• 대한한방소아과학회지
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• 제20권2호
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• pp.147-175
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• 2006

Objective : This study is to investigate the method for assesment and diagnosis of ADHD, especially focusing on behavior rating scales. Methods : We searched the recent date of the publication and paper in ADHD. Results : For Assesment and Diagnosis of ADHD, various method such as interview with parents, child and teacher, behavior observation, behavior rating scales and neuropsychological test are used. The structured interview consists of the restrictive questions and response, and then have diagnostic algorithm, consequently can be used by untrained clinicians. Of the structured interview, standardization of K-SADS in Korean version is finished. Behavior rating scales, the form of parent, teacher and self-report questionnaires, are used as diagnosis and treatment evaluation of ADHD. Behavior rating scales consist of both ADHD-specific scales and broad-band scales designed to screen for various symptoms (including ADHD symptoms). ADHD-specific scales are useful in differential diagnosis, discrimination of subtype, treatment evaluation, However, broad-band scales are useful in preliminary examination. The neuropsychological tests can evaluate attention deficit and effect of attention deficit on cognitive function and academic performance. The neuropsychological tests also used in diagnosis and treatment evaluation of ADHD. Conclusion : For Assesment and Diagnosis of ADHD, various method are used, especially behavior rating scales are both useful and simple tool for diagnosis and treatment evaluation.

• Journal of Preventive Medicine and Public Health
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• 제53권1호
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• pp.29-36
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• 2020

Objectives: Prenatal cadmium (Cd) exposure may be associated with attention-deficit/hyperactivity disorder (ADHD) in children. Therefore, the objective of this study was to examine the relationship between Cd exposure during gestation and ADHD at 6 years of age. Methods: As part of an ongoing cohort study (the Environment and Development of Children study), 479 mother-child pairs from Seoul, Korea were included for analysis between 2008 and 2011. The whole blood concentration of Cd was analyzed using atomic absorption spectrophotometry. The parents were surveyed about ADHD behaviors in their children at age 6. Multivariable linear regression models were used to investigate the relationship between prenatal exposure to Cd and ADHD at 6 years of age. Results: Increased prenatal Cd concentrations were associated with increased scores for ADHD for girls, but not for boys, at age 6. A 2-fold increase in the prenatal Cd level was significantly associated with a 22.3% (95% confidence interval, 11.6 to 34.1) increase in ADHD in girls at 6 years of age, as indicated by the linear regression model. Conclusions: Our results identified significant associations between prenatal Cd exposure and ADHD scores in 6-year-old girls.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제30권2호
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• pp.74-82
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• 2019

Objectives: The objective of this study was to investigate clinical and neuropsychological factors associated with treatment response and adverse events of atomoxetine in children with attention-deficit/hyperactivity disorder (ADHD) in Korea. Methods: Children with ADHD were recruited at the Department of Psychiatry of Asan Medical Center from April 2015 to April 2018. Diagnoses of ADHD and comorbid psychiatric disorders were confirmed with the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. The subjects were subsequently treated with atomoxetine for 12 weeks and illness severity was scored using the ADHD Rating Scale, Clinical Global Impression-Severity scale (CGI-S) and/or Improvement scale (CGI-I), at pre- and post-treatment. They also completed the Advanced Test of Attention (ATA), while their caregivers completed the Korean Personality Rating Scale for Children (KPRC) at pre- and post-treatment. Independent t-test, Fisher's exact test, ${\chi}^2$ test, mixed between-within analysis of variance and correlation analysis were used for statistical analysis. Results: Sixty-five children with ADHD (mean age: $7.9{\pm}1.4years$, 57 boys) were enrolled, of which, 33 (50.8%) were treatment responders. Scores on the social dysfunction subscale of the KPRC (p=0.021) and commission errors on the visual ATA (p=0.036) at baseline were higher in treatment non-responders than in responders; however, the statistical significances disappeared after adjusting for multiple comparisons. Mood changes were also observed in 13 subjects (20.0%), and three of them discontinued atomoxetine due to this. Additionally, atomoxetine-emergent mood change was observed more frequently in girls (p=0.006), while the intelligence quotient (p=0.040) was higher in those subjects with mood changes than in those without. Conclusion: The results of our study suggest that clinical and neuropsychological factors could be associated with treatment response or adverse events of atomoxetine in children with ADHD. Further long-term studies with larger samples are needed.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제34권2호
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• pp.125-132
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• 2023

Objectives: This study investigated the relationship between suicidal behavior and the use of methylphenidate (MPH) or atomoxetine (ATX) in patients with attention deficit hyperactivity disorder (ADHD). Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to conduct a meta-analysis. The Physiotherapy Evidence Database scale was used to score the quality of the studies. Results: Nine studies were included in this quantitative analysis. The analysis included 602864 patients with ADHD (521125 and 81739 patients were taking methylphenidate [MPH group] and atomoxetine [ATX group], respectively) and 19230 healthy controls. The overall estimates were in the order of the control, MPH, and ATX groups; however, no statistically significant between-group difference was observed in the incidence of events (p=0.553 for control vs. MPH; p=1.000 for control vs. ATX; p=1.000 for MPH vs. ATX). Conclusion: The rate of suicidal behavior was higher in the ADHD groups treated with MPH and ATX than in the control group. However, no statistically significant difference was observed between the ADHD groups treated with MPH and ATX, and the control group. Therefore, MPH and ATX did not increase suicidal behavior.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제25권1호
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• pp.28-36
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• 2014

