The Relationship Between Posttraumatic Embitterment Disorder and Stress, Depression, Self-Esteem, Impulsiveness, and Suicidal Ideation in Korea Soldiers in the Local Area

Background@#The purpose of this study was to identify the prevalence of posttraumatic embitterment disorder (PTED) among soldiers, and examine its relation to stress, depression, self-esteem, impulsiveness, and suicidal ideation. @*Methods@#The subjects of this study were 200 soldiers and 197 control subjects, a total of 397 persons. Measurement tools used included the PTED self-rating scale, Stress Response Inventory, Beck Depression Inventory, Rosenberg Self-Esteem Inventory, Barratt Impulsiveness Scale, and Beck Scale of Suicide Ideation.Result: The major findings of the analysis are as follows: first, 11.5% of the soldiers were in the risk group for PTED, and 4% of them had PTED. Second, PTED in the soldiers was significantly associated with a number of variables such as their educational background, stress, depression, self-esteem, impulsiveness, and suicidal ideation, while it was not significantly associated with age. Third, through the hierarchical multiple regression analysis, it was found that academic background, stress, and depression had a statistically significant positive effect on the incidence of PTED in the soldiers. @*Conclusion@#In order to prevent and effectively intervene in PTED in soldiers, there is a need for interventional efforts focused on depression and stress related to negative life events.

Stimulant Induced Movement Disorders in Attention Deficit Hyperactivity Disorder

Stimulants, such as amphetamine and methylphenidate, are one of the most effective treatment modalities for attention deficit hyperactivity disorder (ADHD) and may cause various movement disorders. This review discusses various movement disorders related to stimulant use in the treatment of ADHD. We reviewed the current knowledge on various movement disorders that may be related to the therapeutic use of stimulants in patients with ADHD. Recent findings suggest that the use of stimulants and the onset/aggravation of tics are more likely to be coincidental. In rare cases, stimulants may cause stereotypies, chorea, and dyskinesia, in addition to tics. Some epidemiological studies have suggested that stimulants used for the treatment of ADHD may cause Parkinson’s disease (PD) after adulthood. However, there is still a lack of evidence that the use of stimulants in patients with ADHD may cause PD, and related studies are only in the early stages. As stimulants are one of the most commonly used medications in children and adolescents, close observations and studies are necessary to assess the effects of stimulants on various movement disorders, including tic disorders and Parkinson’s disease.

Comparison of Quantitative Electroencephalography between Tic Disorder and Attention-Deficit/Hyperactivity Disorder in Children

Objective@#Attention-deficit/hyperactivity disorder (ADHD) and tic disorder (TD) are among the most common comorbid psychopathologies and have a shared genetic basis. The psychopathological and neurophysiological aspects of the mechanism underlying the comorbidity of both disorders have been investigated, but the pathophysiological aspects remain unclear. Therefore, this study aimed to compare the neurophysiological characteristics of ADHD with those of TD using resting-state electroencephalography and exact low-resolution brain electromagnetic tomography (eLORETA) analysis. @*Methods@#We performed eLORETA analysis based on the resting-state scalp-recorded electrical potential distribution in 34 children with ADHD and 21 age-matched children with TD. Between-group differences in electroencephalography (EEG) current source density in delta, theta, alpha, beta, and gamma bands were investigated in each cortical region. @*Results@#Compared with the TD group, the ADHD group showed significantly increased theta activity in the frontal region (superior frontal gyrus, t = 3.37, p ＜ 0.05; medial frontal gyrus, t = 3.35, p ＜ 0.05). In contrast, children with TD showed decreased posterior alpha activity than those with ADHD (precuneus, t = −3.40, p ＜ 0.05; posterior cingulate gyrus, t = −3.38, p ＜ 0.05). These findings were only significant when the eyes were closed. @*Conclusion@#Increased theta activity in the frontal region is a neurophysiological marker that can distinguish ADHD from TD. Also, reduced posterior alpha activity might represent aberrant inhibitory control. Further research needs to confirm these characteristics by simultaneously measuring EEG-functional magnetic resonance imaging.

