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Fulltext Prevalence of Overweight and Obesity Among Children and Adolescents With Autism Spectrum Disorder and Associated Risk Factors

Kamal Nor N, Ghozali AH, Ismail J

Front Pediatr, 2019;7:38.
PMID: 30842939 DOI: 10.3389/fped.2019.00038

Introduction: Prevalence of obesity in Autism Spectrum Disorder (ASD) has been reported to be higher than in the general population. Determining prevalence may help increase awareness of obesity in ASD and potentially lead to initiatives to reduce obesity. In order to understand obesity in ASD children, common risk factors were assessed including physical activity, feeding problems and sleep disturbances. Methods: This is a cross-sectional study performed at the Child Development Center at Universiti Kebangsaan Malaysia Medical Center on 151 ASD children aged 2-18 years. Anthropometric and demographic information were obtained and parents completed three questionnaires; Children Sleep Habits Questionnaire (CSHQ), Physical Activity for Older Children Questionnaire (PAQ-C) and Brief Autism Mealtime Behavior Questionnaire (BAMBI). Results: For ASD children in our sample, the prevalence of overweight (BMI ≥85th to <95th percentiles) was 11.3% and the prevalence of obesity (BMI ≥95th percentile) was 21.9%. The overweight/obese ASD children's median age was higher at 8.5 years (IQR 5.81-10.13) compared to the normal/underweight group of 6.33 years (IQR 4.75-7.7) with a p-value of 0.001. The two groups also differed significantly for maternal BMI and paternal age. The median maternal BMI in the overweight/obese group was 26.05 (IQR 23.35-32.25), statistically significantly higher (p = 0.003) than in the non-overweight/obese group, 24.7 (IQR 21-27.9). The median paternal age of 40 years (IQR 37-44) was statistically significantly higher (p = 0.039) in the overweight/obese group, compared to the median paternal age in the non-overweight/obese group of 38 (IQR 35-42). The male overweight/obese children had median PAQ-C score of 2.44 (IQR 2.00-3.00) vs. 2.89 (IQR 2.35-3.53) in the counterpart group with a p-value of 0.01. Using the multiple linear regression stepwise method, three predictors associated with BMI percentiles reached a statistical level of significance; PAQ-C score in males (p < 0.001), the BAMBI domains of Food Refusal (p = 0.001) and Limited Variety of Food (p = 0.001). Conclusions: The prevalence of obesity and overweight is high among Malaysian ASD children and adolescents. Older child age, high maternal BMI, older paternal age, low physical activity, low likelihood of food refusal and high likelihood of food selectivity were found to be risk factors for high BMI in these children.
Fulltext Motor Development in Children With Autism Spectrum Disorder

Mohd Nordin A, Ismail J, Kamal Nor N

Front Pediatr, 2021;9:598276.
PMID: 34604128 DOI: 10.3389/fped.2021.598276

Objective: This study was conducted to determine the gross and fine motor profiles of children with autism spectrum disorder compared to typically developing children. Additionally, we also assessed if the motor delay was more pronounced with increasing age. Method: This was a retrospective study involving children aged 12-60 months of age comparing motor development in children with autism spectrum disorder with typically developing children. Their developmental profile was assessed using Schedule of Growing Skills II. Descriptive statistics was used to analyse the developmental profile between the groups. Results: ASD children had significant gross motor (6.7%) and fine motor delay (38.5%) compared to typically developing children, who did not show any delay. The motor delay in ASD children was more prominent in older children. Conclusion: It is important to assess motor development in ASD children as there is significant motor delay in these children compared to typically developing children, and the delay becomes more prominent with age. Early detection of motor delay could allow provision of early intervention services to optimize developmental outcomes.
Fulltext Estimating the Risk of Attention Deficit Hyperactivity Disorder (ADHD) in Parents of Children with ADHD and the Association with Their Children's Disease Severity and Adherence to Medication

Ragadran J, Kamal Nor N, Ismail J, Ong JJ, Sundaraj C

Children (Basel), 2023 Aug 24;10(9).
PMID: 37761401 DOI: 10.3390/children10091440

