• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.25 no.2
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• pp.65-72
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• 2014

Objectives : The objective of this study was to evaluate the treatment duration and adherence of osmotic-controlled release oral delivery system (OROS) methylphenidate for treatment of attention-deficit hyperactivity disorder (ADHD). Methods : A total of 843 children with ADHD were recruited : 213 children (25.3%) who had previously taken medications for ADHD and 630 drug-na$\ddot{i}$ve children (74.7%) were recruited. The dosage was adjusted according to the clinician's judgment. The primary efficacy endpoint of this study was treatment retention rate, which was estimated at Week 12 and Week 20 using the Kaplan-Meier curve. The Swanson, Nolan and Pelham-IV (SNAP-IV), Clinical Global Impression-Severity (CGI-S), Clinical Global Impression-Improvement, and the side effect rating scale were measured at every visit. Remission rates were presented based on SNAP-IV and CGI-S, respectively. Results : The treatment retention rate at 12 weeks and at 20 weeks was 76.2% and 66.8%, respectively. Divided according to 6-8, 9-11, 12-14 and 15-18 years of age, younger children tended to show a statistically higher treatment retention rate (p=.02). Based on SNAP-IV and CGI scores, children with better response to medication showed tendencies of statistically higher treatment retention rate. The most common adverse events included loss of appetite (7.1%) and insomnia (3.3%). There was no serious adverse event related to the treatment, such as death. Conclusion : The use of OROS methylphenidate for treatment of ADHD was safe and tolerable for children. In this study, lower age and better treatment response showed a statistically significant relationship with higher treatment adherence. Boys showed a trend of high treatment adherence. The treatment adherence at 20 weeks was satisfactory, however, the treatment adherence after 20 weeks showed a sharp decrease. Therefore, treatment persistence for six months after the beginning of ADHD treatment is important. In addition, the positive role of psycho-education for children and parents is necessary for increasing treatment adherence.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.24 no.4
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• pp.220-227
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• 2013

Objectives : This study aims to investigate the clinical characteristics and neuropsychological profiles of children with attention-deficit hyperactivity disorder (ADHD) and their siblings. Methods : Eighteen children (age $8.2{\pm}1.7$ years, 12 boys) with ADHD and their 18 siblings (age $7.8{\pm}1.6$ years, 8 boys) completed Continuous Performance (CPT), Stroop, Children's Trail Making, Rey-Kim Memory, and Kim's Frontal Executive Function tasks. The parents of these subjects underwent the Attention-Deficit/Hyperactivity Disorder Rating Scale (ARS), 10-item Parent General Behavior Inventory (P-GBI), and the Social Responsiveness Scale (SRS). Paired t-tests were used. Results : The inattention (p=.020), and hyperactivity-impulsivity (p=.001), scores of the ARS and the P-GBI score (p=.004) were significantly higher in children with ADHD than in their siblings. Deficits in social communication and motivation on SRS were higher in children with ADHD than in their siblings (p=.017 and p=.011, respectively). Z-scores of omission and commission errors as well as response time variability on visual CPT and omission errors on auditory CPT were in clinically significant range, and z-score of omission errors on auditory CPT was in borderline range in siblings. Omission (p=.018) and commission errors on Visual CPT (p=.007) were significantly higher in children with ADHD compared to their siblings. Recognition efficiency on Kim's Frontal Executive Function Task was lower in children with ADHD compared to their siblings, but in normal range in both groups. Stroop interference and figure fluency on Kims Frontal Executive Function Task were in borderline range in ADHD group, and figure fluency was in borderline range in siblings. Conclusion : Our results support a preliminary evidence for mild degree of attention deficit in ADHD siblings. Further studies are needed to examine the cognitive functions of siblings with ADHD in larger samples.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.21 no.3
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• pp.174-181
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• 2010