A Review of Cognitive and Behavioral Interventions for Tic Disorder

Objectives@#Tic disorder is a neurodevelopmental disorder characterized by multiple involuntary movements of muscles or vocalization. Although tic symptoms subside as the patient ages, some patients suffer from significant functional impairments related to severe tic symptoms. This manuscript aimed to review the latest scientific evidences for the effect of cognitive-behavioral interventions on tic disorder. @*Methods@#The relevant studies were identified by searching medical research databases. We focused our search on studies published between 2000 and 2020 in order to reflect the latest scientific evidence. A total of 821 articles were identified in the initial database search and 27 articles were finally included for the review after the exclusion of duplicated and irrelevant articles. @*Results@#Behavioral therapies including habit reversal training, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention were the most widely studied interventions for tic disorder and are recommended as first-line treatments for tic disorders with high confidence. Cognitive psychophysiologic approaches were also reported to be effective. @*Conclusion@#Further studies are needed to support the future treatment of tics with low-cost and more widely available treatments, in order to ensure better treatment outcomes.

Relationships between Smartphone Addiction and Smartphone Usage Types, Depression, ADHD, Stress, Interpersonal Problems, and Parenting Attitude with Middle School Students

Background@#The purpose of this study was to examine the relationships between smartphone addiction of middle school students and smartphone usage types, depression, attention deficit hyperactivity disorder (ADHD), stress, interpersonal problems, and parenting attitude. In particular, we wanted to find out how smartphone usage types predict smartphone addiction when controlling depression, ADHD, perceived stress, interpersonal problems, and parenting attitudes, which are the main predictors of existing smartphone addiction in this study. @*Methods@#The subjects of this study included 487 local middle school students (253 girls and 234 boys). The measurement instruments used were the smartphone addiction scale, patient health questionnaire-9 (PHQ-9), Korean ADHD rating scales (K-ARS), perceived stress scale (PSS), Short form of the Korean-inventory of interpersonal problems circumplex scales (KIIP-SC), and the parenting attitude scale. We identified the relationships between the variables with correlation analysis and examined the predictors of smartphone addiction with hierarchical multiple regression analysis.Result: The factors that influence smartphone addiction were sex (β = 3.14, P < 0.01), stress (β = 2.99, P < 0.01), and interpersonal problems (β = 3.81, P < 0.001). In addition, when the confounding variables of smartphone addiction were controlled to examine the effects of smartphone usage types on smartphone addiction, social network service (SNS) (β = 2.66, P < 0.01) and music/videos (β = 2.73, P < 0.01) were found to significantly positively affect smartphone addiction, whereas study (β = −2.54, P < 0.05) had a significantly negatively effect. And these factors explained 29.5% of the variance in smartphone addiction. @*Conclusion@#The order of the usage types with the highest influence on smartphone addiction was: enjoying music/videos, SNS, and study. This suggests that selective intervention depending on the main smartphone usage type can be effective.

A Review of Cognitive and Behavioral Interventions for Tic Disorder

Objectives@#Tic disorder is a neurodevelopmental disorder characterized by multiple involuntary movements of muscles or vocalization. Although tic symptoms subside as the patient ages, some patients suffer from significant functional impairments related to severe tic symptoms. This manuscript aimed to review the latest scientific evidences for the effect of cognitive-behavioral interventions on tic disorder. @*Methods@#The relevant studies were identified by searching medical research databases. We focused our search on studies published between 2000 and 2020 in order to reflect the latest scientific evidence. A total of 821 articles were identified in the initial database search and 27 articles were finally included for the review after the exclusion of duplicated and irrelevant articles. @*Results@#Behavioral therapies including habit reversal training, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention were the most widely studied interventions for tic disorder and are recommended as first-line treatments for tic disorders with high confidence. Cognitive psychophysiologic approaches were also reported to be effective. @*Conclusion@#Further studies are needed to support the future treatment of tics with low-cost and more widely available treatments, in order to ensure better treatment outcomes.

