Autistic children are more likely to experience challenges with emotion regulation, which affect their academic, social, and other developmental outcomes. Emerging manualized programs have begun to address this gap, including Regulating Together (RT), a group-based outpatient intervention that incorporates concurrent caregiver training. This qualitative study explored caregivers' perceptions and experiences with the RT intervention. Semi-structured interviews were conducted with twelve caregivers of autistic children following program completion within a randomized controlled trial. Thematic analysis identified six overarching themes: (1) recognizing early signs and building child regulation skills, (2) caregivers' experiences of program value, structure, and application, (3) caregivers' growth as self-regulated learners and supportive coaches, (4) the power of communal learning and growth, (5) creating inclusive spaces through diverse voices, and (6) ecological barriers that impeded practice and participation. Caregivers described benefits of participating in RT and reported positive outcomes for both themselves and their children. Overall, the RT model shows nuanced dyadic child and caregiver learning and growth in addressing emotion dysregulation in autistic children and offers a potentially inclusive model for supporting families. Findings also signify how ecological challenges shaped participation and implementation, highlighting the need for future manualized interventions to account for contextual factors in program design and delivery. TRIAL REGISTRATION: Trial registration took place through ClinicalTrials.gov (NCT05803369).
Aim To investigate parent-reported psychiatric, neurodevelopmental and adaptive functioning outcomes in children with congenital cytomegalovirus (cCMV)-related sensorineural hearing loss. Methods Parents of children aged 5-12 years were recruited nationwide in Sweden into three groups: children with congenital cytomegalovirus-related sensorineural hearing loss (n = 10), children with non-syndromic genetic hearing loss (n = 9) and typically developing controls with normal hearing (n = 23). Parents completed a background questionnaire, the Child Behaviour Checklist (CBCL) and the Five-to-Fifteen Revised (FTF-R). Group differences were analysed using non-parametric statistics. Results Children with congenital cytomegalovirus-related hearing loss had later identification of hearing loss, delayed onset of independent walking and a higher prevalence of neurodevelopmental conditions compared with children with genetic hearing loss. They also had significantly higher parent-reported psychiatric and developmental symptom levels than controls across all main clinical measures. Compared with the genetic hearing loss group, they demonstrated greater developmental difficulties, reduced social participation and poorer school functioning. Conclusion Children with congenital cytomegalovirus-related hearing loss exhibit a substantial burden of psychiatric and neurodevelopmental symptoms extending beyond hearing loss alone. These findings highlight the importance of early identification, structured long-term follow-up and tailored interventions to support this vulnerable population.
Abstract Background: Testicular regression syndrome (TRS), also known as vanishing testes syndrome, is a condition of 46, XY males presenting with male phenotypic genitalia and testicular absence. Normal testes are thought to have once existed in fetal life and subsequently atrophied following a catastrophic event. It may present as partial or complete absence of testicular tissue. Fibrotic remnants are commonly found upon surgical exploration. Case: This is the case of a 20-year-old male with a birth-diagnosis of primary hypogonadism. The patient was born prematurely at 5 months following a motor vehicle accident that resulted in his mother’s death. Neonatal evaluation for cryptorchidism revealed no radiological evidence of intra-abdominal testicular mass. Referral to a pediatric-endocrinologist was done at early childhood. Testosterone replacement was started at 12 years of age and pubarche was adequate. After surgical exploration, a testicular remnant was surgically removed. Pathology report revealed fibrotic tissue, yet no histological testicular tissue was found. Due to lack of testes in the scrotum, testicular prosthesis was implanted at age 14, but the etiology of the hypogonadism was never elucidated. The patient was initially seen in our adult-endocrinology clinics at age 21. Upon evaluation, secondary sex characteristics were adequate for age. Penile length was of 3.5 inches. Bilateral testicular prostheses were palpable, and no gynecomastia was present. Despite testosterone replacement, total testosterone was 3.38 ng/ml (n; 2.41-8.27 ng/ml), FSH was 106 mIU/ml (n; 1.4-18.1 mIU/ml) and LH was 34.7 mIU/ml ml (n; 1.5-9.3 miu/ml). Based on history, laboratory workup and surgical pathology, TRS was presumed as the etiology of this patient’s hypogonadism. Testosterone therapy was adjusted to reach physiological expected levels. Conclusion: TRS is an underdiagnosed cause of hypergonadotropic hypogonadism. It is supposed that the initial embryologic development was normal, followed by a vascular accident. There is no clear recommended approach for evaluating a patient once the diagnosis of TRS is suspected. Diagnostic methods may include hormonal and karyotype testing, imaging, and surgical exploration. Furthermore, although clinical recommendations have been published for other disorders of sex development, TRS management has been understudied. Testosterone replacement therapy at the typical time of puberty ensures the development of secondary sexual characteristics, bone health and pubertal growth. Unlike Klinefelter syndrome and cryptorchidism, TRS has not been associated with increased risk of cancer. Thus, it is important to establish the etiology to avoid invasive and unnecessary workup, which will result in psychological distress and excessive healthcare costs.
