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

DNA methylation is associated with prenatal exposure to sulfur dioxide and childhood attention-deficit hyperactivity disorder symptoms

Epigenetic influence plays a role in the association between exposure to air pollution and attention deficit hyperactivity disorder (ADHD); however, research regarding sulfur dioxide (SO₂) is scarce. Herein, we investigate the associations between prenatal SO₂ exposure and ADHD rating scale (ARS) at ages 4, 6 and 8 years repeatedly in a mother-child cohort (n = 329). Whole blood samples were obtained at ages 2 and 6 years, and genome-wide DNA methylation (DNAm) was analyzed for 51 children using the Illumina Infinium HumanMethylation BeadChip. We analyzed the associations between prenatal SO₂ exposure and DNAm levels at ages 2 and 6, and further investigated the association between the DNAm and ARS at ages 4, 6 and 8. Prenatal SO₂ exposure was associated with ADHD symptoms. From candidate gene analysis, DNAm levels at the 6 CpGs at age 2 were associated with prenatal SO₂ exposure levels. Of the 6 CpGs, cg07583420 (INS-IGF2) was persistently linked with ARS at ages 4, 6 and 8. Epigenome-wide analysis showed that DNAm at 6733 CpG sites were associated with prenatal SO₂ exposure, of which 58 CpGs involved in Notch signalling pathway were further associated with ARS at age 4, 6 and 8 years, persistently. DNAm at age 6 was not associated with prenatal SO₂ exposure. Changes in DNAm levels associated with prenatal SO₂ exposure during early childhood are associated with increases in ARS in later childhood.

Shortened Infant Telomere Length Is Associated with Attention Deficit/Hyperactivity Disorder Symptoms in Children at Age Two Years: A Birth Cohort Study

Environmental factors can accelerate telomere length (TL) attrition. Shortened TL is linked to attention deficit/hyperactivity disorder (ADHD) symptoms in school-aged children. The onset of ADHD occurs as early as preschool-age, but the TL-ADHD association in younger children is unknown. We investigated associations between infant TL and ADHD symptoms in children and assessed environmental factors as potential confounders and/or mediators of this association. Relative TL was measured by quantitative polymerase chain reaction in cord and 12-month blood in the birth cohort study, the Barwon Infant Study. Early life environmental factors collected antenatally to two years were used to measure confounding. ADHD symptoms at age two years were evaluated by the Child Behavior Checklist Attention Problems (AP) and the Attention Deficit/Hyperactivity Problems (ADHP). Associations between early life environmental factors on TL or ADHD symptoms were assessed using multivariable regression models adjusted for relevant factors. Telomere length at 12 months (TL12), but not at birth, was inversely associated with AP (β = −0.56; 95% CI (−1.13, 0.006); p = 0.05) and ADHP (β = −0.66; 95% CI (−1.11, −0.21); p = 0.004). Infant secondhand smoke exposure at one month was independently associated with shorter TL12 and also higher ADHD symptoms. Further work is needed to elucidate the mechanisms that influence TL attrition and early neurodevelopment.

Prospective Association Between Online Game Use and Risk of Internet Gaming Disorder in Korea: 12-Month Follow-up Results From the iCURE Study

Children and adolescents' Internet game use has both functional and dysfunctional aspects. This study aimed to examine how changes in online gaming behaviors impact the risk of Internet gaming disorder (IGD). We observed 1318 adolescent online game users. Baseline and 12-month follow-up evaluations were performed, and it was defined whether the average online gaming time per day exceeded 1.5 hours and whether the number of gaming days per week exceeded 4 days. Gaming disorder was defined using the Internet Game Use-Elicited Symptom Screen. Multiple logistic regression was performed to examine the difference in the incidence rate ratio (IRR) of IGD risk according to changes in gaming time or frequency. Results indicated the IRR of IGD risk was 2.54 (P = .007) for the increased time spent group and 2.38 (P = .015) for the consistent higher time spent group against the consistent lower time spent group. The IRR was 3.76 (P = .007) for the increased frequency group and 2.92 (P = .029) for the consistent higher frequency group against the consistent lower frequency group. Therefore, managing Internet game use not to exceed 1.5 hours per day on average and 4 days per week would help prevent elevation of IGD risk.