Relationships between Smartphone Addiction and Smartphone Usage Types, Depression, ADHD, Stress, Interpersonal Problems, and Parenting Attitude with Middle School Students

Background@#The purpose of this study was to examine the relationships between smartphone addiction of middle school students and smartphone usage types, depression, attention deficit hyperactivity disorder (ADHD), stress, interpersonal problems, and parenting attitude. In particular, we wanted to find out how smartphone usage types predict smartphone addiction when controlling depression, ADHD, perceived stress, interpersonal problems, and parenting attitudes, which are the main predictors of existing smartphone addiction in this study. @*Methods@#The subjects of this study included 487 local middle school students (253 girls and 234 boys). The measurement instruments used were the smartphone addiction scale, patient health questionnaire-9 (PHQ-9), Korean ADHD rating scales (K-ARS), perceived stress scale (PSS), Short form of the Korean-inventory of interpersonal problems circumplex scales (KIIP-SC), and the parenting attitude scale. We identified the relationships between the variables with correlation analysis and examined the predictors of smartphone addiction with hierarchical multiple regression analysis.Result: The factors that influence smartphone addiction were sex (β = 3.14, P < 0.01), stress (β = 2.99, P < 0.01), and interpersonal problems (β = 3.81, P < 0.001). In addition, when the confounding variables of smartphone addiction were controlled to examine the effects of smartphone usage types on smartphone addiction, social network service (SNS) (β = 2.66, P < 0.01) and music/videos (β = 2.73, P < 0.01) were found to significantly positively affect smartphone addiction, whereas study (β = −2.54, P < 0.05) had a significantly negatively effect. And these factors explained 29.5% of the variance in smartphone addiction. @*Conclusion@#The order of the usage types with the highest influence on smartphone addiction was: enjoying music/videos, SNS, and study. This suggests that selective intervention depending on the main smartphone usage type can be effective.

Associations among High Risk for Sleep-disordered Breathing, Related Risk Factors, and Attention Deficit/Hyperactivity Symptoms in Elementary School Children

Objective@#Habitual snoring is a common problem in children. We evaluated the association between a high risk for sleep-disordered breathing and attention deficit/hyperactivity symptoms. @*Methods@#Parents of 13,560 children aged 6 to 12 years responded to questionnaires including items on habitual snoring and the Korean attention deficit/hyperactivity disorder rating scale. The snoring score comprised the number of “yes” responses to habitual-snoring items, and a high risk for sleep-disordered breathing was defined as a snoring score ≥ 2. @*Results@#The odds ratio (OR) of a high risk for sleep-disordered breathing was significantly higher in boys (OR = 1.47; p ＜ 0.001), overweight children (OR = 2.20; p ＜ 0.001), and children with current secondhand-smoking exposure (OR = 1.38; p ＜ 0.001). The Korean attention deficit/hyperactivity disorder rating scale score increased significantly with the snoring score (0 vs. 1, B = 1.56, p ＜ 0.001; 0 vs. 2, B = 2.44, p＜ 0.001; 0 vs. 3, B = 2.48, p＜ 0.001; 0 vs. 4, B = 3.95; p ＜ 0.001). @*Conclusion@#Our study confirms several risk factors of sleep-disordered breathing, namely male sex, overweight, and exposure to tobacco smoking, and found a positive association between habitual snoring and attention deficit/hyperactivity symptoms.

Associations between Exposure to Bisphenol A and Behavioral and Cognitive Function in Children with Attention-deficit/Hyperactivity Disorder: A Case-control Study

Objective@#Bisphenol A (BPA) is a widely produced synthetic chemical used to manufacture polycarbonate plastics and epoxy resins. We aimed to investigate the association between exposure to BPA and behavioral and cognitive function in children with attention-deficit/hyperactivity disorder (ADHD) and healthy controls. @*Methods@#The study included 444 children aged from 6 to 10 years. The ADHD and control groups included 195 and 249 children, respectively. BPA levels were assessed via urinalysis, while behavior was assessed using the Korean version of the ADHD Rating Scale (K-ARS) and the Behavior Assessment System for Children (BASC-2). Cognitive function was assessed using the Continuous Performance Test (i.e., ADHD Diagnostic System [ADS]). Participants were categorized into tertile groups based on urinary BPA concentration. @*Results@#Scores on the K-ARS and the hyperactivity, aggression, anxiety, and depression subscales of the BASC-2 were significantly different among tertile groups for urinary BPA levels. Scores on visual omission error, commission error, response time variability, and auditory commission error of the ADS were significantly different among three BPA groups. Subgroup analysis revealed that these differences of behavior and cognition among three BPA groups were observed in only boys and normal controls. @*Conclusion@#Exposure to BPA was associated with unfavorable behavioral and cognitive outcomes. Our study extends the findings of previous studies regarding the association between BPA exposure and behavior/cognitive function by including children with ADHD. Further studies are required to determine the mechanisms underlying sex- and group-based differences in these associations.