Canales-Ramos N, Burgos-Ortega N, Grana-Santini A et al.
Background: Children and adolescents with autism spectrum disorder (ASD) are generally more sedentary and engage less in physical activity (PA) than their peers. Despite increasing evidence of benefits, practical guidance on implementing adapted PA programs in real-world settings remains limited. This study aimed to document iterative adaptations, implementation processes, and participant experiences in a structured PA intervention for children with ASD. Methods: Nineteen children aged 10-14 years with ASD participated in an adapted PA intervention delivered across three cohorts. The program was progressively modified based on observed barriers and participant feedback. Post-intervention conversations with participants and/or parents were used to assess feasibility and experiences. Results: Most participants trained on-site in small groups and were predominantly boys, many with comorbid ADHD/ADD. Baseline engagement in organized PA was low. Adaptations included adjustments to session structure, group size, instructor-to-participant ratio, and activity content to enhance predictability and autonomy. Individual tailoring and flexible delivery were essential to accommodate neurodevelopmental diversity and fluctuating motivation. Post-intervention feedback suggested generally positive acceptability, while findings should be interpreted descriptively. Conclusions: This study provides preliminary, practice-based insights into how structured PA programs may be iteratively adapted for children with ASD in a supportive clinical context. The findings highlight practical considerations for implementing adapted PA in clinical and community settings.
Purpose Adolescents with epilepsy (AWEs) face a complex mix of medical, cognitive, and psychosocial challenges, leading to highly heterogeneous self-management behaviors. This study aimed to identify distinct engagement patterns among AWEs by applying a persona‑building method to qualitative data, thereby providing a theoretical basis for tailored transitional interventions. Methods A qualitative descriptive study was conducted from August to December 2025 in the neurology ward and outpatient department of a tertiary children's hospital in Southwest China. Maximum variation purposive sampling was used to recruit 28 AWEs aged 10-19 years. Semi-structured interviews, informed by the patient participation framework, explored self-management behaviors. Data were analyzed through an integrated inductive‑deductive approach. The identified behavioral characteristics were synthesized into distinct self‑management profiles and visualized via personas and summary tables. Results Four self-management engagement patterns emerged as context-dependent configurations, not fixed traits: (1) Passive-dependent, lacking knowledge and motivation, reliant on caregivers; (2) Limited-initiative, independently executing core routines but passive in information-seeking, decision-making, and emotional expression; (3) Ambivalent-hesitant, possessing capacity and desiring autonomy yet hesitating to act for fear of mistakes; (4) Proactively engaged, actively seeking and appraising information, participating in decisions, planning and executing self-care, and openly expressing emotions and seeking support. Each pattern calls for tailored intervention strategies targeting specific behavioural dimensions. Conclusion Recognizing the four distinct self-management profiles among AWEs enables clinicians to develop tailored, stepped intervention strategies that align with each patient's behavioral characteristics, potentially improving early risk identification, transitional care coordination, and long-term quality of life.
Abstract Background Divorce among immigrant women in Taiwan has become an increasingly important public health issue due to the instability of transnational marriages and the limited social support available to this population. This study examined the sociodemographic, marital adjustment, and marital trajectory factors associated with divorce among immigrant women in Taiwan. Methods A cross-sectional study was conducted between June and October 2022. A total of 360 immigrant women who had experienced marital transitions were recruited through social welfare organizations across Taiwan using proportional allocation sampling. Data were collected using self-administered questionnaires assessing sociodemographic characteristics, marital adjustment, and marital trajectories. Univariate and multiple logistic regression analyses were performed to identify factors associated with divorce. Results Poor relationships with husbands (AOR = 2.50, 95% CI = 1.35–4.65) and with members of the husband’s family (AOR = 4.08, 95% CI = 2.34–7.09) were strongly associated with divorce. Immigrant women whose natal families were aware of their marital status had higher odds of divorce (AOR = 2.10, 95% CI = 1.33–3.33). Child custody difficulties, lack of alimony, and children’s participation in after-school tutoring were also significantly associated with divorce. In contrast, the use of nongovernmental resources was associated with lower odds of divorce (AOR = 0.51, 95% CI = 0.33–0.80). Sociodemographic factors, including residential region, age, housing ownership, citizenship status, and spouses’ educational attainment, were also related to divorce. Conclusions Divorce among immigrant women is influenced by multidimensional factors, particularly marital adjustment and family interpersonal relationships. External resource utilization appears to reflect coping strategies following divorce. These findings highlight the importance of strengthening family support systems and providing accessible social and legal resources for immigrant women experiencing marital difficulties.
