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Objective@#Adolescent gambling is rapidly increasing recently. However, little is known about the core feature of adolescent gambling that should be the treatment target for adolescents. Thus, the objective of this study was to determine the core symptom of adolescent gambling using network analysis with large-scale data targeting community indwelling adolescents. @*Methods@#We used dataset of the 2018 national survey on youth gambling problems collected by the Korea Center on Gambling Problems to explore symptom networks of gambling in adolescents. Of 17,520 respondents in the dataset of the 2018 national survey on youth gambling problems collected by the Korea Center on Gambling Problems, 5,619 adolescents with experience of gambling were included in the analysis. We computed an association network, a graphical least absolute shrinkage and selection operator, and a directed acyclic graph to model symptom interactions. @*Results@#In each network of online, offline, and all gambling, stealing money or other valuable things in order to gamble or pay off gambling debts was the most centrally situated and skipping practice followed by dropping out of activities. Especially strong connections emerged between stealing money or other valuable things in order to gamble or pay off gambling debts and academic performance degradation due to gambling. Feeling bad due to gamble and skipping hanging out with friends who do not gamble emerged as a highly central node that might be distinctive to adolescents with online gambling. @*Conclusion@#These findings demonstrate central features of adolescent gambling. Different associations among specific network nodes suggest the existence of distinctive psychopathological constructs between online and offline gambling.
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Objective@#There is clinical concern that the stimulant methylphenidate (MPH) might increase the risk of depression, particularly in children. This study aimed to investigate the association between MPH use and the risk of depression. @*Methods@#A population-based electronic medical records database was used. We obtained claims data for prescription of ADHD medication, diagnosis of depression, and prescription of antidepressant medication between January 2007 and December 2016 for 43,259 individuals aged 6 to 19 who were diagnosed with ADHD between July 1, 2007 and December 31, 2007. The final analysis was based on 2,330 eligible participants. A self-controlled case series design was used to identify risk factors for major depressive disorder (MDD). @*Results@#An elevated MDD risk was found during the 90 days before MPH exposure, with an incidence rate ratio (IRR) of 12.12 (95% confidence interval [95% CI]: 10.06−14.61, p ＜ 0.0001). During methylphenidate treatment, the IRR was 18.06 with a 95% CI of 16.67 to 19.56 (p ＜ 0.0001), but it returned to baseline levels after day 31 of MPH treatment discontinuation. The IRR for patients aged 6 to 9 years was 13.11 (95% CI: 9.58−17.95) during the 90 days before MPH exposure, and 17.7 (95% CI: 15.6−20.08) during MPH treatment, but returned to baseline levels after discontinuation of MPH treatment. @*Conclusion@#We confirmed the temporal relationship between depression and methylphenidate use in young people with ADHD. Though the absolute risk is low, the risk of depression should be carefully considered, particularly in the period directly following the start of methylphenidate treatment.
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Objective@#Despite the rapid increase in problematic media device use, relatively little is known about specific characteristics and extent of problematic media device and how they relate to different psychological features. @*Methods@#Data extracted from the Panel Korea Study for the Child Cohort Study were used. At the age of 9 years, media device addiction severity was assessed using the K-scale, and children’s behavioral outcomes were assessed using the Child Behavior Checklist. Among children with problematic media device use (n=339), we performed latent profile analysis using the K-scale to identify subtypes of problematic media device use, and then compared the child behavioral problems and executive function according to the different subtypes of problematic media device use. @*Results@#Children with problematic media device use were divided into class 1 (n=51), class 2 (n=138), and class 3 (n=150). Compared with classes 2 and 3, class 1 had more severe problematic media device use, including daily activity disturbance, withdrawal, and tolerance. Class 1 had the most serious behavioral problems and executive function difficulties among classes. Class 2 had greater daily activity disturbance and tolerance than those of class 3, but executive function showed no significant difference between the two classes. In logistic regression analysis, behavioral problems except for somatization were more common in class 1 than in the control group. @*Conclusion@#Results suggest that problematic media device use is associated with significant behavioral problem and executive function difficulties and underscore the need for further clinical and research attention for these specific subgroup members.
