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• Based on strong research evidence (1), the prevalence of autism spectrum disorders (ASDs) has increased over the past decade, with a 2010 prevalence of 1:68 (1.5%) in children age 8 years. • Based on some research evidence as well as consensus (3), the most recent revision of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) identifies two core dimensions for the diagnosis of ASD: social (social communication and social interaction) and nonsocial (restricted, repetitive patterns of behaviors, interests, or activities). • Based on some research evidence as well as consensus (3) (31) (32) (33) (34), DSM-V identifies social pragmatic communication disorder (SPCD) as a dissociable dimension of language and communication ability that affects how individuals use language for social exchanges. SPCD is often found in children with language impairments and children with attention-deficit/hyperactivity disorder and other genetic/neurologic conditions. • Based on strong research evidence (2) (26) (27) (28), childhood language disorders affect 7.4% of kindergarteners, and 50% to 80% of these children experience persistent language, academic, and social-emotional difficulties into their adult years, despite having normal nonverbal cognitive abilities. • Based primarily on consensus due to lack of relevant clinical studies, differential diagnosis of autism and language disorders may require a multidisciplinary evaluation that takes into account a child’s overall development, including cognitive, communication, and social abilities. Monitoring the response to appropriate interventions and trajectory of development over time may improve the accuracy of diagnosis, especially in very young children.

Purpose: The object of this study was to assess, in cost-effective measures, 3 different models for pediatric first-aid training among caregivers and teachers. Methods: Quasi-experimental design was used. A stratified random sampling method was used to obtain 1282 teachers working at nurseries and kindergartens in Shanghai that consists of 18 districts and 1 county. One thousand two hundred eighty-two teachers were allocated randomly to the 3 models of training: 441 to interactive training model (group A), 441 to lecture-based training model (group B), and 400 to video instruction training model (group C). The first-aid knowledge in the 3 models was evaluated before and after the training. Results: There was a statistical significance in the results of post-assessment among the 3 training models. In group A, 329 (87.3%) trainees passed the course; in group B, 294 (81.7%) passed; and in group C, 262 (79.4%) passed. The total cost of group A was ¥2361 per edition, the total cost of group B was ¥1955 per edition, and the total cost of group C was ¥1064 per edition (P < 0.001). The cost per passed student was ¥151 in group A, ¥74 in group B, and ¥41 in group C (P < 0.001). Conclusions: Although interactive training model may slightly increase the rate of trainees who passed the course, the cost-effectiveness of video instruction training model is clearly superior.

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders during childhood, characterized by the core symptoms of hyperactivity, impulsivity and inattention and puts great burden on children themselves, their families and the society. Osmotic release oral system methylphenidate (OROS-MPH) is a once-daily controlled-release formulation developed to overcome some of the limitations associated with immediate-release methylphenidate (IR-MPH). It has been marketed in China since 2005 but still lacks data from large-sample clinical trials on efficacy and safety profiles. The aim of this study was to evaluate the effectiveness and safety of OROS-MPH in children aged 6 to 16 years with ADHD under naturalistic clinical setting.This 6-week, multi-center, prospective, open-label study enrolled 1447 ADHD children to once-daily OROS-MPH (18 mg, 36 mg or 54 mg) treatment. The effectiveness measures were parent-rated Inattention and Overactivity With Aggression (IOWA) Conners I/O and O/D subscales, physician-rated CGI-I and parent-rated global efficacy assessment scale. Blood pressure, pulse rate measurement, adverse events (AEs) and concomitant medications and treatment review were conducted by the investigator and were served as safety measures.A total of 1447 children with ADHD (mean age (9.52 ± 2.36) years) were enrolled in this trial. Totally 96.8% children received an OROS-MPH modal dose of 18 mg, 3.1% with 36 mg and 0.1% with 54 mg at the endpoint of study. The parent IOWA Conners I/O score at the end of week 2 showed statistically significant (P0.001) improvement with OROS-MPH (mean: 6.95 ± 2.71) versus the score at baseline (10.45 ± 2.72). The change in the parent IOWA Conners O/D subscale, CGI-I and parent-rated global efficacy assessment scale also supported the superior efficacy for OROS-MPH treatment. Fewer than half of 1447 patients (511(35.3%)) reported AEs, and the majority of the events reported were mild (68.2%). No serious adverse events were reported during the study.This open-label, naturalistic study provides further evidence of effectiveness and safety of OROS-MPH in school-aged children under routine practice.

