Medicine-education integration for the healthy development of children and adolescents promotes the cross-field and interdisciplinary integration of education and developmental behavior pediatrics(DBP), and integrates advanced research results of education and DBP, as well as effective educational practice and clinical experience. It will open up the barriers of medicine and education, and will strongly guide the practice of education and DBP.

Mental retardation(MR) and developmental delay(DD) are common disorders of departments of developmental and behavioral pediatrics. Chromosomal abnormalities, copy number variations, and gene variants are known causes of MR/DD. Genetic test has become the first-tier diagnostic method for MR/DD, with the widely used chromosome micro-array analysis and exome sequencing. Here we give a brief introduction of clinical approach to MR/DD patients, discuss some potential risks of genetic tests and propose some recommendations.

Objective To investigate the physical activity pattern of school-age children with autism spectrum disorder(ASD) at different cognitive levels, and explore its association with the weight status. Methods Forty-five children with ASD from the Research Center for Psycho-behavioral Development of Children and Adolescents at SUN Yat-sen University from July 2018 to May 2019 were included. Participants were divided into the high function ASD(HFA) group and the low function ASD(LFA) group, according to their full-scale IQ score assessed by the Chinese Wechsler intelligence scale for children, 4th edition, and clinical interviews from the professional physician. Anthropometric measures were assessed by standard methods in order to calculate body mass index(BMI). After that, participants were asked to wear the Actigraph GT3X+ accelerometers for 7 continuous days. Multiple logistic regression model was used to analyze the association between physical activity and weight status. Results The prevalence of overweight and obesity were 15.6% and 17.8%, respectively. Average daily minutes of moderate to vigorous physical activity(MVPA) was 49.2±20.3, which failed to meet the WHO recommendations(60 min/d). The compliance rate of MVPA was 26.7%. Besides, we found that the LFA group had higher amounts of vigorous-intensity PA(VPA) (Z=2.55, P=0.011) and MVPA (Z=1.98, P=0.048) than the HFA group. Higher levels of moderate-intensity physical activity(MPA), VPA and MVPA were positively associated with the overweight/obesity in the HFA group, even after adjustment for age, gender and average sleep duration(OR=0.09, 95% CI 0.01-0.94; OR=0.06, 95% CI 0.004-0.96; OR=0.06, 95% CI 0.005-0.70, respectively). No significant association was found in the LFA group. Conclusion A high percentage of school-age children with ASD suffer from physical inactivity, overweight, and obesity. There is a difference in the correlation between physical activity and overweight or obesity among children with different cognitive levels, and a negative correlation is found in the HFA group, which can provide a reference for further targeted intervention.

Objective  To explore the cortisol secretion levels and their related factors of children with autism spectrum disorder(ASD). Methods Fifty boys aged 6-12 years, with 30 in ASD group and 20 in typical development(TD) group, were included. The screen for child anxiety related emotional disorders-revised(SCARED-R), social responsiveness scale(SRS), and repetitive behavior scale-revised(RBS-R) were used to evaluate their anxiety, social ability and restricted and repetitive behaviors(RRBs) of ASD. Cortisol levels were measured via saliva at three time points(waking, 30 min after waking, and evening) across 2 d. Sleep patterns were evaluated by 14-day sleep diary. Multiple linear regression, with cortisols as dependent variables and their potential related factors as independent variables, was conducted to evaluate relative factors of cortisols of ASD. Results   Evening cortisol in ASD group（-0.13±0.50） nmoL/L was significantly lower than TD（0.34±0.34） nmoL/L. The sleep pattern significantly differed in two groups, with the characteristics of shorter 24-hour sleep duration and lower sleep efficiency in ASD group. The results of multiple linear regression showed that the evening cortisol level was positively associated with its sleep onset latency and negatively related to its RRBs. Conclusion   Evening cortisols are significantly different between ASD group and TD group. The cortisol level in ASD is associated with its sleep onset latency and RRBs.