The Relationships between Addiction to Highly Caffeinated Drinks, Burnout, and Attention-Deficit/Hyperactivity Disorder

OBJECTIVES: This study aimed to evaluate the addiction to highly caffeinated drinks among university students, and we investigated the relationships between smartphone addiction, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), burnout, self-esteem, impulsiveness in high caffeine drink addiction risk group (high caffeine group). We also compared these mental health factors differences between the high caffeine group and the control group; and, investigated the relative risk between the independent variables of the high caffeine group. METHODS: This study was conducted in Korea, from June 2015 to July 2016. A set of questionnaires was administered on 511 college students. RESULTS: The participants who belonged to the high caffeine group were more likely to demonstrate the symptoms of ADHD and higher levels of burnout and impulsiveness. Further, the results of logistic regression analysis confirmed the association between the high caffeine group and burnout. CONCLUSION: These behaviors among university students addicted to highly caffeinated drinks suggests the need for timely and effective interventions for those at risk of addiction.

Attention-Deficit/Hyperactivity Disorder Symptom Characteristics in Korean Elementary School Children: Comparison with US Population

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in elementary school children. The present study investigated the characteristics of ADHD in Korean elementary school children using the Korean version of the ADHD Rating Scale (K-ARS). The data was compared with those obtained from a comparable American population. METHODS: Participants included 29,914 elementary school children, aged 6–12 years, from a medium-sized city. The parents completed the home version of the K-ARS. The total and subscale-specific normative data and sex- and age-related mean score differences were analyzed. These data were compared with those obtained from the American population using independent t-tests. RESULTS: Mean total and subscale K-ARS scores were significantly higher among boys (vs. girls) and younger children aged equal to or less than 8 years old (vs. older children). Mean scores on the hyperactivity-impulsivity subscale were lower than those of American children, but similar to another Korean sample. CONCLUSION: Our data characterized ADHD symptoms in Korean children. However, further studies are needed to identify the cultural differences underlying ratings of ADHD symptom severity.

The Symptom Trajectory of Attention-Deficit Hyperactivity Disorder in Korean School-Age Children

OBJECTIVE: We aimed to investigate symptom trajectory of attention-deficit hyperactivity disorder (ADHD) in Korean school-age children. METHODS: Four hundred fifty six elementary school children were enrolled when they were in 1st grade and assessed once per year until 4th grade. Symptom severity was assessed by parents using the Korean version of the ADHD rating scale (K-ARS). High-risk was defined as a K-ARS score >18; 377, 325, and 284 children participated in the subsequent assessments. Symptom trajectory was analyzed using a mixed-model approach consistent with the longitudinal nature of the present study including missing data. RESULTS: K-ARS scores demonstrated significant main effects of time (F=35.33; p < 0.001), sex (F=20.77; p < 0.001), and first-year high-risk group (F=240.90; p<0.001). It also demonstrated a significant time×first-year high-risk group interaction effect (F=38.14; p < 0.001), but not a time×sex interaction effect. CONCLUSION: K-ARS scores demonstrated a tendency to decline with aging. Individuals in the high-risk group demonstrated earlier declining tendency than those in the non-high risk group. Although total K-ARS scores differed significantly between the sexes at all assessments, the declining pattern between both sexes did not differ significantly. Further studies including larger sample sizes, diagnostic interviews, and complete data sets are needed to confirm findings of the present study.

Therapeutic Effects of Leuprorelin (Leuprolide Acetate) in Sexual Offenders with Paraphilia

BACKGROUND: This study examined the clinical effects of leuprolide acetate in sexual offenders with paraphilic disorders evaluated by means of objective psychiatric assessment. METHODS: The subjects of this study were seven sexual offenders who were being treated by means of an injection for sexual impulse control by a court order. They had been diagnosed with paraphilia by a psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and had been put on probation by the Ministry of Justice between January 2016 and December 2016. RESULTS: After twelve months, we observed significant improvement in symptoms, as decrease of abnormal sexual interest and activity, sexual fantasy, Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Impulsivity (GCI-I). There were a mild feminization of the body shape, feelings of fatigue, and mild hot flushes. No other adverse effect was reported. CONCLUSION: These results suggested that the clinical effects of leuprolide acetate in sexual offenders might be an effective treatment and safety strategy.