To study the prevalence of internet use and internet addiction in adolescents of Shanghai.From September to October 2007, a total of 5135 adolescents from 16 middle schools of 6 districts of Shanghai took part in the epidemiological study by a cross-sectional survey and 5123 adolescents finally enrolled in the study. A questionnaire of "DRM Adolescent Internet Use 52 Scale" was administrated to investigate the prevalence of internet use and internet addiction in adolescents of Shanghai. On this scale of 5-point rating, the scale includes seven parts of contents as tolerance, abstinence reaction, planning ability, self-control ability, whenness, sociability and hazard.The rate of internet use among the surveyed adolescents was 94.32% (4673/5123), among which the incidence rate of internet addiction was 8.78% (450/5123). Boys, senior middle-school students were more susceptible to internet addiction than girls and junior middle-school students (male scores 122.42+/-43.46, female scores 116.92+/-38.10, F=23.22, P=0.00; senior middle-school students 125.24+/-39.02, junior middle-school students 110.30+/-42.35, F=164.68, P=0.00). Students from vocational senior middle-school were most susceptible (junior middle-school students 110.30+/-42.35, ordinary senior middle-school students 122.83+/-40.99, key senior middle-school students 120.05+/-37.87, vocational senior middle-school students 133.37+/-36.84, F=34.44, P=0.00). The 2nd grade students of senior middle-school have the highest risk for internet-addiction.The prevalence of internet use and internet addiction in adolescents of Shanghai should be comparatively high in China, which indicates that great attention should be paid to the prevention and control.

To survey the sleep habits (bedtime, wake time), sleep duration, and sleep problems in school-age children of China.From November to December, 2005, a total of 19,299 school-age children from 55 elementary schools of 9 cities entered the study by a cross-sectional survey. A parent-administered questionnaire and the Chinese version of the Children's Sleep Habits Questionnaire were applied to investigate children's sociodemographic characteristics and sleep behaviors, respectively.The mean sleep duration was 9 hours and 10 minutes (9:10, SD:48 min) during the weekdays and 9:48 (SD: 63 min) during the weekends. In about 71.4% and 41.8% school-aged children the sleep duration per day did not reach the lowest criterion of 10 hours recommended by the Ministry of Education of China during weekdays and weekends, respectively. Sleep problems were common with prevalence ranging from 14.5% for sleep-disordered breathing to 75.3% for daytime sleepiness. Parasomnia (chi(2) = 13.76, P0.01) and sleep-disordered breathing (chi(2) = 119.83, P0.01) were more prevalent in boys than in girls; however, sleep anxiety was more prevalent in girls than in boys (chi(2) = 19.42, P0.01). Except for night waking, other types of sleep problems were significantly associated with age.Inadequate sleep duration and sleep problems prevail among school-age children, which indicates that children's sleep health may be a major public health concern in China.

To identify the influential factors on auditory receptive and auditory expressive language development and to provide clues to avoid language delay.A questionnaire was conducted among the caregivers of 2794 2-year old healthy children selected by cluster sampling in subdistricts with middle economic level from randomly selected 8 districts of Shanghai by using the "Early language milestone scale". Logistic regression analysis was used to find out the related factors.Five of the 24 items were the risk factors for the expressive language development: seldom practicing speaking (OR = 3.0257), reading quietly (OR = 2.0704), being male (OR = 1.7778), watching TV without discussing (OR = 1.4424), beginning to read after the age of 1.5 years (OR = 1.1576 - 2.0115). Eleven of the 24 items were the risk factors for the receptive language development: father's physical labor occupation (OR = 17.0238), seldom practicing speaking (OR = 2.8410), living in city (OR = 2.0125), reading quietly (OR = 1.7039), watching TV for more than 2 hours a day (OR = 1.6551), watching TV without discussing (OR = 1.5344), lack of communication between children and caregiver (OR = 1.1892), mother's bad education (OR = 1.1870), being male (OR = 1.6722), seldom playing with other children n (OR = 1.1671), beginning to read after the aged of 1.5 years (OR = 1.0435 - 2.0228).There are different factors related to 2-year-old children's receptive and expressive language development. Avoiding the risk factors and providing rich language environment would help prevent and intervene the language delay in early life.

