NTNU Team Leads ICILS Global Study: Taiwan Students Claim #1 in Computational Thinking

December 10, 2024

In response to the arrival of the AI era, Taiwan participated for the first time in the International Computer and Information Literacy Study (ICILS). Led by a research team from NTNU, the Taiwan ICILS National Research Center held a press conference on the evening of November 12 at the Ministry of Education, jointly releasing the results of ICILS 2023 in coordination with the International Association for the Evaluation of Educational Achievement (IEA). The findings revealed that Taiwanese students demonstrated outstanding performance in computational thinking, ranking first in the world—underscoring the nation’s strong foundation in information education. In its first participation in the ICILS program, Taiwan’s research was carried out by a team from NTNU, commissioned by the K–12 Education Administration of the Ministry of Education and the National Academy for Educational Research. The project was personally led by NTNU President Professor Cheng-Chih Wu, who served as National Research Coordinator alongside Professor Meng-Jong Tsai of NTNU’s College of Learning Informatics. Professor Yu-Tzu Lin from NTNU’s Graduate Institute of Information and Computer Education and Professor Jiun-Yu Wu from National Yang Ming Chiao Tung University’s Institute of Education served as co-principal investigators. The press conference was attended by Director-General Fu-Yuan Peng of the K-12 Education Administration, National Academy for Educational Research President Chung-i Lin, and Vice President Chin-Hsiang Yen. Caption: Group photo of the NTNU research team with distinguished guests from the Ministry of Education. From left to right: Professor Yu-Tzu Lin (far left), Vice President Chin-Hsiang Yen (second from left), President Chung-i Lin (third from left), Director-General Fu-Yuan Peng (fourth from left), NTNU President Professor Cheng-Chih Wu (fifth from left), Professor Meng-Jong Tsai (third from right), and Professor Jiun-Yu Wu of National Yang Ming Chiao Tung University (far right). Caption: NTNU President Professor Cheng-Chih Wu (second from right) responds to questions. Caption: Professor Meng-Jong Tsai explains the research findings.   The ICILS is administered by the IEA. It assesses Grade 8 students’ understanding of ICT concepts, practical skills, and problem-solving abilities through online tests and questionnaires. The study also examines teachers’ digital teaching practices and schools’ digital leadership, providing a comprehensive view of the factors influencing students’ computer and information literacy across participating countries. Launched in 2013, ICILS is conducted every five years and surveys Grade 8 students, teachers, ICT coordinators, and principals worldwide. ICILS 2023 marked the third cycle of this global assessment. A total of 34 countries participated, with over 5,000 schools, more than 130,000 students, and over 60,000 teachers taking part. From Taiwan, 169 schools participated, including 5,112 Grade 8 students and 2,233 Grade 8 teachers. The key findings from the survey are as follows: Taiwan Ranks First Globally in Computational Thinking (CT), and Fourth in Computer and Information Literacy (CIL) In computational thinking (CT), Taiwanese students scored an average of 548 points—the highest among the 24 participating countries (global average: 483). The CT assessment evaluates students’ abilities to understand digital systems, analyze problems, devise solutions, and develop algorithms and programs. The results show that Taiwanese students outperformed their global peers in problem-solving using computational methods. CT is a core focus of Taiwan’s current ICT curriculum. Compared to students in other countries, Taiwanese students receive more in-depth instruction in CT-related concepts and skills.   Computational Thinking (CT): Taiwan Ranks First Taiwanese students achieved an average score of 548, significantly above the international average of 483. Ranked 1st among the 24 participating countries.  Computer and Information Literacy (CIL) — Taiwan Ranks Fourth Taiwanese students averaged 515 points, significantly higher than the international average of 476 points, ranking fourth among the 34 participating countries. South Korea, the Czech Republic, and Denmark ranked as the top three.    CIL achievement results show that Taiwanese students scored an average of 515 points (global average 476 points), ranking fourth among 34 countries, only behind South Korea, the Czech Republic, and Denmark. This indicator mainly assesses students’ abilities in using ICT tools, gathering information, producing information, and digital communication. It demonstrates that Taiwanese students perform well in terms of using ICT for problem solving, creation, and interactive communication.  In terms of CT performance, more than half of Taiwanese students (52%) achieved Level 3 or above, demonstrating the ability to independently solve complex problems—far exceeding the international average (29%). Regarding CIL performance, the majority of Taiwanese students (64%) reached Level 2 or above, capable of completing basic information processing tasks, which also surpasses the international average (49%).   CT performance shows little gender difference; female students outperform males in CIL. International assessments found no consistent conclusions regarding gender differences in CT. In most countries, male students slightly outperformed females in CT, but only six countries showed statistically significant differences. In Taiwan, female students scored slightly higher than males, but the difference was not statistically significant, indicating no notable gender gap in CT performance. This aligns with findings from countries like Finland, Norway, and South Korea. In terms of CIL, Taiwanese female students scored significantly higher than males, consistent with global trends. Overall, the results challenge the traditional stereotype that male students have an advantage in ICT-related learning. Taiwan’s CT and CIL performance is less correlated with students’ socioeconomic background. The survey results show that across countries, student performance is associated with socioeconomic background factors such as parental education, occupation, and access to computer resources at home. However, in Taiwan, the correlation between CT and CIL performance and socioeconomic background is significantly lower than the international average. This indicates that ICT education outcomes in Taiwan are less influenced by family background, suggesting more equitable access to information education and a higher degree of social fairness.  ICT Usage Among Students Across Countries Students in all countries reported using ICT more frequently outside of school than in school, and mostly for non-academic purposes. However, trend analysis shows that increased ICT usage frequency does not lead to higher CIL performance. In most countries, students use general-purpose software (e.g., word processing, presentation, spreadsheets) in class more frequently than specialized software (e.g., multimedia production, simulation and modeling software, interactive game-based learning platforms). In contrast, Taiwanese students reported more frequent use of specialized software than general-purpose applications. Taiwanese Principals Show High Awareness of Students' and Teachers' Use of Generative AI Tools Principals across countries expressed mixed views on generative AI tools (e.g., ChatGPT). Over half of the students’ principals globally believe that generative AI will improve student learning, and nearly two-thirds think it will help increase student engagement. However, concerns remain that students may become overly reliant on AI and lose the ability to learn independently. Compared to the international average, Taiwanese principals are more aware of the impact generative AI tools have on both student learning and teacher instruction. While recognizing the potential benefits of AI in education, they are also attuned to its possible disruptions and consequences.   Summary Taiwan’s Grade 8 students performed exceptionally well in CT and CIL, ranking first and fourth respectively among participating countries. Female students stood out in particular, overturning traditional stereotypes. While students’ performance is linked to family SES, the correlation in Taiwan is significantly lower than the international average, demonstrating greater social equity. Students reported opportunities to use ICT both in and out of school, and felt confident in acquiring appropriate internet literacy. Taiwan’s students performed remarkably well in this assessment, clearly reflecting the success of national ICT education strategies and their effective implementation at all levels of teaching, aligning with international trends and enhancing students’ CT and CIL to meet the demands of the digital era. In addition to Taiwan’s internationally advanced ICT curriculum and the concrete implementation of curriculum content in schools, relevant ICT education policies include: (1) establishing a three-tier support system through cooperation between central, local, and school levels to strengthen teachers’ digital teaching competencies and resource sharing; (2) promoting international CT assessment challenges to spark interest in CT learning; (3) implementing the one-tablet-per-student policy and encouraging private-sector investment in rural areas to reduce urban–rural disparities in classroom ICT use; (4) emphasizing online behavior guidance and actively promoting topics such as information ethics and cybersecurity; and (5) advocating gender equality and digital inclusion education, encouraging students to break boundaries and pursue self-fulfillment. NTNU has long been committed to advancing ICT education, not only participating in the development and promotion of national ICT education policies, but also actively engaging in textbook review, promoting widespread information literacy, and collaborating with top domestic and international universities through international conferences and academic exchanges to foster inter-school resource sharing and educational innovation. NTNU also continues to advance professional development programs for in-service teachers, helping them enhance their ability to teach with modern ICT tools to meet the rapidly evolving demands of digital education. Facing the ever-changing challenges of technology, NTNU also spares no effort in teacher education, actively cultivating future educators with contemporary ICT teaching capabilities to ensure they can effectively leverage technology and create digital learning environments that meet the needs of today’s students. (Source: Taiwan ICILS National Research Center / Photo: Chang Shih / Editor: Hu Shih-tse) Download the ICILS 2023 results presentation from the official ICILS National Research Center website (CIRN-ICILS).