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Objective@#Adult attention deficit hyperactivity disorder (ADHD) has a heterogeneous clinical presentation with patients showing very frequent emotional problems. In the present study, patients with adult ADHD were subtyped based on their psychopathology using a person-centered approach. @*Methods@#In the present chart review study, detailed findings of psychological evaluation conducted as part of routine care were utilized. A total of 77 subjects with adult ADHD were included in the analysis. Detailed ADHD symptoms, psychiatric comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, and severity of mood and anxiety symptoms were evaluated in the person-centered analysis. @*Results@#Three clusters were generated using clustering analysis. DSM comorbid conditions did not significantly impact the clustering. Cluster 1 consisted of ADHD combined presentation (ADHD-C) with less mood symptoms, cluster 2 of ADHD predominantly inattentive presentation and cluster 3 of ADHD-C with significant mood symptoms. Patients in cluster 3 had adulthood functional impairment more frequently compared with patients in cluster 1. Patients in cluster 3 showed recurrent thoughts of death and suicidal ideation more frequently compared with patients in cluster 1. @*Conclusion@#Further studies are needed to confirm the relationships observed in the present study.
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Objective@#Despite the rapid increase in problematic media device use, relatively little is known about specific characteristics and extent of problematic media device and how they relate to different psychological features. @*Methods@#Data extracted from the Panel Korea Study for the Child Cohort Study were used. At the age of 9 years, media device addiction severity was assessed using the K-scale, and children’s behavioral outcomes were assessed using the Child Behavior Checklist. Among children with problematic media device use (n=339), we performed latent profile analysis using the K-scale to identify subtypes of problematic media device use, and then compared the child behavioral problems and executive function according to the different subtypes of problematic media device use. @*Results@#Children with problematic media device use were divided into class 1 (n=51), class 2 (n=138), and class 3 (n=150). Compared with classes 2 and 3, class 1 had more severe problematic media device use, including daily activity disturbance, withdrawal, and tolerance. Class 1 had the most serious behavioral problems and executive function difficulties among classes. Class 2 had greater daily activity disturbance and tolerance than those of class 3, but executive function showed no significant difference between the two classes. In logistic regression analysis, behavioral problems except for somatization were more common in class 1 than in the control group. @*Conclusion@#Results suggest that problematic media device use is associated with significant behavioral problem and executive function difficulties and underscore the need for further clinical and research attention for these specific subgroup members.
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Objective@#Adult attention deficit hyperactivity disorder (ADHD) has a heterogeneous clinical presentation with patients showing very frequent emotional problems. In the present study, patients with adult ADHD were subtyped based on their psychopathology using a person-centered approach. @*Methods@#In the present chart review study, detailed findings of psychological evaluation conducted as part of routine care were utilized. A total of 77 subjects with adult ADHD were included in the analysis. Detailed ADHD symptoms, psychiatric comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, and severity of mood and anxiety symptoms were evaluated in the person-centered analysis. @*Results@#Three clusters were generated using clustering analysis. DSM comorbid conditions did not significantly impact the clustering. Cluster 1 consisted of ADHD combined presentation (ADHD-C) with less mood symptoms, cluster 2 of ADHD predominantly inattentive presentation and cluster 3 of ADHD-C with significant mood symptoms. Patients in cluster 3 had adulthood functional impairment more frequently compared with patients in cluster 1. Patients in cluster 3 showed recurrent thoughts of death and suicidal ideation more frequently compared with patients in cluster 1. @*Conclusion@#Further studies are needed to confirm the relationships observed in the present study.