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is characterised by inattentiveness, hyperactivity, and impulsivity. Up to half of the affected children have a parent with ADHD. In this study, the risk of ADHD among parents of ADHD children was estimated. The associations between parental ADHD and child ADHD severity and medication adherence were determined.
METHODOLOGY: Parents of children and adolescents diagnosed with ADHD attending the University Kebangsaan Malaysia Medical Centre (UKMMC) were recruited between June to August 2022 and the administered Conners' Adult ADHD Rating Scale (CAARS) self-report short form, Vanderbilt ADHD Parent Rating Scale (performance section), and Medication Adherence Report Scale (MARS).
RESULTS: Forty-five children with ADHD were recruited and 15 out of 45 (33%) parents were detected to have ADHD. ADHD severity was worse in children with ADHD parents for total severity (mean of 34.67 vs. 29.13, p = 0.047) and difficult behaviours at home (mean of 7.87 vs. 6.27, p = 0.036). The children's academic performance and behavioural challenges at home and school were positively correlated with the parental ADHD scores for 'inattention' and 'problems with self-care' subscales.
CONCLUSIONS: A total of 33% of ADHD children had parents with ADHD. ADHD children with ADHD parents were more likely to have behavioural problems at home and more severe ADHD. However, no statistical significance was noted with medication adherence.
A case of sexual abuse by a traditional faith healer: are there potential preventions?

Chan LF, Tan SM, Ang JK, Kamal Nor N, Sharip S

J Child Sex Abus, 2012;21(6):613-20.
PMID: 23194137 DOI: 10.1080/10538712.2012.719597

Adolescent sexual abuse is not an uncommon phenomenon in Malaysia. It is a traumatic experience that complicates the psychosocial development of young people on the threshold of adulthood. This case report highlights the psychosocial sequelae of adolescent sexual abuse by a traditional healer and discusses management issues in the context of unique cultural and belief systems.
Fulltext Association between Viral Infections and Risk of Autistic Disorder: An Overview

Shuid AN, Jayusman PA, Shuid N, Ismail J, Kamal Nor N, Mohamed IN

Int J Environ Res Public Health, 2021 Mar 10;18(6).
PMID: 33802042 DOI: 10.3390/ijerph18062817

Autism spectrum disorder (ASD) is a neurodevelopmental condition of the central nervous system (CNS) that presents with severe communication problems, impairment of social interactions, and stereotypic behaviours. Emerging studies indicate possible associations between viral infections and neurodegenerative and neurobehavioural conditions including autism. Viral infection during critical periods of early in utero neurodevelopment may lead to increased risk of autism in the offspring. This review is aimed at highlighting the association between viral infections, including viruses similar to COVID-19, and the aetiology of autism. A literature search was conducted using Pubmed, Ovid/Medline, and Google Scholar database. Relevant search terms included "rubella and autism", "cytomegalovirus and autism", "influenza virus and autism", "Zika virus and autism", "COVID-19 and autism". Based on the search terms, a total of 141 articles were obtained and studies on infants or children with congenital or perinatal viral infection and autistic behaviour were evaluated. The possible mechanisms by which viral infections could lead to autism include direct teratogenic effects and indirect effects of inflammation or maternal immune activation on the developing brain. Brain imaging studies have shown that the ensuing immune response from these viral infections could lead to disruption of the development of brain regions and structures. Hence, long-term follow up is necessary for infants whose mothers report an inflammatory event due to viral infection at any time during pregnancy to monitor for signs of autism. Research into the role of viral infection in the development of ASD may be one avenue of improving ASD outcomes in the future. Early screening and diagnosis to detect, and maybe even prevent ASD are essential to reduce the burden of this condition.
Fulltext Missed Appointments at a Child Development Centre and Barriers to Access Special Needs Services for Children in Klang Valley, Malaysia: A Mixed Methods Study

Fadzil F, Idris IB, Kamal Nor N, Ismail J, Mohd Tamil A, Mohamad Noh K, et al.

Int J Environ Res Public Health, 2021 Dec 29;19(1).
PMID: 35010584 DOI: 10.3390/ijerph19010325

Attending appointments is vital for children with special needs, as such appointments involve long-term interdisciplinary care to ensure continuity of care and improve health and well-being. This study was performed to determine the prevalence of missed clinic appointments and identify the factors among those who have ever missed appointments and barriers of access to children's special needs services at the Child Development Centre (CDC) at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Moreover, suggestions for improvement from the caregivers' perspectives were explored. This is an explanatory sequential mixed methods study among caregivers of children with developmental disabilities aged up to 17 years old. Of 197 caregivers, 62 (31.5%) had missed clinic appointments. Forgetfulness was the most frequently cited reason. The bi-variable analysis showed significant differences in missed appointment rates by gender of caregivers and duration of follow-up. The final logistic regression model demonstrated that, when combined with the effect of being a male caregiver as an independent variable, follow-up duration of more than 6 years increased 2.67 times the risk of missing an appointment. Caregivers' perceived barriers were transportation, caregiver, child and healthcare services factors. Policies and strategic plans should be focused on key findings from these factors to improve appointment adherence and accessibility to services for children with special needs.
Fulltext Validation of key components in designing a social skills training content using virtual reality for high functioning autism youth-A Fuzzy Delphi method

Ahmad Basri MAF, Wan Ismail WS, Kamal Nor N, Mohd Tohit N, Ahmad MN, Mohamad Aun NS, et al.