Designing for Impact: Lessons from a Decade of AR in Education

December 10, 2024

　　In the digital era, educational technologies continue to evolve rapidly, and augmented reality (AR) has emerged as one of the most closely watched technologies in the field of education. Hsin-Yi Chang, Chair Professor of the Bachelor’s Program in Learning Sciences at National Taiwan Normal University, led a research team in collaboration with several experts and professors in digital learning to systematically review and conduct a series of meta-analyses on AR-related research from the past ten years, with the goal of examining the effectiveness of AR in education. The study found that AR technology can help cultivate students’ performance abilities, but how to carefully design AR curricula and effectively integrate virtual and real contexts remains a new challenge for contemporary educators.   　　Hsin-Yi Chang specializes in the development of digital science curricula, learning activities, and scaffolding, and conducts in-depth research on key factors influencing students’ science learning. In the past five years, she has contributed to the fields of science education, STEM education, and online learning. Since 2022, she has been listed for two consecutive years among the world’s top 2% of scientists in the “2023 Annual Scientific Impact Rankings,” and she was also awarded the Taiwanese National Science and Technology Council’s Distinguished Research Award in 2023. 　　Augmented reality (AR) is a technology that overlays virtual information onto real-world environments. It not only offers learners immersive learning experiences and enhances student motivation but also effectively aids in knowledge acquisition. However, the actual benefits of AR remain underexamined due to a lack of empirical research. 　　To address this gap, Chang’s research team collaborated with digital learning experts to systematically review studies published between 2012 and 2021. Out of more than 2,000 papers, they selected and analyzed 134 experimental studies. These studies examined the effects of AR on three learning outcome categories—response, knowledge and skill, and performance—spanning over 10,000 students across all levels of education and a wide range of subject areas. Notably, only two to three papers focusing on AR appeared in 2012, but interest rapidly expanded after 2019, especially following the COVID-19 pandemic, marking AR as a rising topic in the research community. Figure caption: Compared to non-AR instruction, AR-based instruction demonstrated a large mean effect size (g = 0.739) for the learning outcome of performance.   　　Over the past decade, studies comparing AR-based instruction with traditional instruction revealed that AR had positive effects across all three learning outcome categories, with the greatest impact observed on performance. This finding highlights the significant potential of AR for supporting students’ ability to perform real-world tasks. 　　The research further found that the effectiveness of AR varied by subject area and instructional design. Meta-regression results showed that AR instruction in language learning and social studies tended to produce higher learner responses. By using AR to concretize abstract concepts and create immersive experiences—for example, visualizing historical scenes or interacting with virtual historical figures—student engagement and interest in learning increased substantially. Figure caption: Meta-regression results indicated that the longer AR was used in instruction, the greater its effect on learning outcomes.   　　However, in the natural sciences, while AR-enabled 3D visualization can allow students to explore the solar system or virtually observe dissection procedures, excessive use of 3D effects may induce “deceptive clarity.” That is, students may falsely believe they understand the content while in fact remaining confused or only partially grasping the material. Furthermore, if AR is used for only a short duration—such as a single class session—the instructional effectiveness may fall short of expectations. 　　Although applying AR in instructional settings may seem to offer more advantages than disadvantages, Hsin-Yi Chang cautions that it should still be implemented with care. In particular, many prior AR applications featured 3D visualizations with inadequate resolution or poorly designed content, which may reduce learning effectiveness. Thus, the question of how to carefully design AR curricula and meaningfully integrate virtual and real contexts has become a major challenge for today’s educators. 　　To prevent students from forming misconceptions due to 3D effects, Chang recommends that future AR instruction focus on the quality of 3D design and make appropriate use of 2D or 1D visualizations to enhance learning outcomes. She also emphasizes that educators should tailor AR instructional design to the characteristics of different subject areas and the specific learning needs of students in order to fully realize the potential of the technology. (This article was provided by The Center of Public Affairs.)   Source: Chang, H.-Y., Binali, T., Liang, J.-C., Chiou, G.-I., Cheng, K.-H., Lee, S. W.-Y., Tsai, C.-C. (2022). Ten years of augmented reality in education: A metaanalysis of (quasi-) experimental studies to investigate the impact. Computers & Education,191, Article 104641.https://doi.org/10.1016/j.compedu.2022.104641  

