Development of an After-School Day Treatment Program for Children with Severe Emotional/Behavioral Disturbances.

This article introduces Aizone, an after-school day treatment program for children with emotional/behavioral disturbances, and examines its effectiveness. Aizone targets children whose problems require intensive care, but are not severe enough to warrant hospitalization, and prioritizes those from low-income families. Based on the bio-psycho-social model, this program provides a variety of therapeutic interventions for both children and their parents, including individual and group therapy integrated under the concept of milieu therapy, as well as community linkage services. This study uses a prospective comparative method to examine the effectiveness of Aizone by comparing and validating the treatment outcomes of seven Aizone programs across Seoul. The Korean Child Behavior Checklist was administered by caregivers before and after intervention and the data was used in a repeated measures analysis. The effectiveness of the program in terms of reduction in emotional, behavioral symptoms, as well as the implications of the results are discussed.

Advanced Test of Attention in Children with Attention-Deficit/Hyperactivity Disorder in Japan for Evaluation of Methylphenidate and Atomoxetine Effects.

OBJECTIVE: This study was conducted to validate the Advanced Test of Attention (ATA) of the visual attention version of Japanese children with attention deficit/hyperactivity disorder (ADHD) and to evaluate the efficacy of methylphenidate (OROS-MPH) and atomoxetine medications. METHODS: To assess pharmacotherapy efficacy, the visual version of ATA was administered to 42 children with ADHD. Results were assessed using discriminant analysis, ANOVA for indices of ATA before and after medication treatment, and correlation analysis between the improvement of indices of ATA and clinical symptoms during medication treatment. RESULTS: Discriminant analysis showed that 69.0% of ADHD children were assigned correctly. The T score of commission errors increased as the trial progressed on the medication-off condition. T scores of commission errors and standard deviation of response times on medication-on condition were low compared to the medication-off condition. A few significant correlations were found between the improvements of indices of ATA and ADHD-Rating Scale (RS) during treatment. CONCLUSION: The performance of the visual version of ATA on medication-off condition reflected the features of ADHD. Furthermore, the medication treatment effects were confirmed sufficiently. In addition, results suggest that indices of ATA reflected aspects of ADHD symptoms that are difficult to elucidate for ADHD-RS. For assessing symptoms and effects of medical treatment in children with ADHD, ATA might be a useful assessment tool.

Neuropsychological and behavioral profiles in attention-deficit hyperactivity disorder children of parents with a history of mood disorders: a pilot study.

OBJECTIVE: We aimed to investigate the neurocognitive and behavioral endophenotypes of premorbid mood disorder. We compared intelligence, neuropsychological functioning, and behavioral problems among three groups: 1) a high-risk group [attention-deficit hyperactivity disorder (ADHD) children of parents with a history of a mood disorder], 2) a low-risk group (ADHD children of parents without a history of a mood disorder), and 3) normal comparison subjects. METHODS: We used the Korean Educational Development Institute Wechsler Intelligence Scale for Children-Revised (KEDI-WISC-R), the Stroop Color Word Interference Test (Stroop), the Wisconsin Card Sorting Test (WCST), and the Rey-Osterrieth Complex Figure Test (RCFT) as neurocognitive measures, and we used the Child Behavior Checklist (CBCL) as a behavioral measure. Performance on these neuropsychological tests and score on the CBCL of 18 high-risk children were compared to those of 20 low-risk children and 24 healthy children. We also assessed the children's current mood state and familial functioning to control for the confounding effects of these variables. RESULTS: Compared to low-risk and healthy children, high-risk children were impaired on the Picture Completion and Stroop Word subtest and showed higher scores on the CBCL subscales representing internalizing symptoms. These significant group differences persisted even after adjustment for the children's current mood state and familial functioning. CONCLUSION: Neuropsychological deficits in the offspring of parents with a mood disorder may be associated with the current mood state rather than with innate characteristics, while their internalizing symptoms may partially stem from innate characteristics that are endophenotypes of a premorbid mood disorder.

