Cross-Cultural Aspect of Behavior Assessment System for Children-2, Parent Rating Scale-Child: Standardization in Korean Children

PURPOSE: Our study aimed to examine psychometric properties and cross-cultural utility of the Behavior Assessment System for Children-2, Parent Rating Scale-Child (BASC-2 PRS-C) in Korean children. MATERIALS AND METHODS: Two study populations were recruited: a general population sample (n=2115) of 1st to 6th graders from 16 elementary schools and a clinical population (n=219) of 6–12 years old from 5 child psychiatric clinics and an epidemiological sample of autism spectrum disorder. We assessed the validity and reliability of the Korean version of BASC-2 PRS-C (K-BASC-2 PRS-C) and compared subscales with those used for US populations. RESULTS: Our results indicate that the K-BASC-2 PRS-C is a valuable instrument with reliability and validity for measuring developmental psychopathology that is comparable to those in Western population. However, there were some differences noted in the mean scores of BASC-2 PRS-C between Korean and US populations. CONCLUSION: K-BASC-2 PRS-C is an effective and useful instrument with psychometric properties that permits measurement of general developmental psychopathology. Observed Korean-US differences in patterns of parental reports of children's behaviors indicate the importance of the validation, standardization and cultural adaptation for tools assessing psychopathology especially when used in populations different from those for which the instrument was originally created.

Characteristics of late-onset epilepsy and EEG findings in children with autism spectrum disorders / 소아과

PURPOSE: To investigate the clinical characteristics of late-onset epilepsy combined with autism spectrum disorder (ASD), and the relationship between certain types of electroencephalography (EEG) abnormalities in ASD and associated neuropsychological problems. METHODS: Thirty patients diagnosed with ASD in early childhood and later developed clinical seizures were reviewed retrospectively. First, the clinical characteristics, language and behavioral regression, and EEG findings of these late-onset epilepsy patients with ASD were investigated. The patients were then classified into 2 groups according to the severity of the EEG abnormalities in the background rhythm and paroxysmal discharges. In the severe group, EEG showed persistent asymmetry, slow and disorganized background rhythms, and continuous sharp and slow waves during slow sleep (CSWS). RESULTS: Between the two groups, there was no statistically significant difference in mean age (P=0.259), age of epilepsy diagnosis (P=0.237), associated family history (P=0.074), and positive abnormal magnetic resonance image (MRI) findings (P=0.084). The severe EEG group tended to have more neuropsychological problems (P=0.074). The severe group statistically showed more electrographic seizures in EEG (P=0.000). Rett syndrome was correlated with more severe EEG abnormalities (P=0.002). Although formal cognitive function tests were not performed, the parents reported an improvement in neuropsychological function on the follow up checkup according to a parent's questionnaire. CONCLUSION: Although some ASD patients with late-onset epilepsy showed severe EEG abnormalities, including CSWS, they generally showed an improvement in EEG and clinical symptoms in the long-term follow up. In addition, severe EEG abnormalities tended to be related to the neuropsychological function.

Neurodevelopmental Disorders of Children Screened by The Infantile Health Promotion System

OBJECTIVE: To perform an in depth evaluation of children, and thus provide a systematic method of managing children, who after infantile health screening, were categorized as suspected developmental delay. METHOD: 78 children referred to the Developmental Delay Clinic of Ilsan Hospital after suspected development delay on infantile health examinations were enrolled. A team comprised of a physiatrist, pediatrician and pediatric psychiatrist examined the patients. Neurological examination, speech and cognitive evaluation were done. Hearing tests and chromosome studies were performed when needed clinically. All referred children completed K-ASQ questionnaires. Final diagnoses were categorized into specific language impairment (SLI), global developmental delay (GDD), intellectual disability (ID), cerebral palsy (CP), motor developmental delay (MD) or autism spectrum disorder (ASD). RESULTS: 72 of the 78 patients were abnormal in the final diagnosis, with a positive predictive value of 92.3%. Thirty (38.4%) of the 78 subjects were diagnosed as GDD, 28 (35.8%) as SLI, 5 (6.4%) as ASD, 9 (12.5%) as MD, and 6 (7.6%) as normal. Forty five of the 78 patients had risk factors related to development, and 18 had a positive family history for developmental delay and/or autistic disorders. The mean number of abnormal domains on the K-ASQ questionnaires were 3.6 for ASD, 2.7 for GDD, 1.8 for SLI and 0.6 for MD. Differences between these numbers were statistically significant (p<0.05). CONCLUSION: Because of the high predictive value of the K-ASQ, a detailed evaluation is necessary for children suspected of developmental delay in an infantile health promotion system.