Characteristics of Attention-Deficit/Hyperactivity Disorder Subtypes in Children Classified Using Quantitative Electroencephalography

PURPOSE

This study used quantitative electroencephalography (QEEG) to investigate the characteristics of attention-deficit/hyperactivity disorder (ADHD) subtypes in children.

PATIENTS AND METHODS

There were 69 subjects (42 with ADHD and 27 neurotypical (NT)) in this study. A semi-structured interview was conducted with each participant for psychiatric diagnostic evaluation. We measured the absolute and relative power in 19 channels and analyzed QEEG using the following frequency ranges: delta (1-4 Hz), theta (4-8 Hz), alpha 1 (8-10 Hz), alpha 2 (10-12 Hz), beta 1 (12-15 Hz), beta 2 (15-20 Hz), beta 3 (20-30 Hz), and gamma (30-45 Hz). Group analyses and EEG noise preprocessing were conducted using iSyncBrain, a cloud-based, artificial intelligence EEG analysis platform. Analysis of covariance adjusted for IQ, age, and sex was used.

RESULTS

QEEG analysis revealed three ADHD subtypes, characterized by (A) elevated relative fast alpha and beta power, (B) elevated absolute slow frequency (delta and theta power), or (C) elevated absolute and relative beta power. A significant difference was found in the Korean ADHD Rating Scale (K-ARS) among the four groups (df=3, F=8.004, p<0.001); group C had the highest score (25.31±11.16), followed by group A (21.67±13.18). The score of group B (12.64±7.84) was similar to that of the NT group (11.07±6.12) and did not reach the cut-off point of the K-ARS. In the Wender-Utah Rating Scale (WURS), group B score (55.82±23.17) was significantly higher than the NT group score (42.81±13.26).

CONCLUSION

These results indicate that children with ADHD do not constitute a neurophysiologically homogenous group. Children with QEEG subtype B (elevated slow frequency) may be difficult to distinguish from normal children using the K-ARS, which is the most common screening tool for ADHD. Moreover, parents of children with this subtype may be less sensitive to observing ADHD symptoms.

Effects of Antidepressant Treatment on Symptom Measures of Attention in Adolescents with Depression: A Preliminary Open-Label Study

Objective: The effects of selective serotonin reuptake inhibitor (SSRI) on deficits in attention and executive function in adolescents with major depressive disorder (MDD) are relatively unknown. We aimed to investigate changes in symptom measures of attention in adolescents with MDD treated with escitalopram. Methods: The study included 82 MDD adolescents and 54 healthy controls aged from 12 to 17 years. Symptom measures of attention were assessed using the Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS) and Child Behavior Checklist attention problems scale at baseline and during week 8. Adolescents who showed at least 40% improvement in the Children's Depression Rating Scale-Revised (CDRS-R) scores from baseline to week 8 were referred to as "responders." Results: No baseline differences were found between the responders (n = 47) and nonresponders (n = 35) in their age, sex, intelligence quotient, CDRS-R score, and attention measures. Linear mixed models showed significant group-by-time interaction effect in the ADHD-RS inattention subscale score, but not in the other attention measures. Conclusion: Our results suggest that treating depressive symptoms with SSRI may lead to improvements in attention in MDD adolescents. Monitoring changes in symptom measures of attention can be useful when treating adolescents with MDD. ClinicalTrials.gov identifier: NCT03547219.

Methylphenidate Treatment Adherence and Persistence in Children in the Netherlands