Singing always off pitch? Study shows that it may not entirely be your fault

November 10, 2024

　　Have you ever experienced difficulty controlling your pitch while singing, or been thrown off by the voices of others around you? This phenomenon is closely related to the brain’s mechanisms for controlling sound. A study by Professor Li-Hsin Ning from the Department of English at National Taiwan Normal University revealed human responses to auditory interference, identifying three distinct response types: switching, opposing, and following. This research offers new insights and potential directions for fields such as speech learning and language therapy. 　　The human brain utilizes two main mechanisms when processing sound: feedforward and feedback. To illustrate, think of driving a car. The feedforward mechanism is like the “accelerator,” where the brain draws on accumulated experience to quickly and accurately produce speech. The feedback mechanism, on the other hand, acts like the “brake,” adjusting the pitch or sound in real time when it detects deviation. These two mechanisms work together in the brain to ensure our speech aligns with our expectations, much like how the accelerator and brake must be properly controlled for safe driving. 　　The study collected data from 36 Mandarin Chinese speakers. Each participant was asked to repeatedly produce the vowel sound /a/ for 3 seconds, followed by a 2-second rest before producing the next vowel, for a total of 30 trials. During the process, participants listened to their own voice through headphones, but they also heard an artificial pitch shift, either higher or lower than their original pitch, lasting for 200 milliseconds. This pitch shift could potentially influence their pitch control. Using latent class analysis, the researchers identified three main response patterns from the participants. 　　Among the participants, 57% exhibited a “switcher” response type, alternating between opposing and following the interfering sounds during the test. This group demonstrated high plasticity in their responses, sometimes following the direction of pitch-shift stimulus and other times correcting their pitch. This suggests that their brains are highly adaptable to varying situations, akin to a driver who alternates between pressing the accelerator and brake based on the circumstances. 　　The “opposer” response type accounted for 28% of participants, who primarily exhibited immediate pitch correction. Their brains displayed a high degree of resilience to pitch variation, quickly responding to errors and maintaining pitch accuracy. The “follower” response type made up 15% of the participants, who were more easily influenced by surrounding sounds. These individuals tended to mimic the pitch shift they heard, showing a more relaxed brain response to auditory signals. When others sang off-pitch, they followed suit, demonstrating looser control over their pitch regulation.   Caption: This study collected data from 36 Mandarin Chinese speakers, where each participant sequentially produced the vowel sound "/a/" for 3 seconds, followed by a 2-second rest before producing the next vowel. A total of 30 trials were conducted.   　　Previous research often suggested that individuals with excellent pitch control, such as singers or vocalists, are better able to resist pitch interference from their environment, quickly “braking” when they detect an incorrect tone. However, Professor Ning, who has long studied phonetics, articulatory phonetics, and psycholinguistics, challenges this perspective. Through her research and analysis, she proposes a more complex response model—following, opposing, and switching—which demonstrates the variety of human responses to pitch interference. Furthermore, when the direction of pitch change is predictable, the proportion of following responses significantly increases, highlighting the importance of predictability in language control.  　　The study also discovered that as the experiment duration increased, participants’ responses began to change. Professor Ning divided the experiment into three stages: initial, middle, and final. Initially, participants tended to use a consistent response mechanism. However, as time passed, their response patterns switched between opposing and following. By the later stages of the experiment, their responses stabilized, with participants selecting a fixed response strategy. This phenomenon provides new insights into the plasticity of language learning, suggesting that adaptability in response patterns evolves over time.  　　This research, spanning across fields such as motion science, speech science, and language learning, exemplifies an interdisciplinary collaboration. Professor Ning acknowledges the significant challenges faced during the process, particularly the relative scarcity of experts in acoustic engineering in Taiwan. Finding a suitable collaborator took one to two years. Ultimately, the team partnered with Dr. Tak-Chang Hsu, a Senior Lecturer at Hong Kong Metropolitan University, who not only has a background in music, but also has programming skills and experience in electronic music production. Through collaboration with a partner from a different professional background, the research team was able to overcome technical barriers and successfully complete the study. 　　When discussing the applications and future directions of the research, Professor Ning highlighted that the findings could be applied to language learning and speech therapy, particularly for learners who struggle with pitch control. In language learning, the study revealed different response patterns among learners when processing speech, suggesting that, based on their response types, personalized learning strategies could be developed for individuals with high plasticity or those exhibiting more fixed responses. This could also help improve speech control abilities, offering new therapeutic avenues for individuals with speech disorders. 　　National Taiwan Normal University also houses a Neurolinguistics Laboratory. Professor Ning mentioned that current research primarily focuses on behavioral experiments. Moving forward, she hopes to integrate this research with neuroscience to observe how the brain controls responses during speech production. This would allow for further validation of the behavioral findings, providing more precise scientific data to support the proposed theories. (This article was provided by The Center of Public Affairs.)   Source: Ning, L. H.(2022).Identifying distinct latent classes of pitch-shift response consistency: Evidence from manipulating the predictability of shift direction. Frontiers in Psychology, 13, https://doi.org/10.3389/fpsyg.2022.1058080

Triboelectric Generators Could Change the Future of Wearable Devices

November 10, 2024

　　What types of microgenerators can be worn on the body? Professor Chii-Rong Yang from the Department of Mechatronic Engineering at National Taiwan Normal University and his research team have made a significant breakthrough by integrating flexible electronics with triboelectric technology. They have successfully developed a self-powered wearable sensor. This advancement not only opens new avenues for research into energy-autonomous wearable electronics but also introduces novel directions and possibilities for future technological applications. 　　Professor Yang’s primary research areas include micro-electro-mechanical systems (MEMS), nanotechnology, emerging energy devices, and the synthesis of nanocarbon materials. He holds numerous domestic and international invention patents. Initially, his laboratory focused on research in solar and fuel cells. However, the energy-harvesting potential of triboelectric technology soon captured the team's interest. From early experiments using liquid metal electrodes to the later adoption of malleable metal electrodes, the team has continually sought materials and structural designs that offer enhanced functionality, performance, and safety. 　　The triboelectric generator (TEG) is a device capable of converting mechanical energy into electrical energy, making it well-suited for wearable technologies that require self-sustaining power sources. To meet the demand for high flexibility in wearable applications, Professor Yang’s team selected an innovative material that combines liquid metal with glaze powder. This composite not only maintains excellent electrical conductivity but also provides the flexibility and durability essential for wearable use. As the research progressed, and in response to the increasing performance demands of wearable systems, the team replaced conventional polymer substrates with textile-based materials. This shift further enhanced the triboelectric performance and device stability. Ultimately, they succeeded in developing a triboelectric device that is highly flexible, stable, cost-effective, and manufacturable through a simplified process.  　　Experimental tests demonstrated that this TEG, utilizing a GO@PDMS film treated with SF₆ plasma surface modification, was capable of generating an open-circuit voltage of 140.37 V and a short-circuit current of 2.57 μA. Under a load resistance of 50 MΩ, the device achieved a maximum output power of 130.5 μW. These results indicate a significant enhancement in energy conversion efficiency, highlighting the system’s potential for practical applications in self-powered wearable electronics.  　　Due to the triboelectric properties of PDMS, which tends toward negative charge generation, along with its ease of formulation and surface modification, the research team further engineered PDMS into a porous structure. By mixing graphene oxide (GO) flakes with deionized water to form a suspension, and blending it with PDMS slurry, they successfully fabricated a porous GO@PDMS triboelectric layer. This layer was then integrated with conductive fabric composed of 100% polyester electroplated with nickel and copper, resulting in a fabric-based triboelectric device characterized by high flexibility and softness. This configuration is particularly well-suited for integration with wearable electronic devices.  　　During the experiments, the research team integrated a TEG device into clothing and various parts of the body, successfully harvesting motion signals. Remarkably, the device was able to power 180 green LEDs connected in series, showcasing its potential as a micro-scale energy generator. Furthermore, the team demonstrated its application in wireless sensing by transmitting pressure signals to a computer via a Bluetooth module. According to Professor Yang, the triboelectric device also exhibits washability and long-term durability. When embedded in garments, it can function as a motion sensor, capturing human movement data for wearable sensing applications.  　　Professor Yang noted that beyond energy generation, the device also functions effectively as a pressure sensor capable of monitoring human motion and physiological signals. For instance, when embedded in footwear, it can emit light with each step; when integrated into clothing, it can continuously monitor heart rate. In critical situations such as cardiac arrest, the system could instantly alert emergency services or trigger automatic hospital notifications, thereby maximizing the chances of timely medical intervention during the golden rescue   timing.  　　This research has also involved collaboration with the Department of Electrical Engineering, where the sensor was integrated into a robotic arm. Upon detecting contact signals, the system was able to immediately cut power to the arm—functioning like an "electronic skin" that enhances the safety of robotic systems by enabling rapid response and providing crucial escape time in emergency scenarios. Beyond everyday energy harvesting, this technology also shows promise in specialized environments, such as integration into life vests, where it can ensure both safety monitoring and continuous power supply in critical situations.  　　Looking ahead, Professor Yang emphasized that the team is currently working on integrating capacitors with triboelectric generators, aiming to enable energy storage within the system itself. This innovation is expected to significantly expand the application potential of fabric-based triboelectric devices. In the era of the Internet of Things (IoT), where sensors are required in virtually every environment, reliance on conventional batteries becomes impractical. By allowing sensors to harvest mechanical energy and convert it into electricity through triboelectric generators, this technology offers a promising solution for sustainable, maintenance-free sensing systems—paving the way for broader deployment and functionality in the IoT application field. (This article was provided by The Center of Public Affairs.)      Figure 1: LED bulbs illuminated by a TEG   Figure 2: Wireless transmission of pressure sensing data using a TEG    Figure 3: Application of TEG as "electronic skin" for a robotic arm   Source: Yang, C. R., Ko, C. T., Chang, S. F., & Huang, M. J. (2022). Study on fabric-based triboelectric nanogenerator using graphene oxide/porous PDMS as a compound friction layer. Nano Energy, 92, Article 106791. https://doi.org/10.1016/j.nanoen.2021.106791