Clinical Characteristics of Children with Williams Syndrome According to Age

PURPOSE: Williams syndrome (WS) is an autosomal dominant genetic disorder, caused by deletion at chromosome 7q11.23. Although WS is characterized by congenital heart disease (CHD), mental retardation, and distinctive facial dysmorphism, clinical features may vary according to a patient's age, making the diagnosis more difficult. We reviewed clinical, psychosocial, and behavioral developmental manifestations of WS patients according to age. METHODS: We retrospectively studied nine children with WS from March 2003 to February 2009 at NHIC Ilsan Hospital Developmental Disorder Clinic. Patients were divided into three groups by age: infancy, preschool age and school age. Patients' facial dysmorphism, motor, speech, and cognitive development and associated symptoms were analyzed. RESULTS: Prominent clinical features of the infants group were feeding difficulty, hypotonia, constipation, sleep disturbance, hernia with facial features which were not characteristic. The preschool age group showed developmental delays, had very friendly personalities, and hyperacusis. Their typical facial features included long philtrum, prominent lips, and teeth malocclusion. The school age group showed mental retardation, learning disorders, and typical facial dysmorphism, as well as short stature. Although overly sociable, they were not able to adapt to school life. Eight patients out of nine showed CHD. CONCLUSION: WS can be suspected when an infant primarily presents with hypotonia, feeding difficulty, failure to thrive with CHD, and occasional hypercalcemia. When a patient in early childhood presents with delayed development with good verbal language ability and has hyperacusis, WS must be suspected. When an older or adolescent child has unique learning disabilities and has facial dysmorphism, short stature, and a loquacious personality, WS should also be suspected.

One-year evaluation of the national health screening program for infants and children in Korea / 소아과

PURPOSE: Results of the Korea National Health Screening Program for Infants and Children, which was launched in November 2007, were evaluated for future research and policy development. METHODS: Data from a total of 2,729,340 cases were analyzed. Five visiting ages, such as 4, 9, 18, 30, and 60 months, were included. Several parameters such as stunting, obesity, and positive rate of developmental screening were also analyzed. Telephone survey was performed in 1,035 users. For the provider survey, 262 doctors participated in our study. RESULTS: The overall participation rate of users was 35.3%. This participation rate showed a decrement tendency to old age and low income. Only 6.9% of users participated in oral screening. Health screening was performed mainly in private clinics (82.6%). The recall rate of 4 months program users at the age of 9 months was 57.3%. The positive rate of screening was 3.1%, and was higher in the low-income group. By telephone survey, users reported that questionnaires were not difficult (94%) and overall satisfaction was good (73%). Longer duration of counseling was related with more satisfied users. Counseling and health education were helpful to users (73.2%). Doctors agreed that this program was helpful to children (98.5%). CONCLUSION: Korea National Health Screening Program for Infants and Children was launched successfully. Participation rate should be improved, and a quality control program needs to be developed. More intensive support following this program for children of low-income families may lead to effective interventions in controlling health inequality. Periodic update of guidelines is also needed.

Epilepsy, EEG Abnormalities in Children with Autism Spectrum Disorders

PURPOSE:The comorbidity of epilepsy varies from 8% to 42% in autism spectrum disorders(ASD), and currently its estimate is approximately one-third of the whole spectrum. Additionally, it is reported that certain ASD patients have EEG abnormalities without epileptic history. This study was conducted to analyze the prevalence of epilepsy and EEG abnormalities in ASD patients, as well as discover the risk factors for such conditions. METHODS:329 cases with ASD were identified from the 1252 patients who visited the Developmental Disorder Clinic at Ilsan Hospital, National Health Insurance Corporation, from April 2001 to June 2008. Among the total ASD cases, the 186 patients who have had EEG test were selected, from which 54 patients with abnormal EEG were classified as a test group and 132 patients with normal EEG as a control group. The results were analyzed and compared between the test and control groups retrospectively. RESULTS:1) A total 186 patients of 143 males and 43 females participated in the study. Subjects were subdivided into 5 groups as follows: 14 Asperger syndrome, 70 pervasive developmental disorder, NOS, 95 autistic disorder, 7 Rett's syndrome, and no childhood disintegrative disorder. The test group was a total of 54 cases with 36 males and 18 females and average age of 56.44+/-27.51. The control group was a total of 132 cases with 107 males and 25 and its average age was 48.86+/-27.44. 2) EEG abnormalities were seen in 54 out of 186 patients(29%) and epileptic symptoms were found in 26 out of 186 patients(14%). 3) Among 186 cases of ASD patients, a total of 217 EEG were conducted and 71(32.7%) of them showed EEG abnormalities. Furthermore, it was noticed that the prevalence of abnormal EEG findings increased with the severity of the disease(P<0.05). 4) Epilepsy is directly related to the severity of ASD(P<0.05) and even higher prevalence was seen in patients with positive family history of epilepsy(P<0.05). 5) On the other hand, abnormal EEG was seen in 31 out of 160 non-epileptic patients. 6) 179 out of 186 ASD patients had taken cognitive function tests and those 156 patients with cognitive impairment were more likely to show abnormalities in EEG. Severe ASD patients were more likely show abnormal EEG and the degree of cognitive impairment was closely related to the severity of ASD(P<0.05). CONCLUSION:Our study showed that risk factors for epilepsy comorbidity and EEG abnormalities in ASD were directly related to family history of epilepsy,the severity of ASD, the presence of cognitive impairment, and the severity of cognitive impairment. It is thought that epilepsy and EEG abnormalities are thought to be markers for underlying brain pathology that resulted in ASD. Furthermore ASD patients showed higher prevalence of EEG abnormalities than the general population, from which it can be speculated that the cause of ASD lies more closely in underlying neurobiological dysfunctions in individual patients, rather than inadequate nurturing environment.