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Objective@#This study aimed to examine personality profiles and behavioral problems of children with nail biting (NB) to gain insight into the developmental trajectory of pathological NB. @*Methods@#681 elementary school students were divided into non NB (n=436), occasional NB (n=173) and frequent NB group (n=72) depending on the frequency of NB reported in Child Behavioral Checklist (CBCL). Children’s personality was assessed using the Junior Temperament and Character Inventory (JTCI), and behavioral problems were assessed using the CBCL. Latent Profile Analysis (LPA) was performed using JTCI profiles to classify personalities of the children with NB (belonging to frequent and occasional NB group, n=245). @*Results@#For subscale scores of CBCL, the total, internalizing, externalizing, anxious/depressed withdrawn/depressed, depression, thought, rule-breaking, and aggressive behavior problems, were most severe in the frequent NB group followed by occasional NB and non NB group. LPA of personality profile in children with NB revealed four classes (‘adaptiveness,’ ‘high reward dependence,’ ‘low self-directedness,’ and ‘maldaptiveness’). The four personality classes demonstrated significant group differences in all of the CBCL subscales. Children who showed low self-directedness and cooperativeness and high novelty seeking and harm avoidance personality profiles demonstrated highest tendency for problematic behavior irrespective of the frequency of NB. @*Conclusion@#Children with NB reported significantly more problematic behaviors compared to children without NB. Children with specific personality profile demonstrated higher tendency for problematic behavior irrespective of the frequency of NB. Therefore, accompanying personality profiles should be considered when assessing behavioral problems in children with NB.
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This study's aim was to investigate whether the incidence of neutropenia was higher in subjects who received a combination pharmacotherapy with valproate (VPA), antipsychotics (APs), and attention deficit hyperactivity disorder (ADHD) medication than in those administered only VPA and APs combination pharmacotherapy. We conducted this study through retrospective review of medical records. We collected the records of 231 children admitted to the National Center for Mental Health. The incidence of neutropenia was significantly higher in the VPA–APs–ADHD combination group than in the other groups (55.2% vs. 25% vs. 12%, VPA + AP + ADHD vs. VPA + AP vs. AP). The presence of the combination of VPA, APs, and ADHD medication was a powerful predictor of neutropenia occurrence after adjusting for age, gender, and body mass index (odds ratio, 6.43; 95% confidence interval, 2.26–18.26; P < 0.001) The combination of VPA, APs, and ADHD medication in children with psychiatric disease appears to increase the incidence of drug-induced neutropenia.
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OBJECTIVE: Anxiety has been shown to influence functional impairment in patients with attention deficit hyperactivity disorder (ADHD). This study aimed to compare functional impairment in subjects with and without adult ADHD and to investigate the associations among trait anxiety, functional impairment, and ADHD symptom severity. Moreover, the effects of ADHD symptom subtypes on trait anxiety and functional impairment were also examined. METHODS: The sample included 209 adults between the ages of 20 and 31 years. Fifty-one adults received a diagnosis of ADHD, and an additional age, sex-matched group of 51 adults comprised the adult control. Participants were assessed with Conners’ Adult ADHD Rating Scales (CAARS), the Beck Depression Inventory (BDI), the Spielberg Trait Anxiety Inventory (STAI-T), and the Sheehan Disability Scale (SDS). The relationships among ADHD severity, anxiety, and functional impairment were investigated using Pearson’s correlation analysis. Subtypes of ADHD symptoms that predicted anxiety and functional impairment were investigated using regression analyses. RESULTS: Adult ADHD patients significantly differed from normal control subjects according to BDI, STAI-T, and SDS assessment. Significant positive correlations were noted between ADHD severity, anxiety, and functional impairment. Multiple linear regression analysis confirmed anxiety as a mediator between functional impairment and ADHD CAARS symptom subscales. CONCLUSION: Patients with adult ADHD showed higher levels of anxiety, depression, and functional impairment. Additionally, ADHD symptoms and anxiety impacted subject functional impairment. Our results suggest that anxiety may be a strong mediator between ADHD severity and functional impairment.
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Adult , Humans , Anxiety , Attention Deficit Disorder with Hyperactivity , Comorbidity , Depression , Diagnosis , Linear Models , Quality of Life , Weights and MeasuresABSTRACT
This correction is being published to correct the degree of the author Maehwa Oh, in the article.