Applying three treatment methods for enuresis in children with primary nocturnal enuresis (PNE) in a randomized controlled clinical trial (RCT) to compare the curative effects and characteristics of the three methods.If the parents and children consented to accept the treatment for 4 months and to keep on follow-up, the children diagnosed as primary nocturnal enuresis in the department of developmental and behavioral pediatrics in Shanghai Children's Medical Center from April 2003 to August 2004 were randomized into three groups: 52 children were in physio-psychological treatment group and were treated by utilizing the conditioning training role of alarm and other psychological and behavioral training programs; 46 children were in drug treatment group and were treated by taking DDAVP tablets orally; 40 children were in combined treatment group who were treated by applying the former two methods simultaneously. If the parents and children did not accept treatment, they were enrolled into the control group and were followed-up. Then, the curative effects of the four groups were compared statistically when the 4-month treatment was over and compared again 3 months later.Applying the physio-psychological treatment for 4 months, the short-term cure rate of children with enuresis was 75.0%. Three months after the end of the treatment, the long-term cure rate was 71.2%. As for drug treatment group, the short-term cure rate of children with enuresis was 47.8%, the long-term cure rate was 28.3%; As for combined treatment group, the short-term cure rate of children with enuresis was 85.0%, the long-term cure rate was 80.0%. The short-term and long-term curative effects of physio-psychological treatment group and combined treatment group were better than that of drug treatment group (P0.01). However, the short-term and long-term curative effects were not significantly different between physio-psychological treatment and combined treatment group (P0.05). Physio-psychological treatment exerts effects slowly, but showed sustained curative effects. While Drug treatment exerts effects rapidly, but the relapse rate was very high after discontinuation of the medication.Physio-psychological treatment and drug treatment are currently generally recognized the best ways to treat enuresis, both of them are suitable for Chinese enuresis children, both of them showed good curative effects. Physio-psychological treatment develops children's ability to control nocturnal micturition, its curative effects were better than that of the drug treatment whilst its relapse rate is lower as compared to drug treatment. So, physio-psychological treatment is more suitable for widespread use to treat PNE in China.

To develop the Chinese version of Children's Sleep Habits Questionnaire (CSHQ) by translating and retranslating the English version of CSHQ and to examine the reliability, content validity, construct validity of the Chinese version in a general population of school-age children.During November and December 2005, a total of 20 457 school-age children from 55 primary schools of 9 cities were recruited through cluster-stratified selection, using geographic location, economic standard, and population density as criteria. A parent-administered questionnaire and the Chinese version of CSHQ were completed to quantify sociodemographic characteristics and to characterize sleep patterns and sleep disturbances, respectively.The internal consistency of overall questionnaire and the eight subscales of the Chinese version of CSHQ was good (Cronbach's alpha coefficient was 0.73 and ranged from 0.42 to 0.69, respectively). The consistency between mother and father was ICCs = 0.89 for overall questionnaire and ranged from ICCs = 0.83 to ICCs = 0.92 for subscales. The test-retest reliability was ICCs = 0.85 for overall questionnaire and range from ICCs = 0.60 to ICCs = 0.88 for subscales. Factor analysis revealed a three-factor structure, which could represent bedtime behavior problems, sleep disturbance, sleep duration and daytime sleepiness, respectively, and the three factors could be used to explain 58.63% of the total variance. The factor loading was above 0.5 for the corresponding subscale.Reliability, content validity and construct validity of the Chinese version of CSHQ in a general population of school-age children are good. It appears to be a suitable instrument for measuring sleep patterns and screening for sleep problems in school-aged children.