Objectives: Numerous studies have examined determinants contributing to methylphenidate adherence and persistence, but these were mainly conducted in adults. These determinants are likely to be different in children as they usually rely on their parents to provide them with the care they need. The objective was to study child and family characteristics as determinants of methylphenidate adherence and persistence in children. Methods: The study population consists of 307 children from the Generation R Study in the Netherlands, who had at least one dispensing record of methylphenidate until the age of 16 years. Adherence was defined as a medication possession ratio ≥0.80 up to 2 years after treatment initiation. Persistence was defined as the duration of treatment until a discontinuation period of ≥6 months. Family and child characteristics were tested as determinants of adherence with multivariable logistic regression analysis. Persistence was evaluated using a Kaplan-Meier analysis. Results: Children of mothers with one child (adjusted odds ratio [OR]: 2.31, 95% confidence interval [CI]: 1.17-4.54) or of mothers with an average household income (compared to high) were more likely to be adherent (adjusted OR: 3.45, 95% CI: 1.43-8.31). Children who started treatment at the age of 12-16 years (compared to <12 years) (adjusted hazard ratio [HR]: 3.55, 95% CI: 2.54-4.98) and girls (adjusted HR: 1.44, 95% CI: 1.07-1.95) were more often nonpersistent. Conclusion: Both child and family characteristics may play a role in methylphenidate treatment adherence. Furthermore, gender and the start age of treatment were found to be associated with nonpersistence. These findings may be important for health care professionals when initiating methylphenidate treatment in children.

Maternal Sociodemographic Factors Are Associated with Methylphenidate Initiation in Children in the Netherlands: A Population-Based Study

Multiple factors may contribute to the decision to initiate methylphenidate treatment in children such as maternal sociodemographic factors of which relatively little is known. The objective was to investigate the association between these factors and methylphenidate initiation. The study population included 4243 children from the Generation R Study in the Netherlands. Maternal sociodemographic characteristics were tested as determinants of methylphenidate initiation through a time-dependent Cox regression analysis. Subsequently, we stratified by mother-reported ADHD symptoms (present in 4.2% of the study population). When ADHD symptoms were absent, we found that girls (adjusted HR 0.25, 95%CI 0.16-0.39) and children born to a mother with a non-western ethnicity (compared to Dutch-Caucasian) (adjusted HR 0.42, 95%CI 015-0.68) were less likely to receive methylphenidate. They were more likely to receive methylphenidate when their mother completed a low (adjusted HR 2.29, 95%CI 1.10-4.77) or secondary (adjusted HR 1.71, 95%CI 1.16-2.54) education. In conclusion, boys and children born to a mother of Dutch-Caucasian ethnicity were more likely to receive methylphenidate, irrespective of the presence of ADHD symptoms.

Gene co-expression networks in peripheral blood capture dimensional measures of emotional and behavioral problems from the Child Behavior Checklist (CBCL)

The U.S. National Institute of Mental Health (NIMH) introduced the research domain criteria (RDoC) initiative to promote the integration of information across multiple units of analysis (i.e., brain circuits, physiology, behavior, self-reports) to better understand the basic dimensions of behavior and cognitive functioning underlying normal and abnormal mental conditions. Along those lines, this study examined the association between peripheral blood gene expression levels and emotional and behavioral problems in school-age children. Children were chosen from two age- and sex-matched groups: those with or without parental reports of any prior or current psychiatric diagnosis. RNA-sequencing was performed on whole blood from 96 probands aged 6-12 years who were medication-free at the time of assessment. Module eigengenes were derived using weighted gene co-expression network analysis (WGCNA). Associations were tested between module eigengene expression levels and eight syndrome scales from parent ratings on the Child Behavior Checklist (CBCL). Nine out of the 36 modules were significantly associated with at least one syndrome scale measured by the CBCL (i.e., aggression, social problems, attention problems, and/or thought problems) after accounting for covariates and correcting for multiple testing. Our study demonstrates that variation in peripheral blood gene expression relates to emotional and behavioral profiles in children. If replicated and validated, our results may help in identifying problem or at-risk behavior in pediatric populations, and in elucidating the biological pathways that modulate complex human behavior.

Residential pyrethroid insecticide use, urinary 3-phenoxybenzoic acid levels, and attention-deficit/hyperactivity disorder-like symptoms in preschool-age children: The Environment and Development of Children study

