ADHD Family Support Group: A Hospital-based Model in Taiwan

Attention deficient hyperactive disorder (ADHD) is one of the most common childhood psychiatric disorders worldwide. In Taiwan, its prevalence is estimated at between 7.5% and 9.9%, however, according to analysis of the National Health Insurance dataset, as few as 20% seek medical help for the condition. This action research project consisted of forming a hospital-based ADHD family support group and evaluating how well it functioned. First, the formation of a hospital-based family support group in central Taiwan was announced by newspaper, following a news report on 21 August 2008 of a local teacher tying a hyperactive child to a chair. After attending lectures or receiving services at this hospital, some parents and teachers asked to participate in the ADHD support group. A family support group was organized in 2011 and the research team helped appl y for publ i c educati on fundi ng from pharmaceutical companies like Eli Lily and Janssen. In January 2013, to evaluate the group’s functioning and the program results, we identified core leaders in the group and started interviewing them using an oral history approach. One child psychiatrist, eight family members, and two patients were selected for interviews. This family support group has demonstrated high motivation and efficiency in addressing its members’ concerns, as well as convincing therapeutic benefits. There is a need for pragmatic solutions that cannot be satisfied by purely scientific or therapeutic public discourse. For this reason, the family support group needed autonomy to respond to their own needs and to develop a new sense of identity

A common link between clinical practice and research:the ADHD model for Central Taiwan

This study aimed to describe a research model regarding the Attention Deficit Hyperactive Disorder (ADHD) in Central Taiwan based on the strategy of routine data collection from clinical practice. Therefore, a prospective study with naturalistic observation was used. Modeling study was developed in clinical evaluation and treating for the ADHD children at Department of Psychiatry, Chung Shan Medical University Hospital in Central Taiwan. For all new patients, their first visit information were collected, including sociodemography, ADHD symptom scale, family support, academic performance, enuresis, severity of disability, mother depression, blood pressure(BP), heart rate(HR), weight, height, help-seeking behavior. After the clinical interview, patients were arranged to be assessed by the Neuropsychological test such as Continuous Performance Test (CPT). During the follow-up period, many variables (messages for the side effects, BP, HR, Weight, Height, CPT, ADHD symptom scale) were recorded. Finally, the ADHD clinical–based research model was contributed using all variables into many studies such as the ADHD comorbidity study, family study, sleep study, assessment tool development and treatment outcome study. The results had shown a several ADHD related papers have been published from this model. New treatment strategies emerged from the findings of studies. This is a feasible model for combining clinical practice with research to produce international publications. Clinical benefits of this model include creating culture-specific knowledge from the clinicians’ own clinical practice, focusing essential processes on cost-effective patient retreatment, and maintaining ongoing relationships with patients. In conclusions, our experience shows the clinical practice based longitudinal study is feasible and the results can nurture the quality of clinical practice vice versa

Using Narrative to Reflect on Three Therapeutic Models in Taiwan : Lessons for Community Approaches to Child Mental Health

As the shortcomings of deinstitutionalization become evident, models of institution-based therapeutic communities are starting to appear as promising alternatives. While institution-based therapy models produce desirable outcomes for some categories of mental illness, these lessons have not been applied to exploring community approaches to child mental health. To this end, we use an identity narrative approach to explore the relation between mental illnesses and childhood or adolescent development in narratives of patients treated under different therapeutic models for three conditions: severe mental illness (SMI), substance abuse and ADHD. Only the ADHD patients were children; the SMI and substance abuse treatment models were designed for adult patients. But all patient narratives showed the illness had roots in childhood. This secondary analysis examines patient narratives collected from three independent projects between 2005 and 2013. The oral history study of the Yu Li therapeutic model for SMI was conducted from 2005 to 2006. The project documenting a therapeutic model for substance abusers in the Tsao Tun Psychiatric Center was carried out from 2009 to 2010. Lastly, we took oral histories from participants in an ADHD family support group between 2011 and 2013. The development and nature of these models will be illustrated first, then contrasted, to identify the key elements of empowerment in each type of therapeutic community. We further apply the Jonsen’s four-topic approach to clinical decision making to clarify the ethical dilemmas in assignment of tasks and to distinguish how each division of labor affects patient empowerment. While considering the nature of illness or recovery for different categories of patients, we find narrative understandings are crucial for ascertaining the residual functioning of each patient, and for striking a balance between individual existence and social being. We conclude narrative medicine constitutes a specialized approach for building recovery models and promoting mental health

Transformation of physicians' public identities in Taiwan and the United States: A comparative and historical study of ambivalence, public policy and civil society.