Objectives : The goal of this study was to examine the association between zinc and lead level and symptoms of attention-deficit hyperactivity disorder (ADHD) among Korean children. Methods : A total of 89 clinic-referred children participated in the study (ADHD group=45, control group=44). The participants were 5-15 years old, and were mainly from urban areas of Seoul, Korea. ADHD was diagnosed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. We excluded children with a comorbid psychiatric disorder, medical illness requiring medication, or a prior history of taking ADHD medication. In order to evaluate the severity of ADHD symptoms, parents' Korean ADHD Rating Scale (K-ARS) was used. The ADHD diagnostic system (ADS) was used for evaluation of the severity of inattention and impulsivity. All participants completed the intelligence test and hair mineral analysis. Multiple regression analysis was used to examine the effect of hair zinc and lead levels on the K-ARS and ADS. We measured the predictive ability of the zinc and lead levels using logistic regression analysis. Results : The lead level explained the score for omission errors, commission errors, and response time SD in visual ADS in the ADHD group (adjusted $R^2$=.243, p<.01, adjusted $R^2$=.362, p<.01, and adjusted $R^2$=.275, p<.01), the score for omission errors of auditory ADS in ADHD group (adjusted $R^2$=.407, p<.01) and the entire group (adjusted $R^2$=.292, p<.01). Zinc was significantly explanatory for the K-ARS scores for the entire group (adjusted $R^2$=.248, p<.001) and the ADHD group (adjusted $R^2$=.247, p<.05). Conclusion : These findings suggest a possible role of zinc and lead in ADHD. Lead concentration in hair samples affected the ADS scores, and this was more prominent in children with ADHD. Children with ADHD had a lower zinc concentration in their hair, and the zinc concentration in hair showed negative correlation with the K-ARS score.

• 대한한방소아과학회지
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• 제15권2호
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• pp.141-165
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• 2001

Attention-deficit/hyperactivity disorder(ADHD) is one of the most common childhood-onset psychlatric disorders. It is distinguished by symptoms of inattention, hyperactivity, and impulsivity. ADHD may be accompanied by learning disabilities, depression, anxiety, conduct disorder, and oppositional defiant disorder. The etiology of ADHD is unknown, and the disorder may have several different causes. Individual with ADHD present in childhood and may continue to show symptoms as they enter adolescence and adult life. Public interest in ADHD has increased along with debate in the media concerning the diagnostic process and treatment strategies. The purpose of this study is oriental medical approach to ADHD. This study was progressed for oriental diagnosis and treatment for ADHD. In oriental medicine, the reason of ADHD was deficiency of the kidney, hyperactivity of the liver(腎虛肝亢), deficiency of the heart and the spleen(心脾不足), heart disturbed by phlegm and heat(痰熱擾心). The method of medical treatment was nourishing the kidney and checking exuberance of yang(滋腎潛陽), relieving mental stress and promoting wisdom(寧神益智), nourishing the heart and strengthening the spleen(養心健脾), tranquilzation(安神定志). removing heat-phlegm(淸熱化痰), inducing resuscitation and tranquilzation(開窮安神). The prescription was commonly used as Liuwei Dihuang Wan jiajian(六味地黃丸加減), Guipi Tang he Ganmai Dazao Tang jiajian(歸脾湯合甘麥大棗湯加減), Huanglian Wendan Tang jiawei(溫黃連溫膽湯加味). It should help primary care providers in their assessment of a common child health problem.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제25권2호
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• pp.89-94
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• 2014

Objectives : This study was conducted naturalistically in order to observe the long-term effects of attention-deficit hyperactivity disorder (ADHD) medications on growth rates among Korean school-aged boys with ADHD. Methods : Participants in the study were boys with ADHD aged 6 to 11 years who have taken ADHD medication, methylphenidate (extended release) or atomoxetine. They attended scheduled visits monthly or bimonthly for clinical assessment with measurement of height and weight. In this study, 35 boys with ADHD (mean age at baseline=$7.90{\pm}1.77$ years ; mean age at endpoint= $12.54{\pm}1.91$ years) were included, with a mean follow-up period of 4.64 years (${\pm}1.62$ years), ranging from 2 to 9.7 years. Height, weight, and body mass index (BMI) measurements were converted to "age-corrected Z-scores" using data from Growth Charts provided by the Korean Center for Disease Control and Prevention from 2007. Results : Age-corrected endpoint growth parameters (height, weight, BMI Z-scores) did not differ significantly from the baseline values (height t=0.027 ; weight t=-0.61 ; BMI t=-1.86, in paired t-test). Especially high correlation was observed between the baseline and endpoint height Z-scores (r=0.876, p<.001), for which the coefficient of determination $r^2$ was 0.767, meaning that the amount of variability in endpoint height Z-scores explained by the baseline height Z-scores was 76.7%. Conclusion : Our results suggested that the long-term effects of ADHD medications on growth parameters to be tolerable in Korean school-aged boys with ADHD.