Objectives: To identify the factors affecting long-term adherence to methylphenidate treatment in children with attention-deficit hyperactivity disorder (ADHD). Methods: A retrospective medical record review of 239 ADHD patients (mean age $9.3{\pm}2.6$ years, range 6.0-17.4 years) who had visited the child and adolescent psychiatry clinic at a university hospital, in Seoul, Korea from March 2005 to February 2008. Subjects were diagnosed as ADHD based on the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision version (DSM-IV-TR) and underwent neuropsychological tests including the continuous performance test (CPT). Treatment discontinuation was defined as the last prescription date when the medication possession rate (MPR) became less than 0.80. Subjects were divided into three groups and labeled as Group I, non-adherence without pharmacotherapy, Group II, non-adherence with short-term pharmacotherapy, and Group III, adherence with long-term pharmacotherapy. Results: Ninety (37.7%) patients were grouped as non-adherent (Groups I+II) and 149 (62.3%) as adherent (Group III). The adherence group exhibited lower intelligence, higher symptom severity, and a higher number of comorbid psychiatric disorders than controls. The use of stimulants was significantly associated with long-term adherence to treatment. Additionally, the duration of interval between the date of the first visit and the date of the first prescription was positively associated with long-term adherence. Conclusion: About two-thirds of patients diagnosed as ADHD adhered to the treatment six months after the first visit. With respect to patient evaluation and the development of treatment strategies, factors affecting early drop-out and longer follow-up must be considered.

• Child Health Nursing Research
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• v.19 no.3
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• pp.228-237
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• 2013

Purpose: This study was done to test a hypothesized model, the Biobehavioral Family Model (BBFM), on the relationship of family emotional climate, security of parent-child relationship, depression symptoms and eating problems in adolescent girls, to further understanding of eating problems in this population. Methods: With a convenience sample of 647 girls, aged 15 to 18, a self-report survey was conducted which included the Korean form of the Eating Attitude Test (EAT-26) to assess eating problems. Results: The estimated results of the structural equation modeling indicated a good fit of data to the hypothesized model proposing that family emotional climate and security of parent-child relationship were associated with the risk of eating problems by way of depression symptoms. That is, negative family emotional climate and insecure parent-child relationship increased the risk of eating problems indirectly by way of depression symptoms. Conclusion: The findings are consistent with the BBFM, which suggests a psychobiologic influence of specific family processes on children's stress-sensitive physical disease activity by way of depression symptoms. Therefore, the applicability of the BBFM for understanding adolescent girls' eating problems is supported. The psychobiologic pathways from depression to eating pathology should be addressed in future studies.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.24 no.1
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• pp.21-27
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• 2013

Objectives : Dysregulation of the central noradrenergic system may be involved in the pathophysiology of attention-deficit hyperactivity disorder (ADHD). The aim of this study was to examine the differences in pre- and post-treatment cerebral perfusion according to the MspI polymorphisms of the alpha-2A-adrenergic receptor gene (ADRA2A) in children with ADHD. Methods : Thirty seven drug-naive ADHD children (8.9+1.8 years old, M=32, F=5) were genotyped. Baseline single-photon emission computed tomography (SPECT) and clinical assessments were performed for ADHD children. After treatment with methylphenidate for eight weeks, SPECT and clinical assessment were repeated. Results : No differences in baseline clinical assessments or cerebral perfusion were observed according to the MspI genotype. However, after treatment, ADHD children with the G/G genotype at the MspI polymorphism showed hyperperfusion in the right cerebellar declive (p=.001, uncorrected) and hypoperfusion in the left lentiform nucleus and left cingulate gyrus (p<.001 and p=.001, uncorrected), compared to children without the G/G genotype. Conclusion : Although the results of this study should be interpreted cautiously, they suggest a possible role of the MspI polymorphisms of the ADRA2A gene in methylphenidate-induced changes in cerebral perfusion.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.28 no.4
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• pp.213-219
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• 2017

