties in bonding and earlyattachment. These risks could be reduced by providing effective treatment for antenatal
depression. As a part of this ongoing study, a new iCBT intervention for antenatal depression
has been developed. The intervention "Stronger Together” is delivered in internet platform andit includes highly structured phone coaching by health care professionals. The intervention
contains seven weekly themes and it utilizes core components of CBT adapted to pregnancy.
The aim of the RCT-study ( n= 400 + 400) is to combine population based screening (EPDS ≥10
points) in Finnish maternity clinics, with a low threshold intervention. The efficacy of theintervention is studied. In this workshop we will introduce the RCT- study and the content of theStronger together –intervention.
The study has been registered at ClinicalTrials.gov (ID NCT04223115). It has been approved by
the Research Ethics Board of the Hospital District of Southwest Finland (115/1801/2019).
Participation in the study is voluntary.
Authors declare no conflict of interest.
S28-5
Tele-mental health bridging the service gap in child and adolescent mental healthin NepalArun Raj Kunwar1
1
The Head, Child and Adolescent Psychiatry unit, Kanti children's hospital, Kathmandu, Nepal
ABSTRACTChild and adolescent mental health (CAMH) is a critical issue in developing countries, where139access to mental health services is often limited. The CAMH needs and services in Nepal have asignificant gap. There is only one full-time child and adolescent psychiatry (CAP) out-patient
clinic in the country. Tele-mental health is a promising solution that can help to improve accessto mental health care for children and adolescents in countries like Nepal. In the first half of thispresentation we discuss the use of Tele-mental health intervention during COVID pandemic inproviding CAMH support. In the second half, we will discuss the use of chatbot and direct televideo consultations to bridge the service gap in CAMH in Nepal.
Authors declare no conflict of interest.
12:30-13:10 Research Topics 23
Project to reinforce medical treatment, care, and promotion of mental healthamong children and adolescents collaborated with Japan and Philippines
Masahide Usami1
1
Deaprtment of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for
Global Health and Medicine, Ichikawa, Japan
ABSTRACT
National Center for Global Health and Medicine (NCGM) conducted training programs incollaboration with the University of the Philippines Manila, the National Center for Mental
Health, and the Philippine Society of Child and Adolescent Psychiatry in 2017,2019,2020 and
2021 to discuss the children’s mental health issues.
The Philippine Mental Health Act came into force in 2019, and it is expected that people withmental illness will be more concerned about human rights protection. Children with mental
health problems are also a cause of concern (Cagande, 2013, Larson LM., 2017). In thePhilippines, 16% of children had mental disorders (WHO AIMS, 2007). Furthermore, due to theimpact of COVID-19, there is no prospect of resumption of face-to-face classes in thePhilippines, and the problem of psychological stress is expected to be even greater than in Japandue to the strict restrictions on going out. The COVID-19 pandemic has exacerbated mental
health problems among children and adolescents. The COVID-19 mitigation measures such as
school closures and stay-at-home orders have disrupted the daily routine of children andadolescents, which subsequently increased the risk of their exposure to violence and developing
mental health problems such as depression, anxiety, and internet addiction. The disruption in thedelivery of mental health care and promotion emphasizes the need for strengthening theprovision of psychiatric care not only in specialized health facilities but also in empoweringcommunities in addressing mental health concerns of children and adolescents. Collaboration
between health facilities, schools, the local government, different stakeholders, and the families,
is needed to ensure the well-being of children and adolescents during public health emergencies
such as the COVID-19 pandemic. Therefore, we think that children's mental health during
COVID-19 pandemic will be more social important issues in future.
The face to face and/or online activities of the training program by NCGM provided an
opportunity to share the current situation, challenges, and good practices in mental healthtreatment, care, and promotion for children and adolescents in Japan and the Philippines
before/during the COVID-19 pandemic. The training program provides an opportunity forsharing best practices towards the improvement of child and adolescent mental health care andpromotion after COVID-19 pandemic.
13:20-14:50 Symposium 32
Social phenotypes of autism spectrum disorders and Williams syndrome
Moderator 1: Ryo Kimura (Department of Anatomy and Developmental Biology, Graduate
School of Medicine, Kyoto University, Kyoto, Japan)

140Moderator 2: Masahiro Hirai (Department of Cognitive and Psychological Sciences, Graduate
School of Informatics, Nagoya University, Nagoya, Japan)
S32-1
Williams syndrome：Clinical features, diagnosis, and management
Ryo Kimura1
1
Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto
University, Kyoto, Japan
ABSTRACT
Williams syndrome (WS), also referred to as Williams–Beuren syndrome, is a rare genetic
disorder caused by the heterozygous deletion of 26–28 genes at 7q11.23, occurring in 1 of
10,000 individuals. In particular, hypersociability and over-friendliness to strangers, so called“cocktail party” personality, have received considerable attention. Such hypersocial behavior
seems to be opposite to autism spectrum disorders (ASD), which are characterized by reduced
interest in social stimuli and genetic heterogeneity. Therefore, studying WS is expected toilluminate genes and pathways relevant to social behavior.
In addition to hypersociability, WS presents with characteristic fairy-like facial features,cardiovascular abnormalities (such as supravalvular aortic stenosis), endocrine abnormalities(such as hypercalcemia), intellectual disability, visual cognitive impairment, attention
deficit/hyperactivity and hyperacusis. However, not all symptoms are present, and thecomplications vary with age. Moreover, the manifestations of the symptoms after adolescenceare not well understood. Also, the mechanism of the variety of symptoms arise remains largely
unknown.
In this symposium, we will outline the clinical features, diagnosis, and management of WS sothat they will be useful in daily medical practice. We will also present the results of recent
epigenomic studies that we have been conducting with the cooperation of patient and family
associations. WS is a rare disease and is not yet fully recognized. Throughout this symposium,
we hope to attract more people's interest in WS, and to encourage collaborative research.
Our study was approved by institutional ethics committees at each participating institution.
Written informed consent was obtained from all participants and/or their parents according to
the Declaration of Helsinki. I have no financial relationships to disclose.
S32-2
Exploring social phenotype in Williams syndrome: cross-syndrome approach
Masahiro Hirai1
1
Department of Cognitive and Psychological Sciences, Graduate School of Informatics, Nagoya
University, Nagoya, Japan
ABSTRACT
Williams syndrome (WS) is a rare genetic disorder caused by a partial deletion of chromosome
7 with a prevalence of approximately 1 in 10,000. In recent years, WS has attracted muchinterest due to its characteristic sociability (hypersociability), and the social phenotype of WS
has been discussed in comparison with autism spectrum disorders (ASD), which are associatedwith difficulties in social communication. Using the Social Responsiveness Scale-2, wedemonstrated that WS had lower severity scores than autism for social motivation and social
communication, but no differences were found for other social cognition, social awareness, andrestricted repetitive behaviors (Hirai et al., 2022). Regarding social perception, it has beenreported that children with ASD have difficulty orienting to faces (Riby et al., 2011). We
investigated looking behavior of individuals with WS using an eye tracker. The results of a141

series of studies showed that children with WS had significantly greater attention to faces
unrelated to the task than typically developing children, suggesting that they may have difficulty
disengaging their attention from faces during a search for a target. Furthermore, we found anegative correlation between the duration of looking time for faces and nonverbal reasoning
ability (Hirai et al., 2016a; Hirai et al., 2016b). As for social cognition, it has been reported thatchildren with ASD have difficulty understanding the perspective of others, which is an
important social interaction (Hamilton et al., 2009). We demonstrated that children with WS
also have more difficulty understanding others' perspectives than in controlled tasks.
Furthermore, while the performance of children with typical development improved with thedevelopment of verbal mental age, the performance of children with WS on the task ofperspective-taking did not correlate significantly with the development of verbal mental age(Hirai et al., 2013).
The results of these studies suggest that the social perceptual and cognitive characteristics ofchildren with WS, which have been uniformly regarded as "hypersocial," may have socialcognitive characteristics similar to those of children with ASD, with unevenness depending on
the hierarchy of processing of social information.
A series of studies were approved by institutional ethics committees at each participating
institution. Written informed consent was obtained from all participants and/or their caregivers
according to the Declaration of Helsinki. I have no financial relationships to disclose.
S32-3
The ambiguity of the generative model of rational agents in relation to mindreading deficits
Kazunori Terada1
1
Gifu University, Faculty of Engineering, Gifu, Japan
ABSTRACT
Prediction of others individuals' behavior is essential in society. In a highly organized society, it
is difficult to pursue one's own interests alone, so people cooperate, but cooperation can be
exploited by so-called 'free-riders'. Therefore, it is important to predict whether the other party
will output good (cooperative) or bad (exploitative) behavior. Behavior prediction is performed
based on models. One powerful possible model is mechanical causality, such as the if-then rule,
but it cannot make predictions when the rule is not archived in memory. To address this, people
employ generative models of rational agents that endeavor to attain goals. Behavior prediction
is made by using the observed situation and behavior, Bayesian inference of the agent's goalusing the generative model of rational agents as the likelihood, and the assumption that theagent will take rational action to achieve that goal. In this presentation, we will introduce
experiments that showed that people actually infer their counterpart agent's goals and makerational decisions in iterated two-person two-move games in which the preference structures are
given by a 2x2 matrix. We also discuss the possibility that the difficulty in reading the minds ofothers, which is the typical deficit of people with autism spectrum disorder, can be explained by
the ambiguity of the generative model of rational agents.
S32-4
Communication characteristics of individuals with Autism spectrum disorder andWilliams Syndrome
Kosuke Asada1
1
Department of Social Psychology, Faculty of Sociology, Toyo University, Tokyo, Japan142

ABSTRACTIn this presentation, I present a review of the studies using experimental psychological methods
on the communication characteristics of individuals with autism spectrum disorder (ASD) andWilliams syndrome (WS). ASD is a developmental disorder, characterized by difficulties insocial communication and interaction, as well as restricted and repetitive behavior, interests, or
activities. WS is a genetic disorder, characterized by relatively good vocabulary skills anddifficulty in visuospatial cognition. The social phenotypes of ASD have been contrasted withthose of WS. In other words, individuals with ASD are not particularly sociable (preferring not
to interact with others), but individuals with WS are hypersociable (preferring to interact
excessively with others). However, recent studies have proposed the similarities in these
disorders in addition to the differences. For example, individuals with ASD preferred shorter
interpersonal distances than typically developing individuals. In addition, children with ASD
showed difficulties with understanding pragmatic language, as shown by their understanding of
conversational rules, compared with typically developing children. On the other hand, children
with WS showed less attention-sharing communication than did typically developing children,
even though children with WS produced the same amount of language. In addition, children
with WS showed greater difficulty in clarifying their meaning when miscommunication
occurred than did typically developing children. Overall, individuals with these disorders have
opposite characteristics where the tendency to interact with others is concerned. However, bothindividuals with ASD and WS show difficulty in social communication. A model forunderstanding developmental disorder with social difficulties can be derived from these studies.
Individuals with ASD have difficulties in both social communication and interaction. If wefocus on the ASD model, the ability to communicate successfully and tendency to interact withothers can be regarded as being closely related. However, individuals with WS have difficulties
in social communication despite their preference for interacting with others. If we focus on the
WS model, the ability to communicate successfully and tendency to interact with others can be
regarded as being dissociated. I discuss how social difficulties are manifested in different
disorders and how characteristics of communication and interaction are related to each other incases of typical and atypical development. I also discuss the importance of cross-syndrome
studies, examining different developmental disorders with social difficulties.
The studies presented were conducted in accordance with ethical considerations through theapproval of institutional review boards. I have no financial relationships to disclose.
15:00-16:30 Symposium 36
Epidemiological Studies of Children in Japan and Taiwan
Moderator 1: Kazuhiko Nakamura (Department of Neuropsychiatry, Hirosaki University
Graduate School of Medicine, Hirosaki, Japan)
Moderator 2: Susan Shur-Fen Gau (Department of Psychiatry, National Taiwan University
Hospital and College of Medicine, Taipei, Taiwan)
S36-1
Is screen time in infancy associated with suboptimal neurodevelopment?
Findings from a birth cohort study
Kenji J. Tsuchiya1,2, Mika Sugiyama1, Tomoko Nishimura1,2
1
United Graduate School for Child Development, Osaka University, Kanazawa University,
Hamamatsu University School of Medicine, Chiba University, University of Fukui, Suita, Japan
2
Research Center for Child Mental Development, Hamamatsu University School of Medicine,
Hamamatsu, Japan
ABSTRACT
Is higher screen time (ST) at age 2 years associated with suboptimal neurodevelopment in143

communication, daily living skills, and socialization at age 4 years? If so, how strong is theassociation, and is there any mediating factor, of the association? We addressed these questions
using a population-based birth cohort, the Hamamatsu Birth Cohort for Mothers and Children(HBC Study; Takagai et al., 2016, Int J Epidemiol). HBC Study has enrolled 1 258 children
born from 1 138 mothers, representative of Japanese children and pregnant women, since
December, 2007 until March, 2012. Using a subsample (n=885) of HBC Study participants, wefound higher ST (>1 hour a day) at age 2 years was associated with both lower communication(-0.2SD) and daily living skills (-0.1SD) at age 4 years. For daily living skills, 18% of theassociation was mediated by the frequency of outdoor play at 2 years 8 months. A link between
ST in infancy and suboptimal neurodevelopment was confirmed but small in magnitude, andfrequent outdoor play mitigated the link. Future research should specify factors that could
alleviate the association enabling targeted interventions that reduce the potential risk in ST.
Ethical considerations: This study was approved by the Institutional Review Board ofHamamatsu University School of Medicine (No. 20-233). Written informed consent was
obtained from all caregivers for their own and their child’s participation.
COI disclosure: No authors reported conflict of interest to be disclosed.
S36-2
Co-occurring neurodevelopmental disorders of autism spectrum disorders infive-year-old children
Yui Sakamoto1, Manabu Saito2, Tomoya Hirota1,3, Ayako Osato1, Tamaki Mikami2, Ai Terui1,
Kazuhiko Nakamura1
1
Department of Neuropsychiatry, Hirosaki University Graduate School of Medicine, Hirosaki,Japan
2
Department of Comprehensive Rehabilitation Science, Graduate School of Health Sciences,
Department of Clinical Psychological Science, School of Medicine, Hirosaki University,
Hirosaki, Japan3
Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences,
University of California San Francisco, San Francisco, USA
ABSTRACTIn Japan, we have a health check-up system for children aged 18 months and 3 years old, whichis required by law, and the participation rate is over 90%. However, the problem is that thedetection rate for neurodevelopmental disorders (NDDs) is low and many children with NDDs
miss the opportunity for early intervention.
For this reason, we have been in cooperation with the Hirosaki Municipal Health Center and theHirosaki City Government to conduct the Hirosaki Five-year-old Children Developmental
Health Check-up (HFC) annually since 2013. The HFC was conducted in two stages: initial
screening and comprehensive assessment. In the initial screening stage, the following measures
were used: Autism Spectrum Screening Questionnaire (ASSQ), Strengths and Difficulties
Questionnaire (SDQ), ADHD-Rating Scale-IV (ADHD-RS-IV), Developmental Coordination
Disorder Questionnaire (DCDQ), and Parenting Stress Index (PSI). Caregivers complete all of
the above screeners, and the teachers of nursery schools complete the SDQ. All children who
screened positive were invited to a comprehensive assessment. The clinical data were taken
together to diagnose neurodevelopmental disorders (NDDs), specifically autism spectrum
disorder (ASD), attention deficit hyperactivity disorder, developmental coordination disorder,
and intellectual disability. Between 2013 to 2016, caregivers of 3954 children returned thescreening and 559 children underwent the assessment.
87 children received an ASD diagnosis and only 11.5% of them had ASD alone; the remaining
88.5% had at least one co-existing NDD. Common co-occurring conditions include ADHD
50.6%, DCD 63.2 %, 36.8% ID, and 20.7% borderline intellectual functioning. This result is144

consistent with previous research. In view of these results, it is necessary to examine the broaddevelopmental characteristics and the support that depends on each characteristic.
This study was approved by the Committee of Medical Ethics of Hirosaki University Graduate
School of Medicine. The authors declare that they have no competing interests.
S36-3
Trajectories to Onset of Non-suicidal Self-injury in 9th Grade Students in Japan
Nobuya Takayanagi1, Hiroyuki Ito2, Megumi Hamada3, Mitsunori Myogan4, Yasuo Murayama5,
Masatsugu Tsujii6,71
Department of Psychology, Aichi University of Education, Kariya, Japan
2
Faculty of Human Life and Environmental Sciences, Ochanomizu University, Bunkyo-ku,
Japan
3School of Human Care Studies, Nagoya University of Arts and Sciences, Nisshin, Japan
4
School of Psychology, Chukyo University, Nagoya, Japan
5
Institute of Human and Social Sciences, Kanazawa University, Kanazawa, Japan
6
School of Contemporary Sociology, Chukyo University, Toyota, Japan
7
Research Center for Child Mental Development, Hamamatsu University School of Medicine,
Hamamatsu, Japan
ABSTRACT
Although many studies have reported that non-suicidal self-injury (NSSI) is associated withmental health problems, family distress, and social maladjustment, comprehensive research has
not yet been conducted in Japan. Since 2007, our project has been surveying preschool through9th grade students, their parents, and teachers in our partner city to examine mental healthissues. This study examined factors associated with the onset and trajectories of NSSI inadolescents. We obtained data from 4050 students (2051 boys and 1999 girls, 7–9th grades)from five cohorts who were followed up for three years. A comparison between the selfinjurious group in 9th grade (NSSI group) and the non-self-injurious group showed that the
NSSI group had more problems such as depression (0.29-1.17SD), family distress (0.441.04SD), and rumination (0.40-0.89SD) from 7th to 9th grade. The NSSI group not only had
significant problems in 9th grade, but also showed a tendency toward depressive, family
distress, and school maladjustment as early as 7th grade. The findings are expected to lead toearly identification and prevention of high-risk students.
Ethical considerations: This study was approved by the Institutional Review Board ofHamamatsu University School of Medicine (No.18-166). An explanatory document was
distributed to all adolescents and parents, and opt-out/refusal by them were obtained.
COI disclosure: No authors reported conflict of interest to be disclosed.
S36-4
Prevalence of DSM-5 mental disorders and disease burden in a nationally
representative sample of children in Taiwan
Susan Shur-Fen Gau1
1
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
ABSTRACTIntroduction: There has been a lack of prevalence estimates of DSM-5 mental disorders in childpopulations at the national level worldwide. Little is known about the discrepancies in the145burden of child mental disorders based on differences in prevalence between treated anduntreated populations. Identifying such discrepancies provides a better understanding of theunmet needs related to child mental disorders. Hence, this study estimated the lifetime and sixmonth prevalence of DSM-5 mental disorders and compared the years lived with disability(YLD) between children with treated and untreated mental disorders using a representative
national survey, Taiwan’s National Epidemiological Study of Child Mental Disorders(TNESCMD), and the Taiwan National Health Insurance Research Database (TNHIRD).
Methods: TNESCMD used stratified cluster sampling to select 69 schools in Taiwan, resulting
in a nationally representative sample of 4816 children in grades 3 (n=1352), 5 (n=1297), and 7(n=2167). All the participants underwent face-to-face psychiatric interviews using the KiddieSchedule for Affective Disorders and Schizophrenia-Epidemiological version, DSM-5 version.
The comorbidity-adjusted YLD rate ratio (RR) was reported to quantify the YLD discrepancy.
Results: The inverse probability censoring weighting (IPCW) adjusted weighted (lifetime andsix-month) prevalence rates for overall mental disorders were 31.6% and 25.0%, respectively.
The most prevalent mental disorders (lifetime and six-month prevalence rates) were anxiety
disorders (15.2%, 12.0%) and attention-deficit hyperactivity disorder (ADHD; 10.1%, 8.7%),
followed by sleep disorders, tic disorder, oppositional defiant disorder, and autism spectrum
disorder. The overall YLD rate in the TNESCMD was 9.05 times higher than that in the
TNHIRD, with the lowest and highest YLD RRs for autism spectrum disorder (RR: 3.51) andanxiety disorders (RR: 360.00). Unlike the YLD proportion explained by attentiondeficit/hyperactivity disorder and autism spectrum disorder, the proportions explained byanxiety disorders and conduct disorder/oppositional defiant disorder compared to the total YLD
were relatively lower in the TNHIRD than in TNESCMD and the Global Burden of Disease
2016.
Conclusions: DSM-5 mental disorders are common in the Taiwanese child populationsuggesting the need for public awareness, early detection, and prevention. High YLD
discrepancies in child mental disorders suggest significant unmet needs for care in child mental
disorders and that estimates of disease burden that rely heavily on a single source may result in
unreliable results.
This study was approved by the Research Ethics Committee of National Taiwan University
Hospital. No conflicts of interest.
Venue 5 (Room C-2)
9:10-9:50 Research Topics 20
Is ADHD a Disorder of Altered Reinforcement Sensitivity?: Evidence from fMRI
studiesEmi Furukawa1, Patrica Bado2, Raquel Quimas Molina Da Costa2, Gail Tripp1, Jeff Wickens1,
Paulo Mattos2, Jorge Moll2
1
Okinawa Institute of Science and Technology Graduate University (OIST), Human
Developmental Neurobiology Unit, Okinawa, Japan
2
D’Or Institute of Research and Education, Rio de Janeiro, Brazil
ABSTRACT
Altered behavioral sensitivity to positive reinforcement has been proposed as a core deficit inattention deficit hyperactivity disorder (ADHD). The neurobiological mechanisms underlying
this alteration are unclear. In non-human primates and rodents, dopamine cells fire in response
to unexpected rewards; this transfers to cues that predict rewards with repeated pairing. Tripp &Wickens (2008) hypothesized this transfer of dopamine firing from reward to reward-predicting
cues may be impaired in ADHD, leading to altered reinforcement sensitivity. Referred to as a
Dopamine Transfer Deficit (DTD).

146

To evaluate this proposal in humans, we conducted a series of functional magnetic resonanceimaging (fMRI) studies in young adults with and without ADHD. In these studies, we used aclassical conditioning paradigm, in which one cue was followed by reward and another cue by
non-reward. We assessed blood-oxygen-level-dependent (BOLD) activation in the striatum in
response to reward-predicting cues and to monetary, food and affiliative rewards (Furukawa etal, 2014; 2022). We also examined the effects of stimulant medication, methylphenidate (MPH)on BOLD activation in response to cues and monetary reward (Furukawa et al, 2020).
Increased striatal responses to cues predicting monetary and affiliative rewards were observed incontrol but not ADHD participants. Conversely, increased striatal responses to images ofmonetary and affiliative rewards were observed in the ADHD groups, relative to controls. The
ADHD and control groups responded similarly to food reward cues and images of food. These
results suggest individuals with ADHD have reduced sensitivity to reward cues while increased
sensitivity reward images, likely modulated by reward modality.
Separately, we showed that MPH modulates striatal responses to reward-predicting cues inadults with ADHD (Furukawa et al., 2020). BOLD responses to reward cues were larger in
ADHD participants when taking MPH versus placebo. MPH appears to improve
discriminability between reward and non-reward cues. MPH also reduced the fronto-striatal
BOLD time-series correlation during reward delivery.
Together these results suggest individuals with ADHD do not develop robust responses toreward-predicting cues compared with their typically developing peers. The observed BOLD
response patterns in these studies are consistent with impaired predictive dopamine signaling in
ADHD as proposed in the DTD hypothesis and may underlie their altered reinforcement
processing.
All studies were reviewed and approved by the OIST Human Subjects Review Committee(HSR-2010-002) and D’Or Institute of Research and Education Scientific Review Committee(25000.638339). The author has no conflicts of interest.
10:00-11:30 Symposium 29
Attachment perspectives on children and adolescent psychopathology –Clinicalapplication in child and adolescent mental health in Japan–
Moderator 1: Keiko Yoshida (Mental Clinic Iris and Kyushu University Hospital, Fukuoka,
Japan)
Moderator 2: Hiroshi Yamashita (Department of Child Psychiatry Kyushu University Hospital,
Fukuoka, Japan)
S29-1
Adolescent Psychiatric Care from the Perspective of Attachment and Emotional
Availability
Arata Oiji1
1
Mamenoki Clinic, Tokyo, Japan
ABSTRACTI am a child and adolescent psychiatrist engaged in clinical assessment of developmental
disorders and consultation for professionals who are caring maltreated children. In thisoccasion, I described my consideration on adequate approaches for treatment of children andadolescents in my daily clinical practice from the perspective of attachment and emotional
availability.
Puberty is a period when secondary sexual characteristics begin to emerge and children who
have grown up under the protection of their parents question their parents' values and rebel
against them. Peter Blos (1962) thought this period as the second individuation process. Erik
Erikson described the developmental task of this period as”'identity vs. role confusion”.

147

Adolescents are interacting with their peers, separating from their parents, and deciding theirown direction in their life and their place in society. In a clinical setting with relatively healthy
young people at the end of the 20th century, it was not inadequate to adapt these understandings
to psychiatric consultation.
The problem is that in the current child and adolescent psychiatric care, the pathology of thepatients seems to be more severe and complicated. Above all, more and more patients havedevelopmental disorders. At the same time, an increasing number of patients have beenmaltreated. There is also an impression that an increasing number of children have problems
in terms of emotional development from infancy, even if they do not have developmental
disabilities and have not been explicitly maltreated. The quality of parenting may be changing
and the number of children with attachment problems may be increasing in a situation where
community ties are fading, the number of children is decreasing, and the gap between rich andpoor is widening. In the treatment of these recent patients, I believe that therapeutic
approaches that considers understanding from the perspective of attachment and emotional
responsiveness will be necessary.
Attachment problems are naturally also an important therapeutic target in young people whohave been maltreated. However, I believe that attachment problems are often a therapeutictarget in developmental disorders as well. This is because developmental disabilities often
result in poor parent-child interactions in infancy. In any case, psychiatrists and psychotherapists
working with patients with serious pathologies who have attachment problems need to be able
to read the patient's emotions and mental processes, create a good framework, draw boundaries
and be emotionally stable.
The author has no financial conflict of interest to disclose concerning the presentation.
S29-2
Therapeutic approach to complex PTSD by a multidisciplinary team in a childpsychiatric ward and a child welfare institution
Naoki Horikawa1
1
Nozoenooka Hospital, Fukuoka, Japan
ABSTRACTChildren and families in social care are a high-risk population for trauma-related disorders dueto their cumulative experiences of childhood adversity, but the pathways from early detection
and assessment to treatment and care are still being developed. In formulating treatment andcare for the complex difficulties of treatment cases, it is necessary to describe broad-band
emotional and behavioral problems at the symptom level, as well as assess the care needs ofeach developing child and caregiver from multiple dimensions. Complex PTSD is arevolutionary diagnostic concept that includes categorical assessment: PTSD symptoms anddimensional assessment: disorders of self-organization, and can be clinically formulated tocomprehensively address both treatment and care aspects. In pediatric and psychiatric care, it isoften difficult for a single institution to provide multidisciplinary, multifaceted assessment andcare for complex PTSD. Timely introduction of assessment tools and psycho-educationalsessions for understanding and recognizing complex PTSD can lead to multi-agency treatment
and care. Specialized child psychiatric unit and child welfare institutions are tertiary support
organization, and can provide specialized treatment support through multidisciplinary
assessment and multidisciplinary cooperation. They are expected to play a key role in providing
treatment and care for complex PTSD and other trauma-related disorders in children in social
care and their families.
At Nozoenooka Hospital, the Child Psychiatry Unit and the Child Psychotherapy Facility (Child
welfare institution) are working together in a new initiative that integrates psychodynamic teamapproach and a therapeutic community model. This approach enables the provision of148

comprehensive treatment and care for children in social care. Through the experiences fromthese unique clinical practices, the clinical significance of the diagnosis of complex PTSD inchildren and the creation of a therapeutic environment and approach to children and families bya multidisciplinary team will be discussed.
The author has no financial conflict of interest to disclose concerning the presentation.
S29-3
Social care and attachment: treatment and support for adolescents in social care
Kenichi Yamane1
1
Department of Child Psychiatry Kyushu University Hospital, Fukuoka, Japan
ABSTRACTSocial care for children is classified as institutional and foster care, and millions of children
worldwide live in institutional care. In the USA and Western Europe, a shift from institutional tofamily foster care was promoted, but in Japan, the Child Abuse Prevention Act was finallyenacted in 2000 and the foster care system began to be developed. Recent years. Attachment
theory has been of central significance in the formulation of treatment and support for children
facing the breakdown of emotional bonds and the loss and separation of attachment objects
under social care . A large body of empirical evidence on attachment has been reported inprospective cohort studies in foster care intervention programmes based on international support
measures for Romanian orphans in the UK and the USA. There is evidence of treatment
responsiveness of foster care interventions, making it important to understand the broad rangeof mental health problems of children who have been inappropriately fostered as attachment
problems in an integrated way and to address child and adolescent treatment and support in along-term framework.
The Fukuoka City Child Guidance Centre was established in 1972. The "Comprehensive
Consultation Centre for Children", which was conceived as a centre for child and adolescentmental health in the "three-tier system for supporting children and families", was opened in May
2003. When conducting detailed, multifaceted assessments of the needs of children withcomplex family environments and diverse problems, who experience threats and crises on adaily basis, not only the child's developmental status but also attachment and trauma
perspectives are incorporated. Boris and Zeanah propose to view the level of adjustment in
attachment on a continuous spectrum from mild to severe. The adaptive level of a child's
attachment behaviour corresponds to the adaptive level of attachment-based family nurturancefunctioning and is also a process of assessing the child's safety. By understanding the child'sdevelopmental status, attachment and trauma issues, and by assessing the problems in the child's
care environment and family functioning, the following support strategies can be established:((1)in-home support, (2) alternative care measures and family reunification, and (3) nurturing
care environments other than the original caregivers'. In this presentation, present status andnew initiatives of Attachment based assessment and intervention system will be shared.
The author has no financial conflict of interest to disclose concerning the presentation.
S29-4
Clinical Application of Attachment Framework and concept of complex PTSD inchildren with Adverse Childhood Experience
Hiroshi Yamashita1
1Department of Child Psychiatry Kyushu University Hospital, Fukuoka, Japan

149

ABSTRACTA major clinical issue in child psychiatry is the diagnosis and treatment of trauma-relateddisorders as well as comorbidities in children with neurodevelopmental disorders. Specialized
child psychiatric units belong to the secondary and tertiary levels of psychiatric care and arecapable of multidisciplinary assessment and multidisciplinary collaboration. Children in social
care and their families are a high-risk population for trauma-related disorders due to theircumulative experiences of childhood adversity, but the pathways leading from early detection
and diagnosis to treatment and care are still being developed. As a child psychiatrist, I am
involved in medical consultation at child guidance centers and child psychotherapy facilities.
When formulating the complex difficulties of consultation cases, It is important to visualize theclinical needs by describing the emotional and behavioral problems at the symptom level, and at
the same time, assessment of the care needs of the developing child in the framework of
attachment. Complex PTSD is a comprehensive diagnostic concept that includes bothcategorical assessment: PTSD symptoms and dimensional assessment: disorders of selforganization, and is an innovative concept that can formulate both treatment and care needs
aspects.
To introduce such a multiaxial diagnostic system combining categorical and dimensional
assessment into clinical practice, multiple disciplines capable of assessing multi-dimensional
aspects of child development, family functioning, and multigenerational upbringing history. A
support team with multidisciplinary expertise is needed.
On the other hand, when the process of receiving treatment and care in social welfare system is
examined in medical consultation, two generations of parents and children use general
psychiatric care in many cases. The recognition, diagnosis, and intervention from theperspective of trauma-related disorders in the two generations of parents and children in general
psychiatric care leads to primary and secondary prevention in the community. In general
psychiatric care settings, it is often difficult for a single institution to provide comprehensive
multidisciplinary assessment and care. The introduction of screening tools andpsychoeducational sessions for understanding and recognizing complex PTSD can lead totreatment and care in collaboration with multiple institutions. Specialized child psychiatrictreatment facilities and child psychological treatment facilities belong to tertiary support
institutions among psychiatric and child welfare institutions. These specialized institutions are
expected to play a key role in providing treatment and care for complex PTSD and othertrauma-related disorders in children and families in social care.
The author has no financial conflict of interest to disclose concerning the presentation.
12:30-13:10 Research Topics 24
Longitudinal MRI studies of children with Attention-Deficit/Hyperactivity Disorder
Ayaka Ishii-Takahashi1, Rio Yamaguchi1
1
Department of Developmental Disorders National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACTIn the past two decades, neuroimaging studies of children with Attention-Deficit/Hyperactivity
Disorder (ADHD) have shown developmental changes in brain volumes, cortical changes,
gyrification, and connectivity using structural and functional MRI. Early studies focused on
structural development of the brain whilst recent work shows development of diffusion neuralnetwork in children with ADHD. However, there is no systematic review conducted to date, of
longitudinal developmental changes in the brain of children with ADHD.
In this review, we aimed to summarize the evidence to date regarding the trajectory of brain
development for children with Attention-Deficit/Hyperactivity Disorder, specifically using MRI.
The protocol was registered with the Database for Prospective Register of Systematic Reviews

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PROSPERO (No. CRD42022303719). All modality of brain structure and development(measures of anatomy including but not limited to volume, surface area, thickness; resting state
MRI, DTI..etc) was reviewed. A comprehensive search was conducted using seven databases(PubMed, Web of Science, CINAHL, PsychINFO, ERIC, Scopus and Medline) by two
independent researchers. The search strategy was as follows: an initial search conducted with
ADHD related terms; a second search conducted with terms associated with longitudinalstudies; a third search was then conducted with MRI related terms. Subsequently, a combined“AND” search was conducted with the three initial searches, extracting papers that were
included in all three searches. The entire article was retrieved and read if the abstract indicatedthe article potentially met the inclusion criteria. The initial search produced 5328 studies. Afterremoving duplicates, 2691 remained. Following a careful screening of the title and the abstracts,
the full paper was reviewed for 56 studies. In the end, seventeen studies were selected for the
purpose of the current review. In this systematic review, we found that the volume of the brain
was the most studied modality and the frontal lobe was the most studied region. While theassociation between brain development and clinical outcomes were reported in five studies, two
did not find any associations and ten did not examine such relationships. Due to the highly
heterogenous designs, analyses and results in the reviewed papers, the findings could not be
combined, quantitatively. Studies using MRI to uncover the longitudinal trajectory of brain
development in ADHD is increasing. However, it is critical that future studies address theheterogeneity in the methodology used in order to validate and replicate ﬁndings which could
contribute to improved clinical care.
13:20-14:50 Symposium 33
Elucidating pathology of ADHD: updates from recent neuropsychological studies
Moderator 1: Yuka Egashira (Department of Developmental Disorders, National Institute of
Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan)
Moderator 2: Sayuri Hayashi (Department of Developmental Disorders, National Institute of
Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan)
S33-1
Heterogeneity in ADHD: possible contributions of cognitive neuroscience andtheir clinical implications
Takashi Okada1
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACT
Attention-deficit hyperactivity disorder (ADHD) is diagnosed by inattention and/or
hyperactivity in two or more different settings that started before the age of twelve andcontinues for at least six months. These symptoms appear unsuitable for developmental age, andinterferes with daily functioning. It is often comorbid with other neurodevelopmental disorders
or psychiatric disorders.
Neuropsychological studies vigorously explored the neurobiological basis of ADHD. These
hypotheses include 1) disturbance in executive functions, 2) delay aversion, 3) difficulty intaking timing, and 4) low activations of default mode network. These disturbances areassociated with brain dysfunctions in prefrontal cortex, reward system, and cerebellum.
However, it is also important to emphasize that individuals with ADHD don’t have all of these
disturbances, i.e. the ADHD is heterogenous in its pathology. This fact is essential because theheterogeneity may be related with different trajectory and responses to interventions.
Recent cohort studies indicated that ADHD in childhood persists in to adulthood in less casesthat has been considered so far. Recent diffusion tensor imaging study reported that low
fractional anisotropy in the left uncinate and inferior fronto-occipital fasciculi, which is151

associated with inattention. In addition, neuropsychological studies examining time
reproduction suggested the impairments in adults with ADHD and unaffected first-degree
relatives and that increased grey-matter volume in the cerebellum was associated with poorer
temporal reproduction performance. Persistent ADHD may be one of the phenotypes among
originally diagnosed ADHD in childhood, and its neurobiological basis will be more specificallydetermined.
It is also well known that ADHD is frequently comorbid other mental disorders: internalizing
disorder, such as depressive or anxiety disorder, and externalizing disorders, such as
oppositional and defiant disorder or conduct disorder. It should be cautious because these
symptoms appear to fulfill the item to diagnose ADHD. To identify the core ADHD, clinicians
should understand the precise life history from childhood, and rule out the influences tobehavioral presentations from other psychopathologies.
In summary, recent studies are elucidating the true nature of ADHD as a neurodevelopmental
disorder. In future studies, follow-up studies are essentially important to elucidate therelationship between ADHD and comorbidities.
Presenter declared that there is no conflict of interest to disclose in this presentation.
S33-2
Executive function in attention deficit hyperactivity disorder and its impact on
reward feedback
Sayuri Hayashi1, Shota Uono1, Yuka Egashira1, Masatoshi Ukezono1, Miki Takada1,2, Takashi
Okada1
1
Department of Developmental Disorders, National Institute of Mental Health National Centerof Neurology and Psychiatry, Kodaira, Japan2
Department of Frontier Medicine and Pharmacy, Graduate School of Medical andPharmaceutical Sciences, Chiba University, Chiba, Japan
ABSTRACT
Positive feedback from others can help facilitate appropriate behavior in children with attention
deficit hyperactivity disorder (ADHD). Psychological research has shown that positive feedback
activates the reward system and aids cognitive processing. Meta-analyses have indicated that
feedback rewards improve executive function for all ages, sex, and diagnoses, including thosewith and without ADHD regardless of reward type. However, it is essential to note that theeffectiveness of feedback rewards in adults with ADHD is not yet fully understood.
We investigated the impact of social reward feedback on response inhibition task performancein adults with ADHD. A total of 39 participants with ADHD and 39 typically developed adults,
matched for age and sex and Full Scale Intelligence Quotient, participated in the study. They
completed a social incentive go/no-go task under three feedback conditions: mosaic, certain, anduncertain. In the mosaic condition, both successful and unsuccessful inhibition trials were
followed by the presentation of a mosaic image. In the certain condition, a succussed inhibition
trial was followed by a presentation of a happy face, and a missed trial was followed by aneutral face. In the uncertain condition, approximately 87.5 % of succussed inhibition trials
were followed by a happy face, while the remaining trials were followed by a neutral face.
Contrary to our expectations, feedback effects were not clear in adults with ADHD. The low
effectiveness of the feedback was not attributed to autistic traits or negative moods among theparticipants. Previous large cross-sectional studies have demonstrated that neural systems
involved in the feedback-reward effects vary among children, adolescents, and adults. However,few studies have examined these developmental effects in individuals with ADHD. We
speculate that neurological development might play a role in changing the feedback-reward
effects of ADHD, which should be the focus of further research.

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The study was conducted per the Ethical Guidelines for Medical and Health Research Involving
Human Subjects. The Ethics Committee of the National Centre of Neurology and Psychiatry,
Japan (A2021-125) approved the study protocol. The authors have no conflict of interest.
S33-3
Investigation of the Characteristics of “Genuine” Time Perception in ADHD
Yuka Egashira1, Sayuri Hayashi1, Shota Uono1, Miki Takada1,2, Masatoshi Ukezono1, Takashi
Okada1
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
2
Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
ABSTRACTTime perception deficit is one important factor of the pathological model of attentiondeficit/hyperactivity disorder (ADHD). The functional networks related to ADHD pathology
and the neural networks involved in time and timing perception overlap. Children andadolescents with ADHD show decreased connectivity in a fronto-striato-parieto-cerebellar
network, which are partly involved in processing time or timing. Regarding time and timing
perception, the cerebellum and basal ganglia networks are involved in the sub-second timing
tasks, whereas the supra-second timing tasks activated cortical structures, such as the
supplementary motor area and prefrontal cortex in typically developing individuals. Although
low performance on both sub- and supra-second timing tasks has been reported in ADHD, it isunclear whether the dysfunction is uniform regardless of temporal duration or task
characteristics.
To clarify the specific time perception deficits in ADHD, we examined this ability in adults andchildren with/without ADHD using three conventional time perception tasks. In addition, how
the performances are associated among tasks in typically developing adults are considered.
Three tasks were performed: the time reproduction (TR) as sub-second task, the duration
discrimination (DD) as supra-second task, and the tapping as supra-second motor timing task. In
the TR, the participants sustained a button pressing for the same duration as the preceding
stimulus (5 seconds). In the DD, the participants detected a target tone among three tones,
consisting of two pure tones (1200ms) as standard and one target tone (400, 700, 800, 900,
1000, or 1100ms). In the tapping task, the participants pressed the button to 50ms tones with
450ms intervals for 15 seconds; after that, they continued the button pressing for 15 seconds
without tones.
As a result, children with ADHD (C-ADHD) demonstrated lower duration discrimination rate of
DD compared to typically developing children (TDC). However, in the TR, mean duration
reproduction length had no significant difference, although standard deviation (SD) ofreproduction length in C-ADHD was bigger than TDC. In addition, in case of adults with
ADHD, only SD of TR’s length was bigger than non-ADHD. These results suggest that timeperception deficits related to cerebellum and basal ganglia networks in ADHD might be affectedby neural development. Moreover, the prefrontal cortex related task performance, such as SD of
reproduction length might need to be separated from time perception ability. The neuroimaging
approach will help to clarify the common aspects of tasks in detail.
S33-4
Why children with ADHD can’t wait?: The impact of reward availability andpredictive cues
Emi Furukawa1
1
Human Developmental Neurobiology Unit, Okinawa Institute of Science and Technology

153

Graduate University (OIST), Okinawa, Japan
ABSTRACT
Altered motivational processing is considered as one of the core mechanisms underlying ADHD
symptoms. It has been well documented that children with ADHD have a stronger preference
for immediate rewards and discount delayed rewards, even when doing so results in smaller
earnings. However, little attention has been paid to children's capacity to withhold responding
until a "better" reward becomes available, and their behavior while waiting.
We developed a novel computer task to examine the ability of children to wait to collect a large
reward in the presence of a small available reward, and the effects of reward-predicting cues on
waiting (Furukawa et al., 2022). Data from 136 children (6-12 years), 90 with ADHD and 46
typically developing (TD) children were examined. The children could collect a small
immediately available reward or wait to access a larger reward after a variable delay, its
imminent availability sometimes signaled by a cue. Unlike other commonly used tasks, children
were not required to make a decision between the two choices before waiting was initiated.
Children with ADHD were less successful in waiting for a better outcome in the presence of animmediate reward opportunity. They were also more likely to terminate waiting once
commenced, collecting the small reward or attempting to collect the large reward early. Rewardpredicting cues increased their response readiness but interfered with their ability to wait when
the cue-reward association was disrupted. Children with ADHD more often abandoned efforts towait, especially when wait times were extended and when expected rewards failed to appear.
The results highlight the complexity of difficulties children with ADHD experience in waiting
and the impact of cues in the environment on their reward seeking and waiting behavior.
Increased vulnerability to immediate reward opportunities likely results in suboptimal outcomesfor children with ADHD.
The study was reviewed and approved by the OIST Human Subjects Review Committee (HSR2008-001). The authors have no conflict of interest.
Furukawa E, Alsop B, Alves H, Vorderstrasse V, Carrasco KD, Chuang CC, Tripp G. Disrupted
waiting behavior in ADHD: exploring the impact of reward availability and predictive cues.
Child Neuropsychol. 2022 May 9:1-20.
15:00-16:30 Symposium 37
Behavioral parenting programs for ADHD: Cross-cultural considerations andimplementation challenges
Moderator 1: Yushiro Yamashita (Kurume University School of Medicine, Department ofPediatrics and Child Health, Fukuoka, Japan)
Moderator 2: Gail Tripp (Okinawa Institute of Science and Technology Graduate University
Human Developmental Neurobiology Unit, Okinawa, Japan)
S37-1
Well Parent Japan: A Pragmatic Multi-Site Trial of Parenting Program Designed toAddress the Needs of ADHD
Shizuka Shimabukuro1, David Daley2, Takahiro Endo3, Satoshi Harada3, Akemi Tomoda4,
Yushiro Yamashita5, Takashi Oshio6, Boliang Guo7, Gail Tripp1
1
Okinawa Institute of Science and Technology Graduate School (OIST), Human Developmental
Neurobiology Unit, Okinawa, Japan
2
Nottingham Trent University, Department of Psychology, Nottingham, United Kingdom
3
National Hospital Organization Ryukyu Hospital, Okinawa, Japan
4
University of Fukui, Research Center for Child Mental Development, Fukui, Japan
5
Kurume University School of Medicine, Development of Pediatrics and Child Health,Fukuoka, Japan

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6

Hitotsubashi University, Institute of Economic Research, Tokyo, Japan
University of Nottingham UK, Division of Psychiatry and Applied Psychology, School of
Medicine, Nottingham, United Kingdom
7

ABSTRACT
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorderassociated with numerous functional deficits and poor long-term outcomes for the affectedchild, threats to the mental health of the parents, and with significant financial burden to theindividual and society.
Internationally, parent training is recommended as part of a multimodal treatment approach forchildren with ADHD. In Japan, parent training programs target general behavior problems anddo not expressly target the needs of children with ADHD and their parents. The effectiveness ofavailable programs has not been rigorously evaluated and training for therapists is limited.
There is a recognized need for empirically supported parenting programs addressing the needsof Japanese children with ADHD and their families, and the training needs of those deliveringsuch programs.
We conducted a pragmatic multi-site randomized control trial (RCT) to examine theeffectiveness of Well Parent Japan (Shimabukuro et al, 2020) against treatment as usual (TAU)
in routine child psychiatry services. Well Parent Japan (WPJ) is a new parent training programthat combines psychological support for mothers with parenting skills specifically developed forfamilies dealing with ADHD (NFPP, Thompson et al, 2009; Thompson et al 2017). This study
included 124 mothers of children with ADHD recruited from three hospitals in Fukui, Fukuoka
and Okinawa prefectures. Therapists were trained and supervised to deliver the 13-session WPJ
program in groups of 6-8 mothers (two therapists per group).
The primary outcome for the study was stress in the parent domain with secondary outcomes
addressing child behavior, parenting efficacy, parenting practices and family strain. Analyses
were conducted with data collected immediately post intervention and at three-month follow-up
using intention to treat methodology (ITT). The cost of program delivery and cost effectivenessof WPJ were also evaluated in this study.
The study findings confirm the superiority of WPJ over TAU in routine clinical care in reducing
parenting stress, improving parenting practices, enhancing parenting efficacy and reducing
family strain. Treatment delivery costs are moderate. We believe WPJ is a valuable addition to
the suite of parenting programs currently available in Japan.
The study was reviewed and approved by the OIST Human Subjects Review Committee. The
three implementation and data collection sites for this study received the ethical approvals fromtheir own Research Ethics Committees. The author has no conflict of interest.
S37-2
Community Implementation of Well Parent Japan (WPJ): From Research to
Clinical Practice
Ryoko Shigematsu1, Shizuka Shimabukuro2
1
Life, Support Center for People with Developmental Disabilities, Kasuga, Fukuoka, Japan
2
Okinawa Institute of Science and Technology Graduate School (OIST), Human Developmental
Neurobiology Unit, Okinawa, Japan
ABSTRACTThe first community implementation (outside of a research program) of Well Parent Japan(WPJ) is being undertaken at the Life, Support Center for People with Developmental
Disabilities in Fukuoka. This group program for mothers of children with ADHD is being led byan accredited WPJ group leader who participated in the recent pragmatic multi-site trial of the
program (Shimabukuro et al, 2022).

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WPJ is a 13-session group delivered program (2 hours per session) program for mothers ofchildren with ADHD. This includes 5 sessions of psychoeducation and parent support (stressmanagement, problems solving, communication skills, cognitive restructuring) and 8 sessions of
the culturally adapted New Forest Parenting Program (NFPP) for ADHD. The results of two
randomized control trials (RCT) have demonstrated the efficacy of WPJ for Japanese mothers
parenting children with ADHD. On the basis of their experiences in the research trial, service
providers in Fukuoka have decided to implement a parenting program, specifically WPJ. The
first community implementation of the WPJ program is currently underway.
In this presentation the group leader implementing the WPJ will share her experiences of
initiating the program in in their service center. This will include a discussion of the challenges
of moving the program from research to clinical practice and barriers to implementation
including recruitment. With participants’ consent, the group leader will anonymously review thegroups experiences of receiving the program and any changes in their wellbeing, parenting
practices, and the behavior of their children. Lessons learned through this implementation will
be shared in the hope that other health care agencies will be encouraged to implement evidencebased programs such as WPJ.
The author has no conflict of interest.
S37-3
Mobile-Health Parenting Program in Brazil: Development and “Wizard-of-Oz”
Pilot TestingEmi Furukawa1, Patrica Bado2, Camila Bernardes2, Raquel Quimas Molina Da Costa2, Paulo
Mattos2
1
Okinawa Institute of Science and Technology Graduate University (OIST), Human
Developmental Neurobiology Unit, Okinawa, Japan
2
D’Or Institute of Research and Education, Rio de Janeiro, Brazil
ABSTRACT
Accessible and affordable quality behavioral healthcare for children is limited in many
countries, especially in non-English speaking and lower-resourced countries. We conducted aqualitative needs assessment to understand the experiences and needs of families of children
with Attention Deficit Hyperactivity Disorder (ADHD) in Brazil. Semi-structured telephoneinterviews were conducted with parents (n = 23), health professionals (n = 16), and educators (n= 15). Two major barriers to access were identified: 1) difficulty obtaining a diagnosis to accesstraditional in-person non-pharmacological treatment, and 2) lack of professionals trained toprovide evidence-based behavioral interventions for ADHD symptoms and associateddifficulties.
In response to these identified needs, we are developing a mobile health program to increase
access to research-informed behavioral management training for caregivers of children with
ADHD. The program aims to provide training and support for caregivers through WhatsApp, a
popular messaging application. This program integrates the latest research findings on alteredreinforcement sensitivity in ADHD. Training materials and instruction are provided tocaregivers via short videos and text messages, designed to be easily digested and engaging.
We conducted a before-and-after pilot study to examine the feasibility and acceptability of the
program (n = 34). This was done using Wizard-of-Oz methodology, where participantsinteracted with what they believe to be an autonomous program, which was managed byhumans. Researchers manually sent videos, tips, reminders, and behavior ratings twice daily via
WhatsApp throughout the study. Pilot results are promising; caregivers used and liked theprogram and reported that they gained new knowledge which changed their perceptions andbehaviors. Questionnaire data indicated significant reduction in their children’s ADHD
symptoms and oppositional behaviors, and negative parenting practices.

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This program has the potential to provide low-cost quality caregiver training to families
struggling to access and utilize services to support their children’s needs in Brazil and othercountries.
The studies were reviewed and approved by the OIST Human Subjects Review Committee(HSR-2020-029/HSR-2021-011) and D’Or Institute of Research and Education Scientific
Review Committee (4.507.418/4.974.614). The authors have no conflict of interest.
S37-4
A Community-Based Participatory Research Approach to Developing a
Behavioral Parenting Program
Aya Kasai1, Kiraboshi Family Support Group2, Gail Tripp3, Emi Furukawa3
1
Miyazaki International College, School of International Liberal Arts, Miyazaki, Japan
2
Myojo Kindergarten, Miyazaki, Japan
3
Okinawa Institute of Science and Technology Graduate University (OIST), Human
Developmental Neurobiology Unit, Okinawa, Japan
ABSTRACTParent training programs have been recognized and promoted by Japanese governmental
agencies and mental health professionals as an effective means to support families with children
who are experiencing behavioral difficulties. Behavioral parent training is the recommended
form of psychosocial treatment for ADHD. However, challenges remain in reaching families
who may benefit from such programs.
We are currently developing a stakeholder-driven parenting program in a small suburban
community in Japan using community-based participatory research (CBPR). In CBPR,
researchers and community stakeholders engage as partners in all steps of the research processwith the goal of educating, improving practice or bringing about social change. Community
partners in the current research include: parents of pre-school and school-age children (somewith children demonstrating developmental and/or behavioral difficulties), special educationteachers, a kindergarten principal and vice principal, and a founder and staff member of a nonprofit organization (with a mission to create a community that supports children and families ofdiverse needs).
Researchers and community partners have met monthly to discuss the needs of the community,
the content of the parenting program, and possible modes of implementation. Identified needs
include: reducing the stigma of neurodevelopmental disorders, reaching families who arestruggling with the child’s behavioral difficulties but who are reluctant to seek help, andcreating opportunities for parents to support each other. Our community partners emphasize thatparents may hesitate to engage with evidence-based behavioral strategies unless they feel safe
and supported. The consensus was that the program should consider the specific needs ofchildren with ADHD, while being inclusive of all parents who show interests in learning
behavioral strategies. Community partners also expressed strong desire that the content be easily
understood and readily accessed, in this case via electronic media.
We will continue to work with our community partners on program content and to pilot test thefeasibility and acceptability of the program. We will identify the similarities and differenceswith other parenting programs in Japan, highlighting where the program fits within Japaneseefforts to promote effective parent and child support.
The study was reviewed and approved by the OIST Human Subjects Review Committee (HSR2022-016). The authors have no conflict of interest.