To explore the mode of intervention for children with language developmental delay under the current condition of China.The study population consisted of a cross-sectional convenience sample of 206 children, ages 13 - 24 months, from six communities of Qingpu in Shanghai. Parents were asked to complete detailed questionnaires about their child's spontaneous use of vocabularies. Fourteen children with vocabularies less than 5 percentile of every age group were identified as having language developmental delay. During the 12-month intervention, developmental pediatricians did the developmental assessment for every child and set goals of intervention for everybody according to their language abilities and family situation. Then kindergarten teachers who got the training in language therapy carried out the intervention. Gesell development scale was used for developmental assessment before and after the intervention.The developmental quotient (DQ) in areas of language and personal-social behavior was elevated significantly after 12 months of intervention (P0.01). The developmental quotient (DQ) in the area of adaptive behavior was also elevated (P0.05). There was an obvious catching up effect in both areas of language and personal-social behavior. Increased developmental age in both areas was (18.0 +/- 5.3) months and (16.2 +/- 5.9) months, respectively. The language ability of 71.4% samples was in the normal range at the end.The mode of medical and educational cooperation to give early intervention for children with language developmental delay is feasible. It can significantly improve the abilities in language and communication of children 1 - 2 years of age.

To investigate the efficacy of early intervention on language, pronunciation and cognitive developments of infants and toddlers with hearing loss and to build up an early intervention model.Fifty-six children with moderate to profound sensorineural hearing loss aged 10 months to 2 years were divided into two groups. 20 children, aged 10 months to 2 years, received early intervention services after wearing hearing aids for 6 - 18 months, and 36 children, aged 11 months to 2 years, didn't receive any intervention. The type and degree of hearing loss were measured by a series of auditory tests. Language and cognitive developments of the children with hearing loss and 28 age, and sex-matched children with normal hearing, aged 10 to 23 months, were evaluated by the Gesell developmental schedules. The results were expressed as developmental quotient (DQ). Pronunciation test in mandarin Chinese was adopted to evaluate the speech development of the 56 children with hearing loss.(1) The language DQ according the Gesell developmental schedules of the children with hearing loss who received early intervention was (92.25 +/- 17.32), significantly higher than those children with hearing loss who didn't receive intervention (70.44 +/- 29.99, P = 0.00), whish was significantly lower than that of the normal hearing children (P = 0.00). However, there was no significant difference in language DQ between the children who received early intervention and the normal hearing children. There was no significant correlation between the degree of hearing loss and language DQ in the children who received early intervention (P = 0.27). (2) The personal-social developmental quotient (DQ) of the children who received intervention was (101.40 +/- 7.66), significantly higher than that of the children who didn't receive intervention (83.94 +/- 22.09, P = 0.00), that were significantly lower than that of the children with normal hearing (P = 0.00). However, there were no significant difference in the personal-social DQ between the children who received early intervention and the children with normal hearing. No significant differences in the gross motor ability, fine motor ability and adaptive ability were observed between the two groups of children with hearing loss and normal hearing children. (3) The consonant pronunciation of the children with moderate to severe hearing loss who received early intervention was normal. Among those children only one case with profound hearing loss had/d/error. The consonant pronunciation of the children with moderate hearing loss who didn't receive early intervention of those was normal. One case with moderate-severe hearing loss and one case with severe hearing loss had/d/errors. Six cases with profound hearing loss had/d, m/errors. The tone of the children with moderate to severe hearing loss who received early intervention was normal. Three cases with profound hearing loss exhibited tone errors. Among the children who didn't receive early intervention, tone errors were found in two cases with moderate hearing loss, one case with moderate-severe hearing loss, one case with severe hearing loss, and twelve cases with profound hearing loss showed.The language, pronunciation and cognitive developments of the children who don't receive early intervention are significantly lower than those of the children with normal hearing. Early intervention can significantly improve the language, speech and cognitive abilities of children with hearing loss.

