Quantitative Electroencephalography Findings in Attention-Deficit Hyperactivity Disorder According to Korean DISC-IV / 신경정신의학

OBJECTIVES: This study was designed to investigate the clinical availability of quantitative electroencephalography (QEEG) as an auxiliary diagnostic tool in attention-deficit hyperactivity disorder (ADHD). METHODS: A total 95 participants completed examinations, which included Korean ADHD Rating Scale (K-ARS), Diagnostic Interview Schedule for Children Version IV-Korean Version (DISC-IV), and QEEG. From the result of the DISC-IV, we divided them into three groups, ADHD, ADHD NOS (not otherwise specified), and Normal control. The QEEG was analyzed by the ranges of Hz : delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12-25 Hz), and high beta (25-30 Hz). RESULTS: ADHD NOS group showed significantly decreased delta activity (NOSnormal, p=0.044) compared with normal control. ADHD group showed increased high beta activity (ADHD>NOS, p=0.043) compared with NOS group. The z-scores of relative power of theta were negatively correlated with the K-ARS at O1, O2 electrodes of ADHD group. On the other hand, the z-scores of relative power of high beta were negatively correlated with the K-ARS at F7, F8 electrodes of ADHD NOS group. CONCLUSION: We confirmed QEEG abnormalities in ADHD patients, especially the difference between ADHD NOS and Normal control. Therefore, we expect to use QEEG as the valuable tool to diagnose ADHD accurately.

Case-Control Association Study of the Norepinephrine Transporter Gene Polymorphism in Children with ADHD

OBJECTIVES: This study aimed to examine the association between norepinephrine transporter gene (SLC6A2) polymorphisms and attention-deficit hyperactivity disorder (ADHD) and to examine the relationship between the genotypes and allele variants of SLC6A2 and results of the Korean version of the parent ADHD rating scale (K-ARS). METHODS: We examined the association between ADHD and norepinephrine transporter gene polymorphism using DNA from 137 Korean children with ADHD and 120 normal controls. We compared the genotype distributions and allele frequencies of SLC6A2 polymorphism between the control group and the ADHD group. Then, we correlated the children's K-ARS mean totals, inattention scores, and hyperactivity/impulsivity scores with the genotypes and alleles for each SLC6A2 polymorphism. RESULTS: There were no significant differences in genotype and allele distribution for each SLC6A2 polymorphism, as shown by the Chi-square test (p>.01). There was a trend toward a difference in allele frequency in rs 5568, but it was not statistically significant after adjusting for multiple comparisons (p=.048). Also, there were no significant differences in K-ARS scores according to the genotypes and alleles for the SLC6A2 polymorphisms. CONCLUSION: Our study found no significant evidence of an association between SLC6A2 polymorphisms and ADHD.

Impact of Adenotonsillar Hypertrophy on Sleep and Attention Deficit-Hyperactivity Symptoms in Children / 신경정신의학

OBJECTIVES : Adenotonsillar hypertrophy is one of the principal causes associated with snoring, sleep apnea, and restless sleep. These sleep-disordered breathing (SDB) is associated with hyperactivity, rebellious behavior, aggressiveness, enuresis, inattention, social withdrawal, and learning difficulties. The purpose of this study was to assess the impact of adenotonsillar hypertrophy on attention deficit hyperactivity symptoms and sleep-related symptoms in children by standard tests. METHODS : Children aged 5 through 15 years old, a total of 65 who were scheduled for Tonsillectomy and Adenoidectomy, were studied. The control group consisted of 30 healthy children of the same age. In both groups, attention-deficit hyperactivity dis-order (ADHD) was evaluated by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). The degree of inattention, hyperactivity and sleep-related symptoms was evaluated by Korean ADHD Rating Scales (K-ARS), ADHD diagnostic system (ADS) and pediatric sleep questionnaire. The K-ARS and sleep questionnaire were completed by the parents of the children. RESULTS : Acording to K-SADS-PL, 23 subjects out of 65 subjects in the patient group and 2 subjects out of 30 subjects in the control group were diagnosed with ADHD. According to sleep questionnaires, the patient group reported significantly more problems than the control group. The patients had significantly higher cumulative questionnaire scores than the control group. In linear regression analysis, the cumulative score of sleep questionnaire was associated with inattention subscale scores, hyperactivity/impulsivity subscale scores and the total score of K-ARS, and also with the response time and the standard deviation of response time of ADS. In relation to ADHD, the patient group had significantly higher ADHD scores in K-ARS inattention subscale and significantly slower response time in ADS compared to the control group. Comparing SDB children without ADHD and the control group without ADHD by excluding ADHD children in both groups, SDB children without ADHD did not show significantly higher scores in K-ARS but did show significantly slower ADS response time. CONCLUSION : Children with adenotonsillar hypertrophy are associated with increased SDB and ADHD symptoms. Therefore they may need intensive treatment such as surgical intervention.