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Venue 6 (Room K)
9:10-9:50 Research Topics 21
Cognitive-behavioral therapy intervention for parenting stress of parents ofchildren with autism spectrum disorder
Atsurou Yamada1, Fujika Katsuki2
1
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University
Graduate School of Medical Sciences, Nagoya, Japan2
Department of Psychiatric and Mental Health Nursing, Nagoya City University School of
Nursing, Nagoya, Japan
ABSTRACT
Autism spectrum disorders (ASD) are disorders defined by symptoms such as persistent deficits
in social communication and interpersonal interaction, restricted and repetitive patterns of
behavior, interests or activities. A prevalence of 1.85% has been reported among 8-year-old
children, and it is considered to be a common disease. Parents raising children with ASD are
known to be more stressed, have lower quality of life, and exhibit higher rates of psychiatric
symptoms such as depression.
Various studies have been conducted on parental stress from the perspective of parental coping
and direct interventions against stress. Coping strategies are divided into problem-focused
coping strategies and emotion-focused coping strategies. Parents of children with ASD havebeen reported to have more symptoms of parenting stress, depressive symptoms, and use
aggressive avoidance coping than parents of children with normal development. Another reportfound that problem-focused coping was associated with lower levels of depression andpessimism, while emotionally-focused coping was associated with higher levels of coping bymothers of children with ASD.
Direct interventions are effective but limited, restoring parenting confidence and slightly
improving mental health. The family psychoeducation we tried for parents did not have asignificant effect. There are some reports that a cognitive-behavioral therapy (CBT) approach iseffective. For example, acceptance and commitment therapy for parents whose children haverecently been diagnosed with an ASD has been reported to reduce parental depression. The
effectiveness of problem-solving therapy (PST) has also been pointed out. It has been reported
that depressive symptoms were alleviated when PST was given to mothers of children
diagnosed with ASD, and that negative emotions of parents were reduced and problem-solving
skills were improved.
Recently, several attempts have been made to make such interventions via the web. One study
reported that a web-based parent training tutorial increased parental knowledge and increased
satisfaction, and another study reported that a web-based parent–child physical activity program
improved the mental health of parents.
We focused on PST using smartphones as information and communication technology. In fact,
CBT using computers and smartphones has been performed, and its usefulness has been
demonstrated. This time, we have developed a PST using smartphones, and we are actuallyconducting it on breast cancer patients and confirming its effectiveness.
This trial uses CBT that combines not only PST but also behavioral activation and assertion
training simultaneously, and verifies its effects in a multicenter, randomized, open-label, parallelgroup comparison trial design.
10:00-11:30 Symposium 30
Atypical sensory processing and its consequence in autism spectrum disorder― Social cognition, language, and adaptive function
Moderator 1: Shota Uono (National Center of Neurology and Psychiatry, Kodaira, Japan)
Moderator 2: Sayaka Yoshimura (Kyoto University, Kyoto, Japan)

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S30-1
Role of verbal communication: A perspective on speech rate perception
Ayako Kaneko1,2
1
Department of Rehabilitation for Brain Functions, Research Institute of National Rehabilitation
Center for Persons with Disabilities, Tokorozawa, Japan
2
Japan Society for the Promotion of Science, Tokyo, Japan
ABSTRACT
Verbal conversations are a part of daily life and allow the successful interactions. Speaking
manners differ among ethnic groups that use different languages, dialects, and accents.
Furthermore, infants engage in “baby talk”, while individuals with high positions in society tend
to talk authoritatively. Manners of speaking allow the recognition of relationships withconversation partners. For example, the culture of a conversation partner can often be inferredfrom their speech. Individuals with similar manners of speaking tend to be perceived as
belonging to the same group, while those with different manners of speaking are placed into
different social categories (Giels & Ogay, 2007). Individuals with autism spectrum disorder(ASD) have a different manner of speaking to typically developing (TD) individuals (Hauser etal., 2019). This difference would lead TD individuals and individuals with ASD to perceive eachother as different; ASD individuals tend to be perceived as having a communication difficulty.
This talk will focus on speech rate because studies have indicated that ASD individuals have a
specific form of temporal perception that relates to communication difficulties (Wallace et al.,2020). Speech rate varies from person to person, with some individuals speaking faster thanothers. Studies conducted on TD individuals have shown that speech rate similarity increasessocial attractiveness and confidence, as perceived by conversation partners (Buller & Aune,
1992). In addition, TD participants altered their speech rates to match those of theircommunication partners (Borrie & Liss, 2014). These indicate that the entrainment to the otherperson can earn the conversation partners' friendly feeling, and in return, the conversation
partners' entrainment can be expected. Thus, speech rate matching with a partner helps ensure a
successful interaction. However, ASD individuals have tendency to maintain their speech rate
regardless of that of their partner (Wynn et al., 2018). Our group investigated the perceptual
mechanism underlying this tendency in individuals with ASD. It was hypothesized that ASD
individuals have a low sensitivity to speech rate differences or a low likelihood of making
partners’ impression according to that of the communication partner. The elucidation ofparticular perceptual manners in ASD would improve our understanding of verbal
communication impairments.
Ethical considerations: All procedures of the author’s researches performed in studies involving
human participants were in accordance with the ethical standards of the ethics committee of the
National Rehabilitation Center for Persons with Disabilities and with the 1964 Helsinki
declaration and its later amendments or comparable ethical standards. All participants gave
written informed consent after the study procedures had been fully explained.
COI: The author has no conflict of interest.
S30-2
Variation in temporal processing and multisensory integration and theircontribution to non-verbal communication
Sayaka Kawakami1
1
Research Center for Child Mental Development, Hamamatsu University School of Medicine,
Hamamatsu, Japan

159

ABSTRACT
Communication requires the sharing of considerable amounts of nonverbal information, in
addition to verbal information. This involves the use of facial expressions, gestures, eye contact,
distance, language, vocal tone, pauses, and several other nonverbal cues. Among them,information that includes others’ emotions is important in several situations, such as decisionmaking (e.g., whether or not to approach another person).
In most cases, there are multiple modalities used to provide nonverbal information that
expresses emotion. For instance, emotional recognition would differ between a case seeing
smile while speaking in a happy tone and a case seeing smile while speaking in a depressed
tone. It is essential to integrate information from various modality to accurately infer a person's
mental state.
We conducted experiments in typically developing and people with a certain degree of autistic
traits or autism spectrum disorder (ASD), and investigated whether it was easier to infer themental state of other individuals in social situations on the basis of multisensory information or
information from a single sensory domain (e.g., visual information only) using the Reading theMind in Films task. We also performed the following two experiments: a test to determine
whether the integration of multisensory information is more difficult for individuals with ASD
or autistic traits, even in the case of simple information (flashes and beeps) with no social
meaning, and a test assessing the perceived accuracy of the temporal proximity of various
pieces of information, which may be important for determining whether or not specific pieces of
information should be integrated.
We demonstrate that subtle differences in lower-order functions may have some effect onhigher-order social cognitive functions, such as inferring the mental states of others. These
subtle differences in lower-order functions may not be easy to change, and it remains unknown
whether or not they should be adjusted. However, if these subtle differences are causing
problems in some circumstances of their daily lives, it may be important to implement
appropriate solutions for each circumstance based on how their perceptions and recognitions
differ.
Ethical Approval & Informed Consent: Our researches, introduced in this presentation, wasconducted in accordance with the ethical standards of the Ethics Committee of the Graduate
School and Faculty of Medicine at Kyoto University and/or the Ethics Committee ofHamamatsu University School of Medicine, as well as with the 1964 Declaration of Helsinki
and its later amendments. All individual participants in the current study either provided written
informed consent for those who had not experienced the tasks or provided an opportunity for
denial about the secondary use of their data for those who had.
COI: I declare that I have no conflict of interest.
S30-3
Autistic traits and speech perception in noise
Yurika Tsuji1,2
1Graduate School of Humanities and Sciences, Ochanomizu University, Tokyo, Japan
2
Japan Society for the Promotion of Science, Tokyo, Japan
ABSTRACT
Background noise can exacerbate internalizing problems in autism spectrum disorder (ASD)
individuals. I investigated the relationship between sensory abnormalities and internalizing
problems in children with and without ASD. Higher sensory abnormality scores were associatedwith greater suffering due to sensory abnormalities, which served as a predictor of internalizing
problems. The parents of the ASD children reported that their children suffered most frombackground noise, and could not concentrate in class because of the noisy environment.
Speech perception difficulties may be related to the suffering caused by background noise. ASD

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children may not be able to concentrate because they cannot hear teachers and other children in
noisy classrooms. Previous experimental studies have demonstrated that ASD individuals havespeech perception difficulties only in the presence of background noise with temporal dips. This
indicates that ASD individuals are less able to integrate the auditory information present in thetemporal dips of background noise. It has been suggested that these deficits in temporal
integration may also affect other modalities, including vision. However, the autistic traits mostrelated to these deficits remain unknown.
Therefore, I investigated the relationship between speech-in-noise test performance and autistic
traits in the general population, and found that participants with greater imagination difficulties
performed worse on the test. Thus, imagination difficulties in autism may be related to deficits
in temporal integration and speech perception in the presence of background noise.
Speech perception difficulties in the presence of noise may influence language development andcommunication in noisy places, as well as exacerbate internalizing problems in individuals with
ASD or autistic traits. It is hoped that these findings will aid measures designed to support ASD
individuals with social deficits and internalizing problems.
Ethical consideration: Our researches introduced in this talk were approved by the ethics
committee of Kitasato University School of Allied Health Sciences, Ochanomizu University,
and Chiba University, and with the 1964 Declaration of Helsinki and its later amendments. All
participants gave written informed consent after the study procedures had been fully explained.
COI: The author declares no conflict of interest.
S30-4
Social function and sensory processing in autism spectrum disorder: A brief
literature review
Shota Uono1
1
National Center of Neurology and Psychiatry, Kodaira, Japan
ABSTRACT
Autism spectrum disorder (ASD) is characterized by persistent deficits in social
communication, along with restricted and repetitive behavior. Inattention to social information,such as faces, eye gaze, and biological motion, in the early years of life may impair joint
attention, and the development of theory of mind and empathy. However, prospective studies of
infants at high risk for ASD have demonstrated clear differences in sensory and motor function,rather than social function, compared with typically developing infants in the first year of life.
In recent years, significant attention has been paid to the influence of atypical sensory
processing on social functioning. Up to 95% of ASD children have sensory abnormalities, suchas hyper- and hypo-sensitivity, across multiple domains that can influence social function
through multiple pathways. Sensory abnormalities reduce attention to social stimuli, resulting inlimited opportunities for learning social stimuli; moreover, abnormalities such as
hypersensitivity may indirectly affect overall brain development (e.g., through sleep
disturbances), and atypical sensory processing may make it more difficult to process social
stimuli. ASD individuals have an intact or enhanced ability to process simple sensory stimuli,
but have difficulty processing complex stimuli and integrating information across sensory
modalities. Electrophysiological studies have suggested the neural mechanism underlying thesefeatures: the sensory cortices of ASD individuals show greater variation in their responses to thesame sensory stimuli than those of typically developing individuals. This might lead todifficulties in forming stable representations, particularly of complex social stimuli. To
determine the role of sensory processing in atypical cognitive development, future studies needto investigate differences in fundamental sensory processing between individuals with andwithout ASD, and how these differences affect symptoms. In this symposium, researchers will
present the role of temporal processing and/or multisensory integration on verbal and nonverbal

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communication in ASD
Ethical consideration: This presentation is a brief literature review and do not include newly
collected data.
COI: The author declared no conflict of interest.
12:30-13:10 Research Topics 25
Functional analysis of autism spectrum disorder risk gene mutations using highcontent analysis
Jun Egawa1, Vance P. Lemmon2, Toshiyuki Someya1
1
Departments of Psychiatry, School of Medicine, and Graduate School of Medical and Dental
Sciences, Niigata University, Niigata, Japan2
Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, USA
ABSTRACT
Comprehensive analysis using Next Generation Sequencing has identified single-nucleotide
polymorphisms (SNPs) and copy number variations (CNVs) that are reproducibly associatedwith autism spectrum disorders (ASD). Although functional analysis of individual risk genes
has progressed, the overall picture of ASD pathogenesis as portrayed by the vast number of risk
genes is unclear. The main reason for this may be the biological heterogeneity at the gene levelin the ASD patient population. By focusing on ASD risk genes associated with specific clinicalphenotypes (e.g., CNTN5, ASD risk genes associated with auditory abnormalities) andanalyzing the function of these genes, discovering common features at any phenotypic level(protein, cell, brain region, and brain circuit) is possible. Using a high-content analysis
approach, we are conducting functional analysis at the cellular level. We will identify
compounds that ameliorate the effects of these mutations using comprehensive methods such as
mixture-based and common structure ranking approaches that can comprehensively examine theeffects of more than 400 million compounds. The comprehensive approach, which eliminates
bias as much as possible, is expected to identify candidate drugs for ASD that affect thepathogenesis of risk gene mutations that act similarly at the cellular level. All animal
experiments were performed following approval from the Animal Resource Center of Niigata
University.
The presenters declare no conflicts of interest associated with this presentation.
13:20-14:50 Symposium 34
The Progress of WHO CST in Asian Countries (Part I: Adaptation and Outcomes)
Moderator 1: Yen-Nan Chiu (Department of Psychiatry, National Taiwan University Hospital,
Taiwan)Moderator 2: Yeni Kim (Department of Neuropsychiatry, Dongguk University School of
Medicine, Republic of Korea)
S34-1
The effects of WHO CST on challenging behaviors and adaptive functioning ofchildren with developmental delays: Taiwan experience
Guan-Jye Seng1,2, Yen-Nan Chiu1,3, Wen-Che Tsai1,3, Hsiang-Yuan Lin4, Su-Chen Li1, Mei-Ni
Hsiao1,5, Tseng-Jung Liu6, Heng-Man Chen6,7, Andy Shih8, Ya-Chih Chang9, Wei-Tsuen Soong1,31
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
2
Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan
University, Taipei, Taiwan

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3

Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health,
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
5
School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei,
Taiwan6Foundation for Autistic Children and Adults in Taiwan, Taipei, Taiwan
7
Department of Special Education, National Taipei University of Education, Taipei, Taiwan
8Autism Speaks, NY City, NY, USA
9
Department of Special Education and Counseling, California State University, Los Angeles,
CA, USA
4

ABSTRACTThe World Health Organization Caregiver Skills Training for families of children with
developmental delays or disabilities (WHO CST) is a global program designed to improve thecaregiving skills and the developmental outcomes of children with developmental delays, suchas autism. The program focuses on important caregiver skills, including shared engagement,
facilitating communication, dealing with challenging behaviors, building up skills, and the wellbeing of caregivers. In 2022, CST-Taiwan reported its adaptations, promotion model, and theeffectiveness of the program on caregiver and child outcomes. However, the previous study did
not measure the improvements in challenging behaviors and adaptive functioning of children
with developmental delays.
To investigate the effects of CST-Taiwan on these outcomes, a new study was conducted with anindependent sample of 71 children and 70 caregivers (mean age of children [standardized
deviation, SD] = 3.69 [1.03] years, mean age of caregivers [SD] = 38.96 [6.94]). Caregiver
outcomes, including knowledge, confidence, and empowerment, were assessed, as well as childoutcomes, including autistic symptoms (assessed using the Autism Treatment Evaluation
Checklist), challenging behaviors (assessed using the Aberrant Behavior Checklist), andadaptive functioning (assessed using the Adaptive Behavior Assessment System-II, ABAS-II).
Assessments were conducted before the intervention, after the intervention, and 3 months after
the completion of the intervention.
The results showed significant improvement in all caregiver outcomes between the baseline andpostintervention assessment (n=52), and this improvement was maintained at the 3-monthfollow-up (n=40). There was also a significant reduction in autistic symptoms, including
speech/language/communication, sociability, sensory/cognitive awareness, and the total score,
between the baseline and postintervention assessment (n=54), which was maintained at thefollow-up (n=40). In terms of challenging behaviors, significant reduction was only found inlethargy/social withdrawal between the baseline and postintervention assessment, but significant
reductions were found in irritability/agitation/crying, lethargy/social withdrawal,
hyperactivity/noncompliance, and inappropriate speech between the baseline and follow-up. In
terms of adaptive functioning, significant improvement was found in all subscales of the ABASII except motor between the baseline and postintervention assessment (n=51), and thisimprovement was also maintained at the follow-up (n=37).
In conclusion, the WHO CST program was effective in improving caregiver knowledge,
confidence, and empowerment, as well as reducing autistic symptoms in participating children,which is consistent with our previous report. We also found that it was effective in improving
challenging behaviors and adaptive functioning in children.
Ethical statement: The study was approved by National Taiwan University Hospital Institutional
Review Board (#201703123RIND). We obtained written informed consent from the parent or
substitute decision maker of each participated child after explaining the present objectives andprocedures.
Conflicts of Interest: Andy Shih is employed by Autism Speaks. The remaining authors declarethat the research was conducted in the absence of any commercial or financial relationships that
could be construed as a potential conflict of interest.

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S34-2
From adaption to sustainability: The implementation process of the WHO-CST in
Hong Kong
Paul Wai-Ching Wong1,2
1
The University of Hong Kong, The Department of Social Work and Social Administration,
Hong Kong Special Administrative Region, China
2
The University of Hong Kong, The Faculty of Social Science, Hong Kong Special
Administrative Region, China
ABSTRACTThe World Health Organization Caregiver Skills Training Program (WHO-CST) was developed
to strengthen caregivers’ skills in supporting children with developmental delays and the
caregivers’ well-being. The WHO-CST Hong Kong (HK) was adapted, and pre-pilot tested tosupport families with children suspected of having developmental delays and autism spectrum
disorder and to empower the caregivers to foster their children’s learning, social
communication, and adaptive behavior. A sequential mixed-methods research methodology was
undertaken to examine the adaptation process and initial implementation experiences. The
acceptability, feasibility, and perceived benefits of the WHO-CST were assessed using
stakeholders’ and caregivers’ qualitative and caregivers’ quantitative pre- and post-intervention
feedback. The data included materials generated from (1) three consultation meetings withstakeholders; (2) detailed reviews of the translated and adapted WHO-CST materials by mastertrainees (n=10) trained by WHO-CST representatives; (3) needs assessment focus groupinterviews with caregivers (n=15) of children with autism spectrum disorder; and (4) pre- andpost-CST program qualitative focus group interviews and quantitative evaluation. Consultation
with stakeholders suggested that the program was acceptable for the local community, but thehome visit and fidelity components were initially considered to be challenges to the feasibility
and sustainability of the program. Caregivers in the needs assessment focus groups gave widely
diverse views about the program’s uniqueness, length, delivery mode, and the inclusion ofvideotaping in-home visits. Post-intervention comments by caregivers about the program weremainly positive, while the MTs were critical of the content and length of the training and fidelity
process. As one of the first high-income locations to adopt the WHO-CST, the evaluation
findings of the WHO-CST-HK indicate that it is feasible and acceptable to implement the
program in a metropolitan area where families have busy work schedules and are very consciousof privacy issues. The study results suggest that the WHO-CST program in HK and other highincome countries require scaling up and further evaluation of its implementation in realcommunity settings. This involves systemic and contextual changes to allow task-sharing
between professionals and non-specialists at the macro level. Furthermore, technology should
be used to support the supervision of non-specialists. In addition, easier access to the WHOCST materials at the micro level is required to ensure equity, equality, diversity, and inclusion ofdiversified families of children with developmental delays.
Ethical statement: The study was approved by HKU’s Human Research Ethics Committee(EA1901033). All data collection was conducted in accordance with HKU guidelines andregulations.
Conflicts of Interest: The author declares no competing interests.
S34-3
Challenges and issues in translating WHO-CST module to the Malay Language
Sazlina Kamaralzaman1, Mardhiah Mohd Zain1, Syahidatul Amirah Zubir1, Masne Kadar1,
Hasnah Toran2, Nur Zakiah Mohd Saat1, Nor Afifi Razaob1, Hanani Harun Rasit3, Azlis Sani
Md. Jalil3, Kartini Ilias4, Nil Farakh Sulaiman5, Zulkarnain Abdul Wahab3, Anis Abdul Razak3,

164

Puteri Nurfariza Arbain5, Nilam Suhana Othman5
1
Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
2
Faculty of Education, Universiti Kebangsaan Malaysia Bangi, Malaysia
3Southeast Asian Ministers of Education Organisation (SEAMEO) Regional Centre of Special
Educational Needs, Melaka, Malaysia
4
Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia
5
GENIUS Kurnia Centre, Kuala Lumpur, Malaysia
ABSTRACT
Access to healthcare services and assistance for parents of children with developmental delay ordisabilities was restricted by the COVID-19 pandemic. Therefore, researchers in Malaysia
initiated the translation and adaption of the WHO-CST modules from English to Malay, theofficial language of Malaysia. Even though English is the second language in Malaysia andwidely spoken in the community, the Malay translation process proved challenging. The
purpose of this paper is to explore the difficulties encountered by researchers when translating
modules. This study had received approval from The Research Ethics Committee at Universiti
Kebangsaan Malaysia (UKM PPI/111/8/JEP-2022-366). The translation and adaption
procedures were adapted from the World Health Organization's Adaptation Implementation
Guidelines. The three-phase project consists of (1) the translation and modification of WHOCST modules, (2) pre-pilot testing, and (3) a pilot study in the central region of West Malaysia.
This study employs sequential mixed methods and a formative qualitative approach. It took
more than a year to complete Phase 1, which engaged more than fifty experts with diverse
backgrounds in healthcare, linguistics, and education, as well as stakeholders from ministries
and non-government organisations. Initially, the translation, which started in early 2022, wasbased on the WHO-CST 3rd version. When WHO launched the final version of the programme,
modifications were made, and the modules were successively harmonised. Throughout thetranslation process, issues included grammatical translation, syntax, context interpretation, andcultural application based on Malaysia's diverse ethnicities and regions. In addition, the Malay
language lacked number of English terms and expressions such as ‘regulation’ and ‘sharedengagement’. This paper discusses researchers' solutions and language adaptation
recommendations for overcoming these obstacles. After various harmonisation procedures,
version 4.0 of the WHO-CST Malay language has just been completed and is ready to be usedin the pre-pilot testing. Overcoming the challenges not only creates translation groundwork for
the WHO-CST programme to all Malay-spoken countries such as Brunei and Indonesia but also
provides guidelines to researchers conducting similar English-Malay translation study inhealthcare.
Ethical statement: The Research Ethics Committee at Universiti Kebangsaan Malaysia approved
this study (UKM PPI/111/8/JEP-2022-366).
Conflicts of Interest: This study is sponsored by Southeast Asian Ministers of Education
Organisation (SEAMEO) Regional Centre of Special Educational Needs with registered grant
number, NN-2021-013. We thank Autism Speaks and WHO Focal Point for their continuous
support.
S34-4
CST Adaptation and Implementation in Korea
Seokyeon Ji1,2, Lee-Kyung Kim1,3, In-Young Sung1,4, Yeni Kim1,5, Eun-Chung Lim6, Young
Namgung7, Eunyong Namkoong8, Jihoon Park9, Seonmi Hwang10, Minsun Cheong1, Yujoung
Kim11, Meesun Kim2, Insun Kim12, Kiwoong Kim13 Yongjik Kim1
1
Autism Society of Korea, Seoul, Korea
2Center of Sensory Integration toward Social and Occupational being, Seoul, Korea
3
Department of Early Childhood Education, Seoil University, Seoul, Korea

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4

Department of Rehabilitation, Asan Medical Center, Seoul, Korea
Department of Neuropsychiatry, Dongguk University, School of Medicine, Goyang, Gyeonggi,
Korea
6
The Willow by Lake: Child and Family Research Institute. Daejeon, Korea
7
Research Center for Sensory Integration and Behavior Improvement, Seoul, Korea
8
Seoul Metropolitan Children’s Hospital, Seoul, Korea
9
Oullim Child Development Center, Daejeon, Korea
10
Thejaram Inc., Seoul, Korea
11
National Center for Mental Health, Seoul, Korea
12
Wildflower Sensory Integration and Development Counseling Institute, Seoul, Korea
13
Bombom Child Developmental Clinic, Hwasung, Gyeonggi, Korea
5

ABSTRACT
According to a survey in Korea, the major difficulties reported by parents of children with
developmental disorder and delay were the acceptance of their children’s disability and the lackof information or resources related to support for disability. To solve these issue of parents,
Autism Society of Korea, one of the major organizations of parents of people with
developmental disabilities had introduced WHO CST since 2015.
In 2018, the Pre-Pilot test was conducted for the feasibility and reliability of CST, and theresults were reported at the International CST Adaptation and Implementation TechnicalConsultation Meeting. The CST pilot test for the effectiveness was conducted online to reduce
the risk of COVID-19 infection and inconvenience from a distance. In this symposium, theprocess and results of the CST Pilot test in Korea will be presented.
Evaluation tools for the Pilot test were explored through the CST Pre-Pilot test. The
experimental design method was used which compares the pre-non-intervention period and the
CST intervention period. Caregivers reported caregiver's knowledge and confidence, caregiver's
mental health, child's functioning and disability, child's need for help, child's challenging
behavior, and family functioning and professionals observed caregiver's social interaction withchild. A total of 17 caregivers participated in the pilot study during the year.
During the CST period, caregivers' knowledge and confidence, caregivers' social interaction,
children's self-help and social functions, and family functioning increased significantly
compared to the non-CST period. And it was statistically significant to decrease difficulties inchildren's life activities and social participation. The depression and stress of the caregivers
decreased but were not statistically significant and children’s challenging behavior showed nodifference. CST participants expressed satisfaction and effectiveness, and some of themvoluntarily shared their experience of participating in CST to spread it to more caregivers
through YouTube of the Autism Society of Korea.
The current results of pilot tests in Korea are limited by the small numbers of research data.
Since the CST was first introduced in Korea in 2015, it has taken about 3 years to establish
reliability and feasibility of CST, and additional 3 years to prove its effectiveness. In 2022, theMinistry of Health and Welfare of Korea has supported 10 CST sites. It is expected that moredata-based research will be conducted through more participation and support in the future.
Ethical statement: The study was approved by Autism Society of Korea Institutional Review
Board(#ASKIRB-2017-001, #ASKIRB-2021-S001). In this study, written consent was obtained
from the parent or legal guardian of each participating child after explaining the purpose andprocedure of the study.
Conflicts of Interest: All authors declare that they have no conflicts of interest.
15:00-16:30 Symposium 38
The Progress of WHO CST in Asian Countries (Part II: Training of Trainers andthe Users’ Stress)
Moderator 1: Yen-Nan Chiu (Department of Psychiatry, National Taiwan University Hospital,

166

Taiwan)Moderator 2: Wei-Tsuen Soong (Department of Psychiatry, College of Medicine, National
Taiwan University, Taiwan)
S38-1
Experience of Implementing WHO CST Training of Trainers in India
Disha Zaveri1, Sanchita Mahadik1, Dr. Koyeli Sengupta1
1
Ummeed Child Development Center, Mumbai, India
ABSTRACTIn Low-Middle Income countries (LMIC) like India, access to evidence-based intervention forchildren with developmental disabilities is limited and expensive. Among the available therapies
for young children with autism, parent-mediated interventions (PMIs) are effective, feasible,
and acceptable in increasing parent engagement and thereby reducing the service gap. Due tothe almost 2-year long period of home confinement during Covid -19 pandemic, remotely
delivered intervention became the need of the hour. The World Health Organization-Caregivers
Skills Training (WHO-CST), an evidence-based, culturally, and linguistically adapted PMI in
India was conducted online during this period.
Changes were made in training structure and delivery, the process of competency building andattaining fidelity in the WHO-CST, and a mixed-methods approach was adopted to evaluate theacceptability, feasibility, and efficacy of the program. Remotely delivered training of trainers(TOT) made it possible to reach 27 professionals across 10 different cities in India, who in turn
trained 102 caregivers. Quantitative results (n = 27) showed positive changes in trainer fidelity
and significant changes in trainers’ efficacy in delivering training and coaching caregivers.
Qualitative analysis from interviews revealed that trainers found internet-based TOT convenientand acceptable and in turn, could enhance caregivers’ confidence in improving their children’scommunication skills and behaviours. The Covid-19 pandemic has allowed us to rethink
training models and provide a catalyst for further research to deliver better services for children
with ASD.
Ethical statement: All participants provided informed consent for their participation in the study
as well as sharing of data. Ethical guidelines are followed while conducting studies on
behaviour to ensure a safe and secure environment for the participants to protect them from any
psychological/physical/emotional harm.
Information of conflict of interest (COI): The authors have no conflicts of interest to disclose.
S38-2
The Adaptation of WHO CST Training of Trainers in Taiwan: A Comparison
between pre- and post-COVID-19 Pandemic
Mei-Ni Hsiao1,2, Heng-Man Chen3,4, Su-Chen Li1, Guan-Jye Seng1,5, Yen-Nan Chiu1,6, Wen-Che
Tsai1,6, Hsiang-Yuan Lin7, Tseng-Jung Liu3, Andy Shih8, Ya-Chih Chang9, Wei-Tsuen Soong1,61
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
2School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei,
Taiwan3Foundation for Autistic Children and Adults in Taiwan, Taipei, Taiwan
4Department of Special Education, National Taipei University of Education, Taipei, Taiwan
5
Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan
University, Taipei, Taiwan
6Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
7
Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health,
Department of Psychiatry, University of Toronto, Toronto, ON, Canada

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8

Autism Speaks, NY City, NY, USA
Department of Special Education and Counseling, California State University, Los Angeles,
CA, USA
9ABSTRACT
In order to address the treatment gaps and worldwide needs of children with developmental
disorders or delays, the World Health Organization Caregiver Skills Training for families ofchildren with developmental delays or disabilities (WHO CST) program has been developed.
WHO CST utilizes a concatenation training model and continuous supervision approach tomaintain scalability and sustainability. Through the Training of Trainers (ToT), both knowledge
and skills of intervention and coaching will be ensured, starting with the training of Master
Trainers (MTs), then moving on to the training of Facilitators (FTs). The ToT consisted of a 5day workshop with post-ToT supervision; while the Taiwan CST team adapted the workshop
into two 2.5-day sessions with more in-person practice among lectures, incorporated threerehearsals in post-ToT supervision, and had two FTs deliver jointly supervised by one MT.
Unfortunately, the COVID-19 outbreak in Taiwan impeded one-on-one interaction with childand face-to-face feedback from MT, which were the key elements of ToT to foster active
learning of FT. To accommodate such constraints, Taiwan CST team adapted the ToT into
predominantly on-line with partial on-site training. COVID-19 pandemic adapted ToT in
Taiwan, especially the format preceding post-ToT supervision, included four modules to fit
different situations of COVID community alert. In Module 1, FTs were instructed to practicewith peers remotely, using the demonstration part of the Facilitator Guide. Module 2 required
each FT to do self-record videos of interaction with either an adult or a child, and to gain
feedback from one MT. In Module 3, MTs offered real-time coaching for FT-child interaction
and individual consultation at local institutions of FTs. Module 4 featured a whole-day live
practice workshop of FT-child and FT-peer interaction sessions supervised by MTs.
Feedback from FTs and evaluation from MTs suggested that Module 4 was the most beneficial,followed by Module 3, Module 2, and Module 1. Such results indicated that it was difficult to
substitute virtual training for actual interaction in the practice component of ToT; further, FTchild interaction was best conducted in groups for not only practicing but also observational
learning and mutual discussion.
In conclusion: 1. As the adaptation of ToT for continuing CST promotion in Taiwan was
inevitable during COVID-19 pandemic, the flexibly modified modules did compromise theeffectiveness of the training to some degree. 2. Although web-based training could benefit
imparting intervention knowledge, implementation skills still heavily relied on close in-person
FT-child interaction supervised by MTs.
Ethical statement: The study was approved by National Taiwan University Hospital Institutional
Review Board (#201703123RIND).
Information of conflict of interest (COI): Andy Shih is employed by Autism Speaks. The
remaining authors declare that the research was conducted in the absence of any commercial or
financial relationships that could be construed as a potential conflict of interest.
S38-3
Exploring the Changes of Caregivers' Perception of Parenting Stress after
Participation of WHO CST
Heng-Man Chen1,2, Mei-Ni Hsiao3,4, Chiou-Shiue Ko2, Yen-Nan Chiu3,6, Wen-Che Tsai3,6, SuChen Li3, Guan-Jye Seng3,5, Hsiang-Yuan Lin7, Tseng-Jung Liu1, Andy Shih8, Ya-Chih Chang9,
Wei-Tsuen Soong3,61
Foundation for Autistic Children and Adults in Taiwan, Taipei, Taiwan
2
Department of Special Education, National Taipei University of Education, Taipei, Taiwan
3
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan

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4

School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei,
Taiwan5
Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan
University, Taipei, Taiwan
6Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
7
Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health,
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
8
Autism Speaks, NY City, NY, USA
9
Department of Special Education and Counseling, California State University, Los Angeles,
CA, USA
ABSTRACT
Caregivers of children with developmental delays or disabilities generally reported higher
caregiving stress which might be alleviated in various ways, such as enhancing family support,
offering caregiver skills training and providing early intervention for their children. However,caregiver skills training programs for families with children with developmental delays havebeen rather inadequate in Taiwan. World Health Organization Caregiver Skills Training Programfor Families of Children with Developmental Delays or Disabilities (WHO CST) has been
proved as an effective early intervention model in helping the caregiver participants and theirchildren. Since 2015, The Taiwan CST team has been putting much effort in the promotion of
WHO CST. They published the effectiveness of culturally adapted Taiwan CST program as
positively affecting caregiver knowledge and confidence and reduced the severity of thechildren’s autistic symptoms last year. However, changes in perceived parenting stress of the
caregiver participants were not examined in previous reports.
The aim of this study was to explore the changes of caregivers' perception of parenting stressafter participation of WHO CST program.
This study recruited 32 caregivers, 17 from the WHO CST program (experimental group) and
15 from community early intervention sample (control group). Qualitative information wascollected through focus groups and quantitative data was collected through a structured
questionnaire, Parental Stress Scale Simplified Chinese Scale - Fourth Edition (PSI). Paired ttest and repeated measure analysis of variance (ANOVA) were performed to evaluate the Time xGroup differences on the outcome measure.
From qualitative analysis, the CST group reported overt reduction of perceived parenting stresswhich was attributed to gains of skills of sharing engagement through play and home routinesand managing challenging behaviors for facilitating the development of their children, peerinteractions in the group, feeling empowered regarding self-care, and recognizing both the limits
and potential of their children. ANOVA of pre- and post-test PSI of the two comparison groups
revealed significant group difference only in the subscale of parent-child dysfunctional
interaction, but not in other subscales and total score.
In conclusion, the WHO CST reduced parenting stress among parents of children with
developmental delays or disabilities; however, only parent-child interaction was statisticallysignificant, which was essential for caregivers. Accordingly, we encourage families toparticipate in WHO CST that can positively impact parent-child interaction and reduce parentalpressure.
Ethical statement: The study was approved by National Taiwan Normal University Research
Ethics Committee (#202007ES012). We obtained written informed consent from the parent or
substitute decision maker of each participated child after explaining the present objectives andprocedures.
Information of conflict of interest (COI): Andy Shih is employed by Autism Speaks. The
remaining authors declare that the research was conducted in the absence of any commercial or
financial relationships that could be construed as a potential conflict of interest.

169S38-4The Strategy of Developing Master Trainer Assistant Scheme for Implantation of
WHO CST in Taiwan
Yen-Nan Chiu1,2, Wen-Che Tsai1,2, Su-Chen Li1, Mei-Ni Hsiao1,3, Guan-Jye Seng1,4, Heng-Man
Chen5,6, Tseng-Jung Liu5, Wei-Tsuen Soong1,2
1
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
2
Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
3
School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei,
Taiwan4
Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan
5Foundation for Autistic Children and Adults in Taiwan, Taipei, Taiwan
6Department of Special Education, National Taipei University of Education, Taipei, Taiwan
ABSTRACT
Background: Taiwan has been participating WHO caregiver skills training program (CST) since2015, in order to reduce the gap of needs for children with developmental delays and theirfamilies. Among four fully trained master trainers (MTs) of Taiwan, only one works full time for
CST. Facing the vast demand in promotion of CST, Taiwan CST team started master trainer
assistant (MTA) scheme in 2020.
Objectives: To evaluate the initial effect of MTA scheme and its impact on MTs and MTAs.
Study Design & Methods: This is a qualitative study. Interviews with MTs were conducted, andself-designed questionnaires for MTs and MTAs were collected separately. The expansion of
Taiwan CST program, content of core team meetings and the budget were reviewed.
Results: Well-trained facilitators (FTs) of CST with good performance and strong motivation
may be recruited into the MTA scheme to assist the training of FTs. There are three stages oftraining and evaluation for MTAs, i.e. MTA3, MTA2 and MTA1, which may be completed inthree years under close supervision by MTs. Reimbursement scheme for the participation of
MTs and MTAs was designed. In 2022, Taiwan CST program had eighteen collaborative units
holding nineteen caregiver groups. Four MTAs were involved in four units separately. All the
MTs and MTAs were satisfied with the MTA scheme. Although most MTs and MTAs
experienced additional stress from executing MTA scheme, due to time constraints from theirjobs and the need to accommodate different situations, while they were positive towards thescheme and took this opportunity as valuable for the development of their professions. MTAs
shared the load in training workshop and supervisions for FTs. MTA2 was mature enough tosupervise FTs independently. There were overt individual variations among MTAs, and some ofthem expected to get MT qualification. Difficult issues met by MTs were discussed during CST
core team meetings or helped by senior members. Subsidy for the MTAs scheme took asignificant portion of the total budget. Group supervision for or after MTA1 stage wassuggested.
Conclusions: The CST MTA scheme is helpful for the promotion of CST in Taiwan. However,to be more successful, intensive supervision and strong financial support are much needed.
Minor modifications for the scheme may be considered in the future, including the developmentof group supervision for MTA1s.
Ethical statement: National Taiwan University Hospital IRB approval: 201703123RIND
Information of conflict of interest (COI): The authors declare that the research was conducted in
the absence of any commercial or financial relationships that could be construed as a potential
conflict of interest.

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Exhibition Booth: “Calm-down Space”
Kanako Ueno1
1
Department of Architecture, School of Scienceand Technology, Meiji University, Kawasaki, Japan

Calm-down Space
set at a sensory friendly event
Summary of the exhibition:
Calm-down space, or cool-down space, is a place for people with developmental
disabilities or hypersensitivity to escape from environmental stimuli and take rest. In Japan, there
is a recommendation regarding the installation of the calm-down space as a facility for people
with developmental disabilities in “The guidelines for smooth movement, etc. regarding
passenger facilities of public transportation”. In recent years, calm-down spaces have been
installed in public facilities such as advanced international airport terminals. Even in facilities thatare used on a daily basis, such as supermarkets, movie theaters, and museums, the indoor
environment is sometimes adjusted to suppress sensory stimulation, so-called sensory-friendly
events, and in such cases, a calm-down space can be temporary installed.
From the standpoint of architectural acoustics, we have been investigating soundenvironment adjustment methods for people with atypical hearing characteristics. The soundenvironment is controlled in two ways: sound insulation which blocks the propagation of sound,and sound absorption which suppresses the reflection of sound. Here, materials for soundabsorption are easy to introduce into living spaces, and can suppress reflected sounds andreverberations, as well as increase quietness. By applying these control methods, we installed
temporary calm-down spaces at sensory-friendly events and introduced assistive spatial settings
using sound-absorbing materials.
In this exhibition, we set up a temporary calm-down space using panels and soundabsorbing materials. In addition, a small calming box with sound-absorbing materials, attachedinside to allow one to place his/her head down and take rest in a quiet environment, is exhibited.
These examples of use, as well as other tools using sound-absorbing materials that have beenutilized at after-school day care service facilities for children with developmental disabilities, will
be introduced in a poster.

171

Art Exhibition Theme: “SAISAISAI〜差異才彩”
Ayaka Ishii-Takahashi1
1Department of Developmental Disorders, National
Institute of Mental Health, National Center of Neurology
and Psychiatry, Kodaira, Japan“Nampujisai(南風時差異)” in cooperation with
Diversity on the Arts Project（DOOR）

Illustration by Udon
for Dokuneko’s novel “Insect”
Summary of the exhibition:
This exhibition is an art installation in cooperation with the Diversity on the Arts
Project (DOOR) of Tokyo University of the Arts. It features a documentary film in which
students diagnosed with developmental disorders and students from the university discuss therelationship between developmental disorders and art. All the participants in the film took turns
interviewing each other and expressed what inspired them on the canvas. Additionally, we will
exhibit related works, including a novel titled “Insect” written by one of the participants, astudent with Attention Deficit Hyperactivity Disorder (ADHD), as well as illustrations for thatnovel by another participant, a student also diagnosed with ADHD.
We hope that this exhibition will not only highlight the differences among people but
also showcase the creativity that arises from those differences.
This project was designed and produced by a team of six students from DOOR withdifferent backgrounds, including students from the University of the Arts, a psychiatric nurse,
and a child psychiatrist. They collaborated under the name "南風時差異 (Nanpujisai).” One of
the team members has a hearing impairment, and the team uses an application that automaticallytranscribes speech during their discussions and in the documentary video.
The communication was sometimes transcribed incorrectly, and the team had to work
together to resolve any discrepancies. The team’s name, "南風時差異 (Nanpujisai)" comesfrom a line in the documentary, which was accidentally mistranscribed.
Within our group “Napujisai,” which was arbitrarily formed within the DOOR
program, there were a number of “gaps” in communication due to many differences amonggroups members, including those in occupation, generation, gender, and hearing ability. While
such differences sometimes caused frustration during the production process of this artwork,
they also produced moments of endearment.

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POSTER PRESENTATIONS
PO-1
Risks of Hyperopia, Myopia, Astigmatism, and Strabismus in Children with
Autism Spectrum Disorder: A National Population-Based Cohort Study
Cheng-Fang Yen1
1
Department of Psychiatry, Kaohsiung Medical University Hospital, and School of Medicine,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
ABSTRACT
Background: Research has indicated that several ophthalmic diseases (e.g., hyperopia, myopia,
astigmatism, and strabismus) are cross-sectionally associated with autism spectrum disorder(ASD) in children. However, further cohort study is needed to longitudinally examine the risks
of incidences of these four pediatric ophthalmic diseases in children with ASD. This populationbased cohort study investigated the risks of incident hyperopia, myopia, astigmatism, andstrabismus in children with ASD compared with those without ASD.
Ethical consideration: The study was approved by the Research Ethics Committee of the China
Medical University and Hospital (approval number: CMUH108-REC1-142 and date of
approval: 25 December 2019).
Methods: This study enrolled children in the Taiwan Maternal and Child Health Database who
were born at any time from 2004 to 2017. We included 20,688 children with ASD and 2,062,120
matched controls to assess the risks of incident hyperopia, myopia, astigmatism, and strabismus.
Cox proportional hazards regression models were implemented to estimate the risks of incident
four ophthalmic diseases in children with ASD after adjustments for age, sex, and gestational
age at birth. Statistical significance was indicated using adjusted hazard ratios (aHRs) and 95%
confidence intervals (CIs).
Results: Children with ASD had higher risks of incident hyperopia (aHR = 2.06, 95% CI: 1.922.21), astigmatism (aHR = 1.43, 95% CI: 1.37-1.50), and strabismus (aHR = 3.82, 95% CI:
3.53-4.13) compared with the control group. However, children with ASD had a lower risk ofincident hyperopia (aHR = 0.96, 95% CI: 0.93-0.99) compared with the control group.
Conclusions: Children with ASD had higher risks of incident hyperopia, astigmatism, andstrabismus but a lower risk of incident hyperopia compared with those without ASD.
Conflict of interest: The authors declare no conflict of interest.
PO-2
Have Children with Attention-Deficit/Hyperactivity Disorder an Increased Risk of
Alopecia Areata?
Chih-Kai Wong1, Cheng-Fang Yen2
1
Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan
2
Department of Psychiatry, Kaohsiung Medical University Hospital, and School of Medicine,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
ABSTRACT
Objective: Alopecia areata (AA) is an autoimmune disease that causes sudden hair loss.
Although few studies have reported the association between AA and attentiondeficit/hyperactivity disorder (ADHD), the impact of methylphenidate (MPH) on AA has notbeen examined. This study examined whether AA risk is higher in children with ADHD than inthose without ADHD as well as the impact of MPH use on AA risk in children with ADHD.
Ethical consideration: The study was approved by the Research Ethics Committee of the China
Medical University and Hospital (approval number: CMUH108-REC1-142 and date of
approval: 25 December 2019).

173

Method: From the Taiwan Maternal and Child Health Database, we enrolled all 1,750,456
newborns from 2004 to 2017 in Taiwan. Of them, 90,016 children received a diagnosis of
ADHD whereas the remaining 1,660,440 did not. To compare AA risk in ADHD and the impactof MPH treatment on it, multiple Cox regression with adjustments for covariates (i.e., age, sex,
and psychiatric comorbidities) was performed.
Results: The results indicated that 88 (0.098%) children with ADHD and 1,191 (0.072%)
children without ADHD had AA. Nevertheless, after adjustment for the covariates, AA risk was
higher in children with ADHD than in those without ADHD (adjusted hazard ratio [aHR]: 1.30,
95% confidence interval [CI]: 1.04–1.64). Our data indicated a considerable reduction in AA
risk (aHR: 0.64) among children with ADHD who received MPH than among those who did notreceive MPH; however, this difference was nonsignificant, indicated by a wide 95% CI (0.32–
1.25).
Conclusions: ADHD and AA may share some underlying mechanisms.
Conflict of interest: The authors declare no conflict of interest.
PO-3
Gender Difference on the Association between Sexting and Self-harm Behavior
among Taiwanese Adolescents
Chun-Hao Liu1
1
Department of Child Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan
ABSTRACT
Sexting, defining as the transmission of sexually explicit content (such as texts, images, orvideos) to others through digital technology (such as smartphones or computers), is one of theemerging issues in the Internet era, especially among adolescents. Sexting had been linked withnegative mental health, such as depression or anxiety. We tried to identify the gender effect on
association between sexting and self-harm behavior among adolescents. A representative sample
of total 5190 adolescents (aged 14.5 ± 2.0 years, 49.0% were female) were enrolled into thissurvey. Demographic data, bully and sexting experiences, and self-harm behaviors wererecorded, and two-way interaction linear regression model was used to identify the gender effecton the association between sexting and self-harm behaviors. There were 130 (2.5%) adolescents
had all kind of sexting in recent 1 year, while 89 (1.7%) sexting their own picture/video, 53(1.0%) had experience of non-consensual sexting, 47 (0.9%) sexting under pressure. Sexting
one's own information (β = 3.869 95% CI [1.918-5.819], p<0.001) and pressured sexting (β =7.573 95% CI [4.839-10.307], p<0.001) showed significantly positive association with selfharm, while male sex had negative association with self-harm (β = -1.215 95% CI [-1.477- 0.952], p<0.001). In both genders, having history of sexting one's own information (β = 1.581,
95% CI [0.412-2.751], p=0.008, and β = 4.336, 95% CI [2.059-6.612], p<0.001, for male andfemale respectively) and pressured sexting (β = 4.662, 95% CI [2.962-6.361], p<0.001, and β =7.772, 95% CI [4.574-10.969], p<0.001, respectively) had significantly higher risk of self-harmbehavior, and the risk was higher in female compared to male. Our study highlight the concern
about negative mental health impact of sexting on female adolescents.
This study was approved by the Institutional Review Board of National Health ResearchInstitute of Taiwan (EC1100502).
The author had no conflict of interest.
PO-4
Association between language processing speed, inhibition, and behavioral
problems, among children with language delay: A longitudinal study from174

preschool to school age
Chu-Yin Shih1, Hsin-Hui Lu1
1
Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
ABSTRACT
Background and purpose: Children with language delay (LD) have difficulties with language
processing speed, often along with inhibition problems. However, the relationship among
language processing speed, inhibition, and behavioral problems, in children with LD were notclear. This study aimed to examine the association between preschool language processing
speed and inhibition, and school-aged behavioral problems among children with LD. Methods:
Thirty-eight children with LD participated in this study at two time points, preschool (T1: Mage(SD)=5.70 (0.40) years) and first-grade (T2: Mage (SD)=6.63 (0.32) years). Their nonverbal
intelligence quotient assessed by Wechsler Preschool and Primary Scale of Intelligence Fourth
Edition were above 70. Inhibition subtest (Condition 1- Naming) of NEPSY-II was used toassess a child’s language processing speed (i.e., Total error (TE)) and inhibition problems (i.e.,
Self-corrected error (SCE)) at T1. Child Behavior Checklist (CBCL/6-18) was used to measurea child’s emotional and behavioral problems (anxiety, depression, somatic complaints, social
problems, thought problems, attention problems, rule-breaking behavior, and aggressive
behavior) based on parent rating at T2. The severity of problems was indicated by T-score.
Results: Pearson’s correlation analysis showed that attention problems T-score is negatively
related to language processing speed (r(38)＝-.345, p＝.036) and positively related to inhibition
behaviors (r(38)＝.472, p＝.003). In addition, hierarchical linear regression analysis was used
to predict attention problems T-score, initially controlling for age in step 1. In step 2, language
processing speed and inhibition behaviors accounted for 18.2% (p < .05) increment in thevariability; inhibition behaviors was positively associated with attention problems T-score(𝛽=.491, p=.054), but language processing speed was not (𝛽=-.073, p=.772). Conclusions: Bothlanguage processing speed and inhibition, are associated with attention problems in children
with LD. Furthermore, preschool impulsivity behaviors may be a predictor for school-aged
attention problems among children with LD.
This study is ethical and has no conflicting interests to declare. (IRB code number: CS2-19046)
PO-5
Social Media Influencers: How They Shape Young Peoples’ Attitudes towards
Mental Health
Adeane E1, Stasiak K1
1
University of Auckland, Auckland, New Zealand
ABSTRACT
Background: Social media “influencers” have enormous reach and sway with youth. With
thousands to millions of followers, many researchers have acknowledged the successful role ofinfluencers in commercial marketing and even public health. However, aside from limited
ethnographic observations, little is known about how influencers talk about mental health andwhat impact (if any) this may have on young people. The aim of this doctoral research is to
explore the role of social media influencers in young people’s knowledge, beliefs andbehaviours (e.g. help-seeking) in relation to mental health.
Methodology: Two qualitative studies consisting of in-depth interviews with A) youth who
actively follow influencers and B) local influencers. Interviews (60-90 min) are conducted
online using text (e.g. WhatsApp) or video conferencing (e.g. Zoom). Participants receive$30-$50 gift cards as incentive. To date, Study A included 23 youth (aged 16-24) and Study B
included 7 influencers (aged 18+) who meet audience, post frequency and advertising criteria.

175

Findings: Preliminary thematic analysis suggests there are several key tensions in how
participants view the role of influencers in discussing mental health online. Further analysis isscheduled, with Study B still actively recruiting. We will present further insights as they come to
hand.
Conclusions: Social media and its influencers are here to stay, however their possible future rolein shaping youth mental health is underexplored. It is important that clinicians, services andhealth promotion agencies understand the dynamics of this evolving space to bring youth mental
health into the digital future.
Conflicts of interest: None to declare
PO-6
Regarding the significance of assessing the sensorial properties in support
strategies destined toward improving inappropriate behaviors in children with
autism spectrum disorder: Two cases of the analysis of occupational therapists'
professional reasoning and their pre- and post-case behavior
Takumi Hamada1
1
Faculty of Health Sciences, Suzuka University of Medical Science, Suzuka, Japan
ABSTRACTIntroduction: Despite the commonly held belief that developmental stage and environmental
factors are the primary causes of inappropriate behaviors in children with autism spectrum
disorder (ASD), recent years have seen an increased focus on the role of sensorial properties,
such as sensation seeking and sensitivity to stimuli, as potential causes. However, it remains
challenging to demonstrate the impact of assessing sensory characteristics on the goal-setting
and intervention selection for inappropriate behavior in children with ASD.
Objectives: The aim of this report is to validate the significance of assessing sensorial properties
in the occupational therapy process to improve inappropriate behaviors in children with ASD.
Ethical approval was obtained from the research ethics review committee of the relevant
medical institution on August 24, 2018.
Method: Two ASD case children (from a set of triplets) at a similar developmental stage andliving environment but presenting with different sensorial properties were subject tooccupational therapy performed at the same time and with the same frequency (once a week for
10 weeks). The occupational therapist's professional reasoning towards each child, and the
behavior of the cases before and after, were analyzed and compared accordingly.
Results and Implications for Practice: The results showed that the narrative, pragmatic, andethical reasonings of the occupational therapist were similar in the two cases, whereas thescientific and interactional reasonings of the occupational therapist differed in the two cases.
This preliminary categorization of the causes of the inappropriate behavior was crucial, as forcase A, it was related to inadequate sensory modulation, while for case B, considerations wererelated to sensory processing. As a result, these differences affected the goal-setting ofobjectives and the selection of suitable intervention methods.
Conclusion: This paper highlights the importance of assessing sensorial properties along with awell-defined strategy for supporting children with ASD in improving their inappropriate
behaviors.
No conflicts of interest with any companies or entities in connection with the presentation ofthis abstract exist.
PO-7
Effectiveness of the group social cognition program on jumping to conclusion176

bias in adolescents with autism spectrum disorder
Hidehiro Umehara1, Tomoya Takeda2, Kanae Matsuura3, Yasuko Abe4, Tarishi Masuda4, Naoki
Yamada4, Shusuke Numata1
1
Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University,
Tokushima, Japan2
Department of Psychological Sciences, University of Human Environments, Ehime, Japan
3
Medical Affairs Division, Tokushima University Hospital, Tokushima, Japan
4
Department of Psychiatry, Tokushima University Hospital, Tokushima, Japan
ABSTRACT
Background and Purpose: Jumping to conclusion (JTC)—a cognitive bias in thinking
processes—leads to drawing conclusions based on little information, and could be related to
psychosis and paranoia. JTC bias is a cognitive trait widely found in schizophrenia withremission of the expressed symptoms, as well as in autism spectrum disorders (ASD) and evenin healthy controls, and has been noted to be associated with a reduced level of functioning inlongitudinal follow-up. Although social cognition programs targeting JTC bias in adults withschizophrenia exist, there have been no reports of the effectiveness of interventions targeting
JTC bias in adolescents with any of the disorders other than schizophrenia. First, this
exploratory study investigated the effects in adolescents with ASD, using a previously reported
comprehensive social cognition program that includes interventions for JTC bias. Next, wecreated a program specifically designed to improve JTC bias, based on the previously reported
comprehensive social cognition program, and examined its effectiveness.
Patients and Methods: First the group rehabilitation using social cognition and interaction
training (SCIT) and then the original program was conducted for 12- to 18-year-old adolescentswith ASD. The changes before and after the SCIT intervention, social cognitive functioning
tasks, and subjective quality of life (QOL) were examined. The beads task was used to assess
JTC bias. Subjective QOL was assessed using a QOL questionnaire. The change before andafter SCIT was determined using McNemer’s test and Wilcoxon signed-rank test. Differences,with p < 0.05, were considered statistically significant in all cases. Ethical approval was
obtained for the study (Ethics Committee of Tokushima University Hospital). Results: In SCIT
program group, the proportion of participants with JTC bias decreased significantly before andafter SCIT (before: 7/10; after: 1/10; p = 0.041), and subjective QOL increased significantly (p= 0.014). In original program group, the proportion of participants with JTC bias and subjective
QOL did not change significantly before and after SCIT (beads task; before: 2/5; after: 2/5).
Conclusion: The group social cognition program with a JTC bias approach may improves the
JTC bias and increases subjective QOL in adolescents with ASD. Further study is needed in theoriginal program.
Conflict of Interests Disclosure: There is no conflict of interests to disclose in relation to thispaper.
PO-8
Association of preschool emotional understanding and school-aged behavioral
problems among children with language delays
Hsin-Hui Lu1
1
Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
ABSTRACTLongitudinal studies found a negative association between behavioral problems and emotional
understanding in samples from the general population. However, it was not clear whether
behavioral problems can negatively correlate with emotion comprehension among children with177

language delays (LD)—and can also be independently explained unique variance in theirunderstanding of emotions. This study aimed to examine that the emotion understandings werelower in preschoolers with language disorders than in preschoolers with typical language
development, and emotional understandings was a predictor for their later behavioral problems.
A total of 66 preschoolers aged 4–6 were included in this study, including 38 preschoolers withLD (Mage [SD]=5.80 [0.42] years, boys=28) and 28 preschoolers with typical language
development (TLD; Mage (SD)=5.90 (0.27) years, boys=25). No significant differences werenoted regarding age, and NVIQ (nonverbal intelligence quotient, i.e., assessed with WPPSI-IV),and sex ratio in both groups (PS>.05). The Test of Emotion Comprehension (TEC; Pons andHarris, 2000) was used to test participant’s preschool emotional understandings (EU; Time 1).
Further, it was employed to calculate correct rates of emotional understanding and threecomponents, i.e., external component, mental component, and reflective component,
respectively. Behavioral problems of children with TLD were assessed at Time 2 (i.e., in thefirst-grader) using the Mandarin-Chinese version of the Child Behavior Checklist for Ages 6–18
years, a component of the Achenbach System of Empirically Based Assessment (CBCL-MC).
The independent samples t-tests across both groups revealed that preschoolers with LD had asignificantly lower correct rate of total [LD: MEU(SD)=0.35(0.12); TLD:
MEU(SD)=0.41(0.12)], external component [LD: Mexternal(SD)=0.62(0.16); TLD:
Mexternal(SD)=0.74(0.14)], and mental component [LD: Mmental(SD)=0.22(0.21); TLD:
Mmental(SD)=0.33(0.24)] than children with TLD [t(64)s = 2.03, 3.08, and 2.06, ps=0.046,
0.003, and 0.043]. Two-tailed Spearman’s correlations further revealed that emotional
understandings were negatively associated with aggressive behaviors and total problems
behaviors [r(38)s = -0.36 and -0.36, ps = 0.029 and0.027]. Mental components were positively
associated with activity and school competencies [r(38)s = -0.43 and -0.35, ps = 0.007
and0.031], and negatively associated with externalizing behaviors[r(38) = -0.37, p = 0.024]. Tosummarize, the ability to understand emotions is lower among preschool children with LDcompared to those of the same age with similar nonverbal cognitive abilities. The findings ofthis research suggest that it may be essential to provide early intervention to help improve theemotional understandings of preschool children with LD.
Conflict of interest: The author declares that the research was conducted in the absence of any
commercial or financial relationships that could be construed as a potential conflict of interest.
Ethics statement: The Institutional Review Board of the Chung Shan Medical University
Hospital approved the study and the parents of all the participants provided informed consent(CS2-19046).
PO-9
The Impact of Music Therapy on Speech, Music and Emotion Perception inChildren with Hearing Impairment: A Case Series Study
Lin,Li-Chun1, Iris, Chih-Tsai Chen1,21
Master's course in Music Therapy, Department of Music, Fu Jen Catholic University, Taiwan
2
Department of Child and Adolescent Psychiatry, Taoyuan Psychiatric Center, Ministry of
Health and Welfare, Taoyuan City, Taiwan
ABSTRACTChildren with hearing impairment have difficulty in tone recognition of speech perception; inmusic perception, it is difficult to distinguish between tone and pitch; and in emotional
perception. Children with normal hearing can foster musicality in daily musical experiences inlife, but hearing-impaired children are struggling against the difficulty to understand and enjoy
music and found not easy to benefit from the musical experience.
Therefore, the purpose of this study is to explore the effect of music therapy activities inchildren with hearing impairment on speech, music, and emotional perception. We conducted178

music therapy activities and applied the music elements to promote the training of children withhearing impairment on speech, music and emotional perception.
This is a cross-sectional study. 5 school-age children with congenital hearing loss on hearing
aids were recruited during the period 2020~2021. We designed once a week, a total of eight
thirty minutes music therapy activities sessions including using various musical elements suchas rhythm, tone, melody, harmony, loudness, speed etc., with the hand sign, pictures, compose
simple music songs and reciting ballad, and the concept of oral motor and respiratory exercises
and rhythmic speech cuing in neurological music therapy. The effect of impact is design using
pre- and post-test by Praat: doing phonetics by computer, Profile of Music Perception Skills(PROMS), and Wong-Baker Face Pain Rating Scale.
The preliminary results of this study showed that music therapy activities are effective way forchildren with hearing impairment in the area such as the perception of changes in spoken tone,
improved in terms of time pauses and beat points, recognition of music perception and musicalemotions.
Conflict of Interest: No conflicts of interest to disclose.
(Approved by the IRB of Fu Jen Catholic University, FJU-IRB No C108055)
PO-10
Prevalence and Characteristics of Temper Tantrum in 1-6 year old Children andImpact from Temper Tantrums on Caregivers
Issarapa Chunsuwan1, Warangkana Prutipaisan1, Tippawan Hansakunachai1
1
Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
ABSTRACT
Background: Temper tantrums are common behaviors whereby children show anger or
frustration, which are found in 50-80% of children. Although tantrums are classified as agerelated behaviors that tend to disappear on their own as children grow older, there are certain
tantrum characteristics that might indicate problematic behaviors. These include tantrums morethan 15 minutes, more than 3 times a day, violent tantrums which harm self or others, andtantrums in children older than 5. These types of tantrums can be associated with mental healthissues in children and can also negatively impact their caregivers’ emotional wellbeing.
Objective: To study the prevalence and characteristics of temper tantrums in children aged 1-6
years at the daycare center and the kindergarten of Thammasat University, Thailand, and impact
of temper tantrums on their caregivers.
Method: This cross sectional-descriptive study was conducted in 2021.The main caregivers ofparticipants completed self-reported questionnaires. The questionnaires collected data including
demographic information, characteristics of temper tantrums and impact from temper tantrums
on caregivers’ emotions.
Results: Data of 221 children were included for analysis. Mean age of children was 4.4 years ±1.2 years. Two hundred and three (91.9%) parents reported that their children had at least one
tantrum behavior, of which verbal tantrums were the most common among these children(85.97%). One hundred and twenty-two (60%) children had tantrums which were defined asproblematic tantrums; tantrums that exhibit aggressive physical behavior, duration greater than
15 minutes, frequency greater than 5 times per day, or more than 3 days per week. The
emotional burden of children’s temper tantrums on their parents reveals scores of 23.3 (8.4) and17.7 (8.3) out of 55 in parents of children with problematic tantrums and without problematictantrums, respectively, which were statistically significant.
Conclusion: Almost all children aged 1-6 years had exhibited some form of tantrum behaviors
toward their parents. Problematic temper tantrums significantly impacted their caregivers’
emotions. Therefore, children with problematic tantrums and their families should be assisted
without allowing the problem to improve on its own.