Objectives: Early intensive interventions are very important for children with autism spectrum disorder. We examined the actual conditions of hospital-based early intensive interventions for autism spectrum disorder in Seoul, in order to help develop and implement an evidence-based early intensive intervention model for use in Korea. Methods: Nine hospital-based institutes running an early intensive intervention program for children with autism spectrum disorder responded to a questionnaire in September 2014. They provided a brief introduction to their program, explained its theoretical bases, and reported the number of children, their age, intervention time, duration and so on. Results: In the majority of the institutions, the intervention was provided for over 20 hours every week, and the theoretical bases included various applied behavioral analysis (ABA) methods and other therapies (language and occupational therapy). The therapist-child ratio ranged from 1:1 to 5:3. Various types of therapists were involved, including behavioral analysts, special education teachers and (or) language pathologists. There was only one clinic where the behavioral analyst was the main therapist. Usually, the intervention was terminated just before the child entered elementary school. The main merit of the hospital-based intervention in our survey was the effectiveness of the multi-disciplinary intervention plan and its other merits were the accuracy of the diagnosis, its ability to be combined with medicine, and so on. Conclusion: The current hospital-based early intensive intervention programs provide interventions for over 20 hours per week and employ multidisciplinary approaches. However, there are very few institutes for children with autism and very few intervention specialists and specialist education courses in the country. We need more educational programs for intervention therapists and have to try to develop policies which encourage the implementation of an evidence-based early intensive intervention program nationwide.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.28 no.4
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• pp.244-251
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• 2017

Objectives: The objective of this study was to investigate the effect of pharmacological treatments for attention-deficit hyperactivity disorder (ADHD) on motor coordination, using the Developmental Coordination Disorder Questionnaire (DCDQ). Methods: The participants were recruited from April 2015 to November 2016 from the Department of Psychiatry of Asan Medical Center and were treated for 3 months with methylphenidate or atomoxetine. The illness severity at baseline and 3 months were scored using the ADHD Rating Scale (ARS), Clinical Global Impression-Severity Scale (CGI-S) and/or Clinical Global Impression-Improvement Scale (CGI-I). A total of 39 children with ADHD (age $8.0{\pm}1.4years$, 36 boys) completed the Advanced Test of Attention (ATA) and their parents completed the DCDQ at baseline and 3 months. The paired t-test, mixed between-within analysis of variance and correlation analysis were used. Results: The CGI-S (p<0.001), ARS (p<0.001), and fine motor/hand writing (p=0.005) on the DCDQ were significantly changed between pre-treatment and post-treatment. When the participants were divided into those who were suspected of having developmental coordination disorder (DCD) (n=23) and those who probably did not (n=16), the control during movement, fine motor/hand writing and general coordination scores on the DCDQ showed the main effects for group (p<0.001, p<0.001 and p<0.001, respectively). The fine motor/hand writing on the DCDQ has a significant main effect for time [F(1,37)=7.31, p=0.010, ${\eta}^2=0.405$] and the interaction effect between group and time was also significant [F(1,37)=4.63, p=0.038, ${\eta}^2=0.111$]. The baseline visual commission error on the ATA is significantly correlated with the changes in the DCDQ total scores (r=0.330, p=0.040). Conclusion: Our results provide preliminary evidence that pharmacological treatment for ADHD improves not only the core symptoms of ADHD, but also the motor coordination. Further studies are needed to confirm the effect of the pharmacological treatment for ADHD on the motor coordination.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.23 no.2
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• pp.57-62
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• 2012

Objectives : Characteristic symptoms, including hyperactivity and easy distractibility, in children with attention-deficit hyperactivity disorder (ADHD) suggest that their brain status, even at rest, might differ from that of healthy children. This study was conducted in order to determine whether resting state brain activity is compromised in medication-naive children with ADHD. Methods : Twenty medication-naive children with ADHD (mean age $10.3{\pm}2.5$) and 28 age- and gender-matched healthy volunteers (mean age $10.3{\pm}2.0$) underwent measurements for resting state brain activity using functional magnetic resonance imaging (fMRI). Among resting state related-independent components (RSICs) extracted from fMRI data using independent component analysis, a significant difference in RSICs was observed between groups, using a mixed Gaussian/gamma model. Results : Except for IQ, which was higher in the healthy control group, no demographic difference was observed between the two groups (p<.001). Significantly less activation of one RSIC, which includes the bilateral precuneus/posterior cingulate cortex, occipito-temporal junction, and anterior cingulate cortex, was observed in the ADHD group, compared with the control group (p<.05). Conclusion : An abnormal RSIC, posterior default mode network (DMN), was observed in the medication-naive ADHD group. Results of our study suggest that abnormality of posterior DMN is one of the main pathophysiologies of ADHD.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.27 no.1
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• pp.64-71
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• 2016