Impact of Adenotonsillar Hypertrophy on Sleep and Attention Deficit-Hyperactivity Symptoms in Children / 신경정신의학

OBJECTIVES : Adenotonsillar hypertrophy is one of the principal causes associated with snoring, sleep apnea, and restless sleep. These sleep-disordered breathing (SDB) is associated with hyperactivity, rebellious behavior, aggressiveness, enuresis, inattention, social withdrawal, and learning difficulties. The purpose of this study was to assess the impact of adenotonsillar hypertrophy on attention deficit hyperactivity symptoms and sleep-related symptoms in children by standard tests. METHODS : Children aged 5 through 15 years old, a total of 65 who were scheduled for Tonsillectomy and Adenoidectomy, were studied. The control group consisted of 30 healthy children of the same age. In both groups, attention-deficit hyperactivity dis-order (ADHD) was evaluated by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). The degree of inattention, hyperactivity and sleep-related symptoms was evaluated by Korean ADHD Rating Scales (K-ARS), ADHD diagnostic system (ADS) and pediatric sleep questionnaire. The K-ARS and sleep questionnaire were completed by the parents of the children. RESULTS : Acording to K-SADS-PL, 23 subjects out of 65 subjects in the patient group and 2 subjects out of 30 subjects in the control group were diagnosed with ADHD. According to sleep questionnaires, the patient group reported significantly more problems than the control group. The patients had significantly higher cumulative questionnaire scores than the control group. In linear regression analysis, the cumulative score of sleep questionnaire was associated with inattention subscale scores, hyperactivity/impulsivity subscale scores and the total score of K-ARS, and also with the response time and the standard deviation of response time of ADS. In relation to ADHD, the patient group had significantly higher ADHD scores in K-ARS inattention subscale and significantly slower response time in ADS compared to the control group. Comparing SDB children without ADHD and the control group without ADHD by excluding ADHD children in both groups, SDB children without ADHD did not show significantly higher scores in K-ARS but did show significantly slower ADS response time. CONCLUSION : Children with adenotonsillar hypertrophy are associated with increased SDB and ADHD symptoms. Therefore they may need intensive treatment such as surgical intervention.

Screening for Attention Deficit/Hyperactivity Disorder for Children in Seoul / 신경정신의학

OBJECTIVES: The purpose of this study is to investigate a cut-off value for screening children with ADHD in community based sample using the Korean Child Behavior Checklist (K-CBCL) and the Korean ADHD Rating Scale (K-ARS). METHODS: Children aged 6 to 8 (n=661) participated in this study. The K-CBCL and the K-ARS were used as the screening instruments. Diagnoses were confirmed through the Diagnostic Interview Schedule for Children Version IV (DISC-IV). RESULTS: Of the 189 subjects who underwent the DISC-IV, 26 subjects were diagnosed as ADHD. In the K-CBCL, scores in the attention problems, externalizing problems and total behavioral problems were positively correlated with the total score of the K-ARS. The K-ARS-Parent version (K-ARS-P) and above three scales in the K-CBCL showed significant screening validity in the ROC curve analysis. The reasonable level of sensitivity, specificity, and negative predictive value were obtained in the total scores > or =90th percentile in the K-ARS-Parent and > or =60T scores in the K-CBCL attention problems. The optimal level of specificity, positive predictive value and negative predictive value were obtained when combined the K-CBCL (> or =60T scores in the attention problems and > or =63T scores in the total problems) and the total scores > or =90th percentile in the K-ARS-P. CONCLUSION: The combined use of the K-CBCL and the K-ARS-P may serve as useful screening methods for ADHD children.