179

Conflict of Interest: None
PO-11
The Treatment Effects of Daycare Program on Preschool Children with Autistic
Spectrum Disorder – See the Progress and Future
Ji-Yu Lin1, Yen-Nan Chiu1, Wen-Che Tsai1, Su-chen Li1, Chi-Liang Yang1, Mei-Ni Hsiao1,
Guan-Jye Seng1, Wei-Tsuen Soong1, Susan Shur-Fen Gau1, Chi-Yung Shang1
1
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
ABSTRACTThe benefits of early intervention for children with autism have been well-established, but
relatively few studies have examined the effectiveness of treatment provided in an autistic
daycare setting.
In this study, we recruited children who received early intervention in the inpatient daycare
ward for autism at National Taiwan University Hospital (NTUH) from 2016 to 2019. We
measured their progress using the Chinese Child Developmental Inventory (CCDI), Group
Adaptation Function Index (GAFI), and Clinical Global Impression (CGI) both at admission
and before discharge. We then compared pre-treatment and post-treatment scores using a pairedt test and examined the correlation between improvement and children's age at admission. We
also divided the children into good responder and poor responder groups based on their CGIimprovement scores and used an independent t-test to compare the characteristics of the twogroups. We used binomial logistic regression to predict response group based on information atadmission.
Our sample included 94 children with autism (80 male, 85.1%), ranging in age from 1 to 6
years. The mean age at admission was 3.07 and that mean inpatient days was 298. At discharge,
we found statistically significant improvements in CCDI scores for expressive language,
concept comprehension, social comprehension, self-help, personal social, and generaldevelopment compared to pre-treatment scores. All scores on the GAFI also improved
significantly at discharge, including group regulation, learning response, communicating
behavior, and social behavior. We also found that age at admission was negatively correlatedwith the improvement of concept comprehension on the CCDI and learning response on the
GAFI, and was positively correlated with the improvement of gross motor on the CCDI. Good
responders have longer inpatient days, higher score of concept comprehension on the CCDI, andlower CGI-severity score compared with poor responders.
In conclusion, the early intervention program provided in the inpatient daycare ward for autism
at NTUH is a beneficial treatment for preschoolers with autism in multiple domains ofdevelopment. Future research should focus on specific areas of improvement and explore which
populations are most likely to benefit from treatment in this setting.
Ethical considerations: The institutional review board of National Taiwan University Hospital
approved the publication of this research (IRB protocol number = 202012259RINB).
Conflict of interest: The authors report no financial relationships with commercial interests.
PO-12
Sleep Disturbance among Adolescents and Youths with Substance Use Disorder
Attending a Therapeutic Community in Taiwan
Meng-Huan Wu1, Wei-Jian Hsu1, Vincent Chin-Hung Chen2,3
1
Department of Child and Adolescent Psychiatry, Tsaotun Psychiatric Center, Ministry of Health180and Welfare, Nantou, Taiwan
2School of Medicine, Chang Gung University, Taoyuan, Taiwan
3
Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
ABSTRACT
Objective: Sleep disturbance is a growing health concern among young people, especially thosewith substance abuse. Previous studies indicate a bidirectional association between sleep andsubstance use. Sleep disturbance influences mood regulation, cognitive performance, and may
increase the risk of mental illness and substance relapse. We conducted a cross-sectional study
to investigate the prevalence of sleep disturbance and its relations with socio-demographic,
substance-related factors, family support, life events, and depression among adolescents andyouths.
Method: Young people aged 15-24 years with the diagnosis of substance use disorder based on
the Diagnostic and Statistical Manual, Fifth Edition (DSM-5), attending the therapeuticcommunity at Tsaotun Psychiatric Center between February 2007 and April 2020 wererecruited. Participants completed questionnaires on the first day of treatment program, which
included socio-demographic data, substance-related characteristics, List of Threatening
Experiences, Family APGAR score, Centre for Epidemiologic Studies Depression Scale,
Severity of Dependence Scale, and Pittsburgh Sleep Quality Index. Sleep disturbance wasdefined as a global score of Pittsburgh Sleep Quality Index greater than 5. All participants
agreed to participate in this study and provided written informed consent before participation.
The study was reviewed and approved by the Institutional
Review Board of the TsaoTun Psychiatric Center, Ministry of Health and Welfare, Taiwan.
Mann-Whitney U test, chi-square test, and multivariate logistic regression were used to examine
the relationship between variables and sleep disturbance.
Results: Among 135 young substance users, the 1-month prevalence of sleep disturbance was
47.4 %. Compared to those without sleep disturbance, participants with sleep disturbance hadhigher frequency of substance use, greater severity of dependence, higher rate of lifetime
suicide attempt, more life events in the previous year, and greater severity of depression. In themultivariate logistic regression, the severity of depression was independently associated withsleep disturbance after adjusting for key variables.
Conclusion: Sleep disturbance affect about half of adolescents and youths with substance use
disorder and warrants early assessment and intervention, especially for those with depression.
Conflict of interest: The authors have no conflicts of interest to declare.
Ethics approval: This study was reviewed and approved by the Institutional Review Board of
TsaoTun Psychiatric Center, Ministry of Health and Welfare, Taiwan (IRB No. 110023).
PO-13
Efficacy and tolerability of psychostimulants for symptoms of ADHD inpreschool children: a systematic review and meta-analysis
Ming-Yu Wang1
1
Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical
University, Hsinchu, Taiwan
ABSTRACT
Background The benefits and safety of medications for attention-deficit hyperactivity disorder(ADHD) in preschool children. remain controversial, and guidelines are inconsistent on which
medications are preferred across different age groups. There was no previous meta-analysis
investigating efficacy and tolerability of psychostimulants for symptoms of attention-deficit
hyperactivity disorder (ADHD) in preschool children.
Methods: Electronic databases including PubMed, the Cochrane Library, EMBASE,

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ScienceDirect, and ClinicalTrials.gov were searched from inception to March 2022 for eligible
randomized controlled trials (RCTs) investigating the therapeutic efficacy of psychostimulants
against ADHD symptoms in preschool children (defined as ≤6 years of age) compared withplacebos. A random effects model was employed to calculate the effect size using standardized
mean difference (SMD) and odds ratio (OR) .The primary outcomes were (1) changes in ADHD
symptoms evaluated by any clinically validated rating scale from parents’ and teacher’sobservation, or (2) post-intervention improvements in neuropsychological performance.
Secondary outcomes were risks of adverse events.
Results: Meta-analysis of nine eligible trials including 544 preschool children (mean age=4.86
years, female=11.98%, median treatment duration=4.33 weeks) showed efficacy ofpsychostimulants against global symptoms from observations of parents (Hedges’g=0.6152,
p<0.0001) and teachers (Hedges’g=0.6563, p=0.0039). Efficacy of psychostimulants was also
noted against symptoms of inattention and hyperactivity/impulsivity especially for symptoms ofhyperactivity/impulsivity (i.e., main symptoms in preschool children). Moreover, male gender,
older age, and longer treatment duration were associated with better therapeutic effectiveness.
Regarding adverse events, only risk of poor appetite was higher in the psychostimulant groupthan in the placebo group (OR: 2.39).
Conclusions: Our results supported effectiveness of psychostimulants against the symptoms of
ADHD in preschool children, especially hyperactivity/impulsivity from teachers’ observation,with tolerable side effects for most preschool children. More research is warranted to support
our findings.
This metanalysis does not need any institutional review board approval.
I declare no conflict of interest.
PO-14
Autism spectrum disorder features in children with selective mutism
Natsuki Tsujita1, Yasuko Funabiki1
1
Graduate School of Human and Environmental Studies, Kyoto University, Kyoto, Japan
ABSTRACT
Background: Selective mutism (SM) is classified as an anxiety disorder and autism spectrum
disorder (ASD) is considered as an exclusion criterion for SM in the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition. However, recent studies have shown that not only
social anxiety but also problems related to ASD contribute to SM. In addition, a study
examining clinical reports of SM in Japan reported comorbidity of ASD in 10.6% of participants
with SM, suggesting that SM and ASD may coexist. Therefore, the purpose of this study was tocompare the ASD features of children with SM with those of children with ASD and typicaldeveloping (TD).
Methods: We investigated the ASD features of 22 SM, 22 ASD, and 198 TD children aged 6–18.
The SM group consisted of children who had experienced states in which they could speak athome but had been unable to speak at school or preschool for more than one month. The ASD
group consisted of children who had been pointed out as having ASD or had been diagnosed
with ASD. ASD features were assessed using the Autism Spectrum Screening Questionnaire(ASSQ). Participants were asked to answer about how their child was in the lower grade ofelementary school, considering that ASD traits appear in early childhood. We compared the total
ASSQ scores and the three subcategories of social difficulties, tics/motor/obsessive-compulsive
disorder (OCD), and autistic style among the three groups using the Kruskal-Wallis test. This
study was approved by the Kyoto University Graduate School and Faculty of Medicine, Ethics
Committee (R0018-6).
Result: The scores of social difficulties and tics/motor/OCD in the SM and ASD groups weresignificantly higher than those in the TD group, without significant differences between the SM

182and ASD groups. Autistic style scores in the SM group did not differ from those in the TD
group, but those in the ASD group were significantly higher than those in the TD group andmarginally significantly higher than those in the SM group. Both the SM and ASD groups had
significantly higher total scores than the TD group, with marginally significantly higher scoresin the ASD group than in the SM group.
Conclusion: Children with SM were shown to have ASD features partially, suggesting thatassessment of ASD features is necessary in children with SM as well, regardless of diagnostic
criteria.
Conflicts of interest: All authors have no conflict of interest.
PO-15
Associations between media use and executive dysfunction in Thai preschool
childrenPrakasit Wannapaschaiyong1, Saruta Wattanakitthamrong1, Kraiwuth Kallawicha2, Sureelak
Sutchritpongsa1
1
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok,
Thailand2
College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
ABSTRACT
Background: Executive dysfunction in preschool children is related to school failure duringadolescence, adult unemployment, and physical and mental health problems. Screen-based
media use is usually one of the essential factors associated with impaired executive function.
Although the association between executive functions and screen time has been frequently
studied, the contexts of media utilization such as co-viewing and quality of content are rarely
explored and mostly are in terms of experimental research. Therefore, this study aims to address
the relationship between media use characteristics in the real-world setting and executivefunctions in Thai preschoolers.
Methods: A cross-sectional study was conducted among 114 caregivers of preschool children
applying structured questionnaires. The question includes: (1) a sociodemographic information
form for children and the caregiver; (2) a parenting style and dimensions questionnaire (PSDQ);(3) a one-week screen time diary, and (4) the behavior rating inventory of executive functionpreschool version (BRIEF-P). This study protocol was approved by the Siriraj Institutional
Review Board (COA no. 833/2562 (IRB4)). Descriptive analysis, Chi-square tests, andmultivariable logistic regression analysis were used to investigate the association between
media use, other potential factors, and executive dysfunction.
Results: The prevalence of executive dysfunction among Thai children aged 4 to 6, who studied
in kindergarten schools in Bangkok, was 22.8%. The characteristics of children’s media use thatassociated with the impaired global executive function was less time for co-viewing withcaregivers (Adjusted OR 5.51, 95%CI = 1.56-19.45). Considering each aspect of executivefunctions, children who spent less co-viewing time with caregivers were at greater risk of
impairments of inhibition (Adjusted OR 11.12, 95%CI = 2.69-45.96), emotional control(Adjusted OR 17.87, 95%CI = 1.75-182.18), and plan and organization (Adjusted OR 4.52,
95%CI = 1.32-15.50). Meanwhile, more extended periods of viewing low-quality content wereassociated with impaired working memory (Adjusted OR 6.97, 95%CI = 1.37-35.40). However,total screen time and setting screen time limits had no association with executive dysfunction.
Conclusion: Our findings suggest that co-viewing with caregivers and limiting low-quality
content exposure should be promoted to minimize adverse effects on the development ofexecutive functions. Since Thailand has no policy to control the use of children’s screen media,
our results may be an important message to raise awareness for policymakers in the future.

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Conflicts of interest: The authors declare no conflicts of interest.
PO-16
Reliability and Validity of the Child Externalizing Disorder Scale - ADHD-RS-5 and
DBDRS
Saeko Ishibashi1,2, Takeshi Nishiyama3, Futoshi Suzuki4, Takuya Makino4,5, Hidetaka
Nakamichi6, Takuma Higashi5, Tomoko Iida7, Sawa Kurata4,8, Shoko Hamamura4,8, Shinji
Tomari5, Eiji Imanari5, Shintaro Fukumoto5, Takuma Kimura9, Hirotaka Kosaka5
1
Faculty of Nursing Science, Tsuruga Nursing University, Tsuruga, Japan
2
Integrated and Advanced Medical Course, Graduate School of Medical Sciences, University of
Fukui, Eiheiji, Japan3
Department of Public Health, Nagoya City University Graduate School of Medical Sciences,
Nagoya, Japan
4
Research Center for Child Mental Development University of Fukui, Eiheiji, Japan
5
Department of Neuropsychiatry, Faculty of Medical Sciences, University of Fukui, Eiheiji,
Japan
6
Kokoro to KARADA Clinic Fukui, Fukui, Japan
7
Niigata Prefectural Shibata Hospital, Shibata, Japan
8
Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital,
Eiheiji, Japan
9
Faculty of Education, Tokai Gakuin University, Nagoya, Japan
ABSTRACT
Objectives: Attention-Deficit/Hyperactivity Disorder(ADHD) with aggression , Oppositional
Defiant Disorder(ODD) and Conduct Disorder(CD) in childhood can cause serious
psychological and social problems if not treated, and affect their long-term prognosis, so
appropriate screening and early treatment is necessary.
In this study, we examined the diagnostic performance of the ADHD Rating Scale for DSM5(ADHD-RS-5) and the Disruptive Behavior Disorder Rating Scale (DBD-RS) for ADHD,ODD, and CD in a psychiatric outpatient setting, using the Schedule for Affective Disorders andSchizophrenia for School-Age Children-Present and Lifetime version for DSM-5 (K-SADS-PL5) and the child behavior checklist for ages 4–18 (CBCL/4-18) as reference.
Methods: Since there is no Japanese version of the DSM-5 version of ADHD-RS, ODD and CD
items of ADHD-RS, and DBD-RS, we translated them into the Japanese version. The internalconsistency reliability, test-retest reliability, inter-rater reliability, and diagnostic performance of
the ADHD-RS and DBD-RS were examined in 135 Japanese psychiatric outpatients, using thebest estimate diagnosis of ADHD, ODD, and CD based on the K-SADS-PL-5 as the gold
standard diagnosis.
All procedures for this study were approved by the Ethical Review Committees of the
University of Fukui School of Medicine (No. 20210009), Tsuruga Nursing University (No.
21004)
Results: Test-retest reliability was high for ADHD-RS-5 and DBD-RS. Internal consistency
reliability was also high for ADHD-RS and DBD-RS. The internal consistency reliability of the
ADHD-RS-5 and DBD-RS was high for both the parent and teacher versions, but only the CD
item of the teacher version could not be calculated due to a large number of non-responses.
The area under the ROC curve of ADHD items for ADHD-RS-5, ODD and CD items for
ADHD-RS, and ADHD, ODD, CD items for DBD-RS were greater than 0.7, indicating criterion
related validity.
The correlations between ADHD items for ADHD-RS-5, ODD and CD items for ADHD-RS,
and ADHD, ODD, CD items for DBD-RS, and each related item of CBCL were higher than 0.7,
and construct validity was confirmed.
Conclusions: The ADHD-RS-5, ADHD-RS and DBD-RS, which detect ADHD, ODD, and CD184

in children and adolescents, functioned well as screening instruments.
Disclosure Statement of COI: The authors have no financial conflicts of interest to disclose
concerning the presentation.
PO-17
The therapeutical effects of computerized cognitive training via the internet inchildren with ADHD
Shoou-Lian Hwang-Gu1,2, Hsing-Chang Ni2, Chia-Hsiung Cheng1, Susan Shur-Fen Gau3
1
Division of Clinical Psychology, Graduate Institute of Behavioral Sciences, College ofMedicine, Chang Gung University, Tao-Yuan, Taiwan,
2
Department of Child Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
3
Department of Psychiatry, National Taiwan University Hospital and College of Medicine,
Taipei, Taiwan
ABSTRACTThe proximal (neural function and neurocognitive performance) and external effects (behavioral
symptoms) of computer-based cognitive training for attention-deficit/hyperactivity disorder(ADHD) were inconclusive. Our main objective was to broadly assess the therapeutic effects ofthe cognitive training by event-related potential (ERP) on Stop Signal Task, visual/auditory
working memory, continuous performance task, and the multiple behavior rating scales (theseverity of ADHD symptoms and executive function performance). We recruited thirty-two
children with ADHD into the high-training group (five times a week), 32 children with ADHD
into the low-training groups (training twice times a week), and 26 elementary school students as
the typically developing group (TD). The results showed that the high-training ADHD group
had significant improvement in the severity of Inattentive and Hyperactivity/Impulsive
symptoms; the improvement also showed in working memory assessed by the CHEXI rating
scale. However, the low-training ADHD group did not show significant training effects in any
assessment. Meanwhile, the training effect did not show in neural function assessed by ERP and
the performance of the neurocognitive function.
The current study showed that computerized cognitive training delivery via the internet had
some therapeutic effects. However, there still had a lot of clinical and theoretical arguments for
ADHD that need to be concerned.
PO-18
Relationship between autism spectrum characteristics and decision-making
style
Tomoya Takeda1, Koudai Fukudome2, Hidehiro Umehara3, Kimiya Nakamura4
1
Department of Psychological Sciences, University of Human Environments, Matsuyama, Japan2
Department of Psychology, Fukuyama University, Fukuyama, Japan3
Department of Psychiatry, Graduate School of Biomedical Sciences, Tokushima University,
Tokushima, Japan
4
Nakamura Clinic, Tokushima, Japan
ABSTRACTPrevious studies on the decision-making styles of people with autism spectrum disorder (ASD)
have had inconsistent results. Brosan et al. (2014, 2016) showed that people with ASD havecircumspect reasoning bias, while Jansch et al. (2014) and Sahuqullo-Leal et al. (2019) showedthat people with ASD have jumping to conclusions bias (JTC). One reason for the discrepancy
in these results may be that previous studies focused on whether a person had a diagnosis of

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ASD or exceeded the cutoff score of a scale measuring ASD propensity, and did not consider
individual differences in the characteristics that constitute ASD. Therefore, this study focusedon the characteristics that constitute ASD and examined their influence on decision-making
styles.
The participants included 33 university students (male=8, female=25, mean age=19.33±1.65).
ASD characteristics were measured using the Autism Quotient (AQ), which measures social
skills, attention switching, attention to detail, communication, and imagination. The beads task
was used to measure decision-making style. In this task, participants were presented with two
physical jars, one containing 85 red beads and 15 blue beads and the other containing 85 blue
beads and 15 red beads. Then, the two jars were hidden and the participants were told that oneof the jars would be selected at random by the experimenter, who would then draw beads from it
upon their request. If participants needed fewer than two beads to reach a conclusion about
which jar was being taken out, they were considered to have JTC. Mann-Whitney's U test was
conducted with JTC as the independent variable and AQ as the dependent variable for eachsubfactor. This study was conducted with the approval of the Research Ethics Review
Committee of the University of Human Environments.
Mann-Whitney's U test results showed a significant difference between groups in imagination(U=166.00, p=0.02, r=0.42). There was no significant difference in total AQ scores between
groups (U=1467.00, p=0.11, r=0.28).
The results of this study indicate that imagination is related to the characteristics that influence
decision-making styles in people with ASD. That is, participants with imagination difficulties
were more likely to make quick decisions. However, the beads task used in this study has low
cognitive load, and further studies are needed to determine whether similar results can beobtained through tasks with high cognitive loads.
Conflict of interest: The authors declare no COI for this study.
PO-19
Do Preschool Autism Symptoms Predict School-Aged Emotional Go/No-Go
Performances in Children with Autism Spectrum Disorder?
Ying Ru Chen1, Hsin-Hui Lu1
1
Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
ABSTRACTIntroduction: Children with Autism Spectrum Disorder (ASD) tend to have poor emotional
regulation. Although previous studies have found a relationship between autism symptoms andemotion regulation, only few have investigated their predictive relationship. Thus, in this study,
we aimed to examine whether severity in preschool autism symptoms can predict school-aged
emotional regulation in children with ASD. Method: Fifty-four preschoolers (male=49) with
ASD diagnosis and a nonverbal intelligence quotient >70 participated in this study at two-time
points; preschool (T1: Mage(SD)= 5.93y(0.40)) and school age (T2: Mage(SD)= 6.72y(0.34)).
The Autism Spectrum Quotient-Children’s Version (AQ-Child) was used at T1 as a measure ofautism symptoms. The AQ-Child five symptom domains (social skills, attention switching,attention to detail, communication, and imagination) were recorded. An emotional Go/No-Go
Task with three emotional conditions: Happy/Neutral, Angry/Neutral, and Fearful/Neutral, wasused at T2 as a measure of emotion regulation. The commission error rate in the three emotional
No-Go trials (Neutral Go/Happy No-Go, Neutral Go/Angry No-Go, and Neutral Go/Fearful NoGo) were calculated. Results: Hierarchical multiple regressions were conducted with thecommission error rate in Neutral Go/Happy No-Go, Neutral Go/Angry No-Go, and Neutral
Go/Fearful No-Go as the dependent variables, respectively. The age was entered in Step 1 as acontrol variable while scores of the AQ-Child social skills, attention switching, attention todetail, communication, and imagination, were entered using a stepwise method in Step 2.

186

Results revealed that the commission error rate in Neutral Go/Happy No-Go trials was
significantly predicted by attention to detail (β =0.316, p =0.022), while that in Neutral
Go/Angry No-Go and Neutral Go/Fearful No-Go were not predicted by any symptom domain(ps >0.05). Repeated measures were carried out on the commission error rates using ANOVA. A
significant difference was found (F(2, 78) =4.58, p =0.013); the commission error rate in
Neutral Go/Happy No-Go trials was significantly higher than that of Neutral Go/Angry No-Go(p =0.004) and Neutral Go/Fearful No-Go (p =0.004). Conclusion: Severity of preschool autism
symptoms, particularly attention to detail, can predict school-aged emotional regulation to
happy emotional stimuli in children with ASD. The result of this study highlights theimportance of early identification of the types of autism symptoms and their severity in children
with ASD.
This study is ethical and has no conflicting interests to declare. (IRB code number: CS2-19046)
PO-20
Association Between Autism Symptoms Severity and Facial Emotion
Recognition Ability in Children with Autism Spectrum Disorder: A Longitudinal
Study from Preschool to School Age
Yu-Han Liao1, Hsin-Hui Lu1
1
Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
ABSTRACT
Background/purpose: Previous research has suggested that children with autism spectrum
disorder (ASD) may experience challenges in accurately interpreting emotions through facial
expressions. However, it is currently unknown what factors may contribute to this deficit infacial emotion recognition ability in children with ASD from preschool to school age. This
study aimed to determine if ASD symptoms in preschool-age children predict their ability torecognize facial emotions at school age. Methods: This study included 60 children with ASD(boys=53) with a Full Scale Intelligence Quotient of more than 70. The data were collected at
two-time points (T1: Mage (SD)=5.92 (0.40) years; T2: Mage (SD)=6.73 (0.34) years). At
preschool age assessment (T1), parents reported on the severity of their children’s autism
symptoms using the Autism Spectrum Quotient—Children’s Version (AQ-Child). The total AQChild score and scores in five subdomains (social skills, attention switching, attention to detail,communication, and imagination) were calculated. At school age (T2), participants’ emotion
recognition abilities were assessed using the NEPSY-II Affect Recognition subtest and total
recognition accuracy was recorded. Results: The AQ-Child score (r [58]=-.268, p = .039) andcommunication score (r [58]=-.275, p = .034) were negatively associated with emotion
recognition, respectively. Additionally, a linear regression analysis showed that children with
ASD with higher AQ-Child scores in preschool age tended to have lower emotion recognition
abilities at school age (B=-.268, p=.039). Finally, we used multiple linear regression with a
stepwise method to analyze the influence of social skills, attention switching, attention to detail,communication, and imagination on emotion recognition. Communication skills in preschoolage children with ASD were found to be a predictor of their emotion recognition ability at
school age (B=-.275, p=.034). Conclusions: The study found that children with ASD who havemore severe autism symptoms may have difficulty recognizing facial emotions at school age,particularly with communication problems. Thus, the severity of autism symptoms may be a
predictor of facial emotion recognition ability in children with ASD.
This study has been approved by the institutional review board (IRB; code number: CS2-19046)
and there are no conflicts of interest.

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PO-21The Effect of Experiences of Family Abuse on the Treatment of Anorexia Nervosa
Akira Ota1, Hideki Fukatsu1, Junichi Fujita1, Akitoyo Hishimoto2
1
Department of Child Psychiatry, Yokohama City University Hospital, Yokohama, Japan2
Department of Psychiatry, Yokohama City University Hospital, Yokohama, Japan
ABSTRACT
Background: Stress is deeply involved in the development and maintenance of eating disorders
such as anorexia nervosa, and Sports that require a thin body shape, physical and psychologicalabuse, and interpersonal stress are risk factors for the development of these disorders.
Psychological factors that predispose to the onset of the disease include perfectionism,
introversion, obsessive-compulsive, etc. The evidence suggests that family therapy is the mosteffective treatment for the treatment of anorexia nervosa in patients under 19 years of age andwithin 3 years of onset, followed by cognitive-behavioral therapy.
Objects: In the case of neurogenic emaciation in abused children, whether the experience ofabuse affects treatment.
Case: We report a 16-year-old girl with anorexia nervosa (AN) who was physically andpsychologically by her parents. She has always been very particular about her work, and has atendency to do things at his own pace and to be uncomfortable unless things are clearly defined
as black and white. Furthermore, she felt inferior because he had been compared to her superior
younger sister since childhood, and she was unable to talk about her feelings at home. Spendingtime with the parents at home itself was a strong stress for the child. Therefore, family therapy
was initiated to treat the low body weight. Although she had a strong fear of obesity and was
hospitalized and tube feeding was administered, he lost weight again after being discharged
from the hospital, which did not go well. This is because she refused to eat with her family. She
continues to see the patient on an outpatient basis, but her low weight persists due to her strong
refusal to participate in family therapy.
Discussion: The patient's experience of family abuse makes family therapy and cognitivebehavioral therapy as treatment for AN difficult. In the future, Various methods of involvement
are needed, including treatment for abuse and working with parents using social resources as
well.
In order to protect the patient's personal information and privacy, consent was obtained from thefamily in writing.
The authors have no financial conflicts of interest disclose concerning the study.
PO-22
The Associations of Oxytocin Receptor Polymorphism (rs2254298), Right Insula
Cortex Functional Connectivity, Sustained Attention, and Symptom Severity inAutism Spectrum Disorder
Chi Chen1, Susan Shur-Fen Gau1
1
Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
ABSTRACT
Background: Oxytocin is related to social cognitive functions, such as joint attention, and may
be involved in the pathological mechanisms of autism spectrum disorder (ASD). Oxytocin
receptor (OXTR) polymorphism (rs2254298) has been identified as being associated with ASD
risk and social deficits. However, current research on the effects of rs2254298 on brain
functional connectivity and neuropsychological performance in individuals with ASD remains
limited.
Methods: The study was granted ethical approval by the Research Ethics Committee of National

188

Taiwan University Hospital (approval no. 201201006RIB; ClinicalTrials.gov no.
NCT01582256). A total of 105 participants diagnosed with ASD and 105 typically developing
control (TDC) participants were included in the study. All participants underwent a brain restingstate fMRI and neuropsychological evaluation, including Conners' Continuous Performance Test
(CPT) and The Cambridge Neuropsychological Test Automated Battery (CANTAB). The
Autism Spectrum Quotient (AQ), the Social Responsiveness Scale (SRS), and the Chineseversion of the Social Communication Questionnaire (Chinese SCQ) were used to evaluate theseverity of ASD symptoms. ICA-based analysis and dual regression were used to assess
differences in functional connectivity. Further linear correlations were used to explore therelationship between functional connectivity and clinical measurements.
Results: Among all participants, 50.5% of ASD and 45.7% of TDC carry risk allele (A-carrier).
In the ASD group, there was no significant difference in demographic data and clinicalmeasurements, including the AQ, SRS, SCQ, and CPT, between A-carriers and non-A-carriers.
In the resting state fMRI, there was a decrease in functional connectivity between the medial
visual network and the right insular cortex among A-carriers compared to non-A-carriers (p <0.05 after age and sex adjustment). Such hypoconnectivity was also significantly associatedwith longer CPT reaction times (r = -0.286, p = 0.003) and increased severity of ASD
symptoms, as measured by the AQ (r = -0.251, p = 0.024), SRS (r = -0.196, p = 0.049), andSCQ (r = -0.249, p = 0.012).
Conclusion: The OXTR polymorphism (rs2254298) has been associated with aberrant
functional connectivity in regions responsible for visual processing and responding to joint
attention in ASD. This altered connectivity is also significantly associated with ASD symptom
severity. Through the integrative analysis of genetics, neuroimaging, and neuropsychological
performance to clinical measures, these findings highlight the role of OXTR in the pathogenesis
of ASD.
Conflict of Interest: The authors declare that there is no conflict of interest regarding thepresentation of this poster.
PO-23
Detection of dyadic motor synchrony based on automated facial action coding ofsimultaneous video recordings
Chun-Ting Hsu1, Wataru Sato1
1
Psychological Process Research Team, Guardian Robot Project, RIKEN, Kyoto, Japan
ABSTRACT
Real-life and second-person neuroscience aim for more substantial ecological validity using abidirectional interaction design and symmetric measurements to reveal dyadic physiological orneural couplings. We employed a live image relay system that delivered models’ real-time
performance of positive (smiling) and negative (frowning) dynamic facial expressions or theirprerecorded videos to participants. Previous analysis using facial electromyograms (fEMG) of
the zygomaticus major (ZM) and corrugator supercilii (CS) muscles revealed enhanced
spontaneous facial mimicry when observing live facial expressions (Hsu et al., Sci Rep, 2020).
In the present analysis, we used automated Facial Action Coding System (FACS) software,
FaceReader 9, to detect dyadic facial movement coupling based on facial video recordings.
Participants’ action unit (PAU) 12 (lip corner puller) responses significantly correlated withparticipants’ ZM responses (r. = 0.5052, df = 2945, p = 1.09491e-190), but not AU4 responses,
possibly due to the electrode and fixative tape placement around the eyebrows. PAU12
responses reproduced the interaction effect between emotional and presentation conditions (t =3.523, df = 2037, p = 0.000436), showing that live conditions enhanced facial mimicry. Crosscorrelation between model AU (MAU) 12 and PAU12 amplitude up to 27 lags in steps of 1/30
seconds showed that correlations in live-positive conditions peaked at the 4th lag (0.133 s past189

onset, r = 0.114), while correlations in video-positive conditions peaked later at the 13th lag(0.433 s past onset, r = 0.099). Live conditions elicited a faster and stronger facial mimicry.
Dynamic time warping (DTW) between pairs of PAU12 and MAU12 time series showed that
the Euclidian distance was significantly larger in the video than in live conditions (t = 4.904, df= 49.9646, p = 1.04e-05). We performed multilevel vector autoregressive regression (mlVAR)
models, including MAU12 and PAU6, 12, and 25 (based on principle component analysis) withlags of 5, 10, and 15 frames (informed by the cross-correlation results). mlVAR results
suggested a negative-positive-negative temporal pattern of spontaneous facial mimicry, which
progressed faster in the live than in the video condition. Our results indicated that automated
FACS coding of high-quality facial video recordings is valuable for dyadic synchrony detection.
This study was approved by the ethics committee of the Unit for Advanced Studies of the
Human Mind, Kyoto University (approval number: 30-P-7), and performed in accordance withthe ethical standards of the committee. The authors declare no conflict of financial or nonfinancial interests.
PO-24
Our children then and now: Changes in mental health symptoms among
Singaporean children from 2003 to 2017
Lee Yun See Crystal1, Daniel Shuen Sheng Fung2, Goh Tze Jui2
1
Ministry of Health Holdings (MOHH), Singapore, Singapore
2
Institute of Mental Health (IMH), Singapore, Singapore
ABSTRACTIn recent years, there appears to be a rise in the diagnosis and treatment of child mental healthdisorders in many countries, including Singapore. While this increase may be alarming, it could
possibly be attributed to factors such as changes in diagnostic criteria, improved screening inschools and primary health settings, changes in clinical practices, and an increase in helpseeking behaviour. Hence, an examination of community-level trends in mental healthsymptoms can elucidate how child psychopathology has changed over the years. This study
aimed to investigate differences in symptoms of mental health between two cohorts of young
Asian children aged six to eight living in Singapore. Child Behaviour Checklist (CBCL) scoresfrom a sample in 2003 (Cohort 1; n = 524) were compared to another sample taken in 2017
(Cohort 2; n = 655). Cohort 2 had lower externalizing scale scores as compared to Cohort 1, butthere were no significant differences in total problem scores or internalizing scale scores.
Among the CBCL subscales, Cohort 2 had comparatively lower levels of aggressive behaviour
and withdrawn/depressed symptoms, but higher levels of thought problems and somatic
complaints as compared to Cohort 1. Our findings suggest that children in Singapore areprogressing as well as, or even better than, children 14 years ago on most aspects of mental
well-being.
Conflict of Interest
The above research has been published in the Asian Journal of Psychiatry
Lee, C. Y., Goh, T. J., Meaney, M. J., Cai, S., Tan, K.-H., Shek, L. P.-C., Chong, Y.-S.,
Broekman, B., & Fung, D. S. (2021). Our children then and now: Changes in mental healthsymptoms among Singaporean children from 2003 to 2017. Asian Journal of Psychiatry, 63,
102773. https://doi.org/10.1016/j.ajp.2021.102773
PO-25
The Causal Relationship among Personality, Rolefulness, Self-esteem, andIdentity in Japanese High School Students

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Daiki Kato1, Mikie Suzuki2, Aoi Sakakibara1, Keigo Asai3, Makiko Sakai4
1
Kinjo Gakuin University, Nagoya, Japan
2
Aichi University of Education, Kariya, Japan
3
Hokkaido University of Education, Sapporo, Japan
4
Nagoya University, Nagoya, Japan
ABSTRACT
Kato and Suzuki (2018) defined rolefulness as “the continuous sense of role satisfaction in daily
lives” and it includes two subfactors, namely, social and internal rolefulness. Previous studies
demonstrated a partial causal relationship between personality and rolefulness (Sakakibara &Kato, 2021) and among rolefulness, self-esteem, and identity (Kato & Suzuki, 2021). However,studies that comprehensively investigated the causal relationships among these factors remainedlacking. Therefore, the present study intended to examine the causal relationship among
personality, rolefulness, self-esteem, and identity in Japanese high school students. It
hypothesized that rolefulness mediates the causal effects among personality, self-esteem, andidentity.
The study recruited 715 high school students (male: 326, female: 389; first grade: 359, second
grade: 356). Data with missing values were omitted, which left 617 data for analysis. The study
employed the Ten-Item Personality Inventory (Oshio et al., 2012) for measuring personality,
which included five subfactors, namely, extraversion, openness, conscientiousness,
agreeableness, and neuroticism. The study used the Rolefulness Scale (Kato & Suzuki, 2018) tomeasure rolefulness, which included two subfactors, namely, social rolefulness and internalrolefulness. For self-esteem, the study selected four items related to self-esteem from KINDLE(Ravens-Sieberer & Bullinger, 1998a, 1998b). Lastly, the study used the psychosocial identity
factor of the Multidimensional Ego Identity Scale (Tani, 2001) as the criteria of identity.
The study examined the validity of the hypothesized model using structural equation modeling.
Analysis illustrated that social and internal rolefulness were converged into the latent variable ofrolefulness. Agreeableness, conscientiousness, openness, and extraversion increased rolefulness,then facilitated self-esteem and identity in a stepwise manner. In addition, rolefulness directly
increased identity. The fit indexes of the model were adequate (CFI = 0.94, RMSEA = 0.075).
The result will be useful for enhancing the understanding of the dynamic process of theformation of self-esteem and identity in adolescents. Moreover, evidence can be applicable tofuture student support and psychology education.
The ethics committee of Kinjo Gakuin University granted ethical approval of the study. The
authors declare no conflicts of interest that are directly relevant to the content of this article.
PO-26
Case Report: Methylphenidate Improved Chronic Pain in an Adult Patient with
Attention Deficit Hyperactivity Disorder
Ekachaeryanti Zain1,2, Atsunori Sugimoto3,4, Jun Egawa5, Toshiyuki Someya1
1
Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences,
Niigata, Japan2
Department of Psychiatry, Faculty of Medicine, Mulawarman University, Samarinda, Indonesia
3
Department of Community Psychiatric Medicine, Niigata University Graduate School of
Medical and Dental Sciences, Niigata, Japan
4
Department of Psychiatry, Niigata Psychiatric Center, Nagaoka, Japan
5
Department of Psychiatry, Niigata University Medical and Dental Hospital, Niigata, Japan
ABSTRACTIntroduction: Chronic pain remains a health problem that is difficult to treat adequately. Its
unknown cause and complex comorbidity with other illnesses, including mental disorders,
amplify the severity of symptoms, which consequently decreases the quality of life of patients

191

long term. In our clinical practice, we coincidentally found evidence that methylphenidate(MPH) effectively managed chronic pain in an adult patient with attention deficit hyperactivity
disorder (ADHD). The effectiveness of MPH in the treatment of ADHD is well-established;however, its utility in treating pain remains unclear.
Case presentation: We present a rare case of a 43-year-old male patient with 15 years of chronic
idiopathic pain symptoms that did not adequately respond to standard pain management, such asacetaminophen, non-opioid analgesics, and muscle relaxers. Pain also persisted after treatmentswith antidepressants and an epidural block. Furthermore, symptoms worsened following several
sessions of modified electroconvulsive therapy. After a thorough assessment at our child andadolescent psychiatric outpatient clinic, we confirmed a diagnosis of adult ADHD with apredominantly inattentive type. Considering this newly established diagnosis, we prescribed
osmotic-release oral system (OROS) methylphenidate. Within 1 month of treatment at a dose of
18 mg/day of OROS-MPH, the patient’s chronic pain unexpectedly improved dramatically, andthe patient no longer experienced pain symptoms. The dosage of OROS-MPH was titrated
monthly, reaching 72 mg/day as a maintenance dose, and ADHD symptoms improved after 4
months of treatment. The patient was followed up regularly for 7 years during his OROS-MPH
treatment. No adverse effects were reported, including stimulant addiction. He was stable
overall and functioned well in his daily activities. His pain never recurred.
Conclusion: This case report suggests that MPH may be potentially effective in treating chronic
pain. Further studies are needed to confirm whether MPH improved chronic pain
simultaneously with or separately from the improvement in ADHD. Moreover, elucidating theanatomical sites and molecular pharmacological mechanisms related to the action of MPH in
pain modulation and perception is essential. Such sites include the descending dopaminergic
pain pathway and higher cortical areas. Furthering our understanding will reinforce thejustification for treating chronic pain using MPH.
Ethical considerations: this case report did not require institutional review board approval, andwe obtained written informed consent from the patient for presenting the case at a scientificconference.
Conflict of interest: the presenter and co-presenters declare no conflict of interest in this casereport.
PO-27
Association between social support for mothers of patients with eating disorders
and mothers’ active listening attitude: A cohort study
Fujika Katsuki1, Atsurou Yamada2, Masaki Kondo3, Hanayo Sawada1, Norio Watanabe4, Tatsuo
Akechi2
1Department of Psychiatric and Mental Health Nursing, Nagoya City University Graduate
School of Nursing, Nagoya, Japan
2Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University
Graduate School of Medical Sciences, Nagoya, Japan
3National Center for Cognitive Behavior Therapy and Research, National Center of Neurology
and Psychiatry, Tokyo, Japan
4Department of Psychiatry, Soseikai General Hospital, Kyoto, Japan
ABSTRACT
Background: Family members of patients with eating disorders, especially their mothers,
experience heavy caregiving burdens associated with supporting the patient. We predict that
increasing caregivers’ support will have a positive effect on their active listening attitudes,
mental health, loneliness, and self-efficacy. This study aimed to investigate whether there weredifferences in mothers’ active listening attitudes, mental health, loneliness, and self-efficacy
improvements between mothers who did and did not experience increased perceived social

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support.
Methods: Participants were mothers of patients with eating disorders. Questionnaires for thiscohort study were sent to the participants’ homes at three time points (baseline, 9 months, and18 months). Participants were evaluated for social support using the Japanese version of theSocial Provision Scale (SPS-10), listening attitude using the Active Listening Attitude Scale(ALAS), loneliness using the UCLA Loneliness Scale (ULS), self-efficacy using the General
Self-Efficacy Scale (GSES), depression symptoms using the Beck Depression Inventory (BDIII), and psychological distress using the K6. To determine whether participants’ status differed
between the groups that did and did not experience increased perceived social support, we used
an unpaired t-test to compare the two groups. This study was approved by the Ethics Review
Committee of Nagoya City University Graduate School of Medical Sciences, Japan (Ref: No
60-17-0001).
Results: Participants’ mean age was 55.1 ± 6.7 (mean ± SD) years. The duration of theirchildren’s eating disorders was 7.6 ± 5.5 years. The degree of improvement for each variable(active listening attitude, loneliness, self-efficacy, depressive symptoms, and mental health) was
the difference in each score (ALAS, ULS, GSES, BDI-II, and K6) from T1 to T3. The degree of
improvement in active listening attitude and loneliness was significantly greater in the improvedsocial support group than in the non-improved social support group (p < 0.002 and p < 0.012,
respectively).
Conclusions: Our findings suggest that increasing mothers’ perceptions of social support may be
associated with improving their active listening attitudes and loneliness.
Conflict of interest: FK has received speaker fees from Otsuka Pharmaceutical Co., Ltd. AY has
received medical fees from Gifu Hospital, speaker fees from Aichi Education and Sports
Foundation, Kyowa Pharmaceutical Industry Co., Ltd., Meiji Seika Pharma Co., Ltd, Mental
Care Association Japan, Mochida Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd.,
Shionogi & Co., Ltd., and other fees from Nagoya City. HS declares no conflicts of interest. MK
reports a grant from Novartis Pharma K.K., personal fees from Shionogi & Co., Ltd., andpersonal fees from Yoshitomiyakuhin Corporation, outside the submitted work. TA has received
lecture fees from Astra Zeneca Co., Ltd., Daiichi Sankyo Co., Ltd., Dainippon-Sumitomo Co.,
Ltd., Eisai Co., Ltd., Janssen Co., Ltd., Kyowa Co., Ltd., Eli Lilly Japan K.K., MSD K.K., Meiji-Seika Pharma Co., Ltd., Mochida Co., Ltd., Nipro Co., Ltd., Nihon-Zoki Co., Ltd., Otsuka
Pharmaceutical Co., Ltd., Pfizer Co., Ltd., Takeda Co., Ltd., and Tsumura Co., Ltd. TA has
received research funds from Daiichi Sankyo Co., Ltd., FUJIFILM RI Pharma Co., Ltd., MSD
Co., Ltd., Otsuka Co., Ltd., and Shionogi Co., Ltd. NW has received royalties from Sogensha,
Medical View, and Advantage Risk Management. TA has received royalties from the Igakushoin. TA is the inventor of the pending patents (2019-017498 & 2020-135195).
PO-28
Caregivers’ attributing credentialism as the etiology of attentiondeficit/hyperactivity disorder: Its related factors and associations with caregiverdepression and anxiety
Hsin-Yu Lu1, Tai-Ling Liu1,2, Cheng-Fang Yen1,2
1
Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
2
Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, Kaohsiung
Medical University, Kaohsiung, Taiwan
ABSTRACT
Aims: Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent childhood-onset
neurodevelopmental disorder. Although most caregivers attribute their child’s ADHD tobiological causes, such as genetic causes and neurochemical imbalances, caregiver beliefs about
the causes of ADHD may diverge from the biomedical explanatory model. The aim of this193

survey study was to examine the proportion of caregivers who attributed credentialism as the
etiology of their child’s ADHD, the factors related to the attribution, and the associations of
attributing credentialism as the etiology of ADHD with caregiver depression and anxiety.
Methods: This study had 213 caregivers of children with ADHD as participants. Caregivers
were asked whether they considered credentialism as the etiology of their child’s ADHD.
Caregivers’ affiliate stigma was assessed using the Affiliate Stigma Scale. Caregivers rated theirchild’s ADHD and oppositional defiant disorder symptoms on the short Chinese version of theSwanson, Nolan, and Pelham, Version IV Scale. Caregivers’ depression and anxiety wereassessed using the Beck Depression Inventory and Beck Anxiety Inventory, respectively.
Results: In total, 58 (27.2%) caregivers reported that credentialism might be the etiology of theirchild’s ADHD. The results of multivariate logistic regression analysis found that caregivers’
affiliate stigma was significantly associated with caregivers’ attributing credentialism as the
etiology of ADHD. Caregivers who attributed credentialism as the etiology of their child’s
ADHD had higher levels of depression and anxiety compared with those who did not attribute
credentialism as the etiology of ADHD.
Conclusion: Caregivers’ affiliate stigma was significantly associated with their attribution of
credentialism as the etiology of their child’s ADHD. Moreover, caregivers’ attributing
credentialism as the etiology of their child’s ADHD was significantly associated withcaregivers’ depression and anxiety. Health professionals should consider caregivers’ attributed
etiologies when developing intervention programs for enhancing mental health of caregivers
and their children with ADHD.
Institutional Review Board Statement: This study was approved by the Institutional Review
Board of Kaohsiung Medical University Hospital (KMUHIRB-SV(II)-20170077) and Chang
Gung Medical Foundation (201800740A3).
Conflicts of Interest: The authors have no conflicts of interest to declare.
PO-29
Prevalence of Comorbid High-Functioning ASD in Children Initially Diagnosed
with ADHD
Jeewon Lee1, Soyoung Irene Lee1, Hye-in Jung1
1
Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon, Republicof Korea
ABSTRACTIntroduction: Intellectually capable school-aged children with autism spectrum disorders (ASD)
may not exhibit stereotypical features of ASD. Moreover, symptoms of attention deficit
hyperactivity disorder (ADHD) may overshadow the symptoms of ASD. Therefore,
distinguishing a child with both ADHD and ASD from a child with ADHD alone is challenging
in a clinical setting. The purpose of the present study was to examine the prevalence of ASD inchildren with ADHD and to examine the cognitive and clinical characteristics of those with both
ADHD and ASD compared to those with ADHD alone.
Methods: The present study involved a retrospective chart review of the data of the childrenreferred at the psychiatry clinic in a tertiary hospital located in South Korea. The study wasapproved by the institutional review board of Soonchunhyang University Bucheon Hospital(SCHBC 2021-10-0002). The inclusion criteria of the study were school-aged children from 6 to
12 years who were clinically initially diagnosed with ADHD. Those who were initiallydiagnosed with ASD and those who had intellectual disability were excluded in this study.
Autism Diagnostic Observation Schedule (ADOS-2) and Autism Diagnostic Interview (ADI-R)
were performed to confirm the diagnosis of ASD.
Results: Among the 103 children (mean age= 7.83±1.72 years, female=15.53%) initiallydiagnosed with ADHD, 27 (26.21%) children were later co-diagnosed with ASD. While the Full

194

Scale Intelligent Quotient (p=0.485) showed no significant difference between the two groups,
Verbal Comprehension Index (p=0.004) was significantly lower in the ADHD+ASD group, andProcessing Speed Index (p=0.025) was significantly higher in the ADHD+ASD group comparedto the ADHD group. Continuous Performance Test (CPT) results showed that the omission
errors (p-0.001), commission errors (p=0.000) and response time variability (0.008) weresignificantly lower in the ADHD+ASD group than in the ADHD group. Child Behavior Check
List (CBCL) results showed that scores of Anxious/depressed (p=0.002), Social problems(p=0.004), Affective problems (p=0.023), Anxiety problems (p=0.027), and ObsessiveCompulsive Symptoms (p=0.001) were significantly higher in the ADHD+ASD group than in
the ADHD group.
Conclusion: Delayed diagnosis of ASD could deteriorate the prognosis of a child with both ASD
and ADHD. ADHD children with relatively fair results on the processing speed and CPT that do
not reflect the poor daily functions reported by the parents may be distinct characteristics of acomorbid ASD. Higher anxiety and obsessive-compulsive symptoms may also suggest thediagnosis of ASD in children with ADHD.
Conflicts of Interest: The authors have no potential conflicts of interest to disclose.
PO-30
Hopelessness and Its Multidimensionally Related Factors in Children with
Attention-Deficit/Hyperactivity Disorder
Jia-In Lee1,2, Tai-Ling Liu1,2, Ray C. Hsiao3,4, Wen-Jiun Chou5,6, Cheng-Fang Yen1,2,7
1Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical
University, Kaohsiung, Taiwan
2
Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical
University, Kaohsiung, Taiwan
3
Department of Psychiatry, Seattle Children’s, Seattle, WA, USA
4
Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, Seattle, WA, USA
5
Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung
Medical Center, Kaohsiung, Taiwan
6
School of Medicine, Chang Gung University, Taoyuan, Taiwan
7College of Professional Studies, National Pingtung University of Science and Technology,
Pingtung, Taiwan
ABSTRACT
Caring for children with attention deficit hyperactivity disorder (ADHD) is stressful for
caregivers. Hopeless feeling of caregivers can compromise caregivers’ mental health and
impede their ability to take care of their child with ADHD. Identifying factors related tohopelessness in caregivers of CADHD can facilitate the development of intervention programs.
The aims of this study were to examine the associations of caregiver factors (demographics),
child factors (demographics and ADHD symptoms and oppositional defiance), child-caregiverinteraction factor (parenting stress), and child-caregiver-society interaction factor (affiliate
stigma) with caregiver hopelessness among caregivers of children with ADHD in Taiwan. In
total, 213 caregivers of children with ADHD participated into this study. Caregiver hopelessness
was assessed using the Beck Hopelessness Scale. Children’s ADHD symptoms and oppositional
defiance were assessed using the Parent Form of the Swanson, Nolan, and Pelham Scale,Version IV. Parenting stress was assessed using the Parenting Stress Index, Fourth Edition ShortForm (PSI-4-SF). Affiliate stigma was assessed using the Affiliate Stigma Scale. The
multidimensional factors related to caregiver hopelessness were examined suing hierarchicalregression analysis. The result indicated that 26.8% of caregiver had mild hopelessness; 12.2%
had moderate hopelessness; and 1.9% had severe hopelessness. The results of hierarchical195regression analysis found that child inattention, parenting stress, and caregiver affiliate stigma
were significantly associated with caregiver hopelessness. The results of this study indicatedthat hopeless feeling was common among caregivers of children with ADHD. Intervention
programs for relieving hopeless feeling among caregivers of children with ADHD should takechild inattention, and caregiver parenting stress and affiliate stigma into consideration.
This study was approved by the institutional review boards of two university hospitals(201800740A3 and KMUHIRB-SV(II)-20170077).
PO-31
Psychological experiences of mothers of the child with neonatal surgicaldiseases: Focusing on the relationship with the child until school age
Kanna Oyama1, Nami Honda2, Kotaro Nishi3
1
Course in Clinical Psychology, Department of Comprehensive Educational Science, Graduate
School of Education, Tohoku University, Sendai, Japan
2
Clinical Psychology Division, Graduate School of Educational Sciences, Tohoku University,
Sendai, Japan3
Department of Surgery, Miyagi Children's Hospital, Sendai, Japan
ABSTRACTIntroduction: The purpose of this study was to clarify the difficulties for mothers of children
with neonatal surgical diseases and to explore the mothers' experiences based on theirrelationship with their children.
Methods: Six mothers of children with biliary atresias, cloacal anuses, and spina bifida in Japan
were interviewed about their psychological experiences, such as difficulties, feelings, andbehaviors, in relation to their children from infancy to school age.
Results: Qualitative analysis using the Modified Grounded Theory Approach (M-GTA)
indicated that parent-child conflicts were likely to occur after school age. Mothers feel a senseof responsibility for the health of their children after experiencing the confusion of illness ininfancy and the stress of hospitalization. This sense of responsibility facilitates the mothers' care
at home, but the burden of care on the mothers could lead to fatigue and overprotective andcontrolling attitudes toward their children. As the child grow up, they express why surgical scars
exist and medical care need. It may increase the child's doubts about their illness and desire forsocial activities. In the conflict between the child and the mother, the mothers devised somemethods. To give an example, they described the disease positively or respected for the child'sautonomy. This led to the child's sense of acceptance, but if the mother felt difficulty, it tooktime to devise new ways to interact with the child. Through nurturing, the mothers showedchanges in their perceptions, such as affirmation of the existence of the child and acceptance of
the illness.
Conclusion: The results of this study indicate the need for psychological support for mothersfrom infancy to school age. They play a role in conveying the meaning of treatment and theexperience of illness to their children, since children have no memory of their neonatal
surgeries. There is room for support for mothers' sense of difficulty in the school-age period.
This study was conducted with the approval of the ethics review committees of the affiliatedand cooperating institutions.
There are no conflicts of interest (COI) related matters to be disclosed for this paper.
PO-32
A case of psychogenic polydipsia associated with anorexia nervosa

196

Ken Yoshida1, Ken Ebishima1, Akira Uezono1, Takashi Nagasawa1
1
Department of Child and Adolescent Psychiatry, Tokyo Metropolitan Children's Medical
Center, Tokyo, Japan
ABSTRACT
Psychogenic polydipsia, a frequent complication of schizophrenia and other disorders, remains
poorly understood. We report a case of a patient with anorexia nervosa who developed
compulsive drinking behavior. The patient is a 13-year-old female. She was born as the second
child of a pair of siblings, and no developmental abnormalities were observed. In October X-1,
She began restricting her diet and exercising excessively after a school friend commented on her
weight. She also began consuming greater than 6 liters of water daily, based on information
obtained from the internet that suggested water consumption would aid weight loss. She
continued to exercise even during school breaks, and her weight continued to decrease. In May
X, she was diagnosed with anorexia nervosa and admitted to our hospital. Following admission,
we implemented a behavioral therapy regimen in which the patient's scope of activities
expanded in correlation with weight gain. Additionally, we imposed limitations on her fluid
intake. She was steadily gaining weight, resulting in a reduction of her fears of obesity.
However, the patient's obsession with drinking water intensified, and she frequently demandedthat the drinking restrictions be lifted. She also began drinking a specific amount of water at avery precise time each time and insisted that the nursing staff pour the exact amount of water. In
addition, she licked the glass after each drink. She stated that "Initially, I drank water to lose
weight, but now it somehow alleviates my anxiety." An obsessive-compulsive disorder related
to polydipsia was suspected and fluvoxamine was prescribed, however, there was no
improvement in her symptoms. Subsequently, through psychological testing and anotherdetailed interview of her developmental history, it was determined that she had an autism
spectrum disorder. Therefore, her compulsive drinking behavior was thought to have started
with a desire to lose weight in anorexia nervosa and later changed to the repetitive behavior of
autism spectrum disorder, which was exacerbated by prolonged hospitalization, behavioral
restrictions, and other stresses. To alleviate these stresses, we eased her drinking restrictions andallowed her to stay overnight at home. Additionally, the nursing staff refrained fromcommenting on her repetitive drinking behavior, and instead engaged her in conversation onother topics. Gradually, her repetitive drinking behavior improved and she was able to limit her
drinking to 2-3 liters daily. Her weight also increased to a healthy level, and she was discharged
from the hospital in December X.
This study was approved by Tokyo Metropolitan Children's Medical Center, Tokyo and theconsent of the patient and their families was obtained for this presentation. The subjects'
personal information has been carefully considered to maintain her anonymity.
The presenters have no conflicts of interest to disclose concerning the presentation.
PO-33
Long-term effects of online cognitive behavioral therapy for preschoolers withobsessive-compulsive disorder: A case study
Maiko Nonaka1
1
Graduate School of Education, The University of Tokyo, Tokyo, Japan
ABSTRACT
Objective: The prevalence of early onset obsessive-compulsive disorder (OCD) is rather high,and earlier onset symptoms may distress family and patients for long time. Several intervention
programs have been developed to treat very young children with OCD, of which, family based
cognitive behavioral therapy (FB-CBT) is the most promising one. However, few case reports
discuss the effectiveness of FB-CBT in treating preschoolers suffered from OCD in Japan.