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OBJECTIVES: To initiate and develop a treatment guideline in multidisciplinary approaches for related professions who are either working and/or living with children and adolescents with neurodevelopmental disorders who show behavioral problems. METHODS: To collect and reflect opinions from multiple professions who assumedly have different interventions or mediations on behavioral problems, a self-report survey and Focus Group Interview (FGI) were conducted for a group of child and adolescent psychiatrists, behavioral therapists, special education teachers, social welfare workers, and caregivers. RESULTS: According to a self-report survey and FGI results from multiple professional groups, aggressive behavior is the mostly common behavioral problem necessitating urgent interventions. However, both mainly used intervention strategies and effective treatment methods were different depending on professional backgrounds, such as pharmacological treatment, parent training, and behavior therapy, even though they shared an importance of improving communication skills. In addition, there was a common understanding of necessity to include parent training in a guideline. Lastly the data suggested lack of proper treatment facilities, qualified behavior therapists, and lack of standardized treatment guideline in the field needed to be improved for a quality of current therapeutic services. CONCLUSION: It is supported that several subjects should be included in the guidelines, such as how to deal with aggressive behavior, parent training, and biological aspects of neurodevelopmental disorders. Also, it is expected that publishing the guideline would be helpful to above multiple professions as it is investigated that there are lack of treatment facility and qualified behavioral therapists compared to need at the moment.
Subject(s)
Adolescent , Child , Humans , Autistic Disorder , Behavior Therapy , Caregivers , Developmental Disabilities , Education, Special , Focus Groups , Negotiating , Neurodevelopmental Disorders , Parents , Problem Behavior , Psychiatry , Social WelfareABSTRACT
OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) is a disease of high heritability. Parents of children with ADHD have high parenting stress and low parenting efficacy. In this study, we assessed parents' characteristics including inattention, hyperactivity, impulsivity, executive function, anxiety/depression severity level, child's ADHD symptom severity, and parents' emotional distress level. The relationships between severity of ADHD symptoms in children, cognitive and emotional characteristics in parents, as well as parenting stress and parenting efficacy were evaluated. METHODS: 96 parents participated in the study. Each parent assessed their child's ADHD symptom severity, their own ADHD symptom severity, as well as executive function, depression, anxiety, parenting stress and parenting efficacy. Collected data was analyzed using multiple regression analysis. RESULTS: The mean ADHD Rating Scale score of 53 children was 22.91 (±9.63). Of these, 26 (49.0%) were taking medication. Eight (8.3%) of the 96 parents had psychiatric illnesses and 12 (12.5%) had the possibility of ADHD. Mothers showed significantly higher levels of parenting stress (p < 0.001), depression (p=0.006), and parenting efficacy (p < 0.001) compared with fathers. The children's ADHD symptoms, severity, and parental depression were related to high parenting stress. The ADHD symptoms of parents were associated with high parenting stress (p=0.032). Parental executive function was significantly associated with low parenting efficacy (p=0.015). CONCLUSION: Children's ADHD symptoms severity, parental depression and ADHD symptom severity were significantly associated with high parenting stress. Parental executive function was significantly associated with low parenting efficacy. In addition to treating the children with ADHD, evaluation and treatment of parents' symptoms is needed in order to reduce parenting stress and provide a stable parenting environment.
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Child , Humans , Anxiety , Attention Deficit Disorder with Hyperactivity , Depression , Executive Function , Fathers , Impulsive Behavior , Mothers , Parenting , ParentsABSTRACT
OBJECTIVE: Equine-assisted activities and therapy (EAA/T) have been used as adjunct treatment options for physical and psychosocial rehabilitation. However, the therapeutic effects on resting-state brain function have not yet been studied. The aim of this study is to investigate the effects of EAA/T on participants with attention-deficit/hyperactivity disorder (ADHD) by comparing resting-state functional magnetic resonance imaging (rs-fMRI) signals and their clinical correlates. METHODS: Ten participants with ADHD participated in a 12-week EAA/T program without any medication. Two rs-fMRIs were acquired for all participants before and after EAA/T. For estimating therapeutic effect, the regional homogeneity (ReHo) method was applied to capture the changes in the regional synchronization of functional signals. RESULTS: After the EAA/T program, clear symptom improvement was found even without medication. Surface-based pairwise comparisons revealed that ReHo in the right precuneus and right pars orbitalis clusters had significantly diminished after the program. Reduced ReHo in the right precuneus cluster was positively correlated with changes in the scores on DuPaul’s ADHD Rating Scale-Korean version. CONCLUSION: Our results indicate that EAA/T is associated with short-range functional connectivity in the regions related to the default mode network and the behavioral inhibition system, which are associated with symptom improvement.
