A Novel Robot-Assisted Kinematic Measure for Children with Attention-Deficit/Hyperactivity Disorder: A Preliminary Study

Objective@#Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. In contrast to neurocognitive measurements of inattention and impulsivity, there has been limited research regarding the objective measurement of hyperactivity in youths with ADHD. The purpose of the present study was to investigate the clinical effectiveness of a newly developed Robot-assisted Kinematic Measure for ADHD (RAKMA) in children with ADHD. @*Methods@#In total, 35 children with ADHD aged 5 to 12 years and 50 healthy controls (HCs) were recruited, and the parents completed the Child Behavior Checklist and the Korean ADHD Diagnostic Scale. RAKMA performance was represented by RAKMA stimulus–response and hyperactivity variables. We compared the RAKMA performance of those with ADHD and with that of HCs and also investigated the correlation between the RAKMA variables and ADHD clinical scale scores. @*Results@#Significant differences between the ADHD and HC groups were observed regarding most RAKMA variables, including correct reactions, commission errors, omission errors, reaction times, migration distance, and migration speed scores. Significant correlations were detected between various ADHD clinical scale scores and RAKMA variables. @*Conclusion@#The RAKMA was a clinically useful tool for objectively measuring hyperactivity symptoms in children with ADHD. Further studies with larger samples are warranted.

A Novel Robot-Assisted Kinematic Measure for Children with Attention-Deficit/Hyperactivity Disorder: A Preliminary Study

Objective@#Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. In contrast to neurocognitive measurements of inattention and impulsivity, there has been limited research regarding the objective measurement of hyperactivity in youths with ADHD. The purpose of the present study was to investigate the clinical effectiveness of a newly developed Robot-assisted Kinematic Measure for ADHD (RAKMA) in children with ADHD. @*Methods@#In total, 35 children with ADHD aged 5 to 12 years and 50 healthy controls (HCs) were recruited, and the parents completed the Child Behavior Checklist and the Korean ADHD Diagnostic Scale. RAKMA performance was represented by RAKMA stimulus–response and hyperactivity variables. We compared the RAKMA performance of those with ADHD and with that of HCs and also investigated the correlation between the RAKMA variables and ADHD clinical scale scores. @*Results@#Significant differences between the ADHD and HC groups were observed regarding most RAKMA variables, including correct reactions, commission errors, omission errors, reaction times, migration distance, and migration speed scores. Significant correlations were detected between various ADHD clinical scale scores and RAKMA variables. @*Conclusion@#The RAKMA was a clinically useful tool for objectively measuring hyperactivity symptoms in children with ADHD. Further studies with larger samples are warranted.

Cognitive Outcomes of Children with Very Low Birth Weight at 3 to 5 Years of Age

BACKGROUND@#The cognitive consequences and risk factors based long-term outcome of very-low-birth-weight (VLBW; < 1,500 g) infants in Korea has not been studied. The aim of this study was to determine the influence of perinatal and neonatal risk factors on the cognitive performance of VLBW children at 3 to 5 years of age.@*METHODS@#We enrolled 88 VLBW infants without cystic periventricular leukomalacia for the assessment of their demographic data, cognitive performance, and development of cerebral palsy (CP) at 3 to 5 years of age. Cognitive performance was assessed using the Korean version of the Wechsler Preschool and Primary Scale of Intelligence IV. Growth data were assessed with measurements of weight, height, and head circumference (HC) at the corrected ages of 6, 12, and 18 months, and 3 to 5 years of age.@*RESULTS@#In the VLBW group, the full-scale intelligence quotient (FSIQ) was 96.1 ± 15.2 at the mean age of 4.5 years. The incidence rate of CP was 3.4%. Overall, 17% (15/88) of the VLBW children had a below-average FSIQ (< 85). We divided the VLBW children into the abnormal FSIQ group (< 85, n = 15) and the normal FSIQ group (≥ 85, n = 73). VLBW children with intrauterine growth retardation (IUGR) was associated with a below-average FSIQ at the mean age of 4.5 years (< 85, 8/15, 53.3% vs. ≥ 85, 5/73, 6.8%; P < 0.001). After controlling for associated clinical factors, IUGR in the VLBW children was found to be associated with an abnormal FSIQ at the mean age of 4.5 years (P = 0.025). The weight, height, and HC obtained for both groups showed that normal growth was maintained at the mean age of 4.5 years with no significant difference between abnormal and normal FSIQ groups.@*CONCLUSION@#Fifteen of 88 (17%) of the VLBW children had a below-average FSIQ (< 85). VLBW with IUGR is associated with poor cognitive outcomes at the mean age of 4.5 years.