197

Further, because of the COVID-19 pandemic, online treatment is required. This study reports
the case of a five-year-old boy with early-onset of OCD. The purpose of this case study was to
examine the effectiveness of an online CBT program for a child with OCD.
Methods: The participant was a five-year-old child with OCD and Tourette’s Disorder. His OC
symptoms were identified as contamination/washing and aggressive/checking. For example,
owing to the anxiety over writing a letter incorrectly, he erased and wrote the letter repeatedly.
Aggressive obsession involved checking with his teacher or mother whether he had done
something “bad.” Ten sessions were conducted via the Internet: three sessions with the child andseven with his mother. FB-CBT consisted of 1) psychoeducation about anxiety, OCD, andhabituation; 2) monitoring of emotions (for both the child and mother); 3) graded exposure andprevention; 4) a cognitive technique to manage OCD; 5) a relaxation technique; 6) modeling;
and 7) scaffolding. Additionally, children’s yale-brown obsessive-compulsive scale (CY-BOCS),
the strengths and difficulties questionnaire (SDQ), and child behavior checklist (CBCL) were
measured before and after treatment.
Result: Through the program, the OC symptoms and internalizing and externalizing problems
decreased (CY-BOCS: 17 to 13, SDQ difficulties score: 15 to 6, CBCL total score: 58 to 19).
The child gradually tried going to the bathroom alone, changed the rituals for cleaning his teeth,and demonstrated an understanding of how to cope with OCD. Ten months later completing the
program, a detailed progression was reported by his mother, it supported the long-term efficacy
of CBT.
Discussion: As early-onset OCD is difficult to cure and tends to be chronic, intensive
intervention, such as exposure therapy, is necessary. As CBT often requires a certain amount ofcognitive ability, watching and waiting are often recommended for very young patients.
Sometimes, untreated symptoms cause family frustration and deteriorating relationships. Family
accommodations must be reinforced to avoid these frustrations. The risks should be consideredwhen contemplating no treatment for OCD in the very early life stage.
Ethical Considerations: This study was approved by the ethics committee for Life Science
research ethics and safety at the University of Tokyo. Consent for this research was obtained
from the young subject and his mother. This study was partially reported by Nonaka andShimoyama (2022) at the Annual Meeting of the Japanese Association of Behavioral andCognitive Therapies.
The author declares no conflicts of interest associated with this presentation.
This study was supported by a Grant-in-Aid for Young Scientists (18K13316).
PO-34
Challenges of Teachers Working with Children with Social, Emotional, andMental Health Difficulties
Megumi Matsumoto1, Haruo Fujino2, 3
1
Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate
School of Child Development, Suita, Japan2
Department of Child Development, United Graduate School of Child Development, Osaka
University, Suita, Japan3
Department of Special Needs Education, Oita University, Oita, Japan
ABSTRACT
Background: Social, emotional, and mental health difficulties (SEMH) refer to a wide range ofsocial and emotional difficulties experienced by children and young people, reflecting mental
health problems such as attention deficit hyperactivity disorder and attachment disorder.
Although studies have suggested special education teachers’ difficulties in relationships andcommunication aspects of children with SEMH, the core concept of the difficulties in school
situations has not been well-investigated.

198

Purpose: We aimed to understand the actual situation of teaching communication andinterpersonal relationship formation to children with SEMH, as experienced by teachers inspecial needs schools, to identify challenges and issues and discuss potentially effective
supports.
Methods: We conducted semi-structured interviews with 16 special education teachers withexperience working with students with SEMH. Written informed consent was obtained after the
study’s procedures were fully explained to participants. Participants were asked to describe thefollowing aspects regarding their educational practice and experience: a) their emotional
experiences in educational practice with the students, b) how they plan and provide guidanceand support for challenges in learning interpersonal relationship formation and communication,and c) what measures and devises they use to consider the characteristics of students’ disabilities
and challenges. These data were analyzed using thematic analysis.
Results: We identified four main themes: “difficulties and rewards,” “difficult characteristics inchildren,” “role as a professional,” and “perspectives for post-graduation.” Teachers were
working with hesitation and difficulties in teaching and supporting their students, and several
teachers implied that their past “failure experiences” were due to their own lack of knowledge
and sought training sessions and educational opportunities.
Discussion: We found that teachers experienced difficulties in understanding and dealing with 1)children’s absences from school and anxiety disorders and 2) the great diversity among children
with SEMH, which were obstacles to instructional planning based on adequate disability
assessment. Some teachers experienced psychological exhaustion and deadlock on these issues.
Support for teachers working with children with SEMH, such assigning school psychologists or
staff to work with students individually, may have important implications.
Ethical consideration: This study was conducted with ethical approval from the Research Ethics
Committee of the Faculty of Education, Oita University.
COI: The authors declared no conflict of interest to disclose.
Funding: This work was supported in part by research grants from the Japan Society for the
Promotion of Science KAKENHI (20K14050 and 17K14067).
PO-35
Taking care of traumatised children and adolescents: Key learnings andperspectives from a 3-year study by the Nice Pediatric Psychotrauma Centercreated after the 2016 mass terror attack
Auby Philippe1,2, Fernandez Arnaud1,2,3, Askenazy Florence1,2,3, Gindt Morgane1,2,3 and theentire NPPC team1
Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Hôpitaux Pédiatriques deNice CHU-Lenval, Nice, France
2
Université Côte d’Azur, CoBTek, FRIS, Nice, France
3
Centre Expert du Psychotrauma PACA Corse, Nice, France
ABSTRACTThe mass terrorist attack in Nice (France) on the evening of July 14th, 2016 (French NationalDay), is one of several terrorist attacks in public places across European countries in recent
years.
More than 30,000 people were in the area, including many babies, children, and adolescents tocelebrate the national day and enjoy the fireworks on the city’s renowned Promenade desAnglais.
86 people died in the attack, including 10 children, the youngest four years old.
A dedicated Paediatric Psychotrauma Centre (Nice Paediatric Psychotrauma Centre - NPPC)
opened on the 2nd of January 2017 in response to care for children and adolescents who
experienced different traumatic events.

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This poster reports data on traumatic events and psychiatric diagnoses related to the activity of
the NPPC during the three years after the unit inception and provides considerations on healthcare policies.
This study was reviewed and approved by CERNI No: 2021-064. The participant's legal
guardian provided informed consent to participate in this study.
866 children and adolescent outpatients, aged 10±4 years, 51% girls and 49% boys, were
followed by the NPPC between January 2017 and December 2019. This study recorded thepotentially traumatic events, the DSM-5 primary diagnoses and comorbidities, and the numberof new and follow-up consultations per week.
Over these three years, 529 children and adolescents consulted for the terrorist attack and 337
for another type of trauma. In addition, many youngsters impacted by the 2016 mass terrorist
attack required follow-up consultations (an average of thirty consultations per week). One of ourmain findings is that the first request for this mass trauma can still occur three years later (anaverage of one per week in 2019).
Overall, we report a high rate of Post-Traumatic Stress Disorder (PTSD) (DSM-5; 71%) with ahigh level of comorbidities (67%), mainly sleep disorders (34.7%) and mood and anxiety
disorders (16.2%).
This large retrospective study suggests the significant impact of mass trauma in children andadolescents with a very high level of PTSD associated with a high rate of comorbidities, thusemphasising the need for early interventions and long-term care to prevent the development of
PTSD and reduce the severity, chronicity, and consequences of symptoms.
These results evidence the need to create paediatric referral centres without age limitations anddevelop public health policies to care for and prevent paediatric PTSD after mass terrorist
attacks and, more generally, after complex humanitarian emergencies.
PO-36
Emergence of psychiatric adverse events during antipsychotic treatment in anaive paediatric population
Auby Philippe1,2, Menard Marie-Line1,2, Cruzel Coralie3, Cohen David4,5, Bonnot Olivier6,
Askenazy Florence1,2, Thümmler Susanne1,2 for ETAPE study group1
Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, Hôpitaux Pédiatriques deNice CHU-Lenval, Nice, France
2
Université Côte d’Azur, CoBTek, FRIS, Nice, France
3
Department of Clinical Research and Innovation (DRCI), Nice University Hospital, Nice,
France4
Department of Child and Adolescent Psychiatry, GH Pitié-Salpêtrière, APHP, Paris, France
5
CNRS UMR 7222 Institut des Systèmes Intelligents et Robotiques, Pierre & Marie Curie
University, Paris, France
6
Department of Child and Adolescent Psychiatry, University Hospital, Nantes, France
ABSTRACTOver the last decades, antipsychotic (AP) prescriptions in the paediatric population haveincreased worldwide, mainly for second-generation antipsychotics (SGA), quite often off-label.
However, despite SGA having an overall better tolerability and safety profile than firstgeneration AP, adverse events (AEs) are frequently observed, some still poorly documented,
including psychiatric ones.
ETAPE was a French multisite, naturalistic and observational study aiming to determine theincidence of AEs potentially attributed to the antipsychotic treatment prescribed for psychotic or
non-psychotic symptoms in naive paediatric patients (ClinicalTrial.gov NCT 02007928).
The study protocol was approved by the Ethics Committee ‘Sud Méditerranée V’ (number
12.082) and the French National Agency for Medicines and Health Products Safety (number
2012-004546-15).

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All patients and their parents signed informed consent.
The ETAPE protocol and main results have been published:doi:10.1016/j.euroneuro.2019.10.006, doi:10.1136/bmjopen-2015-011020
This poster will report recent additional statistical analyses focusing on psychiatric adverse
events that have just been performed and published: doi:10.1186/s13034-022-00517-3
One hundred ninety children and adolescents, aged 12±3 years, most of them being males(73.7%), were included in the study and followed over 12 months with quarterly visits at theend of the first quarter (Q1), the second (Q2), the third (Q3), and the fourth (Q4).
Several quantitative and qualitative measures were assessed during the study, including thePediatric Adverse Events Rating Scale (PAERS), which allows to search and identify AEs
systematically.
We classified AEs into two clinical dimensions: (1) psychiatric AEs, including
aggressiveness/agitation/challenging behaviours, mood changes, suicidal ideation/behaviour…,and (2) non-psychiatric AEs.
Among these 190 paediatric patients, 63.2% (n=120) presented at least one psychiatric AE, with
55.9% of them potentially attributed to the AP by the investigator. Risperidone and aripiprazole
constituted most prescriptions, respectively, 52.5% and 30.83%. The most frequently observed
psychiatric AEs were externalised behaviours such as aggressiveness, agitation or challenging
behaviours (22.7%), mood changes (18.4%) and suicidal ideas or behaviours (11.8%).
Half of the psychiatric AEs occurred during the first quarter, 49.46% (Q1), compared to 23.79%
during Q2, 15.77% during Q3, and 10.96% during Q4.
This additional analysis of ETAPE emphasises that psychiatric AEs are more frequently
observed than expected in the paediatric population.
The potential risk of psychiatric AEs should be part of the benefit-risk evaluation whenprescribing an AP to paediatric patients.
Psychiatric AEs should be monitored in routine clinical practice, especially during the firstquarter after introducing an AP in a drug naïve paediatric population.
Declaration of interest: David Cohen has consulted for or received honoraria from Otsuka,
Lundbeck, and Nestlé.
PO-37
Effects of A Parent Training Program on Two Spectra of Children’s Behaviour: A
Randomised Controlled Study
Ruziana Masiran1,2
1
Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia,
Selangor, Malaysia
2
Department of Psychiatry, Hospital Pengajar Universiti Putra Malaysia (HPUPM), Selangor,
Malaysia
ABSTRACTIntroduction: Evidence shows a stronger impact of the behaviour-based parent training
programs on children’s externalizing behaviours compared to the internalizing behaviours. The
effects of such intervention on these spectra of behaviours have never been compared in theclinical settings in Malaysia. Methods: This randomized controlled study determined theeffectiveness of the Incredible Years parent training program in improving behaviour inchildren, and compared the improvement of the externalizing behaviour with that of theinternalizing behaviour. Seventy mother-child dyads from three tertiary hospitals with Child andAdolescent Mental Health Service (CAMHS) were divided into the parent training program(PTP) and waitlist control (WLC) groups. Parent training sessions were held for 2-3 hours
weekly for 14 weeks. The main outcomes of interest were the scores of total difficulties (SDQTDS), externalizing behaviour (SDQ-EXT), and internalizing behaviour (SDQ-INT), using the201

Strengths and Difficulties Questionnaire. These were measured at three points: baseline before
randomization (T0), two weeks after the intervention (T1), and three months after theintervention (T2). The generalized estimating equation was used for data analysis. The study
was approved by the Research Ethics Committee of UPM (JKEUPM-2021-163) and the
Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia (NMRR-19107-45772). Results: For overall behaviour scores (SDQ-TDS), compared to children of thecontrol group participants at baseline, intervention group participants had 4.2- and 3.5-point
lower SDQ-TDS at two weeks post-intervention and three months follow-up, respectively, B = 4.20, 95% CI [-6.68, -1.72], p = .001; B = -3.51, 95% CI [-6.37, -0.66], p = .016. Compared tochildren of the control group participants at baseline, intervention group participants had 1.8and 1.9-point lower SDQ-EXT at two weeks post-intervention and three months follow-up,
respectively, B = -1.80, 95% CI [-3.09, -0.51], p = .006; B = -1.891, 95% CI [-3.28, -0.50], p= .008. Compared to children of the control group participants at baseline, intervention group
participants had 2.4-point lower SDQ-INT at two weeks, B = -2.40, 95% CI [-4.21, -0.59], p= .009. Conclusion: The Incredible Years’ parent training program was effective in improving
children’s behaviour. Children whose mothers participated in the program showed a positive andsustained improvement in their externalizing behaviour compared to those in the waitlist
control. However, although the program improved children’s internalizing behaviour right after
program completion, any further improvement was not observed.
The author certifies that there is no actual or potential conflict of interest for this study.
PO-38
Effects of Parents’ COVID-19 Infection Control Burden on their Firstborn Child’s
Depressive Mood and Bulimic Tendencies in Japan
Shiho Tanaka1
1
Bunkyo University, Faculty of Human sciences, Koshigaya, Japan
ABSTRACTIntroduction: Have psychological problems such as adolescent and parents’ depressive
tendencies due to COVID-19 infection improved since the start of the 2020 pandemic? This
study examined adults with a first child between middle and high school age. We examined how
parent-child eating lifestyle, mealtime communication, and parental prevention burden related to
COVID-19 infection affected parent-child mental status, including depressive mood andparents’ and children’s tendencies to overeat.
Methods: This study conducted a web survey using reminiscence ratings and participants
consented to the research responded. Four hundred fifty fathers and four hundred fifty-eightmothers living in government-designated cities with more than one million people in Japan and
the Kanto metropolitan area in 2022 December responded. The inclusion criteria were thatparticipants’ firstborn children should be first-year middle to third senior high school students.
In addition, the participants parent should be marriage lasting and have lived with their firstchild from 2020 to 2022. The measurement tools included the Eating Lifestyle, Mother/Father
and Child Mealtime Interaction, COVID-19 Prevention Burden, Bulimia, and Depressive Moodscales. The Depressive Mood and the Overeating Scales assessed the parents and their first childfrom the parent’s perspective.
Results and Discussion: The Depressive Mood scores of the parents and their perception of theirfirstborn child were highest in 2020. They subsequently decreased in 2021 and 2022. Mothers’
depressive mood scores were higher than fathers’ and decreased significantly over time.
Regarding the COVID-19 Prevention Burden subscale scores, prevention burden of infection
from shopping and eating were significantly higher for mothers than fathers in 2020. These
differences decreased over time. Multiple regression analysis with structural equation modelingsuggested that fathers’ sensitivity to food and health affected the increasing sense of the burden

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of infection prevention. Furthermore, fathers’ depressive mood and burden of infection
prevention scores influenced each other in 2020. For mothers, eating with family positively
affected the first children’s bulimia via family ties with a significant trend in 2020. Furthermore,mothers’ bulimia scores positively influenced the feeling of burden of infection prevention in
2022.
This study was supported by a grant from the Mayekawa Foundation for the Public Interest. The
author has no conflicts of interest to disclose. This study was approved by the Research Ethics
Committee of the affiliated university.
PO-39
Association of Affiliate Stigma with Parenting Stress and Its Moderators Among
Caregivers of Children with Attention-Deficit/Hyperactivity Disorder
Tai-Ling Liu1,2, Cheng-Fang Yen1,2
1
Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical
University, Kaohsiung, Taiwan
2
Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical
University, Kaohsiung, Taiwan
ABSTRACT
Caring for children with attention deficit hyperactivity disorder (CADHD) is stressful for
caregivers. Identifying factors related to parenting stress in caregivers of CADHD can facilitate
the development of intervention programs. The aims of this study were to examine theassociations between affiliate stigma and various domains of parenting stress among caregiversof CADHD and to analyze the moderating effects of demographic characteristics and thesymptoms of childhood ADHD and oppositional defiant disorder (ODD) on the associations
between affiliate stigma and various domains of parenting stress. In total, 213 caregivers of
CADHD participated into this study. Parenting stress was assessed using the Parenting StressIndex, Fourth Edition Short Form (PSI-4-SF). Affiliate stigma was assessed using the Affiliate
Stigma Scale. ADHD and ODD symptoms were assessed using the Parent Form of theSwanson, Nolan, and Pelham Scale, Version IV. The results indicated that affiliate stigma wassignificantly associated with increased parenting stress in all three domains of the PSI-4-SF.
ODD symptoms increased the magnitude of parenting stress in two domains of parenting stressamong caregivers with affiliate stigma. Intervention programs for relieving parenting stressamong caregivers of CADHD should take affiliate stigma and child ODD symptoms into
consideration.
Institutional Review Board Statement: This study was approved by the Institutional Review
Board of Kaohsiung Medical University Hospital (KMUHIRB-SV(II)-20170077) and Chang
Gung Medical Foundation (201800740A3).
Conflicts of Interest: The authors have no conflicts of interest to declare.
PO-40
Relationship between adverse childhood experiences and resilience among
mothers
Wachiraporn Arunothong11Department of psychiatry, Lampang Regional Hospital, Lampang, Thailand
ABSTRACT
Background: Adverse childhood experiences (ACES) are traumatic experiences that occurred203

before the age of 18. The ACEs can have impact on lifelong health, mental health anopportunity.
Objective: To study the relationship between adverse childhood experiences (ACEs) andresilience in women who are in their motherhood.
Methods: A cross sectional study was conducted in mothers aged 18 years and over. Participant
mothers must have a child between 0 to 15 years of age. Participants completed self- reportquestionnaires which included; basic information, ACEs, and Connor-Davidson resilience scale(CD-RISC- 25). The study was approved by Lampang Hospital ethical committee No. 7/2562.
Results: Of 519 participants who completed the questionnaires, 150 had ACEs. Mothers with
ACEs tended to live separately from their husband (AOR= 0.4, P =.001), had lower income (P =0.05), and had more insufficient income (P =.001). In addition, these mothers tended to use
physical and verbal violence against their husbands (AOR = 2.57, P =0.026 & AOR = 2.04,
P=0.008) and tended to have alcoholic and substance abuse husband (AOR = 1.47, P= 0.043 &AOR = 18.8, P=0.023). These mothers had lower resilience scores (68.8 Vs.73.6, P < 0.001).
One event of ACEs could decrease 1.5 points of resilience scores (P= 0.019). The least threeresilience items that these mothers mentioned were “know where to turn for help,” “likechallenges,” and “can handle unpleasant things”
Conclusion: Mothers with ACEs tended to have less life opportunity, more marital problems,and had less resilience in adulthood. Therefore, diagnostic these mothers with any tools thathave and have intervention with them might change their resilience attitude and others impacts
on their later lives.
The author has nothing to declare for this study.
PO-41
Parental burden among caregivers of children with diabetes mellitus type 1 inThailand
Arasuma Pannarunothai1, Jirada Prasartpornsirichoke1, Taninee Sahakitrungruang1, Prima
Pavarojkit1
1
Faculty of Medicine, Chulalongkorn university, Bangkok, Thailand
ABSTRACT
Objective: To assess the perceived parental burden associated with caring for children withdiabetes and the association between parental burden and glycemic control in children with type1 diabetes mellitus at King Chulalongkorn Memorial Hospital.
Methods: This was a cross-sectional study. Participants were the pairs of parents and children
diagnosed with type 1 Diabetes Mellitus aged 8 -18 years old, who were receiving treatment at
King Chulalongkorn Memorial Hospital from November 2021 to April 2022. A questionnaire
was used to assess demographic data, perceive parental burden associated with diabetes care (byPAID-PR Thai version), parental depression and anxiety (by HADS Thai version), and child’squality of life (by PedsQL4.0 Thai version). Glycemic control (HbA1c) and comorbidity werecollected from electronic medical records. The population’s demographic data and questionnairescores were presented in descriptive statistics of percentage, mean, minimum-maximum values,
and standard deviation. The inferential statistics were analyzed for parental burden in relation toother psychosocial factors and glycemic control by Independent T-test and multiple logistic
regression. This study was approved by the Ethics Committee of the Faculty of Medicine,
Chulalongkorn University (COA No. 1435/2021 and IRB No. 756/64).
Results: Mean PAID-PR score (parental burden) was 36.34±22.86 of 100. There was asignificant difference in the mean of parental burden score between the good glycemic control
group and the poor glycemic control group (t = 2.40, P = 0.020, Cohen’s d = 0.74). There wasno significant association between other studied factors and glycemic control in this study.
Conclusion: Since our results showed a significant association between parental burden and204

glycemic control in children with Diabetes Mellitus type 1, we suggested that the emotional
well-being of parents or caregivers of youth with diabetes should be managed properly sincethese may improve glycemic control of pediatric patients.
We have no conflicts of interest to disclose.
PO-42
Sensory characteristics of children at developmental risk due to individual andenvironmental factors: Comparison of children with and without developmental
disabilities and child abuse
Ayako Ide-Okochi1, Mu He2, Satsuki Nakamura1, Shota Uchinono3, Tomofumi Tokieda4,
Nobutomo Matsunaga4
1
Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan
2
Graduate School of Health Sciences Education, Kumamoto University, Kumamoto, Japan3
Department of Health Sciences, Kumamoto University, Kumamoto, Japan
4
Graduate School of Science and Technology, Kumamoto University, Kumamoto, Japan
ABSTRACTThe study aims to clarify the sensory characteristics of children with and without developmental
disabilities and child abuse experience and to obtain suggestions for support.
The subjects were children with developmental disabilities (DD), foster home residents (withdevelopmental disabilities and experience of child abuse, hereafter DA) and children withtypical development (TD). Parents or foster care staff reported the frequency of sensory
problems using the Short Sensory Profile (SSP). SSP assessed overresponsiveness orunderresponsiveness across 38 items with seven subscales: tactile sensitivity, taste/smell
sensitivity, movement sensitivity, underresponsive/seeks sensation, auditory filtering, lowenergy/weak, and visual/auditory sensitivity. We calculated each subscale and total scores. Then
we compared three groups by the Kruskal-Wallis test, followed by Bonferroni correction and
two group comparisons by Mann-Whitney's U-test. The study was approved by the Kumamoto
University Ethics Review Committee (approval number: Ethics No. 1917).
There were 8 (6 males) in the DD group, 10 (4 males) in the DA group and 7 (5 males) in the
TD group, with an overall mean age of 13.16 ± 1.84 years. The three-group comparison showedsignificant differences in taste/smell sensitivity (p=0.012), underresponsive/seeks sensation(p=0.007), auditory filtering (p=0.007) and total SSP (p=0.002). In the Bonferroni-correction,
the three subscale scores were significantly higher among DD children than TD. We foundsignificant differences in the SSP total items for groups between TD and DD and between DA
and DD. The U-test then showed significant differences between DD and TD in taste/smell
sensitivity (p=.014), underresponsive/seeks sensation (p<0.001), auditory filtering (p=0.001),
low energy/weak (p=.029), visual/auditory sensitivity (p=.040) and SSP total (p<0.001). DD andDA showed significant differences in tactile sensitivity (p=0.009) and SSP total (p=0.003). DA
and TD showed significant differences in movement sensitivity (p=0.043).
DD group was characterised by significantly higher taste/olfactory sensitivity,
underresponsive/seeks sensation, auditory filtering and SSP total than TD. DA had significantly
lower tactile sensitivity than DD and significantly lower movement sensitivity than TD. Overall,
DD showed the highest sensory abnormalities among the three groups, whereas DA showed lesssensitivity to tactile and movement. The challenge is to examine the factors contributing to thesedifferences and to provide support.
The authors declare no conflict of interest.

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PO-43
The Development of a Thai Social Skill Assessment for Children Aged 6 to 12
Years
Buranat Runglaksameesri1, Janyaporn Jiamjaroenkul1, Polathep Vichitkunakorn2
1
Yuwaprasart Waithayopathum Child and Adolescent Psychiatric Hospital, Samut Prakan,
Thailand2
Department of Family and Preventive Medicine Faculty of Medicine, Prince of Songkla
University, Hat Yai, Thailand
ABSTRACT
Background: Social skills are essential for children's social and emotional development and cangreatly impact their psychological well-being. However, there is currently a lack of assessment
tools specifically designed for Thai children.
Aim: To develop the Thai Social Skill Assessment for Children Aged 6 to 12 Years.
Method: The tool was developed through a mixed method methodology with three phases. The
first phase was a review of relevant literature to examine the construct of social skill assessment
from around the world. The second phase included focus group sessions with parents, teachers,
and mental health professionals which aimed to gather feedback on the content in Thai culture.
The last phase was a content validity assessment and expert panel evaluations with 16
multidisciplinary experts who have more than 5 years of experience in working with social
developmental delayed children from four regions of Thailand.
Results: An initial version of the Thai Social Skill Assessment Tool was developed, including 63
items from 4 underlying dimensions of social skills:
1. Intrapersonal abilities, which include self-awareness, self-evaluation, self-control, and selfexpression.
2. Interpersonal abilities, which include social sensitivity and expression.
3.Social Learning abilities, which include peer imitation and adaptation to social rules.
4. Motivation to be part of the social group.
The content validity assessment was conducted with 16 experts and resulted in a revised toolwith 57 items, including 35 items with an IOC >=0.8 and 25 items between 0.5-0.8. Some items
were removed due to being culturally inappropriate or redundant.
Conclusion: This newly developed tool is the first social skill assessment tool designed
specifically for Thai children in expected to be a valid instrument for evaluating their social
skills. Its aim is to identify children who may require support in enhancing their social skills,
and it provides valuable insights by assessing four underlying dimensions of social skills. These
insights can be used to create targeted interventions and programs aimed at promoting theirsocial skills, relationships, and overall well-being.
Ethical Considerations: The study was approved by the : Yuwaprasart Waithayopathum Childand Adolescent Psychiatric Hospital Review Board and all ethical principles were strictly
followed. Informed consent was obtained from participants and confidentiality was maintained
throughout the study.
Conflict of Interest: The authors declare no conflict of interest.
PO-44
Facility dog activities at Kanagawa Children's Medical Center
Chiaki Hironai1, Noriaki Nakamura1, Junichi Fujita2
1
Department of Child and Adolescent Psychiatry, Kanagawa Children’s Medical Center,
Yokohama, Japan2
Department of Child Psychiatry, Yokohama City University Hospital, Yokohama, Japan206

ABSTRACT
Facility dogs are working dogs that are professionally bred to work full-time at a particularfacility. They are further selected from pedigrees that have been rigorously screened fortemperament and health, and are then teamed with professionally trained medical personnel(handlers) who have also undergone professional training.
In Japan, the first facility dog was introduced at Shizuoka Children's Hospital in January 2010,
followed by Kanagawa Children's Medical Center (KCMC) in July 2012. Currently, facility
dogs are active at a total of four hospitals, but the number of facility dogs is still small comparedto the United States, where they are widely used.
KCMC's facility dog is currently Annie, the second generation. Annie mainly works in animalassisted therapy, that is performed as a specialized treatment in a medical setting. Examples ofanimal-assisted therapy for in-patients include accompanying patients during procedures such as
blood draws, accompanying patients into the operating room, and accompanying patients duringfunctional training. When an order is received from the medical staff, the handler checks thechild's condition in the medical records. Then, Annie actually interacts with the child to build a
relationship of trust and help the child gain the courage to undergo the treatment. Positivechanges can be seen, such as the child smiling during the treatment or increasing the distancewalked during gait training. In many cases, the child's family is also brought peace of mind.
Annie's current activities in the child psychiatry ward include weekly visits to the wards andround visits to children in private rooms. In the past, Annie has participated in groupoccupational therapy, chaperoned group vaccinations, and attended patient case conferences.
Some of children in this ward have strong interpersonal tension, reject communication with staff
and other children, and withdraw to their rooms. The children's anxiety and nervousness are
greatly reduced when they are visited by Annie. However, there is still limited experience in
integrating facility dogs into the treatment structure on an ongoing basis. Since many children
with eating disorders, emotional and behavioral problem with developmental disorders, andchildren who have been abused are admitted to this ward, we believe there is much room to
explore how facility dogs can be used to facilitate treatment for these patients.
Conflicts of Interest: The authors have no conflicts of interest directly relevant to the content of
this article.
PO-45
Comparing structural and pragmatic language skills in the conversations ofchildren with and without ADHD
Hend Samniya1, Shelly Taylor2, Miho Tatsuki3, Gail Tripp1
1
Okinawa Institute of Science and Technology, Onna, Japan
2
South Coast Psychology, Southland, New Zealand
3
Oklahoma State University, Stillwater, United States
ABSTRACT
Objectives: Children with ADHD obtain lower scores than their peers on standardized language
measures. Such language difficulties may interfere with their ability to communicate effectively.
Here we evaluated the ability of children and adolescents with ADHD, and their peers, tomonitor and repair their language during a conversation (social discourse) with a young adultconfederate.
Methods: Forty-nine 9-14-year-old children with ADHD and 49 typically developing (TD)children, matched for age + 3 months and gender, engaged in a 15-minute conversation with ayoung adult confederate. The conversation was recorded, transcribed, and coded for structuraland pragmatic language use by trained raters blind to the children’s age, gender and groupmembership. The occurrence of structural (e.g., morphosyntactic (grammatical) and semantic
mistakes, word disfluencies) and pragmatic (e.g., unrelated responses, disfluent utterances)207

errors and corrections were compared across the two groups.
Results: Children and adolescents with ADHD made significantly more structural language
errors, specifically morphosyntactic mistakes and word repetitions. The groups did not differ intheir efforts to correct their structural language errors. For pragmatic language, children with
ADHD were more likely to make unrelated utterances and were less successful in repairing
disfluent responses. The young adult confederates made more attempts to keep TD group
participants engaged in conversation and rated them as more likable.
Conclusions: We identify subtle differences in the structural and pragmatic language of children
with and without ADHD during semi-structured conversations with young adults. The
confederates were more engaged in their conversations with the TD children and appeared toexperience these interactions more positively. These findings raise questions about the impact ofsubtle language impairments on the quality of children’s conversations and the reactions ofothers to them. We encourage clinicians to consider the quality of children’s language skills intheir assessment protocols and intervention plans (as needed).
This study was approved by the Otago Ethics Committee approval (Approval number 00/11/82).
There is no conflict of interest (COI).
PO-46
Identifying Predictors of Social Problem-Solving Skills in Children with ADHD
Izabela Porebska1, Kokila Perera Dilhani1, Gail Tripp1
1
Okinawa Institute of Science and Technology, Onna, Japan
ABSTRACT
More than 50% of children with Attention Deficit Hyperactivity Disorder (ADHD) experiencesocial interaction difficulties. The specific cause of these problems is not fully understood.
Poorer social problem skills have been identified in those with ADHD and are thought tocontribute to their ongoing social problems. Here, we explore the contribution of ADHD
symptoms severity, age, verbal working memory, theory of mind (ToM) and language skills tosocial problem-solving performance. We also assess the relationship between social problemsolving performance and reported social skills.
One hundred and eight 6-12-year-old children (69% boys) diagnosed with DSM-5 ADHD
participated in this study. The children completed comprehensive psychological evaluations
including assessment of their ADHD symptoms, cognitive functioning and language skills.
Parents rated their behavior and social skills.
The children also completed a version of the Interpersonal Negotiation Strategies in which
minor social conflict situations were presented via brief video-recordings. The children wereasked a series of questions about the interaction followed by a short role-play with theexperimenter. The children’s answers are being coded to assess their understanding of the
problem situation, the participants emotions, their suggestions for how the problem might be
resolved and their ability to enact these solutions with the experimenter.
Regression analyses are being employed to assess the extent to which the children’s
performance is explained by their symptom severity, age, working memory, ToM and language
skills. This includes mediation and moderator analyses. Correlation between task performanceand parent perception of their children’s social skills is also being explored.
Study findings will be presented and discussed with an emphasis on their meaning for managing
the social difficulties of children with ADHD.
The research described was reviewed and approved by the Okinawa Institute of Science andTechnology Graduate University Human Subjects Research Review Committee.
There is no conflict of interest.

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PO-47
Randomized, double-blind, placebo-controlled trial of oral aripiprazole solution
in children and adolescents with Autistic disorder in China
Jing Liu1, Xuerong Ruo2, Yi Huang3, Ling Sun4, Xiaoyan Ke5, Ying Han6, Yuebing Zhang7, Xue
Li1, Yi Zheng8, Keqing Li9, Yunpeng Hao10, Jianping Lu11, Yunhong Wu12, Bin Wu13, Jinjin
Chen14, Mingji Xian15, Motomichi Uki16
1
Peking University Sixth Hospital, Beijing, China
2
The Second Xiangya Hospital of Central South University, China
3
West China Hospital, Sichuan University, China
4
Tianjin Mental Health Centre, Tianjin Anding Hospital, China
5
Nanjing Brain Hospital, China
6
Peking University First Hospital, China
7
Shandong Daizhuang Hospital, China
8
Beijing Anding Hospital, Capital Medical University, China
9
Hebei Provincial Mental Health Center, China
10
The First Hospital of JiLin University, China
11
Shenzhen Mental Health Center, China
12Children's Hospital of Shanxi, Women Health Center of Shanxi, China
13
Xi’an Mental Health Center, China
14Children's Hospital of Shanghai, Children's Hospital Affiliated to Shanghai Jiao Tong
University School of Medicine, China
15
Otsuka Beijing Research Institute, Beijing, China
16
Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan
ABSTRACTWe evaluated the efficacy and tolerability of an oral aripiprazole solution for children andadolescents (6–17 years) with autistic disorder (AD) in a randomized, double-blind, placebocontrolled, 8-week trial in China. The oral solution was used in this trial to improve compliancein children. All patients received a flexible dose of the oral aripiprazole solution (1 mg/mL,
range, 2 to 15 mg). Among the 111 enrolled patients, 52 (91.2%) in the aripiprazole group and
49 (90.7%) in the placebo group completed the study. The aripiprazole group showed astatistically significant improvement in the parent/caregiver-rated Aberrant Behavior ChecklistIrritability subscale score (ABC-I) compared with the placebo group from week 1 through week
8. The clinician-rated Clinical Global Impression-Improvement (CGI-I) in the aripiprazole
group was significantly higher than that in the placebo group from week 1 through week 8. The
response rate, which was the percentage of patients with a score of 1 or 2 on the CGI-I, in thearipiprazole group was significantly higher than that in the placebo group at week 8. The
aripiprazole group showed a statistically significant improvement in ABC- stereotype behavior
and inappropriate speech subscales, compared with the placebo group at week 8. The incidenceof treatment emergent adverse events (TEAEs) reported in ≥1 patient was 86.0% in thearipiprazole group and 75.5% in the placebo group. All TEAEs had mild or moderate severity.
No serious AEs or death occurred in this study. The oral aripiprazole solution was effective,
well-tolerated, and safe for treatment of children and adolescents with AD. To the best of ourknowledge, this is the first randomized, placebo-controlled trial to investigate the acutetreatment of AD in children and adolescents using an oral aripiprazole solution.
The study protocol and amendments, informed consent form, and patient recruitment materials
were reviewed and approved by the ethics committee at each investigational site. This trial was
supported by Otsuka Beijing Research Institute. Drs. Xian and Uki are employees of Otsuka
Beijing Research Institute, China and Otsuka Pharmaceutical Co., Ltd., Japan, respectively.

209

PO-48How have sleep patterns in ADHD children changed during the COVID-19
pandemic?
Kasama Teparak1, Jarruphong Noitumyae2
1
Psychiatric department, Phichit Hospital, Phichit, Thailand
2
Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
ABSTRACT
Thailand's lockdown policy and measurements on the COVID-19 pandemic caused manychanges in children's daily activities, especially their sleep cycles. This study is the only one in
Thailand that focused on and analyzed the sleep problem in attention deficit hyperactivity
disorder (ADHD) children comparatively.
Objective: To comparatively study and analyze the sleep problem of ADHD children during the
COVID-19 pandemic
Methods: An observational prospective cohort study was 80 ADHD children aged between 4
and 10 years old at Phichit hospital (0173/2564) before the second COVID-19 outbreak andmajor lockdown. Data were collected from participants' parents and guardians, provided
demographic data, sleep patterns (bedtime, wake-up time, and sleep duration), and also
completed the Child's Sleep Habits Questionnaire (Thai version). The statistical analyses were a
Chi-square test, independent t-test, causation analysis, diagnostic analysis, and factor cluster
analysis.
Results: Among 80 ADHD children clearly reported significant sleep and wake-up time delays
during the COVID-19 outbreak. There was a statistical significantly increased in the children's
bedtime 1-1.5 times, while the extended wake-up time was at least 30-60 minutes later thanusual. Their wake-up time was significantly delayed 6 times more than usual (6.14 am- 8.21
am). The sleep duration per day also decreased. Regarding the Child's Sleep Habits
Questionnaire, the increase in sleep-breathing disorder was the only module that significantly
changed during the COVID-19 outbreak. The factor cluster analysis revealed a significant
change in sleep patterns in delayed wake-up time and prolonged sleep duration more than 6times.
Conclusion: During the COVID-19 outbreak, the government enforced many regulations that
inevitably affected the children's regular activities, resulting in profound changes in their sleep
patterns and problems, as found in this study.
Acknowledging and understanding such effects of the COVID-19 outbreak on sleep patterns
will raise awareness and prepare and help all the relevant professionals to manage better, advise
and properly care for ADHD children as well as their parents should a similar circumstanceoccurs again.
Information of conflict of interest (COI)
The author sincerely declares that there has not been any known competition or any financial
interests whatsoever or any personal relationship or any conflict of interest that may havecaused any influence on the conduct and report of this study.
PO-49
The study of prevalence and factors associated with medication nonadherencein child and adolescent psychiatric department, Nakorn Nayok Hospital, Thailand
Matthaneeya Jumpapan1
1Child and adolescent psychiatry, Department of mental health and addiction, Nakorn Nayok
Hospital, Nakorn Nayok, Thailand
ABSTRACT210

Objective: To determine the prevalence and associated factors of medication nonadherence
among children and adolescent psychiatric patients at Nakhon Nayok Hospital,Thailand.
Method: After an approval from the corresponding ethical committee of Nakhon Nayok
Hospital,Thailand (Research Ethics Committees, Number 07/2022), a cross-sectionaldescriptive study was conducted on 71 children and adolescent psychiatric patients aged 5-18
years old. The sample population were patients at the child and adolescent psychiatry outpatient clinic at Nakhon Nayok Hospital from 1 January 2022 to 31 April 2022. The
demographic data and the medication histories of both the parents and their children werecollected by direct question, questionnaire and medical record review, which were analysed bydescriptive and analytic statistics via Statistical Package for the Social Science (SPSS) version
26.
Result: From the analysis of the 71 subjects (63.4% were male) with a mean age of 11.9±4.1
years and lived with their parents. Most of them were studying at the secondary school level(50.7%) and were diagnosed with attention deficit hyperactivity disorder (56.3%). The mostprescribed medication was methylphenidate (56.3%) and the average duration of the treatment
was 20.0±14.9 months. The prevalence of medication nonadherence (defined as not taking
medications for more than one meal/day from 2 days/weeks or more) was 49.3%. The mostcommon causes of medication nonadherence were forgetfulness (28.1%), unattendance tofollow up the appointment (21.1%) and a refusal to take medication (15.5%), respectively.
Drowsiness (15.5%) and headache (8.4%) were the most and second common side effects
among patients. Medication adherence were statistically significant with age 5-10 years (p-value= 0.03) and were resident in domicile, Nakhon Nayok Province, (p-value = 0.03). Factors
associated with medication nonadherence were not found in this study.
Conclusion: The results should be used to determine risk factors and to develop tools to improvemedication adherence in child and adolescent psychiatric patients.
PO-50
Mental health of high school teachers in Chiang Mai during the Covid-19
pandemic: Depression, anxiety, stress, and resilience
Pichaya Pojanapotha1, Patara Napanang1, Issaree Panyawan2, Assawin Narkpongphun1
1
Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand
2
Academic Service and Nursing Developmental Division, Chiang Mai University, Chiang Mai,
Thailand
ABSTRACT
Background: Due to the Covid-19 pandemic, people were forced to regulate themselves to the
new normal, with uncertainty and fewer coping strategies. Consequently, psychologicalproblems are increased in all ages including children and adolescents. Efforts have been made topromote mental health in children and adolescents. A number of researches focus on youth
depression, family function, parenting, and family interventions. School mental health wasmentioned in some studies, however, teacher mental health was rarely mentioned. Previous
works suggested that teachers are at risk for mental health problems and even more stressful
during the pandemic. This work aimed to study the prevalence of depression, anxiety and stresssymptoms among Thai secondary school teachers in Chiang Mai during the pandemic.
Materials and methods: Online survey was conducted on 171 teachers from 6 schools in Chiang
Mai province during July to October 2022. The questionnaire consists of 4 parts; 1)
demographic data such as age, gender, teaching subjects, educational degrees, etc., 2) Selfperception about professional knowledge, money and time management, relationships withstudents/school administrators/colleagues/family members, and stress about the Covid-19
pandemic situation, 3) DASS-21 (Depression, anxiety, stress symptoms), and 4) RI-9
(Resilience). Logistic regression analysis was used to analyze the factors associated withdepression, anxiety, stress, and resilience. The study protocol was approved by the Research211

Ethics Committee, Faculty of Medicine, Chiang Mai University (Certificate of Ethical Approval
no. 213/2022).
Results: Depressive, anxiety and stress symptoms were 34.5%, 42.7%, and 24%, respectively.
Most of the teachers (66.1%) reported high level of resilience. Logistic regression analysis
revealed that type of school (private/government/university demonstration) is the only factor
among demographic data that significantly associated with resilience level (p-value < 0.05);
teachers in private school reported highest level of resilience. Self-perception about professional
knowledge, money and time management, relationships with students/school
administrators/colleagues/family members, and stress about the Covid-19 pandemic situation
were all associated with depression, anxiety, stress, and resilience.
Discussion: Teachers play an important role in child and adolescent mental health as well as
parents. This work showed high level of depression, anxiety and stress among Thai teachers
working in secondary schools during the Covid-19 pandemic. We recommend that school
administrators should pay more attention to teacher mental health. Teacher support about
professional knowledge is needed. In addition, programs to promote their interpersonal
relationships, ability to manage time/money are suggested to improve teacher resilience.
All authors have no potential conflict of interest. This study had no commercial or financial
relationships with any third party.
PO-51
A multicenter, randomized, double-blind, placebo-controlled phase III study toevaluate the efficacy and safety of EDP125 in children and adolescent patientswith attention deficit/hyperactivity disorder (ADHD)
Zheng Yi1, Lin Zhongdong2, Yang Ying3, Zhong Yijuan4, Wang Xiuxia5, Yao Baozhen6, Wang
Wenqiang7, Qian Xu8
1
Beijing An’Ding Hospital, Beijing, China
2
Wenzhou Medical University affiliate 2nd hospital, Zhejiang, China
3
ShanDong province Mental Health Center, Jinan, China
4
Xi'An Mental Health Center, Xi'an, China
5
Hebei Medical University 2nd hospital, Shijiazhuang, China
6
Wuhuan people’s Hospital, Wuhan, China
7
Xiamen Xianyue Hospital, Xiamen, China
8
EddingPharm, Shanghai, China
ABSTRACT
Objective: The purpose of this study was to assess the efficacy and safety of EDP125, a
selective norepinephrine，in children and adolescents patients with attentiondeficit/hyperactivity disorder (ADHD).
Method: In this multicenter, double-blinded, phase III study, 221 subjects aged between 6 to 18
years who were diagnosed as ADHD were randomized at ratio 3:1 to receive EDP125
0.2mg/kg/d or placebo daily, stratified by age (6-12 vs 12-18). The primary endpoint was thechange from baseline in total score of ADHD-IV-parental rating scale at week 8. The secondary
endpoints include the change from baseline in regional scores of ADHD-IV-parental rating,effective rate (score reduction ≥ 40%), WFIRS-P score, CGI-I score and CGI-S score, etc.
Results: A total of 221 patients were randomized to placebo (n = 55) and EDP125 (n = 166),with average age of 8.5 (±1.98) years and 83.5% of male. The results from mixed model
repeated measurement (MMRM) showed that after 8 weeks of treatment, the reduction in total
score of ADHD-IV-Parental Rating Scale in the EDP125 treatment group was statisticallysignificantly greater than that in the placebo group (Lsmean difference: -7.09 [-15.58 for
EDP125 vs-8.5 for placebo]; p<0.0001), which confirmed the efficacy of EDP125 in thetreatment of ADHD. In addition, the secondary endpoints also support the clinical efficacy of212

EDP125. During the study, the incidence of treatment emergent adverse events (TEAE) in the
EDP125 treatment group was 74.7%, and that in the placebo group was 63.6%. Most commonly
treatment related TEAE was decreased appetite, abdominal pain and vomiting, the incidences ofthem were 23.5% vs 10.9%, 10.8% vs 14.5%, and 9.0% vs 3.6% for EDP125 group vs placebogroup. Only two serious AE occurred, and neither was related to the study drug.
Conclusions: EDP125 This study demonstrated the significant efficacy of EDP125 in thetreatment of children and adolescents with ADHD with good safety profile and will be welltolerated.
PO-52
Family cognitive remediation therapy for adolescents with anorexia nervosa: afeasibility study
Rie Kuge1, Kayoko Kojima1, Erina Akahane1, Daimei Sasayama2, Hideo Honda1,3
1
Mental Health Clinic for Children Shinshu University Hospital, Matsumoto, Japan2
Department of Psychiatry Shinshu University School of Medicine, Matsumoto, Japan3
Department of Child and Adolescent Developmental Psychiatry Shinshu University School of
Medicine, Matsumoto, Japan
ABSTRACT
Objectives: Family therapy is the first-line treatment for adolescents with anorexia nervosa(AN). However, there remains a subset of adolescents who do not respond well to family
therapy. Cognitive remediation therapy (CRT) aims to increase patients’ cognitive flexibility
through practicing new ways of thinking as well as facilitating bigger picture thinking,supporting patients with relevant tasks, and making them aware of their own thinking styles.
CRT has been applied in the treatment of both adults and adolescents with AN and could be an
adjunct treatment for severe and enduring AN. Regardless of the treatment that is chosen, family
is a vital part of adolescent AN treatment. This study aimed to examine the feasibility of CRT
for adolescents with AN and their families.
Methods: We recruited participants aged 10-18 at Shinshu University Hospital with a clinicaldiagnosis of AN according to DSM-5 criteria. The participants received a usual treatment that
included individual and family sessions, behavioral therapy, nutritional therapy, andpsychoeducation. They also received four sessions of CRT with their families. All sessions were
provided weekly, and each session lasted for 40 minutes. Feasibility was assessed with regard to
dropout rate and adolescents’ and families’ feedback. The study was approved by the ethics
committee of Shinshu University School of Medicine.
Results: As of currently, six adolescents and their mothers have participated in this study. The
average (standard deviation) age, duration of illness, and standard body weight ratio ofadolescents were 14.5 (1.9) years, 23.3 (19.2) months, and 77.5 (6.5)% at pre-CRT, respectively.
Dropout rate was low (17%, one case dropped out). Adolescents’ and families’ feedback weremainly positive. Most participants actively took part in the sessions and could reflect theirthinking styles and the relationships between their thinking styles and real-life situations.
Conclusions: Family CRT for adolescent AN could be acceptable and feasible. Further research
will be required for more formal evaluation of the effects.
There are no conflicts of interest to disclose.
PO-53
Societal Attitudes Towards Children with Autism
Rinvil Renaldi1,2, Pricilia Bulo Tandungan1
1
Faculty of Medicine, Hasanuddin University, Makassar, Indonesia

213

2

Department of Psychiatry, Child and Adolescent Psychiatry Division, Faculty of Medicine,
Hasanuddin University, Makassar, Indonesia
ABSTRACT
Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorders characterized
by a lack of ability in social communication and limited interest and repetitive behavior. The
disturbance in the field of social communication and limited interest of peoples with autism willaffect their interaction with the social environment. They appear "different", "strange" anddisable make them frequently experiencing bullying at a rate of three to four times more often
than their non-disabled peers. The increase of biological age in children with ASD means thatthe demanding of social environment will increase too. However, their capacity to relate withothers, ability to regulate emotional is still lacking even retarded. Along with lack of ability toregulate their emotion makes them vulnerable to have mental health disorders and implicate toacademic functioning, work, increased risk of violence and suicide and impact on productivity
in society life. Students are the next generation of the nation and also have an important role insociety. As an agent of change in society, it is important if students have positive attitude evenas role model thorough appropriate attitude and behavior toward individuals with autism. This isfeasible to achieve with a good understanding of this disorder.
Objective: To find out the Societal Attitudes of Students of the Faculty of Medicine, Hasanuddin
University, General Practitioner Education Study Program towards Autism Spectrum Disorder.
Method: We recruited students which passed psychiatry subject curriculum as respondent. Using
consecutive sampling until minimum 84 respondents was met. We asked respondent to fillingout the Questionnaire of Societal Attitudes Towards Autism by online.
Results: 60% respondents have very positive attitudes, 37% respondents have positive attitude
and 3% respondents have a negative attitude.
Conclusion: Most students do not have a stigma of autism. Students show sufficient acceptancebut their understanding of autism is still lacking. This shows that education about autism comesfrom mental health of children and adolescents professionals need to be improved so the public
understands on it particularly students become much better.
Conflict of interest: The authors declare no conflict of interest.
This study protocol had been approved by the ethical committee of the Faculty of Medicine,
Hasanuddin University with number 717/UN4.6.4.5.31/PP36/2022.
PO-54
Internalizing and Externalizing subscale performance on SDQ of Kindergarten
aged children in Singapore with learning and/or behavioural concerns
Sharline Suhumaran1, Christelle Tan1, Pratibha Agarwal1, Yeo Cheo Lian1, Sandra Sylvia
Mascarenhas1, Lourdes Mary Daniel1
1
Department of Child Development, KK Women’s and Children’s Hospital, Singapore,
Singapore
ABSTRACT
Background: Behavioural markers of long-term risk for mental health problems are present frompreschool years. The Strengths and Difficulties Questionnaire (SDQ) is widely used forassessing child mental health. Broader internalizing (peer and emotional subscales) andexternalizing (hyperactivity and conduct subscales) are useful when comparing interrater
agreement and for studying behavioural profiles.
Objectives: We aimed to (i)study the behavioural profiles (internalizing vs externalizing) using
SDQ parent (SDQ-P) and teacher (SDQ-T) reports of kindergarten aged children presenting
with primary learning and/or behavioural concerns; (ii)study demographic risk factors such as
household income, gender and parental education levels; and (iii)understand whether language214

or literacy difficulties affect behaviour.
Methods: 226 kindergarten aged children (Mean age = 5.42, SD = 0.62), who were referred to
the Learning and Behaviour (LB) clinic of the Department of Child Development at KK
Women’s and Children’s Hospital in Singapore, had their data retrospectively collected between
2016 and 2018. Data were collected from either Ages & Stages Questionnaires, Third Edition(ASQ®-3) or the Developmental Profile 3 (DP™-3), and also clinically developed screeners forlanguage, literacy, numeracy, along with SDQ-P and SDQ-T. Pearson’s correlation was
conducted to assess interrater agreements, and independent t-tests were performed to understandthe relationships between behavioural profiles and factors that influence SDQ scores.
Results: Ninety-four (94) out of 188 (50%) SDQ-P and 125 out of 184 (67.9%)of SDQ-T scores
were borderline to abnormal, and a higher proportion presented with elevated externalizing
versus internalizing scores. Significant positive interrater agreements were found for both
externalizing (r = 0.38, p <.001) and internalizing (r = 0.37, p <.001) symptoms. SDQ totaldifficulties scores were higher in boys and in children whose parents had <12 years of formal
education. SDQ externalizing scores were higher in boys. SDQ internalizing scores were also
higher in children whose parents had <12 years of formal education and who were within alower monthly household income bracket (<$3000/month).
Children with primary literacy concerns had elevated SDQ-T conduct (p <.001) and peer
problems (p = 0.014) scores as compared to those without.
Conclusion: More than half the children in our cohort presented with abnormal SDQ scores,
with good interrater agreement for both internalizing and externalizing symptoms. Lower
parental education levels, lower monthly household income and male gender were associatedwith higher scores. Literacy difficulties affected conduct and classroom peer scores. Further
longitudinal assessment will be helpful.
Ethics board and approvals: This study was approved by the SingHealth Centralized
Institutional Review Board (SingHealth-CIRB, 2017/2621)
PO-55
Predicting Effect of Mastery Motivation on ADHD Symptoms of Children andAdolescent with ADHD
Fang-ju Tsai1,2, Su-Ying Huang3
1
En Chu Kong Hospital, Taipei, Taiwan
2
National Taiwan University Hospital, Taipei, Taiwan
3
Fu Jen Catholic University, New Taipei City, Taiwan
ABSTRACT
Motivation is correlated with psychopathology of ADHD, but little research has examined thisrelation from multifaceted mastery motivation perspectives. The study aims to explore whether
mastery motivation (a psychological construct that stimulates the child’s attempts to master atask; Morgan et al., 2017) is a predictor of ADHD symptoms in school-age children andadolescents with ADHD. Before this research is conducted, approval was received from an
institutional review board and participants’ informed consents were acquired. It involved 88
children and adolescents with their parents (75 boys, 13 girls; mean age, 10.74 years) in Taiwan.
In this study, six indicators of children’s mastery motivation, namely, Object/Cognitive
Persistence, Gross Motor Persistence, Social Persistence with Adults, Social Persistence withChildren, Mastery Pleasure, and Negative Reactions to Challenge, were rated by children on the
Dimensions of Mastery Questionnaire (DMQ 18; Morgan et al., 2020). The children’s ADHD
symptoms were also rated by their parents on the Attention-Deficit/Hyperactivity Disorder Test
(Gilliam, 1995). Regression analysis reveals that six indicators of mastery motivation madeborderline significant contributions to the children with ADHD symptoms (∆R2 = .13; F(6, 81)= 1.98, p = .079). In the finding, the indicator of Social Persistence with Children was a215

significant negative predictor of ADHD symptoms (β = -.34, p = .04). Negative Reactions toChallenge was a positive predictor of ADHD symptoms (β = .25, p = .07). In contrast,
Cognitive/Object Persistence, Gross Motor Persistence, Social Persistence with Adults, andMastery Pleasure were not significant predictors of ADHD symptoms. The research not only
highlights the associations between mastery motivation and ADHD, but also shows how various
mastery motivations may affect children with ADHD symptoms differently.
Conflicts of Interest: The authors declare no conflicts of interest.
PO-56
The Efficacy of an Online Mindfulness-Based Self-esteem Improvement
Intervention in Adolescents: A Pilot Randomized Controlled Trial
Tuksina Krobtrakulchai1, Kanthip Thongchoi1, Wanlop Atsariyasing1, Natee Viravan1, Pennapa
Prommin2, Tidarat Puranachaikere1
1
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
2
Petchaboon Department of Youth Observation and Protection, Phetchaboon, Thailand
ABSTRACT
Background: Mindfulness-based interventions are effective in improving many psychologicalconditions, including anxiety, depression, and insomnia. Low self-esteem is a predictive factor
of various psychological illnesses, especially in adolescents. The online platform increases theaccessibility of intervention.
Objectives: To evaluate the efficacy of developed online Mindfulness-based self-esteem
improvement (MBSI online) intervention in increasing self-esteem, mindfulness, and resiliencein adolescents and to assess the feasibility and satisfaction of the intervention.
Methods: The MBSI online intervention, established in Thailand, has incorporated standard
mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT)concept, and mindfulness practices with the approval of mindfulness practice experts andprogram tryouts. The study was approved by the Siriraj Institutional Review Board (SIRB),COA no. Si369/2022. Seventy adolescents aged 15 to 18, with low to moderate self-esteem
from across Thailand, were recruited and equally assigned to the intervention and waiting list
control groups by stratified randomization by gender. Baseline demographic data, self-esteem,
mindfulness, and resilience have no statistically significant difference between the two groups.
The intervention group received an 8-week MBSI online group intervention. Self-esteem,
mindfulness, and resilience were measured in both groups at baseline, week 4, after theintervention, 1-month follow-up, and 3-month follow-up. The intention-to-treat analysis forwithin-group and between-group comparison was performed by repeated-measures ANOVA,
independent t-test, and ANCOVA adjusted for baseline.
Results: The results showed an increase in self-esteem, mindfulness, and resilience in theintervention group over time from week 4, after the intervention, 1-month follow-up, and 3month follow-up (p< 0.001) compared to baseline. There also was a statistically significant
difference in self-esteem, mindfulness, and resilience (p<0.05) between the two groups at week
4, after the intervention, 1-month follow-up, and 3-month follow-up. The effect size of theintervention in raising self-esteem was large at both after the intervention(n2 = 0.348) and 3-month follow-up (n2 = 0.251). The dropout rate was 25.7%. The overall
intervention satisfaction was high as most participants rated very satisfied in all five aspects:
usefulness of the intervention (92.3%), user-friendliness (96.1%), homework satisfaction(92.3%), facilitator satisfaction (100%), and online platform satisfaction (96.1%).
Conclusions: The MBSI online group intervention was effective in increasing self-esteem,
mindfulness, and resilience with a large effect size and high satisfaction rate for adolescentswith low to moderate self-esteem. The intervention is considered to be a useful, practical, andeasily accessible intervention, with the goal of preventing psychological illnesses caused by low