Abstract Introduction: Congenital Adrenal Hyperplasia (CAH) is defined as a group of autosomal recessive disorders characterized by a deficiency of the enzyme required to synthesize cortisol by the adrenal cortex. Defects in the 21-hydroxylase enzyme make up of 90% of CAH. It is caused by several mutations in the CYP21A2 gene. These defects impaired cortisol synthesis leading to an ACTH increase resulting in androgen excess, either with salt-wasting or simple virilizing forms. Androgens play a crucial role in the human psychosexual development favoring male psychosexuality. This study was designed to evaluate the impact of androgens on psychosexuality of a cohort of individuals with CAH due 21-hydroxylase deficiency. Methods: This retrospective cohort is made up of 94 four individuals with proved molecular defect of the CYP21A2 gene. External genitalia virilization was scored using Prader scale. Clinical phenotype, age at diagnosis, sex assignment, gender reassignment and gender change were all assessed. The gender role at childhood was assessed through the playmates and favorite toys at childhood. Gender identity was assessed by a projective psychological test (HTP). Sexual orientation was assessed by self-report and sexual attractiveness. Compliance of glucocorticoid replacement was assessed by serum testosterone and 17OHP levels. Results: CAH was diagnosed at neonatal time in 67% (61 out 94). 51% (n=48) had the salt-wasting form (SW) and 49% (n=46) had the simple virilizing form (SV). While all cases of SW were diagnosed at neonatal time (0.12 ± 0.14 months), the mean age at diagnosis among SV was 6.03 ± 8.45 years (F 38.9; p=<.001). A total of 84.5% were assigned as female at birth. The median of Prader score was 3 in both phenotypes. Male sex assignment was associated with more virilized external genitalia (Prader 4 and 5) while the opposite (Prader 1 and 2) was associated with female sex assignment (X2 16, p=.002, V=0.44). Gender change from female to male occurred in 7 cases (7.4%). All cases of gender change had SV form (p=.006). The mean age at diagnosis of those who changed gender was 7.92 yr and 2.67 yr for those who kept the assigned gender, p=.04). There was a strong association between male toys at childhood and male gender identity at adulthood (X2 28, p=.0001, V=0.59). A total of 11% defined themselves as homosexual. External genitalia virilization was associated with gynophilic sexual attractiveness (X2 82, p=0.001, V=0.59). Compliance issues were identified in 60% of individuals who changed their gender. Inappropriate hormonal control between 2 and 11 years of age was also associated with gender change (p=.04). Conclusion: Prenatal androgen exposure favors male psychosexuality in CAH. This influence is substantiated by post-natal androgen exposure since gender changed from female to male occurred in individuals with late diagnosis and bad compliance.
Background The integration of digital technology into art therapy for children with autism spectrum disorder (ASD) represents an emerging trend, yet systematic design frameworks that translate evidence-based interventions into digital media remain underdeveloped. This study developed and evaluated a digital art therapy paradigm that structurally integrates pivotal response treatment (PRT) into video animation design while maintaining cross-media consistency with physical generalization tools. Methods Based on the behavioral characteristics of children with ASD, 12 sets of video animations integrating PRT and corresponding physical scene models were custom developed. Thirty-eight children with mild to moderate ASD were randomly assigned to an intervention group (PRT-based video animation with physical models, n=19) and a control group (conventional video animation, n=19) for a 12-week intervention. Pre- and postintervention assessments were conducted using four dimensions of the Autism Treatment Evaluation Checklist (ATEC) and behavioral observation. Results Compared with the control group, the intervention group demonstrated significantly greater improvements across all ATEC dimensions (language communication: F(1,36) = 67.74, p < 0.001, ηp² = 0.755; social skills, F(1,36) = 80.69, p < 0.001, ηp² = 0.786; sensory/cognitive awareness: F(1,36) = 55.69, p < 0.001, ηp² = 0.717; health/physical behavior, F(1,36) = 36.94, p < 0.001, ηp² = 0.627. The percentage of children who reported " no observable behavioral response" in the intervention group decreased from 35% to 10%. Conclusions This pilot randomized controlled study provides preliminary evidence for the feasibility and efficacy of a multi-component, PRT-informed digital and physical intervention package for children with ASD. The intervention is characterized by three design principles: (1) theoretical translation--embedding the structured steps of PRT into digital interaction logic; (2) cross-media consistency--maintaining visual and functional coherence between video animations and physical generalization tools; and (3) progressive scaffolding--sequencing intervention content from foundational cognition to complex social skills. These findings offer a preliminary design framework for the development of digital art therapy interventions for children with ASD. Future large-checklist replication studies are needed to further validate this approach.