Cognitive Outcomes of Children with Very Low Birth Weight at 3 to 5 Years of Age

BACKGROUND@#The cognitive consequences and risk factors based long-term outcome of very-low-birth-weight (VLBW; < 1,500 g) infants in Korea has not been studied. The aim of this study was to determine the influence of perinatal and neonatal risk factors on the cognitive performance of VLBW children at 3 to 5 years of age.@*METHODS@#We enrolled 88 VLBW infants without cystic periventricular leukomalacia for the assessment of their demographic data, cognitive performance, and development of cerebral palsy (CP) at 3 to 5 years of age. Cognitive performance was assessed using the Korean version of the Wechsler Preschool and Primary Scale of Intelligence IV. Growth data were assessed with measurements of weight, height, and head circumference (HC) at the corrected ages of 6, 12, and 18 months, and 3 to 5 years of age.@*RESULTS@#In the VLBW group, the full-scale intelligence quotient (FSIQ) was 96.1 ± 15.2 at the mean age of 4.5 years. The incidence rate of CP was 3.4%. Overall, 17% (15/88) of the VLBW children had a below-average FSIQ (< 85). We divided the VLBW children into the abnormal FSIQ group (< 85, n = 15) and the normal FSIQ group (≥ 85, n = 73). VLBW children with intrauterine growth retardation (IUGR) was associated with a below-average FSIQ at the mean age of 4.5 years (< 85, 8/15, 53.3% vs. ≥ 85, 5/73, 6.8%; P < 0.001). After controlling for associated clinical factors, IUGR in the VLBW children was found to be associated with an abnormal FSIQ at the mean age of 4.5 years (P = 0.025). The weight, height, and HC obtained for both groups showed that normal growth was maintained at the mean age of 4.5 years with no significant difference between abnormal and normal FSIQ groups.@*CONCLUSION@#Fifteen of 88 (17%) of the VLBW children had a below-average FSIQ (< 85). VLBW with IUGR is associated with poor cognitive outcomes at the mean age of 4.5 years.

Cognitive Outcomes of Children with Very Low Birth Weight at 3 to 5 Years of Age

Psychiatric Evaluation and Treatment of Sexual Offenders with Developmental Disorder / 신경정신의학

The issues related to the sexuality of the people with developmental disorders are many because a low level of intellectual function and sociality do not equate to a low level of sexual curiosity and sexual desire. This study aimed to review the evaluation and treatment through a forensic psychiatric evaluation case of sexual offenders with developmental disorders. An assessment of sex offenders with developmental disorders should be comprehensive. The risk of recidivism, cognitive distortion about sex, impulsivity, and comorbid psychiatric disorders should be included. Some therapeutic programs have been developed, and they exhibited the effect through the decreased rate of recurrence of sexual offenses. Therefore, it is necessary to pay more attention to the development of therapeutic programs of sexual offenders with developmental disorder.