216self-esteem.
All authors declare that they have no affiliations with or involvement in any organization orentity with any financial interest, or non-financial interest in the subject matter or materials
discussed in this manuscript.
PO-57
Adolescent–Caregiver Agreement Regarding the School Bullying andCyberbullying Involvement Experiences of Adolescents with Autism Spectrum
DisorderYen-Ju Lin1, Tai-Ling Liu1, Cheng-Fang Yen1
1
Department of Psychiatry, Kaohsiung Medical University Hospital, and School of Medicine,College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
ABSTRACT
School bullying and cyberbullying victimization and perpetration are prevalent in adolescentswith autism spectrum disorder (AASD). However, the levels of adolescent–caregiver agreement
regarding the bullying involvement of AASD and factors associated with these levels remain to
be evaluated. In the present study, we evaluated the levels of adolescent–caregiver agreement on
the school bullying and cyberbullying involvement experiences of AASD and the factors
associated with the levels of agreement. This study included 219 dyads of AASD and theircaregivers. The school bullying and cyberbullying involvement experiences of the participating
AASD were assessed using the School Bullying Experience Questionnaire and Cyberbullying
Experiences Questionnaire, respectively. Attention-deficit/hyperactivity disorder, oppositional
defiant disorder (ODD), depressive and anxiety symptoms, and autistic social impairment werealso assessed. AASD and their caregivers had poor to fair levels of agreement regarding theschool bullying and cyberbullying victimization and perpetration experiences of AASD. Severe
inattention, hyperactivity–impulsivity, ODD, depressive and anxiety symptoms, and autisticsocial impairment were associated with high levels of adolescent–caregiver agreement. Whenassessing the bullying involvement experiences of AASD, mental health professionals should
obtain information from multiple sources. In addition, the factors influencing the levels ofagreement should be considered.
Ethic considerations: This study was approved by the Institutional Review Boards of Kaohsiung
Medical University (approval number: KMUHIRB-20120084)
Conflicts of Interest: The authors declare no conflict of interest.
PO-58
Randomized, double-blind, placebo-controlled trial of oral aripiprazole solution
in children and adolescents with Tourette’s disorder in China
Yi Zheng1, Yi Huang2, Yunpeng Hao3, Fan He1, Ling Sun4, Xiaoyan Ke5, Bin Wu6, Yucai
Chen7, Ying Han8, Yuebing Zhang9, Jing Liu10, Hong Han11, Mingji Xian12, Motomichi Uki13
1
Beijing Anding Hospital, Capital Medical University, Beijing, China
2
West China Hospital, Sichuan University, China
3
The First Hospital of JiLin University, China
4
Tianjin Mental Health Centre, Tianjin Anding Hospital, China
5
Nanjing Brain Hospital, China
6
Xi’an Mental Health Center, China
7Children's Hospital of Shanghai, Children's Hospital Affiliated to Shanghai Jiao Tong
University School of Medicine, China
8
Peking University First Hospital, China

217

9

Shandong Daizhuang Hospital, China
Peking University Sixth Hospital, China
11
Children's Hospital of Shanxi, Women Health Center of Shanxi, China
12
Otsuka Beijing Research Institute, Beijing, China
13
Otsuka Pharmaceutical Co., Ltd, Tokyo, Japan
10

ABSTRACTWe evaluated the efficacy and tolerability of an oral aripiprazole solution for children andadolescents (6–17 years) with Tourette’s disorder (TD) in a randomized, double-blind, placebocontrolled, 8-week trial in China. The oral solution was used in this trial to improve compliancein children. All patients received a flexible dose of oral aripiprazole solution (1 mg/mL, range, 2
to 20 mg). The starting dose for all randomized patients was 2 mg. The target doses for patientsweighing <50 kg were 2, 5, and 10 mg/day, and those for patients weighing ≥50 kg were 5, 10,15, and 20 mg/day. Among the 121 enrolled patients, 59 (96.7%) in the aripiprazole group and
53 (88.3%) in the placebo group completed the study. The aripiprazole group showed astatistically significant improvement in the Yale Global Tic Severity Scale Total Tic Score
compared with the placebo group from week 3 through week 8. Both the motor and vocal tic
scores were significantly different between the aripiprazole and placebo groups at week 8. The
response rate, which was the percentage of patients with a score of 1 or 2 on the Tourette’s
Syndrome Clinical Global Impression-Improvement scale, in the aripiprazole group was
significantly higher than that in the placebo group at week 8. The incidence of treatment
emergent adverse events (TEAEs) reported in ≥1 patient was 86.9% in the aripiprazole group
and 65.5% in the placebo group. All TEAEs were of mild or moderate severity. No serious AEs
or death occurred in this study. The oral aripiprazole solution was effective, well-tolerated, andsafe for treatment of children and adolescents with TD. To the best of our knowledge, this is thefirst randomized, placebo-controlled trial to investigate the acute treatment of TD in children
and adolescents using an oral aripiprazole solution.
The study protocol and amendments, informed consent form, and patient recruitment materials
were reviewed and approved by the ethics committee at each investigational site. This trial was
supported by Otsuka Beijing Research Institute. Drs. Xian and Uki are employees of Otsuka
Beijing Research Institute, China and Otsuka Pharmaceutical Co., Ltd., Japan, respectively.
PO-59
Sources of knowledge about attention-deficit/hyperactivity disorder and theirassociations with parenting stress and anxiety among caregivers in Taiwan
Yin-Yin Hsu1, Tai-Ling Liu1,2, Cheng-Fang Yen1,2
1
Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
2
Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, Kaohsiung
Medical University, Kaohsiung, Taiwan
ABSTRACT
Aims: Caregivers of children with attention-deficit/hyperactivity disorder (ADHD) may obtainknowledge for ADHD from various sources in addition to medical professionals; however, theassociations between knowledge sources for ADHD and caregiver parenting stress and anxiety
have not been examined. The aims of this questionnaire survey study were to examine the kindsof sources except for medical professionals that the caregivers of children with ADHD obtained
knowledge for ADHD and the associations between knowledge sources for ADHD andcaregiver parenting stress and anxiety in Taiwan.
Methods: A total of 213 caregivers of children with ADHD participated in this study. Sources
except for medical staff that the caregivers used to obtain knowledge about ADHD were
examined. Caregiver parenting stress was examined using the Parenting Stress Index. Caregiver218

anxiety was examined using the Beck Anxiety Inventory. The association of the varieties andnumber of knowledge sources for ADHD with caregiver parenting stress and anxiety were
examined using multivariate linear regression analysis.
Results: The most common source was children’s schoolteachers (55.4%), followed by social
media (52.6%), traditional media (50.7%), friends (33.8%), parents of other children (21.1%),
and family members (18.3%). Caregivers’ mean sources of knowledge for ADHD was 2.32.
Obtaining knowledge for ADHD from social media was significantly associated with caregiverparenting stress. Obtaining knowledge for ADHD from parents of other children was
significantly associated with caregiver parenting stress and anxiety. The number of knowledge
sources for ADHD was significantly associated with caregiver parenting stress and anxiety.
Conclusion: Caregivers of children with ADHD might obtain knowledge for ADHD fromvarious sources. Obtaining knowledge for ADHD from social media and parents of otherchildren was related to caregiver parenting and anxiety. Mental health professionals should
consider what knowledge sources that the caregivers of children with ADHD common use whendeveloping education programs to deliver accurate knowledge about ADHD.
Institutional Review Board Statement: This study was approved by the Institutional Review
Board of Kaohsiung Medical University Hospital (KMUHIRB-SV(II)-20170077) and Chang
Gung Medical Foundation (201800740A3).
Conflicts of Interest: The authors have no conflicts of interest to declare.
PO-60
Application of complementary and alternative intervention strategies forattention-deficit/hyperactivity disorder: relationships with demographics, childsymptoms, and affiliate stigma
Yi-Ya Fang1, Tai-Ling Liu1,2, Cheng-Fang Yen1,2
1
Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
2
Department of Psychiatry, School of Medicine, and Graduate Institute of Medicine, Kaohsiung
Medical University, Kaohsiung, Taiwan
ABSTRACT
It has long been known that use of complementary and alternative intervention strategies(CAIS) was common among children who had received a diagnosis of attentiondeficit/hyperactivity disorder (ADHD) or in whom ADHD was suspected. Preference for only
CAIS without evidence of their effectiveness may delay the use of effective treatment forchildren with ADHD, and untreated individuals have worse outcomes than treated patients interms of academic, occupational, and social functioning. This cross-sectional questionnaire
study was designed to examine the CAIS employed by caregivers for their children’s ADHD
and the associations of demographics, child ADHD and oppositional defiant disorder (ODD)
symptoms, and affiliate stigma with the employment of these CAIS in Taiwan. A total of 213
caregivers of children with ADHD participated. CAIS that the caregivers employed weresurveyed. Associations of demographics, child ADHD and ODD symptoms, and affiliate stigma
with the application of the CAIS were determined using forward conditional logistic regression
analysis. The results indicated that exercise training (22.5%), sensory integration (20.7%), sugar
restriction (17.8%), and omega fatty acid supplementation (15.0%) were the most common
CAIS that the caregivers employed. Caregiver’s affiliate stigma was significantly associatedwith the employment of any CAIS for children’s ADHD. Children’s inattention andhyperactivity/impulsivity was significantly associated with the employment of sensory
integration and sugar restriction, respectively. Caregiver’s education level was significantly
associated with the employment of omega fatty acids supplement. This study found that various
CAIS were employed by the caregivers to address their children’s ADHD. Caregiver’s affiliate
stigma and education level and children’s ADHD symptoms were significantly associated with219

the application of several CAIS.
Institutional Review Board Statement: This study was approved by the Institutional Review
Board of Kaohsiung Medical University Hospital (KMUHIRB-SV(II)-20170077) and Chang
Gung Medical Foundation (201800740A3). Conflicts of Interest: The authors have no conflictsof interest to declare.
PO-61
Applying implementation science in the development of a community mental
health literacy program for adolescents in Singapore
Cheah Xin Ni1, Tay Leng Leng Jaclyn1, Tang Chao Tian2, Tan Shian Ming2, Tsang Yun Ying
Tammy2
1
MOH Holdings (MOHH), Singapore, Singapore
2
Department of Psychiatry, Sengkang General Hospital (SKGH), Singapore, Singapore
ABSTRACT
Background: Mental Health Literacy (MHL) is the knowledge and beliefs about mental
disorders which aid in their recognition, management, and prevention. MHL is essential in
public health, where it empowers individuals to obtain, process, and understand basic healthinformation and services, which in turn increases their capability to make appropriate healthdecisions. The Institute of Mental Health, a tertiary psychiatric hospital in Singapore, hasembarked on a population-based study entitled “Mind Matters: A study of Mental Health
Literacy” to better understand the MHL of the Singaporean population. While there is evidence
that improving MHL can better promote mental health at the individual and public levels, there
is a paucity of data on how to implement and enhance MHL in the community. Implementation
science is a growing field in psychiatry, and is aimed at translating evidence-based practices
effectively into routine clinical usage.
Aims: We aim to apply the framework of implementation science in enhancing mental healthliteracy in adolescents, linking up with a community partner to develop a train-the-trainer
curriculum and evaluate its effectiveness.
Methods: The project will be co-created with a community partner who has expressed a keeninterest in enhancing the mental health literacy within the organization, and to implement themwithin their adolescent outreach programs. With the identified need established, the organization
would proceed to assign several trainers to be involved in the project. Through an internalsurvey, we can establish and identify potential barriers of the implementation. Implementation
strategies considered would include having several in-person half-day workshops, as well as
two reviews of the trainers involved in this train-the-trainer curriculum. Video recordings andwritten materials will also be co-developed, and will be reviewed every quarterly to tailor the
existing needs of the organization as well as to sustain the training. Evaluation of thiscurriculum would include monitoring the fidelity of the training, any changes or increase inknowledge, and measuring confidence in training of the recipients. These evaluations would be
administered and measured in intervals, namely pre-implementation, after training, and at the 6month mark.
Conclusion: The implementation framework enhances the robustness of translating evidencebased practices to more successful applications, and has potential in improving performances ofcommunity interventions and bringing about sustainable systems-level change.
Conflicts of interest: The authors have no potential conflicts of interest to disclose.
PO-62
Effects of Transcranial Magnetic Stimulation in Children and Young People with
Autism Spectrum Disorder: A Systematic Review and Meta-analysis

220

Ya-Ju Tsai1, Chia-Hsiang Chan2,3
1
Department of Psychiatry, New Taipei City Hospital, Sanchong, Taiwan
2
Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan
3
Department of Psychology, Chung Yuan Christian University, Chungli, Taiwan
ABSTRACT
Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disability manifested
as deficits in social interaction and communication, as well as restricted or repetitive behaviors,interests, and activities. Current pharmacologic interventions in ASD are limited to the
management of co-occurring psychopathology and not for the core symptoms of the disorder. In
recent years Transcranial Magnetic Stimulation (TMS), a non-invasive neurostimulation
technique, has drawn much attention for its potential effects on various psychiatric conditions.
However, the effect of TMS on adolescents with ASD still needs to be determined. To examine
the effects of TMS in children and young people with autism spectrum disorder, we conducted asystematic literature review and meta-analysis on the use of TMS to treat the population.
Methods: We performed a systematic literature search on PubMed, EMbase, and PsycInfo.
Controlled and uncontrolled studies reporting treatment response of TMS on behavior andcognitive symptoms of ASD and related adverse effects in the recent decade were eligible.
Studies with investigated individuals below 24 years of age were included. Two researchers,
including one experienced TMS physician and one child and adolescent psychiatrist, performed
article selection and data extraction independently, according to PRISMA guidelines. The
primary outcome measures were changes in ASD clinical symptoms or cognitive function. For
heterogeneity within studies, we applied random-effects models for further meta-analyses.
Results: We identified 18 eligible studies, comprising four sham-controlled trials, five controlled
trials with a comparison of the waiting-list group, and nine non-controlled trials. While moststudies used low-frequency (0.5-1 Hz) repetitive TMS with a treatment frequency of once or
twice a week, studies using high-frequency TMS have been growingly published since 2019.
The unilateral or bilateral dorsolateral prefrontal cortex was the most common target area. The
random-effect meta-analyses showed a moderate effect size on behavior symptoms andcognitive function. Common adverse effects were headache, scalp discomfort, and irritability,
which were mild and temporary, with a prevalence of 10-20%. According to Cochraneguidelines, most studies had a moderate to high risk of bias.
Conclusions: The results of our review revealed that TMS might offer a promising and safe
treatment modality for children and people with ASD. Aside from behavior symptoms andcognitive functions, electrophysiological signals such as heart rate variability or EEG could be
potential predictors for treatment outcomes. However, the current findings need to beinterpreted with caution due to the shortcomings and limitations of study designs. To determine
optimal TMS parameters, target regions, and treatment protocols for various subtypes of ASD,
further randomized sham-controlled trials are warranted.
Conflict of interest: The authors declare that they have no conflict of interest.
PO-63
A transient period of neuroregression in early childhood in a 12- year- old boy
with very early onset schizophrenia
Deva Priya Appan1
1Department of child and adolescent psychiatry, Institute of Mental Health, Singapore,
Singapore
ABSTRACTThe neurodevelopmental theory of early onset schizophrenia proposes the presence of subtle

221abnormalities from an early childhood period. These abnormalities include developmental
delays, difficulties with social interactions and cognitive deficits. Many subtle cognitive, motorand behavioural deviations are seen years before the onset of illness. These have been describedin literature to be more prominent in patients who present with very early onset psychosis.
A 12-year-old boy with very early onset schizophrenia and normal childhood development is
described in this report. His development was generally normal except for a transient period ofneurogression. At the age of 5, he was evaluated for regression in his speech and cognition for aperiod of 8 months. The investigations including a magnetic resonance imaging (MRI) brain andspectroscopy showed no abnormality. There was no known family history of mental illness.
Subsequently, he presented to psychiatric services at age 11 when he had visual hallucinations
and overvalued ideas. He had an extensive organic workup at this juncture, which did not reveal
any abnormalities. He was closely followed up and his symptoms improved for a few months
after. Despite the improvement in his psychotic symptoms, his academic performance started todeteriorate significantly. Subsequently he developed florid paranoid delusions, auditory
hallucinations with disorganized behaviour and speech. He was initiated on oral risperidone andthere has been some improvement so far on a dose of 3.5mg per day.
Although very early onset schizophrenia is rare, it is important for a child psychiatrist to beaware of the varied early presentations of psychosis in children and adolescents, even in theabsence of developmental abnormalities. This would help to prevent delayed diagnosis andresult in early initiation of pharmacological and psychosocial interventions for a better
prognosis.
I declare that I have no conflict of interest. Consent was obtained from the parents for thepresentation. Child is not well enough to assent. Anonymity will be maintained by not including
any identifying information.
PO-64
A pilot study for suicide prevention program to reduce stigma among teachers
Hidehito Miyazaki1, Junichi Fujita1,2
1Department of Psychiatry, Yokohama City University, Yokohama, Japan
2
Child Psychiatry, Yokohama City University Hospital, Yokohama, Japan
ABSTRACT
Currently, partly because of the COVID-19 pandemic, suicide among children and adolescentsis increasing in Japan, and a suicide prevention program targeting these age groups is being
considered. Teachers are key individuals to prevent suicide among children and adolescents, and
it is hoped that they will do so without stigma. However, effective means for educating teachers
to reduce stigma regarding suicide among children and adolescents has not been established.
Therefore, we initiated a study on the effectiveness of suicide prevention education for highschool teachers in Kanagawa Prefecture.
The study comprised lectures on the three topics provided to teachers over a two-year period.
(1) “Medical intervention” that explains the kind of care provided in the psychiatric department.
(2) “Psychological support” that explains the best response to a child who wants to commit
suicide. (3) “Social resource and support” that considers specific suicide prevention measures
and ways to work with the community. We compared the lecture content that was more effective
in reducing teachers’ stigma of suicide and acquiring and retaining knowledge. The lectures areincluded online and in-person because of the COVID-19 pandemic. Each lecture consists ofapproximately 1 h and includes a 15-min question and answer session.
The study period was from 2021.4 to 2023.3, and six schools participated in the study.
Questionnaires, including the stigma of suicide scale, were administered before and after the
first lecture. There were 163 participants who correctly answered the stigma of suicide question.
Stigma of suicide before the lecture was T1 and after the lecture was T2, and the difference222between before- and after the lecture T1-T2 (SD) for each was as follows; ” medical
intervention (N=84)” (estimate=0.67, SE=2.05), “psychological support(N=40)” (estimate=2.87,
SE=1.56), and “social resource and support (N=39)” (estimate=1.30, SE=2.05). Consequently,
the difference between before and after the lecture opened in “psychological support.”
This study indicated that it reduced the stigma of suicide among teachers and facilitated better
cooperation between medical and educational fields. We plan to continue lectures and study
more schools and conduct a cluster randomized controlled trial to further compare effective
methods of knowledge dissemination to teachers.
This study was approved by the Institutional Review Board at the Yokohama City University
Hospital.
There is no conflict of interest (COI).
PO-65
A case of gender identity disorder with anorexia nervosa from maturity-related
fear
Hideki Fukatsu1, Akira Ota1, Junichi Fujita1
1
Department of Child Psychiatry, Yokohama City University Hospital, Yokohama, Japan
ABSTRACT
Background: People with gender identity disorders are at increased risk for developing eating
disorders due to factors such as stigma from others and discrepancies between self-gender andbody. In particular, female secondary sexual characteristics have been identified as a risk factor
for eating disorders in transgender men. We report our experience with a case suffering fromgender identity disorder with anorexia nervosa from maturity fear.
Objects: This presentation aims to review better treatment options for anorexia nervosa
associated with gender identity disorder.
Case: Our patient is a 17-year-old female. After entering elementary school, she began to feel
uncomfortable with her gender, and her first menstrual period triggered a strong aversion to thechanges in her feminine body. After entering junior high school, she became aware of her
gender identity disorder and started a diet to achieve an ideal, slim male body shape. Her weightgradually decreased to the point where she weighed 36.2 kg and had a BMI(Body Mass Index)
of 13.8, which was a markedly low body weight, at the time of her first visit to our department
at the age of 17. Despite receiving outpatient care, her weight did not improve much. Thus, she
was admitted to the hospital. During the course of her treatment, we found that she had aprominent aversion to the secondary sexual characteristics of females, such as menstruation andbreast development. Later, we shared with the patient’s family members her conflicted feelings
about her own sexuality. We will continue to support her in finding an ideal future vision thattakes her selfhood into consideration. After being discharged from the hospital, the patient
received hormone therapy to suppress menstruation in cooperation with her obstetrician andgynecologist. Her progress has been good, with no recurrence of her fear of obesity.
Discussion: The treatment of anorexia nervosa associated with gender identity disorder should
consider not only the fear of obesity but also the gender identity of the patient.
The authors have no financial conflicts of interest to disclose concerning the study.
PO-66
Correlation between Internet Use, Perceived Stress and Depressed Mood among
Secondary School Students at Northern Taiwan
Iris, Chih-Tsai Chen1,2, Ya-Hsing Yeh2

223

1

Department of Child and Adolescent Psychiatry, Taoyuan Psychiatric Center, Ministry of
Health and Welfare, Taoyuan City, Taiwan
2
Center for Mental Health Promotion, John Tung Foundation, Taiwan
ABSTRACT
Objectives: Understand the status and correlation between depressed mood, stress and internet
use among Taiwanese Secondary School Students.
Methods: This study was conducted using the survey datasets from the John Tung Foundation
Mental Health Center. The survey was carried out in June 2019. Senior high school students
from Greater Taipei area in Taiwan were recruited using convenience sampling. A total of 26
senior and vocational high schools participated. 2,140 valid questionnaires were collectedanonymously by allocating students filled out the self-administered questionnaire.
Results: 12.4% of the adolescents was found “Depressed mood, which need help”; 30.7% ofthem “often” and “always” felt stressed over the last 6 months; 13.5% of them “often” and“always” felt lonely. More often they felt lonely, more intense of their depressed mood notedsignificantly. The proportion of “Depressed mood, which need help”; “Often and always felt
stressed”; and “Often and always felt lonely” in girls were significantly higher than that in boys.
The proportion of “four hours or more" average online time on weekdays and holidays in boys
were significantly higher than that in girls, and independent of how often they perceived stress.
Multiple logistic regression analysis was performed to examine factors of gender, depressedmood and loneliness associated with “four hours or more" average online time on weekdays andholidays respectively. After adjusting for other variables, predicting for “four hours or more"
average online time on weekdays was significantly increased with boys, more often of feelingloneliness, more tense of depressed mood; whereas predicting for “four hours or more" average
online time on holidays was significantly increased with boys and more often of feelingloneliness, but nonsignificant with tense of depressed mood.
Conclusions: Untangling the intricacies of relationship between perceived stress, internet use,and depressed mood shed some light on clinical intervention.
Conflict of Interest: No conflicts of interest to disclose.
(Approved by the IRB of National Cheng Kung University, IRB No 111-065)
PO-67
Factors Affecting Changes in Urine Osmolality in Pediatric Bipolar Disorder
Taking Lithium
Jiwoon Jeong1, Hyun-woo Park1, Beom-Sung Choi1, Ji-Hoon Kim1
1
Pusan National University Children's Hospital, Republic of Korea
ABSTRACT
Objective: To investigate the changes in and factors affecting urine osmolal concentration
during hospitalization and discharge following lithium drug treatment in children and adolescentinpatients with bipolar disorder
Methods: Among patients under 19 years of age who were admitted to the pediatric andadolescent psychiatric ward of Yangsan Pusan National University Children’s Hospital from
December 1, 2018 to November 16, 2022, those who were diagnosed with bipolar disorder anddischarged after at least three weeks of hospitalization with lithium treatment were included.
From hospitalization to discharge, urine osmolal concentration tests were periodically
performed. This study was reviewed by Institutional Review Board of Pusan National
University Yangsan Hospital.
Results: The urine osmolal concentration at the time of discharge significantly decreased
compared to that at hospitalization in all groups: lithium-taking, non-lithium-taking, and all
patient groups (p < 0.001). Patients who took lithium before hospitalization had lower urine

224

osmolal concentration at hospitalization than those who did not (p < 0.030). The under-13 group
had significantly higher urine osmolal concentration at hospitalization than the 13 and overgroup (p=0.036) and had significant differences in urine osmolal concentrations between
hospitalization and discharge (p=0.041). Females had significantly lower urine osmolal
concentrations at discharge than males (p=0.008).
Conclusion: In children and adolescents with bipolar disorder, the urine osmolal concentration
at discharge significantly decreased compared to that at hospitalization in all patient groups,
regardless of whether lithium was taken during hospitalization. Factors affecting urine osmolal
concentration at hospitalization and discharge include whether lithium is taken before
hospitalization, age, and sex. Further studies on the long-term effects of lithium on height andsubsequent symptoms are needed.
Conflicts of Interest: The authors declare no conflict of interest.
PO-68
The neural correlates of disembodiment in patients with ASD: possible
correlation with interoceptive accuracy
Jung-Woo Son1,2,3, Ahjeong Hur2, Seungwon Chung1,2, Hoyeon Lee2
1
Department of Psychiatry, Chungbuk National University Hospital, Cheongju, South Korea
2
Autism and Developmental Disorder Treatment Center, Chungbuk National University
Hospital, Cheongju, South Korea
3
Department of Neuropsychiatry, College of Medicine, Chungbuk National University,
Cheongju, South Korea
ABSTRACT
Objective; Many studies of sense of self in patients with ASD have been reported continuously,
but there are still very few studies on their 'disembodiment' experiences. The purposes of thisstudy were to investigate the difference of brain activity between ASD patients andneurotypicals (NTs) in a state of disembodiment, and to find the correlation between thepsychological characteristics, interoception abilities and the activities of disembodiment-relatedareas.
Method: All subjects measured psychological evaluation and cardiac interoception two weeks
before the fMRI scan. The fMRI images were taken while the ASD group (N=18) and the NT
group (N=21) were asked to perform the task composed with ball-throwing animations. The task
reflected on either self-agency about ball-throwing or location of a ball. And each block wasshown with either different (Changing View) or same animations (Fixed View). The
disembodiment-related condition was the interaction between Agency Task and Changing View.
Results: Within-group analyses revealed that the ASD group exhibited higher activation in thebilateral temporo-parietal areas and precuneus. And between-group analyses showed that the
ASD group exhibited higher activation in the area near the left temporo-parieto-occipitaljunction, left precuneus, left hippocampus, and mid-temporal area. Finally, the cardiac
interoceptive accuracy showed significantly negative correlation with the activity of left
temporo-parietal area(superior parietal gyrus), and the social communication scores of ADOS-2
showed significantly positive correlation with the activity of left mid-temporal area in ASD
group.
Conclusion: These results show that the disembodiment-related activation of the brain is easily
manifested in ASD patients. In addition, the disembodiment-related brain activation is closely
related with the problem of interoception in ASD patients.
Conflict of interest: none
Ethical consideration: This study was conducted after receiving IRB and is not a study withethical issues.

225

(Chungbuk National University Hospital IRB No. ;2022-04-021-003)
PO-69
The prevalence and associated factors of depression and anxiety in senior highschool students in Chiang Mai, Thailand
Jutipat Manomaivibul1, Benchalak Maneeton2, Narong Maneeton2, Suttipong Kawilapat2,
Nongluck Kienngam3, Pichaya Pojanapotha2
1Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi,
Thailand2
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
3
Faculty of Education, Chiang Mai University, Chiang Mai, Thailand
ABSTRACT
Depression and anxiety are widespread mental illnesses with rising prevalence among youth.
Early onset of depression and anxiety were associated with poor outcomes. However, most of
the previous studies focused on junior high school students. This study was to determine theprevalence, associated factors, and severity of depression and anxiety in senior high school
students in Chiang Mai.
We conducted a cross-sectional study including 275 senior high school students in 5 randomschools and did a structured interview including information about sociodemographic data,associated factors, depression, anxiety, and self-esteem. PHQ-A, SCARED, and Rosenberg’s
Self-Esteem Scale – Thai versions were used. Potential associated factors were examined using
binary logistic regression analysis.
We found the prevalence of depression was 46.6% (male 40.5%, female 59.5%). The students
who have stress from relationship with their parents (aOR=3.26, 95%CI=1.15–9.26, p=0.026),
stress from relationship with their friends (aOR=3.34, 95%CI=1.25–8.85, p=0.016) and choose
to relax by travelling (aOR=2.80, 95%CI=1.36–5.78, p=0.005) had a high prevalence ofdepression. For the relationship factor, these findings concurred with previous studies thatfamily and peer relationships are positively associated with depression. However, theassociation between travelling and depression was assumed to be the result of the lockdown
during the COVID-19 pandemic, because those who usually relax by travelling cannot use thismethod to relieve their stress.
The prevalence of anxiety was 45.9% (male 29.7%, female 70.3%). Contrary to most studies,
we discovered that students with better GPAs have a significant prevalence of anxiety(aOR=3.18, 95%CI=1.50–6.74, p=0.003). Some studies found that individuals with a moderateamount of anxiety perform better in school. It is possible that the appropriate amount of anxiety
could enhance self-motivation in academic achievement.
Playing games for relaxation was found to have a negative association with anxiety (aOR=0.48,
95%CI=0.25–0.92, p=0.027) which was conflicting with previous studies. Nevertheless, some
findings showed that simple games can improve players’ moods and promote relaxation. Lastly,high self-esteem had negative associations with both depression (aOR=0.83, 95%CI=0.75–0.92,
p<0.001) and anxiety (aOR=0.79, 95%CI=0.72–0.86, p<0.001). These were consistent with theprevious study that high self-esteem correlates with positive relationships and helps emotional
problems.
From this knowledge, we can develop a prevention plan for routine screening and early
management. However, travelling and gaming need further research to verify results andexamine the causality of these associations. To summarize, the interventions to promote selfesteem could reduce the prevalence of both depression and anxiety.
Ethical considerations: Ethical approval for this cross-sectional clinical-based study was
obtained from the ethical committee of the Faculty of Medicine, Chiang Mai University (RECno. 032/2020). Written informed consent and assent were obtained from all parents and the226participants prior to participating in the study. This work was supported by the Faculty of
Medicine, Chiang Mai University, grant no 016/2563. The authors declare that they have noconflict of interest.
PO-70
Psychoeducational approach to the teaching staff and nursing staff of thespecial needs school adjacent to our hospital
Kaori Tayla Mori1, Tomoka Kuroda2
1
NHO Shikoku Medical Center for Children and Adults, Zentsuji, Japan
2
Kagawa Pref. Zentsuji Protective Care School, Zentsuji, Japan
ABSTRACTIn this study, we tried to investigate the influence of aspects of psycho-education for teachersand staff on group art psychotherapy (hereafter referred to as G-APT), which is conducted as amental health measure for teachers and staff of special needs schools.
This school adjacent to our hospital is a special needs school where children who requireongoing medical care and lifestyle management due to illness or other reasons can “learn whilecuring their illnesses”.
The school has elementary, junior high, and senior high schools, and includes 1: regular classes,
2: duplicate classes where students learn in an educational curriculum that focuses on special
support for intellectual disabilities and independent activities, 3: bed classes where students
learn according to their actual conditions in their hospital rooms due to their medical conditions,and 4: in-hospital classes where students learn in an educational curriculum that focuses on
independent activities inside the hospital wards.
The number of students in 2022 is 117 (30 elementary students, 38 middle school students and39 high school students). The difference between this school and other special needs schools isthat this school is attended not only by children with traditional physical disabilities, but also by
children who suffer from emotional disorders. These include children with ASD, ADHD, abusedchildren, and others who are unable to attend regular schools for various reasons. In addition,
since the school is located adjacent to our hospital, some children come from the closed ward of
the child psychiatry department.
Mental health problems among teachers and staff have already become more serious in recent
years, even before the spread of COVID-19 infection.
In previous studies, most of the interventions were conducted as educational practices or in theform of lectures to teachers and staff, and there were no studies in which teachers and staff
actually experienced and deepened their understanding of the subject.
In this study, by having teachers and staff experience art psychotherapy, we expected that there
is an aspect of mental health measures for them, and that the deepening of their own
understanding through this experience may lead to a better understanding of their students.
This study has been approved by the research ethics committee.
Disclosure of COI: I have nothing to declare for this study.
PO-71
The effects of smartphone usage for mental states through body dissatisfaction
among junior high school students in Japan: A path analysis model study
Kentaro Kawabe1, Rie Hosokawa1, Yu Matsumoto1, Kiwamu Nakachi1, Junya Soga1, Saori
Inoue1, Maya Okazawa1, Fumie Horiuchi1,2, Shu-ichi Ueno1
1
Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
2
Center for Child Health, Behavior and Development, Ehime University Hospital, Toon, Japan

227

ABSTRACTIntroduction: Individual body shape strongly influences body dissatisfaction in adolescents, andthey tend to lose weight according to the cultural request of thinness. In addition, mental statessuch as depression and anxiety are their important factors for developmental stage. In recent
years, digital devices such as smartphone are available among junior high school students andtheir internet addiction has been reported to affect body dissatisfaction. This study investigatedrelations among smartphone addiction, mental status such as anxiety and depression, and bodymass index through body dissatisfaction score in junior high school students.
Methods: Participants were junior high school students between the age of 12 and 15 years inJapan. Participants completed items on structured questionnaires; Body Shape Questionnaire(BSQ), Smartphone Addiction Scale-Short Version (SAS-SV-J), Patient Health Questionnaire-9(PHQ-9), and Short-Spence Children’s Anxiety Scale (SCAS). Their body mass index (BMI)
was measured at school. Path analysis was employed to test the model that illustrated the
mediating effects of smartphone addiction using SAS-SV-J, depression using PHQ-9, anxiety
using SCAS, and BMI on body dissatisfaction using BSQ by gender.
Results: The participants included 293 junior high school students (male: 137, female: 156).
Direct effect found smartphone addiction (β=0.64, P<0.001), anxiety (β=0.39, P<0.001), andBMI (β=0.49, P<0.001) in male students, and anxiety (β=0.29, P=0.003) and BMI (β=0.35,
P<0.001) in female students on body dissatisfaction. Although there was no direct effectsmartphone addiction, mediate indirect effect found on smartphone addiction through anxiety
found on body dissatisfaction in female students. However, there was no indirect effect in malestudents.
Conclusion: Body dissatisfaction in junior high school students was affected smartphone
addiction but the effect is different between male and female students.
The study was approved by the Institutional Review Board of Ehime University Graduate
School of Medicine (IRB No. 2002006). Participants and their parents provided written
informed assent and consent, respectively.
PO-72
A systematic review of global trends in the prevalence of child and adolescentmental health symptoms
Lee Yun See Crystal1, Daniel Shuen Sheng Fung2, Goh Tze Jui2, Soh Chui Pin2
1
Ministry of Health Holdings (MOHH), Singapore, Singapore
2
Institute of Mental Health (IMH), Singapore, Singapore
ABSTRACT
There appears to be a global rise in the diagnosis and treatment of child and adolescent mental
disorders in recent years. Studies on community samples are needed to assess if rates of mental
health problems are truly rising in prevalence. Bor and colleagues (2014) conducted asystematic review and reported that adolescent girls experienced increased levels ofinternalising symptoms over time, whereas levels among children remained stable. We
conducted a follow-up systematic review, with the aim of examining recent trends in thecommunity-level prevalence of mental health symptoms among children and adolescents
globally. Studies meeting the following criteria were included in our review: 1) publishedbetween 2013 and 2020, 2) included representative community or school samples of children
aged 0 - 18 years of age with at least two comparative time points, and 3) utilized diagnostic
interviews or formal questionnaires to assess mental health symptoms (self, parent or teacherreported). The studies were identified and evaluated by two independent reviewers. 34 studies
were included in our review. Among children, findings generally suggest stable or improving
trends in mental health symptoms. Among adolescents, levels of externalising symptoms are228stable, but evidence points towards increasing prevalence of internalising symptoms andemotional problems. Our findings suggest that the factors leading to increased presentation ofindividuals seeking treatment for mental health conditions is multi-faceted. Factors such as
improved mental health literacy, reduced stigma and more prompt help-seeking behaviours cancontribute to the rise in the numbers of individuals presenting for treatment. Changes indiagnostic criteria may also play a role. Notably, the majority of the studies reviewed wereconducted in developed countries. More studies are needed to evaluate disparities in mental
health symptoms across different demographic groups as well as mental health trends indeveloping countries.
Conflict of interest: None to declare
PO-73
Psychometric properties of the help-seeking cognitions scale and the helpseeking skills scale for children and adolescents according to the COSMIN
checklist
Masahiro Honda1, Hiroki Shinkawa2
1
Hokkaido University of Education, Hakodate, Japan
2
Hirosaki University, Hirosaki, Japan
ABSTRACTThe systematic review and meta-analysis focusing on help-seeking interventions highlight theneed to develop better measurement instruments (Hayes et al., 2022; Honda, 2021). Based onsuch implications, we developed new scales measuring help-seeking cognitions and skills forchildren and adolescents according to the Consensus-based Standards for the selection of health
Measurement Instruments (COSMIN) checklist. Honda and Shinkawa (in press) have reported
the development of the scales and their content validity using the study design of Terwee et al.
(2018). The purpose of this study was to examine structural validity, internal consistency, andtest-retest reliability. This study was approved by the research ethics review board of Hokkaido
University of Education. Participants were 2,274 children and adolescents in Japan (9-18 yearsold). The questionnaires included both the Help-Seeking Cognitions Scale (HSCS; subscales:“positive expectations of help-seeking” and “thoughts of resistance to help-seeking,” each 9
items) and the Help-Seeking Skills Scale (HSSS; 12 items). Of all participants, 681 completed
the same questionnaire after two weeks interval. The result of confirmatory factor analysis using
robust DWLS estimation showed the robustness for two-factor model on the HSCS (CFI = .975,
TLI = .992, RMSEA = .047, SRMR = .062), and for single-factor model on the HSSS (CFI
= .993, TLI = .992, RMSEA = .027, SRMR = .040). The Cronbach’s alpha for each subscale ofthe HSCS (“positive expectations of help-seeking” = .913, “thoughts of resistance to helpseeking” = .895), and for the HSSS (overall = .888) indicated sufficient internal consistency.
Test-retest reliability was assessed by calculating intraclass correlation coefficients (ICC). Using
data from 681 participants, the ICC for each subscale of the HSCS (“positive expectations ofhelp-seeking” = .855, “thoughts of resistance to help-seeking” = .790), and for the HSSS
(overall = .790) indicated good reliability. These results suggest that both new scales have goodstructural validity, internal consistency, and test-retest reliability. Future research needs toexamine other measurement properties such as measurement error, hypothesis testing forconstruct validity, cross-cultural validity, and responsiveness.
This work was supported by JSPS KAKENHI Grant Number JP20K03408. The authors declarethat they have no conflicts of interest.
PO-74

229

Relative contribution of childhood adversity to suicide attempts and suicidal
ideation among youth offenders
Masaru Takahashi1, Kayoko Myojo2, Kasumi Imahara3, Yukiko Miyamoto4, Michiko Yasuda5,
Izumi Kadomoto6
1
Ochanomizu University, Tokyo, Japan
2
Kyoto Juvenile Classification Home, Kyoto, Japan
3
Osaka Juvenile Classification Home, Osaka, Japan
4
Nagoya Juvenile Classification Home, Nagoya, Japan
5
Osaka Prison, Osaka, Japan
6
Taisho University, Tokyo, Japan
ABSTRACT
Adverse childhood experiences (ACEs) are disturbing traumatic experiences, and longitudinalstudies have shown that ACEs have a significant impact on future mental and physical health.
Justice-involved individuals are one of the groups with the highest accumulation of ACEs. The
purpose of this study was to estimate the prevalence rates of ACEs among Japanese youth
incarcerated offenders, and to examine the relative contribution of the subitems of household
dysfunction and child maltreatment to both suicide ideation (SI) and attempts (SA). A selfreport questionnaire was administered to 398 youths admitted to four Juvenile Classification
Homes (JCHs) between September 2021 and April 2022. This study was approved by the
Humanities and Social Sciences Research Ethics Committee of Ochanomizu University(approval number: 2021-63), and prior written consent to conduct the survey was obtained fromthe respective JCHs. There were 351 (88.19%) boys and 47 (11.81%) girls. The mean age was
17.03 years (SD = 1.59) for boys and 16.62 years (SD = 1.55) for girls, with an age range of 1219 years. Results showed that more than 60% of boys and approximately 90% of girls haveexperienced some form of adversity in their lifetime. The highest prevalence rate was parental
death or divorce, which was reported to have been experienced by more than half of theparticipants, both boys and girls. The next most common type of adversity was physical abuse
for both boys and girls. With the exception of parental death or divorce, the rate of experience
was consistently significantly higher for girls than for boys. The ACE score indicates that girls
report experienced multiple adversities, with an average value of at least 3. Binary logistic
regression analysis was performed to examine the association between respective adversity
items and SI/SA. Participants who reported witnessing their mother being treated violently had
significantly increased odds ratios of SA. Exposure to suicide attempts of family members was
significantly associated in the direction of higher SI among youth offenders in our sample.
Contrary to expectations, incarcerated family members significantly decreased the adjusted odds
ratios for all the dependent variables even after controlling for covariates. Based on thesefindings, suicide prevention and countermeasures among youth offenders will be discussed.
Finally, this work was supported by the Innovative Research Program on Suicide
Countermeasures of the Japan Suicide Countermeasures Promotion Center (JSCP).
All authors declare that they have no conflicts of interests with regards to this presentation.
PO-75
Demand for remote mental health medical consultation from students’ mental
health for school nurses at junior high and high schools in Kanagawa Prefecture
Mayuko Fukatsu1
1
Department of Child Psychiatry, Yokohama City University Hospital, Yokohama, Japan
ABSTRACT
Background: In Europe and the United States, schools have long had school nurses and systems

230

in place to collaborate with medical care, but in Japan, schools are assisted by school nurses
who are not licensed to provide medical care. In Japan, schools are supported by school nurses
who are not medically qualified. To address this issue, we wondered if we could develop a
support system for schools. We first performed a preliminary survey of school nurse teachersand school teachers to find out what their present challenges are.
Methods: Interviews with school nurses and teachers at four junior high and high schools in
Kanagawa Prefecture (as of January 30, 2023)
Results: Some students and guardians are concerned about their mental health, but do not know
how to react to them. Many respondents admitted that they were unsure of how to react whenkids or parents balked at getting medical attention.
Consideration: It is crucial to establish a system to connect medical professionals and school
nurses. The remote consultation service will be launched in April 2023.
The authors have disclosed no financial conflicts of interest concerning the study. The ethics
review approval was obtained for this study.
This work was supported by JST Grant Number JPMJPF1234
PO-76
Evaluating the Impact of the Waiting Period on the Effectiveness of a Parent
Training Program for Parents of Adolescents with Autism Spectrum Disorder
Nanako Matsumura1,2, Haruo Fujino1, Tomoka Yamamoto1, Atsuko Ishii3, Mariko Nakanishi3,
Masaya Tachibana3, Ikuko Mohri1, Hiroko Okuno4
1
Department of Child Development, United Graduate School of Child Development, Osaka
University, Suita, Japan2
Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital,
Eiheiji, Japan3
Molecular Research Centre for Children’s Mental Development, United Graduate School ofChild Development, Osaka University, Suita, Japan
4
Graduate School of Nursing of Health and Human Science, Osaka metropollitan University,
Habikino, Japan
ABSTRACT
Background: Children with autism spectrum disorder (ASD) have problems in acquiring dailyliving skills (DLSs), even after high school graduation. Parent training (PT) is a support
program that aims to help parents of children with ASD by improving children’s adaptive
behaviors and parental psychological distress. Although previous studies have suggested that theeffects are limited in older children, they have not examined the effectiveness of PT targeting
DLSs in children. Various factors may complicate intervention effects, including duration to
medical treatment. Thus, the aim of this study was to evaluate the effect of delayed treatment ina quasi-experimental PT intervention study in parents of adolescent children with ASD.
Methods: Twenty-five parents of adolescent children with ASD aged 10-15 years were divided
into an immediate-treatment (IT) and a delayed treatment control (DTC) group. Assessments
were conducted at three time points: at inclusion (Time 1), the end of the IT
intervention/beginning of the DTC intervention (Time 2), and the end of the DTC intervention(Time 3). The intervention and waiting periods were both for three months in this study. Time 3
evaluation for the IT was not available. The effects were evaluated by the instruments, including
the Vineland Adaptive Behavior Scales-Second Edition (Vineland-II), Child Behavior Checklist,
Parenting Stress Index, and Confidence Degree Questionnaire (CDQ).
Results: In the Time 1-Time 2 group comparison, the IT showed significant improvement in theVineland-II Communication score and for one item on the CDQ (“Praise your child at least oncea day”). The trajectory of change from Time 2-Time 3 in the DTC was also examined to explore
the effects of delayed treatment as reflected by these two scales. For the CDQ item score, the231change in the DTC (mean change = 0.6, 95% confidence interval [CI] = -0.3-1.4) was similar tothat of the IT in Time 1-Time 2 (mean change = 0.7, 95% CI = 0.1-1.3). For the Vineland-II
Communication scores, the change in the DTC (mean change = 4.2, 95% CI = -0.5-8.9) was
slightly less than that of the IT (mean change = 8.8, 95% CI = 5.4-12.3).
Discussion: Despite being explorative and preliminary, the results suggested that treatment
delay may affect expected improvement through PT intervention for some variables, while theparent confidence improved equivalently to immediate treatment.
Even though explorative and preliminary, the results show that despite a treatment delay, PT
intervention was still found to yield a partial improvement.
Ethical Considerations: the study was approved by the Ethical Review Committee of Osaka
University Hospital.
COI: No conflict of interest declared.
PO-77
Reconsidering comorbidity of ADHD and eating disorders
Noriko Kimura1, Chinatsu Takehisa1, Takako Onishi1, Takashi Okada1,2
1
NANIWA IKUNO HOSPITAL Dept. of Psychosomatic Medicine, Osaka, Japan2
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACTPrevious studies have suggested that individuals with attention-deficit/hyperactivity disorder(ADHD) are frequently comorbid with eating disorders (EDs), especially with binge-eating andpurging behaviors. Recent reports show that 20% of children with ADHD develop any EDs.
However, ADHD should be carefully assessed because EDs patients can present with ADHDlike symptoms. Furthermore, various physical effects of frequent binge-eating and purging, lackof sleep due to nocturnal symptoms, and the psychiatric comorbidity such as depression andsubstance use disorders make the diagnosis of ADHD more challenging. A detailed growth
history prior to the onset of EDs is essential to prevent overdiagnosis of ADHD. However, it isoften unavailable for postadolescent patients, and also ADHD may be underestimated inwomen, who account for the majority of EDs.
Although psychosocial treatment is the mainstay of EDs treatment, in patients with ADHD, theircharacteristics may interfere with the treatment of EDs. Furthermore, when clinicians try to
focus on ADHD symptoms, patients tend to associate all of their daily problems with EDs. As aresult, when EDs and ADHD coexist, those two manifestations can interact each other andworsen the outcome.
Regarding pharmacotherapy, lisdexamphetamine is indicated for Binge Eating Disorder in the
United States, and the efficacy of ADHD medications for EDs has been reported overseas, evenin the absence of ADHD comorbidity. On the other hand, there are no drugs available for EDs inJapan, and it should be noted that some patients seek ADHD medication for appetite
suppression and weight loss, which are side effects of the drugs. Clinicians must strictly
diagnose ADHD to avoid misuse and abuse, especially stimulant medication.
Although recent studies of EDs have pointed the need for assessment and therapeuticintervention for comorbid ADHD, many problems still exist in practice. This presentation will
discuss the differences in symptoms between patients with EDs only and those with comorbid
ADHD, key points in the treatment of ADHD in patients with EDs, and some points that needfurther study in the future.
Patients were informed and gave their written consent to use the data. The patients’ privacy will
be protected.
There are no conflicts of interest to be disclosed.

232

PO-78The Association Between Parenting Style, Severity Symptoms of ADHD, andParental Competence Among Mothers of Children with Attention-deficit
Hyperactivity Disorder
Pattaraporn Kong-in1, Sasithorn Preechawuttidech1, Jirada Prasartpornsirichoke11Child and Adolescent Psychiatry Unit, Department of Psychiatry, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand
ABSTRACT
Objective: Raising a child with attention deficit hyperactivity disorder (ADHD) is challenging.
Mothers of children with this disorder are obliged to face doubts about their competence. The
severity of ADHD and parenting styles can have an impact on maternal perception ofcompetence, which has detrimental effects on childcare. The objective of the study was toinvestigate the association between the type of parenting style, the severity of ADHD, andparenting competence among Thai mothers of children with ADHD.
Methods: This was a cross-sectional descriptive study. We recruited 84 mothers of children with
ADHD who visited the Outpatient Child and Adolescent Psychiatry Clinic at King
Chulalongkorn Memorial Hospital from 1 January to 30 June 2022 for the study. Participants
were asked to complete questionnaires as follows: Demographic data questionnaire, short formof the Parenting Styles and Dimensions Questionnaire (PSDQ), Swanson, Nolan and Pelham IV
scale (SNAP-IV), The Parenting Sense of Competence in Thai version. Data on diagnoses andcomorbidities of ADHD were extracted from their medical records. Frequency, mean, andstandard deviation were used to present descriptive statistics of the participants. The
independent T test and Pearson correlation were used to investigate the relationship between
parenting style, severity of ADHD, and mother’s perception of competence. In the study, asignificance level of 0.05 was applied.
Result: The average scores of authoritarian parenting style (r = -0.376, p<0.001) and permissive
parenting style (r = -0.530, p<0.001), and the sum scores of SNAP-IV in the domains of
inattention (r = -0.583, p<0.001), hyperactive-impulsive (r = -0.483, p<0.001), and ODD (r = 0.561, p <0.001) were significantly negatively correlated with maternal perception of parenting
competence.
Discussion and Conclusions Using authoritarian and permissive parenting style and greater
deficits in attention are associated with the perception of poor parenting competency in mothersof children with ADHD. The endorsement of adaptive parenting practice and the alleviation of
ADHD symptoms may help mothers perceive a greater sense of competence, which in turnwould improve their quality of life.
This research has been approved by the Institutional Review Board (IRB) of the Faculty of
Medicine, Chulalongkorn University. IRB number is 847/64.
The Author declares that there is no conflict of interest.
PO-79
Examining Possible Sex Differences in the Effectiveness of Social Skills
Enhancement Programs
Tomoka Yamamoto1, Haruo Fujino1, Aika Tatsumi2, Arika Yoshizaki2, Ikuko Mohri1, Hiroko
Okuno3
1
Department of Child Development, United Graduate School of Child Development, Osaka
University, Suita, Japan2
Molecular Research Center for Children’s Mental Development, United Graduate School ofChild Development, Osaka University, Suita, Japan

233

3

Graduate School of Nursing of Health and Human Science, Osaka Metropolitan University,
Habikino, Japan
ABSTRACT
Background: Girls and boys with autism spectrum disorder (ASD) are different from each otherin terms of social attention, verbal or nonverbal communication, and the nature of friendships.
Social skills training is used to improve social adjustment in children with ASD, and sex
differences in ASD may also have an impact on social skills learning. This study aimed to
examine the relationship between sex and changes in social skills, problem behaviors, andcompetence in children who participated in a social skills enhancement program (SEP).
Methods: Eighty-six children with ASD (68 boys and 18 girls) between the ages of 7 and 10
participated in the SEP. The SEP consisted of 10 sessions, and the content included peer
relationship formation and maintenance and communication skills. Caregivers also participatedsimultaneously in learning sessions focused on social skills. Children completed theCompetence Scale for Children, their school teachers completed the Social Skills Scale (SS),and their caregivers completed the Child Behavior Checklist (CBCL). These were measured
before (T1) and after the intervention (T2). To examine changes between pre- and post-SEP, apaired t-test was used for the overall sample. We compared the change scores of the outcome
variables with the pre-SEP score as a covariate to determine the potential sex difference in theeffectiveness of the SEP.
Results: A comparison of T1 and T2 scores using the overall sample showed that T2 scoredhigher on SS communication skills (t = 3.61, p <0.001) and SS peer relationship skills (t = 2.04,
p <0.05) and lower on CBCL externalizing problem scores (t = -2.59, p <0.05). We found nostatistically significant effects of sex on the change scores, while the CBCL internalizing
problem showed possible effects of sex (β = -0.20; 95% confidence intervals: -0.51 to 0.04; p =0.089). A visual inspection of the confidence intervals suggests that girls may be more effective
than boys.
Discussion: Even though the findings are preliminary, sex could be a potential factor influencing
SEP in children. Girls with ASD may be more likely to adjust after participating in the SEP,
even if changes in social skills are similar to those in boys. Since females with ASD are more
likely to have internal problems, learning social skills in the early school years may be useful.
Ethical Considerations: the study was approved by the Ethical Review Committee of Osaka
University Hospital.
COI: No conflict of interest declared.
PO-80
Differentiation between schizophrenia spectrum and neurodevelopmental
disorders using the Child psychosis-risk screening system
Yukiko Hamasaki1, Yuko Sakaue2, Masahiro Matsuo3, Riku Sanada3, Takao Nakayama4, Shugo
Michikoshi4, Satoko Ueba5, Takatoshi Hikida6
1
Kyoto Women's Universty, Kyoto, Japan2
Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan3
Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
4
Kyoto Women's University, Kyoto, Japan
5
Saiseikai Moriyama Municipal Hospital, Shiga, Japan
6
Osaka University, Osaka, Japan
ABSTRACTIntroduction: Adolescents presenting with a first psychotic episode often have a long history ofpediatric treatment. However, there is insufficient evidence of children’s subclinicalcharacteristics in non-psychiatric settings. To address this issue, we retrospectively studied234

schizophrenia spectrum disorder (SSD) patients to identify characteristic patterns of subclinicalpsychological, behavioral, and physical problems in childhood. In the previous study, we have
had developed the child psychosis-risk screening system (CPSS) that incorporates this pattern as
a risk evaluation algorithm.
Objectives: In this present cross-sectional study, we evaluated the SSD diagnostic specificity of
the CPSS in pediatric and psychiatric patients and determine its discriminatory power and cutoff
values.
Methods: To identify the risk of developing psychosis in pediatric and psychiatric outpatients,
we evaluated data from 336 patients aged 6–18 years selected for the present study using theCPSS. We defined six major diagnostic categories i.e., Neurodevelopmental Disorders, SSD,
Depressive Disorders, Anxiety Disorders (including Obsessive-Compulsive Disorder), Somatic
Symptom Disorders, and Others to examine the specificity of the CPSS variance in diagnosis.
We analyzed the receiver operating characteristic (ROC) curve using the onset of schizophrenia
spectrum as the outcome and determined the discriminatory power and cutoff values of CPSS.
The study was approved by the Ethics Committees of Kyoto Women's University and Shiga
University of Medical Science. Informed assent was obtained from all study participants, andwritten informed consent was obtained from the parents.
Results: We found significant differences in CPSS variance among the diagnostic categories(Kruskal–Wallis test; p<0.001), especially between SSD and neurodevelopmental disorders(Bonferroni method; p<0.001p=0.001). Similarly, significant differences were identified invariance when comparing the CPSS for each neurodevelopmental disorder category and SSD,
particularly between SSD and attention deficit hyperactivity disorder (ADHD) (Bonferroni
method; p<0.001) and SSD and autism spectrum disorder (ASD) (Bonferroni method; p=0.004).
CPSS showed sufficient discriminatory power for SSD diagnosis (area under the ROC
curve=0.853 [95% confidence interval: 0.774–0.931]). The cutoff value for the risk of SSD wasdetermined to be 3.94, achieving the best mean of the sum of sensitivity (90.9%) and specificity(84.0%). 18.3% of patients (12.5% pediatric and 29.1% psychiatric) were identified as risk
groups above the cutoff value.
Conclusions: These results suggest that CPSS can be applied in pediatric clinical practice not
only for early detection and risk identification of psychosis but also for differentiation fromneurodevelopmental disorders.
COI Disclosure: There are no conflicts of interest to disclose for this study.
PO-81
Transdisciplinary collaborative support for children facing neurodevelopmental
disorders in an adverse environment
Atsuko Takei1, Yuko Shibata2, Naomi Hashikura3, Tomoko Kotera4
1
Department of Pediatrics, Takatsuki General Hospital, Osaka, Japan2
Department of Medical social services, Takatsuki General Hospital, Osaka, Japan3
Department of Nursing, Takatsuki General Hospital, Osaka, Japan
4
Department of Clinical Psychology, Takatsuki General Hospital, Osaka, Japan
ABSTRACT
Raising a child with neurodevelopmental disorders (NDDs) significantly strains parenting skills
more than raising typically developing children. As a result, many parents struggle to provide
the best environment for their children with NDDs. Many adverse childhood events haverecently been recognized as significant risk factors for most mental health problems. Whengathering the necessary information for diagnosis and treatment, a pediatrician may be foundthat some children with NDDs face an adverse environment. In such cases, medical
professionals should provide transdisciplinary collaborative support to both parents and children
and follow the progress so that the child's behavioral disorders do not become more severe due