The association between problematic internet use and depression, suicidal ideation and bipolar disorder symptoms in Korean adolescents.

OBJECTIVE: This study used a sample of Korean adolescents to evaluate: (a) associations between problematic internet use and depression, bipolar disorder symptoms and suicidal ideation; and (b) whether mood disorders mediate the relationship between problematic internet use and suicidal ideation. METHOD: A total of 795 middle and high school students were recruited (538 girls; mean age, 13.87 ± 1.51 years). The Internet Addiction Proneness Scale for Youth-Short Form (KS-scale) was used to evaluate the presence and severity of problematic internet use. The frequencies of depression, suicidal ideation and probable bipolar disorder were compared between adolescents with and without internet addiction. The associations between the severity of problematic internet use and the severity of depressive symptoms, bipolar symptoms and suicidal ideation were also analyzed. RESULTS: Seventy-five adolescents (9.4%) met the criteria for problematic internet use. The presence of problematic internet use was significantly associated with suicidal ideation (OR = 5.82, 95% CI = 3.30-10.26, p < 0.001) as well as depression (OR = 5.00, 95% CI = 2.88-8.66, p < 0.001). There was a marginally significant association between problematic internet use and probable bipolar disorder (OR = 3.05, 95% CI = 0.96-9.69, p = 0.059). In the path model, problematic internet use significantly predicted depressive symptoms (ß = 0.296, 95% CI = 0.214-0.367, p = 0.005), which predicted suicidal ideation (ß = 0.699, 95% CI = 0.631-0.751, p = 0.009). Problematic internet use also predicted suicidal ideation directly (ß = 0.115, 95% CI = 0.052-0.193, p = 0.006). Conversely, depressive symptoms (ß = 0.119, 95% CI = -0.005-0.219, p = 0.040) and suicidal ideation (ß = 0.215, 95% CI = 0.089-0.346, p = 0.005) predicted problematic internet use. CONCLUSIONS: There is a complex transactional relationship between problematic internet use, depressive symptoms, bipolar symptoms and suicidal ideation, so these conditions must be assessed together during the evaluation of adolescents. Prospective studies are warranted to elucidate the causal relationships between problematic internet use, mood symptoms and suicidal ideation.

Clinical and genetic characteristics of Korean male alcoholics with and without attention deficit hyperactivity disorder.

AIMS: To examine the clinical and genetic characteristics of Korean male alcoholics with and without attention deficit hyperactivity disorder (ADHD). METHODS: The present study included 85 male alcoholics who were diagnosed as having DSM-IV alcohol dependence. A total of 28 (32.9%) alcoholics were diagnosed as having DSM-IV ADHD with ongoing symptoms in adulthood. For the evaluation of their psychiatric conditions, the alcohol dependence scale (ADS), Beck depression inventory (BDI), Beck anxiety inventory (BAI), Barratt impulsiveness scale (BIS), brief anger-aggression questionnaire (BAQ), overt aggression scale (OAS), codependence test, and obsessive compulsive drinking scale (OCDS) were administered. The genotype frequencies of the dopamine type 2 receptor gene (DRD2), aldehyde dehydrogenase type 2 gene (ALDH2), functional polymorphism in the regulatory region of the serotonin transporter gene (5-HTTLPR), and catechol-O-methyltransferase gene (COMT) polymorphisms were examined. RESULTS: Compared with alcoholics without ADHD, the mean ages for the onset of pathological drinking and alcohol withdrawal hallucinations were significantly earlier in alcoholics with ADHD. There was also a significant difference in the history of antisocial behaviour between the two groups. Compared with alcoholics without ADHD, the mean scores of the ADS, BDI, BAI, OAS, and OCDS were significantly higher in alcoholics with ADHD. With regard to the codependence test results, the mean scores of the interpersonal problem, low self-esteem and anxiety/fear subscales, and the mean total score of the codependence test were significantly higher in alcoholics with ADHD when compared with those without ADHD. There were no significant differences in the genotype frequencies of the DRD2, ALDH2, 5-HTTLPR, and COMT polymorphisms between alcoholics with and without ADHD. CONCLUSIONS: The results of this study suggest that the comorbidity of alcohol dependence and ADHD in this Korean sample forms a distinct clinical phenotype that shows an increased severity of alcohol-related symptoms and behavioural/emotional problems and that ADHD is associated with an increased risk for the early onset of alcohol dependence in Korean male alcoholics.