Objective   To explore the characteristics of adaptive behavior of children with high-function autism spectrum disorder(HFASD) and its influencing factors. Methods   A total of 70 children with HFASD(aged 6-12 yeas) from the Research Center for Psycho-behavioral Development of Children and Adolescents of Sun Yat-sen University from April to July 2017 were recruited. The adaptive behavior, intelligence level, severity of ASD symptoms, executive function, anxiety and intervention therapy were assessed to determine characteristics and influencing factors of adaptive behavior in HFASD children. Results   It revealed that 25.7% HFASD children had a low level of adaptive behavior and 34.3%  a critical level. Only 40% children had adaptive behavior of medium level or above. The difference in the grade distribution between adaptive behavior and intelligence level was statistically significant(P< 0.05). Logistic regression analysis showed that high level of full scale intelligence quotient(FSIQ) was a protective factor for adaptive behavior(OR=1.21, 95%CI: 1.05-1.39), while poor behavioral regulation ability(OR=0.86, 95% CI: 0.74-1.00), lack of social motivation(OR=0.79, 95% CI: 0.57-1.00) and social phobia symptoms(OR=0.01, 95% CI: 0.00-0.33) were risk factors for poor adaptive behavior. Multiple linear regression analysis was carried out, and FSIQ-GAC（full scale intelligence quotient-general adaptive composite）discrepancy scores were taken as dependent variables. It showed that intervention training(β=0.27, P=0.02), especially structured education(β=0.25, P=0.02), could reduce the FSIQ-GAC discrepancy scores and severely damaged social perception(β=0.29, P=0.01) and presence of social phobia(β=0.23, P=0.03) would exacerbate the discrepancy scores. Conclusion The study reveals that adaptive behavior of HFASD children does not match their intelligence level perfectly, and the executive function, severity of symptoms and anxiety symptoms may affect the adaptive behavior.

Objective   To investigate the relationship between gut microbiota and severity of symptoms in children with autism spectrum disorder(ASD). Methods   Between April and July 2017, 45 children with ASD were enrolled in the Research Center for Psycho-Behavioral Development of Children and Adolescents at Sun Yat-sen University in Guangzhou, China. The childhood autism rating scale(CARS) and the social communication questionnaire(SCQ) were used to assess the severity of ASD symptoms. Stool specimens were collected from participants. The fecal microbial DNA was extracted from feces. We characterized the composition of the fecal microbiota using bacterial 16S rRNA gene sequencing. Results   There were no significant diversity and structure differences in gut

microbiota between mild-moderate ASD and severe ASD groups. However, the severe ASD group had a smaller number of operational taxonomic units, the rank abundance curve was steeper and the horizontal span was smaller. In addition, the relative abundance of Clostridium clostridiiforme was positively correlated with the restricted and repetitive behavior subscale score(r=0.391, P=0.008). Conclusion   Gut microbiota was similar in different severity ASD groups. However, the gut microbiota in severe ASD group trended to be less diverse and more uneven.

Objective   To study the status of toddlers' social-emotional development and family nurture environment in urban areas of Shanghai, and explore the correlation between them to establish early promotion and intervention strategies for toddlers based on family nurture environment. Methods   The investigated sites including 4 community healthcare centers were selected by stratified cluster random sampling method and 945 children aged 12-36 months from Shanghai urban areas were enrolled. The toddlers were grouped into 4 age groups(12-17, 18-23, 24-29, 30-36 months). The status of social-emotional development and family nurture environment in toddlers were investigated by Chinese version of Urban Infant Toddler Social and Emotional Assessment(CITSEA), child home nurture environment questionnaire and self-designed sociodemographic questionnaire. Results   The detection rates of poor social-emotional development and adverse family nurture environment were 24.44% and 6.03% respectively in urban areas of Shanghai. Toddlers aged 12-17 months had lower social-emotional competence score and higher detection rate of adverse family nurture environment（P<0.01）. The toddlers in adverse family nurture environment had higher scores for externalizing, internalizing and deregulation domains and lower scores for competence domain than those in good family nurture environment（P<0.05）. The general family nurture environment was influenced by family background factors, including parents' age, monthly household income, living area, parents' education levels, parents' occupation and maternal postpartum mental state. Conclusion   The detection rate of poor social-emotional development is high in urban areas of Shanghai. Adverse family nurture environment has a significant impact on toddlers' social-emotional development. Creating a good family nurture environment is a reliable and effective way to promote early social-emotional development in toddlers.

Objective   To accurately sort out the research hotspots of interparental conflicts, and to explore the future research trend of parental conflicts in China. Methods   We collected and sorted 321 articles from China National Knowledge Infrastructure(CNKI), and used Bicomb 2.0 to extract and count the keywords of each document, and used SPSS 20.0 for cluster analysis and multidimensional scaling analysis, and drew a hot knowledge map of parental conflict research. Results   ① There were 29 high-frequency keywords in parental conflict research. The hot words were parent-child conflict, adolescents, parent-child relationship, and middle school students. ② Different matrix analysis showed that the key factors of middle school students, children, adolescents, and parent-child relationship often appeared in parental conflict research. ③ The results showed that the research on parental conflicts in China mainly focused on three areas, including the role of parenting style in the influence of parental conflicts, the impact of parental conflicts on parent-child relationship, and the impact of parental conflict on mental health. Conclusion   The results of parental conflict research in our country are rich. We should focus on developing research methods beyond questionnaires in future, enriching the sample of college students in this field, exploring practical and effective interventions, and exploring how families, schools, and society should prevent or reduce the negative impact of parental conflict on children.