Asian children are less susceptible to constipation – except for Taiwanese children

October 11, 2024

　　Child or adult, nearly everyone knows what it feels like to be “a little backed up,” so to speak. Assistant Professor Ngan Thi Kim Nguyen from the NTNU Programs of Nutrition Science has conducted in-depth research on the prevalence of constipation among Asian children and its related factors. Her findings reveal that the prevalence of constipation among Asian children is approximately 12%, which is significantly lower than the global average of 29%. Among Asian regions, South Asia has a slightly lower prevalence rate (6.9%) compared to East Asia (14.1%). However, a surprising discovery is that the prevalence of constipation among school-aged children in Taiwan reaches 32.2%, far exceeding that of other regions in Asia. 　　Deputy Director of the Nutrition Science Programs, Szu-Chuan Shen, says that Assistant Professor Nguyen’s paper Prevalence and Determinants of Constipation in Children in Asia: A Systematic Review and Meta-Analysis was recently published in eClinical Medicine, a sub-journal of the internationally prestigious The Lancet. With an impact factor of 15.1, being published in eClinical Medicine speaks to the study’s significance in both the global medical and academic communities. Figure 1: Assistant Professor Ngan Thi Kim Nguyen (left) from the Nutrition Science Programs has had her research published in eClinical Medicine, a sub-journal of the prestigious The Lancet.   Filling the Gaps in Pharmaceutical Research: A Comprehensive Look at Childhood Constipation from an Asian Perspective   　　Assistant Professor Ngan Thi Kim Nguyen from the Programs of Nutritional Science originally graduated as a medical doctor from University of Medicine and Pharmacy at Ho Chi Minh City in Vietnam and was also a practicing clinician. Driven by her deep interest in nutritional science, she moved to Taiwan alone to pursue International Master Degree in Medicine and then Ph.D. in School of Nutrition and Health Sciences at Taipei Medical University. Upon earning her doctorate, she joined the Undergraduate Program of Nutrition Science at National Taiwan Normal University as a faculty member. 　　Assistant Professor Nguyen explains that functional constipation (FC) is characterized by symptoms such as dry, hard stools, infrequent bowel movements, and incomplete evacuation. Despite ongoing research, the pathophysiology of constipation remains insufficiently understood. Currently, most studies on the nutritional factors related to functional constipation are based on data from children in Western countries, while research on Asian pediatric populations is severely lacking. However, given the significant differences between Asia and Western countries in terms of national conditions and dietary habits, the prevalence and causes of functional constipation in children may also differ. Therefore, it would be inappropriate to directly apply Western data to Asian children without further investigation. 　　Assistant Professor Nguyen shared that her personal motivation for studying constipation stemmed from her own niece’s struggles with this condition. She recalled, “There was a time when my little niece was in so much pain while trying to pass stool that she burst into tears—it shook me to the core.” Despite trying various treatments, including enemas, dietary changes, and applying established medical theories, her niece’s condition did not improve. Over time, the painful experiences even led to a fear of using the toilet. Witnessing her niece's suffering firsthand solidified Assistant Professor Nguyen’s determination to dedicate her research to understanding and addressing this issue.   Systematic Meta-Analysis: Mapping Childhood Constipation Across Asia 　　Reflecting on the research process, Assistant Professor Nguyen shared, “The collecting of data alone took two years, and completing the paper took another.” Her study employed a meta-analysis approach, systematically reviewing existing literature to reconstruct an overview of childhood constipation in Asia. She analyzed data from international academic databases, initially screening over 3,000 research papers before narrowing the selection to 50 studies containing relevant data on pediatric constipation in Asia. By examining the correlations within these datasets, she was able to generate advanced findings and provide a comprehensive clinical overview of constipation symptoms among children across Asia.   Figure 2: Research Process   Figure 3: Prevalence of Constipation and Diagnostic Methods Across 15 Countries or Regions. The gradient colors represent the prevalence of constipation. The darker the shade, the higher the prevalence. The symbols denote the diagnostic methods used in each study. If a study was conducted in two cities, the marker is placed between them; if conducted in three or more cities, the marker is positioned at the country's central location.   　　Assistant Professor Nguyen’s research highlights that in Asia, functional constipation is more prevalent among older children aged 1 to 12 compared to those under 1 year old.  Aside from being the first study to report the prevalence of pediatric constipation in Asia, her findings challenge traditional assumptions. She discovered that, contrary to what was previously believed, neither geographical location nor gender are major factors influencing functional constipation. While dietary fiber is known to help alleviate constipation, the lack of comprehensive data on fiber intake among Asian children and its relationship to functional constipation makes it difficult to establish a definitive correlation at this stage. 　　Furthermore, Assistant Professor Nguyen’s research represents a breakthrough in the field of childhood constipation, uncovering a potential link between constipation and children’s mental health. She found that children experiencing psychological distress or significant stress—such as competing with siblings for parental attention—had a higher prevalence of constipation (22.6%). She also proposed a hypothesis: “Constipation and psychological stress may be mutually interactive. Mental health issues could trigger constipation, affect brain development, and ultimately have a negative impact on children's academic performance.”   The Ongoing Research: Exploring Links Between Constipation, Insomnia, Obesity, Gut Microbiota, and Psychological Stress 　　Assistant Professor Nguyen noted that the biggest limitation of her study was the inability to establish a clear link between sleep disorders and childhood constipation. “While many previous studies have shown a connection between constipation and sleep disorders in adults, our study did not find a significant association in children,” she explained. Despite this, her research has paved the way for further exploration in the field. She has now secured funding from the National Science and Technology Council (NSTC) and is actively conducting new studies to investigate the connections between childhood constipation, insomnia, obesity, gut microbiota, and psychological stress. 　　Assistant Professor Nguyen concluded that, historically, the diagnosis and treatment of childhood constipation have largely relied on standards and medications developed in Western countries. However, these methods may not be suitable for Asian children. Her research, which provides a comprehensive analysis of childhood constipation in Asia, offers valuable data that can help develop more accurate and tailored diagnostic frameworks specifically for Asian—and perhaps Taiwanese—children with functional constipation. (This article was provided by The Center of Public Affairs.)   Source: Djurijanto F., Lin S. H., Vo N. P., le N. Q. K., Nguyen-Hoang A., Shen S. C., Wu C. H., Chen J. Y., and Nguyen N. T. K., Prevalence and determinants of constipation in children in Asia: a systematic review and meta-analysis, EClinicalMedicine. (2024) 71, 102578, https://doi.org/10.1016/j.eclinm.2024.102578. 

