• 정신신체의학
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• 제27권2호
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• pp.147-154
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• 2019

연구목적 우울증 환자들에게서는 부주의를 포함한 인지기능 저하는 흔히 동반된다. 우울증 환자들에게서 나타나는 부주의 증상은 주의력결핍/과잉행동장애(Attention Deficit/Hyperactivity Disorder, ADHD)에게서 나타나는 증상과 유사한 양상을 보인다. 부주의 증상의 원인에 따라 치료가 달라지므로 두 질환을 정확히 진단하는 것이 중요하다. 본 연구에서는 우울감을 주소로 내원한 환자들에서 ADHD 증상의 공존율과 증상 별 상관관계를 알아보고자 한다. 방 법 2015년 3월~2018년 7월까지 우울감을 주소로 순천향대학교 부속 서울병원 정신건강의학과 외래에 내원한 158명의 환자를 대상으로 하였다. 모든 대상자들은 사회인구학적 특성(연령, 성별, 학력, 직업), 한국판 역학연구센터 우울척도(The Center for epidemiological Studies-Depression Scale, CES-D), 성인 주의력결핍과잉 행동장애 자기보고척도(Adult Attention Deficit/Hyperactivity Disorder self-report scale-V 1.1, ASRS-V 1.1), 한국판 코너스 성인 ADHD 평정척도(Korean-Conners' Adult ADHD Rating Scale, K-CAARS)를 수행하였다. 우리는 우울증군과 비우울증군을 CES-D점수로 분류하였으며, 자료처리는 기술통계분석, 교차분석, t-tests, 피어슨 상관분석을 실시하였다. 결 과 성인 ADHD 증상 공존율은 우울증군에게서 36.7%로 높았다(p-value<0.001). K-CAARS에서 ADHD 증상 정도는 우울증군(Inattention=1.80, Hyperactivity=1.92, Impulsivity=1.56, Self-concept=2.06)이 비우울증군(Inattention=1.28, Hyperactivity=1.25, Impulsivity=1.09, Self-concept=1.42) 보다 높게 나타났다(p-value<0.001). 결 론 본 연구에서는 ADHD 증상이 우울군에서 공존한다는 것을 확인하였다. 우울감을 호소하는 환자의 증상을 평가할 때, ADHD 증상의 공존 여부와 ADHD 진단 가능성에 관심을 가지고 정확하게 진단하고 적절한 치료를 병행해 나가야 한다고 제안한다.

• Journal of Yeungnam Medical Science
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• 제17권2호
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• pp.108-122
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• 2000

Background: Models of attention deficit hyperactivity disorder(ADHD) that have proposed a hypodopaminergic state resulting in hypofunction of the prefrontal circuitry have assumed a unitary dopamine system, which largely ignores the distinct functional differences between mesocortical dopamine system and nigrostriatal dopamine system. Purpose: The author's goal was to develop a pathophysiological model for ADHD with greater explanotory power than dopaminergic hypofunction hypothesis in prefronal circuitry. Material and Methods: Published clinical findings on ADHD were integrated with data from genetic, pharmacological, neuroimaging studies in human and animals. Results: Molecular genetic studies suggest that three genes may increase the susceptibility to ADHD. The three candidate genes associated with ADHD are each involved in dopaminergic function, and this consistent with the neurobiologic studies implicating catecholamines in the etiology of ADHD. Pharmacological data also provide compelling support for dopamine and noradrenergic hypothesis of ADHD. Neuroimaging studies lend substantial support for the hypothesis that right-sided abnormalities of prefrontal-basal ganglia circuit would be found in ADHD. Conclusions: The present hypothesis takes advantage of the major differences between the two pertinent dopamine systems. Mesocortical dopamine system, which largely lacks inhibitory autoreceptors, is ideally positioned to regulate cortical inputs, thus improving the signal-to-noise ratio for biologically valued signals. In this circuit, therapeutic doses of stimulants are hypothesized to increase postsynaptic dopamine effects and enhance executive functions. By contrast, symptoms of hyperactivity/impulsivity in ADHD are hypothesized to be associated with relative overactivity of nigrostriatal circuit. This nigrostriatal circuit is tightly regulated by inhibitory autoreceptoors as well as by long distance feedback from the cortex, and slow diffusion of therapeutic doses of stimulant via oral administration is hypothesized to produce a net inhibition of dopaminergic neurotransmission and improves hyperactivity.