Objective   To adopt the model of Internet child heath  care to monitor the early growth and development of children and explore the early childhood growth and development assessment and intervention techniques for community in order to provide new strategies for grassroots children's graded diagnosis and treatment model. Methods   A cluster sampling plan was adopted. Infant growth and development monitoring and evaluation system used by the trained grassroots child care physicians from June 2017 monitored the growth and development of 500 infants and provided targeted family intervention guidance and referral. The growth and development data were collected at the end of intervention for 6 months. Results   Through 6 months of monitoring, evaluation and intervention, the body weight, the gross motor, the fine motor, language, and social interactions of children significantly improved(P<0.05). Conclusion   The model of Internet child health care is well integrated with early childhood growth and development assessment and intervention, which is feasible and reliable, profits to graded diagnosis and treatment of diseases, and is worth promoting in community.

Objective   To explore the relationship among preschool education female students' negative affect, self-efficacy, self-esteem, and life satisfaction, and assess the mediating role of self-efficacy and self-esteem between negative affect and life satisfaction. Methods   A total of 382 preschool education female students in higher vocational college were investigated by the depression anxiety stress scale 21(DASS-21), general self-efficacy scale(GSES), self-esteem scale(SES), and satisfaction with life scale(SWLS). Results   ① Pearson correlation analysis showed that negative affect, self-efficacy, self-esteem, and life satisfaction correlated significantly with each other; negative affect were negatively correlated with self-efficacy, self-esteem, and life satisfaction; and self-efficacy, self-esteem, and life satisfaction scores were positively correlated with each other. ② Negative affect influenced life satisfaction directly and indirectly through three indirect paths: self-efficacy, self-esteem, and self-efficacy-self-esteem. ③ Self-efficacy and self-esteem played a chain mediating role between negative affect and life satisfaction, and the total mediating effect accounted for 44.24% of the total variance. Conclusion   Negative affect and life satisfaction of preschool education female students are influenced by self-efficacy, self-esteem, or through the mediating chains of self-efficacy and self-esteem.

Objective   To explore the relationship between individual attachment level and self-esteem. Methods   A group of college students and technical secondary school students were selected as subjects. The score data of experiences in close relationship scale(ECR)，and two-dimensional self-esteem scale were collected, and the descriptive and related relationships of attachment level and self-esteem level were analyzed. Experiments were designed using the Ravens intelligence test, the state self-esteem scale, and the intimate experience relationship scale to analyze the impact of threat situations on the state self-esteem of individuals with different attachment types. Results   ① The attachment anxiety dimension and avoidance dimension were significantly negatively correlated with self-esteem's self-acceptance dimension and self-competence dimension. Stepwise regression analysis found that the predictive effects of attachment anxiety dimension and avoidance dimension were significant. ② Threat situation had a significant effect on the self-esteem of individuals with different attachment types. The self-esteem level of individual's behavioral status under threat situations was significantly lower than that of neutral situations. ③ The social status self-esteem levels of individuals with different attachment types were significantly different. The safety type was significantly higher than the fear type and obsession type, and the indifference type was significantly higher than the fear type and obsession type. Conclusion   Individual attachment levels can have a significant effect on self-esteem, both from a trait and state perspective.

Objective   To explore the correlations among academic self-efficacy, time management disposition and self-regulated learning. Methods   A total of 856 prospective preschool teachers were recruited to complete the academic self-efficacy questionnaire, time management disposition questionnaire, and self-regulated learning inventory. A mediation model of academic self-efficacy on action self-regulated learning by  time management disposition was constructed and used to verify the correlation among these three indices. Results   There were significant correlations between the three indices, and time management disposition exhibited a partial mediating effect on relationship among academic self-efficacy and self-regulated learning. Conclusion   For normal university,

it is a need to help prospective preschool teachers to form a positive self-evaluation, elevate academic self-efficacy, and improve time management disposition, which may eventually enhance their self-regulated learning ability.

Autism spectrum disorder(ASD) is a complex group of neurodevelopmental disorders characterized by impaired social interactions and communication together with repetitive and restrictive behaviours. Many ASD children also display symptoms of gastrointestinal disturbance, which may aggravate social withdrawal, stereotyping, hyperactivity and other behavioral problems. Gut microbiota established the bidirectional communication between the gut and brain by the “microbiota-gut-brain axis”, suggesting gut microbiota disturbance may play an important role in the development or presentation of ASD symptoms. This article reviews the relationship between gut microbiota and ASD, and provide theoretical basis by discussing gut microbiota as a potential target for ASD therapy.