235to reduced family functioning. In this study, we report on the background and support methodsof 115 children (81 males, 34 females, ages 2-14) with NDDs who visited our pediatricdepartment between 2020 and 2022 and were supported in collaboration with local specialized
support agencies. They were suspected of being raised in an adverse environment (e.g., abuse or
dysfunctional families). The diagnoses were attention deficit hyperactivity disorder (ADHD) in
57 (49.6%), autistic spectrum disorder (ASD) in 30 (26.1%), comorbidity of ASD and ADHD in
22 (19.1%), and intellectual disability in 6 (5.2%); 65 (56.5%) had a (possible) history of abuse.
In addition, parental impairment was identified in 55 (47.8%) and sibling impairment in 57(49.6%). Regarding support methods (some duplicated), 88 cases were linked to educational
institutions (e.g., preschools and schools), 86 cases were linked to administrative institutions(e.g., health and child guidance centers), and 43 were linked to local rehabilitation andeducation institutions. Only five cases dropped out during the three years of treatment. We
found that if medical staff paid attention to the child's treatment and daily life problems at homeand school, they could provide support according to the child’s and family’s needs, thusbuilding a trusting relationship, leading to appropriate consultations for the child.
This presentation has been modified so that it does not affect the study’s main purpose. The
utmost care has been taken to protect personal information. There are no conflicts ofinterest(COI) to be disclosed.
PO-82
Social behaviors observed from teachers may predict future medical adherence
among children with ADHD (attention deficit and hyperactivity disorder): a
preliminary study
Chien-Ho Lin1, Chung-Feng Liu2
1
Department of Psychiatry, Chimei Medical Center, Tainan, Taiwan
2
Medical Research Department, Chi Mei Medical Center, Tainan, Taiwan
ABSTRACT
Background and object: Adherence to continuous medical intervention is important to theoutcomes of children with ADHD (attention deficit and hyperactivity disorder). The objective of
this study was to explore the behavior and social factors that can predict further medical visit
adherence.
Method: We reviewed medical chart records for patients who were diagnosed during 2020-2021.
Patients who visited below 3 times were excluded. The adherence was defined by the medical
visit times in the following one year after first visit. Those who visited below the median ofvisits per month were defined as a low adherence group. Social competence and behavior
problems were assessed by social behavior assessment system for children (SBASC) rating
scales, which is an established tool filled by parents and teachers at their first visit. The study
was conducted in accordance with the Declaration of Helsinki and approved by the Institutional
Review Board of Chi Mei Medical Center (protocol code 11112-009), with approval granted on
January 6, 2023.
Results: Sixty-nine patients were included (17 females and 52 males, age = 8 ± 2.2, 1.1 ± 1.7
visits per month). Lower adherence was not associated with rating from parents, but with ratingfrom teachers in several domains, including emotional management (p<0.001), communication
expression (p=0.016), cooperation empathy ((p=0.001), learning habit(p=0.045), total social
competence (p=0.001), self-coping (p<0.001), interpersonal coping(p=0.002), environment
coping(p<0.001) hyperactivity/impulsivity (p=0.049), oppositional defiant (p=0.003), instinct
delinquency (p=0.036), total problem (p=0.005).
Conclusion: Our results suggest these factors can be used to predict medical visit adherence inchildren with ADHD. The rating from professionals, such as teachers, would bring important
information for clinical decisions. Additional attention should be paid on those children to236

improve medical quality. In order to further explore this topic, we will need to carry out further
studies with larger sample sizes. Additionally, other factors such as and family environment
should also be considered in order to provide a more accurate prediction of medical visit
adherence.
The authors declare no conflict of interest (COI).
PO-83
Child dissociation: The descriptive psychopathology analysis of a case
Wing Ki Kwok1, Hoi Lam Ho1, Chui-De Chiu1
1
Experimental Psychopathology and Psychotherapy Laboratory, Department of Psychology, The
Chinese University of Hong Kong, Hong Kong, China
ABSTRACTWith a reliable retrospective link to early-life traumatic stress, dissociation is commonly
formulated as a pathology of abnormal socioemotional development. Legitimately, dissociation
should be identifiable and diagnosable in childhood for early intervention. However, except forsome experts’ analysis primarily of western cases, no clear guidance is offered for the diagnosis
of dissociation in children. With the still developing reflective ability, the applicability of adult
criteria to children remains unknown, particularly for the discontinuous self-knowledge which is
key to making a differential diagnosis from other mental disturbances such as psychosis.
A 10-year-old boy in a residential care setting accommodating children from high-risk families(e.g., accidents and financial crisis, domestic violence, or child maltreatment) was referred toassessment and individual psychotherapy. Discontinuity of autobiographical memory wasevident from the observation of episodic memory lapses and delayed recall of emotion-laden
memories. Discontinuity was also noted in consciousness and self-perception, including aswitch into a trance state when there came a distressing internal experience and sensory
experiences from disowned self-aspects (e.g., hearing voices of a meeting among internal
others, and falling asleep to stop hearing the voice of an internal hostile other). Imaginary others
were reported, for their support in managing intolerable distressing episodes (e.g., acquiring a
sense of security when feeling threatened or a sense of affiliation when feeling lonely).
In conclusion, a symptom profile similar to adult dissociation is documented, with a disruptionof ordinarily integrated functions in multiple domains of mental processing. Crucially, thediscontinuous self-knowledge which is core to dissociative pathology is ready to be detected inchildren. While discontinuity of self-perception as well as autobiographical memory is evident,
our finding highlights that some children may be able to recognize and articulate pertinent
anomalous experiences. This finding gives support for the current formulation of dissociative
pathology and its applicability to high-risk cases in an early developmental stage.
The Survey and Behavioral Research Ethics Committee of The Chinese University of Hong
Kong approved the experimental design. Written informed consent was obtained. The authors
declared that there were no conflicts of interest with respect to the authorship or the publicationof this abstract.
PO-84
Children’s report of parental involvement in emotion regulation and trauma
symptoms
Hoi Lam Ho1, Wing Ki Kwok1, Chui-De Chiu1
1
Experiential Psychopathology and Psychotherapy Laboratory, Department of Psychology, The
Chinese University of Hong Kong, Hong Kong, China

237

ABSTRACT
A child’s capacity for emotion regulation is theorized to emerge from the dyadic regulatory
system involving significant others. Collaborative involvement by caregivers, such asencouraging the expression of emotion, facilitating the containment of emotion, and modeling
how to tackle the problem, may enhance a child’s management of stress. Dysfunctional
parenting is hence nominated as a cardinal candidate for the vulnerability to mental
disturbances, particularly for those with an intimate tie to childhood maltreatment. Thishypothesis gained empirical support from the correlation between trauma-related
psychopathologies and perceived early-life experiences in adult patients. Yet, there comecritiques in clinical science for such a relationship, for the susceptibility to recall bias ofretrospective self-report. Interpretation of early experiences may also be shaped andmisrepresented by late-life exposure such as mass media or psychotherapy.
The current study aimed to address this gap by analyzing the association of children’s
experience of parental involvement in emotion regulation with their trauma symptoms,
including symptoms of post-traumatic stress disorder (PTSD) and dissociation. Participants
were recruited from local communities. In addition to individual assessment, to facilitatechildren’s introspection, we adopted an interactive approach with assistance from an interviewer(i.e., an interviewer-assisted self-report). Our results showed a differential pattern of negativeand positive parental involvement. While negative parental involvement contributed to bothclusters of trauma symptoms, a lack of positive parental involvement, either through anexperiential approach or a problem-solving strategy, contributed solely to dissociation.
In alignment with studies using adult participants, we found a correlation in children between
negative parental involvement and trauma symptoms. Furthermore, the potential role of positiveparental involvement was discovered in the formation of complex trauma symptoms such as
dissociation. Our findings refute the sociocognitive account for trauma and dissociation as thecorrelation cannot be accounted for by the exposure to mass media or psychotherapy. For futurestudies, the role positive parental involvement plays in the development of complex trauma
symptoms should be investigated.
The Survey and Behavioral Research Ethics Committee of The Chinese University of Hong
Kong approved the experimental design. Written informed consent was obtained. The authors
declared that there were no conflicts of interest with respect to the authorship or the publicationof this abstract.
PO-85
Assess pathological trauma memory in children: Formulation andoperationalization of a measure for affect-centric narrative coherence
Cho Ying Chong1, Hoi Lam Ho1, Wing Ki Kwok1, Chui-De Chiu1
1
Experimental Psychopathology and Psychotherapy Laboratory, Department of Psychology, The
Chinese University of Hong Kong, Hong Kong, China
ABSTRACTThe assessment of trauma memory is crucial for the diagnosis and intervention for survivors ofa potentially traumatizing event. While the event-based approach popular for adult survivors
concentrates on the very episode of a potentially traumatizing event, it meets difficulty inassessing the trauma memory of child survivors. Childhood trauma typically involves close
others such as family members, which prevents the likelihood of the incident to be reported andidentified before the assessment. Also, childhood trauma occurs repetitively, with multiple
blows across various contexts. The incident is hard to be established and specified for theassessment.
To address this issue, we designed a new measure that targets the cardinal feature of238

pathological autobiographical knowledge in trauma survivors—affect-centric narrative
incoherence. In this theme-based approach, we targeted the self-referential deficit in theorganization of affective autobiographical knowledge. Using a validated story-telling test, theRoberts-2, we elicited narratives from pictures depicting moments of parent-child interaction ina family context. We analyzed the coherence of the narratives, rating to what extent the narrative
was well organized and elaborated, with event boundaries set, self-other dynamics developed,
and emotional reactions articulated.
In a community study, we investigated the reliability of this new measure in school-aged
children (8 to 12 years old). Three raters scored the narratives independently. Our results
showed promising interrater reliability comparable to those of the conventional Roberts-2
indices, indicating the usefulness of the criteria. Besides, we found that this new measure wassensitive to younger children as well (8 and 9 years old). Compared with the content-specificindices of the Roberts-2, a high score of affect-centric narrative coherence could be obtainedwith less abstract knowledge for problem identification and resolution. We conclude that affectcentric narrative coherence can serve as a reliable tool to analyze the relational autobiographicalknowledge in school-aged children. Future studies should examine its predictive validity for thedifferentiation of trauma-related pathologies.
The Survey and Behavioral Research Ethics Committee of The Chinese University of Hong
Kong approved the experimental design. Written informed consent was obtained. The authors
declared that there were no conflicts of interest with respect to the authorship or the publicationof this abstract.
PO-86
Looking into the shattered mirror: Linking narrative incoherence to symptoms of
post-traumatic stress disorder and dissociation
Chui-De Chiu1, Cho Ying Chong1, Wing Ki Kwok1, Hoi Lam Ho1
1
Experimental Psychopathology and Psychotherapy Laboratory, Department of Psychology, The
Chinese University of Hong Kong, Hong Kong, China
ABSTRACT
Despite the widespread impact of adverse childhood experiences on mental and physical health,early detection and intervention of trauma-spectrum disorders remain challenging for mental
health professionals, particularly those working with children. Identification of high-risk cases
is uneasy as caregivers, the key persons who can spot children’s need for clinical care, could be
the source of stress. For those high-risk cases who are known to clinical service, behavioral
symptoms such as emotional outbursts, conduct problems, and inappropriate social behaviors
often become the treatment focus, yet overlooking the unresolved traumatic stress. With thestill-developing reflective ability, atypical memory experiences which define pathologicalautobiographical knowledge—memory intrusion, memory discovery, and memory
unavailability—are less likely to be reported spontaneously by school-aged children.
Narrative incoherence, an inability to give a reflective account of an affect-charged situation inconnection with emotions and cognitions with reference to the rest of personal experiences,characterizes the traumatic event and autobiographical memory of adult patients with traumaspectrum disorders (e.g., intrusive memory of post-traumatic stress disorder, recovered memoryof dissociation, or memory with intimate others of borderline personality disorder). A decade ofexperimental research in our laboratory indicates the importance of neurocognitive
underpinning, i.e., atypical attentional disengagement and self-referential processing, in linking
pathological autobiographical knowledge to trauma-spectrum disorders. This finding, whichstresses the essential role of neurocognitive footing, provides an alternative model to delineate
the impact of traumatic stress on mental well-being.
To devise an assessment tool for the diagnosis of trauma-spectrum disorders in school-aged
children, we launched a study of children aged 8-12 recruited from ordinary families in local239

communities and high-risk families from a residential setting. In this initial analysis, we
explored the applicability of narrative incoherence to the assessment of trauma-spectrum
disorders. Affect-centric narrative incoherence, a measure newly devised for the assessment ofpathological autobiographical knowledge, was derived from a story-telling test designed toinvestigate a child’s internal working model of self-other relationships (i.e., The Roberts-2).
PTSD symptoms and dissociation were assessed through a clinician-assisted self-report scale.
Our results showed a negative correlation between affect-centric narrative incoherence and
PTSD symptoms. Intriguingly, a positive correlation was evident with dissociation when PTSD
symptoms were controlled for. The results provided preliminary support for the predictive
validity of affect-centric narrative incoherence.
The Survey and Behavioral Research Ethics Committee of The Chinese University of Hong
Kong approved the experimental design. Written informed consent was obtained. The authors
declared that there were no conflicts of interest with respect to the authorship or the publicationof this abstract.
PO-87
Interprofessional collaboration using a partial program of Dialectical Behavior
Treatment (DBT) that was effective for a junior high school boy attempting
suicideFumika Takasato1, Yuka Sugiyama1, Shiho Kato1, Masaki Ono1, Toru Yoshikawa1, Kikuko
Kuriyama1
1Department of Child Psychiatry, Aichi Developmental Disability Center Central Hospital,
Kasugai, Japan
ABSTRACTThis poster presentation was made with the consent of the patient and his family. To prevent
recurrence of repeated suicide-related behaviors, we were able to provide effective inpatient
treatment for a 13-year-old boy with autism spectrum disorder and attention-deficit
hyperactivity disorder by partially using the DBT program. Because it worked effectively when
it is used through interprofessional collaboration among the attending physician, the certified
psychologist, and the ward nurse in charge, and be shared the treatment details with his parents.
In addition to adults, evidence of DBT for adolescents has emerged that it is effective forsuicide-related behavior and emotion dysregulation, and we use a partial program of DBT forcases with high impulsivity and suicide-related behavior.
Here, the physician provided weekly personal psychotherapy and monthly family interviews,
and the psychologist provided weekly personal psychotherapy. The nurse supported him withvarious problems that arise in self-care and interpersonal relationships with other patients andstaff in the ward and the in-hospital class. In this therapeutic structure, a partial program of DBT
was used.
The physician, the psychologist, and the nurse used DBT validation skills to help him verbalize
his feelings and thoughts, accumulate experiences of being understood by others, and build a
relationship of trust with the treatment team. For suicidal-related behavior, the psychologist
used mindfulness skills and distress tolerance skills that avoids acting impulsively with strong
emotions.
The physician used behavioral chain analysis of drug overdose and used the skills he hadlearned from the psychologist to prevent recurrence. The nurse encouraged him to strengthen
and generalize the use of the skills in his daily ward life, and used them to make a plan toprevent recurrence before staying home overnight. The physician also used validation skills toparents, verbalizing various thoughts and feelings about their children and building trust, andexplained the treatment based on the DBT-like approach to the parents to help him cope at
home.

240

The physician, the psychologist, and the nurse had a common understanding of the DBT-likeapproach and consistently engaged with the patient and his parents through interprofessional
collaboration. Therefore, it was easy for us to understand each other's treatments, cooperation
was easily strengthened, and efforts were focused on preventing recurrence, and effective
inpatient treatment was possible. After this inpatient treatment, he only needed respite
hospitalization.
In connection with this presentation, there is no COI to be disclosed with any companies.
PO-88
Setting up another Adolescent Mental Health Service in Singapore – What are theneeds?
Jaclyn Tay Leng Leng1, Cheah Xin Ni1, Seow Su Yin1, Iris Rawtaer1, Tsang Yun Ying Tammy11
MOH Holdings (MOHH), Sengkang General Hospital (SKGH), Sengkang, Singapore
ABSTRACT
Findings from The Singapore Mental Health Study (SMHS) 2010 and 2016 revealed that theonset of many mental health disorders in Singapore occurs during childhood to early adulthood
years. Mental health statistics in Singapore also show an increasing trend of suicide amongst
youths in Singapore over the past few years. With the highest proportion and growing numbersof young population in the North-East region of Singapore, there is foreseeable increase in theneed and demand for child/adolescent psychiatric services particularly in this region. Amongst
the 6 public hospitals providing adolescent psychiatric services in Singapore, Institute of Mental
Health (IMH) is currently the sole child/adolescent psychiatric service provider in the NorthEast region. However, limited bed space, manpower and resources may make it increasingly
difficult for IMH alone to meet this growing demand, calling for further measures to be put inplace to plan for the future. To target this mismatch in supply to the demand for childpsychiatric services particularly in the North-East region of Singapore, Sengkang General
Hospital which is a restructured hospital in this region is currently setting up an adolescentmental health service. The aim of this poster is to highlight the needs and key requirements insetting up a new adolescent mental health service in an urbanized city of Singapore withexisting hospitals running well established services. This new service looks to provide
secondary services for adolescents with mild to moderate mental illnesses in the North-East
region and to right-site cases with higher needs to the appropriate tertiary service. However,setting up a new service requires careful designing, ensuring the presence and availability of
relevant manpower and resources, ensuring right sitting of patients to the service, andintegrating the new service to existing community network and infrastructure. Barriers to setting
up a new service may include difficulty in designing an integrative and comprehensive service,
shortage of qualified professionals to form a specialized multidisciplinary team, underdeveloped
postgraduate training in child and adolescent psychiatry, underdeveloped network for interagency communication, and limited funding.
Conflicts of interest: The authors have no potential conflicts of interest to disclose.
PO-89
The relationship between parental adverse childhood experiences and parenting
behaviors
Kewalin Wattanatchariya1, Assawin Narkpongphun1, Suttipong Kawilapat1
1
Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

241

ABSTRACT
Background: Adverse childhood experiences (ACEs) are traumatic events in various forms ofabuse, neglect, and household dysfunction experienced in childhood. ACEs are common andstrongly related to several health problems. The researches on the intergenerational effect of
ACEs have found the association between parental ACEs and child psychopathology. The
potential factors that mediated this association are parent mental health and parenting. However,
the mechanism of this intergenerational transmission has not been clearly examined and thestudies on the effects of ACEs on parenting practices are still limited.
Objectives: This study aimed to examine the relationship between parental ACEs and theirparenting, the effect of mental health problems which possibly related to parental ACEs andmediated parenting behaviors, and the prevalence of ACEs in parents of students in Chiang Mai.
Methods: Data were obtained from 403 parents of 6–18-year-old students in Chiang Mai,
Thailand. Participants reported their information, history of ACEs, current mental health, andparenting behaviors using (1) ACE questionnaire, (2) Depression Anxiety Stress Scales (DASS21), and (3) Alabama Parenting Questionnaire (APQ) parent form. Relationships between
ACEs, parent mental health, and parenting were examined using correlation analysis. The direct
and indirect effects of potential associated variables on five dimensions of parenting were
examined using path analysis.
Results: In the current sample, 62.5% of parents reported at least one ACE. Path analysis
revealed statistically significant direct effect from number of ACEs to poorer parent mental
health in all subscales – depression, anxiety, and stress (β=0.19, 0.20, 0.18 and 95% CI [0.17,
0.52], [0.17, 0.48], [0.19, 0.61] respectively). Parental ACEs was directly associated with use of
corporal punishment (0.14, [0.05, 0.27]). Parental ACEs also had positive indirect effect on
inconsistent discipline via parents’ reports of stress (0.03, [0.001, 0.16]) while stress had
positive direct effect on inconsistent discipline (0.18, [0.03, 0.36]).
Conclusions: ACEs are common in parents and associated with mental health problems.
Parental ACEs also affect parenting behaviors via direct and indirect pathways. It is important todetect and provide interventions to parents having histories of ACEs and poor mental health, toimprove the quality of parenting and mitigate the intergenerational transmission of ACEs totheir children.
Ethical considerations: This study was approved by the Research Ethics Committee of theFaculty of Medicine, Chiang Mai University (REC no. 442/2022).
Conflict of interest: The authors declare no conflict of interest.
PO-90
Relationship Between Occupational Performance and Challenging Behavior of
Persons with Developmental Disabilities and Mental Health of Parents
Yaena Ha1, Seokyeon Ji2, Hyojin Keum3, Minkyung Hong41
Department of Occupational Therapy, Graduate School, Yonsei University, Republic of Korea
2Center of Sensory Integration toward Social and Occupational being, Seoul, Republic of Korea
3
Department of Occupational Therapy, Kyung-Bok University, Republic of Korea
4
Department of Occupational Therapy, Woosong University, Republic of Korea
ABSTRACT
Background: Occupational performance (OP) is the ability to recognize, plan, execute
occupational behaviors and an important indicator of development. Challenging behaviors, oneof characteristics among people with developmental disabilities (DD) make difficulties for theirdevelopment. Diverse developmental issues of children affect parents' mental health difficulties,
which in turn tends to lead to negative impacts on children. This mutual effect worsens whenproper support is not provided to DD and their families.
Objective: The purpose of this study was to analyze the relationship between the level of OP

242

and types of challenging behaviors of DD and their parents' depression, anxiety, and stress.
Method: Participants were selected as DD (n = 23) and their parents (n = 23) living in themetropolitan area in Korea among participants of camp held to support DD and their families
during the COVID-19 pandemic and endemic situation. The level of DD’s OP was measured bymodifying the scales presented in ICF (International Classification of Functioning, Disabilities
and Health), OTPF-4 (Occupational Therapy Practice Framework: Domain & Process 4th), andOTIPM (Occupational Therapy Intervention Process Model) and it was measured byoccupational therapists who trained OP assessment. DASS-21 (Depression Anxiety Stress Scale)
was used to measure parents’ depression, anxiety, and stress, and MAS (Motivation Assessment
Scale) was used to measure the types of challenging behaviors by parents’ report. Statisticalanalysis was performed with SAS 9.4.
Results: In this study, the mean age of DD was 20.89 ± 5.67 years old, and there were moremales (86.96%) than females (13.04%). The higher the level of DD’s OP, the lower the parental
anxiety (β = -3.62, p = .02), stress (β = -3.60, p = .01), and depression (β = -3.21, p = .08). The
higher the challenging behavior score of DD, the higher the parental depression, anxiety, andstress. Attention-seeking behavior was the most influential of the challenging behavior types toparents and was statistically significant (depression: β = 2.38, p = .00; anxiety: β = 1.83, p = .01;
stress: β = 1.69, p = .01).
Conclusions: DD’s OP and challenging behaviors are related to their parents’ mental health. It
suggested that health support for DD should focus on improving OP and focusing on family
mental health.
Ethical Statement: The data in this study obtained all written consent in advance from theparents or legal guardians of the DD. This study was conducted by analyzing using existing
data, and the IRB for it will be approved later.
COI: There are no conflicts of interest to disclose regarding this study.
PO-91
A Systematic Review of Clinical Practice Guidelines for the Diagnosis &Management of Attention Deficit Hyperactivity Disorder: Assessment Using theAppraisal of Guidelines for Research and Evaluation (AGREE II) Instrument
Muhammad Dwi Wahyu1, Atsunori Sugimoto2,3, Ekachaeryanti Zain1,4, Faisal Budisasmita
Paturungi Parawansa1, Hiroyuki Kasahara3, Kiyohiro Yoshinaga2,3, Jun Egawa1, Toshiyuki
Someya1
1
Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences,
Niigata, Japan2
Department of Community Psychiatric Medicine, Niigata University Graduate School of
Medical and Dental, Niigata, Japan3
Department of Psychiatry, Niigata Psychiatric Center, Nagaoka, Japan
4
Department of Psychiatry, Faculty of Medicine, Mulawarman University, Samarinda, Indonesia
ABSTRACT
Background: Trustworthy clinical practice guidelines (CPGs) for the diagnosis and managementof attention deficit hyperactivity disorder (ADHD) are crucial to assist in decision-making.
Thus, we conducted a systematic review to critically appraise the quality of current guidelines
related to the diagnosis and management of ADHD by using the Appraisal of Guidelines for
Research and Evaluation (AGREE II) instrument and to identify which methodological rigor
quality needs to improve for the future development of high-quality guidelines.
Methods: We performed a systematic review (protocol registration number
INPLASY202280001) with a literature search in PubMed, Google Scholar, the Agency for
Healthcare Research and Quality (AHRQ), Dynamed, the National Institute for Health and Care
Excellence (NICE), the National Health and Medical Research Council (NHMRC), and other243local or online databases between January 19 and January 31, 2021, by 3 independent authors.
Our study was conducted according to the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) guideline. Informed consent was not necessarily required due tono humans being involved in this study, and the Ethics Committees of Niigata University
approved this study’s protocol (approval No. 2021-0360).
Results: After screening, 11 CPGs were included and appraised for methodological quality using
the AGREE II Instrument by five reviewers, who were unaware of each other's scores. The
majority of the CPGs reached the highest score in domain 4 "Clarity of Presentation" (mean ±SD, 73,73% ± 12,5%). On the other hand, the domains that achieved poor scores were domain 5"Applicability" (mean ± SD, 45,18% ± 16,4%), and domain 3 "Rigour of Development" (mean± SD, 51,09% ± 24,1%). The guidelines from the National Institute for Health and Care
Excellence (NICE) and the Ministry of Health Malaysia (MAHTAS) were identified as the only
strongly recommended guidelines. All AGREE II domains illustrated poor to excellent interrater
reliability, with the full domain intraclass correlation coefficient (ICC) ranging from 0,265 (95%CI, -0,470-0,665) to 0,758 (95% CI, 0,515-0,889).
Conclusion: According to the quality assessment from AGREE II, strongly recommended,recommended, and not recommended CPGs were identified. Findings from this study highlightthe need for special attention to all domains based on the AGREE II validated tool, especiallydomains 3 and 5 (rigour of development and applicability), while developing new ADHD
guidelines to improve the quality that can be implemented in daily practice.
Conflict of Interest: Muhammad Dwi Wahyu: None; Atsunori Sugimoto: received researchfunding or honoraria from the following organizations in the last 5 years, including
Developmental Science Research and Education Center, Taiju Life and Welfare Foundation,
Kawano Pediatric Medical Scholarship Foundation, Shimadzu Corporation, Takeda
Pharmaceutical Co., Ltd., Nobel Pharma Co., Ltd., Shionogi Co., Ltd., and MochidaPharmaceutical Co., Ltd.; Ekachaeryanti Zain: None; Faisal Budisasmita Paturungi Parawansa:
None; Hiroyuki Kasahara: None, Kiyohiro Yoshinaga: None, Jun Egawa: received researchfunding or honoraria from the following organizations in the last 5 years, including Takeda
Pharmaceutical Co. Ltd., and Shionogi Co. Ltd; Toshiyuki Someya: received research fundingor honoraria from the following organizations in the last 5 years, including Astellas Pharma Inc.,Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., MochidaPharmaceutical Co., Ltd., MSD K.K., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd.,
Shionogi Co., Ltd., and Sumitomo Pharma Co., Ltd.
PO-92
Relationship between perceived parental academic pressure, academic selfefficacy and test anxiety among high-school students
Pichaporn Mongkoladisai1, Jirada Prasartpornsirichoke1, Nuttorn Pityaratstian1
1
Department of child and adolescent psychiatry, Faculty of medicine, Chulalongkorn university,
Bangkok, Thailand
ABSTRACT
Background: For Thai high-school students, high academic performance was not only required
for admission, but was also family value. High level of test anxiety could impair academic
achievement and subjective well-being. Understanding personal and situational factors that
effected on test anxiety could lead to evidence-based interventions.
Objective: To study the prevalence of test anxiety related to midterm exam in Thai high-school
students. To study the relationship between perceived parental academic pressure and test
anxiety related to midterm exam among Thai high-students. To Investigate the mediating effectof academic self-efficacy in this relationship.
Methods: Our study was a cross-sectional descriptive study. 235 High-school students from two244

public schools completed questionnaires in June 2022. Questionnaires were composed ofdemographic questionnaire, Thai version of FRIEDBEN Test Anxiety Scale (FTA)questionnaire, Thai version of Perceived Parental Academic Pressure (PPAPS) questionnaire
and Thai version of Academic self-efficacy scales of Self-Efficacy Questionnaire for Children(SEQ-C) questionnaire. Relationships were examined through correlational and mediation
analysis.
Results: 85.1% of students were male. Mean age was 16.22± 0.95 years old. Data was collected
one month prior to midterm exam. 83.8% of students did not attend cram school. Prevalence ofstudents with high level of test anxiety was 4.7 percent. Perceived parental academic pressure
had both direct effect (β= .535, 95% Cl: .444, .626) and indirect effect (β= -.038, 95% CI: -.075,-.004) on test anxiety. Academic self-efficacy was the mediating factor of this relationship.
Conclusion: Perceived parental academic pressure had not only directly positive effect on test
anxiety, but also indirectly negative effect on test anxiety via increasing academic self-efficacy.
However directly positive perceived parental academic pressure was beyond indirectly negative
effect. Interventions promoting academic self-efficacy and parental support could prevent test
anxiety.
The study was approved by Chulalongkorn university Institutional Review Board. (IRB
NO.845/64)
Conflict of Interest: The authors declare that they have no conflict of interest.
PO-93
Are the socioeconomic factors associated with the children's Internet addiction?
Satoshi Suyama1, Mariko Nakau1, Takuya Saito1
1
Funded Research Division of Child and Adolescent Psychiatry, Hokkaido University Hospital,
Sapporo, Japan
ABSTRACT
Background: The Internet has become widespread and easily accessible to young children.
According to the survey conducted by the Ministry of Internal Affairs and Communications ofJapan in 2020, the Internet usage rate for all ages was 83.4%, and the rate for 6-12-year-olds
was 80.7% with increased tendency. While there are benefits for children, such as the sharing of
information and the spread of communication technology education, there are also increasingproblems associated with the Internet, and the internet addiction is one of them. According to
the "Survey on the Internet Use Environment of Youth" conducted by the Cabinet Office in
2020, more than half of children aged 12 and older have their personal Internet terminals. We
investigated whether there are any factors related to internet addiction in the young generationthat most people use the internet by the devices shared with their family.
Methods: Of the 308 first-time patients who visited the Department of Child Psychiatry at
Hokkaido University Hospital between April 2020 and November 2022, 106 children aged 5 to
11 who were able to obtain written consent from their parents or guardians participated in the
study. The database was created based on the medical records of eligible children, including
gender, age, initial diagnosis, mother's education level, and household income. We used theInternet addiction test (IAT) developed by Kimberly Young to assess internet addiction. This
study was conducted with the approval of the Hokkaido University Hospital Division of ClinicalResearch Administration.
Results: The mean age of the participating children in this study was 8.28 (SD 1.81), and 67(63.2%) were boys; the mean IAT score was 37.40 (SD 14.40), with 37.7% of the participating
children scoring above 40, indicating that they had Internet use problems. Multiple regression
analysis adjusted for child gender and age showed that the IAT score was significantly lower forthe group with higher household income (β = 0.24, 95% CI: 0.35-13.08).
Conclusion: This study suggests the socioeconomic factors of the family are associated with245

internet addiction.
COI: Satoshi Suyama, Mariko Nakau, and Takuya Saito are endowed by the City of Sapporo.
PO-94
Developing the Japanese version of the Mental Health Knowledge Questionnaire(MHKQ-J)
Shanshan Li1, Toshinobu Takeda1
1
Ryukoku University, Kyoto, Japan
ABSTRACTIntroduction: Knowledge of mental health is significant in improving people's mental health,and proper knowledge of mental illness can effectively reduce the stigma associated with mental
illness.
However, there are few studies of knowledge on psychiatric disorders in Japan. One reason forthe lack of studies is the absence of a standardized scale of knowledge on psychiatric disorders.
This study aimed to develop the Japanese version of the Mental Health Knowledge
Questionnaire (MHKQ-J), which was translated form the Chinese original version (MHKQ) andto examine its reliability.
Methods: A total of 100 university students were recruited in for our survey. The questionnaire
consisted of the Japanese version of the MHKQ which was developed through the process ofrelated works in translation, and a preliminary investigation of the scale.
Moreover, opinions on the first author's Japanese translation were obtained from someone withboth Japanese and Chinese backgrounds.
Besides, within a preliminary investigation of the scale, internal consistency (100 participants)
and test–retest reliability (21 participants) were examined.
Results: Using the Japanese version of the MHKQ (20 items, 2-point scale), we obtained
responses from 100 participants, an internal consistency reliability test was performed for thecollected data and obtained Cronbach’s α coefficient = 0.487
However, when verifying the test-retest reliability, there is no significant difference between thescores with one-week interval.
Discussion: The Japanese version of the MHKQ was found to have unacceptable reliability, interms of internal consistency. However, as for test-retest reliability, it is satisfactory enough.
The reason we concerned is that there are several questions which are too difficult to answer for
students. And from the results of this study, it is also essential to investigate the issue of theeffect of the difference in cultural backgrounds between Japan and China on the results of thesame questionnaire. Therefore, further research is required regarding the reasons leading to thisresult, for example, using statistical methods to optimize and re-implement the survey, etc.
The institutional review board at Ryukoku University approved this study.
The authors declare no conflict of interest associated with this presentation.
PO-95
Effects of increased game playing time on children's anxiety during a COVID-19
pandemic in a disaster-affected area: a longitudinal study
Shusaku Chiba1,2, Junko Yagi1,3, Yasuhito Yoshioka1,3, Takehito Yanbe1,3, Mare Uchide1,3, Kanae
Kakisaka1,3, Naru Fukuchi4,5, Jiro Masuya6, Naomi Matsuura7
1
Department of Child Psychiatry, Iwate Medical University Hospital, Iwate, Japan
2
Faculty of Education, Graduate School of Education, Tohoku University, Sendai, Japan3
Department of Neuropsychiatry School of Medicine, Iwate Medical University, Iwate, Japan

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4

Department of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan
Miyagi Disaster Mental Health Care Center, Sendai, Japan
6
Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
7
Faculty of Education, Mie University, Tsu, Japan
5

ABSTRACT
Problems and objectives: COVID-19 disaster is thought to have placed restrictions or changes
on lifestyles, in particularly children, and it is unclear how they have affected their mental
health. In addition, behavioral problems such as restlessness is recognized for children born
within a year in disaster-affected area after the Great East Japan Earthquake (GEJE), and it ispossible that the lifestyle changes caused by the COVID-19 disaster had some impact on theirmental health. In this study, we focus on game playing time as a children’s lifestyle, and reporteffects of increased game playing time from 2020 to 2021 on children’s mental health, based on
the result of a cohort study conducted in GEJE-affected area.
Methods: 148 data with consent from 2020 to 2021 was included in this study, and they wereobtained from “a longitudinal supportive study for children born after the Great East Japan
Earthquake and their families” (MICHINOKU CHILDREN COHORT) conducted in the coasts
of a disaster-affected prefecture. We also included 31 data with consent during the same time
periods in the interior of a disaster-affected prefecture as areas with little damage from the
GEJE, for the purpose of comparing with the coasts as a seriously damaged regions. We used
SCAS and DSRSC as children’s mental health scales, and also measured children’s lifestyles inhouses such as a game playing time. This study was approved by the Ethics Committee of Iwate
Medical University (No H27-89).
Results: Statistical analysis showed a significant increase of about 10% in the group playing
games for more than 2 hours on weekdays in one year from 2020 in the coasts. To examine theeffect of the increase in game time, we conducted a mixed linear model analysis comparing
groups that had more than 2 hours of game time and those that did not over time, and found asignificant increase in separation anxiety only in the group that had increased game time. In
contrast, there was no significant increase in weekday game time in the interior of the disasteraffected prefecture.
Discussion: The results of this study revealed that increased playing game time on weekdays
affected the separation anxiety for children. Because the increase in game time was particularly
pronounced in the coasts of affected area, suggesting that lifestyle changes for children forced to
COVID-19 pandemic was likely to be happened and associated with the increased anxiety forchildren, especially in this region.
Conflict of interest (COI): The authors report no competing interests.
PO-96
Social dysfunctions and its hormonal background in autism spectrum disorders
Takashi Okada1,2, Yota Uno2,3
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan2
Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of
Medicine, Nagoya, Japan3
Department of Psychiatry, Yokohama Psycho-Developmental Clinic, Yokohama, Japan
ABSTRACT
Objectives: It has been demonstrated that the recognition of facial affect recognition is impaired
in individuals with in autism spectrum disorders (ASD), which are associated with their social
dysfunction. Some previous studies reported that intranasal or intravenous oxytocin (OXT)
reduces social misrecognition and obsessiveness, however clinical efficacy seems controversial.

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We hypothesized that the enhancement in social recognition is evident in specific domains, wecannot detect the clinical efficacy of OXT in overall assessment. Therefore, we examined six
basic facial affect recognition in ASD before and after administration of OXT.
Methods: This study is conducted in parallel with randomized controlled trial (RCT) of
intranasal oxytocin (Mol Psychiatry, 2020). Twenty-four male adults with ASD were randomly
assigned to OXT and placebo groups. They were administered OXT (24 unit, twice a day) or
placebo for seven weeks. In open trial following the RCT, all participants were administeredOXT for six weeks. Benton Facial Recognition Test and facial expression recognition task were
examined for all participants at three time points (baseline, after randomized controlled trial,
after open trial).
Results: OXT does not influence on the identifications of unfamiliar faces. Although the correct
response rates for angry and disgusted faces after RCT are higher than those at baseline only in
OXT group, it does not reach the significance level. After the open trial, patients recognized
more accurately angry faces (p<0.01) and disgusted faces (p<0.05) than baseline. In error
analysis, the misrecognition of angry for disgusted faces (p<0.05) and misrecognition of
disgusted for angry faces (p<0.01) reduced after OXT administration. These effects are notsignificantly correlated with reduction in severity of social impairments.
Conclusion: Although both anger and disgust are negative emotions, they were followed bydifferent aggressive expressions to the others. Misrecognition between disgusted and angry
faces was also reported in delinquents (Child Adolesc Psychiatry Ment Health. 2009). Oxytocin
reduces misrecognition of negative facial emotions in ASD, and it may be theneuropsychological background for improvements associated with social disturbances. Thishypothesis should be examined in larger samples with comprehensive assessment of social
functions in future.
Ethical consideration: This study protocol was approved by the Ethics Committee of the Nagoya
University Graduate School of Medicine.
Funding: This study is funded by Japan Agency for Medical Research and Development(AMED).
COI disclosure: There is nothing to declare.
PO-97
The degree of interest in people at 4 years old predicts development ofsocialization at 5 years old
Toru Fujioka1, Hirotaka Kosaka2
1
Department of Science of Human Development, Humanities and Social Science, Faculty of
Education, University of Fukui, Fukui, Japan2
Department of Neuropsychiatry, Faculty of Medical Sciences, University of Fukui, Eiheiji,
Japan
ABSTRACT
Background: The development of socialization and communication are very complex processes.
It is meaningful to identify factors related to development of them. The purpose of this study
was to determine how attention to social information affects the development of socializationand communication by typically developed children.
Methods: We recruited 24 typically developed preschool children. Using the all-in-one-eyetracking system, Gazefinder, we measured the percentage fixation time allocated to areas ofinterests (AoIs) depicted in movies (the eyes and mouth in movies of a human face with/withoutmouth motion, upright and inverted biological motion in movies showing these stimuli
simultaneously, people and geometry in preference paradigm movies showing these stimuli
simultaneously, and objects with/without finger-pointing in a movie showing a woman pointing
toward an object) at Wave1 (4.01 ± 0.84 years）, Wave2 (5.22 ± 0.66 years）, and248

Wave3 (6.57 ± 0.63 years). We also used Vineland Adaptive Behavior Scales Second Edition
for measuring socialization and communication at Wave from 1 to 3. We then carried out using
3-wave cross-lagged effects model in structural equation modeling framework to determine theimpact of attention to social information on the development of socialization andcommunication. The study protocol was approved by the ethics committee of the University of
Fukui. After a complete explanation of the study, all participants or their parents/legal guardians
provided written informed consent.
Results: In the preference paradigm movies simultaneously showed people and geometricshapes, the percentage fixation times to people region of the preference paradigm at Wave1
affected the score of socialization at Wave2.
Limitations: The sample size was very small. Additionally, it is necessary to identify factors thatpredict the development of socialization and communication using a variety of factors otherthan attention to social information.
Conclusions: The degree of interest in people has a strong positive influence on thedevelopment of sociability at ages 4 to 5, and the degree of interest in people has a strong
positive influence on the development of socialization for a limited period of time.
The authors declare that the research was conducted in the absence of any commercial or
financial relationships that could be construed as a potential conflict of interest.
PO-98
Reducing and exacerbating factors of social stigma, considering psychiatricdisorders among university students in Japan
Toshinobu Takeda1, Yuri Kanbayashi1, Shanshan Li1, Hironori Komasa1
1
Department of Clinical Psychology, Ryukoku University, Kyoto, Japan
ABSTRACTSocial stigma for psychiatric disorders has a huge impact on the development of these issues
over time. Social stigma makes it difficult for support workers as well as ordinary people to help
individuals with psychiatric disorders. When social stigma is internalized, individuals withpsychiatric disorders are shown to feel ashamed of having the disorders (self-stigma).
Consequently, they become reluctant to see mental health professionals to seek help. In thisstudy, Factors that reduce or exacerbate a public stigma for mental disorders among university
students were investigated.
Participants were university sophomores attending lectures on special needs education, one ofthis project’s researchers was a teacher. One of the main purposes of these lectures was toreduce a public stigma for psychiatric disorders through lectures including three speeches froma mother and a sibling of individuals with autism spectrum disorder (ASD) and while not a
psychological disorder an LGBT individual provided their perspective on dealing with theirstigmatized position in Japanese society.
Among the students attending the lectures, 32 students answered open-ended questions, “Whatis the main event which positively or negatively affected your stigma on psychiatric disorders
until now?” Each answer was tagged with code, then based on this, a set of codes wasestablished and applied to categorize the answers.
Stigma-reducing events (the number of students): the speeches of an LGBT individual andrelatives (a parent or a sibling) of ASD (5), lectures on special needs education or other lecturesat the university (5), interaction with individuals (incl. family members) with psychiatricdisorders or marginal perspective (5), student’s own experience suffering from psychiatricdisorders or marginal perspective (3), TV programs or books (3), DK answer (13); stigmaexacerbating events: media coverage on crimes committed by individuals with psychiatricdisorders or marginal perspective (6), negative memories of individuals with psychiatricdisorders (1), student’s own experience of being teased by others about his psychiatric disorders

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(1), the pessimism about the recovery of psychiatric disorders (1), DK answer (23).
Results show the possibility of reducing stigma for psychiatric disorders even after university
admission and accordance with previous research, the grave negative influence of media
coverage on crimes committed by individuals with psychiatric disorders. In this presentation,
the efforts of mental health professionals against this biased media coverage on psychiatricdisorders in Japan will be introduced.
The institutional review board at Ryukoku University approved this study.
The authors declare no conflict of interest associated with this presentation.
PO-99
A longitudinal study of the relationship between mental health of parents andproblem behaviors of children born after the Great East Japan Earthquake
Yasuhito Yoshioka1,3, Junko Yagi1,3, Shusaku Chiba1,2, Takehito Yanbe1,3, Mare Uchide1,3, Kanae
Kakisaka1,3, Naru Fukuchi4,5, Jiro Masuya6, Naomi Matsuura7
1
Department of Child Psychiatry, Iwate Medical University Hospital, Iwate, Japan
2
Faculty of Education, Graduate School of Education, Tohoku University, Sendai, Japan3
Department of Neuropsychiatry School of Medicine, Iwate Medical University, Iwate, Japan
4
Department of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan
5
Miyagi Disaster Mental Health Care Center, Sendai, Japan
6
Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
7
Faculty of Education, Mie University, Tsu, Japan
ABSTRACT
Objective: The purpose of this study is to investigate longitudinal associations between problem
behaviors of children born one year after the Great East Japan Earthquake (GEJE) and mental
health of their parents.
Methods: The subjects were 132 pairs of parents and children one year born after GEJE n Iwate
Prefecture coastal areas where damage was severe and in Iwate Prefecture inland areas where
damage was small. The IES-R, PTG, QOL, and BDI-II were used to assess mental health ofparents, and the CBCL was used to assess children's behavioral problems. To make year-to-yearcomparisons, we used data measured in 2016, 2020 and 2021. For the statistical analysis, we
divided the subjects into coastal group (N=88) and inland group (N=44), we conducted ouranalysis with a mixed linear model with each child and parent variable as dependent variables
and group (coastal group, inland group) and time (2016, 2020, 2021) as independent variables.
We performed a multigroup analysis using path analysis techniques to compare whether there
were differences between the two groups in terms of associations between variables over time.
Results: In the mixed linear model, the coastal group had significantly higher IES-R scores than
the inland group, but there was no significant change over time. In the multigroup analysis,
there were differences in the way the variables were related between the coastal and inlandgroups. In the coastal group, past child CBCL scores had a positive effect on parental IES-R
scores, but not in the inland group.
Conclusion: In coastal areas where damage was severe, parental trauma symptoms persisted
several years after GEJE and were associated with children's problem behaviors. Therefore, it isnecessary to observe the mental health of the parents and the problem behaviors of the children
over a long period of time.
Ethical consideration: This study was approved by the Ethics Committee of the Iwate Medical
University School of Medicine.
Conflict of interest (COI): The authors report no competing interests.

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PO-100
Factors associated with suicidal ideation in Japanese junior high school
students with Autism Spectrum DisorderYu Matsumoto1, Kentaro Kawabe1, Toshihiro Jogamoto2, Rie Hosokawa1, Kiwamu Nakachi1,
Yumina Tachibana1, Junya Soga1, Saori Inoue1, Maya Okazawa1, Fumie Horiuchi1,3, Eguchi
Mariko2, Shu-ichi Ueno1
1
Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan2
Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan
3
Center for Child Health, Behavior and Development, Ehime University Hospital, Toon, Japan
ABSTRACTIntroduction: Although suicidal ideation is one of the leading causes of death in adolescents, risk
factors of their suicides are complex and remain unclear. Current cohort study reported that ahigher rate of suicide ideation and attempt in individuals with Autism Spectrum Disorder (ASD)
than without ASD. In this study, we hypothesized that influenced factors of suicidal ideation
was different between students with ASD and without ASD. The purpose of this study was toinvestigate factors affecting suicidal ideation in junior high school students with or without
ASD.
Methods: The study design was from retrospective medical records from April 2015 to March2022 at Center for Child Health, Behavior and Department, Ehime University Hospital.
Participants were junior high school students aged 12 to 15 years old who visited our center for
the first time. Participants who had intellectual disability, schizophrenia, or bipolar disorderwere excluded. They completed the Strengths and Difficulties Questionnaire (SDQ) and theGeneral Health Questionnaire 30 (GHQ30), and their parents completed the Autism Screening
Questionnaire, the Attention Deficit Hyperactivity Disorder Rating Scale, and the Social
Responsiveness Scales. Suicidal ideation was assessed by item 28 of GHQ30: ‘make away withyourself’. Participants were divided into two groups: ASD group and non-ASD group, andcompared by Mann-Whitney’s U test. Each group was performed by multiple logistic regression
analysis, with the presence of suicidal ideation as the dependent variable and each questionnairescore as independent variables. The significance level was set at p < 0.05.
Results: The total of 250 participants were included in this study, and categorized ASD
group(n=84) and non-ASD group (n=166). Thirty-two participants (38.1%) of ASD group and
71 participants (42.8%) of non-ASD group had suicidal ideation, and the prevalence was not
significantly different between both groups. Multiple logistic regression analysis revealed that
the SDQ subscale "Peer Problems" was the most significantly associated with suicidal ideationin the ASD group (OR 1.63, 95% CI: 1.22-2.19). In both groups, the SDQ subscale "Emotional
Symptoms" was significantly associated with suicidal ideation (ASD group: OR 1.63, 95% CI:
1.22-2.19, non-ASD group: OR 1.49, 95% CI: 1.29-1.73).
Conclusion: In this study, there were positive association with suicidal ideation and “Emotional
Symptoms” of SDQ in junior high school students both with ASD and non-ASD. “Peer
Problems” of SDQ may be a specific risk factor for suicidal ideation in the students with ASD.
The authors have no potential conflicts of interest to disclose. There are no funders report forthis submission. The study was approved by the Institutional Review Board of the Ehime
University Graduate School of Medicine (IRB No. 1507007).
PO-101
Relationship between Sleep Habits and Behavioral Problems in 3-Year-Old
Children, and Differences in Sleep Habits with and without Social Development
Delay
Ai Terui1, Manabu Saito2, Ayako Osato2, Yui Sakamoto1, Tamaki Mikami2, Kazuhiko251

Nakamura1
1
Departments of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki,Japan
2
Department of Comprehensive Rehabilitation Science, Graduate School of Health Sciences,
Department of Clinical Psychological Science, School of Medicine, Hirosaki University,
Hirosaki, Japan
ABSTRACT
Background & Aims: Recently, there has been growing interest in the effects of children's sleepon their health and development. Children with sleep problems have more behavioral problems(Reynaud, 2018) , and children with Autism Spectrum Disorder (ASD) have more sleep
problems than without it (Johansson, 2018). The Aims in this study are to investigate theassociation between sleep habits and behavioral problems in 3-year-old children, anddifferences in sleep habits with and without social development delay (SDD).
Methods: Among the parents of 3-year-old children who underwent health checkups in a city in
the Tohoku region in 2021-2022 and responded to a questionnaire, 1327 people who could beanalyzed were included. We used the Child Sleep Habits Questionnaire (CSHQ) to assess sleep
habits, the Child Behavior Checklist (CBCL) to assess behavioral problems, and Screening forSocial Development-14 (SSD-14), which was created by Hirosaki University, to evaluate thesocial development delay. All participants were examined for associations between sleep habits
and behavioral problems. In addition, we examined differences in sleep habits between a groupwith social development delay (SDD group, n=154) and a group without social development(non-SDD group, n=1173). We used multiple regression analysis for statistical analysis, the χ2
test and the Mann-Whitney test.
Results: As a result of multiple regression analysis (dependent variable: CBCL, independent
variable: CSHQ), there was a moderate effect size association between total scores (β = 0.431,
R2 = 0.185). In the subsections of CBCL and CSHQ, there were significant associations
between sleep habits such as Sleep onset delay, Sleep anxiety, Parasomnias, and Sleep
disordered breathing and behavioral problems such as Emotional reactive, Anxious/Depressed,
Attention problems, Aggressive behavior, Internalizing, and Externalizing. A chi-square test
showed that the SDD group was significantly more likely to have some sleep problems(p<0.01). As a result of comparing the sleeping habits of both groups, the total score (p<0.001),
each subitem; Bedtime resistance (p<0.01), Sleep onset Delay (p<0.001), Sleep duration(p<0.01), Sleep anxiety ( p<0.05), Night time awakenings (<0.001), Parasomnias (p<0.001),
Sleep disordered Breathing (p<0.001), and Daytime sleepiness (p<0.001) were all significantly
higher in the SDD group.
Conclusions: A community survey suggested a significant association between sleep habits andbehavioral problems in 3-year-olds. Children with SDD also had more problems with sleep
habits.
This study has been approved by the Ethics Committee of Hirosaki University Graduate Schoolof Medicine. All presenters have no conflict of interest.
PO-102The Effect of Medication Guidance from Pharmacists on Medication Adherence
among Child and Adolescent Outpatients with Mental Disorders
Parawansa FBP1, Sugimoto A2,3, Yamashita T4, Zain E1,5, Yoshinaga K2,3, Egawa J6, Someya T1
1
Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences,
Niigata, Japan2
Department of Community Psychiatric Medicine, Niigata University Graduate School of
Medical and Dental Sciences, Niigata, Japan3
Department of Psychiatry, Niigata Psychiatry Center, Niigata, Japan

252

4

Department of Pharmacy, Niigata Psychiatry Center, Niigata, Japan
Department of Psychiatry, Faculty of Medicine, Mulawarman University, Samarinda, Indonesia
6
Department of Psychiatry, Niigata University Medical and Dental Hospital, Niigata, Japan
5

ABSTRACT
Background: Poor adherence to medical treatment severely compromises patient outcomes andincreases patient morbidity and mortality. Due to language and comprehension problems, there
is a negative link between adherence rates and a need for more explanation of the adverse
effects of medications. Ignorance about adverse effects happening usually cause treatment
discontinuance from the patients. There are currently few reports on medication guidance andits impact on adherence in this field. This study aims to examine the effect of medication
guidance by a pharmacist on children's adherence.
Methods: This study included 38 child and adolescent outpatients in Niigata Psychiatric Centre
who were receiving pharmacotherapy. The medication guidance showing a picture story of thebenefits and side effects of medications was given to the patients and their guardians by apharmacist. We use the Child Adherence Questionnaire (CAQ), which is a modified DAI-10, tomeasure medication adherence in children receiving psychotropic medications. The CAQ scoreconsists of CAQ total, CAQ attitude, and CAQ comprehension. The CAQ was administered
before the medication guidance and at the final outpatient visit after the medication guidance.
Results: Of all subjects, 81.6% were male (n=31) and were predominantly diagnosed withattention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Somepatients received more than one drug therapy. As a result, 19 (35,85%), 14 (26,42%), 11(20,75%), and 9 (16,98%) subjects received Methylphenidate/MPH, Atomoxetine/ATX,
Aripiprazole/ARP, and Risperidone/RIS, respectively. With using paired t-test, CAQ total,
attitude, and comprehension scores did not improve before and after the intervention. According
to the multiple regression analysis, there were positive correlations between the age of subjects
with CAQ total change (R = 0.505; p < 0.001), CAQ attitude change (R = 0.525; p = 0.013), andCAQ comprehension change (R = 0.525; p < 0.001).
Conclusion: Our study reveals that medication guidance is significant with medication
adherence alteration positively. Moreover, age is significant in understanding medication
adherence with the administration and consumption of psychotropic drugs in child andadolescent outpatients with mental disorders.
Ethical considerations: This study was approved by the Ethical Review Committee of the
Niigata Psychiatric Centre. All patients and their guardians were fully informed, and theirwritten consent was obtained.
Conflict of Interest: Faisal Budisasmita Paturungi Parawansa: None; Atsunori Sugimoto:received research funding or honoraria from the following organizations in the last 5 years;
Developmental Science Research and Education Center, Taiju Life and Welfare Foundation,
Kawano Pediatric Medical Scholarship Foundation, Shimadzu Corporation, Takeda
Pharmaceutical Co., Ltd., Nobel Pharma Co., Ltd., Shionogi Co., Ltd., Mochida PharmaceuticalCo., Ltd; Tomoe Yamashita: None; Ekachaeryanti Zain: None; Kiyohiro Yoshinaga: None; Jun
Egawa: received research funding or honoraria from the following organizations in the last 5
years, Takeda Pharmaceutical Co. Ltd., Shionogi Co. Ltd; Toshiyuki Someya: received researchfunding or honoraria from the following organizations in the last 5 years, Astellas Pharma Inc.,Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., MochidaPharmaceutical Co., Ltd., MSD K.K., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd.,
Shionogi Co., Ltd., Sumitomo Pharma Co., Ltd.
PO-103Three cases of neurofibromatosis type 1 (NF1) with neurodevelopmental
disorders -A clinical practice of child and adolescent psychiatry in in-hospital
clinical network for NF1-

253

Ibuki Tomita1, Hidekazu Kato2, Yoshihiro Nawa2, Itaru Kushima1,3, Hiroyuki Kidokoro4,
Yoshihiro Nishida5, Nagahide Takahashi2
1
Department of Psychiatry, Nagoya University Hospital, Nagoya, Japan2
Department of Child and Adolescent Psychiatry, Nagoya University Hospital, Nagoya, Japan
3
Medical Genomics Center, Nagoya University Hospital, Nagoya, Japan
4
Department of Pediatrics, Nagoya University Hospital, Nagoya, Japan
5
Department of Rehabilitation Medicine, Nagoya University Hospital, Nagoya, Japan
ABSTRACTIntroduction: Neurofibromatosis type 1 (NF1) is known to have frequent neurodevelopmental
comorbidity, but in many cases, psychiatric evaluation is inadequate or not connected tosupport. In 2014, Nagoya University Hospital established the NF1 In-Hospital Treatment
Network (Nishida et al. Sci Rep, 2021), and the Department of Psychiatry and the Departmentof Child and Adolescent Psychiatry are also participating in the network to evaluate, diagnose,and treat comorbid neurodevelopmental disorders and psychiatric disorders. There are few
reports on the actual clinical practice for patients with NF1 in child and adolescent psychiatry,
and we report three cases with each of the typical comorbid neurodevelopmental disorders.
Case presentation:
Case 1: 9-year-old boy with attention deficit/hyperactivity disorder (AD/HD)
Prominent hyperactivity and impulsivity had been observed since early childhood. At the age of9, he was referred to a child and adolescent psychiatrist by his pediatrician and was diagnosed.
Although some improvement was observed with environmental adjustment andpsychoeducation, he continued to have difficulties in his daily life, and his symptoms became
milder after starting ADHD medication.
Case 2: 13-year-old boy with autistic spectrum disorder and AD/HD
From early childhood, problems with social communication, repetitive behaviors or interests,
and inattention were observed. He was diagnosed with NF1 at pediatric clinic and evaluated anddiagnosed with neurodevelopmental disorders at child and adolescent psychiatric clinic.
Consultation on how to deal with his developmental characteristics is ongoing.
Case 3: 9-year-old boy with specific learning disorder (dysgraphia) and AD/HD
Hyperactivity and inattention were observed since childhood. After schooling, his difficultywith writing was more pronounced than his other learning abilities. He was referred to a childand adolescent psychiatrist and was evaluated and diagnosed with neurodevelopmental
disorders. Cooperation with the school was conducted to discuss learning considerations basedon the developmental characteristics of the child.
Discussion: When treating patients with NF1, especially pediatric patients, it should be notedthat neurodevelopmental disorders often coexist, and support should be tailored to theircharacteristics after a thorough developmental evaluation. Improvement in daily life adjustment
and prevention of secondary mental health problems is expected. It is also expected that anunderstanding of developmental characteristics will lead to psychological support in the courseof treatment of physical ailments.
Authors have no conflict of interest. The patients and/or their parents gave written informed
consent for this presentation.
PO-104
Association between Physical Activities, Perceived Stress and Depressed Moodamong Metropolitan Secondary School Students in Taiwan
Iris, Chih-Tsai Chen1,2, Ya-Hsing Yeh2
1
Department of Child and Adolescent Psychiatry, Taoyuan Psychiatric Center, Ministry of
Health and Welfare, Taoyuan City, Taiwan

254

2

Center for Mental Health Promotion, John Tung Foundation, Taiwan

ABSTRACT
Objectives: To understand the association between physical activities, perceived stress anddepressed mood among six metropolitan secondary school students in Taiwan. Methods:
This study was conducted using the survey datasets from the John Tung Foundation Mental
Health Center. The survey was carried out from May through June in 2020. A total of 30 juniorand senior high schools from six metropolitan including Taipei City, New Taipei City, Taoyuan
City, Taichung City, Tainan City, and Kaohsiung City were recruited using conveniencesampling. 2,222 valid questionnaires were collected by anonymously filled out the selfadministered questionnaire by the students allocated.
Results: 27.6% of the teenagers often and always felt stressed in the past six months. 17.6% ofthem was found “Depressed mood, which need help”. Beside physical education in school, 55%
of teenagers keep a regular 31-60 minute of exercise habits each time. The most frequently
physical activities engaged are “ball games”: followed by “running/walking”: and “dance class”.
There were significantly associated between regular exercise habits and gender; and status of
depressed mood; but not significantly associated between how often of perceived stress. Parents
with regular exercise habits, encouragement from parents, and exercise with parents werefactors that significantly high in teenager with regular exercise habits.
Conclusions: Having a regular exercise habit for teenagers is significantly association withstatus of depressed mood and gender. Perception of how teenagers think about the amount of
exercise and benefit of physical activities will further discussed. Furthermore, the role of parents
is important to cultivate a regular exercise habit for teenagers.
Conflict of Interest: No conflicts of interest to disclose.
(Approved by the IRB of National Cheng Kung University, IRB No 111-065)
PO-105The title: Parental intervention program for appropriate smart device usage inpreschool children with neurodevelopmental problem
Min Jeong Park1, Min Sook Koh1, Kil Yun Song2, Jin-Hwa Moon1
1
Department of Pediatrics, Hanyang University Guri Hospital, Republic of Korea
2
Department of Pediatrics, Hanyang University College of Medicine, Hanyang University Guri
Hospital, Republic of Korea
ABSTRACT
Objects: The use of smart devices in young children is increasing worldwide. In Korea, National
information society agency reported that the risk group for overdependence on smart devices inchildren aged 3 to 8 reaches 28% in 2021. The purpose of this study is to evaluate the effects ofthe parental intervention program for appropriate smart device usage for children withneurodevelopmental disorder (NDD).
Methods: The children aged 2.5-7 years old with NDD and their parent were enrolled. The
parental intervention program for appropriate smart device usage developed in the authors’previous study for children with typical development (TD) with work book was used. In-personor online meetings (during COVID-19 period) were conducted once a week for a total of 6
sessions. At enroll periods, comprehensive neurodevelopmental evaluations and smart device
usage related questionnaire were conducted to each patients. Before (A) and after (B) theintervention period, the parent filled the brief questionnaire for smart device usage of theirchildren to compare the effect of intervention. The intervention program included understanding
their children, managing the time and frequency of smart device usages, encouraging parental
engages while their child is using smart devices, and increasing the ability to apply the contents
watched together on smart devices during daily activities with their child.

