• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• v.22 no.3
• /
• pp.182-191
• /
• 2011

Objectives: The aim of this study was to investigate the sleep patterns of South Korean elementary school children and whether the differences in sleep patterns were related to behavior, emotional problems, attention and academic performance. Method: This study included a community sample of 268 boys and girls from fourth-, fifth- and sixth-grade classes in a South Korean metropolitan city from November to December 2010. The primary caregivers completed a questionnaire that included information on demographic characteristics, as well as the Child's Sleep Habit Questionnaire (CSHQ), the Korean version of Child Behavior Checklist (K-CBCL), the Korean version of the Learning Disability Evaluation Scale (K-LDES), the Korean version of ADHD Rating Scale (K-ARS) and the Disruptive Behavior Disorder Scale (DBDS). We conducted analyses on the CSHQ individual items, between the subscales, on the total scores and on the K-CBCL, the K-LEDS, the K-ARS and the DBDS. Results: Based on the findings from the CHSQ, the subjects had significantly higher scores for bedtime resistance ($9.18{\pm}2.17$), delayed sleep onset ($1.32{\pm}0.62$), the sleep duration ($4.19{\pm}1.52$) and daytime sleepiness ($14.10{\pm}3.55$) than the scores from the previous reports on children from western countries. The total CHSQ score showed positive correlations to all subscales of the K-CBCL : withdrawn (r=0.24, p<.005), somatic complaint (r=0.24, p<.005) and anxious/depressive (r=0.38, p<.005). Bedtime resistance was associated with oppositional defiant disorder (r=0.15, p<.05) and a positive correlation was demonstrated between sleep anxiety and the oppositional defiant disorder score (r=0.13, p<.05), night waking and the conduct disorder score (r=0.16, p<.05). Delayed sleep onset was related with low performance on the K-LDES with respect to thinking (r=-0.17, p<.05) and mathematical calculation (r=-0.17, p<.05). Conclusion: The results of this study reconfirm Korean children's problematic sleep patterns. Taken together the results provide that the reduced sleep duration and disruption of sleep pattern can have a significant impact on emotion, behavior, performance of learning in children. Further studies concerning more diverse psychosocial factors affecting sleep pattern will be helpful to understanding of the sleep health in Korean children.

• Sleep Medicine and Psychophysiology
• /
• v.20 no.2
• /
• pp.53-58
• /
• 2013

Autism Spectrum Disorder (ASD) is characterized by persistent deficits in social communication and restricted, repetitive patterns of behavior and interest. Sleep problems are not uncommon in children with autism spectrum disorders. Symptoms of insomnia are the most frequent sleep problems in individuals with ASD. Sleep problems can cause significant difficulties in the daily life of children with ASD and their families. Genetic factor, deregulations of melatonin synthesis, extraneous environmental stimuli and psychiatric and medical conditions may cause sleep problems. The first line treatment of sleep problems in ASD includes managements for potential contributing factors and parent education about sleep hygiene care for child and behavioral therapy. Supplementation with melatonin may be effective before considering other medications, such as risperidone, clonidine, and mirtazapine.

• The Journal of Korean Academy of Sensory Integration
• /
• v.21 no.2
• /
• pp.69-83
• /
• 2023

