A Comparison of Comorbidity and Psychological Outcomes in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

OBJECTIVE: The purpose of this study was to compare psychiatric comorbid disorders and psychological outcomes in children and adolescents with Attention-deficit/hyperactivity disorder (ADHD). METHODS: Subjects were divided into a child group (aged under 12 years) and an adolescent group (aged 12 years and above). All subjects were diagnosed with ADHD based on the DSM IV diagnostic criteria using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Korean Version (K-SADS-PL-K). The K-SADS-PL-K was also used to evaluate those psychiatric disorders comorbid with ADHD. And the Korean version of the Child Behavior Checklist (K-CBCL) was used to examine the subjects' psychological outcomes. RESULTS: The rate of comorbidity in adolescent group was significantly higher than that in the child group. In particular, the adolescent group had a significantly higher ratio of comorbid conduct disorder and mood disorder than the child group. With respect to the predominantly inattentive type and Not Otherwise Specified, the school subscale scores on the K-CBCL for the children were significantly higher than those for the adolescents. CONCLUSION: These results suggest that the psychiatric comorbidity may differ between adolescents and children with ADHD. Therefore when treating adolescents with ADHD, more careful assessment and treatment targeting a range of comorbidities are needed.

Comparisons of Temperamental and Sociodemographic Characteristics in Three Groups of Preschool Children with Delayed Language Development / 신경정신의학

OBJECTIVES: Temperamental and sociodemographic characteristics of developmentally delayed preschool children have not been adequately studied. This research compares temperamental and sociodemographic characteristics in 3 groups of preschool children: those with communication disorder (CD), those with mental retardation (MR), and those with pervasive developmental disorder (PDD). METHODS: One hundred ninety eight preschool children (160 males, 38 females, average age 37.8 months) with delayed language development were included in this study. Developmental status of children was assessed by Bayley scales of infant development II, and temperamental characteristics were assessed by PTQ (Parental Temperamental Questionnaire). Sociodemographic characteristics of children were assessed with a questionnaire developed by us. Subjects were divided into three groups according to Bayley scale and Childhood autism rating scale (CARS). RESULTS: CD groups showed higher scores on rhythmicity and persistence than MR and PDD groups. CD group showed lower scores on threshold of reaction than MR group. On intensity of reaction and quality of mood, CD group showed higher scores than the PDD group. Sociodemographic characteristics were not different among the 3 groups. CONCLUSION: There are differences in temperamental characteristics but not in sociodemographic characteristics among CD, MR, and PDD.

Temperament and Character Patterns of Patients with Attention Deficit Hyperactivity Disorder / 신경정신의학

OBJECTIVES: The purpose of this study is to compare temperament/character patterns of patients with attention deficit hyperactivity disorders with normal controls. METHODS: The Junior Temperament and Character Inventory was given to a clinical sample of one hundred-four patients with ADHD (all male, mean age 10.46+/-1.45) and their parents. The diagnoses were done using DSM-IV criteria. Fifty ones of the patients with ADHD were confirmed by K-SADS-PL-K. One hundred forty four normal controls (all male, mean age 13.26+/-0.26) and their parents were enrolled to compare temperament and character patterns with ADHD patients. RESULTS: Novelty seeking was significantly higher in parental JTCI of patients with ADHD. Reward dependence, persistence, self directedness, cooperativeness and self transcendence (ST23) were significantly lower in both self and parental JTCI of patients with ADHD. Using K-SADS-PL-K, ADHD patients were divided into three groups with their ADHD subtype (combined type: 32, inattentive type: 11, NOS type: 7). Self transcendence (ST23) in self JTCI was significantly lower in ADHD patients of the inattentive type than those of the combined type. CONCLUSION: The temperament and character patterns of ADHD patients were different from those of normal controls. Novelty seeking was significantly higher in the ADHD patients. Reward dependence, persistence, self directedness, cooperativeness, self transcendence (ST23) were significantly lower in the ADHD patients.