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Results: Twenty-six NDD child-parent pairs were completed the intervention program. (Meanage 3.8±1.0 years, male: female 22:4). The smart device use frequency and time per a day weresignificantly decreased after the intervention program (A: 1.7±0.7 times/day and 75.7±48.4
minutes/day, B: 1.3±0.8 times/day and 51.5±31.9 minutes/day). The total co-viewing or cotalking times per a day or a week with their parent during smart device usage were notsignificantly changed. However, the time and frequencies to apply the co-watched contents todaily activities were significantly increased after the program (A: 2.2±1.7 times/day and8.7±13.9 minutes/day, B: 3.7±2.3 times/day and 13.0±11.3 minutes/day). Although co-talking
times per a day was not significantly changed, the percent ratio of co-talking time out of total
use time a day were significantly increased after intervention (A: 0.3±0.3, B: 0.8±0.7).
Conclusion: As in TD group, the parental intervention program for smart device usage was
effective in reducing the time simply used the device and increasing time interactively use with
their parent. If used together with other ore developmental therapies, parental program canpromote the adaptive use of smart device in children with NDD older than 2 years.
This work was supported by the research fund of National research foundation of Korea (NRF2019R1F1A1058704) and preliminary results of the research.
This work was modified result from the oral presentation in 2022 Oct. 53th Korean Child
Neurology Society conference in Seoul. It has not been published in any other form.
Conflict of interest: None of the authors have any conflicts of interest to declare.
Ethical considerations: This work was approved by institutional review board approval of
Hanyang University Guri Hospital (IRB file No. 2019-08-003)
PO-106
Survey of Practice for Children and Adolescents with Eating Disorder in Nagano
Prefecture, JapanKen Shiraishi1,2, Rie Kuge2, Daimei Sasayama1, Hideo Honda2,3
1
Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
2
Mental Health Clinic for Children, Shinshu University Hospital, Matsumoto, Japan3
Department of Child and Adolescent Developmental Psychiatry, Shinshu University School of
Medicine, Matsumoto, Japan
ABSTRACTIntroduction: Recently, many countries have reported a substantial increase in the number of
eating disorders. The National Center for Child Health and Development reported an increase inpatients with eating disorders in Japan after the eruption of the coronavirus disease 2019
(COVID-19) pandemic. Some research have reported a small proportion of medical institutions
are required to provide a disproportionate amount of care to these patients. Furthermore, there
are few professionals working with eating disorders in Japan. This survey was conducted toelucidate the medical demand and current treatment status of children and adolescents witheating disorders in Nagano Prefecture and to evaluate the issues related to child and adolescenteating disorder treatment.
Method: We sent questionnaires on child and adolescent eating disorder treatment to thepediatric and psychiatric departments of medical institutions in Nagano. Questionnaires returned
between April 2022 and June 2022 were used in the analysis. Questionnaires were sent to 205
medical facilities; 49 pediatric hospitals, 59 pediatric clinics, 39 psychiatric hospitals, and 58
psychiatric clinics. The questionnaire included whether they provide outpatient or inpatient
treatment for children and adolescents with eating disorders, what kind of cases they finddifficult to treat, challenges in the treatment, and requirements needed for better treatment
delivery. The ethics committee of the Shinshu University approved this study.
Result: A total of 138 (67%) medical facilities responded to the survey. Forty pediatric hospitals(81%), 36 pediatric clinics (61%), 28 psychiatric hospitals (71%), and 34 psychiatric clinics

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(58%) responded. There were 289 patients, treated at 42 medical facilities, which isapproximately 20% of the total number of pediatric and psychiatric departments in Nagano.
Pediatricians reported difficulty in treating psychiatric complications and adolescent cases,
while psychiatrists reported difficulty in treating physical complications and patients below theadolescent age. Both departments reported difficulty in treating cases with significant weightloss and undernutrition. The difficulties in treatment included a lack of professional medical
staff, dealing with parents, and the long duration of treatment. The following were mentioned as
possible facilitating factors for treatment: access to supervision, securing medical professionals
with expertise, collaboration between pediatricians and psychiatrists, and presence of medical
facilities that could accept patients when their condition deteriorates.
Discussion: Many medical institutions in Nagano reported difficulty treating children andadolescents with eating disorders. In order to improve the treatment system, it is necessary to
train and supervise medical staff and establish a network among hospitals.
The authors have no competing interests to disclose.
PO-107
A preliminary magnetoencephalography study of brain activities during cue
reactivity
in internet gaming disorder
Yoshinaga K1,2,3, Sugimoto A2,3, Sakuma F4, Nanba T5, Nakazawa Y5, Kasahara H3, Zain E1,
Parawansa FBP1, Wahyu MD1, Sato K1, Egawa J1, Shirozu H6, Iijima A4,5,7, Someya T1
1
Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences,
Niigata, Japan2
Department of Community Psychiatric Medicine, Niigata University Graduate School of
Medical and Dental Sciences, Niigata, Japan3
Department of Psychiatry, Niigata Psychiatric Center, Niigata, Japan
4
Human Sciences and Assistive Technology Course, Department of Electrical and Information
Engineering, Niigata University Graduate School of Science and Technology, Niigata, Japan
5
Interdisciplinary Program of Biomedical Engineering, Assistive Technology, and Art andSports Sciences, Faculty of Engineering, Niigata University, Niigata, Japan
6
Department of Functional Neurosurgery, NHO Nishiniigata Chuo Hospital, Niigata, Japan
7
School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan
ABSTRACTIntroduction: Internet Gaming Disorder (IGD) is a new behavioral addiction in psychiatricdisorders that has been recognized as a disorder because, like gambling disorder, it has beenreported to have functional abnormalities in the reward system of the brain. Functional brain
testing in gaming disorder has indicated dysfunction in prefrontal and limbic regions, but it
remains unclear whether these brain function changes are plastic and whether theseabnormalities are predictive of treatment success. We aim to construct an experimental system
to reveal brain activity in IGD patients using 306-channel whole-head magnetoencephalography(MEG).
Method: The patient is a 14-year-old boy diagnosed with IGD according to DSM-5 diagnostic
criteria. The patient participated in group therapy sessions once a week for an hour for a total offour times, and MEG was measured before and after the sessions. We presented a cue stimulus
task consisting of 48 dependent game images and 48 blurred images alternately for a total of
288 seconds during the MEG measurements. Maxfilter (MEGIN) was applied to remove
external noise, a noise covariance matrix was calculated using the empty room data to remove
the effect of environmental noise, and the evoked brain magnetic fields were additionallyaveraged for each condition. Data were analyzed using Brainstorm and SPM12.
Results: Provisional results showed that the first measurement showed significant brain activity

257

in the cuneus and middle and inferior temporal gyri under cue stimulation compared to theblurred images. In addition, comparing the first and second measurements when the gameimages were presented, we found reduced brain activity in the occipital gyrus and fusiform
gyrus, parahippocampal gyrus, and temporal gyrus.
Conclusion: This experimental system suggests that MEG can capture target brain activity in
IGD. We look forward to a larger sample size in the future to provide clinical and biologicalevidence of the neurobiology of IGD as a psychiatric disorder and the efficacy of group therapy
in improving IGD.
Ethical considerations: The study was conducted in accordance with the standards of the
Declaration of Helsinki and was approved by the Niigata University Ethics Review Committee(approval number 2018-0393), and a patient gave written consent.
Disclosures: Yoshinaga K: received research funding or honoraria from the following
organizations in the last 5 years; Taiju Life and Welfare Foundation; Sugimoto A: received
research funding or honoraria from the following organizations in the last 5 years;
Developmental Science Research and Education Center, Taiju Life and Welfare Foundation,
Kawano Pediatric Medical Scholarship Foundation, Shimadzu Corporation, Takeda
Pharmaceutical Co., Ltd., Nobel Pharma Co., Ltd., Shionogi Co., Ltd., Mochida PharmaceuticalCo., Ltd. The other authors declare no competing interest; Egawa J: received research fundingor honoraria from the following organizations in the last 5 years, Takeda Pharmaceutical Co.
Ltd., Shionogi Co. Ltd, Someya T: received research funding or honoraria from the following
organizations in the last 5 years, Astellas Pharma Inc., Eli Lilly Japan K.K., Janssen
Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Mochida Pharmaceutical Co., Ltd., MSD
K.K., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Shionogi Co., Ltd., Sumitomo
Pharma Co., Ltd. Other speakers have no COI to disclose.
PO-108Is On-Site, Practical Training Effective in Reducing Burnout and Improving SelfEfficacy of Inpatient Staff Working with Individuals with Challenging Behaviors?
Kyoko Tanaka1
1
National Hospital Organization, Kikuchi Hospital, Koshi, Japan
ABSTRACT
It is not easy to support children and adults with challenging behaviors (CBs), such as selfinjury and aggression toward others, even in specialized inpatient settings. Professional staff
working in specialized psychiatric settings may report psychological burden resulting from theirwork with patients with CBs. It is said that the lack of knowledge and practical training on
effective support methods increase the burden on staff. The presenter investigated whether onsite training of staff based on the TEACCH approach would reduce burnout and increased
caregiving confidence among staff. A series of on-site workshops were held from August 2022
to February 2023 on one unit of Kikuchi Hospital in Kumamoto, Japan. Participants included 20
nurses and 6 co-medical personnel. Workshops consisted of (a) lectures on the TEACCH
approach and (b) “homework” applying one TEACCH strategy with one inpatient presenting
CBs. Outcome measures included the General Self-Efficacy Score (GSES), the Japanese
Burnout Scale (JBS), Behavior Problems Inventories - Short version (BPI-S) and presenterdeveloped pre- and post- training/intervention questionnaires. In the post-workshop
questionnaire, subjects reported an increase in “using effective strategy for inpatients withCBs”. Although some subjects reported that patients functioned more independently, overallchanges in BPI-S scores were not statistically significant. Unexpectedly, self-efficacy scores
decreased and scores on the burn-out measure increased post-training. Some staff commented
that they were too busy to participate in the training even though they wanted to learn more. The
presenter suggests the importance of continuing to assess the effectiveness of on-site, applied258

training and possible relationships with caregiver variables such as self-efficacy and chronic
work fatigue. In the future, training models need to continue to develop to increase theknowledge and skills of inpatient staff.
This study was conducted with the approval of the ethics committee of Kikuchi Hospital.
The presenter has no financial conflicts of interest associated with this presentation.
PO-109
Associations between ADHD Symptoms, Irritability, and Quality of Life inChildren/ Adolescents: A Network Analysis
Mana Oguchi1,2, Fumito Takahashi3
1
Okinawa Institute of Science and Technology, Onna, Japan
2
Japan Society for The Promotion of Science, Tokyo, Japan
3
Institute of Education, Shinshu University, Nagano, Japan
ABSTRACT
Hypothesis/Objective: Individuals diagnosed with attention-deficit/hyperactivity disorder(ADHD) have reported a lower quality of life (QOL) across all age groups (Coghill &Hodgkins, 2016; Klassen, Miller, & Fine, 2004; Lee et al., 2016). These studies have comparedindividuals with an ADHD diagnosis to those without, who are assumed to be the recipients ofclinical support. However, individuals with severe ADHD symptoms who remain undiagnosed
may also experience psychosocial challenges (Okumura et al., 2019). Therefore, it is important
to identify the support needs of children who exhibit ADHD symptoms but remain undiagnosed.
The purpose of this study is to investigate the effects of inattention, hyperactivity/impulsivity
symptoms, and irritability on various aspects of quality of life, while considering the presenceor absence of an ADHD diagnosis.
Method: An online cross-sectional survey was conducted, in which a total of 2,000 parents
participated; 1,000 with and 1,000 without an ADHD diagnosis in children. Four eligibility
criteria were established for parents, including being 20 years of age or older, having a child in
their care, having a first child in either the first or third grade at the time of survey response, andexpressing willingness to participate in the study. Parents answered about their first child's
ADHD symptoms (ADHD-RS), irritability (ARI), and quality of life (KIDSCREEN-52), as well
as demographic details such as the child and parent's age and gender, sibling number, academic
achievement, nationality, annual income, and place of residence. This study received approval
from the institutional review board of the second author's affiliation (Ethics Review Committee,
Faculty of Education, Shinshu University) for all the procedures conducted.
Results/Conclusions: A network analysis was performed to investigate the relationship between
measurements, with and without an ADHD diagnosis. The results revealed that in children withan ADHD diagnosis, symptoms of ADHD and irritability had effects on quality of life, while inthose without a diagnosis, the effect was found to be minimal. Specifically, among children withan ADHD diagnosis, hyperactivity/impulsivity symptoms and irritability were found to becorrelated with decreased peer acceptance, and it connect to other quality of life factors.
Conversely, inattention symptoms were associated with increased peer acceptance. Hence, inorder to enhance the quality of life of children with ADHD, it is imperative to provide themwith support to promote a sense of acceptance and security in their peer relationships,
particularly in the school environment where they spend a significant portion of their time.
This work was supported by Health Labour Sciences Research Grant 20DA0101.
The authors have declared that they have no competing or potential conflicts of interest.
PO-110259

Creation of a new scale " Screening for Social Development-14 (SSD-14)" forearly detection of neurodevelopmental disorders in 3-year-old children andsocial implementation of its web system
Manabu Saito1, Ayako Osato1, Yui Sakamoto2, Ai Terui2, Tamaki Mikami1, Kazuhiko Nakamura2
1
Department of Comprehensive Rehabilitation Science, Graduate School of Health Sciences,
Department of Clinical Psychological Science, School of Medicine, Hirosaki University,
Hirosaki, Japan2
Departments of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaku,
Japan
ABSTRACT
Background & Aims: Early detection of neurodevelopmental disorders (NDDs) is important, but
the current situation is that NDDs are not detected in infant health examinations in Japan,
compared to the prevalence of about 10%. We created Screening for Social Development-14(SSD-14), which aims to detect NDD at the age of 3 years. Here, we report on the process ofcreating the scale and its accuracy.
Methods: SSD-14 was created over a period of 5 years.
(1) In 2017, we conducted a preliminary survey of 123 3-year-old health checkup participants
and decided on a screening method.
(2) In 2018, 3 criteria were extracted from 1090 screening participants and 63 detailed
examination participants in the 3-year-old health checkup.
(3) In 2019, we examined the equivalence of the three new criteria in 1174 screening
participants in the 3-year-old health checkup, and finally selected SSD-14.
(4) In 2021-2022, we verified the reproducibility of the scale and the validity of the contents in
1327 children who responded to the SSD-14 in the 3-year-old health checkup.
Results: (1) The cutoff value of SRS-2 useful for screening for NDD in children aged 3 years
and 6 months was 43.5.
(2) The accuracy and predictive validity of the three criteria are as follows: sensitivity 88.9,
specificity 99.5, AUC 0.993 for 14 items; sensitivity 88.9, specificity 99.4, AUC 0.995 for 15
items; and sensitivity 87, specificity 99.7, AUC 0.996 for 16 items.
(3) The predictive validity of the three criteria was almost the same. The SSD-14 cut-off value
was ≤29 on a 40-point scale [sensitivity 82.8%, specificity 96.8%, AUC 0.975]). The estimateddetection rate for NDD-risk children was 11.4%. Cronbach’s coefficient alpha(4) Cronbach’s coefficient α was 0.794. The average value was 34.1 (SD4.55), and the score of
29 points was 1 SD value. The number of NDD-risk children extracted was 11.6%, and the
reproducibility was good.
Conclusion: SSD-14 is a convenient and accurate screening at 3 years of age. SSD-14 hasalready been made into a WEB system, and social implementation has started in Hirosaki City.
It is planned to be used throughout Aomori Prefecture in 2024.
This study has been approved by the Ethics Committee of Hirosaki University Graduate Schoolof Medicine. All presenters have no conflict of interest.
PO-111
Acceptability of Parent Child Interaction Therapy in the rural area of Hokkaido
Mariko Nakau1, Satoshi Suyama1, Takuya Saito1
1
Funded Research Division of Child and Adolescent Psychiatry, Hokkaido University Hospital,
Sapporo, Japan
ABSTRACT
Background: Parent Child Interaction Therapy (PCIT) is an evidence-based parenting program.

260

PCIT was introduced to Japan by the members of Tokyo Women’s Medical University in 2008,
and has been spreading out However, in Hokkaido, which is the biggest prefecture in Japan, theprogram is not accessible to all the families, especially for those who live in the rural area. In
this study, we have conducted PCIT in Biei, which is in the central of Hokkaido. Until We
started PCIT, most of the staffs working at child rearing support center of Biei, or the publichealth nurse in Biei did not know PCIT. This study report the qualitative investigation of
supporters who experienced PCIT for rural or regional Hokkaido Family.
Methods: Qualitative questionnaire were conducted to the supporters of family who experienced
PCIT. The questionnaire was conducted after they saw the PCIT for the first time in their life.
This study was conducted with the approval of the Hokkaido University Hospital Division ofClinical Research Administration.
Results: Most of the staffs were favorable to the therapy. The result will be presented in theposter.
Conclusion: Even for those who support families in burden of childcare, PCIT has a very strong
impact in a sense the therapy changes the relationship between parent and the child and also theparent her/his self. We would like to continue conducting PCIT in the rural area of Hokkaido,
and solve the obstacle that is making difficult to reach PCIT to the families living in the ruralarea.
COI: Satoshi Suyama, Mariko Nakau, and Takuya Saito are endowed by the City of Sapporo.
This study was funded by Yasuda-Life Welfare Foundation
PO-112
Exploring book titles on neurodevelopmental disorders in Japan: A text-mining
investigation
Mebuki Sunagawa1, Yuria Demizu1
1
Ochanomizu University, Tokyo, Japan
ABSTRACT
Background: The number of individuals diagnosed with neurodevelopmental disorders in Japan
is growing. This study focused on published book titles about the disorders. Book titles are
considered one of the indicators reflecting public awareness and the needs of those involved, asbooks are a readily available source of information.
Methods: We retrieved all available bibliographic datasets from the National Diet Library(NDL). Searched criteria were: books 1) that include the words “developmental disorders,”“autism spectrum disorder,” “attention deficit hyperactivity disorder,” “specific learning
disorder,” and related words in the title and source data; 2) written in Japanese; and 3) registered
the database by January 11, 2023. The search terms were taken from the search results of the
WEB NDL authorities. The WEB NDL authorities permitted the retrieval of authority data
produced by NDL. The first and second authors individually classified ambiguous titles as“developmental disorders,” “ASD,” “ADHD,” or “LD” and then ascertained the match. Titles
containing several classifications duplicated the counts. We applied KH coder, an automatedtext-mining tool, to explore frequently occurring words and their co-occurring relationships.
Results: A total of 2887 books were covered. Of these, about 47% were about “developmental
disorders,” followed by “ASD” (36%), “ADHD” (10%), and “LD” (7%). With the enactment of
the Act on Support for Persons with Developmental Disabilities in 2006, the number of books
increased rapidly, particularly those with a title including “developmental disorders,” which has
seen an upward trend since then. A total of 39 books had words related to girls and women in
the titles. The top five frequently occurring words were “children,” “support,” “education,”“understanding,” and “guidance.” There are many overlapping topics for individual disorders,such as educational support for children, understanding and practice of the disorders, and life
stages (childhood and adulthood). However, specific co-occurring relationships were observed261

for LD with “school,” “learning,” and “parents”; for ADHD with “diagnosis” and “brain”; for
ASD with “mind,” “behavior,” and “research”; and for developmental disorders with “nurture,”“life,” and “psychology.”
Conclusions: The findings suggested that neurodevelopmental disorders in Japan are broadly
understood as “developmental disorders.” Moreover, the framework for understanding eachdisease and phenotype was not widespread. Books on educational support for children are
published mainly for parents, teachers, and professionals. However, there is still a lack of books
covering specific characteristics of the disorders, in adulthood, for women, or for individuals
with neurodevelopmental disorders.
Ethical considerations: This study is a bibliographic study of publicly available data and does
not fall under ethical considerations.
Conflict of interest information: The authors have no conflicts of interest to declare.
PO-113
Reducing Student Absenteeism through a Latent Growth Model Comprising
Maladaptive Factors and Signs, and Interest in School Counselors
Mikie Suzuki1, Keiko Otsuka2, Sachiko Hida3, Yukari Taniguchi2, Hitomi Baba2
1
Aichi University of Education, Kariya, Japan
2
Kinjo Gakuin University, Nagoya, Japan
3
Aichi Toho University, Nagoya, Japan
ABSTRACTIntroduction: This longitudinal study focuses on school maladjustment and absenteeism. It
examines school-related factors of maladaptive signs (physical and emotional signs of school
maladjustment) and factors (friendship problems and low self-esteem), which areconceptualized as related but distinct constructs. The analysis of a change in these factors andtheir impact on student absenteeism across time helps understand the larger phenomenon of
student absenteeism.
Method: A sample comprising 194 Japanese elementary school students from Grades 3 to 6 whocompleted measures over 3 years were investigated. The School Maladjustment Scale (Suzuki etal., 2018) was used to measure school maladjustment, which included two subfactors, namely
maladaptive signs (physical and emotional signs of school maladjustment) and factors(friendship problems and low self-esteem). To measure absenteeism, we counted the number ofdays each student was absent from school during the year. The study selected four items fromthe “Interest in School Counselor Scale” (Suzuki et al., 2018). Latent growth modeling was
employed to examine the predictors of maladaptive signs (physical and emotional signs ofschool maladjustment) and factors (friendship problems and low self-esteem), and “interest in
school counselors” in understanding changes in absenteeism.
Results and discussion: We conducted LGM analyses by using Amos 22.0. Given the significant
variances in both intercept and slope, we examined a subsequent LGM model with maladaptive
signs and factors, and “interest in school” as predictor. The data fit the model well: χ2(4) =2.368, p = .668, CFI = 1.000, GFI=.991, RMSEA = 0.000. Maladaptive factors were thestrongest predictors of changes in absenteeism. Maladaptive signs and “interest in school
counselors” predicted an increase and decrease in absenteeism over time, respectively. Future
research should continue to examine the complex relationship between individual-psychologicaland school-environment variables in impacting the incidence of absenteeism. School-based
intervention programs may benefit from deploying an approach that targets friendship problems
and low self-esteem among students, and from promoting individual psychological help-seeking
behaviors.
The ethics committee of Aichi Toho University granted ethical approval of the study. The

262

authors declare no conflicts of interest that are directly relevant to the content of this article.
This work was supported by JSPS KAKENHI (22K03099) JP.
PO-114
Factors Affecting Child Development Problems in Fukushima Disaster Areas
Tokio Uchiyama1,2,3, Keiko Kawashima1, Satomi Suzuki2, Ikuko Abe4
1
Fukushima collage, Fukushima, Japan
2
Taisho University, Tokyo, Japan
3
Yokohama Psycho-Developmental Clinic, Yokohama, Japan
4
Fukushima University, Fukushima, Japan
ABSTRACT
Objective: Twelve years are passing since the Great East Japan Earthquake and the subsequent
accident in Fukushima Daiichi Nuclear Power Station. This research is a follow-up study inwhich we use data from infant health checkups conducted in the coastal areas of Fukushima
Prefecture to examine factors that influence child development and the associated problems in
the affected areas of the Prefecture. Few studies have clarified how children are affected by thelong-term evacuation due to the nuclear disaster.
Methods: A longitudinal study design was adapted. We administered a questionnaire to parentsof second- or fifth-grade of elementary school students regarding their children's current mental
and behavioral problems, the parents' mental health, and evacuation status from 2019 to 2021.
The Strength and Difficulties Questionnaire (SDQ-Japanese version) was used to measurechildren's problems. The questionnaires returned were link to the results of health checkups
conducted for infants aged 1.5 years and 3.5 years. The reasons for children's behavioral
problems in the second and fifth grade of elementary school were investigated by means ofmultiple logistic regression analysis, using SPSS ver. 26.
Results: Questionnaires were distributed to 947 parents of 2nd graders and 1057 parents of 5th
graders, and of those who responded, 139 were able to link both 1:6 and 3:6 checkups to 2ndgraders and 100 to 5th graders. In the children with high-needs of SDQ in the second grade, thelow overall sense of health of the parents, the children’s emotional problems at the time of thecheckup, and the family's living conditions during the evacuation period at 3.5 years of age
contributed to the children’s developmental problems. The high-needs group of fifth graders
was affected by the lack of support from parents since childhood.
Ethical considerations: This study was approved by Taisho University Ethics Committee(approval number:20-21)
COI: There are no companies with COI relationships that should be disclosed by the presenters
for this research presentation.
PO-115
Impact of COVID-19 on the mental health of parents of children with autism two
years after the outbreakSatomi Suzuki1, Hironobu Ichikawa2, Tokio Uchiyama1,2,3,4
1
Taisho University, Tokyo, Japan
2
Autism Society Japan, Tokyo, Japan
3
Fukushima collage, Fukushima, Japan
4
Yokohama Psycho-Developmental Clinic, Yokohama, Japan
ABSTRACT
Objective: Over two years have passed since the outbreak of the global novel coronavirus

263

(COVID-19) pandemic. While many studies have examined the various impacts on COVID-19,
few studies have targeted parents of children with autism. Therefore, this study aimed to
identify factors associated with the risk of depression among mothers of autistic children during
the pandemic the in Japan.
Method: In this cross-sectional study, a questionnaire survey on the internet was conducted in
March 2022 with mothers who were members of the Autism Society Japan. The questionnaire
included the parents' socioeconomic status and changes, changes of the parents' and thechildren's psychiatric and physical status, and changes in behavior and lifestyle in the beginningof Omicron-dominant periods. Risk of depression and anxiety disorder of the parents wereassessed using the Kessler Psychological Distress Scale (K6-Japanese version). Regression
analysis was performed using the K6 score as the dependent variable. All statistical analyses
were performed using SPSS Statistics 26.
Results: Totally, 260 responses (mean [SD]age, 47.2[8.9] years) were obtained and the averagescore on the K6 was 7.51 points. There were 47 mothers who scored 13 or more points, whichcorresponds to the equivalent of a severe mental disorder, with a mean score of 16.72 points.
Logistic regression analysis performed on the basis of this cut-off value revealed that “family
structure: single parent and child", "increase in the child’s requests that cannot be met by theparent" and "increase in the child’s violence" were associated with worse psychiatric symptoms
in the mothers. （single parent and child OR=.222 (CI:.088-.561, p=.001), increase in thechildʼs requests OR=.404 (CI:.181-.903, p=.027)，violence OR=.420 (CI:.185-.953, p=.038)）
Ethical considerations: This study was approved by Taisho University Ethics Committee.
COI: There are no companies with COI relationships that should be disclosed by the presenters
for this research presentation.
PO-116
Correlation between individual’s trait of attention-deficit/hyperactivity disorder(ADHD) and microsaccadic responses following presentation of other’s gazewith fearful expression
Sayuri Hayashi1,2, Ryousei Kurose1, Hiroki Yoshida1, Shigekazu Higuchi3, Takashi Okada2, Yuki
Motomura3
1
Department of Human Science, Faculty of Design, Kyushu University, Fukuoka, Japan2
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan3
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACT
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disordercharacterized by inattention and/or hyperactivity-impulsivity persistent from childhood. Somestudies have reported deficits in social cognitive processing in ADHD with abnormality in theoculomotor control, including microsaccadic responses. In this study, we investigated whether
the microsaccadic responses to a social cue is associated with ADHD traits. Twenty healthy
male university students (22.90 ± 0.91 years old) participated in this study. Their ADHD traits
were assessed by Japanese version of Conners’ Adult ADHD Rating Scale (CAARS). They
performed a gaze cueing task – 6 blocks with 24 trials in each. In each trial, a face image(neutral or fearful expression, left or right gaze) was randomly presented for 200ms following agaze point in the center of a display. After the facial image disappeared, the gaze point
reappeared in the center for 800 ms; subsequently, a target stimulus was presented at either theleft or right box. The participants reported the target stimulus location (right or left) by pressing
a key as soon as possible. We conducted exploratory correlational analysis for testing theassociation between microsaccadic responses (occurring rate and directional bias) measured by264

eye-tracking system in the two intervals (rebound and after-rebound phase), and CAARS
subscales’ scores. We observed a significant correlation between the occurring rates for a fearfulexpression in the after-rebound phase and the scores of inattention/memory problems.
Moreover, in this after-rebound phase, we found the correlation between directional biases for a
fearful expression and the scores of the inattention/memory problems, as well as DSM-Ⅳ
inattentive symptoms. We did not observe a significant correlation between microsaccadic
responses in the rebound phase and CAARS subscales’ scores. Our results suggest thatspecifically in the after-rebound phase, low microsaccade occurrence rates following other’s
fearful expression were associated with the high-trait of inattention. Moreover, in this phase,microsaccade direction toward the opposite to the other’s fearful gaze was possibly reduced inindividuals with high-inattentive traits. These results indicate that the inattentive symptom may
be associated with the attenuated effects of the fearful expression in the after-rebound phases,
which possibly explain a part of the physiological and psychological mechanisms underlying
social problems in individuals with high-ADHD traits. Future studies are expected to test ourfindings with other population, especially individuals with ADHD.
The study was conducted per the Ethical Guidelines for Medical and Health Research Involving
Human Subjects. The Research Ethics Committee of Kyushu University approved the study
protocol. The authors have no conflict of interest.
PO-117Comparison of School Life Between Students with Autism Spectrum Disorderand Students with Normal Development: A Study Based on the NSCH data
Yaena Ha1, Eunyoung Yoo2
1
Department of Occupational Therapy, Graduate School, Yonsei University, Republic of Korea
2
Department of Occupational Therapy, College of Software and Digital Healthcare
Convergence, Yonsei University, Republic of Korea
ABSTRACT
Background: Students with autism spectrum disorder (ASD) experiencing more difficulties inschool life compared to students with normal development. The characteristics of children andadolescents with ASD should be taken into consideration so that they can participate well inschool life. Objective: The purpose of this study is to compare the school life of children andadolescents with or without ASD, and find out difficulties ASD students have in school life. In
addition, the school life according to the severity of ASD and the first diagnosis period of ASD
was analyzed. Method: Study participants were 12,820 children and adolescents aged 6 to 17
years, using data from National Survey of Children’s Health (NSCH) collected in 2021.
Independent t-test was conducted to compare the demographic characteristics of students with
ASD and those with normal development. Multiple regression analysis was performed toanalyze the relationship between the severity of ASD and school life, and between the firstdiagnosis period of ASD and school life. SAS 9.4 was used for data management and analysis.
Results: A total of 12,820 children and adolescents were included in the analysis. There were
930 students with ASD (mean age = 11.96 ± 3.55; male =78.82%; female = 21.18%) and 11,890
students with normal development (mean age = 11.40 ± 3.56; male = 48.59%; female =51.41%). Comparison of school life between the two groups showed statistically significant
differences in all school life items. Students with ASD were more likely to have difficulty
controlling themselves when faced with challenges (β = 0.84, p < .0001). From the school, theirparents were more contacted about problems at school (β = 0.78, p < .0001). They had difficulty
making and keeping friends (β = 0.76, p < .0001) and finishing the work they started (β = 0.76,
p < .0001). Conclusions: Children and adolescents with ASD had difficulties in school
compared to those with normal development. The more severe the ASD, the more difficulties
there were. Schools, specialist and parents of ASD students should ensure that the265characteristics of them are taken into account in school life so that they can better participate inschool life.
COI: There are no conflicts of interest to disclose regarding this study.
Ethical Statement: The NSCH's data is child health data collected through online and offline
parent surveys. The NSCH data used in the study is secondary data that has been processed anddisclosed so that a specific individual cannot be identified, and the data can be used without IRB
approval. If the IRB is necessary for poster submission, it is possible to obtain an IRB waiver
review prior to poster presentation.
PO-118
Management of stealing from parents in the children and adolescents withneurodevelopmental disorders: A case series
Yosuke Ishijima1, Rie Wakako2
1
Kariya Hospital, Child Psychiatry, Kariya, Japan2
Toyota Municipal Child Development Center Nozomi Clinic, Child Psychiatry, Toyota, Japan
ABSTRACTIn children with neurodevelopmental disorders such as ASD, ADHD, repeated stealing fromparents is one of the clinical problems.
Epidemiological findings on the relationship between neurodevelopmental disorders anddelinquency have been inconsistent. Stealing from parents in particular, much previous literature
has attempted to link alcohol, tobacco or drug use problems to the delinquency, but no literature
can be found linked to neurodevelopmental disorders.
Here we present the five cases where the children and teenagers stole money repeatedly fromparents. The patients are five boys (no girls) between the ages of 11 and 17. Diagnosis isassessed according to DSM-5. Of the five cases, two were diagnosed with ASD and ADHD, twowith ASD, and one with ADHD. No case met the criteria of oppositional defiant disorder,
conduct disorder, or kleptomania. In all five cases, the first presenter was their primary doctor.
In this presentation, we show the course of treatment for each case and discuss of therelationship between neurodevelopmental disorders and the theft.
In each case, the doctor and the parents discussed how to deal with the theft at home. We also
worked with the school, the Child Guidance Center, and other agencies to address the problem.
In all cases, there was no theft outside the home. Although the background of the problem wasdifferent in each case, counseling at the Child Guidance Center and social skills training by theschool teacher helped to improve the problem. In all cases, the stealing stopped within a year.
According to the literature, there is evidence both for and against the idea that crime is moreprevalent in people with ASD than in the general population. With regard to ADHD anddelinquency, it has been suggested that ADHD alone is not a risk factor, but that thecharacteristics of the disorder, the child's environment, and inappropriate interactions with thosearound the child are risk factors.
Mills(2011) discussed ASD and delinquency in terms of three factors; predisposing factors,
precipitating factors and perpetuating factors. In the cases presented here, neurodevelopmental
disorders were associated with poor coping skills and immature rule compliance, which werepredisposing factors for delinquency. Impulse control difficulties related to ADHD, problems
with parents at home, or school refusal were precipitating factors for the delinquency.
Inappropriate interactions with those around them, if present, were perpetuating factors. These
factors should be considered by clinicians when dealing with stealing from parents.
Ethical considerations: This study was approved by the Institutional Review Board (IRB) of
Kariya Hospital and with the written informed consent of all participants.
Disclosure: The authors have no potential conflicts of interest to disclose.

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PO-119
Implementation of Social Skills Training for Japanese Part-Time High SchoolStudents: Preliminary Effectiveness Verification through Comparison with the
General High School Students in Japan
Yugo Kira1, Miku Shimizu2, Natsumi Kataoka2, Seiko Uzu2
1
Department of Social and Clinical Psychology, Hijiyama University, Hiroshima, Japan
2
Graduate school of Contemporary Culture, Hijiyama University, Hiroshima, Japan
ABSTRACTIn Japan, part-time high schools (PTHSs) aim to provide opportunities for higher education toadolescents who cannot attend full-time high school for various reasons. PTHS students havelower social skills than full-time high school students, leading to school maladjustment andpsychological problems such as depression (Kira et al., 2017). However, a few practicalexamples of classroom-based social skills training (SST) for PTHS students exist. In addition,
curriculum and ethical issues make it difficult to set up control groups, so effectivenessverification has not been sufficiently conducted. Therefore, we aimed to preliminary evaluate
the effectiveness of classroom-based social skills training for PTHS students.
We conducted the SST program for 32 Japanese PTHS students from grades 10 to 12 (25 males;mean age 16.34 years, SD = 1.13) on a grade-by-grade basis (SST group). The program wasconducted over three months, and social skills (Kira et al., 2020), school adjustment (Ishida,2009), and depression (CES-D; Shima et al., 1985) were measured at the pre-, post-, and followup-time (three months later). In addition, as a method to enable the validation of the effect evenin Japan, where it is difficult to set up a control group, this study compared the data with thoseof high school students in general throughout Japan (general group). The survey used a Japanese
online service with the same questionnaire at the same time as the SST group's pre- and followup-time points. We used 327 high school students (71 males; mean age 16.51 years, SD = 0.96)
who participated in the survey at the two-time points in the analysis. The study was conductedwith the approval of the ethical review board of the authors' institution.
A hierarchical linear model was used to test whether there were differences in changes in social
skills, school adjustment, and depression between the SST and general groups. Results of theanalysis, social skills, the prime indicator, were found to be significantly increased in the SST
group than in the general group (β11 = 0.91, p < .05). Besides, the SST group was alsosignificantly improved the relationship with their school teachers regarding school adjustment
than in the general group (β11 = 0.21, p < .05). These results indicate that classroom-based SST
for PTHS students increases their social skills and improves their relationships with teachers. It
is desirable to implement it on a larger scale and measure its effectiveness over a more extended
period.
All authors declare that they have no competing interests.
This study was supported by JSPS KAKENHI Grant Number 21K13702.
PO-120
Neuropsychological Investigation of Parafoveal Recognition of Japanese Kanji
Compound Words in Children with Specific Learning Disabilities Co-morbid
Attention Deficit/Hyperactivity Disorder
Yuka Egashira1, Yoshimi Kaga1,2, Atsuko Gunji1,3,4, Yousuke Kita1,5,6, Motohiro Kimura7,
Naruhito Hironaga8,14, Hiroshige Takeichi1,9, Sayuri Hayashi1, Yuu Kaneko10, Hidetoshi
Takahashi4,11, Takashi Hanakawa4,12, Takashi Okada1, Masumi Inagaki1,13
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan2
Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan

267

3

College of Education, Yokohama National University, Yokohama, Japan
Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan
5
Cognitive Brain Research Unit (CBRU), Faculty of Medicine, University of Helsinki, Helsinki,
Finland6
Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan
7
Department of Information Technology and Human Factors, National Institute of Advanced
Industrial Science and Technology (AIST), Tsukuba, Japan
8
Brain Center, Faculty of Medicine, Kyushu University, Fukuoka, Japan
9Open Systems Information Science Team, Advanced Data Science Project, RIKEN Information
R&D and Strategy Headquarters (R-IH), RIKEN, Yokohama, Japan10
Department of Neurosurgery, National Center Hospital, National Center of Neurology andPsychiatry, Kodaira, Japan
11
Department of Child and Adolescent Psychiatry, Kochi Medical School, Kochi University,
Kochi, Japan
12
Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine,
Kyoto, Japan
13
Department of Pediatrics, Tottori Prefectural Rehabilitation Center, Tottori, Japan
14
Department of preventive intervention for psychiatric disorders, National Institute of Mental
Health, National Center of Neurology and Psychiatry, Kodaira, Japan
4

ABSTRACTSpecific learning disorder (SLD) and attention-deficit/hyperactivity disorder (ADHD) arefrequently co-occurred; however, the cognitive characteristics of the visual word recognition of
SLD with ADHD are still unclear. The specific activities of SLD with ADHD in the visualcortex during processing Japanese kanji compound words were investigated using withmagnetoencephalography (MEG). Fourteen neurotypical children (NTC, 5 males, mean age:
11.8 years) and seven children with SLD comorbid ADHD (SLD+ADHD, 7 males, mean age:
13.1 years) participated. While the MEG data were acquired, the participants watched a video at
the fovea on mute with a sequence of serially-presented kanji compound words. Each sequence
was composed of a high (80%) frequency standard stimulus and a low (20%) frequency deviant
stimulus. There were three conditions for the sequences: in the font-type (FT) condition, thestandard and the deviant differed only in the font type for different visual stimulation with thesame compound word identity. In the correct-kanji-in-incorrect-kanji (KC-in-KI) condition, thestandard and deviant differed in lexical correctness. The pseudo kanji (PK) condition was thesame as the KC-in-KI condition except that individual kanji characters in the compound words
were replaced with pseudo kanji characters with similar appearance, i.e., with one stroke shifted.
In either condition, either standard or deviant stimulus was randomly chosen and was presented
for 500 ms followed by a 1000 ms inter-stimulus-interval in each 1500 ms-long trial. The MEG
amplitudes at the occipital pole and the posterior transverse region of the collateral sulcus(pCoS) were obtained as the measure of the responses. Neither group showed different
amplitudes to different font types in the FT condition. There was no difference between the
kanji correct (KC) compound and the kanji incorrect (KI) compound in the KC-in-KI condition.
In contrast, the amplitudes of pCoS to the deviant PK stimulus was larger on the NTC than on
the SLD+ADHD (p<0.05, Wilcoxon rank sum test). The present results suggest atypical
processing of parafoveally and pre-attentively presented kanji compound stimuli among
SLD+ADHD. The amplitudes to pseudo kanji was less prominent among SLD+ADHD and may
be related to filtering out irrelevant stimuli that are not kanji characters at a preliminary stage inword recognition. The results may thus empirically indicate that a part of reading problems inchildren with ADHD and SLD stems from pre-attentive or non-attentive processing.
Ethical considerations: The studies involving human participants were reviewed and approvedby the Ethics Committee of the National Center of Neurology and Psychiatry (A2018-031).
COI: The authors declare that the research was conducted in the absence of any commercial or
financial relationships that could be construed as a potential conflict of interest.

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PO-121
Measurement of brain activity by magnetoencephalography during a gazecognition task in adults with autism spectrum disorder
Sugimoto A1,2, Yoshinaga K1,2,3, Sakuma F4, Nanba T5, Nakazawa Y5, Kasahara H2, Zain E3,
Parawansa FBP3, Wahyu MD3, Sato K3, Egawa J3, Shirozu H6, Iijima A4,5,7, Someya T3
1
Department of Community Psychiatric Medicine, Niigata University Graduate School of
Medical and Dental Sciences, Niigata, Japan2
Department of Psychiatry, Niigata Psychiatric Center, Niigata, Japan3
Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences,
Niigata, Japan
4
Human Sciences and Assistive Technology Course, Department of Electrical and Information
Engineering, Niigata University Graduate School of Science and Technology, Niigata, Japan
5
Interdisciplinary Program of Biomedical Engineering, Assistive Technology, and Art andSports Sciences, Faculty of Engineering, Niigata University, Niigata, Japan
6
Department of Functional Neurosurgery, NHO Nishiniigata Chuo Hospital, Niigata, Japan
7
School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan
ABSTRACTIntroduction: Previous studies using functional magnetic resonance imaging have suggested thatthe responses in the superior temporal sulcus, inferior frontal cortex, and medial frontal cortex
during gaze cognition tasks are different in autism spectrum disorder (ASD) than in typicallydeveloping individuals. However, it is not yet clear what the mechanism is for these brain
regions to differ. We examined how these brain regions are synchronized and interlocked using
magnetoencephalography (MEG), and aimed to elucidate the neural basis of gaze recognition in
ASD.
Method: The subjects were 10 individuals in the patient group with ASD and 11 in the typicaldevelopment (TD) group. Measurements were taken with a 306-channel full-head MEG during
a gaze perception response task that was originally developed using visual stimulation software.
Image analysis software, Brainstorm, was used for brain image analysis. A non-parametric test
was performed by setting the 12 brain regions pointed out in previous studies as ROIs. False
Discovery Rate correction was performed for multiple testing, and sites with significant
differences between both groups were detected.
Results: There was no difference in gender, age, and FIQ between the two groups, and only
Autism Spectrum Quotient (AQ) was significantly higher in the ASD group (33.5 ± 4.6 vs 10.8
± 7.2, p < 0.001). There was also no difference in reaction time when eye movement wasmeasured. In the right fusiform gyrus, right lower middle superior temporal gyrus, and left
superior temporal gyrus, 340-380 msec after stimulus presentation, the TD group showedsignificantly stronger responses than the ASD group. Significantly stronger responses to thearrow condition than to the gaze condition were observed in the right fusiform gyrus, bilateral
temporal poles, bilateral inferior temporal gyrus, right middle temporal gyrus, and bilateralsuperior temporal gyrus at 250-290 msec in the ASD group.
Conclusion: In the ventral visual pathway from the fusiform gyrus to the temporal pole, the partnear the temporal pole performs more advanced visual processing. In addition, the area aroundthe superior temporal sulcus is related to gaze recognition. The TD group may have moreadvanced processing for gaze perception and response. The gaze of the stimulus image under
the arrow condition is looking to the subject, and under the gaze condition, it is looking to theright or left. It was suggested that the ASD group may show a stronger reaction when being
looked at.
Ethical considerations: The study was conducted in accordance with the standards of the
Declaration of Helsinki and was approved by the Niigata University Ethics Review Committee269

(approval number 2018-0415), and all the participants gave written consent.
Disclosures: Sugimoto A: received research funding or honoraria from the following
organizations in the last 5 years; Developmental Science Research and Education Center, Taiju
Life and Welfare Foundation, Kawano Pediatric Medical Scholarship Foundation, Shimadzu
Corporation, Takeda Pharmaceutical Co., Ltd., Nobel Pharma Co., Ltd., Shionogi Co., Ltd.,
Mochida Pharmaceutical Co., Ltd. The other authors declare no competing interest; Yoshinaga
K: received research funding or honoraria from the following organizations in the last 5 years;
Taiju Life and Welfare Foundation; Egawa J: received research funding or honoraria from thefollowing organizations in the last 5 years, Takeda Pharmaceutical Co. Ltd., Shionogi Co. Ltd;
Someya T: received research funding or honoraria from the following organizations in the last 5
years, Astellas Pharma Inc., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., Mitsubishi
Tanabe Pharma Co., Mochida Pharmaceutical Co., Ltd., MSD K.K., Novartis Pharma K.K.,
Otsuka Pharmaceutical Co., Ltd., Shionogi Co., Ltd., Sumitomo Pharma Co., Ltd.; Other
speakers have no COI to disclose.
PO-122A study of parent-child relationships in children with 22q11.2 deletion syndrome–Toward parent-child support based on the emotional aspects of mothers andchildren–Aya Yamauchi1,3, Takashi Okada2,3
1
Department of Medical Technique, Nagoya University Hospital, Nagoya, Japan2
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan3
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACT
Background: 22q11.2 deletion syndrome (22DS) is a disorder with a high rate of comorbidities
including congenital heart disease, delayed mental development, immunocompromise, cleft
palate, closure defects, and psychiatric disorders such as schizophrenia after adolescence. The
demand for medical care for a wide variety of physical dysfunctions from early childhood
places a heavy burden on families, and empowerment of caregivers is a challenge. In this study,
we investigated the characteristics of the mother-child relationship of children with 22DS andexamined how to support affected children and their families based on the support needs of thepeople involved.
Methods: Of the 17 children with a confirmed diagnosis of 22DS and consent to participate in
the forward-looking observational study, 7 pairs of children (3 boys and 4 girls) and theirmothers who underwent psychological testing (WISC-Ⅳ, Vineland-Ⅱ, CBCL/6-18 and FDT)
between October 2020 and August 2021 were included. This study was conducted in accordancewith the approval requirements of the Bioethics Committee of the Nagoya University School of
Medicine and affiliated hospitals.
Results:
1. Profile of the subject child
The mean age of the subjects was 12.4 (9-14) years. All subjects had IQs below 85 and total
adaptive behavior scores below 85 (particularly low scores in "communication," "daily living
skills," and "social skills"). In addition, 5 patients fell into the borderline/clinical range on the
CBCL total score (many problems in "social skills," "thinking," and "attention").
2. Profile of parent-child relationship
Based on the results of the FDT, the mother-child relationship from the mother's point of viewand the mother-child relationship from the child's point of view fell into the "stable" category in
all cases. Mothers' child-rearing attitudes tended to be high in "child-rearing anxiety" and"marital discrepancy," and low in "achievement demands," "noninterference," and "strict
discipline. The children's perceptions of their mothers' attitudes toward child-rearing tended to270be high for "disagreement between parents," "psychological interference," and "achievement
demands. The discrepancy in perception between mother and child in "achievement demands"
was 43%.
Conclusions: All of the children in this study had impaired intellectual and adaptive functioning
and communication difficulties. Behavioral characteristics included children with problems in
attention, thinking, and social skills. The type of parent-child relationship between the affectedchildren and their mothers was generally stable, but there were cases of mothers having
parenting anxiety and differences in how they perceived the parent-child relationship.
Conflict of interest: The authors have no financial conflicts of interest disclose concerning thestudy.
PO-123
Difficulties Emotion Regulation and Perceived Stress among Senior High School
in Indonesia
Febrianti Santiardi Danasasmita1, Efi Fitriana2,3, Fredrick Dermawan Purba3,4, Irvan Afriandi5,
Veranita Pandia1
1
Department of Psychiatry, Faculty of Medicine, Universitas Padjadjaran – dr. Hasan Sadikin
General Hospital, Bandung, Indonesia
2
Department of General and Experimental Psychology, Faculty of Psychology Universitas
Padjadjaran, Bandung, Indonesia
3
Center for Psychological Innovation and Research, Faculty of Psychology Universitas
Padjadjaran, Bandung, Indonesia
4
Department of Developmental Psychology, Faculty of Psychology Universitas Padjadjaran,
Bandung, Indonesia
5
Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung,Indonesia
ABSTRACTIntroduction: High school students are the population who are in the period of adolescent. In
adolescence, there is a regression emotion regulation techniques before reorganizing toward
adult adaptive response. Students are a group that is especially susceptible to academic stressor
and peer competition, making new relationship, and family issues. Students may encounter avariety of psychological issues related to emotion, including eating disorders, alcohol use
disorders, problem gambling, non-suicidal self-injury, post-traumatic stress disorder, depression,and anxiety. This study aimed to evaluate associations between difficulties of emotion
regulation and perceived stress among high school students.
Methods: A correlational, cross-sectional study with 1526 senior high school students (62.9%
female) that completed the Difficulties Emotion Regulation Scale Short Form (DERS-SF) andPerceived Stress Scale (PSS). The data were collected through online survey via SurveyMonkey
app and supervised by researcher using Zoom video conference. Pearson correlation and linear
regression were used to evaluate association between difficulties of emotion regulation andperceived stress.
Results: Analysis showed that difficulties emotion regulation were associated with perceived
stress. Strategies, impulse, goals, awareness, and clarity subscales of the DERS-SF weresignificantly associated with perceived stress. However, nonacceptance subscales were notsignificant.
Conclusions: Developing students' ability to control their emotions may help to lower theirstress levels. In order to support students, this might inspire educational institutions to create
mental health initiatives that focus on emotion control.
Ethical Approval Statement: Ethical approval has been given by the Universitas Padjadjaran

271

Research Ethics Committee (No.1135/UN6.KEP/EC/2020).
Conflict of Interest: The authors declare no conflict of interests.
PO-124
Get a hope to see you: A study proposal of process and outcome training for eye
contact aversion in youth with social anxiety
Kam Hei Hui1, Chui-De Chiu1
1
Experimental Psychopathology and Psychotherapy Laboratory, Department of Psychology, The
Chinese University of Hong Kong, Hong Kong, China
ABSTRACT
Avoid making eye contact is a prominent sign of social anxiety. Failing to receive social
information conveyed in others’ eyes, the gesture is also negatively perceived by others,
therefore hampering one’s capability in social interactions. An important question concerns how
to increase eye contact for individuals refraining from this behavior. Recent training programsfor eye contact aversion have focused on alternating individuals’ outcome expectation towards
this social behavior. Various rewards are offered when individuals perform eye contact or its
approximated behaviors. While reward-based training programs may allow individuals tocorrect the contingency of eye contact and negative consequences, this outcome-focused
approach may not help reduce the likelihood of taking the avoidance in action, for the sake ofhopelessness.
Hope, a process-focused approach involving one’s perception of his or her own ability to
produce concrete routes for action (pathways) and the perception that he or she can achieve it(agency), may also play an important role. Imagining the process along for looking into others’eyes could engender hope in individuals with eye contact aversion by allowing them to mentally
try out alternatives to prepare for possible obstacles (e.g., intrusive worries for social judgment),
therefore establish successive steps for initiating and maintaining eye contact. This contrasts
with imagining the positive outcome of eye contacts that elevates one’s expectation for theseoutcomes to occur. Compared with outcome imagination, process imagination showed improved
academic performance in test anxiety contexts.
The current proposal presents the design of an intervention for eye contact aversion. We aim toincrease hope in individuals with difficulties to make eye contact through imagination training.
Additionally, the effectiveness on reducing eye contact aversion for process and outcome
imagination will be evaluated. Ninety adolescents with eye contact aversion will be recruitedand randomly divided into 1) process imagination training, 2) outcome imagination training,and 3) control. Visualizing themselves in an admission interview with an examiner, individuals
in the process imagination will focus on picturing how eye contacts are made and maintained
and the outcome imagination will focus on what happens following smooth eye contacts. Afterthe imagination training, they will complete explicit tests for estimating eye contact ability and abehavioral task implicitly measuring eye contact. Hope for making eye contact is expected toelevate after the process imagination training. Compared with other conditions, individuals withprocess imagination should show better performance for both explicit and implicit eye contact
tests.
The study proposal will obtain approval from The Survey and Behavioral Research Ethics
Committee of The Chinese University of Hong Kong. All authors declare that they have noconflict of interest.
PO-125
Mental Health Services Using Video Content for Japanese Schools in Southeast
Asia: A Pilot Study Protocol

272

Kayoko Taguchi1, Motohisa Hirose2, Emiko Ohshita1, Tomoko Kawasaki1, Eiji Shimizu1,2
1Research Center for Child Mental Development, Chiba University, Chiba, Japan
2
Chiba university Graduate school of medicine Chiba University, Chiba, Japan
ABSTRACT
Mental health support is overwhelmingly inadequate in Japanese school abroad. Our studies aim
to develop video content program for mental health and examine the safety and feasibility. Our
program focuses on neuro developmental disorder and stress care using cognitive behavioral
therapy. we will present a study protocol in Southeast Asia: pilot single arm study. Ethics
approval will be granted by the Certified clinical Research Review Board Chiba University.
We have no financial conflicts of interest to disclose concerning this poster presentation.
PO-126COVID-19 disaster may affect the duration of sleep and internet usage : finding
from the continuous survey among junior high school students in Japan
Kiwamu Nakachi1, Kentaro Kawabe1, Rie Hosokawa1, Junya Soga1, Saori Inoue1, Yu
Matsumoto1, Maya Okazawa1, Fumie Horiuchi1,2, Shu-ichi Ueno1
1
Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
2
Center for Child Health, Behavior and Development, Ehime University Hospital, Toon, Japan
ABSTRACTIntroduction: Various studies have pointed out several effects of the COVID-19 disaster on
growing up, and clarifying the actual situation is an important finding when examining themental health of children and adolescents in the wake of the COVID-19 disaster. We
hypothesized that there were some changes of children’s behaviors and mental states by the longspread of the COVID-19 disaster. Thus, the aim of this study was to clarify the effects of the
COVID-19 disaster spread on junior high school students.
Methods: The participants were the second and third grade Junior high school students in asmall city in Japan. Questionnaires included weekdays and weekends sleep duration and internet
usage time and children’s behavior and mental states were assessed by The General Health
Questionnaire ("GHQ"), Quick Inventory of Depressive Symptomatology ("QIDS"), Strengths
and Difficulties Questionnaire ("SDQ"), and Diagnostic Questionnaire ("DQ"). Two years ofquestionnaires participants completed before (2018 and 2019) and after (2020) the COVID-19
disaster were analyzed, and divided into the two groups: the COVID-19 unaffected group(questionnaires answered consecutively in 2018 and 2019) and the affected group(questionnaires answered consecutively in 2019 and 2020).
Results: One hundred eight students were included in this survey. In GHQ, QIDS, SDQ, andDQ, there were no significant changes in the both groups. The COVID -19 unaffected group
showed no significant change of weekdays sleep hours and the significant increase of weekends
sleep hours. However, the COVID-19 affected groups showed a significant decrease in
weekdays sleep hours, although there were no change in weekends sleep hours. Internet usage
time significantly increased on weekdays and weekends both groups except for the weekends
internet usage time of the COVID-19 affected group.
Conclusion: The COVID-19 disaster would affect not only sleep duration but also internet usage
time, although the influence could be different between the COVID-19 disaster nonaffected andaffected groups. Internet usage time might be an aggravating factor for sleep durations.
All data were protected according to the general data protection regulation. This study wasapproved by the Institutional Review Board of the Ehime University Graduate School of
Medicine (IRB No. 2002006).
The authors declare no conflicts of interest associated with this manuscript.

