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.

Differences of Clinical Characteristics and Phenotypes between Prepubertal- and Adolescent-Onset Bipolar Disorders

The aim of this study is to describe the clinical characteristics of prepubertal- and adolescent-onset bipolar disorder (BD) and to identify any clinical differences between patients with prepubertal- and adolescent-onset BD. We analyzed the clinical records of 53 inpatients with BD. These patients were divided into prepubertal-onset and adolescent-onset groups. We also divided the subjects into narrow, intermediate, and broad phenotypes according to the definitions proposed by Leibenluft and colleagues. Of the total sample, 16 patients (30.2%) were in the prepubertal-onset group and 37 (69.8%) were in the adolescent-onset group. Patients with prepubertal-onset BD were more likely to display an insidious clinical presentation, atypical features, and comorbid psychopathology. And the majority of the subjects, especially in the prepubertal-onset group, were classified under the intermediate and broad phenotypes. These results suggest that the clinical presentation of BD with prepubertal-onset is different from that of adolescent-onset BD. It is inferred that a significant number of patients with prepubertal- and adolescent-onset BD do not meet DSM-IV criteria for mania or hypomania from the results of this study.

The KIDSCREEN-52 Quality of Life Measure for Children and Adolescents (KIDSCREEN-52-HRQOL): Reliability and Validity of the Korean Version

The KIDSCREEN-52 quality-of-life (KIDSCREEN-52-HRQOL) is a relevant, worldwide tool used for assessing the health-related quality of life in children and adolescents. The purpose of this study was to define measurement properties of the Korean version of the KIDSCREEN-52 HRQOL. The original questionnaire was translated following international translation guidelines. Analysis regarding psychometric properties showed that the Cronbach-alpha ranged from 0.77 to 0.95. The correlation coefficient between the PedQL and KIDSCREEN-52 dimensions were high for the assessments of similar constructs. Therefore, the Korean version of the KIDSCREEN-52 was found to be suitable for use in Korean adolescents.

Psychiatric Comorbidity in Korean Children and Adolescents with Attention-Deficit Hyperactivity Disorder: Psychopathology According to Subtype

It is well-known that more than 50% of attention-deficit hyperactivity disorder (ADHD) cases also have comorbid psychiatric disorders. We evaluated the comorbid psychopathology of Korean children and adolescents with ADHD using a standardized diagnostic instrument. The Korean Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL-K) was administered and completed in 105 patients who had been referred to the outpatient and inpatient clinics at the Samsung Medical Center from March 2004 to May 2005. All of the cases were diagnosed as ADHD according to DSM-IV criteria. We analyzed their clinical characteristics and psychiatric comorbidities, and assessed the correlation of any comorbidity with gender, age and ADHD subtype. Among our 105 participants, 70 (66.7%) subjects were diagnosed with combined-type ADHD, 22 (21.0%) were the predominantly inattentive type, only 1 (1.0%) was determined to have the predominantly hyperactive-impulsive type of ADHD, and 12 (11.4%) were classified as not otherwise specified (NOS) ADHD. Eighty (76.2%) subjects had at least one comorbid disorder such as oppositional defiant disorder (n = 53, 50.5%), anxiety disorders (n = 35, 33.3%) and affective disorders (n = 15, 14.3%). Our patients ranged in age from five to 16 years. Among the factors including gender, age, and ADHD subtype, ADHD subtype was the only one significant to comorbidity in our study. The results of this study suggest that psychiatric comorbidity in Korean children with ADHD is similar to the results of previous studies in western countries. Out of all the ADHD subtypes, the combined-type group had a significantly higher ratio of comorbid disorders and psychopathologies.

Prevalence and Correlates of Attention Deficit Hyperactivity Disorder: School-Based Mental Health Services in Seoul / 신경정신의학

OBJECTIVES: To estimate the prevalence and correlates of children who had Attention Deficit Hyperactivity Disorder (ADHD) in Seoul. METHODS: A cross-sectional survey of 2,429 children included in four elementary schools at Seoul. Parents and teachers completed the Korean ADHD Rating Scales (K-ARS) and the Korean version of the Strengths and Difficulties Questionnaire (SDQ-Kr). Child psychiatrists interviewed the children who demonstrated clinically significant scores on K-ARS and SDQ-Kr. Further assessments were conducted with other psychological tests if needed. RESULTS: 1) Of 2,429 children, 158 (6.5%) children had ADHD. 2) Compared to controls, ADHD children showed more frequently male preponderance, more single parent family, lower parental education level, more paternal no employment, poorer sibling relationship, fewer number of friends, and lower ability in language and mathematics. 3) In multivariate analysis, ADHD were associated with boys, single parent family, poor sibling relationship, and low language ability. Our stratified analysis by gender, there were association with single parent family and lower language ability in boys, and poor sibling relationship and lower mathematics ability in girls. CONCLUSION: This study found 6.5% prevalence of ADHD and ADHD were associated with gender, family environment, and academic achievements. Understanding of high-risk children would help in developing an ADHD school mental health program.

Adjustment of Korean-American physicians in Korea: aspect of personal satisfaction

This study was conducted to assess the psychosocial adjustment of Korean-American physicians in the aspect of personal satisfaction after returning to Korea. A questionnaire was mailed to 72 Korean-American physicians who were practicing medicine in Korea and forty physicians responded. These physicians, typically in their 50s, lived in America for 21-30 years before coming back to Korea. The most frequent motives for them to come back to Korea were giving back to their native country, longing for their native country, filial duty, and suggestions from their colleagues or professors to move back. Eighty percent of them were extremely satisfied or slightly satisfied with their work in Korea, and only 10% are extremely or slightly dissatisfied with their decision to return. Although most of them are content for the time being in Korea, only 12.5% have definite plans to stay in Korea after retirement. The variables that were most significantly related to personal satisfaction of returning to Korea were how well treated at work and how much satisfied with job rather than other factors such as motives for returning, duration of staying in America and in Korea, and family situation.

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.

DNA Testing for Fragile X Syndrome in School for Emotionally Severely Handicapped Children in Korea

Though Fragile X syndrome is one of the most common inherited causes of mental retardation, it is not much detected yet in Korean population. One of the reason may be that the syndrome is not well known to the special education teachers as well as to the clinicians in this country. Thus, molecular test was undertaken to screen out fragile X syndrome in 122 children of two Korean schools for emotionally severely handicapped children. The subjects were all boys, previously known as having pervasive developmental disorder with or without mental retardation. Southern blot analysis of peripheral blood showed the abnormally enlarged (CGG)n repeat sequence associated with fragile X syndrome in two children. This finding suggests that the DNA testing for fragile X syndrome is warranted for Korean high risk population and that more concern about this syndrome is needed for the professionals who work for mentally handicapped children. The issues involved in genetic counseling for fragile X syndrome are discussed.