The Characteristics of Adolescent Substance Abuse by the Age of the First Exposure to Substances / 신경정신의학

OBJECTIVE: To determine whether the age of the first exposure to substances influences the characteristics of substance abuse. METHOD: Ninety seven adolescent boys in a substance abuse treatment facility were evaluated by using questionnaires, individual diagnostic interviews, and psychology tests. They were classified into 3 groups, preadolescence group(PA), early adolescence group(EA), and middle adolescence group (MA) according to the age of the first exposure to substances, and the data were statistically analyzed by SPSS 9.0. RESULTS: The average age was 16.4+/-1.2 years. There were 39 in PA, 29 in EA, and 29 in MA. In comparison to EA, PA showed higher frequency in substance use, substance dependence, and positive family history of alcohol abuse. In comparison to MA, PA had higher frequency in troubles in interpersonal relationship, functional impairment, dependence on substances, withdrawal symptoms, amount of alcohol and gas consumed, positive family history of alcohol abuse. presence of comorbid psychiatric disorders, and higher score in K-subscale of MMPI. PA also used more variety of substances more frequently, and had shorter duration before starting the second substance. In comparison to MA, EA showed higher frequency of substance use, functional impairment, trouble in interpersonal relationship, diagnoses of substance dependence, and shorter duration before starting the second substance. However, less EA were from disorganized families. Among the 3 groups, there were no statistically meaningful differences in combined use of alcohol, trial of abstinence, duration of abstinence, child abuse history, family support, intelligence, and frequency and duration of running away from home. CONCLUSION: Earlier exposure to substances may lead to more serious problems of drug abuse. Earlier drug prevention education for adolescents should be provided.

Autoimmune Neuropsychiatric Disorder and Tic Symptom Exacerbation in Tourette's Disorder: Comparision of Treatment Modalities / 신경정신의학

OBJECT: The purpose of this study was to investigate that infection with group A[beta] hemolytic streptococcus may associate the mechanisms that cause or exacerbate some cases of Tourette's disorder and to evaluate the treatment effect of IG therapy, comparing between IG therapy and drug therapy. METHOD: The subjects were divided into three groups composing of the groups with increasing level of ASO titer and the group with normal level of ASO titer, treating with antipsychotics. Children with infection-triggered exacerbation of Tourette's disorder were assigned treatment with IVIG (400mg/kg/daily on 5 consecutive days) or antipsychotic drugs. Symptom severity was rated at baseline, and at 4weeks, at at 8weeks after treatment by use of standard assessment scale of tics. RESULTS: 1) The motor tic score, global severity scores and overall TS impairment rating scores of YGTSS in the group with incresing level of ASO titer were related with ASO titer. 2) Immune therapy was more effective in the group with incresing level of ASO titer than antipsychotic drug therapy. CONCLUSION: These results suggest that increasing level of ASO titer, resulting from group A[beta] hemolytic streptococcal infection has affected worsening the tic symptoms in Touette's disorder and in group with increasing level of ASO titer, IVIG therapy is more effective than drug therapy.

Korean Standardization of Parent Temperament Questionnaire for Children / 신경정신의학

OBJECTIVES: One of the factors that obstructs active progress of the temperament study in Korea is lack of the standardized assessment tools. Therefore, this study was designed and conducted for the purpose of Korean standardization of "Parental Temperament Questionnaire(PTQ)", which was developed by Thomas and Chess, to assess the temperament of children between the ages of 3 and 7 years through parental questionnaire. METHOD: The samples consisted of 1,175 children who were attending nurseries nationwide. PTQ was translated into Korean language by the authors and distributed to the parents of these children, along with "Toddler Temperament Scale(TTS)" and "Yale Child Inventory(YCI)" which had been previously standardized by different investigators. The reliability and validity of the Korean version of PTQ were tested. RESULTS: Test-retest reliability, item-category correlations and internal consistency of the Korean version of PTQ were generally satisfactory. Correlations between the perceived temperament and the rated temperament were statistically significant in all temperamental categories except distractibility. The correlation between PTQ and TTS was statistically significant in all categories. The 9 categories of PTQ correlated variously with 11 subscales of preschool behavioral assessment of YCI. CONCLUSIONS:The Korean version of PTQ is a standardized tool to assess the temperament of children between ages 3 and 7 years, which will be a useful basic tool for the study of temperament of Korean children.