Professor Yung-Chih Chen’s Top Three Strategies to Counteract Negative effects of Prolonged Sitting

October 11, 2024

　　In modern society, prolonged sedentary behavior has become a common lifestyle, particularly among office workers who may not have the time for regular exercise. However, extended periods of sitting can have detrimental effects on health, including impaired postprandial blood glucose and insulin regulation, as well as an increased risk of weight gain and obesity. Associate Professor Yung-Chih Chen from the Department of Physical Education and Sport Sciences at National Taiwan Normal University has conducted two studies demonstrating that interrupting prolonged sitting can promote metabolic health by stimulating the secretion of gut hormones and increasing energy expenditure. His research also explores simple strategies to break up sedentary behavior and enhance overall well-being. 　　Professor Yung-Chih Chen was awarded a government-funded scholarship by the Ministry of Education, and earned his Ph.D. in 2016 from the Department for Health at the University of Bath, UK. He subsequently conducted two years of postdoctoral and visiting scholar research at the same institution. His current research focuses on various health-related issues in daily life, including the impact of sedentary behavior on health, the relationship between physical activity and circadian rhythms, and the effects of exercise on energy balance and eating behavior. 　　During his postdoctoral research, Professor Chen conducted two studies examining the health implications of prolonged sitting. Gut hormones play a crucial role in human metabolism and appetite regulation, with key hormones including glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), and peptide YY (PYY). After food intake, these hormones are secreted by the gut, stimulating pancreatic β-cells to release insulin while suppressing pancreatic α-cell secretion of glucagon to regulate blood glucose levels. Additionally, gut hormones have appetite-suppressing effects, making them key factors in weight control. However, individuals who are overweight or obese often exhibit reduced or abnormal postprandial gut hormone secretion. While bariatric surgery and pharmacological interventions can enhance gut hormone secretion, these methods are invasive. Therefore, Professor Chen’s research focuses on identifying non-invasive strategies to increase postprandial gut hormone levels in this population. 　　In his study, Professor Chen recruited middle-aged individuals with a sedentary lifestyle and central obesity (average age: 51 ± 5 years) to compare the effects of prolonged sitting (SIT: 5.5 hours of uninterrupted sitting) and interrupted sitting (BREAKS: 2 minutes of brisk walking every 20 minutes, accumulating 30 minutes of physical activity over 5.5 hours) on the concentrations of GLP-1, GIP, and PYY. The results showed that breaking up prolonged sitting significantly increased postprandial GLP-1 (Figure D) and PYY (Figure F) levels. This finding suggests that even low-intensity physical activity to interrupt prolonged sitting can enhance gut hormone concentrations, similar to the effects of continuous exercise, clinical surgery, or medication. As a result, individuals who are unable to engage in continuous exercise or who are required to sit for extended periods at work may benefit from such intermittent activity to boost gut hormone levels. Professor Chen also noted that due to genetic and physiological differences between Western and Asian populations, a similar study was conducted at National Taiwan Normal University to collect data on Asian participants. The research further examined differences between individuals with normal weight and those who are overweight. The findings have recently been accepted for publication in an international journal (https://pubmed.ncbi.nlm.nih.gov/38767985/).   Source: Chen YC, Walhin JP, Hengist A, Gonzalez JT, Betts JA & Thompson D. (2022). Interrupting Prolonged Sitting with Intermittent Walking Increases Postprandial Gut Hormone Responses. Medicine and science in sports and exercise 54, 1183-1189.    　　Another study examined the impact of standing and neuromuscular electrical stimulation (NMES) on health. NMES is commonly used in physical therapy and muscle relaxation, promoting muscle contraction through passive stimulation. 　　This study recruited young, healthy adults (average age: 28 ± 9 years) and conducted three experimental conditions: (1) 2 hours of uninterrupted sitting (SIT), (2) 2 hours of continuous standing (STAND), and (3) 2 hours of NMES applied to the quadriceps and calf muscles at a self-selected comfortable intensity (NMES). During each condition, participants underwent a 2-hour glucose tolerance test and energy expenditure measurement.  　　The results showed that both 2 hours of STAND and lower-limb NMES at a self-selected comfortable intensity effectively increase energy expenditure ( Figure A) and reduce insulin concentrations during the glucose tolerance test (Figure B). According to Professor Chen, these results show that low-intensity active (e.g., standing) and passive (e.g., NMES-induced) muscle contractions can immediately enhance energy expenditure and improve insulin sensitivity.    Source: Chen YC, Davies RG, Hengist A, Carroll HA, Perkin OJ, Betts JA & Thompson D. (2022). Effects of neuromuscular electrical stimulation on energy expenditure and postprandial metabolism in healthy men. Applied Physiology, Nutrition, and Metabolism 47, 27-33.   　　Professor Chen summarized three effective strategies for breaking up prolonged sitting and improving health based on the findings of his two studies.  First, engage in brief, regular physical activity – performing 2 to 5 minutes of brisk walking every 20 to 60 minutes, accumulating a total of 30 minutes of activity throughout the day. Simple actions such as walking around, getting up to refill a water bottle, or taking the stairs can effectively interrupt prolonged sitting. Second, use a sit-stand desk – alternating between sitting and standing can help reduce sedentary time in office settings. Finally, apply NMES – this method passively induces muscle contractions, offering an alternative for those who may not be able to engage in physical movement.  These three approaches can be integrated into work environments where prolonged sitting is common to help individuals mitigate the negative health effects of sedentary behavior. 　　Professor Chen emphasized that the appropriate duration of standing varies from person to person, and NMES should be applied at a comfortable intensity tailored to individual tolerance. Additionally, NMES should not be used near the heart, on injured muscles, or by individuals with neuromuscular sensory impairments to ensure safety.   (Interview and article provided by the NTNU Public Affairs Center.)   Source: 1.Chen, Y. C., Walhin, J. P., Hengist, A., Gonzalez, J. T., Betts, J. A., & Thompson, D. (2022). Interrupting Prolonged Sitting with Intermittent Walking Increases Postprandial Gut Hormone Responses. Medicine and Science in Sports and Exercise, 54(7), 1183-1189. https://doi.org/10.1249/MSS.0000000000002903 2.Chen, Y. C., Davies, R. G., Hengist, A., Carroll, H. A., Perkin, O. J., Betts, J. A., & Thompson, D. (2022). Effects of neuromuscular electrical stimulation on energy expenditure and postprandial metabolism in healthy men. Applied Physiology, Nutrition and Metabolism, 47(1), 27-33. https://doi.org/10.1139/apnm-2021-0361