Parental attachment and its impact on the development of psychiatric manifestations in school-aged children.

BACKGROUND: Few studies have examined the relationship between the attachment styles of the primary caregivers and the behavioral problems of their school-aged children. This study was performed to identify the impact of insecure attachment patterns of parents on the development of their children's psychiatric manifestations and disorders. SAMPLINGS AND METHODS: We included 494 2nd to 3rd graders and their primary caretakers. A relationship questionnaire was applied to identify the parental attachment patterns. We investigated the children's mental and behavioral problems by using the Korean Child Behavior Checklist. For objective psychiatric diagnoses, we interviewed 130 high-risk subjects using the Korean Kiddie-Schedule for Affective Disorders and Schizophrenia - Present and Lifetime version. RESULTS: Those parents judged to be preoccupied had children with more internalized symptoms than those who were judged to be secure (p< 0.01); dismissing/avoidant parents had children with higher scores on Attention problems (p = 0002), and fearful/avoidant parents had children with more externalized symptoms (p < 0.01). Moreover, children with insecure attachment type parents revealed more psychiatric morbidity than children with secure parents (p = 0.042). CONCLUSION: Parental insecure attachment was associated with the development of the psychopathologies and psychiatric illness of their children.

Behavioral and developmental characteristics of children with inversion of chromosome 9 in Korea: a preliminary study.

The purpose of this study is to examine the behavioral and developmental characteristics of children with inv(9). This case control study included 12 inv(9) subjects and 45 normal students. All of the subjects, together with their parents, underwent a psychiatric interview and parent questionnaire consisting of a Child Behavior Checklist (CBCL). The mean scores with regard to the social problems and total problems profiles of the CBCL were significantly higher in the inv(9) group than in the normal control group. The inv(9) group exhibited language and motor developmental delay. These findings suggest that there is a possibility of inv(9) being associated with child developmental or behavioral problems.

Behavioral characteristics of Prader-Willi syndrome in Korea: comparison with children with mental retardation and normal controls.

The purpose of this study was to examine the psychiatric characteristics of children with Prader-Willi syndrome in Korea, focusing particularly on their behavioral problems and obsessive-compulsive spectrum symptoms. Fourteen patients with Prader-Willi syndrome, together with their parents, underwent a psychiatric interview and parent questionnaire consisting of a Child Behavior Checklist. Twenty-four patients with mental retardation and 45 normal students were selected as control groups. Compared with the normal control group, the rates of inclusion in the clinical range and the mean scores with regard to social problems, thought problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems, and total problems profiles were significantly higher (P < .01) in the Prader-Willi syndrome group according to the results of the Child Behavior Checklist. Compared with the mental retardation group, there was a statistically significant (P < .05) difference in the delinquent behavior profile. Comparing selected Child Behavior Checklist items related to obsessive-compulsive spectrum symptoms, the Prader-Willi syndrome group showed significantly more (P < .05) compulsion, skin picking, and stealing than the mental retardation or normal control groups. These findings suggest that children with Prader-Willi syndrome in Korea have many behavioral problems, including obsessive-compulsive spectrum symptoms, needing proper psychiatric attention and treatment. This is the first study in Korea to evaluate the psychiatric and behavioral characteristics of children with Prader-Willi syndrome.

The child behavior checklist together with the ADHD rating scale can diagnose ADHD in Korean community-based samples.