Visual Hyper-vigilance But Insufficient Mental Representation in Children with Overweight/Obesity: Event-related Potential Study with Visual Go/NoGo Test / 대한소아소화기영양학회지

PURPOSE: The neural processing of children with overweight/obesity (CWO), may affect their eating behavior. We investigated the visual information processing of CWO under response control condition, by event-related potential (ERP) study, an electrophysiologic study for cognitive mechanism. METHODS: Seventeen CWO (mean age: 10.6±1.9), and 17 age-matched non-obese children (NOC), participated in the study. Neurocognitive function tests and visual ERP under Go/NoGo conditions, were implemented. Area amplitudes of major ERP components (P1, N1, P2, N2, and P3) from four scalp locations (frontal, central, parietal, and occipital), were analyzed. RESULTS: For Go and NoGo conditions, CWO had significantly greater occipital P1, fronto-central N1, and P2 amplitudes compared with NOC. P2 amplitude was significantly greater in CWO, than in NOC, at the frontal location. N2 amplitude was not significantly different, between CWO and NOC. For CWO and NOC, Go P3 amplitude was highest at the parietal location, and NoGo P3 amplitude was highest at the frontal location. In Go and NoGo conditions, P3 amplitude of CWO was significantly less than in NOC. CONCLUSION: The greater P1, N1, and P2 suggested hyper-vigilance to visual stimuli of CWO, but the smaller P3 suggested insufficient mental representation of them. Such altered visual processing, may affect the eating behavior of CWO.

Cognitive Function, Emotional and Behavioral Problems, and Temperament of Premature Children

OBJECTIVES: We aimed to compare preterm, neurodevelopmentally disordered and healthy full-term children. METHODS: We enrolled 47 children who were born preterm, 40 neurodevelopmentally disordered children, and 80 healthy children as control participants, in order to assess the cognitive functioning and the risk of behavioral problems at the age of 5. Children were assessed using the Korean Wechsler Preschool and Primary Scale of Intelligence-4th edition (K-WPPSI-IV), the Child Behavior Checklist (CBCL), and the Temperament and Character Inventory (TCI). RESULTS: The mean K-WPPSI-IV score of the preterm group was 87.19±17.36, which was significantly higher than that of the neurodevelopmental disorder group (69.98±28.63; p < 0.001) but lower than that of the control group (107.74±14.21; p < 0.001). The cumulative CBCL scores of the preterm children were not significantly different from those of the control group. Additionally, the TCI scores for reward dependence of the preterm children were higher than those of the control group. CONCLUSION: The cognitive performance of preterm infants was lower than that of healthy full-term infants at the age of 5, and there was an association between slower growth and decreased cognitive ability.

Predicting Autism Spectrum Disorder Using Blood-based Gene Expression Signatures and Machine Learning

OBJECTIVE: The aim of this study was to identify a transcriptomic signature that could be used to classify subjects with autism spectrum disorder (ASD) compared to controls on the basis of blood gene expression profiles. The gene expression profiles could ultimately be used as diagnostic biomarkers for ASD. METHODS: We used the published microarray data (GSE26415) from the Gene Expression Omnibus database, which included 21 young adults with ASD and 21 age- and sex-matched unaffected controls. Nineteen differentially expressed probes were identified from a training dataset (n=26, 13 ASD cases and 13 controls) using the limma package in R language (adjusted p value <0.05) and were further analyzed in a test dataset (n=16, 8 ASD cases and 8 controls) using machine learning algorithms. RESULTS: Hierarchical cluster analysis showed that subjects with ASD were relatively well-discriminated from controls. Based on the support vector machine and K-nearest neighbors analysis, validation of 19-DE probes with a test dataset resulted in an overall class prediction accuracy of 93.8% as well as a sensitivity and specificity of 100% and 87.5%, respectively. CONCLUSION: The results of our exploratory study suggest that the gene expression profiles identified from the peripheral blood samples of young adults with ASD can be used to identify a biological signature for ASD. Further study using a larger cohort and more homogeneous datasets is required to improve the diagnostic accuracy.