Normative Study of the K-ARS(Korean ADHD Rating Scale) for Parents

OBJECTIVES: The K-ARS(Korean ADHD Rating Scale) is one of the most important assessment tool of attentiondeficit hyperactivity disorder(ADHD) in Korea. In this study, we presented detailed normative data on the K-ARS for school-aged children in Seoul metropolitan area to put it to practical use. METHODS: The subjects were 2,397 students(1,223 boys and 1,174 girls, aged 6-12) from 4 elementary schools in Seoul, and one caretaker of each child completed the K-ARS for parents. Children who showed high scores of the KARS for parents were screened, and 2 child psychiatrists interviewed them to make a clinical diagnosis. We compared the mean scores of the K-ARS for parents between ADHD and normal group, and examined the percentage of correct classification. RESULTS: There were some differences in score of the K-ARS for parents according to sex and age, so we presented continuous normative data with T score and subdivided cut-off points for ADHD screening. Interviews with child psychiatrists using DSM-IV criteria were performed to test diagnostic validity, and the difference in every the K-ARS for parents index between ADHD and normal group was significant(p<.001). Using 3 different cut-off points(80th, 90th, 93rd percentage), the accuracies of ADHD correct classification were 67.9, 72.2, 71.1% and all 3 canonical discriminants were significant(p<.05) between ADHD and normal group. CONCLUSION: The normative data and cut-off points on the K-ARS for parents are useful in screening ADHD children in Seoul metropolitan area.

Screening for Attention Deficit/Hyperactivity Disorder in Community Mental Health Services for Children / 신경정신의학

OBJECTIVES: Developing mental health services and systems to identify children with Attention Deficit/Hyperactivity Disorder (ADHD) and providing early therapeutic interventions for them are important to prevent further impairments or disturbances associated with the disorder. The purpose of this study is to examine the clinical validities and efficiencies of Korean Child Behavior Checklist (K-CBCL) and Korean ADHD Rating Scale (K-ARS) for screening and identifying children with ADHD in community. METHODS: Randomly selected 1st to 3rd graders of the two elementary schools (n=1668) in the City of Gunsan participated in the study. K-CBCL and K-ARS were used as screening instruments. Diagnoses were determined by clinical psychiatric interviews and confirmed by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version-Korean Version (K-SADS-PL-K) using DSM-IV criteria. RESULTS: The rate of inclusion above the T score of 60 with regard to the attention problems profile of K-CBCL was 4.5%. There was a significant correlation (p or =60 in attention problems) and K-ARS (parent/teacher total> or =90th percentile) reports were combined. CONCLUSION: These findings suggest that the K-CBCL and K-ARS together could serve as a rapid and useful screening instrument to identify children with ADHD in epidemiologic case definitions.

Normative Data on the Korean ADHD Rating Scales(K-ARS) for Parents and Teacher / 신경정신의학

OBJECTIVES: Identifying children with Attention-Deficit/Hyperactivity Disorder (ADHD) and providing early therapeutic interventions for them are important to prevent secondary problems in academic achievement and emotional disturbances. The aims of the study is to examine the characteristics of K-ARS for parents and teachers, a screening questionnaire to identify children with ADHD, by age and sex of the children, to examine its clinical validity, and to provide norm data of K-ARS for school-aged children which will facilitate the use of K-ARS in clinical practice and research. METHODS: Randomly selected 1st to 6th graders of the two elementary schools (N=1044) in Anyang City participated in this study. Twenty three children diagnosed with ADHD at the child and adolescent clinic at the Hallym University Sacred Heart Hospital were included in this study for the analysis of validity. Parents and teachers completed K-ARS. Descriptive statistics, t-test and analysis of variance were performed. RESULTS: K-ARS scores showed significant difference according to the gender, with boys having higher scores than girls. There was no significant difference of the scores by ages. Validity analysis showed that K-ARS distinguishes children with ADHD from children without ADHD well. The normative data were presented by age and sex. CONCLUSION: K-ARS for parents and teachers has an excellent clinical validity to discriminate children with ADHD from children without ADHD. Different normative data of K-ARS need to be used due to the gender difference. K-ARS is a useful tool for screening and identifying children with ADHD. Future studies are required to include larger samples with adolescents in various geographic areas.