To explore the clinical characteristics and speech therapy of 62 children with lingua-apical articulation disorder.Peabody Picture Vocabulary Test (PPVT), Gesell development scales (Gesell), Wechsler Intelligence Scale for Preschool Children (WPPSI) and speech test were performed for 62 children at the ages of 3 to 8 years with lingua-apical articulation disorder. PPVT was used to measure receptive vocabulary skills. GESELL and WPPSI were utilized to represent cognitive and non-verbal ability. The speech test was adopted to assess the speech development. The children received speech therapy and auxiliary oral-motor functional training once or twice a week. Firstly the target sound was identified according to the speech development milestone, then the method of speech localization was used to clarify the correct articulation placement and manner. It was needed to change food character and administer oral-motor functional training for children with oral motor dysfunction.The 62 cases with the apical articulation disorder were classified into four groups. The combined pattern of the articulation disorder was the most common (40 cases, 64.5%), the next was apico-dental disorder (15 cases, 24.2%). The third was palatal disorder (4 cases, 6.5%) and the last one was the linguo-alveolar disorder (3 cases, 4.8%). The substitution errors of velar were the most common (95.2%), the next was omission errors (30.6%) and the last was absence of aspiration (12.9%). Oral motor dysfunction was found in some children with problems such as disordered joint movement of tongue and head, unstable jaw, weak tongue strength and poor coordination of tongue movement. Some children had feeding problems such as preference of eating soft food, keeping food in mouths, eating slowly, and poor chewing. After 5 to 18 times of therapy, the effective rate of speech therapy reached 82.3%.The lingua-apical articulation disorders can be classified into four groups. The combined pattern of the articulation errors is the most common one. Most of the apical sounds are replaced by velar sounds. The speech localization method is very useful in the therapy of apical articulation disorder. For children with feeding problems and oral motor dysfunction, it is needed to improve food texture and administer oral motor skill training.

To study the development of self-regulation competence and its relationship with behavioral problems in Chinese children with the method of questionnaire assessment.The subjects of the study consisted of 18 to 36 months old toddlers and 3 to 6 years old children. Self-regulation competence in this study included effortful control and self-regulation development. Effortful control is the concept described in Rothbart theory. Attentional focus and inhibitory control were two components in effortful control, which mainly reflect the positive control of emotion and behavior. The Early Childhood Behavior Questionnaire (ECBQ) and Children's Behavior Questionnaire (CBQ) were adopted to assess the attentional focus and inhibitory control of effortful control and impulsivity in children at different ages. Achenbach's Children Behavioral Checklist was used to measure behavioral problems in three to five years old children.Totally 114 18 to 36 months old toddlers and 443 3 to 6 years old children were enrolled in data analysis. (1) The internal consistency of attentional focus in ECBQ and CBQ, alpha (Cronbach) value was respectively 0.89 and 0.75. The internal consistency of inhibitory control, alpha value was respectively 0.84 and 0.78. The alpha value of self-regulation development was respectively 0.84 and 0.94. (2) In 18 to 36 months old toddlers, there was no significant difference between genders in effortful control and self-regulation development. In 3 to 6 years old children, the score of girls' effortful control was higher than the score of boys' effortful control, the scores of girls' self-regulation development factor except regulation motion were significantly higher than boys (t = 4.27 and 11.14, P0.05 or P0.01). (3) The self-regulation competence including attentional focus, inhibitory control and all the factors in self-regulation development was significantly higher with age in three to six years old children (F = 2.9-10.16, P0.05 or P0.01). Children in this period already had some regulation skills. The development of regulation competence and regulation skill was not on the same step. Some were fast and some were slow. (4) The scores of attention focus and inhibitory control had significantly positive correlation with the general score of self-regulation development, the coefficient of partial correlation analysis was 0.52 and 0.64, respectively (P0.001). (5) The impulsivity had no significant correlation with self-regulation competence in 18 to 36 months old toddlers. The scores of impulsivity and behavioral problems scores had significantly negative correlation with attentional focus, inhibitory control and self-regulation development in 3-to-6 years old children. The coefficients were at low level, none was beyond -0.30 (P0.001).Effortful control or self-regulation had sex differences, girls had higher competence than boys, except motivation of self-regulation. But such sex differences did not show significant difference in children younger than three years of age in this study. This phenomenon is consistent with the development of self-regulation reported by Kopp. Child self-regulation competence increases with age. Generally speaking, the lower self-regulation competent, the higher impulsivity and behavioral problems, but the correlation was at a low level. For assessment and prediction of occurrence of behavioral problems, self-regulation competence should be combined with the other influential factors.