PLoS One, 2024;19(4):e0301517.
PMID: 38574084 DOI: 10.1371/journal.pone.0301517

The use of virtual reality in social skills training for high functioning autism spectrum disorder (HFASD) youth has been found to be engaging and enjoyable. Despite the promising results, previous literature indicates that there has been no consensus on the social skills target in the training content. There is also limited research on how evidence-based strategies like cognitive and behaviour techniques are instantiated into the VR environment to teach social skills. The aim of this study is to determine the key components to design a social skills training content using virtual reality for youths with HFASD. The Fuzzy Delphi method (FDM) was used to obtain expert consensus on social skills difficulties and cognitive behavioral techniques included in the content in three phases. In phase 1, a questionnaire was developed from in-depth interviews and scientific literature review. The in-depth interviews were conducted with 13 HFASD youth, 7 parents and 6 experts. In phase 2, 3 experts rated the relevance of the items in the questionnaire using an item-level content validity index (I-CVI) assessment. In phase 3, the questionnaire was distributed to 10 experts to rate their level of agreement on each component using a 7-point Likert scale. Components that received a value above 75%, threshold value (d) ≤ 0.2, fuzzy score (A) ≥ α - cut value = 0.5 and higher rank based on defuzzification score were prioritized to be included in the content. Items that received higher expert consensus on social skills difficulties included assessing non-verbal responses, initiating, maintaining, and leaving conversations, emotional difficulties and difficulties in perspective taking. Cognitive and behavioral techniques that received higher expert consensus were psychoeducation, modelling, relaxation techniques, reinforcements, and perspective-taking questions. These key components can be used as a framework for the development of virtual learning content for social skills training in future studies.
Fulltext Malay translation and validation of modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F)

Ariffin RA, Ismail J, Abd Rahman FN, Wan Ismail WS, Ahmad N, Abdul Ghafar A, et al.

Front Pediatr, 2024;12:1384292.
PMID: 39764164 DOI: 10.3389/fped.2024.1384292

INTRODUCTION: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition diagnosed clinically based on phenotypic characteristics and criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Due to its significant social, emotional, and psychological impacts, early identification and diagnosis are crucial for starting early intervention and improving outcomes. A screening tool is imperative in identifying young children at risk so timely intervention can be instituted. The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is a reliable and valid screening tool used worldwide, with the previous iteration used for a long time in Malaysia. To enhance ASD screening in Malaysia, the latest version of M-CHAT-R/F was translated into Malay and evaluated for reliability and validity, as majority of the population speaks Malay, while the tool is originally in English. This study is a cross-sectional study performed in the Universiti Kebangsaan Malaysia (UKM) hospitals, between May 1st, 2020, to June 30th, 2022.
METHODOLOGY: The English version of the M-CHAT-R/F was translated into Malay using forward and backward translation methods. Content and face validity were ascertained and a pilot study was performed for internal reliability. A total of 244 children attending clinics and wards in UKM hospitals aged 16-30 months were recruited based on three categories: children with typical development, suspected cases, and established cases of ASD. All caregivers of the recruited children were asked to complete the Malay M-CHAT-R/F. Reliability and validation assessments were performed.
RESULTS: Malay M-CHAT-R/F was found to be a reliable tool with good internal consistency (Cronbach's alpha = 0.906, p < 0.001). The Receiver Operating Characteristic (ROC) curve showed that cut-off scores of 2 on Malay M-CHAT-R/F lead to successful ASD classification with Area Under the Curve (AUC) = 0.887, p < 0.001 with a 95% CI (0.840, 0.933).
DISCUSSION: The assessment of the Malay M-CHAT-R/F showed satisfactory psychometric properties. Based on this study, the Malay M-CHAT-R/F is a reliable and valid screening tool to screen for ASD in children aged 16-30 months. Translating the M-CHAT-R/F into Malay is expected to improve community outreach and screening, which is essential for early diagnosis and timely intervention for children with ASD in Malaysia.