Effects of Early Childhood Peer Relationships on Adolescent Mental Health: A 6- to 8-Year Follow-Up Study in South Korea

OBJECTIVE: Peer relationships are one of the important factors in children's development. The present study examines the relationship between the effects of early peer relationships and adolescent psychological adjustment. METHODS: The first survey took place from 1998 to 2000, and a follow-up assessment obtained data in 2006, as the original participants reached 13-15 years of age. The first assessment used the Korean version of the Child Behavior Checklist (K-CBCL) and simple questions about peer relationships to evaluate the participants. The follow-up assessment administered the Korean Youth Self Report (K-YSR). RESULTS: Children's peer relationships have longitudinal effects on mental health and adjustment. Children who had qualitative peer-relation problems were more likely to exhibit internalizing problems as adolescents. CONCLUSION: Children who have poor peer relationships might become more vulnerable to emotional problems and social adjustment as adolescents.

Psychological characteristics of Korean children and adolescents with type 1 diabetes mellitus

PURPOSE: This study investigates the behavioral and emotional characteristics of Korean children and adolescents with type 1 diabetes mellitus (T1DM) as compared to healthy controls, and examines whether their psychological status is associated with glycemic control, insulin regimens, or disease duration. METHODS: A total of 37 Korean children and adolescents with T1DM, aged 6-17 years, and 38 sex- and age-matched healthy controls were included in this study. Psychological distress was assessed using the Korean child behavior checklist (K-CBCL) and children's depression inventory (CDI) after the subjects and their parents were interviewed. RESULTS: The CDI and K-CBCL scores were significantly higher in T1DM subjects compared to normal controls. The T1DM subjects with "poorly controlled" blood glucose (glycosylated hemoglobin > or =8%) and "old patients" (disease duration > or =1 year) had a tendency to show higher CDI and K-CBCL scores. There were no significant differences in CDI and K-CBCL scores between the intensive and conventional insulin therapy groups. CONCLUSION: Children and adolescents with T1DM seem to have inferior psychological adjustment to their normal counterparts, which might be associated with glycemic control and disease duration. Psychological evaluation and intervention should be considered in the management of T1DM in children and adolescents.

The Effect of Environmental Tobacco Smoke Exposure and Glutathione S-Transferase Polymorphism on Childhood Behavioral Development during Mid-Pregnancy and Early Childhood / 신경정신의학

OBJECTIVES: The author investigated the relationship between the environmental tobacco smoke exposure during mid-pregnancy and early childhood and neurobehavioral outcomes of preschool children and if there is any effect of the genetic polymorphism of glutathione S-transferase (GST) M1 and T1 on this relationship. METHODS: The participants were the pregnant women (week 24-28) who visited the obstetrics and gynecology department (between 2001 and 2004). They had been evaluated for their sociodemographic data including direct and environmental tobacco smoke exposure history and the urine specimen had been sampled for the measurement of cotinine. The offsprings' urine specimen and blood sampling had been done and the socioeconomic data including the environmental tobacco smoke exposure history was evaluated at age 3. The cotinine level of urine specimen was measured and GST polymorphism was analyzed. The offsprings completed Korean-Childhood Behavioral Check List (K-CBCL) at age 4-5. RESULTS: The environmental tobacco smoke exposure during mid-pregnancy based on urine cotinine level has a significant association with increased total score and externalizing problem score of K-CBCL (p<0.05). The environmental tobacco smoke exposure based on urine cotinine level at age 3 is associated increased total score, externalizing problem score and internalizing problem score of K-CBCL with no statistical significance. The environmental tobacco smoke exposure after controlling for tobacco smoke exposure during pregnancy, however, is significantly associated with the increased externalizing problem scores (p=0.04). The environmental tobacco smoke exposure is associated with increased total score, externalizing problem score and internalizing problem score of K-CBCL with GSTM1 null type or GSTT1 null type at age 3 although there was no statistical significance. CONCLUSION: The environmental tobacco smoking exposure during pregnancy and at early childhood is associated with childhood behavioral problems. The clinical implication of this study is that it is important to avoid the environmental tobacco smoke exposure during pregnancy and early childhood and to monitor the possible emergence of behavioral problems of children.