To explore the genetic susceptibility of children to vitamin D deficiency rickets through studying the association between Vitamin D receptor (VDR) gene polymorphism and vitamin D deficiency rickets.One hundred and fifty-nine children (100 boys and 59 girls, aged 0 to 2 years), with new-onset vitamin D deficiency rickets were enrolled. The patients sampled from a community of Jiamusi City, Heilongjiang Province. Seventy-eight healthy age-matched children (46 boys and 32 girls) were used as the controls. VDR gene polymorphism (cleaved by restriction endonuclease Fok I) was analyzed by polymerase chase reaction-restriction fragment length polymorphism (PCR-RFLP). The frequencies of the VDR genotype and allele were compared between the two groups.The frequencies of FF, Ff and ff genotypes were 37%, 51% and 12% in the Rickets group, and 18%, 55% and 27% in the Control group. A significant difference was found in the frequency distribution of the VDR genotype between the two groups (chi(2)(0.01(2))=9.210, chi(2)=13.3880, P0.01). In the Rickets group, f allele frequency was lower (37% vs 54%), while the F allele was more common than the Control group (63% vs 46%).There is an association between the VDR gene Fok I polymorphism and vitamin D deficiency rickets. The individuals with the F allele are more susceptible to vitamin D deficiency rickets.

To investigate the anxiety state in high school students and related factors in order to get reasonable suggestions for prevention.The mental health test (MHT) for high school students, and the living environmental and parental style were used in this study.MHT served as an assessment scale of anxiety. The efficiency sample was 3,050, aged 11 to 18 years old. The level of total anxiety and its each contents was low to moderate (0.24 to 0.54). The percentage of moderate to high of total anxiety was 16.7%, the percentage of moderate to high of each anxiety aspects were 8.8%-21.8%. The mostly high aspects were self-blame, schooling anxiety, social anxiety and over sensitiveness. In general, the girls' anxiety level was higher than boys', but the boys' lonely feeling was higher than the girls'. The total score of anxiety was decreased with age. Except of the over sensitiveness, the decrease tendency of each anxiety contents was significant in boys. For girls, the lonely feeling was deceased and the over sensitiveness increased with age. The age of fifteen seems as a significant changing age. The related disadvantage factors of students' anxiety were: the low education level, the parents' anxiety and depression characters, the authoritarian or neglecting parental style, the often contradiction parental styles between mother and father, parents often quarrel, the experience of often being scalded and physical punishment, lacking in care of others when in difficulties.The schooling pressure should be decreased to an appropriate level. The students' self-confidence and social ability should be emphasized. Good family environments and the support outside the family should be quite important for adolescents' mental health, these factors might decrease the adolescents' anxiety.

To study the feasibility of the programme "Focusing on early childhood development" in impoverished rural areas in China.A questionnaire survey was conducted among 100 mothers, about half with junior middle school education, 18% with grade-school education, and 29% being illiterate, of children aged under two years in 7 villages in Changfeng County, Anhui Province, a native impoverished county, to understand their knowledge and attitudes about child healthcare. Then these mothers were randomly divided into 2 equal groups: experimental group, receiving face-to-face guidance in the practice of early healthcare for children at home with a pamphlet developed by WHO as teaching material; and control group without receiving guidance. Two months later the mothers received the second session of guidance. Six months after the same questionnaire survey was conducted among the 100 mothers to investigate the changes in knowledge and practice and Gesell development test was made to observe the changes in mental development. Two-days' training on the technique of early child healthcare in the form of reading, videotape presenting, and exercise, was given to 29 village doctors. Questionnaire survey was conducted among them before and 1 month after the training to understand the changes of their knowledge and attitudes towards early child healthcare.After the guidance the knowledge and fostering skills in terms of early child healthcare were improved significantly among the mothers of the experimental group in comparison with the mothers of the control group (P0.01). After the training most of the village doctors managed put the knowledge they had learned into practice, however, the percentage of those who lacked confidence in the smooth implementation of the programme remained unchanged (38% vs. 41%). Before the experiment the abilities in different fields were not significantly different between the children in these 2 groups. Six months after the implementation of the programme the abilities in fine motion, speech, and interpersonal communication were improved significantly among the children of the experimental group (all P0.05).Economic, simple, and effective, the programme "Focusing on early childhood development" is suitable for the impoverished rural areas in China.