• 정신신체의학
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• 제24권2호
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• pp.157-164
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• 2016

Objectives : The objective of this study was to investigate the characteristics of language profiles according to whether or not Korean children with autism spectrum disorder(ASD) also have ADHD, and to examine the relationship with executive function. Methods : Participants in the study were boys with ADHD aged 6 to 11 years who visited the clinic from January 2012 to December 2013. In this study, 25 boys with ASD were included, and completed scales included the Korean version of Autism Diagnostic Interview-Revised(K-ADI-R), Korean version of Autism Diagnostic Observation Schedule(K-ADOS), Korean ADHD Rating Scale(K-ARS), and Korean-Conners' Parent Rating Scale(K-CPRS). They also completed neuropsychological tests and assessed language profiles. Patients were categorized into two groups(with ADHD and without ADHD). T-test and Multivariate analysis of covariance (MANCOVA) was used for analysis. Results : Statistically, no difference was found in receptive and expressive language ability between the ASD groups with and without ADHD. However, a lower score in Test of Problem solving(TOPS) was observed for ASD with ADHD than for ASD without ADHD, with problem solving and finding cues showing significant differences. Conclusions : These findings suggest that language profiles in the ASD group without ADHD could be similar to those in the ASD group with ADHD, but comorbid ADHD could lead to more difficulty in linguistic ability for problem solving and could be related with executive function of the frontal lobe.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제32권4호
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• pp.129-136
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• 2021

Objectives: To investigate the relationship between brain structure and empathy in early adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods: Nineteen early adolescents with ADHD and 20 healthy controls underwent 3T MRI. All the participants were assessed for different aspects of empathy using measures including the Interpersonal Reactivity Index and Empathy Quotient. Cortical thickness and subcortical structural volume based on T1-weighted scans were analyzed using FreeSurfer. Results: Cognitive empathy (t=-2.52, p=0.016) and perspective taking (t=-2.10, p=0.043) were impaired in the ADHD group compared with the control group. The cluster encompassing the left posterior insular, supramarginal, and transverse temporal cortices [cluster-wise p-value (CWP)=0.001], which are associated with emotional empathy, was significantly smaller in the ADHD group, and the volume of the left nucleus accumbens was greater than that of the control group (F=10.12, p=0.003, effect size=0.22). In the control group, the left superior temporal (CWP=0.002) and lingual cortical (CWP=0.035) thicknesses were positively associated with cognitive empathy, while the right amygdala volume was positively associated with empathic concern (Coef=14.26, t=3.92, p=0.001). However, there was no significant correlation between empathy and brain structure in the ADHD group. Conclusion: The ADHD group had a smaller volume of the cortical area associated with emotional empathy than the control group, and there was no brain region showing significant correlation with empathy, unlike in the control group.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제24권4호
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• pp.191-198
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• 2013

Objectives : The objective of this study is to find out the differences in psychopathology, temperament, and character factors between young adults with and without childhood attention-deficit hyperactivity disorder (ADHD) symptoms. Methods : The subjects consisted of 314 university students (male=72, female=242) in Gongju. They were divided into childhood ADHD group (N=54) and normal group (N=260) to the Wender-Utah Rating Scale. Participants were assessed using Korean Adult ADHD Scale, Beck Depression Inventory-II, Beck Anxiety Inventory, Kimberly Young's Internet Addiction Test, Barratt Impulsiveness Scale, Paranoia Scale, Korean-Schizotypal Ambivalence Scale, Lubben Social Network Scale, and Temperament and Character Inventory-Revised. Descriptive statistics, t-test, chi-square, spearman correlation, and stepwise multiple regression were applied to analyze the data. Results : Participants with childhood ADHD symptoms had high level of adult ADHD symptoms (p<.001), impulsiveness (p=.001), depression (p<.001), anxiety (p<.001), internet addiction (p<.001), paranoia tendency (p<.001) and low level of selfesteem (p<.001) compared to normal group. Self-directedness (p<.001) was lower, Harm avoidance (p=.001) and Self-transcendence (p=.029) were higher in the childhood ADHD group. In correlation and stepwise multiple regression, childhood ADHD symptoms were significantly associated with cooperativeness (r=-0.515 and ${\beta}$=-0.547, p<.001 respectively). Conclusion : This result showed that young adults with childhood ADHD symptoms had various forms of psychopathology and childhood ADHD symptoms were influenced by character such as cooperativeness. Therefore, more thorough evaluation regarding childhood ADHD symptoms is needed.