Objective : This study sought to systematically examine the intervention effect of social stories when applied in relation to children with sleep disorders. Methods : Studies available in the SCOPUS, ScienceDirect, PsycArticles, and PubMed databases that were published from 2001 to 2022 were searched. The keywords used for the search were as follows: ("social story" OR "social stories") AND ("sleep" OR "sleep disorders" OR "sleep wake disorder bedtimes" OR "sleep initiation and maintenance disorders" OR "sleep wake disorder" OR "sleep arousal disorders"). Based on the selection criteria, six experimental studies were selected and analyzed. Results : The selected studies were two randomized controlled trials, three individual trials, and one case study. The subjects were mostly children diagnosed with autism spectrum disorder who were school-aged or adolescent. The intervention types were often complex interventions, including social stories and other interventions, while the durations of the interventions varied from one day to more than 40 days. The interventions had a positive effect on the subjects' sleep quality, with night wakings, sleep onset delay, and sleep anxiety all being improved. As standardized assessment tools to evaluate the effectiveness of social stories, the Child Sleep Habits Questionnaire and the Child Behavior Checklist were used in two papers each, and were the most commonly used. As non-standardized assessment tools, each of the four papers used turbulence and sleep diaries as assessment tools. Conclusion : The effect of social story mediation can be divided into sleep quality and sleep-related behavior. In terms of sleep quality, studies showing improvements in night wakings, sleep onset delay, and sleep anxiety accounted for a large proportion of the sample. The detailed effect area of sleep quality showed a significant improvement after the interventions in most studies, and in all six studies analyzed in the present study, the continuation of the effect after the intervention was confirmed via follow-up tests. Thus, the findings of this study are expected to be helpful when applying social stories in children with sleep disorders in clinical practice due to presenting the intervention effects, outcome evaluation tools, and intervention periods in children with sleep disorders in prior investigations involving social stories.

• Child Health Nursing Research
• /
• v.5 no.1
• /
• pp.18-26
• /
• 1999

The purpose of this study was to explore the late schooler's health concept and health behavior. The research was a descriptive method using a self-report questionaire which include semi open-ended questions. the subjects were 458 late schooler's from 4 to 6 grade. The results were as follows : 1. Perceived health concepts were ‘having no illness’ ‘having normal physical feature and strength’ ‘eating food well’ ‘take exercise’ ‘having a bright mind’ ‘having good interpersonal relationships’‘having strong will’ ‘recovering well’. 2. Perceived health behaviors to maintain health were ‘taking proper exercise’ ‘eating proper food’ ‘maintaining cleanliness’ ‘taking sufficient rest and sleep’ ‘having a vigor life and positive thought’ ‘having good interterpersonal relationships’ ‘receiving health check and immunization’. 3. Health behaviors carried out at present were ‘taking proper exercise’ ‘eating proper food’ ‘having a vigor life and positive thought’ ‘receiving health check an immunization’ ‘taking supplementary drugs’ ‘having a regular life’ ‘maintaining cleanliness’ ‘maintaining warmth’. 4. Perceived causes of illness were ‘taking inproper food’ ‘uncleanliness’ ‘insufficient warmth or environment’ ‘lack of exercise or overexertion’ ‘irregular life habits’ ‘contact with germs’ ‘mental stress’. 5. Perceived treatments of illness were ‘having sufficient rest and sleep’ ‘mental relaxation’ ‘eating food’ ‘ maintinging cleanliness’ ‘ maintaining warmth’ ‘taking supplementary drug’ ‘receiving medical treatment’.

• The Journal of Korean Academy of Sensory Integration
• /
• v.10 no.2
• /
• pp.23-32
• /
• 2012

Objective : The aim of the present single subject research was to identify the effect of sensory diet based on proprioception on toddler's sleep pattern and the continuance of the effect. Methods : The sensory diet based on proprioception consisted of 14 session was provided to a 13 months old girl for 2 weeks. The time taken to fall asleep, amount of sleep, bed time and severity of behavior before sleep were recorded by her mother who was taken the education about observation. Results : After the sensory diet, the child present change of time taken to fall asleep, amount of sleep, bed time and severity of behavior before sleep, and the effect on time taken to fall asleep, continued temporally. Conclusion : The sensory diet based on proprioception was related to stabilize the sleep pattern of a toddler, and the effect of the sensory diet continued temporally after the sensory diet. For future research, more subjects and methodical measure are need to generalize the result of sensory diet based on proprioception affecting to toddler's sleep pattern.