The Effect of Low Birth Weight and Age on the Cognitive Performance of Preterm Preschoolers

OBJECTIVES: The current study examined the effect of birth weight on the relationship between age and IQ of children, who were born preterm with very low birth weight (VLBW) or extremely low birth weight (ELBW). METHODS: The study subjects were 82 children, aged between 3–5 years, who visited the neonatal intensive care unit of a university hospital located in Seoul. The children had been born prematurely with VLBW or ELBW. Their IQ was tested using the performed Korean-Wechsler Preschool and Primary Scale of Intelligence fourth edition. RESULTS: A hierarchical regression analysis showed a significant interaction effect of birth weight and age on Full Scale IQ (FSIQ); the effect of age on FSIQ differed according to birth weight. For the group with VLBW, FSIQ was more likely to be higher with increasing age. Conversely, for the group with ELBW, FSIQ remained low regardless of the age level. In addition, birth weight and age had a significant interaction effect on the Visual Spatial Index. Birth weight had a significant main effect on Verbal Comprehension Index. CONCLUSION: This research suggested the possibility of predicting the cognitive developmental of premature children, by highlighting the fact that prematurely born children, with VLBW/ELBW, have different cognitive developmental trajectories.

Introduction: Neurodevelopmental Disorders / 한양의대학술지

No abstract available.

Socially Assistive Robotics in Autism Spectrum Disorder / 한양의대학술지

Autism spectrum disorder (ASD) is a neurodevelopmental disorders that is characterized by complex behavioral phenotype and deficits in both social and cognitive functions and has been gradually increasing for the past 20 years. However, practically there are some difficulties in diagnosis and treatment due to a limited number of specialist and considerable cost. Emerging technology, especially socially assistive robotics (SAR), has expanded into the evaluation and intervention for children with ASD. SAR refers to a robot that provides assistance to the user in a social interaction setting. SAR becomes a tool that can teach or demonstrate socially desirable behaviors to help children who have trouble expressing themselves to others owing to their underdeveloped communication and social skills as a result of ASD. This paper reviews the use of SAR to assist in the therapy of children with ASD and the extent to which the robots were successful in helping the children in their social, emotional and communication deficits was investigated. The study investigates the different roles that these robots were observed to play with children with ASD by categorizing and the outcome of studies that have been conducted in Korea. Despite the fact that SAR research is still in its formative stages, if rigorous research plans are developed based on clinical usefulness and effectiveness, and if a clinician with specialized knowledge of ASD participates in or evaluates the results of the research, there is the possibility to create a new paradigm for the treatment of ASD.

Life Persistence of Attention-Deficit/Hyperactivity Disorder / 한양의대학술지

This paper is to review Attention Deficit-Hyperactivity Disorder (ADHD) in the developmental perspective, focusing on clinical features, diagnosis and treatment of ADHD throughout life stage. When diagnosed with ADHD, before entering elementary school early diagnosis and early intervention is encouraged to reduce various impairments that occur during development. Thirty to eighty percent of school-age ADHD symptoms remain throughout the adolescence or meet the ADHD diagnosis criteria. During adolescence, hyperactivity and impulsiveness from other existing symptoms become less severe but children have insufficiency to continue studying or task compared to their peers. Pharmacologic treatment had been shown to be the most effective treatment regimen for adolescents who continue to have ADHD symptoms. In adults, representative symptoms of ADHD, hyperactivity and impulsiveness, often gradually decrease while lack of concentration remains. As Conner's Adult ADHD Diagnostic Interview for DSM-IV (CAADID), a structured interview for the diagnosis of adulthood ADHD has been translated into Korean, it can be applied clinically. Pharmacological and nonpharmacological treatment in adults had been shown to be effective.