Well Baby Clinic: Developmental Guidance according to the Parent's Chief Complaints

Despite the relatively high prevalence (5~10%) of developmental disability, the early identification for such problems remains difficult. Doctors who care children with developmental delay tried to find out these disorders as early as possible in order to apply an early intervention and reduce the long-term disabilities among them. Identification of a delayed young child by routine out-patient's clinic mandates a careful search for an underlying etiology. This article discusses the available approaches for the infants and young children with various kinds of developmental disabilities, according to the parent's chief complaints including 'unable to walk', 'unable to speak', 'unable to control temper', and 'unable to contact his or her eyes'.

Treatment of Attention-Deficit Hyperactivity Disorder

This article presents the knowledges regarding the evaluation and the management of attention-deficit/hyperactivity disorder (ADHD). Probably the most important components to a comprehensive evaluation of patients with ADHD, are the clinical interview, the medical examination, and the completion and scoring of behavior rating scales. The treatments of ADHD are followings: pharmacologic treatment such as stimulants, atomoxetine, modafinil, and bupropionn, and non-pharmacologic treatment such as parental education/training and cognitivebehavioral treatment.

Overview of the national health screening program for infant and children / 소아과

The mission of National Health Screening Program for Infant and Children is to promote and improve the health, education, and well-being of infants, children, families, and communities. Although the term 'diagnosis' usually relates to pathology, a similar diagnostic approach applies to the child seen primarily for health supervision. In the case of health, diagnosis determines the selection of appropriate health promoting and preventive interventions, whether medical, dental, nutritional, educational, or psychosocial. Components of the diagnostic process in health supervision include the health 'interview'; assessment of physiological, emotional, cognitive, and social development (including critical developmental milestones); physical examination; screening procedures; and evaluation of strengths and issues. Open and informed communication between the health professional and the family remains the most significant component of both health diagnosis and health promotion. Families complete medical history forms at their health supervision visit. Family-friendly questionnaires, checklists, and surveys that are appropriate for the child''s age are additional tools to improve and update data gathering. This type of information helps initiate and inform discussions between the family and the health professional. This article provides a comprehensive review of current National Health Screening Program for Infant and Children in Korea.

Introduction of National Health Screening Program for Infant and Children

No abstract available.

Early Developmental and Clinical Characteristics of Autism Spectrum Disorders

PURPOSE: Current evidence of the benefits of early intensive behavioral intervention (EIBI) in children with autism spectrum disorders(ASD) is increasing. In order to get the benefits from EIBI, early identification of ASD is essential but a challenge for clinicians. Therefore, we designed this study to know what differs from other developmental disorders in terms of early developmental patterns and clinical and laboratory characteristics. METHODS: Among 518 children diagnosed developmental delay in Ilsan Hospital Developmental Disorder Clinic from April 2001 to January 2005, we analyzed 122 ASD patients as a study group, and 133 mentally retarded(MR) and 101 specific language impaired(SLI) patients as control groups. We used a questionnaire survey to assess past and family history. We performed various kinds of tools for the evaluation of the development, and cognitive and speech functions according to the patients' age. MRI, SPECT, EEG, genetic and metabolic studies were performed as optional tests. RESULTS: The mean age of ASD was 55.9+/-30.7 months and male was predominant in ASD(male:female ratio was 3.2:1). In early developmental history, motor functions are relatively well preserved in ASD(P<0.05). In speech and social milestones, single word speech was noticeably delayed in all the 3 groups. However, there was no appreciable difference in stranger anxiety among the 3 groups. In the developmental evaluation, speech and social functions were most significantly delayed in ASD(P<0.05). There was a significant motor delay in ASD and MR than SLI(P<0.05). In physical examination, a raised rate of macrocedphaly in ASD was not noted. Abnormal EEG findings were significantly noted in ASD and MR than in SLI and MRI abnormalities were least found in these groups. The etiologic diagnosis was much less identified in ASD than MR. CONCLUSION: In an early stage, absence of stranger anxiety was not statistically significant. However, this seems to be an important risk factor for predicting ASD. Motor functions were relatively well preserved in ASD in an early stage. In the developmental evaluation, social and language areas were the most significantly delayed domains in ASD and motor functions were most delayed in MR. Routine MRI studies are not indicated for identifying the etiology in ASD. It was harder to find out the etiology in ASD than MR.