• Child Health Nursing Research
• /
• v.6 no.3
• /
• pp.291-304
• /
• 2000

The purpose of this study was to explore the health and illness concepts of hospitalized preschoolers. The subjects were 52 hospitalized preschoolers from 3 to 6 grade in one general hospital. Data were collected through semistructured interviews by author. this study was conducted from Mar 2, 2000 to Jun. 30, 2000. Data were coded and categorized by content analysis. The results were as follows : 1. Hospitalized preschoolers's answers about health concepts were coded and then classificated to 7 categories(physical well-being, food, powerfulness, exercise, obedience to authority, cleanliness, sleep.) 2. Hospitalized preschoolers's answers about health behavior to maintenance health were coded and then classificated to 8 categories (food, obedience to authority, treatment, exercise, cleanliness, powerfulness, sleep, psychological stability). 3. Hospitalized preschoolers's answers about prevention of illness were coded and then classificated to 9 categories(food, treatment, obedience to authority, powerfulness, emotional stability, psychological stability, exercise, physical well-being, ability of social adaption). 4. Hospitalized preschoolers's answers about cause of illness were coded and then classificated to 3 categories(illness, trauma, food). 5. Hospitalized preschoolers's answers about treatments of illness were coded and then classificated to 9 categories(treatment, rest, emotional stability, sleep, psychological stability, food, obedience, exercise, powerfulness). 6. The levels of health and illness concepts in this sample were higher than those of the physical causality.

• Therapeutic Science for Rehabilitation
• /
• v.10 no.2
• /
• pp.129-140
• /
• 2021

Objective : The purpose of this study was to examine differences in social maturity and behavioral problems according to the level of sleep problems in children with ASD. Methods : The participants were 102 mothers of infants with ASD aged 1-5 years. The Social Maturity Scales (SMS) and Child Behavior Checklist 1.5-5 were used as the measuring tools. Results : The level of sleep problems in infants with ASD was 56.58T on the sleep problems scale. The participants were grouped based on scores on the sleep problems scale: those with scores <65 (good sleepers) or scores ≥65 (poor sleepers). Sleep problems significantly correlated with all the scales on the CBCL. However, no association was found between sleep problems and social quotients. Poor sleepers achieved significantly lower scores on the social quotient scale of the SMS than good sleepers. Poor sleepers achieved significantly higher scores in internalizing problems, externalizing problems, and DSM-oriented scales on the CBCL compared to those in the good sleepers. Conclusion : The significance of this study is that it has verified the severity of sleep problems in infants with ASD and has examined the differences in social maturity and behavioral problems between poor sleepers and good sleepers.

• Sleep Medicine and Psychophysiology
• /
• v.11 no.2
• /
• pp.106-109
• /
• 2004

Adenotonsillar hypertrophy is the leading cause of childhood obstructive sleep apnea. Obstructive sleep apnea syndrome in childhood, however, can occur from various causes such as obesity or craniofacial abnormalities. Childhood obstructive sleep apnea syndrome can be accompanied by enuresis, parasomnias and behavior problems. For patients with the symptoms of snoring and apnea, obstructive sleep apnea should be suspected and diagnosed properly. In addition, the evaluation of complications and proper treatment are indispensable. When the cause of childhood obstructive sleep apnea is adenotonsillar hypertrophy, symptoms can be improved by surgical methods. If the cause is other than adenotonsillar hypertrophy, such as obesity, it should be treated with other therapeutic modalities, like nasal continuous positive airway pressure (nCPAP), weight reduction and modification of life style. This paper reports a case of nCPAP used to manage severe sleep apnea when it was not resolved after adenoidectomy and tonsillectomy. Differential diagnosis of narcolepsy in a case with excessive daytime sleepiness and reflections on accompanying enuresis and parasomnia were also described.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• v.22 no.2
• /
• pp.120-127
• /
• 2011