Association between GABA3 Gene Polymorphisms and Attention Deficit Hyperactivity Disorder in Korean Children

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is common disorder of the school-age population. ADHD is familial and genetic studies estimate heritability at 80–90%. The aim of the present study was to investigate the association between the genetic type and alleles for gamma-aminobutyric acid receptor subunit beta-3 (GABA3) gene in Korean children with ADHD. METHODS: The sample consisted of 180 ADHD children and 159 control children. We diagnosed ADHD according to DSM-IV. ADHD symptoms were evaluated with Conners' Parent Rating Scales and Dupaul Parent ADHD Rating Scales. Blood samples were taken from the 339 subjects, DNA was extracted from blood lymphocytes, and PCR was performed for GABA3 rs2081648, rs1426217 and rs981778 Polymorphism. Alleles and genotype frequencies were compared using the chi-square test. We compared the allele and genotype frequencies of GABA3 gene polymorphism in the ADHD and control groups. RESULTS: This study showed that there was a significant correlation among the frequencies of the rs2081648 (OR=0.71, 95% CI=0.51–0.98, p=0.040) of alleles of MAO, but the final conclusions are not definite. Follow up studies with larger patient or pure subgroups are expected. CONCLUSION: These results suggested that GABA3 might be related to ADHD symptoms.

Minnesota Multiphasic Personality Inventory Characteristics of Parricide Offenders with Schizophrenia in Korea

OBJECTIVE: This study aims to examine the personality characteristics in parricide offenders, by using the Minnesota Multiphasic Personality Inventory (MMPI) test, which is commonly used in clinical medicine. METHODS: A total of 73 parricide offenders with schizophrenia who were admitted to National Forensic Hospital in Gongju city between September 2014 and February 2015, and 104 comparison schizophrenia patients who had been admitted to Dankook University Hospital in Cheonan city the same hospital, completed the Korean version of the MMPI. RESULTS: The parricide offender group showed significantly higher on L, F, Hs, Hy and Pd than the comparison group. The result of the regression analysis indicated that Pd and Si significantly increased the odd ratio of the sexual offender group by 2.77 times and 0.32 times, respectively (p=0.029 and p=0.023). The offenders of parricide may have developed the following characteristics: hypochondriasis, hysteria and psychopathic deviate. CONCLUSION: These results suggested that the psychopatholgy in the offenders of parricide might be different, compared to the control group.

Prevalence of Attention-Deficit/Hyperactivity Disorder and its Comorbidity among Korean Children in a Community Population

The aim of this study was to determine the prevalence of attention deficit hyperactivity disorders (ADHD) in children according to socio-demographic factors and the distribution of ADHD subtypes in a community in Korea. A screening survey using the Korean version of ADHD Rating Scale (K-ARS) was conducted between 2007 and 2008, and clinical interviews by a pediatric psychiatrist were performed for selected children between 2009 and 2010. A total of 49,573 elementary school students, between ages of 7 and 12, constituted the target population, among which 38,365 students (77.2%) and respective parents gave consent to participate. Of the participants, 200 screened children were clinically examined to confirm the diagnosis of ADHD. We estimated the prevalence of ADHD and its comorbidity in the population, after adjusting for nonresponse and nonparticipation. The prevalence of ADHD was 11.7% in boys and 5.2% in girls, with an overall prevalence of 8.5%. The combined type of inattentive and hyperactive was the most frequent at 4.7% of the whole population. Children were more likely to have ADHD if their parents were separated and had less education. Most commonly combined comorbidity was autism spectrum disorder (ASD) (10.1%). The prevalence of ADHD in the school-aged population is an essential information for improving the quality of public health mental services for evaluation and treatment of ADHD.

Harmful Environmental Factors Leading to Attention-Deficit Hyperactivity Disorder

Attention-deficit hyperactivity disorder (ADHD) is a common, childhood-onset, neuropsychiatric disorder with an estimated prevalence of 2–7.6% in Korean children. Although the etiology of ADHD is not well understood, evidence from genetic factor and environmental factor studies suggests that ADHD results from a gene environmental interaction. In the current study, we reviewed the evidence for and clinical implications of the hypothetical roles of organophosphate pesticides, organochlorine pesticides, polychlorinated biphenyls, phthalate, bisphenol, polyfluoroalkyl chemicals, polycyclic aromatic hydrocarbons, mercury, lead, arsenic, cadmium, manganese, tobacco, alcohol as harmful risk factors in the development of ADHD.