273

PO-127
Self-evaluations of academic performance and eyestrain between paper-based
and digital-based learning among undergraduate medical, nursing, andpharmaceutical students during the COVID-19 pandemic in Japan
Masaaki Yamada1, Michikazu Sekine1, Takashi Tatsuse1
1
Department of Epidemiology and Health Policy, School of Medicine, University of Toyama,
Toyama, Japan
ABSTRACT
Background: Excessive internet use has serious health effect on children and adolescents;
however, little is studied about internet use for academic study. Since the emergence of thecoronavirus disease 2019, university education has drastically transformed into digital-basedlearning. We aimed to examine the self-evaluations of academic performance and eyestrain
between digital-based and paper-based learning among medical, nursing, and pharmaceuticalstudents in Japan and to explore whether a positive association exists between students’evaluations and their studying time with digital devices.
Method: A cross-sectional study using an online questionnaire, prepared using Google Forms,
was conducted at the University of Toyama, Japan, in April and May 2022. A link to the online
questionnaire was sent to 939 undergraduate medical, nursing, and pharmaceutical students inthe pre-clinical grade at this university. It contained questions that assessed the student’s generaldemographics, daily usage of digital devices, and self-evaluations of academic performance andeyestrain between paper- and digital-based learning. In terms of academic performance,
comprehension, memory retention, and absorption (concentration) were assessed.
This study was conducted according to the Helsinki declaration. We consulted with a member ofthe university ethical review board and our study was exempted from the ethical review because
participant’s anonymity was kept from the beginning and collecting data were mainly subjective
evaluations on academic performance, not including personal medical records.
Results: A total of 344 (191 medical, 73 nursing, and 80 pharmaceutical, response rate 36.6%)
university students completed the questionnaire. An even distribution was observed in thestudents’ evaluation on the devices used for better comprehension: paper, 32.0%; equivalent
32.8%; and digital, 35.2%. Majority of the students (memory retention: 71.2% and absorption:
74.7%) reported that paper-based learning was better than digital-based learning. Approximately
84.6% of the students strongly experienced eyestrain during digital-based learning. No positive
association was observed between students’ evaluations (memory retention, absorption, andeyestrain) and daily studying time with digital devices.
Conclusions: Majority of the students reported that paper-based learning was better than digitalbased learning in terms of academic performance and eyestrain. A learning on digital device
required more mental effort to memorize and concentrate. Digital devices may only be used as asupplement rather than as a replacement for paper-based learning. A learning environment inwhich students can study on papers should be continued.
COI: We declare no competing interest in this article.
PO-128Differences of Initial Medical Consultations between Japanese Children andChildren with Foreign Roots: In the Department of Child Psychiatry, Intervention
CenterMieko Kubo1, Eriko Niimi1, Toshiaki Matsuura1, Mami Kamiya2, Rie Wakako1, Osamu
Takahashi1
1Nozomi Medical Clinic, Toyota Municipal Child Development Center, Toyota, Japan
2
Counseling Room, Toyota Municipal Child Development Center, Toyota, Japan274

ABSTRACTObjectives: Toyota has an increasing population of foreign residents. The number of children
with foreign roots (hereafter “foreign children”) was 3.209, approximately 4.3% of the total
child population of the city in October, 2022.
The “Toyota Early Intervention and Support System for Children with Disabilities” aims forearly detection of and early support for children with developmental concerns regardless of theirnationality. The system includes various service and institutions as opportunities for early
detection, such as infant health checkups, intervention groups, and local kindergartens. When achild with developmental concerns is detected, they are referred to the child psychiatry sectionof Nozomi Medical Clinic, Toyota Municipal Child Development Center.
In this study, we conducted a retrospective survey on initial consultations at Nozomi Medical
Clinic to examine whether foreign children are provided with the same opportunities forappropriate detection and medical consultation as Japanese children.
Participants: Participants were 388 children (359 Japanese and 29 foreigners) residing in Toyota,
Aichi who had their initial consultation at Nozomi Medical Clinic between January andDecember, 2022.
Methods: Clinical data on the participants were collected from Nozomi Medical Clinic’s
medical records and statistically analyzed. The characteristics of initial consultations such as
consultation rates and referral pathways were compared between the foreign and Japaneseparticipants.
Results:
1. The consultation rates of foreign children (0.9%) was significantly higher than that ofJapanese children (0.5%, p＜.01).
2 Referral from intervention groups was significantly less common among the foreign
participants (10.3%) than Japanese children (39.3%, p＜.01). No significant difference between
the foreign and Japanese participants was found in referrals from health checkups (24.1% and16.4% respectively) and kindergartens (6.9% and 8.6% respectively, p＜.01).
Conclusions: Foreign children in Toyota had child psychiatric consultation at higher rate toJapanese children. The early intervention and support system seems to be successfully detecting
and referring foreign children with developmental concerns.
However, significantly less foreign children were referred from intervention groups thanJapanese children. This may be partially because caregiver participation is required to use theservice, but an interpreter is unavailable. Foreign parents with limited command of Japanese
may thus decide not to participate. The employment status of parents may also be a factor
contributing to the low referral rate from intervention groups. Further study will be needed tomore closely examine such factors and promote early support for foreign children.
Ethical Considerations: The institutional review approved this survey.
Conflict of interest: No Conflict of Interest (COI) in this abstract.
PO-129Feasibility and acceptability of a group family psychoeducation for adolescentswith anorexia nervosa
Miku Nakano1.2, Rie Kuge3, Ken Shiraishi1,3,4, Kayoko Kojima3, Kasumi Kitazawa4, Erina
Akahane3, Miyu Akahane4, Daimei Sasayama4, Hideo Honda3,5
1
Department of Medical Sciences Shinshu University Graduate School of Medicine,
Matsumoto, Japan2
Department of Rehabilitation Shinshu University Hospital, Matsumoto, Japan
3
Mental Health Clinic for Children Shinshu University Hospital, Matsumoto, Japan
4
Department of Psychiatry Shinshu University School of Medicine, Matsumoto, Japan
5
Department of Child and Adolescent Developmental Psychiatry Shinshu University School of275

Medicine, Matsumoto, Japan
ABSTRACT
Objectives: In recent years, the incidence of anorexia nervosa (AN) in adolescents has
increased. Family is an important part of adolescent AN treatment. But caregivers of patientswith eating disorders experience a great deal of burden, with high levels of anxiety anddepression. However, research on family psychoeducation is scarce, and few studies havefocused on family health as outcomes. We aimed to assess the feasibility and acceptability of agroup psychoeducation and changes in depression of families. This study was approved by
Shinshu University School of Medicine (4524).
Methods: We recruited parents and grandparents of adolescents under 19 years of age with aclinical diagnosis of AN according to DSM-5 criteria at Department of Pediatrics, Departmentof Psychiatry, and Mental Health Clinic for Children of the Shinshu University Hospital from
December 2020 to December 2022. The participants received four sessions of grouppsychoeducation. All sessions were provided weekly, and each session lasted for 60 minutes.
Each session consisted of a lecture in the first half and a free conversation in the second half. An
occupational therapist participated as a facilitator and a lecturer, and a child psychiatrist, adietitian, and a clinical psychologist participated as lecturers and co-facilitators. Depression wasassessed using the Quick Inventory of Depressive Symptomatology (QIDS-J) before and after
group psychoeducation. Feasibility and acceptability were assessed with regard to dropout rate
and participants’ feedback.
Results: We recruited 14 parents and grandparents of adolescents with AN (9 adolescents).
Three members dropped out (dropout rate 21.4%). Two dropped out due to being a close contact
of COVID-19 and one due to refusal to continue. Eleven participants (8 mothers, 1 father, 1
grandmother, and 1 grandfather) completed the group psychoeducation. Feedbackquestionnaires showed that 91% of the participants were satisfied and 9% felt neutral with theprogram. The most common responses were "I was able to understand the disease" and "Thefree conversation with other families who have adolescents with the same disease was very
useful”. The mean (standard deviation) QIDS-J score improved slightly from 9.8 (6.1) to 7.9(5.7).
Discussion: The scores of QIDS-J showed that families of adolescents with AN weremoderately depressed. Low drop-out rate and high satisfaction rate suggest that the grouppsychoeducation is a feasible and acceptable treatment.
The authors have no financials conflicts of interest to disclose concerning the study.
PO-130
The Next Step in Coaching in Asia – Future Directions for Improving Mental
Health among ADHD
Mizuho Takeda1
1
Department of Psychology, Jumonji University, Niiza, Japan
ABSTRACTOne of the psychosocial approaches for individuals with ADHD is coaching. Coaches work
collaboratively and goal-oriented manner with them who are facing difficulties in a variety ofsettings, such as school, work, and home. ADHD coaching has traditionally been developed
mainly in the United States, but in recent years, the number of coaches has been increasing in
Asia.
Comparisons of pre- and post-coach assistance by trained coaches have reported changes in
ADHD symptoms (Bloeman et al., 2008), organization (Reaser, 2008), social skills (Kubik,2010), and so on. A distinctive feature of the support provided is the frequent use of e-mail andphone calls to help clients independently and steadily achieve the goals they set for themselves.

276

In addition, unlike traditional counseling, the interaction between the coach and the client has ahigh degree of freedom, such as via a Zoom call or conducting the interaction at various
locations.
These characteristics of ADHD coaching may indirectly contribute to the improvement of
mental health. Those who fail to manage their time, lose confidence, and have low self-esteem
may experience fewer failures and regain motivation to work as a result of improving their time
management skills with the assistance of a coach. In fact, improvements in self-esteem andquality of life have been reported after ADHD coaching interventions.
As a future development, it is expected that coaches will indirectly step into the mental health of
ADHD individuals. Activities to maintain better mental health include exercise, mindfulness,and good dietary habits. However, it is difficult for them to continue a desirable new lifestyle.
For example, regarding exercise for ADHD, evidence is accumulating especially in Asia,
however, much of the validation is about short-term effects, and the long-term effects ofexercise are still unclear. This is because it may be difficult for them to make exercise into a
habit. Therefore, if psychological changes are shown through continuous and sustained exercise
with the support of an ADHD coach, this could be the next step in improving the mental healthof ADHD.
Since this presentation is a narrative review, it may be exempt from formal ethical approval.
The author declares no conflict of interest associated with this presentation.
PO-131
Quantification of proneness of dissociation by magnetic resonance imaging
Sawako Hayami1, Kaho Nakahara1, Yoshifumi Mori2, Takashi Hanakawa2
1
Faculty of Medicine, Kyoto University, Kyoto, Japan
2
Integrated Neuroanatomy and Neuroimaging, Graduate School of Medicine, Kyoto University,
Kyoto, Japan
ABSTRACT
Background: Childhood trauma is well known subsequently to cause PTSD and dissociation.
PTSD has a growing amount of biological research and evidenced-based treatment whereas
dissociative disorder does not. Unlike PTSD, furthermore, the disease is short of its studies
using objective non-invasive neuroimaging like magnetic resonance imaging (MRI). Little has
been unveiled about neural networks that determine the dissociated state or that underlie
pathophysiology. On top of that, MRI studies related to dissociation rarely come from the Asia.
Before studying pathological dissociation, thus, we attempted to find if neuroimaging
techniques could quantify the proneness of dissociation.
Method: We collected T1-weighted images and resting state functional MRI (rs-fMRI) of
Japanese healthy university students (23 subjects at this point; still increasing) MR with thefollowing questionnaire scores: ACE (Adverse Childhood Experience), AQ (Autism Quotient),
DES (Dissociative Experience Scale), and NEO-FFI (NEO Five Factory Inventory). We adopted
VBM method (voxel-based morphometry) and connectivity analysis using SPM12 software(UCL Queen Square Institute of Neurology, London, UK) to calculate correlation of brain
morphology and inter-regional functional connectivity with DES scores, respectively. Our study
is approved by the ethical committee of Kyoto University. The authors of this report have no
COI to be declared.
Results: All the 23 subjects showed very small scores in ACE and AQ questionnaires, whichwere omitted from the later analysis with MRI. Preliminary analyses show that DES score
correlates positively with the functional connectivity between left superior temporal gyrus andright parahippocampal gyrus and inversely with that between left cerebellum and left fusiform
gyrus without apparent confounding effects from the other questionnaire scores.
Discussion: Indeed we cannot jump to a conclusion that the connectivity mentioned above277

might be explanatory of neural machinery of dissociation, but if the same phenomenon mightperhaps be found also in the patients, there would be a possibility that intervention of thesebrain regions by, for example, transcranial magnetic stimulation (TMS) might possibly alleviatedissociation. Another limitation of this study obviously lacks subject number so we expect thatthe data with an adequate sample size will lead to a better understanding of dissociation.
Our study is approved by the ethical committee of Kyoto University. The authors of this report
have no COI to be declared.
PO-132The influence of marital relationships on maladaptive behavior of children with
ADHD
Shoko Mano1, Azusa Kawakami2, Kentaro Kawabe3,4, Fumie Horiuchi3,41
Faculty of Nursing, Setsunan University,2
Department of Nursing, Nara Medical University, Kashihara, Japan3
Department of Neuropsychiatry, Ehime University Graduate School of Medicine, Toon, Japan
4
Center for Child Health, Behavior and Development, Ehime University Hospital, Toon, Japan
ABSTRACT
Objective: The purpose of this study was to clarify the relations between marital relationships
and children’s maladaptive behavior and to suggest ways to how support families of children
with Attention Deﬁcit Hyperactivity Disorder (ADHD).
Methods: Semi-structured interviews were conducted on 11 mothers of children with ADHD.
During interviews, mothers were asked about their parenting, their children’s behavior, and theirhusbands. Data was analyzed by using inductive qualitative methods. All study participants
provided informed consent, and the study design was approved by the appropriate ethics review
board.
Results: The results showed that a poor marital relationship is one factor that influences theexpression of maladaptive behavior of children with ADHD. Marital relationships were found to
be composed of the following concepts: <Disagreement between mothers and fathers regarding
parenting policies >，<Couples talking and deciding how to cope with children >，<Expressing thoughts to fathers without reservation>，<Mothers and fathers struggling tounderstanding each other>，<Pressure on mothers from fathers >，<Fathers do not help
mothers with parenting and housework>，<Irritation with fathers who do not understandchildrenʼs struggles>．A lack of marital communication was considered to be a factor that had abad influence on the marital relationship.
Conclusions: The results suggested that communication between mothers and fathers is very
important and the promotion of the bidirectional communication between couples is necessary.
The authors have no conflicts of interest to declare.
PO-133
Reflexive attention orienting triggered by gaze cues in adults with ADHD
Shota Uono1, Yuka Egashira1, Sayuri Hayashi1, Miki Takada1, Masatoshi Ukezono1, Takashi
Okada1
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
ABSTRACT
Attention-deficit/hyperactivity disorder (ADHD) is characterized by developmentally278

inappropriate levels of inattention, hyperactivity, and impulsivity. Children with ADHD exhibitsocial difficulties that put them at risk for psychotic symptoms such as peer rejection. They also
show deficits in theory of mind and facial expression recognition, suggesting they havedifficulty processing social information. However, despite the inclusion of attention problems inthe diagnostic criteria, there is little evidence for deficits in attentional functions such as joint
attention and gaze-following, which play an important role in the development of social
cognition. This study examined whether gaze shift triggers reflexive attention orienting in 45
adults with attention deficit/hyperactivity disorder (ADHD) and 45 age-, sex-, and intelligencequotient-matched typically developing (TD) adults. A neutral expression and direct gazesimultaneously changed to an emotional expression and averted gaze, respectively, under thethree emotional face conditions; only the gaze direction changed under the neutral facecondition. The target appeared in the gazed-at or not-gazed-at location immediately after cue
onset. Participants were asked to press a button as rapidly and accurately as possible when theyfound the target. An analysis of variance for reaction time (RT) revealed a significant main
effect of cue-target congruency (F[1, 88] = 216.40, p < .001) and an interaction between groupand cue-target congruency (F[1, 88] = 4.85, p = .03). The gaze-cueing effect (RT difference
between the incongruent and congruent conditions) was also present in the ADHD group (12.8ms ± 8.8) but was smaller than in the TD group (17.3 ms ± 10.6). In addition, in the ADHD
group, the gaze-cueing effects were positively associated with inattention symptoms(Spearman's ρ = .34, p = .02). The present study revealed robust gaze-cueing effects in adults
with and without ADHD. However, the magnitude of the gaze-cueing effect was smaller in the
ADHD group than in the TD group. Moreover, a larger gaze-cueing effect was observed inpeople with ADHD who exhibited more severe inattention symptoms. The gaze-cueing effectreflects the ability of maintaining attention to the cue stimulus, detecting and processing gaze
direction, orienting attention to the cued direction, and suppressing gaze information anddetecting the target. ADHD might have difficulties in processing gaze direction, but inattentive
symptoms may have caused difficulties in maintaining attention to the cued stimulus andsuppressing its information, resulting in a larger gaze cue effect in those with stronger
inattentive symptoms.
Ethical considerations: The study protocol was approved by the Ethics Committee of the
National Centre of Neurology and Psychiatry, Japan; the study was performed in accordancewith the Ethical Guidelines for Medical and Health Research Involving Human Subjects. All
participants provided written informed consent before participating in the study.
COI: The authors declare no conflict of interests.
PO-134
Health-Related Quality of Life among Mothers of Children with
Neurodevelopmental Disorders
Sophie Hsin-Yi Liang1,2, Yi-Chen Lee3, Brent Allan Kelsen4
1
Department of Child and Adolescent Psychiatry, Taoyuan Chang Gung Memorial Hospital,
Taoyuan, Taiwan
2College of Medicine, Chang Gung University, Taoyuan, Taiwan
3
Graduate Institute of Early Intervention, College of Medicine, Chang Gung University,
Taoyuan, Taiwan
4
Language Center, National Taipei University, New Taipei City, Taiwan
ABSTRACT
Background: Caring for a child with a neurodevelopmental disorder can be a significant sourceof stress for mothers, as indicated by research. Studies have shown that mothers of children withneurodevelopmental disorders tend to experience higher levels of parental stress and lower
quality of life. To further understand this issue, this study examined the impact of three common

279

disorders (autism spectrum disorder, attention deficit hyperactivity/impulsive disorder, andintellectual disability) and the child's functional impairments and competence on maternal
health-related quality of life (HRQOL).
Methods: The study recruited a total of 460 children, consisting of 352 typically developingchildren (mean age: 10.19 ± 2.13 years) from several primary schools in north Taiwan, and 43
children diagnosed with intellectual disability (mean age: 10.37 ± 1.83 years), 65 children with
autism spectrum disorder (ASD) (mean age: 10.19 ± 2.13 years), and 48 children with attention
deficit hyperactivity/impulsive disorder (ADHD) (mean age: 9.48 ± 1.72 years). The study
collected demographic data, information on the children's emotional and behavioral problems,and maternal health-related quality of life. Prior to data collection, the Research Ethics
Committee of Chang Gung Memorial Hospital Linkou approved the study.
Results: The HRQOL of mothers of children with ASD and ADHD was worse than that ofmothers of typical developmental children, particularly in physical and social domains. Motherswith intellectual disability and ADHD had worse HRQOL in psychological domains. Mothers ofchildren with intellectual disability had worse quality of life in the environment domains thanmothers of typical developmental children, while mothers of children with ADHD had evenworse HRQOL in this domain. Additionally, mothers of children with ASD also had worse
HRQOL in environmental domains compared to typical developmental children. Multiple
regressions found that factors consistently related to the HRQOL of mothers of children withneurodevelopmental disorders and those of children with typical developmental groups werematernal depression and perceived family support after controlling for several familial, parental
and child variables.
Conclusion: The findings indicate that a comprehensive treatment approach for children withneuropsychological developmental disorders should involve enhancing family functions,providing increased support services, and assisting parents in developing healthy coping skills.
We, the authors of this research, confirm that we have no conflicts of interest that could
influence the results or interpretation of our study.
PO-135
Clinical profile of adolescent females with substance use disorder at a tertiarycare center in Bangalore- A retrospective chart review
Sowmyashree Narayan1, Rajendra Madegowda1, Eesha Sharma1, Arun Kandasamy2
1
Department of Child and Adolescent Psychiatry, National Institute of Mental Health and
Neurosciences, Bangalore, India
2
Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences,
Bangalore, India
ABSTRACT
Background: In the recent times, increasing number of girls and women are presenting with
substance use disorders. The age of onset of using any substance is steadily decreasing over the
decades leading to unique concerns related to physical, mental, and spiritual health of theadolescents. Substance use disorders in children can disrupt the normal developmental
trajectories and affect healthy transition of adolescents to adulthood. The existing literature on
substance use disorders in children and adolescents is limited and the representation of female
population in the existing literature is significantly less compared to the male population. Thereis a need for systematic research in this area to understand the unique risk factors andvulnerabilities particular to girls in this age group, which will help formulate the targeted
prevention strategies, specific to girls.
Objectives: To study the clinical profile of adolescent girls presenting with substance use
disorders. To study the factors affecting substance use behavior among adolescent girls.
Mathodolgy: Retrospective file review of all the adolescent girls within the age range of 10 to280

18 years, clinically diagnosed to have substance use disorder, who have availed either outpatient
and/or inpatient services at the departments of child and adolescent psychiatry and addiction
medicine at National Institute of Mental Health and Neurosciences from 2016 onwards, till thetime of analysis. A semi-structured proforma including details of socio-demographic profile,
onset and course of substance use disorders, family history, medical and psychiatric comorbidities, temperament characteristics and parenting styles will be used to collect data fromthe files. Descriptive statistics will be used for analyzing the data. NIMHANS Ethics Committee
approval has been sought for the study.
Results: Since the study is ongoing, the results will be declared once the study is completed.
Conclusion: This retrospective chart review will be useful in understanding what factors are
unique to females and will become an important resource for planning prospective studies tofurther explore all the factors affecting substance use disorders in adolescent females.
There are no conflicts of interest.
PO-136
Case series of completed suicides in Child and Adolescent Psychiatry
department at a tertiary care centre in Bangalore
Sowmyashree Narayan1, Sreyoshi Ghosh2
1
Department of Child and Adolescent Psychiatry, National Institute of Mental Health and
Neurosciences, Bangalore, India
2
Consultant Child and Adolescent psychiatrist, Bangalore, India
ABSTRACT
Background: Suicide is the result of complex neurochemical interplay affected by individual,familial, social, and cultural factors. Suicide in pre-adolescent age has been considered rare.
However, in the recent times, there has been an increasing number of pre-adolescent suicides.
Although research focusing on suicidal behaviour exists, literature on completed suicides islimited. There is a need to understand the processes preceding completed suicide in this age
group.
Objective: To understand the vulnerabilities, various risk factors of suicide and protective
factors against suicide in six cases belonging to pre-adolescent and adolescent age groups. To
highlight the possible preventive strategies in each of the cases.
Methodology: We describe six cases with age range of 9 to 17 years, with onset of illness threemonths to three years prior to inpatient treatment. They were admitted in view of severe
psychopathology and high risk of suicide. Management included antidepressant and moodstabilizing medications as well as intensive psychotherapy. An eclectic approach including
components of cognitive behaviour therapy, dialectical behaviour therapy, supportive therapy
and age appropriate and sensitive parenting was used. The children showed good response totreatment and were discharged. The children were followed up for a duration ranging from 2 to
18 months post discharge. In each of these cases suicide occurred as an untoward incident andwas informed to the treating team by one of the family members. Condolences were conveyed
and the families were offered psychological support by the treating team.
Consent was sought from the parents and NIMHANS ethical committee approval was sought
considering the sensitivity of the information. The files were retrieved from the medical records
section and data was collected.
Results: Suicides in all the cases were impulsive in nature in the background of severe
depressive symptoms, cognitive distortions of self-blaming and internalized guilt and depressive
cognitions of hopelessness. Co-morbid Attention deficit hyperactivity disorder increased thecomplexity of presentation. Thorough preparation to resume school and face the academic stressand stigma together with extensive support from parents and frequent follow ups with thetreating team can be construed as possible preventive measures.

281

Conclusion: This case series helps us understand the interaction between various risk andprotective factors leading to suicide during a sensitive period in development and has
implications in formulating prevention strategies.
There are no conflicts of interest.
PO-137
Problematic media use in Indian children during COVID – 19 pandemic: Crosssectional parental interview study of the impact on behavior and association withparenting style
Sreelakshmi Vaidyanathan1, Suyog. V. Jaiswal1
1
Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Nagpur, India
ABSTRACT
India went into a country wide lockdown in March 2020 for the containment of COVID
pandemic causing significant change in life as we knew it. Children being a vulnerable agegroup, have been reported to develop several psychological and behavioural issues in thisperiod, especially related to screen use. One month into the lockdown, with the institutional
ethics committee approval, we conducted an online cross-sectional study with the aim ofassessing for problematic media use among children, its impact on behaviour and association
with parenting style during the COVID pandemic. Data was recorded using a questionnaire forsocio demographic, screen use details and behavioural issues (temper tantrums, disruptive
behaviour, sleep issues, etc.), Problematic Media Use Measure Short Form (PMUM - SF) andParenting Styles & Dimensions Questionnaire – Short Version (PSDQ – SF). Two hundred andeighteen parents completed the questionnaire (Child mean age = 9.29; SD = 3.07). Sixteen
percent (N=35) of population showed problematic media use (PMU). PMU was associated withsleep and appetite issues, clingy / attention seeking behaviour and temper tantrums (p = <0.05).
Authoritarian (p=0.001) and permissive (p=0.000) style of parenting was found to besignificantly higher in those with PMU. The results provide a snapshot of the situation during
the initial phases of the pandemic in terms of PMU in children and shows its behaviouralimpact. It also brings to light the importance of parenting style and possibility of developing
parental skills in order to work on the issue of PMU.
Conflict of interest: The author(s) declare(s) that there is no conflict of interest.
PO-138The Efficacy of Executive Functions Group Training in Children with ADHD
Tzung-Fang Chiang1, Sophie Hsin-Yi Liang1,2, Wen-Yi Huang3,4, Bing-Hsin Guo3
1
College of Medicine, Chang Gung University, Taoyuan, Taiwan
2
Department of Child and Adolescent Psychiatry, Taoyuan Chang Gung Memorial Hospital,
Taoyuan, Taiwan
3
Department of Child and Adolescent Psychiatry, Linkou Chang Gung Memorial Hospital,
Taoyuan, Taiwan
4
Institute of Allied Health Science, College of Medicine, National Cheng-Kung University,
Tainan, Taiwan
ABSTRACT
Background: Research has shown that ADHD is linked to deficits in executive function (EF),which can lead to poorer academic and occupational functioning. Thus, early intervention
targeting EF impairments is crucial in preventing negative long-term outcomes. The study

282

aimed to investigate the effectiveness of an executive function training in improving targets
multiple EF components and reducing the severity of ADHD symptoms in children with ADHD.
Methods: A total of 36 school-age children with ADHD, of whom 75% were boys, and theirparents were recruited to participate in 8 sessions of executive function training that lasted for
10 weeks. The study examined the effects of the training using neuropsychological tests,
including NEPSY-II subsets of inhibition and animal sorting, WISC-IV digital span, and WCST,
as well as parental-reported executive function. Additionally, information on demographic data,
emotional and behavioral problems of participants was recorded. The Research Ethics
Committee (IRB) of Chang Gung Memorial Hospital Linkou approved this study.
Results: The study found that children with ADHD showed significant improvements after the
EF group training, including decreased severity of ADHD symptoms (SNAP-IV total score:
8.41+11.74, t =2.95, P=.009), improved global executive function (EF score: -6.03 ± 11.55, t=2.909, P=.007), and decreased anxiety/depressive symptoms (CBCL subscale ofanxiety/depression, 9.69 ± 16.13, t=2.402, P=.03). The neuropsychological tests also
demonstrated significant improvements in several components of executive functions, including
inhibition (NEPSY inhibition: -1.90 ± 2.41, t=-4.32, P<.000), short-term memory (WISC-IV
digital span: -1.00 ± 1.60, t=-3.43, P=.019), and cognitive flexibility (WCST: -7.00 ± 15.79, t=2.387, P=.024).
Conclusions: The study found that the executive function group training program was feasible
and well-received by both children with ADHD. Although further research is needed to replicate
the results with a larger sample and an active control group, the study suggests that an executivefunction group training program that targets multiple EF components and involves parents inreal-life activities could be a promising non-pharmacological intervention for improving EF andreducing ADHD symptoms.
We, all authors of this research, hereby declare in a formal manner that we have no conflict ofinterest in this study.
PO-139The Impact of Perceived Burdensomeness toward Suicidal Ideation Moderated
by Reasons for Living in Indonesian Adolescents
Veranita Pandia1
1
Department of Psychiatry, Padjadjaran University, Bandung, Indonesia
ABSTRACT
Suicide is currently one of the most serious mental illnesses and a worldwide concern. Suicide
is the fourth leading cause of death among adolescents and young adults (15–29 years old),
according to the World Health Organization (WHO). Suicides occur in four out of every fivelow- to middle-income countries, including Indonesia. One of the determining factors in theemergence of suicidal ideas in adolescents is perceived burdensomeness (PB), while reasons forliving (RFL) is expected to be a protective factor. The objective of this study was to examine at
the effect of PB on suicidal ideation as moderated by RFL in adolescents in Indonesia.
A cross-sectional design study of 1,526 adolescent high school students in Bandung, Indonesia,
566 men and 960 women, was used. Data was collected online via Zoom Meeting during the
COVID-19 pandemic, and informed consent was obtained. The Suicide Ideation Scale (SIS), theInterpersonal Needs Questionnaire (INQ-15), and the Brief Reason for Living Inventory for
Adolescents (BRFL-A) were used as questionnaires. Multiple linear regression statistical tests
are used to examine the data. Ethical approval was obtained from the Universitas Padjadjaran
Research Ethics Committee (No.1135/UN6.KEP/EC/2020). The findings of this study revealed
that PB had an effect on the presence of suicidal thoughts. The data is analyzed using multiple
linear regression statistical tests.
The results of this study found that PB had an effect on the presence of suicidal ideas (β=1.26;283

p<0.05), but RFL served as a moderator between PB and suicidal thoughts (β = -0.01; p <0.05).
In this case, RFL weakens the impact of PB on the presence of serious suicidal thoughts.
The conclusion of this study is that the impact of perceived burdensomeness on suicide ideation
will be protected by the existence of reasons for living in adolescents in Indonesia. The strategic
values of this research that can be useful in contributing to improving the mental health of theIndonesian people by developing suicide prevention intervention programs, specificallymodules about reason for leaving awareness.
The authors have declared that no competing interests exist.
PO-140Traumatic Experiences and beliefs associated with recovery in Sexual Abuse
Survivors' Online Postings
TAO Yingxue
Affiliation: None
ABSTRACTSurvivors of child sexual abuse post in online communities to discuss difficulties in their lives.
Sexual abuse victimization has significant mental health effects such as post-traumatic stressdisorder (PTSD) and depression. Survivors who were abused as children are more likely to havebeen exposed to years of other kinds of traumas, many of whom are unable to access proper
treatment and share their experiences and impact of trauma with those around them, making
them more likely to isolate themselves mentally and present with complex symptoms. These
include low self-esteem, anxiety, depression, anger and aggression, PTSD, dissociation,
substance abuse, sexual difficulties, excessive attention to the body, self-harm, and borderline
personality disorder. The current study employed an inductive qualitative analysis of over 800
posts made in one Chinese online discussion forum to identify the long-term effects of sexual
abuse as well as values, and beliefs of this group. In many cases, individuals have managed tocope in some ways on their own instead of reaching out for treatment and support. Analysis
found that survivors’ posts were structured around six interrelated themes: the ways perpetrators
approach to them were unnatural but rationalized at that time by the education they received andby the norms of society, hence were not easily noticed on the spot or afterwards; feelings ofshame surrounding the failure to disclose or resist and feeling different and isolated from others;
growing up in an environment where emotional expression was suppressed and criticized,
believing that life is all about fighting and defending; suggestions on "how to deal with reality.";recognizing one’s own coping style and externalizing responsibility; believing that both thesituation and themselves are changeable and being concerned with symptoms and effects of
their own trauma.
Ethical approval for this study was obtained from Osaka University Graduate School of Human
Sciences Ethics Committee (Number 21035). The author declare no conflicts of interest
associated with this study.
PO-141
How can Harry Potter be an ACE of Hogwarts nonetheless he had huge ACEs?
Geon Ho Bahn1, Jong Won Lee2
1
Department of Psychiatry, Kyung Hee University Hospital, Kyung Hee University College ofMedicine, Seoul, Korea
2
Mind On Psychiatric Clinic, Seoul, Korea

284

ABSTRACT
Although neuroscience is developing rapidly, psychiatry still relies on phenomenologicaldescription. As the human mind is invisible, there is a limit to the public understanding. The
concept of psychiatry is difficult even for psychiatrists to understand, and more difficult for the
public. Ignorance breeds prejudice.
Medical educators have developed character analysis in popular literary works as one of theways to share this mental health and psychopathology with the public. In particular, Harry
Potter, written by Joanne Rowling, has been analyzed in various areas. Harry Potter has alreadybecome a mental health literature for children and adolescents through numerous papers andbooks since the first volume was published in 1997. The author has also published several
related papers.
One of the state-of-the arts in the field of child development is the impact of adverse childhood
experiences (ACEs). Harry also grows up in the abuse-level parenting environment of his aunt
Petunia Dursley and her family. In this study, beyond serious ACE factors, the protective factorsthat Harry, who entered Hogwarts, a boarding school, contributed to becoming an ACE studentat Hogwarts were explored.
The first protective factor is early identification and early intervention of problem situations.
Principal Dumbledore assumed the worst that could happen to Harry and began protective
measures such as the protection enchantment at uncle Dursley’s house against Voldemort. The
protection exists inside the whole house and members while both Harry and Dursleys live there.
This means that protective measures have already begun even before the problems against Harry
have occurred.
Second, positive childhood experiences (PCE) are linked to the third factor, safe, stable,
nurturing relationships and environments. Though Harry was abused and neglected by The
Dursley family, Ms Arabella Figg, a squib who lives next to Dursley's house, also deployed byDumbledore, was helping and protecting Harry as a neighbor from sight. Fourth, Harry’s
mother's love, which was able to neutralize Voldemort's magic, is cited as a factor that promotes
resilience.
Despite the negative experience of such a clearly poor growth environment, Harry's growth intoa healthy teenager who can adapt to Hogwarts School and confront the evil herd may have been
due to these protective factors. It will be important to find healthy developmental resources suchas PCEs in the evaluation and intervention process of children growing up in a negative
childhood environment.
References:
1. Bahn GH, et al. Is Sorting Hat in Harry Potter Identity Identifier for Adolescents? J Korean
Acad Child Adolesc Psychiatry 2017;28:38-43.
2. Sinyor M. The boy who lived: Harry Potter, suicide, and an opportunity for mental healthliteracy. JAACAP Connect 2017 Fall:13-16.
3. Yoo HJ. Harry Potter and the blooming adolescent. Psychoanalysis 2005;16(2):205-214.
IRB & COI: Since it was a study for novel books, the IRB was exempted. The authors have noconflicts of interest.
PO-142
Effects of types of stressful events on adolescent cognitive processing andposttraumatic growth
Mami Fukaya1,2, Hitoshi Kaneko3
1
Department of Psychology and Human Developmental Sciences, Graduate School of Educationand Human Development, Nagoya University, Nagoya, Japan
2
Division of Student Affairs, Ritsumeikan University, Kyoto, Japan
3
Psychological Support and Research Center for Human Development, Nagoya University,
Nagoya, Japan285

ABSTRACT
Adolescents experience a positive transformation, conceptualized as posttraumatic growth,following various stressful events, including bereavement, natural disasters, and disease.
However, the effects of event types on the development of posttraumatic growth have not been
fully examined. The present study investigated how posttraumatic growth and cognitive
processing vary by the categories of events.
The study administered a survey to 413 Japanese university students (Mage = 19.4 years). They
were asked to report the most stressful event by type during the period from middle school tohigh school from a list consisting of six items (Relationship, Self, School, Family, Bereavement,
Other) and answer questions assessing cognitive processing (along the two dimensions ofdeliberate and intrusive rumination) at two points in time (at the time the survey was taken andsoon after the events) and posttraumatic growth. The study was approved by the ethicalcommittee at Nagoya University, Japan.
To compare the effect of the types of stressful events on posttraumatic growth as well as
intrusive and deliberate rumination, the study conducted a one-way ANOVA, which, along with
Tukey’s honestly significant difference test for multiple comparisons, revealed the following.
First, those who selected “School” as the most stressful event they experienced reported
significantly lower intrusive rumination soon after the events compared with those who chose“Relationship” and “Self.” Second, those who selected “School” reported significantly lower
intrusive rumination than those who selected “Self” at the time the survey was taken. Lastly,
those who selected “School” and “Bereavement” reported significantly higher posttraumatic
growth than those who selected “Family.”
These results indicate that stressful experiences regarding school, such as failure on an
examination or significant academic problems, are less likely to cause unconscious andautomatic rumination about the event and more likely to cause a sense of growth for Japaneseadolescents. One of the presumed reasons for this is that academic-related failures are events
that most people experience and thus are characterized by the ease of sharing sadness and painwith family and friends and of gaining sympathy. Further studies are needed to examine
posttraumatic growth and the process of developing it with consideration for the characteristics
of events.
We have no conflicts of interest to disclose.
PO-143
Correlation between parent and self-reports of emotional and behavioral
difficulties among adolescents in Singapore: results from the YEAR Study
Muhammad Nabil Syukri Bin Sachiman1, Wong Chee Meng, John1
1
National University Hospital Singapore, Singapore
ABSTRACT
Despite adolescence being a period of particularly unique challenges and transitions, research
has found that parents are often not fully aware of problems experienced by their children. Thismay be attributed in part to a growing need for autonomy and a tendency to spend less time withthe family at this stage. Although differences between parent and self-report of problems among
adolescents are to be expected, this discrepancy varies widely across countries; with somedemonstrating stronger associations than others. The aim of the present research was to examine
the correlation between parent and self-report of emotional and behavioral difficulties among anationally representative sample of adolescents in Singapore. We utilized data from the Youth
Epidemiology and Resilience (YEAR) Study, a national investigation into the state of mental
health among 10–18-year-olds in Singapore. A total of 2546 parent-child dyads completed theChild Behavioral Checklist (CBCL) and Youth Self Report (YSR) respectively, and we
calculated Pearson correlations between the total problem scores from the two questionnaires.

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Overall, the CBCL and YSR demonstrated a significant but weak correlation (r = 0.34, p <.001).
Further comparisons between gender and age, however, found relatively stronger correlation
among girls (r = 0.34 , p<.001) than boys (r = 0.29, p<.001) as well as among older (r = 0.37,
p<.001) than younger adolescents (r = 0.28, p<.001). The results demonstrate a need to increase
parent’s knowledge and understanding of their children’s emotional and behavioral difficulties
in Singapore, particularly boys and younger adolescents.
Ethical consideration and Conflict of Interest: During recruitment, participants were informed of
the research purposes and study procedures, before signing their consent to participate in the
study. All participants were informed of their rights to withdraw from the study at any stage.
The research study collected data through questionnaires and verbal interviews by individuals
trained in the instrument administration, minimizing any potential of harm to participants. To
ensure participants’ privacy and anonymity, all participants are de-identified and the researchdata was stored in National University of Singapore’s institutional online dropbox, where it is
only accessible to the research team. All authors declare that they have no conflicts of interest.
PO-144
Perceived resilience moderates the relationship between stress and emotionaland behavioral difficulties in Singaporean adolescents
Muhammad Nabil Syukri Bin Sachiman1, Wong Chee Meng, John1
1
National University Hospital Singapore, Singapore
ABSTRACT
While there has been growing research supporting the role of resilience in the prevention andtreatment of psychopathology, there has not been a study examining the moderating effects ofperceived resilience on stress and emotional and behavioral difficulties among adolescents in
Singapore. Furthermore, because resilience is multifaceted, it remains unclear which aspects ofresilience is most useful to target for intervention. The present study aimed to fill these two gaps
by utilizing data from the Youth Epidemiology and Resilience (YEAR) Study; an investigation
into the state of mental health among a nationally representative sample of adolescents aged 1018 years in Singapore. A total of 3336 adolescents completed self-reported measures of stress,
behavioral and emotional difficulties as well as perceived resilience: Cohen’s Perceived Stress
Scale (PSS), Achenbach’s Youth Self Report (YSR) and Singapore Youth Resilience Scale(SYRESS) respectively. We ran a regression analysis with the total score of the PSS, YSR andSYRESS, and found that perceived resilience significantly moderates the relationship between
stress and behavioral and emotional difficulties (p<.001). We also ran additional regression
analyses to examine the moderating effects of the ten subdomains of resilience within the
SYRESS. The analyses revealed that the subdomains of Perseverance/Commitment, Positive
Self-Image/Optimism, Relationship/Social Support, Spirituality/Faith and Personal
Confidence/Responsibility were significant moderators (p<.001). The results reaffirm theimportance of building resilience among adolescents and clarify the importance of focusing
beyond just personal attributes but also on the aspects of their relationship and spirituality as
well.
Ethical consideration and Conflict of Interest: During recruitment, participants were informed of
the research purposes and study procedures, before signing their consent to participate in the
study. All participants were informed of their rights to withdraw from the study at any stage.
The research study collected data through questionnaires and verbal interviews by individuals
trained in the instrument administration, minimizing any potential of harm to participants. To
ensure participants’ privacy and anonymity, all participants are de-identified and the researchdata was stored in National University of Singapore’s institutional online dropbox, where it is
only accessible to the research team. All authors declare that they have no conflicts of interest.

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PO-145
Identity Confusion, Depression, and Resilience in Adolescents: The ModeratingRole of Personal control
Yau Xin Yue, Coco1, Wong Chee Meng, John1
1
National University Hospital Singapore, Singapore
ABSTRACT
There has been extensive research on the relationship between identity confusion anddepression. However, there are still uncertainties about the effects of identity confusion on
depression due to mixed findings in the literature, alluding to possible additional pathways
between identity confusion and depression. Despite adolescence being the optimal timeframe toinvestigate this pathological relationship, and the pressing need to protect adolescents fromdepression, such studies on adolescents remain scarce. Using a Singapore sample of 650
adolescents aged 11 to 18 years old, this study addresses these gaps by examining how personal
control, a resilience trait, possibly mitigates the adverse effects of identity confusion on four
aspects of depression: depressive symptoms, presentations of Major Depressive Disorder,
suicide ideation, and suicide or self-harm attempt. This study’s results confirm the positive
association between identity confusion and depression. However, personal control only
moderated the relationship between identity confusion and depressive symptoms, and not theother depression aspects. These findings warrant greater focus on the complex effects of identity
confusion on depression during adolescence. Moreover, the results highlight the benefits in
exploring the experience of identity development, as well as developing healthy levels of
personal control in clinical interventions for adolescents experiencing symptoms of depression.
Ethical consideration and Conflict of Interest: During recruitment, participants were informed of
the research purposes and study procedures, before signing their consent to participate in the
study. All participants were informed of their rights to withdraw from the study at any stage.
The research study collected data through questionnaires and verbal interviews by individuals
trained in the instrument administration, minimizing any potential of harm to participants. To
ensure participants’ privacy and anonymity, all participants are de-identified and the researchdata was stored in National University of Singapore’s institutional online dropbox, where it is
only accessible to the research team. All authors declare that they have no conflicts of interest.
PO-146
Physical Disability and Psychiatric Symptoms― A Case Study
Yu Grace Okada1
1
Osaka Seikei University, Osaka, Japan
ABSTRACT
Psychiatric symptoms such as delusion or auditory hallucinations in adolescents are sometimes
handled as “at-risk mental state”, and careful assessment is important. We have experienced acase in which a physical disability has influenced the appearance of psychiatric symptoms, andwe would like to review and discuss the previous literature.
The family and the patient gave their permission for the presentation, and some modifications
have been made to prevent identification of the patient.
The case is a high school boy. He can walk on his own, but he has mild paralysis on his left sidein the upper and lower extremities. He had been diagnosed with ASD by the pediatrician when
he was 5th grade. No intellectual disability was diagnosed. He went to normal classes. However,
because of his physical disability symptoms, his school classes and activities are often limited.
He has few friends due to the drawbacks of his physical disability.
After he entered high school, he complained that he sometimes heard voices at school telling288

him to “Die.” The voices were heard only at school, even if no one is around him. He
sometimes kicked a trash can when he was frustrated by hearing them. He was prescribed
medication, but his symptom continued.
He fell and sprained his ankle on the way to school, and started to receive a massage at an
osteopathic clinic. He couldn’t walk to visit us for a few months. However, when he came to theclinic later, he said that he no longer heard voices telling him to die. He was told at theosteopathic clinic that due to his hemiplegia, his body was out of balance and his muscles
throughout the body were in a state of intense contraction. He has continued rehabilitation sincethen, and no auditory hallucinations or other complaints have been observed to this day.
It is widely known that physical symptoms lead to anxiety and depressive symptoms, but thispatient's complaints were auditory hallucinations. And the patient's symptoms were alleviatedby reducing the tension in the body. Although psychiatrists are not accustomed to examining the
body in detail, we felt it necessary to evaluate the growing child with particular care.
There is no conflict of interest.
PO-147
Photobiomodulation Therapy on ADHD animal model
Yu-Jui Huang1, Hsi Chang2
1
Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital,
Taipei, Taiwan
2
Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan
ABSTRACT
Objective: The pathophysiology of Attention-deficit hyperactivity disorder (ADHD), whichcharacterized by three core symptoms: inattention, hyperactivity, and impulsivity, remains
unclear. Previous studies had indicated that neuronal network (prefrontal cortex, caudate
nucleus, and cerebellum) involved in the regulation of attention, emotion, and behavior.
Furthermore, alterations in the activity of monoamine neurotransmitters such as dopamine or
norepinephrine due to the dysfunction of neurons associated with this network further contributeto the pathophysiology of ADHD. But the minority of patients do not respond to standard
pharmacotherapy, limited by side effects and concerns of abuse. The effectiveness on ADHD ofother noninvasive brain stimulation method, such as Photobiomodulation therapy (PBMT) , has
not been reported yet.
Method: In this study, we used the well accepted ADHD animal model, male SHR/Izm rats, andWistar-kyoto/Izm as the control animal respectively. PBMT (808nm, continuous mode,
27.79mW/cm2) applied on both group of rats and evaluated with different exposure time. The
two-tailed two-sample t test was used to observe between-group differences. The statistical tests
were corrected by controlling the false discovery rate [FDR] q = 0.05 to avoid errors related tomultiple comparisons in these calculations. Pearson’s correlation coefficients were computed toreveal the relationships between functional coherence andneuropsychological/behavioral/neuroimage changes.
Results: The group which received PBMT for 25 seconds had significantly improvement in
ADHD symptoms compared to other groups(p<0.05). Similar to the previous human clinicalresearch, the decreased FA(Fractional anisotropy) value within WM(white matter) area, such as
corpus callosum and internal capsule, were also found in SHR group compared with WKY
group before laser treatment, suggesting the disturbed WM maturation in SHRs. Thesesignificant differences of averaged FA values within brain white matter were diminished at
SHR25 group at the 2nd week after laser treatment while the differences between SHR0 groupand WKY0 group sustained.
Conclusion: Through our study, PBMT could also significantly improves ADHD symptoms inboth behaviorally and biologically.

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None of the authors has conflicts of interest regarding any of the products or devices mentioned
in this manuscript.
The animal use protocol has been reviewed and approved by the institutional Animal Care and
Use Committee or Panel (IACUC/IACUP) in Taipei Medical University.
PO-148Multiple risk-taking behaviors in Korean adolescents and associated factors:
2020 and 2021 Korea Youth Risk Behavior Web-based Survey
In Hee Cho1,2, Jae Won Oh3, San Lee2,3, Junghan Lee1,2
1Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital,
Yonsei University College of Medicine, Seoul, Republic of Korea
2
Department of Psychiatry and the Institute of Behavioral Science in Medicine, Yonsei
University College of Medicine, Seoul, Republic of Korea
3
Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine,
Yongin, Republic of Korea
ABSTRACT
Purpose: Despite the negative health impact of multiple risk-taking behaviors (RTBs), there is alack of understanding of adolescents who are more prone to multiple RTBs. This study aimed to
identify sociodemographic, mental, and physical health variables associated with increased
susceptibility to multiple RTBs in each sex.
Methods: Cross-sectional data from the 2020 and 2021 Korea Youth Risk Behavior Web-based
Survey was used for this study. A total of 106,979 Korean adolescents (55,460 men and 51,519
women) were assessed on five RTBs (alcohol use, smoking, sexual intercourse, illicit substanceuse, and no seat belt wearing). In comparison to no RTB group, odds ratios of the relevant
covariate factors were calculated in one RTB or multiple RTBs groups using multinomial
logistic and multivariable logistic regression analyses. The institutional review board approvaland consent were waived as the analyses used de-identified, publicly available secondary data.
Results: Male and female adolescents engaging in multiple RTBs were 6.4% and 3.8%,
respectively. Among sociodemographic variables, increasing age, low subjective socioeconomic
status, and living in rural areas were associated with multiple RTBs regardless of sex. All mental
health variables except anxiety, which are the experience of depression, suicidal ideation,
physical trauma, and high smartphone use, were associated with multiple RTBs in both sexes.
Physical inactivity and obesity were associated with decreased odds of multiple RTBs in both
sexes.
Conclusions: This study identifies diverse factors associated with multiple RTBs of Koreanadolescents and demonstrates existing sex differences. Age and mental health condition are themost critical factors that distinguish multiple risk-taking groups from those involved in one or
no RTB.
The authors declare that the research was conducted in the absence of any commercial or
financial relationships that could be construed as a potential conflict of interest.
PO-149Is There Any Difference in PCIT Attrition Rates Among Different Cultural
Backgrounds? Insights from a Systematic Review
Miki Takada1,2, Takashi Okada1
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
2
Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan290

ABSTRACT
Background: Parent-child interaction therapy (PCIT) is a behavioral parent-child psychotherapy
that reduces a child’s disruptive behaviors and improves parents’ parenting skills. It was
founded in the United States and has been reported to be effective for a broad range of families
in many countries. Its treatment protocol has been acknowledged as versatile, even translated
into different languages. However, despite its effectiveness, PCIT has a high attrition rateinternationally, and not every parent-child dyad benefits from the treatment.
Objective: The systematic review aimed to examine the attrition rates of PCIT and theinfluences of cultural backgrounds on the attrition.
Method: A systematic review was conducted using PubMed, PsycINFO, Web of Science, andEmbase. Through screening processes, appropriate articles were analyzed.
Results:[Reported Attrition Rates] The 12 studies were conducted in the United States, the Netherlands,
and Taiwan. While the attrition rates in the United States ranged from 36% to 82%, the attrition
rate in the Netherlands was 40%, and in Taiwan, it was 27%.
[Racial Differences] There were five studies with majority of participants with minority
backgrounds (i.e., African American, Latino, Asian) with attrition ranging from 27% to 81%;
there were four studies with majority of Caucasian participants with attrition ranging from 36%
to 71%. These ranges indicate that the different ethnic groups illustrated similar attrition ranges.
Discussion: Although the attrition rates of PCIT are high, its root is not necessarily from thedifference in racial or cultural backgrounds. When comparing each study from the scope ofdifferent racial and ethnic backgrounds, the studies do not demonstrate large racial and ethnic
background differences on attrition, implying the PCIT protocol itself is culture-free. However,previous studies suggested the influence of psychosocial factors on PCIT attrition, which are
generally interrelated to cultural backgrounds. Therefore, when therapists conduct PCIT, it is
crucial to be aware of such differences and engage in the treatment accordingly.
As this study is a systematic review based on previous publications, ethics committee approval
is not required.
The authors disclosed no conflicts of interest.
PO-150Relationship Between Parent's Child-Rearing Experience, Defense Mechanisms,
Internal Working Model, and Postpartum Depression and Bonding Difficulties: A
Study on Japanese Mothers
Miki Takada1,2,3, Masatoshi Ukezono1, Arata Oiji3,4, Takashi Okada1,2
1
Department of Developmental Disorders, National Institute of Mental Health, National Centerof Neurology and Psychiatry, Kodaira, Japan
2
Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan3
Department of Clinical Psychology, Kitasato University Graduate School of Medical Sciences,
Sagamihara, Japan
4
Mamenoki Clinic, Tokyo, Japan
ABSTRACT
Background and Objectives: A parent's own child-rearing experience has been found to be
associated with postpartum depression as well as bonding difficulties with their own child.
Previous studies have demonstrated a relationship between bonding difficulties and childabusive behaviors. While many studies illustrate the importance of screening for child abuse
prevention, little research has been conducted to explore the process between a parent's rearing
experience and postpartum depression and bonding difficulties. Therefore, the current study
aimed to examine the relationship between a parent's child-rearing experience and postpartum
depression and bonding difficulties by using defense mechanisms (DM) and internal working

291

model (IWM) as mediators.
Methods: Fifty-eight mothers completed questionnaires about their child-rearing experience,
DM, IWM, bonding difficulties, and postpartum depression. Principal component analysis(PCA) and multiple regression analysis (MRA) were conducted to examine the relationshipbetween the mother's child-rearing experiences and postpartum depression and bonding
difficulties with DM and IWM as the mediators.
Results: PCA revealed four components from DM and IWM. MRA illustrated the relationshipbetween a mother's child-rearing experience, each PC, and postpartum depression as well as
bonding difficulties. PC1 (maladaptive DM and unstable IWM) was associated with a mother'schild-rearing experience, postpartum depression, and bonding difficulties.
Discussion: The current study suggested that there are relationships between a mother's childrearing experience and DM and IWM, and also between DM and IWM and postpartum
depression as well as bonding difficulties. Specifically, mothers who had low caring and highoverprotective rearing experience were more likely to develop PC1, which was associated withthe development of postpartum depression and bonding difficulties.
Conclusion: The current study revealed that for some types of mothers, DM and IWM mediate
the relationship between a mother's child-rearing experience and the development of postpartum
depression and bonding difficulties. By understanding the function of DM and IWM and theprocess behind the development of these disorders, practitioners can be aware of the tendency ofthese mothers and provide appropriate support to prevent child abuse.
This study was approved by the Kitasato University School of Allied Health Sciences Review
Board for Clinical Research. The authors declare no conflicts of interest.

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Abstract book of ASCAPAP 2023 in Kyoto, Japan-The 11th Congress of The Asian Society for Child and Adolescent Psychiatry and Allied Professions

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