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Attention Deficit Disorder with Hyperactivity , Brain , Equine-Assisted Therapy , Magnetic Resonance Imaging , Methods , Parietal Lobe , Pilot Projects , Psychiatric Rehabilitation , Therapeutic UsesABSTRACT
OBJECTIVES: The aim of this study was to examine the association between current suicidal or violent behavior and deficits of specific neurocognitive variables in child and adolescent inpatient samples diagnosed with mood disorder. METHODS: A retrospective review of the charts of mood disorder patients hospitalized at Samsung Medical Center between April 2004 and April 2015 was conducted. Child and adolescent patients aged between 10 and 18 years old and those who finished neurocognitive function testing during their hospitalization were included. Among them patients whose full scale IQ was between 85 and 115 were selected (N=111). Participants were first divided into two age-groups-group Y (10≤age≤15, N=54) and group O (16≤age≤18, N=57)-because neurocognitive function test tools were different according to age [Wechsler Intelligence Scale for Children (WISC) for 10 to 15-year-old patients, Wechsler Adult Intelligence Scale (WAIS) for 16 to 18-year-old patients]. They were then divided according to their suicidal or violent behavior-non suicidal/violent group (NG), suicidal group (SG), violent group (VG), and both suicidal/violent group (BG). The Child Behavior Checklist (CBCL) was checked for measurement of participants' behavior and the Gordon Diagnostic System was checked for measurement of their attention efficiency. Kruskal-Wallis Test and Tukey test was used to determine the differences in neurocognitive function between groups. RESULTS: O-SG patients showed lower scores on the comprehension subscale of WAIS-III than O-NG patients (χ2=8.454, p=.015). O-VG patients showed lower scores on the block design subscales of WAIS than O-SG patients (χ2=7.496, p=.024). Y-VG patients showed higher scores in aggressive behavior, externalizing problems, and total problems scores of CBCL. CONCLUSION: This study showed relationship between specific neurocognitive deficits and suicidal or violent behavior. These relationships were significant in relatively older adolescents.
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Adolescent , Adult , Child , Humans , Checklist , Child Behavior , Comprehension , Hospitalization , Inpatients , Intelligence , Mood Disorders , Retrospective StudiesABSTRACT
OBJECTIVES: This study researched the clinical effects of hippotherapy and medication in attention deficit hyperactivity disorder (ADHD) children. METHODS: The study employed an open label randomized controlled trial. Participants were 10 children of ages between 6 and 12 years. These subjects were placed in 2 groups : the hippotherapy group and the medication group. Evaluation tools used in this study include Affective Disorders and Schizophrenia-Present and Lifetime Version- Korean Version, the Wechsler Intelligence Scale for Children-IV, Korean Child Behavior Check List (K-CBCL), ADHD rating scale (ARS), Clinical Global Impression (CGI), and Quantitative electroencephalography (QEEG). RESULTS: Grossly scores of investigator-administered ADHD rating scale (ARS-I), K-CBCL, and CGI-Severity of Illness scale were improved in both the hippotherapy and the medication group. The ARS-I scores of the Hippotherapy group were not significantly different from baseline after 12 weeks. In the QEEG, theta/beta ratio of Pz area in the hippotherapy group was significantly different from baseline. Children treated with medication showed significant difference from baseline in ARS-I, K-CBCL subscales, and QEEG. CONCLUSION: The use of hippotherapy could be a viable treatment strategy as a part of a multimodal therapy for children with ADHD. This pilot study provides good prospects for future studies to document these positive trends on larger samples.