Objectives:The purpose of this study was to verify discriminant validity and the clinical cutoff score of Child Behavior Checklist 1.5-5 in the diagnosis of developmental delayed infants. Methods:The participants were screened by Denver II which includes 156 developmental delayed infants and 288 normal infants. Chi-squared test, t-test, ROC curve analysis, odds ratio analysis were performed on the data. Results:Only 47 items out of 99 items among the CBCL 1.5-5 of total groups, 36 items of boys and 48 items of girls, discriminated developmental delayed infants well. Discriminant validity was confirmed by mean differences on the subscales of Withdrawn, Sleep Problems, Attention Problems, Internalizing Problems, Externalizing Problems, Total Problems, DSM Pervasive Developmental Problems and DSM Attention Deficit/Hyperactivity Problems between the two groups. Additionally, ROC analyses demonstrated that Withdrawn, Attention Problems, Internalizing Problems, Total Behavior Problems and DSM Pervasive Developmental Problems significantly predicted developmental delayed infants compared to normal infants. Also, the clinical cutoff score criteria adopted in the Korean CBCL 1.5-5 for subscales of Withdrawn, Attention Problems, Internalizing Problems, Total Behavior Problems and DSM Pervasive Developmental Problems were shown to be valid. Conclusion:The subscales of Withdrawn, Attention Problems, Internalising Problems, Total Behavior Problems and DSM Pervasive Developmental Problems significantly discriminated in the diagnosis of developmental delayed infants well.

• Sleep Medicine and Psychophysiology
• /
• v.3 no.1
• /
• pp.85-95
• /
• 1996

Obstructive sleep apnea syndrome(OSAS) in childhood is unique and different n-om that in adulthood in several aspects, including pathophysiology, clinical features, diagnostic criteria, complications, management, and prognosis. Characteristic features of childhood OSAS in comparison with the adult form are the variety of severe complications such as developmental delay, more prominent behavioral and cognitive impairments, vivid cardiovascular symptoms, and increased death risk, warranting a special attention to the possible diagnosis of OSAS in children who snore. However, the childhood OSAS is often neglected and unrecognized. We, therefore, report a case of very severe OSAS in a 5-year-old boy who was sucessfully treated with continuous positive airway pressure(CPAP) treatment. Interestingly, the patient was comor-bid with the attention deficit hyperactivity disorder. Prior to the initial visit to us, adenotonsillectomy had been done at the age of 4 with no significant improvement of apneic symptoms and heavy snoring. On the initial diagnostic procedures, marked degree of snoring was audible even in the daytime wake state and the patient was observed to be very hyperactive. Increased pulmonary vascularity with borderline cardiomegaly was noted on chest X-ray. The baseline polysomnography revealed that the patient was very sleep-apneic and snored very heavily, with the respiratory disturbance index(RDI) of 46.9 per hour of sleep, the mean SaO2 of 78.8%, and the lowest SaO2 of 40.0%(the lowest detectable oxygen level by the applied oxymeter). The second night polysomnography was done for CPAP titration and the optimal pressure turned out to be $8.0\;cmH_2O$. The applied CPAP treatment was well tolerated by the patient and was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. After 18 months of the CPAP treatment, the patient was followed up with nocturnal polysomnography(baseline and CPAP nights) and clinical examination. Sleep apneas were still present without CPAP on the baseline night. However, the severity of OSAS was significantly decreased(RDI of 15.7, mean SaO2 of 96.2%, and the lowest SaO2 of 83.0%), compared to the initial polysomnographic findings before initiation of long-term CPAP treatment. Wechsler intelligence tests done before and after the CPAP treatment were compared with each other and surprising improvement of intelligence(total 9 points, performance 16 points) was noted. Clinically he was found to be markedly improved in his attention deficit hyperactive behavior after CPAP treatment, but with minimal change of TOVA(test of variables of attention) scores except conversion of reaction time score into normal range. On the chest X-ray taken after 18 months of CPAP application, the initial cardiopulmonary abnormalities were not found at all. We found that the CPAP treatment in a young child is very effective, safe, and well-tolerated and also improves the co-morbid attention deficit hyperactive symptoms. Overall, the growth and development of the child has been facilitated with the long-term use of CPAP. Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment. We suggest that early diagnosis and active treatment intervention of OSAS in children are crucial in preventing and ameliorating possible serious complications caused by repetitive sleep apneas and consequent hypoxic damage during sleep.