Association between RELN Gene Polymorphisms and Attention Deficit Hyperactivity Disorder in Korean Children

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is common disorder of the school-age population. ADHD is familial and genetic studies estimate heritability at 80–90%. The aim of the present study was to investigate the association between the genetic type and alleles for RELNgene (rs736707, rs2229864, rs362746, rs362726, rs362691, rs1062831, rs607755, and rs2072403) in Korean children with ADHD. METHODS: The sample consisted of 180 ADHD children and 159 control children. We diagnosed ADHD according to DSM-IV. ADHD symptoms were evaluated with Conners' Parent Rating Scales and Dupaul Parent ADHD Rating Scales. Blood samples were taken from the 339 subjects, DNA was extracted from blood lymphocytes, and PCR was performed for RELN Polymorphism. Alleles and genotype frequencies were compared using the chi-square test. We compared the allele and genotype frequencies of RELN gene polymorphism in the ADHD and control groups. RESULTS: This study showed that there was a significant correlation among the frequencies of the rs736707 (OR=1.40, 95% CI=1.03–1.90, p=0.031) of alleles of RELN, but the final conclusions are not definite. CONCLUSION: Follow up studies with larger patient or pure subgroups are expected. These results suggested that RELN might be related to ADHD symptoms.

Smart-Phone Addiction, Depression/Anxiety, and Self-Esteem with Attention-Deficit Hyperactivity Disorder in Korean Children

OBJECTIVES: The current study investigated the risk of smartphone addiction among children and adolescents with or without attention-deficit hyperactivity disorder (ADHD), risk of depression, anxiety, and self-esteem using the Smartphone Addiction Scale Proneness, Kovac's Children's Depression Inventory, State-Trait Anxiety Inventory, and Rosenberg Self-Esteem Scale, commonly used in clinical medicine. METHODS: Ninety five students with ADHD who visited psychiatry outpatient clinics completed the questionnaire. At the same time, 592 middle and high school students living in a similar area regardless of ADHD diagnosis, completed the questionnaire as control subjects. RESULTS: Overall, 40.0% of 95 ADHD and 12.8% of 592 control subjects were classified as the smartphone addiction proneness group, 26.3% of the ADHD subjects and 8.3% of the control group were classified as the depression group, and 32.6% of the ADHD subjects and 16.2% of the control group were classified as the anxiety group. Significant differences were observed between the two groups. CONCLUSION: The results of this study suggest that ADHD subjects are more prone to smartphone addiction, becoming depressed or anxious than those in the control group. From this study, we could suggest that students with ADHD are more easily affected by smartphone addiction than normal control subjects. In addition, we might understand how some psychiatric problems like depression, anxiety, and low self-esteem are related to ADHD and smartphone addiction.

Use of Various Treatment Modalities for Autism Spectrum Disorder and Mental Retardation

OBJECTIVES: The purpose of this study was to investigate the use of various treatment modalities including pharmacotherapy, education-behavior therapy, and complementary alternative treatment for children with mental retardation (MR) or autism spectrum disorder (ASD) in Korea. METHODS: The sample consisted of 50 parents who have children with MR (N=28) or ASD (N=22), 38 boys, 12 girls ; mean age 14.06 (4.14) years old. A questionnaire was composed of the experienced modality, duration, cost, satisfaction etc. RESULTS: According to the results, 56.0%, 100.0%, and 36.0% of children with MR or ASD have experienced pharmacological treatment, educational-behavioral therapy and complementary alternative medicine (CAM), respectively. Children who experienced education-behavioral therapy and CAM experienced 3.52 kinds of education-behavioral therapy and 2.78 kinds of CAM, respectively. Monthly cost of pharmacological treatment was lowest among three modality categories. Regarding treatment satisfaction by parental report, the lowest score was recorded fir CAM. CONCLUSION: Parents who have a child with MR or ASD are trying many treatment modalities and feeling the burden of their treatment.