The Effects of Intrauterine Oxidative Stress and Antioxidant Vitamins on Childhood Behavioral Development at Age 4 Years / 신경정신의학

OBJECTIVES : We aimed to define the effects of antioxidant vitamins and oxidative stress in the intrauterine period on childhood neurobehavioral development. METHODS : The behavioral status of 100 children (aged four) at Ewha Womans University Mokdong Hospital in Korea was examined using the K-CBCL. Their maternal vitamin and oxidative stress status were analyzed at midterm as intrauterine circumstance indices. The relationship between intrauterine condition and childhood behavioral development was analyzed using a general linear model. RESULTS : K-CBCL scores were lower in the group which took high levels of maternal vitamins B6 and B12 than scores in the group which too low levels of these vitamin. In contrast, the group with high maternal oxidative stress exhibited higher scores in behavioral problem scales. After adjusting for inborn and childhood environmental covariates, K-CBCL differences were statistically significant in the B2 group comparison (high group vs. low group;total problem : 47.0+/-1.0 vs. 53.0+/-1.8, internalizing problem 46.5+/-1.0 vs. 51.2+/-1.8). In addition, significant highest means of K-CBCL were in low vitamin and high oxidative stress group than other combined groups. CONCLUSION : We have established a relationship between maternal vitamins and oxidative stress during pregnancy, and a 4 year-old child's behavioral development. This suggests that preventive efforts during pregnancy are influential on early childhood behavioral problems.

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.

The Cognitive Performance, Emotional and Behavioral Problems of the Children with ADHD Showing the Difference between Visual and Auditory Attention

OBJECTIVE: The purpose of this study was to investigate the differences of the cognitive performance, emotional and behavioral problems among the attention-deficit/hyperactivity disorder(ADHD) groups that show the difference between visual and auditory attention. METHOD: Using'ADHD Diagnostic System(ADS)', visual attention and auditory attention of 98 children diagnosed as ADHD were measured. According to the omission and commission error of ADS, they were divided into three groups; 1) the group whose each visual omission and commission error scores were higher than each auditory omission and commission error scores(VV group), 2) the group whose each auditory omission and commission error scores were higher than each visual omission and commission error scores(AA group), 3) the group that was the rest of VV and AA group(M group). And the results of both the subscales of Korean Educational Development Institute-Wechsler Intelligence Scale for Children(KEDI-WISC) and the subscales of Korean Child Behavior Checklist(K-CBCL) among three groups were compared. Finally, the correlation between the visual omission, visual commission, auditory omission, auditory commission error and the results of KEDI-WISC, K-CBCL were investigated. RESULTS: The results were as follows; 1) In 98 ADHD children, the number of VV group(N=56) was higher than that of AA (N=10) and M group (N=32). 2) All mean scores of the subscales of KEDI-WISC of VV group were higher than those of M and AA group. The score of verbal IQ(p=.039) of VV group was significantly higher than that of AA group and the scores of block design(p=.015), Kaufman's factor 2(p=.045), performance IQ(p=.004) were significantly higher than those of M group. The score of full IQ(p=.004) were significantly higher than that of M and AA group. 3) The mean scores of all K-CBCL subscales of VV group were higher than those of M and AA group, except the score of Somatic complaint subscale. The score of Social subscale(p=.041) of VV group was significantly higher than that of AA group. The score of Withdrawn subscale(p=.021) of AA group was significantly higher than that of VV group. 4) There were no significant correlation between the scores of visual omission/commission error and those of each subscale of KEDI-WISC. But, there were many significant correlations between the scores of auditory omission/commission error and those of each subscale of KEDI-WISC. 5) There were significant correlation between the score of the visual omission error and that of Thought problem subscale(r=.205, p=.043) of K-CBCL. There were significant correlation between the scores of the auditory omission error and those of Social subscale(r=-.319, p=.001), Social problems subscale(r=.206, p=.042), Thought problem subscale(r=.235, p=.021). Finally, there were significant correlation between the scores of auditory commission error and those of Social subscale(r=-.241, p=.017), Thought problem subscale(r=.235, p=.020). CONCLUSION: The ADHD children whose auditory attention ability were higher than visual attention ability had relatively better cognitive performance and less emotional/behavioral problems than the others. The more comprehensive experiment will be needed about the cognitive performance, emotion and behavior problems of the ADHD children showing the difference between visual and auditory attention.