Previous animal studies have reported that pyrethroids can cause dopamine system abnormalities and attention-deficit/hyperactivity disorder (ADHD) phenotypes. However, epidemiological studies investigating the associations between pyrethroid exposure and ADHD are limited. We aimed to investigate the association between pyrethroid exposure and ADHD-like symptoms among preschool-age children. We used data from 385 children at 4 years of age participating in the Environment and Development of Children (EDC) study. We evaluated pyrethroid exposure through questionnaires and urinary 3-phenoxybenzoic acid (3-PBA) concentrations. We assessed ADHD-like symptoms using the Korean ADHD rating scale (K-ARS). We conducted negative binomial regressions to evaluate the associations between pyrethroid exposure and ADHD-like symptoms. Residential use of insecticide adhesive (β = 0.42, 95% CI: 0.11, 0.74) and insecticide spray (β = 0.33, 95% CI: 0.08, 0.59) was associated with an increase in log-transformed creatinine-adjusted urinary 3-PBA concentrations. Residential insecticide adhesive use was associated with a 51.6% increase in K-ARS scores (95% confidence interval [CI]: 6.3, 116.1) among boys, when compared with non-users. When compared with creatinine-adjusted 3-PBA levels <0.50 μg/g creatinine, creatinine-adjusted 3-PBA levels ≥3.80 μg/g creatinine were associated with a 58% increase in K-ARS scores (95% CI: 0.1, 150.5) among boys. We found associations of residential pyrethroid insecticide use and urinary 3-PBA concentrations with K-ARS scores among preschool-age boys. Since the present study explored cross-sectional associations in preschool-age children, the possibility of reverse causality cannot be dismissed. Further studies implementing a cohort study design are warranted.

Gaming patterns and related symptoms in adolescents using cluster analysis: Baseline results from the Internet User Cohort for Unbiased Recognition of Gaming Disorder in Early Adolescence (iCURE) study

PURPOSE

The risk and protective factors of Internet gaming disorder (IGD) could vary by individual. The identification of more homogeneous subgroups may lead to better understanding of gaming behaviors and their consequences in adolescents. The purpose of this study was to investigate the prevalence of IGD among the subgroups defined by cluster analysis in adolescents.

METHODS

A total of 2319 adolescents were enrolled in the Internet User Cohort for Unbiased Recognition of Gaming Disorder in Early Adolescence (iCURE) study at baseline. Self-reported IGD was assessed with a DMS-5 adapted measurement. Smartphone addiction, musculoskeletal discomfort, and dry eye symptoms were evaluated by self-administered questionnaires. Cluster analysis was performed using risk and protective factors of IGD after considering multicollinearity.

RESULTS

Three different clusters were identified. Cluster 1 (19.2%) was users with combined potential psychological and social issues. Cluster 2 (32.3%) was users with potential social but no psychological issues. Cluster 3 (45.6%) was users with no potential issues of either a social or psychological nature. Adolescents from both clusters 1 and 2 showed higher degrees of IGD, smartphone addiction, musculoskeletal discomfort, and dry eye symptoms than did those from cluster 3. Also compared with adolescents in cluster 3, those in cluster 1 showed statistically higher risks of IGD (aOR:11.9, 95%CI:7.5-19.9), smartphone addiction (aOR:5.4, 95%CI:4.0-7.2), musculoskeletal discomfort (aOR:2.6, 95%CI:2.1-7.4), and dry eye symptoms (aOR:3.8, 95%CI:3.0-4.9). Those in cluster 2 also showed statistically higher risk of IGD, smartphone addiction, musculoskeletal discomfort, and dry eye symptoms compared with cluster 3 (aOR:4.5, 95%CI:2.8-7.6; aOR:2.8, 95%CI:2.1-3.7; aOR:1.6, 95%CI:1.3-1.9; and aOR:1.9, 95%CI:1.6-2.4, respectively).

CONCLUSIONS

Clustering based on the risk and preventive factors of IGD may be suitable for determination of high risk of IGD in adolescents. However, we need to confirm the usefulness and clinical application of the classifications by observing their longitudinal changes.

Application of Attention-Deficit/Hyperactivity Disorder Diagnostic Tools: Strengths and Weaknesses of the Korean ADHD Rating Scale and Continuous Performance Test

PURPOSE

We aimed to compare the Korean version of the ADHD Rating Scale (K-ARS) and Integrated Visual and Auditory Plus (IVA+Plus), a continuous performance test, by analyzing their abilities to distinguish different groups (attention-deficit/hyperactivity disorder [ADHD], ADHD-not otherwise specified [NOS], and normal control [NC]).