The Effects of Attention-Deficit/Hyperactivity Disorder Symptom and Impulsivity on Abstinence Period of Male Patients with Alcohol Use Disorder / 신경정신의학

OBJECTIVES: Alcohol use disorder (AUD) is closely associated with attention-deficit/hyperactivity disorder (ADHD). However, the mechanism involved in this association remains unclear. Impulsivity is one of the core traits of ADHD, and an elevated level of impulsivity increases the risk of onset of AUD. Our study focused on impulsivity as the common trait factor of these disorders. We examined the effects of ADHD symptoms and impulsivity on the abstinence period of patients with AUD. METHODS: Male participants with AUD completed the contents of the Adult ADHD Self-Report Scale and the Barratt Impulsiveness Scale. We investigated participant alcohol abstinence period to evaluate severity and frequency of relapse. RESULTS: Both ADHD symptom presence and abstinence period were significantly correlated with impulsivity. Motor impulsivity showed the highest correlations with ADHD and abstinence. The results of hierarchical regression analysis showed that impulsivity is a predictor of abstinence period, while ADHD had a moderating effect on the relationships between impulsivity and abstinence period. Moreover, we undertook hierarchical regression analysis of motor, cognitive, and non-planning impulsivity ; only motor impulsivity and ADHD symptom showed a statistically significant interaction with abstinence period. CONCLUSION: The results indicate a possible causal relationship between the treatment of ADHD symptoms and the extension of AUD abstinence period. In other words, treatment of ADHD symptoms may prevent AUD relapse. Impulsivity, especially motor impulsivity has an important role in the base mechanisms of these two disorders.

The Code of Medical Ethics for the Korean Academy of Child and Adolescent Psychiatry: Why Is It Important?

This article provides an overview of the developmental history and rationale of medical ethics to establish the code of ethics and professional conduct of the Korean Academy of Child and Adolescent Psychiatry (KACAP). Most medical professional organizations have their own codes of ethics and conduct because they have continuous responsibility to regulate professional activities and conducts for their members. The Ethics and Award Committee of the KACAP appointed a Task-Force to establish the code of ethics and conduct in 2012. Because bioethics has become global, the Ethics Task Force examined global standards. Global standards in medical ethics and professional conduct adopted by the World Medical Association and the World Psychiatric Association have provided the basic framework for our KACAP's code of ethics and professional conduct. The Code of Ethics of the Americal Academy of Child and Adolescent Psychiatry has provided us additional specific clarifications required for child and adolescent patients. The code of ethics and professional conduct of the KACAP will be helpful to us in ethical clinical practice and will ensure our competence in recognizing ethical violations.

The Factors Affecting the Registration Rates for Emergency Department Based Post-suicidal Care Program

PURPOSE: The aim of this study was to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). METHODS: This prospective observational study was conducted between March and December 2013 at the academic ED at the tertiary urban hospital. During the study period, the pre-designed registry was recorded. The variables examined included the following: patients' demographic data (Sex, age, address, type of insurance, marital status, level of education, and history of previous psychiatric disease), suicide-related data (suicidal methods, combined drink of alcohol and number of previous attempts), and management-related data (disposition at ED, physician's training level, etc.). Univariated and multivariated logistic regression analyses were performed for identification of factors affecting the registration rate for the community-based post suicidal care program. RESULTS: A total of 163 suicides were included during the study period. Of these, 33 (20.2%) patients were registered in the post-suicide care program. Factors including a patient's address (OR: 14.92, 95% CI: 3.606-61.711), immediate intervention by psychiatric healthcare center (OR: 5.05, CI: 1.688-15.134), admissions in hospital (OR: 3.69, CI: 1.286-10.605), and history of previous psychiatric disease (OR: 3.52, CI: 1.216-10.201) showed significant association with registration for the program. CONCLUSION: The community-based post-suicidal care program, which is available 24 hours a day, should be operated in each district in order to increase the registration rate. Emergency physicians should actively consider the inpatient treatment program for suicidal patients and strongly recommend registration to the program, particularly for patients without previous history of psychiatric disease.