VR can help pupils develop empathy and boost creativity, says Professor Yu-Shan Chang

September 10, 2024

　　Virtual Reality (VR) has emerged as an innovative technology across various industries, and has proven to be a valuable tool in education, offering students an entirely new sensory experience. Professor Yu-Shan Chang from the Department of Technology Application and Human Resource Development at National Taiwan Normal University has found that VR provides students with immersive contextual experiences, enhances their spatial and three-dimensional conceptualization, and facilitates the design of user-centered blueprints.  　　Professor Chang specializes in creativity education and technology education. His research team is dedicated to developing technology-based teaching materials and tools, which are actively promoted in elementary and secondary schools. In recent years, his research has also expanded to AI education and the application of AR/VR in teaching. Recent education research findings have consistently shown that VR applications are effective not only for enhancing conceptual understanding and skill training, but also for improving attitudes and emotional intelligence. Even neuroscience studies have provided physiological evidence to support these claims. Given this, it is increasingly important to explore whether such emerging technologies can be applied effectively in the realm of creative education—this is therefore a topic of growing interest among researchers.  　　To investigate the impact of VR applications on creativity and design performance, Professor Yu-Shan Chang led his research team in implementing a study within the eighth-grade Living Technology course across six middle school classrooms. In the interior design instructional unit, three classes were assigned to be the experimental group, which received VR-based instruction, while the other three served as the control group, receiving traditional slideshow-based instruction.    　　The study's findings indicated that VR’s high-quality visuals, animations, interactive features, and immersive environments significantly enhanced students’ learning outcomes. Not only did VR stimulate learners’ learning motivation and foster a positive attitude, but it also helped students develop empathy by allowing them to better understand user needs within specific contexts. As a result, students demonstrated a heightened sensitivity to situational factors in the design process.  　　In contrast, the control group, which lacked the immersive experience of a virtual environment, relied solely on teacher instruction and personal imagination. However, without a concrete visual reference, students struggled to form clear mental images. Additionally, during the design thinking process, their performance in the empathy stage was noticeably less defined compared to the experimental group.  　　Of course, the use of VR in the education setting is not without its challenges. According to Professor Yu-Shan Chang, one of the greatest difficulties is finding the right software—a challenge that persists to this day. Furthermore, the available software often has functional limitations; for instance, some VR content does not accurately reflect real-life scenarios and lacks essential physics and engineering simulation features. Another challenge stems from the target learners—middle school students—who have limited hands-on experience and design skills. The lack of prior knowledge and minimal design experience made it difficult for some students to grasp more complex operations and design concepts, which in turn affected their learning outcomes. Additionally, some students experienced motion sickness induced by VR. 　　Professor Yu-Shan Chang emphasizes that VR applications provide students with immersive experiences, helping them develop spatial awareness and three-dimensional conceptualization. Moreover, VR encourages creative exploration by offering more opportunities for experimentation and risk-taking during the design process. He believes that creativity requires the courage to take risks and embrace failure. Through VR, students can repeatedly simulate various scenarios, allowing them to experiment more freely and confidently in a safe, controlled environment.  　　However, the impact of VR applications on divergent thinking—a key aspect of creative thinking—remains unclear. In other words, while VR’s high-quality 3D visual design enhances students’ conceptual understanding and knowledge acquisition, it does not have a significant effect on general creative thinking abilities. Therefore, additional instructional strategies are needed to further develop students' creative thinking skills. The study also found that factors such as context and task type, different forms of creativity (e.g., leap-based vs. incremental creativity), and varying learning styles all influence learners’ VR engagement, cognitive load, creative thinking, and overall creative performance. Moreover, VR has great potential for educational applications in environments that are high-risk, costly, or difficult to access, making it a valuable tool for achieving instructional goals in such settings.  　　Regarding future research, Professor Yu-Shan Chang stated that he will continue exploring the effects of VR applications in creativity education, with a particular focus on how VR influences physiological responses such as emotional changes and brainwave activity. By employing scientific methods, his research aims to objectively assess students' creative performance, providing deeper insights into the relationship between creativity and cognition. (This article was provided by The Center of Public Affairs.)    Source: Chang, Y. S., Kao, J. Y., & Wang, Y. Y. (2022). Influences of virtual reality on design creativity and design thinking. Thinking Skills and Creativity,46, Article 101127. https://doi.org/10.1016/j.tsc.2022.101127.

Passwords Keep Getting Cracked? A New Verification Scheme Helps Improves Security