• 대한감각통합치료학회지
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• 제12권1호
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• pp.39-50
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• 2014

목적: 본 연구는 주의력결핍과잉행동장애(Attention Deficit Hyperactivity Disorder: ADHD) 아동의 중재방법과 측정도구를 ICF모델의 분류기준인 기능과 장애영역 그리고 배경요인으로 분류하여, 건강과 장애와 관련된 ADHD 아동의 중재방법과 측정도구를 알아보고자 한다. 연구방법 : 본 연구는 체계적 고찰방법을 사용하였다. 2000년 1월부터 2013년 7월까지 학회지에 게재된 논문을 MEDLINE/PubMed, Sciencedirect, Ovid를 통해 검색하였다. 주요 검색어는 'ADHD, Children, intervention, outcome measure'으로 하였으며, 최종적으로 8개의 논문을 분석하였다. 결과 : 1. 본 연구에서 제시된 ADHD 아동은, 순수 ADHD가 75.8%로 가장 많았으며, 그 다음으로 ADHD 공존장애는 난독증(dyslexia), 품행장애(conduct disorder), 틱 장애(tic disorder), 발달협응장애(DCD), 마지막으로 정서장애(emotional disorder) 순이었다. 결과 : 2. ADHD아동의 중재방법은 기능과 장애영역에서 80%이고, 배경요인은 20%이다. 기능과 장애영역의 신체 기능과 구조의 관한 중재(NF training, computer training program)는 60%로 가장 많았고, 활동은 10%, 참여도 10%이다. 배경요인은 환경적 요인이 20%이고, 개인적 요인은 없었다. 결과 : 3. ADHD아동에게 사용된 측정 도구는 기능과 장애영역은 80.5%이고, 배경요인은 19.5%이다. 신체구조와 기능영역(아동의 문제행동과 특성의 변화)에서 70.8%로 가장 많았으며, 활동영역은 7.3%, 그리고 참여영역은 2.4%이었다. 배경요인은 환경적 요인에서 19.5%이고 개인적 요인은 없었다. 결론 : ADHD아동의 중재방법과 측정도구를 ICF모델의 분류기준에 근거하여 체계적 고찰을 하였다. 이는 건강과 장애와 관련된 ADHD아동의 중재와 측정방법을 이해하고 사용하는데 기초자료 될 것이다.

• 대한간호학회지
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• 제45권2호
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• pp.169-182
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• 2015

Purpose: This study was a meta-analysis designed to identify effects of Cognitive Behavioral Therapy (CBT) interventions in alleviating main symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among school-aged children in Korea. Methods: Examination of several databases including Research Information Sharing Service, Korean Studies Information Service System, Data Base Periodical Information Academic and hand-searched article references, resulted in identification of 1,298 studies done between 2000 and 2013 of which 21 met the inclusion criteria. Comprehensive Meta-Analysis version 2.0 was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and its trim-and-fill analysis. Results: Overall effect size of CBT intervention was large (g=1.08) along with each outcome of self-control (g=1.26), lack of attention (g=1.02), social skills (g=0.92), and hyperactivity (g=0.92). For heterogeneity, moderator analysis was performed, but no significant differences were found between the RCT (Randomized Controlled Trials) group and the NRCT (Non RCT) group. Also, meta-regression was performed using sample size, number of sessions, and length of session as predictors, but no statistically significant moderators were found. Finally, a funnel plot along with trim-and-fill analysis was produced to check for publication bias, but no significant bias was detected. Conclusion: Based on these findings, there is clear evidence that CBT intervention has significant positive effects on the main symptoms of school-aged children suffering ADHD. Further research is needed to target diverse age groups with ADHD along with more RCT studies to improve the effectiveness of the CBT intervention.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제7권2호
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• pp.179-189
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• 1996

주의력결핍 ${\cdot}$ 과잉운동장애 아동의 주의력결핍 양상을 발견하고자 뇌사건관련전위(ERP)를 측정하고, 연령을 맞춘 정상대조군과 비교하여 다음과 같은 결과를 얻었다. 1) 9세 이후의 주의력결핍 ${\cdot}$ 과잉운동장애 환아군은 동일한 연령군의 정상아동보다 선택적 주의집중력 및 자극변별력을 시사하는 파형의 잠복기(N1, P2)가 과제와 연관된 자극에 대해서 정상아동보다 통계적으로 유의하게 지연되어 있었다. 2) 환아군은 과제와 무관한 자극에 대해서는 정상아동보다 주의력을 시사하는 파형의 잠복기가 단축되고 진폭이 증가되어 있었다. 이를 통해 주의력결핍 ${\cdot}$ 과잉운동장애 환아군은 정상아동보다 쉽게 산만해지며 과제와 무관한 자극에 주의를 기울이는 반면, 과제를 수행하는 선택적이고 지속적인 주의집중력은 정상아동보다 떨어진다는 결론을 얻었다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제28권2호
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• pp.115-122
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• 2017