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.

Comparison of child behavior checklist between allergic and non-allergic patients / 천식및알레르기

BACKGROUND AND OBJECTIVE: There have been several reports suggesting close relationships bet- ween problem behavior syndrome scale and/or social competence scale and pediatric allergic disorders such as bronchial asthma and atopic dermatitis. The aim of the present study was to confirm these relationships. We compared the behavioral symptoms and social competence scale between allergic and non-allergic patient groups using Korean-Child Behavior Checklist (K- CBCL). MATERIALS AND METHOD: One hundred and seventy-one subjects(aged 4-11 years) were enro- lled in this study. Allergy patient group(N=84) was divided into 4 subgroups, according to the allergic diseases such as atopic asthma(Group 1, BA), allergic rhinitis(Group 2, AR), atopic dermatitis(Group 3, AD), and chronic urticaria(Group 4, CU). Eighty-seven non-allergic patients (Group 5, NA) included those with pediatric general disorders, except psychomotor retardation, neurologic deficit, malignancy or other chronic disorders. K-CBCL which was filled in by parents or guardian, included eight dimensions of problem behavior: withdrawal, somatic problems, anxiety/ depression, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior. The first three scales were classified as an Internalizing broadband group and the last two scales as Externalizing group. In addition, the questionnaire included social scale, school scale, and total competence scale. RESULTS: There were no significant differences in age, sex, social economic status between 5 subgroups of allergic and non-allergic patients(p>0.05). The mean problem behavior scores tended to be higher in allergic patient group, but no statistical significance was noted(p>0.05). The mean school scale, social scale, total competence scale of allergic patient group were not significantly higher than those of non-allergic patient group(p>0.05). Combined disease group with more than 2 allergic disorders showed problem behaviors compared to non-allergic group or asthma only group. Total social competence scale was lower in allergic patient group with 1-3 years of disease duration than for shorter(less than 1 year) and longer(more than 3 years) durations. CONCLUSION: Taken together, combined disease group and allergic disease group with 1-3 years of duration showed more problem behaviors and the lowest total social competence scales, respectively.

A Clinical Study of Comorbidity of ADHD / 대한소아신경학회지

PURPOSE: A number of emotional, behavioral, cognitive conditions co-occur with ADHD(Attention Deficit/Hyperactivity Disorder). These conditions were commonly unrecognized due to the lack of appropriate questioning and evaluation. Thus, This study is aimed to evaluate the comorbidity of ADHD using K-CBCL(Child Behavior Check List). METHODS: Among the patients diagnosed with ADHD by using DSM-IV. A total of 41 patients(11 female and 30 male) were examined by K-CBCL. They ranged in age from 4 years to 14 years with a mean age of 8 years. They were classified into three clinical types; Inattentive, Hyperactive/Impulsive, and Combined type. They were subgrouped again by the presence of Learning Disability(LD). The Scores were compared among the groups and the data were analyzed with Mann-Whitney test, Kruskal-Wallis test, and post hoc analysis. RESULTS: Fifty-six percent of the cases scored greater than 70 on at least one factor measured, and 27% seemed to have LD. Female patients were more likely to have social withdrawal and thought problems(P<0.05), and Hyperactive/Impulsive type was more likely to have aggression as compared with Inattentive type(P<0.01). The patients with LD scored worse on the item of attention compared with the cases without LD(P<0.05). CONCLUSION: Comorbidity of ADHD is relatively common and may have a significant impact on functioning, management, and prognosis of patients with ADHD. Rating scales such as K-CBCL can provide a lot of information at a relatively low cost and help sketch the clinical pictures of patients.