OBJECTIVE: The purpose of this study was to examine the clinical validities and efficiencies of the Child Behavior Checklist (CBCL) and the ADHD Rating Scale-IV (ARS) in identifying children with attention-deficit hyperactivity disorder (ADHD) in Korean community-based samples. METHOD: A large sample of elementary school students (n = 1668) participated in this study. We used the CBCL and the ARS as the screening instruments. Diagnoses were determined by clinical psychiatric interviews and confirmed by DSM-IV-based structured interviews. RESULTS: Of the 46 subjects who underwent clinical psychiatric interviews, 33 were diagnosed as having ADHD. A T score of 60 with regard to the Attention Problems profile of the CBCL resulted in a reasonable level of sensitivity or positive predictive value in the diagnosis of ADHD. In both the parent and teacher reports of the ARS, 90th percentile cut-off points resulted in a high level of predictive value. The highest levels of specificity and positive predictive value were obtained when we combined the CBCL (T > or = 60 in Attention Problems) and the ARS (parent-teacher total > or = 90th percentile) reports. CONCLUSIONS: These findings suggest that the combined use of the CBCL and the ARS could serve as a rapid and useful clinical method of predicting or even diagnosing children with ADHD in epidemiologic case definitions.

The reliability and validity of the junior temperament and character inventory.

The purpose of this study was to evaluate the reliability and validity of the Junior Temperament and Character Inventory (Junior TCI), a child and adolescent version of the Adult Temperament and Character Inventory (TCI), which is based on Cloninger's biosocial model of personality. The Junior TCI was translated into Korean and administered to 663 Korean middle school students (male/female, 360/303; age, 13.3 +/- 1.0 years) and their parents (mother/father, 444/84). Internal consistency was calculated by Cronbach alpha. A test-retest study of the Junior TCI was conducted across a 3-month interval with 97 subjects. Factor analyses for the temperament and character dimensions were performed using principal component analysis, rotating factors by Promax. Cronbach alpha values of the Junior TCI scales ranged from.48 to.80 for the temperament scales and from.64 to.68 for the character scales. Test-retest correlations ranged from.62 to.85 for the temperament scales and from.76 to.79 for the character scales. Principal component factor analyses showed three factors out of four temperament scales (Harm Avoidance 1 to 4; Novelty Seeking 1 to 4; Persistence; and Reward Dependence 1, 3, 4) and three factors out of three character scales (Self-Directedness 1 to 5; Cooperativeness 1 to 5; and Self-Transcendence 1 to 3) that were similar to factor structures of adult versions of the TCI. Explorative factor analysis with a condition of eigenvalue greater than 1 produced six factors, as compared to seven factors extracted in Cloninger's original report of the adult TCI. In conclusion, this was the first study to tests and report detailed psychometric properties of the Junior TCI. The current study confirms that the Junior TCI has satisfactory psychometric properties for the use in child and adolescent populations and reflects Cloninger's biosocial model of personality.

The segmented regional volumes of the cerebrum and cerebellum in boys with Tourette syndrome.

Neuropathological deficits are an etiological factor in Tourette syndrome (TS), and implicate a network linking the basal ganglia and the cerebrum, not a particular single brain region. In this study, the volumes of 20 cerebral and cerebellar regions and their symmetries were measured in normal boys and TS boys by brain magnetic resonance imaging. Brain magnetic resonance images were obtained prospectively in 19 boys with TS and 17 age-matched normal control boys. Cerebral and cerebellar regions were segmented to gray and white fractions using algorithm for semi-automated fuzzy tissue segmentation. The frontal, parietal, temporal, and the occipital lobes and the cerebellum were defined using the semiautomated Talairach atlas-based parcellation method. Boys with TS had smaller total brain volumes than control subjects. In the gray matter, although the smaller brain volume was taken into account, TS boys had a smaller right frontal lobe and a larger left frontal lobe and increased normal asymmetry (left>right). In addition, TS boys had more frontal lobe white matter. There were no significant differences in regions of interest of the parietal, temporal, or the occipital lobes or the cerebellum. These findings suggest that boys with TS may have neuropathological abnormalities in the gray and the white matter of the frontal lobe.