September 10, 2024

　　When logging into computer systems, using email, or accessing various social networking sites, the first step typically involves entering a username and password. If authentication credentials are compromised, they can be exploited. Dr. Albert Guan, Assistant Professor in the Department of Computer Science and Information Engineering at National Taiwan Normal University, has pioneered research on “A Novel Verification Scheme to Resist Online Password Guessing Attacks.”  This research has effectively tackled the risks related to passwords, offering innovative insights into information security. 　　In modern information systems, usernames and passwords are the most commonly used mechanisms for verifying user identities. Although the public generally understands the importance of protecting their accounts and passwords, incidents of account misuse remain frequent. The primary reason is that poorly conceived password settings can be easily guessed, which, like the leakage of account credentials, can lead to identity theft. This type of threat is referred to as a "password guessing attack." 　　To prevent passwords from being guessed, Dr Albert Guan explains that a common authentication method is to limit the number of password attempts for the same account to a maximum of three within a certain time frame. If all three attempts fail, further attempts are blocked, and users must wait before trying again. However, this approach addresses only the symptom but not the underlying issue. Another method requires passwords to have a certain length and complexity criteria. While this makes passwords harder to guess, they are also harder for users to remember, reducing convenience. 　　In response to these challenges, Dr Albert Guan launched research aimed at finding a simple yet effective method to prevent malicious password guessing attacks and account theft. His research begins by analysing the behaviour patterns of users when they enter their usernames and passwords, aiming to distinguish legitimate users from attackers. The study assumes that the legitimate user knows their password, while the attacker has no prior knowledge of the password and can only make guesses. Using probability and statistics, Dr Guan developed a mathematical model to represent the behaviours of both users and attackers. He then applied principles from information theory to determine whether an entered password is likely to come from the user or an attacker. 　　For example, let's examine the following two different  password-entering scenarios:  A： admin, wellcome, welcome B： abc123, password, welcome 　　Dr Guan explains that even though both scenarios involve successfully entering the correct password on the third attempt, most people would consider User A as a legitimate user and User B as a possible attacker. The reasoning lies in the behaviour: User A might have accidentally entered the password for a different account on the first attempt, typed an extra character on the second attempt, and then succeeded on the third. In contrast, User B’s attempts seem more like intentional trial and error. This observation inspired the research team to establish a theoretical framework to support such judgments. Figure 1: Entropy values of different password strings calculated by the research team     　　Based on the research results shown in the above graphs, Dr Guan analysed that the dark red line represents the entropy of password strings entered by attackers, while the other three lines in different colours represent the entropy of password strings entered by legitimate users. The graph reveals that even if users make an average of two typing errors per password attempt, the entropy of their input remains lower than that of random guesses made by attackers. This disparity is particularly pronounced when it takes 2 to 4 attempts for the user or the attacker to enter the correct password. This finding indirectly validates the rationale behind the commonly used authentication mechanism of blocking further password attempts after three consecutive failures. 　　The research team employed the concept of uncertainty to develop their inference method and ultimately designed a simple yet effective approach to estimate whether a password input is the result of "random guessing." The method involves calculating the number of unique characters used in the entered password strings. For example, if User A's input contained 12 unique characters while User B's input included 18 unique characters, it can be inferred that A is likely a legitimate user, whereas B is more likely an attacker. 　　Dr Guan explains that this new authentication mechanism is not only theoretically valuable but also highly practical. It requires only minor modifications to existing user authentication systems and does not rely on knowing the user's original password. This makes it easy to integrate into current authentication systems. The mechanism improves password security by allowing users to choose easily memorable passwords while simultaneously preventing password guessing attacks. 　　It is important to note that this research does not diminish  the value of strong passwords. Strong passwords are inherently challenging to guess and remain essential. The primary contribution of this study is its ability to provide  an added  layer of protection to existing password systems, regardless of the strength of the chosen password. When suspicion arises, the system can activate a secondary authentication process to enhance security further. 　　Regarding future advanced research, Dr Albert Guan stated that, in addition to collaborating with industry to enhance the applicability of the study, further research could focus on estimating the residual uncertainty of passwords after multiple failed guessing attempts by attackers. When the uncertainty drops below a certain threshold, the system could notify users to change their passwords, thereby reducing the risk of account compromise. (This article was provided by The Center of Public Affairs.)   Source: Guan, A., & Chen, C. M. (2022). A novel verification scheme to resist online password guessing attacks. IEEE Transactions on Dependable and Secure Computing, 19(6), 4285-4293.https://ieeexplore.ieee.org/document/9773951 

How to Help Teenagers Overcome Internet Addiction

August 11, 2024

The internet has become an indispensable part of modern life, with nearly every adolescent owning a mobile device. This not only changes the way they learn, but also poses the risk of internet addiction. Professor Min-Pei Lin from the Department of Educational Psychology and Counseling at National Taiwan Normal University conducted a two-year longitudinal study on first-year high school students in Taiwan to investigate the phenomenon of internet addiction among Taiwanese adolescents and its underlying causes. The study found that when adolescents experience negative psychological states and have lower distress tolerance, they often turn to the internet or vent their emotions as a way to "escape" from stress, gradually becoming addicted to the internet. In recent years, scholars have found an association between distress tolerance and internet addiction, yet longitudinal studies on this topic remain scarce. To explore the causes and impacts of internet addiction, Professor Lin conducted a two-year longitudinal study, distributing surveys to approximately 2,170 first-year high school students in Taiwan. The first year focused on assessing the distress tolerance of adolescents, while the second year followed up to investigate how these adolescents coped with stress. The study aimed to understand their coping strategies in response to pressure, and how these strategies relate to their internet usage behaviors. The study found a strong correlation between internet addiction and adolescents' coping strategies for stress. Adolescents who lack proper emotional regulation skills are more prone to developing internet addiction when faced with setbacks. Those with low distress tolerance are likely to choose avoidance or emotional reactions when encountering stress, often relying on the internet as a means to alleviate uncomfortable emotions. In the survey, Professor Lin categorized adolescents' sources of stress into four scenarios: academic workload, being criticized or misunderstood, major life events such as exams or surgeries, and relationship issues. The study found that when adolescents encounter these stressors without appropriate coping strategies, they are more likely to turn to the internet as a means of escaping reality or seeking temporary relief. Adolescents prone to internet addiction often exhibit four types of addictive behavior. The first is gaming addiction, where adolescents become engrossed in online games that offer instant gratification and a sense of achievement, enabling them to avoid addressing real-life issues. The second is social media addiction, characterized by adolescents seeking instant interaction and feedback on social media platforms. While this provides a strong sense of belonging and accomplishment, it can also hinder their ability to engage in face-to-face communication in real-life settings. The study also found that some adolescents become addicted to binge-watching shows or browsing short videos, behaviors that can be difficult to control and may disrupt their daily lives and academic performance. Additionally, a portion of adolescents may fixate on online content featuring pornography or violence, which not only harms their mental health but may also lead to behavioral issues in real life. Sudden restrictions on internet use can result in withdrawal symptoms, such as irritability and anger, or feelings of depression and low mood, both of which pose challenges for parents and educators. Following the COVID-19 pandemic, the Taiwanese Ministry of Education introduced the "Tablets for Every Student" policy, which has become a double-edged sword in addressing internet addiction. On one hand, it is seen as a powerful tool for enhancing learning; on the other hand, parents worry that if not used strictly for educational purposes, excessive use of smartphones and tablets, or even addiction to them, could negatively impact academic performance and mental health. Professor Lin noted that while adolescents are aware of the negative aspects of excessive internet use, they simultaneously enjoy its benefits and drawbacks, creating a struggle between wanting to control their behavior and being unable to stop. To address the issue of internet addiction, Professor Lin proposed two educational solutions: Social and Emotional Learning (SEL) and mindfulness education, as strategies to shift the current situation. Through Social and Emotional Learning (SEL), adolescents can enhance their emotional regulation and social skills, enabling them to cope more effectively with setbacks and stress. Mindfulness education, on the other hand, encourages students to develop an awareness of their emotions and behaviors, allowing them to acknowledge discomfort without immediate reaction, and to cultivate a sense of calm. Both approaches equip adolescents with healthier and more rational strategies for responding to stress. Professor Lin also suggested that when adolescents encounter stressful events, educators and parents should guide them to avoid resorting to escapism, such as isolating themselves at home, excessive internet use, or smartphone reliance. They should also discourage emotional venting behaviors like crying, anger, or complaining as primary coping mechanisms. Instead, adolescents should be encouraged to leverage their inner strength or seek support from their social networks to face and navigate the stressful event together, ultimately weathering the emotional turbulence.  Professor Lin likened overcoming internet addiction to the "philosophy of investment," emphasizing the importance of diversifying sources of happiness, akin to not putting all one’s eggs in one basket. Adolescents should be encouraged to explore alternative sources of fulfillment and joy. (This article was provided by The Center of Public Affairs.)   Figure 1: The causal pathways of adolescent internet addiction     Source: Lin, M. P. (2022). Avoidance/emotion-focused coping mediates the relationship between distress tolerance and problematic Internet use in a representative sample of adolescents in Taiwan: One-year follow-up. Journal of Adolescence, 94(4), 600-610. https://doi.org/10.1002/jad.12049