Objectives: The objective of this study was to examine the effects of osmotic-controlled release oral delivery system methylphenidate on changes in regional cerebral blood flow (rCBF) in children with attention-deficit hyperactivity disorder (ADHD) using single photon emission computed tomography (SPECT). Methods: A total of 26 children with ADHD (21 boys, mean age: $9.2{\pm}2.05$ years old) were recruited. Each ADHD participant was examined for changes in rCBF using technetium-99m-hexamethylpropylene amine oxime brain SPECT before and after 8 weeks methylphenidate medication. Brain SPECT images of pediatric normal controls were selected retrospectively. SPECT images of ADHD children taken before medication were compared with those of pediatric normal controls and those taken after medication using statistical parametric mapping analysis on a voxel-wise basis. Results: Before methylphenidate medication, significantly decreased rCBF in the cerebellum and increased rCBF in the right precuneus, left anterior cingulate, right postcentral gyrus, right inferior parietal lobule and right precentral gyrus were observed in ADHD children compared to pediatric normal controls (p-value<.0005, uncorrected). After medication, we observed significant hypoperfusion in the left thalamus and left cerebellum compared to pediatric normal controls (p-value<.0005, uncorrected). In the comparison between before medication and after medication, there was significant hyperperfusion in the superior frontal gyrus and middle frontal gyrus and significant hypoperfusion in the right insula, right caudate, right middle frontal gyrus, left subcallosal gyrus, left claustrum, and left superior temporal gyrus after methylphenidate medication (p-value<.0005, uncorrected). Conclusion: This study supports dysfunctions of fronto-striatal structures and cerebellum in ADHD. We suggest that methylphenidate may have some effects on the frontal lobe, parietal lobe, and cerebellum in children with ADHD.

• Clinical and Experimental Pediatrics
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• v.50 no.5
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• pp.436-442
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• 2007

Purpose : To promote awareness and efforts by pediatricians to identity and prevent child abuse by investigation of characteristics of victim and types of injury caused by abuse. Methods : A retrospective study was performed with 20 patients who had been diagnosed or suspected as child abuse at Hallym University Hospital from January 1999 to December 2005. The medical records, radiologic documents, and social worker's notes were reviewed to investigate age, sex, visiting time, form of abuse, perpetrator, risk factor, and type of injury. Results : The mean age of the subjects was 2.8 years. Fourteen patients were between 0-1 years old, 2 patients between 1-6 years old, 3 patients between 7-12 years old, and 1 case over 13 years old. The ratio of male to female was 1:1. The majority of these patients (70%) visited via emergency department. Eight five percent of these patients reported with physical abuse, 5% psychological abuse, 5% sexual abuse, and 5% neglect respectively. The suspected perpetrator was the biological father in six cases, the biological mother in three cases, the stepmother in two cases, caregiver in one case, relatives in one case and "unknown" in six cases. Bruise and hematoma (80%) were the most common physical findings. Skull fractures were diagnosed in six cases, long bone fractures in two cases, hemoperitoneum in two cases, subdural hemorrhage in 10 cases, epidural hemorrhages in two cases, subarachnoidal hemorrhages in two cases, and retinal hemorrhages in five cases respectively. Seventeen cases required hospitalization and surgical operations performed were in nine cases. Four patients died and three patients had sequalae such as developmental delay and quadriplegia. Conclusion : Child abuse results in high mortality and morbidity in victims. Therefore early recognition and prevention is very important. Pediatricians should always suspect the possibilities of abuse in cases of fracture, intracranial hemorrhage, abdominal injury, or even any injury to the body. We recommend that the clinical investigation of suspicious children should include a full multidisciplinary social assessment, a skeletal survey and CT or MRI.