Multidisciplinary Diagnostic Approach and Etiologic Evaluation of Patients with Developmental Disorders

PURPOSE: The prevalence of developmental delay is 5-10% of the total pediatric population and early diagnosis and proper intervention are essential but a challenge for clinicians. We performed this study for several purposes. First is to know the distribution & characteristics of developmental disorders in Korea. Second is to identify all possible causes of these disorders through a multidisciplinary diagnostic approach, and thus to find out the clinical variables that are helpful in finding the etiology. And finally to develop a useful protocol that eliminates the cost of unnecessary tests and raises the diagnostic rate of the cause. METHODS: 518 patients(M 349, F 169) were studied who visited Ilsan Hospital Developmental Disorder Clinic(DDC) for the evaluation of developmental delay from April 2001 to Jan 2005. RESULTS: The mean age was 51.5+/-32.9 months, ranging from 2 months to 16.0 years of age with a majority of the preschool children(<6 yr)(79.3%). Phenomenological diagnosis consisted of 133 cases of mental retardation, 122 cases of autistic disorders, 101 cases of delayed language disorders, 27 cases of cerebral palsies, and 91 cases labeled as simple developmental delay requiring follow up due to age less than 2 years of age. Etiologic diagnosis was obtained in 119 cases(22.9%) out the 518 cases of developmental delays. 37 cases of chromosomal anomalies, 23 cases of Periventricular leukomalacia and hypoxic ischemic encephalopathy, 21 cases of syndromes, 7 cases of malformation of cortical development, 4 cases of myopathies, 4 cases of neuropathies, and 4 cases of cerebral infarctions were found. Among the clinical variables, low birth weight, facial dysmorphism, hypotonia, focal neurologic signs, and abnormalities in MRI, chromosome, EEG and EMG studies contributed to the yields of etiologic diagnosis significantly. CONCLUSION: Possible etiology was determined in about 23% of the subjects. The most important part of the assessment for the identification of etiology is thorough history taking, physical and neurologic examination. Neuroimaging study is useful in case of micro or macrocephaly, focal neurologic signs. Genetic studies increasingly produce a yield, when there is family history of inherited disorder and there are dysmorphic features. Routine metabolic screening test has limited utility. Development of a useful screening protocol adequate for Korean situation is required.

Naeng: A Korean Folk Illness, its Ethnography and its Epidemiology

No abstract available.

A Study on the Usefulness of Birth Registration Data in Rural Korea / 예방의학회지

The onprovement of civil registration reguires continuous study rather than periodic efforts. More and better statistics, however, are urgently required to formulate development programs and planning, Data obtainable from the civil registration are usually marred by errors of omission which are difficult to correct. This study aimed at finding out the problems occurring when a set of crude birth registration data in a rural area is used. Data Sources of this study are : 1) For birth registration : government birth registration records obtained from myun office and other government offices. 2) for the actual number of births : birth and child records from the Kang Wha Community Health Project. The study area is Sunwon Myun and Naega Myun in Kang Wha Gun, Gyunggido. The reference period for the accumulated data is one full year : Jan. 1st 1975 - Dec. 31st 1975. Major findings are as follows : If the number of registered birth is compared with the actual number of births which occurred in the target area, the former os far greater than the latter. The general assumption usually is , that the actual number of exceeds the registered number of birth in Korea. The observation from this specific study in this specific target area, shows the opposite trend. The number of births which actually occurred during the year of 1975 in the study area namely 256. The difference comes mainly from the fact that many cases of births from other areas were registered in the target area. In other words birth is not registered where it occurred but where the permanent residence address is. Among 550 births registered in the target area 66% did not occur in the target area. Only one third of all registered births were registered within the legal period for birth registration which is 2 weeks. 34% of the registered births actually occurred in 1974, but were registered in 1975. In 55% of the cases a difference was observed between the actual data of birth and the registered data of birth. From the 256 births which occurred in the target area, only 153 births (59%) were registered at the myun office and the remaining 130 births (41%) were not resistered there in the year of study. 6% of the 550 cases listed as registered have no separate registration sheets. Nevertheless, they definitely have been registered in the birth list at the myun office. 3% of the 550 cases are not recorded in this list but have a separate registration sheet at the myun offices. In conclusion, birth registration data have many errors and problems. Their usefulness as a source for vital and other statistics should be reconsidered. A series of sound methological studies will be necessary to establish their actual usefulness. A continuous and permanent compulsory system of birth recording is needed.