To study classification of the articulation errors, find the related factors which affect the therapy effect, and compare the therapy effect in the different patterns of the phonemic errors and build up a clinical model of the speech therapy on the basis of more than 4 years speech therapy in the clinic.After excluding the organic articulation disorders, 91 cases of consonant phonemic errors were classified into different patterns according to the phonemic placement errors. The 91 cases were divided into two groups as effective one and ineffective one depending on whether the symptoms disappeared or not after the speech therapy. Ten factors including sex, age, oral-motor function problem, developmental delay, history of language development delay, history of middle ear affection, lingua frenata, mental retardation, the therapy frequency and times, were analyzed. The statistics software SPSS (SPSS Inc, 1997) was applied to show the factors related to the therapy effect by logistic multiple stepwise regression analysis. The therapy effect was compared between the single pattern (phonemic error2 groups) and multiple pattern (phonemic errorsor = 2 groups).The 91 cases with consonant phonemic errors were classified into four groups. The multiple pattern of the articulation errors was the most common (37 cases, 41%) among the 4 groups, followed by velar errors (33 cases, 36%). The third one was the apico-dental errors (12 cases, 13%) and the last one was the linguo-alveolar errors (8 cases, 9%). Only one case had labiodental error (/f/). The logistic multiple stepwise regression analysis showed that the history of the positive developmental delay, language delay and the frequency of the speech therapy were related to the therapy effect. The effective rate of the speech therapy in the single pattern of the phonemic error was as high as 87% while the one in the multiple pattern group was only 2.7%. The difference was significant (P0.000 1) when the therapy effect in these two groups was compared. The clinical model of the speech therapy included speech assessment, designing of the goal, choice of the target sound, sound production and oral-motor functional training.The consonant phonemic errors in the clinic represent four groups. The developmental delay, the language delay and frequency of the speech therapy influence the therapy effect. The frequency of the speech therapy should be increased every week, for example not less two times a week. The therapy effect of the single pattern of the phonemic errors is much better than that of the multiple pattern. The primary model of the speech therapy has been built in the clinics.

To understand prevalence of sleep problems and presence of improper sleep habit of children aged one to 23 months in Shanghai, and to identify their related factors.Totally, 1 252 normal children, without severe illness and abnormal delivery history, aged one to 23 months were randomly selected from five districts of Shanghai. Under strict quality control system, their parents were interviewed with questionnaire to look into their familial and social environment, as well as sleep-related factors.Fully-completed information was obtained in 1 129 of 1 252 children, with a response rate of 90.18%. Prevalence of sleep problems in children was 65.90% in Shanghai, remarkably higher than in the other areas. Prevalence of nightmare, level of fright at night, snore and sleep apnea in boys were significantly higher than those in girls. Prevalence of improper sleep habit in children was also higher, including sleeping with their parents, parental presence at sleep onset and irregular sleep time. Main risk factors related to children's sleep problems were maternal anxiety, children's irregular sleep time, parental presence at sleep onset, difficulty-type temperament and maternal poor sleep during pregnancy.In Shanghai, prevalence of sleep problems in children aged one to 23 months was relatively higher and main risk factors for them were social, cultural and familial environment, especially negligence of cultivating proper sleep habit and parental improper response to children's poor sleep behavior.

BackgroundUnintentional injury remains the leading cause of morbidity and mortality among children worldwide. The aims of this study were to assess a baseline level of first aid knowledge and overall attitudes regarding first aid among staff members in Shanghai preschools.MethodsA cross-sectional study was carried out among the staff members at selected preschools. A stratified random sampling method was first used to identify suitable subjects. Data were obtained using a multiple-choice questionnaire. A standardized collection of demographics was performed and participants were given the aforementioned questionnaire to indicate knowledge of and attitudes toward first aid.Results1067 subjects completed the questionnaire. None of the surveyed employees answered all questions correctly; only 39 individuals (3.7%) achieved passing scores. The relative number of correct answers to specific questions ranged from 16.5% to 90.2%. In particular, subjects lacked knowledge regarding first aid for convulsive seizures (only 16.5% answered correctly), chemical injuries to the eye (23%), inhaled poison (27.6%), and choking and coughing (30.1%). A multiple linear regression analysis showed scores were significantly higher among staff members with more education, those who had received first aid training before or were already healthcare providers, younger employees, and staff members from rural districts. Most employees agreed that giving first aid was helpful; the vast majority felt that it was important and useful for them to learn pediatric first aid.ConclusionsThe level of first-aid knowledge among preschool staffs in Shanghai was low. There is an urgent need to educate staff members regarding first aid practices and the various risk factors relating to specific injuries.