Objectives: Executive dysfunctions including working memory deficit have been suggested to be one of the major neuropsychological etiologies of attention-deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate the augmentative effects of working memory training on the behavioral problems, quality of life, and parental stress of medicated children with ADHD. Methods: Twenty-five children with ADHD, aged 9 to 19 years, who were being treated with ADHD medication, were included. The participants were trained with a commercially available and computerized working memory program ($Cogmed^{(R)}$) for 5 weeks without any alteration of their medication. The Child Behavior Checklist (CBCL), KIDSCREEN-52 quality of life measure, and Parenting Stress Index-Short Form (PSI-SF) were administered before training, and 4 weeks and 7 months after training, respectively. Results: After completing the training, the anxiety/depression, social problems, thought problems, attention problems, aggressive behavior, and externalizing problems scores in the CBCL were significantly reduced. The score on the Parent-child dysfunctional interaction in the PSI-SF was also decreased. However, the scores related to the quality of life were not changed. These changes were still observed 7 months after the training. Conclusion: Cogmed working memory training can be a promising training option for the additional improvement of behavioral problems and parental stress in medicated children with ADHD.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제22권2호
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• pp.74-80
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• 2011

Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder with an onset of symptoms before 7 years of age, often starting as early as the preschool years. The off-label use of methylphenidate (MPH) for 3- to 6-year-old preschool children with ADHD is being more common, although MPH is not licensed for use in children younger than age 6 years, in most countries. Despite the limited data, the review of the literature suggests that MPH meets evidence based criteria as beneficial and safe for carefully diagnosed ADHD preschool children. Carefully monitored administration of evidence-based psychotropic medication in preschool children with ADHD may be indicated if psychosocial treatments are ineffective.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제26권3호
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• pp.190-196
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• 2015

Objectives : The aim of this study was to determine whether children with Tourette disorder (TD) have functional impairment and executive dysfunction in comparison to children with attention-deficit hyperactivity disorder (ADHD) and non-affected controls. Methods : From January 2006 to December 2013, 45 children and adolescents with TD and 50 children and adolescents with ADHD diagnosed at the Soonchunhyang University Bucheon Hospital and 50 non-affected controls were enrolled in this study. Functional impairment of the subjects was assessed using the Child and Adolescents Functioning Impairment Scale (CAFIS), parent and teacher versions. In addition, neuropsychological tests including Stroop color-word Test, Finger windows Test (FWT), and Digit span were administered. Outcomes were compared across the TD, ADHD, and non-affected controls. Results : No difference in CAFIS-parent and CAFIS-teacher results was observed between children with TD and non-affected controls, whereas, children with ADHD showed more impairments relative to non-affected controls in the CAFIS-parent. According to the Stroop color-word Test, FWT, and Digit span, executive function in children with TD did not differ from non-affected controls. Children with ADHD had poorer performance in measures of the Stroop color-word Test compared to children with TD. Conclusion : Children and adolescents with TD but not ADHD were not significantly different from non-affected controls on most measures of functional impairment and executive function. These findings suggest that an education program and intervention for children with TD would be important to reducing the stigma of TD.

• Clinical and Experimental Pediatrics
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• 제60권11호
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• pp.337-343
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• 2017

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in childhood. This disorder, in addition to its main symptoms, creates significant difficulties in education, social performance, and personal relationships. Given the importance of rehabilitation for these patients to combat the above issues, the use of virtual reality (VR) technology is helpful. The aim of this study was to highlight the opportunities for VR in the rehabilitation of children with ADHD. This narrative review was conducted by searching for articles in scientific databases and e-Journals, using keywords including VR, children, and ADHD. Various studies have shown that VR capabilities in the rehabilitation of children with ADHD include providing flexibility in accordance with the patients' requirements; removing distractions and creating an effective and safe environment away from real-life dangers; saving time and money; increasing patients' incentives based on their interests; providing suitable tools to perform different behavioral tests and increase ecological validity; facilitating better understanding of individuals' cognitive deficits and improving them; helping therapists with accurate diagnosis, assessment, and rehabilitation; and improving working memory, executive function, and cognitive processes such as attention in these children. Rehabilitation of children with ADHD is based on behavior and physical patterns and is thus suitable for VR interventions. This technology, by simulating and providing a virtual environment for diagnosis, training, monitoring, assessment and treatment, is effective in providing optimal rehabilitation of children with ADHD.

• 한국컴퓨터정보학회논문지
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• 제20권11호
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• pp.127-133
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• 2015

In this paper, we propose that college counselors be more knowledgable of adult ADHD symptoms and develop better understandings of subtypes of the disorder. The findings in this study show that college students with different subtypes of ADHD symptoms experience different types of psychological maladjustment as well as different levels of psychological distress. Specifically, combined-type trait group show the highest levels of each of subscale of SCL-90-R among the other groups (i.e., normal, predominant inattentive subtype, hyperactive-impulsive type). Furthermore, combined typed trait group show significantly higher levels of animosity and paranoid ideation than the others. Therefore, college counselors need to provide effective interventions addressing intense emotion and cognitive distortion among college students with ADHD combined symptoms.