How have social, cultural, and historical processes that constitute relations between professional groups, civil society and modern states transformed physicians' public identity? Can similar trends of professional dominance be seen in states whose political and cultural histories differ? These questions are explored by comparing the public discourse about physicians' rights and responsibilities in the United States and Taiwan during three time periods, when the civil society in each country was posing similar challenges to both the state and to physicians, and when the two states had adopted almost identical policies to control utilization of physicians' services. In contrast to most studies of professions which focus on the structural position and work of doctors, I demonstrate that the modern form of the medical profession, although a derivative of modern discourse throughout the world, can only be understood when rooted in both local historical genealogies as well as in the broader dynamics of modern state building and nation formation. Drawing on concepts from the post-structuralist tradition, and Ortner's practice-centered framework in particular, and by deploying a contrast-of-context comparative design, I locate physicians' identities in Taiwan's cultural conflict between an alien state and nativist civil society, and in the USA between a schema of individualism and one based on communitarianism. This broad comparison is analyzed in three stages: the Golden Age of Medicine, in which the physician's public identity is institutionalized and transformed from profession-in-itself to profession-for-itself in each country; during physician manpower planning, where a new conjuncture allows the contest over the physicians' definition to emerge, with the larger cultural conflicts defining the terms of debate; and during the move to comprehensive health centers, in which discursive formation between physicians' public identities and national identities in both countries becomes more apparent. By identifying the organic or traditional intellectual ties of physicians and by placing physicians in their historical conjunctures alongside international transfers of health planning experience, this study helps us understand that cultural logic which shaped the distinct transformation of physicians' public identities in Taiwan and the USA.Ph.D.American historyAsian historyCultural anthropologyHealth and Environmental SciencesHealth sciencesModern historySocial SciencesSocial structureUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/130146/2/9712108.pd

Suicide and other-cause mortality after early exposure to smoking and second hand smoking:A 12-year population-based follow-Up study

The association between smoking and suicide is still controversial, particular for early life cigarette smoking exposure. Few studies have investigated this association in adolescents using population-based cohorts, and the relationship with second hand smoking (SHS) exposure has not been addressed.In this study, we followed a large population-based sample of younger people to investigate the association between smoking, SHS exposure and suicide mortality. Between October 1995 and June 1996, 162,682 junior high school students ages 11 to 16 years old living in a geographic catchment area in Taiwan were enrolled and then followed till December 2007 (1,948,432 person-years) through linkage to the National Death Certification System. Participants who were currently smoking at baseline had a greater than six-fold higher suicide mortality than those who did not smoke (29.5 vs. 4.8 per 100,000 person-years, p<0.001) as well as higher natural mortality (33.7 vs. 10.3 per 100,000 person-years, p<0.001). After controlling for gender, age, parental education, asthma, allergic rhinitis, and alcohol consumption, the adjusted hazard ratios for suicide were 3.69 (95% CI 1.85-7.39) in current smokers, and 1.47 (95% CI 0.94-2.30) and 2.83 (95% CI 1.54-5.20) respectively in adolescents exposed to SHS of 1-20 cigarettes and >20 cigarettes/per day. The estimated depression-adjusted odds ratio did not change substantially. The population attributable fractions for suicide associated with smoking and heavy SHS exposure (>20 cigarettes/per day) were 9.6% and 10.6%, respectively.This study showed evidence of excess suicide mortality among young adults exposed to active or passive early life cigarette smoking

Baseline sample characteristics (N = 162,682).

<p>*Missing data excluded.</p><p>Baseline sample characteristics (N = 162,682).</p

STROBE style flow chart of the cohort in southern Taiwan included in analysis.

<p>STROBE style flow chart of the cohort in southern Taiwan included in analysis.</p

Cox proportional hazards regression analyses of factors associated with suicide mortality.

<p>Note. HR = hazard ratio; CI = confidence interval; AHR = adjusted hazard ratio</p><p>^aAdjusted for gender, age, SHS exposure and the highest education of parents,</p><p>^bAdjusted for gender, age, the highest education of parents, SHS exposure and cigarette smoking,</p><p>^cAdjusted for gender, age, the highest education of parents, SHS exposure, cigarette smoking, the lifetime asthma, and allergic rhinitis,</p><p>^dAdjusted for gender, age, the highest education of parents, SHS exposure, cigarette smoking, the lifetime asthma, allergic rhinitis, and alcoholic drinking</p><p>Cox proportional hazards regression analyses of factors associated with suicide mortality.</p

Cause-specific mortality by smoking status (N = 162,098).

<p>^a. PYs: person-years</p><p>^b. incidence: number per 100,000 person-years.</p><p>The difference of incidence in specific causes of deaths between smoker and non-smoker group were calculated using Wilcox (Gehan) Statistic by survival life table analysis.</p><p>Cause-specific mortality by smoking status (N = 162,098).</p