Big Data Confirms that Methylphenidate is good for reducing ADHD Mortality in the Long Term

August 11, 2024

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adolescents, significantly impacting cognitive learning and social interactions. Methylphenidate (MPH) is the primary pharmacological treatment for ADHD; however, parents’ concerns about potential side effects, including self-harm and suicide, have posed substantial challenges for clinical management. Professor Tzu-Chi Lee from the Department of Health Promotion and Health Education at National Taiwan Normal University has pioneered research in Taiwan to clarify the relationship between MPH use and mortality rates. The findings reveal that individuals who use MPH exhibit lower overall mortality rates compared to those who do not. Additionally, earlier initiation of MPH treatment following an ADHD diagnosis, as well as long-term use of the medication, is associated with further reductions in mortality risk. Professor Tzu-Chi Lee specializes in biostatistics and big data analysis, leveraging extensive datasets from health and medical databases to provide novel insights for clinical medicine. Using high-efficiency analytical programs he developed himself, and employing methods from epidemiology and genomics, his work frequently sheds light on complex medical phenomena. His research topics often stem from "unexplained cases" encountered by pediatric psychiatrists during clinical practice—issues that lack clear scientific explanations. Resolving these challenges typically requires his expertise in statistical research to provide empirical evidence and support. Over the past two decades, methylphenidate (MPH) has been regarded as the primary medication for ADHD treatment. Professor Lee noted that some physicians have reported parental concerns regarding side effects observed in their children after taking the medication. However, these concerns are not centered on the commonly listed side effects, such as sleep disturbances or appetite loss, as indicated on the package insert. Instead, parents are particularly worried about anecdotal cases they have heard of, such as incidents of suicide or accidents occurring after medication use. The lack of causal research on such cases has contributed to parents viewing MPH use with apprehension. This skepticism often leads to medication discontinuation or interruption, significantly impacting the effectiveness of treatment. In response to clinical physicians' requests for assistance, Professor Lee embarked on a comprehensive study, revisiting and adopting a novel research methodology to conduct a "repeated measures cohort study." At the outset, he accessed Taiwan's National Health Insurance Research Database (NHIRD) through the Ministry of Health and Welfare, identifying a cohort of 68,096 children and adolescents aged 4 to 17 who had been diagnosed with ADHD and prescribed MPH between the years 2000 and 2010. He analyzed the annual dosage of MPH prescribed, and employed a Cox regression model with repeated measures to examine the association between MPH use and mortality rates. Professor Lee further categorized mortality into natural causes (e.g., physical illness) and non-natural causes (e.g., suicide, accidents, homicide). The study revealed that MPH use did not increase mortality from natural causes. More notably, the mortality rate from non-natural causes during periods of MPH use was lower than during periods without MPH use. This analysis confirmed that MPH not only does not contribute to deaths from natural causes, but also provides a protective effect against non-natural causes of mortality. A 2020 epidemiological study on ADHD in Taiwan reported that 8.7% of school-aged children and adolescents met the diagnostic criteria for ADHD, equating to approximately 220,000 individuals. However, when compared with statistical data from the National Health Insurance database, the prevalence rate of ADHD was only 2.44%, indicating that most children have not received proper diagnosis and treatment. This disparity is likely influenced by the stigma surrounding the disorder, as well as parental attributions of symptoms to personality traits or school disciplinary methods. Without consistent treatment, an estimated 60% of individuals with ADHD will continue to experience symptoms into adulthood. The findings of this study underscore the critical importance of early detection and treatment in influencing the progression of ADHD. In addition to examining the relationship between MPH use and mortality, Professor Lee further analyzed the differences between early, long-term use and late, short-term use of the medication. The results revealed that patients who began MPH treatment earlier and adhered to long-term usage exhibited significantly lower mortality rates. In other words, when parents observe temporary symptom relief in their children and request discontinuation of medication, physicians may use this research to support the recommendation for continued treatment and advise parents that long-term use may yield greater benefits. This study not only provides safety guidance for ADHD patients using MPH, but also offers clinical physicians robust data support. However, the research data span from 2000 to 2013, and with the rapid advancement of pharmacological developments, new ADHD medications have emerged in recent years. Future research could extend to analyzing MPH usage data from 2014 to 2024, as well as evaluating the efficacy of alternative treatments. Additionally, investigations into the comparative effectiveness of single-drug versus combination therapies could offer further insights into optimizing ADHD treatment.   Figure 1: Data selection flowchart of this study    This study utilized data from Taiwan's National Health Insurance Research Database, focusing on 183,480 children and adolescents aged 4 to 17 newly diagnosed with ADHD (International Classification of Diseases, Ninth Revision (ICD-9): 314) between 2000 and 2010. This age group was chosen because ADHD is rarely diagnosed outside this range. The primary objective of the analysis was to examine the relationship between MPH treatment and mortality rates.   Between 2000 and 2010, MPH was the primary medication used for treating ADHD in Taiwan. Atomoxetine was approved for use in Taiwan in 2007; however, its prescription rate was much lower than that of MPH, accounting for only 4% of all ADHD patients. As a result, this study excluded participants who were prescribed Atomoxetine.   To better control for the influences of gender, birth year, and the year of initial ADHD diagnosis, the research team used exact matching to select a control group of 68,096 children and adolescents who were not prescribed MPH, but matched the MPH group in terms of gender, birth year, and ADHD diagnosis year. Both groups were followed from the study baseline (the date of the first MPH prescription) until death, migration, or the end of the observation period on December 31, 2013. The flowchart systematically illustrates the process of exclusion and selection of study participants, establishing two comparable study groups—those who used MPH and those who did not—balanced in terms of gender, birth year, and ADHD diagnosis year, for subsequent analysis. (This article was provided by The Center of Public Affairs.)   Source: Chen, V. C. H., Chan, H. L., Wu, S. I., Lu, M. L., Dewey, M. E., Stewart, R., & Lee, C. T. C. (2022). Methylphenidate and mortality in children with attention-deficit hyperactivity disorder: Population-based cohort study. British Journal of Psychiatry, 220(2), 64-72. https://doi.org/10.1192/bjp.2020.129