Abstract Background Finnish mental health policy has aimed to reduce psychiatric inpatient beds and the average duration of psychiatric inpatient treatment period has been reduced noticeably since 1980s. At the same time, the aim has been to increase outpatient services for people with schizophrenia and other psychotic disorders. Along with this policy, there is some evidence that increasing number of people with psychosis have never been admitted to hospital. The purpose of this study was to harmonize health care data in five large Finnish birth cohorts and evaluate evidence on whether the cumulative incidence of adolescent and adulthood hospitalization due to schizophrenia and other psychotic disorders has changed over the decades. Methods We used data from five different Finnish birth cohorts: Northern Finland Birth Cohort 1966 (NFBC 1966), 1987 Finnish Birth Cohort (FBC 1987), Finnish 1981 Birth Cohort Study (FBCS 1981), Northern Finland Birth Cohort 1986 (NFBC 1968) and 1997 Finnish Birth Cohorts (FBC 1997). NFBC 1966 includes the people born in the two northern most provinces of Finland with the expected date in the year 1966, comprising of 12,231 children and the NFBC 1986 between July 1st, 1985 and June 30th, 1986 including 9,479 children. FBCS 1981 consist of a sample including 10% of the Finnish children born in 1981. The sample is based on the school sampling, comprising of 5,417 children. FBC studies follows all children survived perinatal period born in Finland in 1987 and in 1997. FBC 1987 comprises of 59,476 children and FBC 1997 of 58,802 children. The main outcome in this study was hospitalization due to schizophrenia and other psychotic disorders. The data of mental disorders were obtained from the Care Register for Health Care (CRHC). Data covers the years from 1969 to 2017. The CRHC data was harmonized in each cohort using the same program. The harmonization included personal identification number and dates (entry date, date of discharge) revisions. The diagnoses were confirmed to be on the right format. Final dataset included total N = 145,405 subjects. The follow-up for the study subjects was from age 0 to 18 years in all five birth cohorts and from age 0 to 28 years in all other cohorts except FBC 1997. Cumulative incidence of hospital treated schizophrenia and other psychotic disorders in each cohort was calculated. Test of equal proportions was used to calculate the Pearson’s chi-squared statistic. The linear association was also tested using chi-squared test for trend in proportions. Results At ages of 0 to 28 years the cumulative incidences of hospital treated psychosis were in NFBC 1966 1.0% (N=124), FBCS 1981 1.5% (N=81), NFBC 1986 1.2% (N=109) and FBC 1987 1.6% (N=947) (χ²: 30.6, p<.001; χ²trend: 23.5, p<.001). Respective numbers at age of 0 to 18 years were in NFBC 1966 0.1% (N=14), FBCS 1981 0.3% (N=15), NFBC 1986 0.3% (N=33), FBC 1987 0.4% (N=256) and FBC 1997 0.3% (N=195) (χ²: 31.6, p<.001; χ²trend: 9.9, 0.001). Hospital treated schizophrenia between ages of 0 to 18 years was too rare to analyze (NFBC 1966 N=5, FBCS 1981 N=4, NFBC 1986 N=4, FBC 1987 N=41 and FBC 1997 N=15). At ages of 0 to 29 years the cumulative incidences were NFBC 1966 0.4% (N=59), FBCS 1981 0.6% (N=34), NFBC 1986 0.3% (N=27) and FBC 1987 0.5% (N=297) (χ²: 10.5 p=0.015; χ²trend: 0.01, p = 0.912). Discussion The main finding of the study was that the cumulative incidence of first-admission inpatient treated psychosis has increased over the decades in Finland. This is somewhat opposite to the Finnish mental health policy plan aiming to treat people with schizophrenia and other psychotic disorders mainly in outpatient services.
Autism spectrum disorder (ASD) has a continuously rising global prevalence, imposing a heavy burden on affected families and society. Emotional and behavioural problems are the most common comorbidities of ASD and severely impair the long-term prognosis of affected children. While mindful parenting represents a validated positive parenting model, the internal mechanisms underlying its association with emotional and behavioural developmental outcomes in children with ASD remain unclear. This study adopted a cross-sectional design. Between April and August 2023, 268 parent-child dyads were recruited via convenience sampling from hospitals and special education settings in Jinan, China. Validated instruments were used to assess mindful parenting, parenting stress, family management, and child emotional and behavioural problems, and data were analysed using path analysis with observed variables. The results showed that the sequential chain mediation pathway was fully consistent with the data for total difficulties, with the total indirect effect accounting for 66.71% of the total association. For prosocial behaviour, the model received only partial support, with a 61.54% total indirect association, as the unique indirect path via parenting stress did not reach statistical significance. These findings indicate that mindful parenting is associated with fewer child difficulties through a sequence involving reduced parenting stress and better family management. For prosocial behaviour, this association appears primarily linked to family management, with no significant unique contribution of parenting stress. The study reveals potential family process mechanisms and can inform the development of family-centred interventions.