Study of Medical Carein Health Subcenter / 예방의학회지

Reorganization of myun health care service is one of the main issues in health care delivery in rural Korea. The fundamental, concept of the role and function of the myun health subcenter is that it is the basic unit of rural health care service and is to provide comprehensive health care service through the integration of curative and preventive services. The aim of this study is to analyze the patterns of curative activities in the myun health subcenter in terms of the most prevalent types of diseases, necessary diagnostic methods and required equipment, types of treatment, necessary drugs and materials, and finally the cost of curative services. The population on which this study was done was the 1596 patients who visited the two myun health subcenters (Sunwon Myun and Naega Myun) in Kang Hwa County, the area of the Yonsei University Community Health Teaching Project, during period from May 1, 1975 to June 10, 1976. For the patient's record in the clinic, problem oriented medical records were used. Decisions regarding the disease classification, the diagnostic methods used and selection of the most appropriate and adequate medical treatment were made by a group of three experienced physicians after reviewing the medical records which had been written by public physicians who were treating patients in the study area. The records were reviewed by resident staff members of the Department of Preventive Medicine, of Yonsei University College of Medicine. A brief summary of results of the study is as follow: 1. 29.9% of the patients who visited the clinics were ages between 0-4. No sex difference was observed among patients less than 20 years of age. However, among patients over 20 years old, females predominated. Thus it is evident that the majority of patients were either children or mothers and grandmothers. 2. The distance from the individual villages to the myun health subcenter was one of important factors in determining the ratio of clinic visits. However, other factors such as the activities of the health workers also affected the rates substantially. 3. The most common 25 diseases comprised 90.2% of all the diseases recorded. Acute respiratory infection (25.5), skin (12.7%), diarrheal diseases (6.8%), neuralgia and back pain (4.9%) and all other injuries (3.9%) were the five most common diseases. 4. Of all the diseases diagnosed and treated, 9.2% required simple laboratory tests for diagnosis, 6.5% required X-ray examination, and altogether 13.6% required either laboratory test of X-ray examination. 5. Treatment and management of 42.0% of the cases could be accomplished with simple, inexpensive drugs, 12.8% required the use of more expensive drugs (mostly antibiotics) and injections were required in 19.7% of the cases. Minor surgery and referral were necessary in 5% of the cases. 6. The cost for diagnosis and treatment was estimated with a standard which was set by general concensus. The average cost of diagnosis was 144 per case and the cost of treatment was 726 per case. The total average cost per visit was 870.

The Health Post Project: An Approach to Improve Health Care Delivery at the Grass-Roots in Rural Korea

The Health Post Project in Gang Wha Gun is part of the Yonsei University Medical College's Community Health Teaching Project. Two townships, Son Won Myun and Nae Ga Myun, with a total population of 14,000 are being guided through a planned change process in order to raise health consciousness in the community based education of medical and other health manpower through demonstration of relevant community health principles and provision of entry points for applied teaching. The key to community access is provided through village based Family Health Workers (FHW) who, according to carefully designed selection procedures, functions, service package, training and implementation plan now serve as semi-independent village health representatives. The FHW is supervised by the government employed township health workers who in turn received re-orientation as multi-purpose workers. Their functions were re-designed according to project needs. Thus the government health services in the target area have been extended to the household level through FHW activities in MCH, TB care and Family Planning. The Health Post Project provides a statistically controlled environment with a base line survey and constantly incoming data. It also provides communication channels for reciprocal understanding of the health issues and problems between traditional villagers and city educated faculty and students. Moreover, the Health Post Project provides motivation for the communities to solve their health problems with existing resources to the highest degree possible. Finally, the development of grass-root level services in cooperation with the communities has potential for long term benefits. These include relevant training of health manpower regarding principles and practice of rural community health. It also includes the study and development of health manpower and service packages, streamlining of administrative and evaluation procedures, and information urgently needed for health planning.