Clinical and Neuropsychological Characteristics of Adult Alcohol Use Disorder Patients with or without Attention-Deficit Hyperactivity Symptom

OBJECTIVES: Alcohol use disorder (AUD) is often comorbid with adult attention-deficit hyperactivity disorder (ADHD) and other psychiatric illnesses. When associated with other mental problems, the prognosis of the AUD can be more serious. This study shows research on the clinical and neuropsychological characteristics according to whether or not ADHD symptoms and AUD were comorbid. METHODS: MethodsA total of 64 adult inpatients who completed AUD scales about adult ADHD, alcohol dependence, depression, anxiety, and impulsiveness. They also completed neuropsychological tests about attention and executive function. According to the Adult ADHD Self-Report Scale score, patients were categorized into two groups (ADHD symptom positive/negative group). RESULTS: Fourteen among the 64 subjects were part of the ADHD symptom positive group (21.9%). They had statistically significant shorter abstinence periods and a higher rate of history of 'rule violation during school' and 'physical damage in childhood' compared to the ADHD symptom negative group. CONCLUSION: The comorbidity rate with ADHD symptom in adult AUD is higher than the general population. The ADHD symptom positive group suffered from more severe and refractory AUD. Considering the more frequent history of rule violation during school in the ADHD symptom positive group, the association between ADHD and AUD may be mediated by conduct disorder. Therefore we suggest the necessity of careful evaluation and intervention in children and adolescents with ADHD and conduct disorder.

A Practice Patterns of Child and Adolescent Psychiatrists in South Korea

OBJECTIVES: The aim of this study is to assess the career paths and practice patterns of child and adolescent psychiatrists in South Korea. METHODS: A survey on demographic data, work environment, opinion on fellowship training program, and current practice patterns was conducted in 76/223 (34.0%) of all child and adolescent psychiatrists (N=223) were from 1980 to 2008. The survey data from the responders were analyzed. RESULTS: More than half of those surveyed were women. The mean age of survey participants was 40.8 years; most were married, and lived in the Seoul National Capital Area. In general, the responders were very satisfied with their work. They worked in private practice, public sector, group practice, and as consultants. Up to 87% of the patients treated were children and adolescents. The most common treatment modalities were medication and parent psychoeducation. Social skills training and play therapy were applied mainly for children aged 4 to 12 years old. Cognitive behavioral therapy and counseling were preferred in adolescents. CONCLUSION: The current study used a database approach in order to define current practice patterns. These data may be helpful in consideration of future training programs, workforce issues in child and adolescent psychiatry in South Korea, and also in collaboration with other mental health providers.

The Relationship between Identity and Mental Health for Successful Aging in Old-Aged Women

OBJECTIVE: The aim of this study was to explain what the relationship is between identity and psychological well-being and how these are related to successful aging of old-aged women. METHODS: The subjects were thirty females above 60 years old in the first study where we interviewed each ten subjects for 2 hours in three groups. In the second study we surveyed 320 old-aged men and women by questionnaire for about 15 minutes. RESULTS: From focus-group interview we found the freedom from everything in life was perceived as an important change in old-aged women. But their identity was mainly derived from family relationship in aspects of economy and/or care of their grandson/-daughter. The results from analyses of questionnaire survey (n=320) were as follows ; first, women were more positive than men (female 63.1% versus male 56.5%) in the evaluation of their past life. Second, women were also more positive (female 23.7% versus male 15.2%) in the expectation for the future. Third, the successful aging had positive relationships with acceptance for aging, cohabitation with family members, income, female gender and age (65-69 years) ; and negative relationships with stress and loneliness/depression, but no relationships with decreased memory and poor sleep. CONCLUSION: We concluded that identity for the successful aging in old-aged women is mainly derived from family relationship.

Study on the Improvement Plan for the Department of Psychiatry in University Hospitals / 신경정신의학

The aim of the current study is to investigate plans for improvement of psychiatric departments in university hospitals of Korea. We examined the operation situation in the department of psychiatry in university hospitals of foreign countries. In addition, consultation conferences with experts were conducted. To improve the situation of the department of psychiatry in university hospitals, policy development, expansion of psychiatric fields, strengthening of education and research, and support from government may be necessary.