PATIENTS AND METHODS

Individuals of 7-12 years of age who visited our child and adolescent psychiatric clinic were recruited. Seventy-four participants (58 males, 16 females) were classified into three groups according to results from the Korean Version of Diagnostic Interview Schedule for Children Version IV. The K-ARS and IVA+Plus were administered. An analysis of covariance (ANCOVA) was conducted. The tools' accuracy in discriminating patients with ADHD or NOS from NCs was evaluated using a receiver operating characteristic (ROC) curve analysis.

RESULTS

ANCOVA revealed significant differences in the K-ARS results of the three groups (ADHD [n=29], NOS [n=33], NC [n=12]), whereas a difference in IVA+Plus results was observed only between the ADHD and NC groups. In the ROC curve analysis of the K-ARS, the areas under the curve (AUCs) for each group were 0.960 (ADHD vs NC), 0.885 (NOS vs NC), 0.920 (ADHD+NOS vs NC), and 0.779 (ADHD vs NOS+NC). In the ROC curve analysis for the IVA+Plus hyperactivity-impulsiveness scale, the AUCs for each group were 0.740 (ADHD vs NC), 0.643 (NOS vs NC), 0.688 (ADHD+NOS vs NC), and 0.626 (ADHD vs NOS+NC); those for the inattention scale were 0.731 (ADHD vs NC), 0.658 (NOS vs NC), 0.692 (ADHD+NOS vs NC), and 0.625 (ADHD+NOS vs NC).

CONCLUSION

The K-ARS was useful to distinguish the ADHD and NOS groups from the NC group, while the IVA+Plus was useful to distinguish the ADHD group from the NC group. Clinicians should ensure they understand the properties of each tool and apply them appropriately in the diagnosis of ADHD.

Study protocol of the internet user Cohort for Unbiased Recognition of gaming disorder in Early adolescence (iCURE), Korea, 2015-2019

INTRODUCTION

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) proposed nine internet gaming disorder (IGD) diagnostic criteria as a condition warranting further empirical and clinical research. The aim of this study is to clarify the natural and clinical courses of IGD proposed DSM-5 in adolescents and to evaluate its risk and protective factors.

METHODS AND ANALYSIS

The Internet user Cohort for Unbiased Recognition of gaming disorder in Early Adolescence (iCURE) study is an ongoing multidisciplinary, prospective, longitudinal cohort study conducted in 21 schools in Korea. Participant recruitment commenced in March 2015 with the goal of registering 3000 adolescents. The baseline assessment included surveys on emotional, social and environmental characteristics. A parent or guardian completed questionnaires and a structured psychiatric comorbidity diagnostic interview regarding their children. Adolescents with the Internet Game Use-Elicited Symptom Screen total scores of 6 or higher were asked to participate in the clinical diagnostic interview. Two subcohorts of adolescents were constructed: a representative subcohort and a clinical evaluation subcohort. The representative subcohort comprises a randomly selected 10% of the iCURE to investigate the clinical course of IGD based on clinical diagnosis and to estimate the false negative rate. The clinical evaluation subcohort comprised participants meeting three or more of the nine IGD criteria, determined by clinical diagnostic interview, to show the clinical course of IGD. Follow-up data will be collected annually for the 3 years following the baseline assessments. The primary endpoint is 2-year incidence, remission and recurrence rates of IGD. Cross-sectional and longitudinal associations between exposures and outcomes as well as mediation factors will be evaluated.

ETHICS AND DISSEMINATION

This study is approved by the Institutional Review Board of the Catholic University of Korea. Results will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (identifier: NCT02415322).

Social Behavioral Problems and the Health-Related Quality of Life in Children and Adolescents with Epilepsy

OBJECTIVE

The purpose of this study was to investigate the impact of specific behavioral problems on the health-related quality of life (HRQOL) in children and adolescents with epilepsy.

METHODS

Children and adolescents with epilepsy (n=92; age range=6-17 years) and their mothers completed questionnaires about behavioral problems, HRQOL, socio-demographics, and epilepsy-related variables. To determine significant predictor variables of the HRQOL, the stepwise regression analyses and partial correlations were performed to adjust for other behavioral problems and covariates.

RESULTS

The analyses revealed that an increase in social behavioral problems and delinquent behavior was associated with a decrease in the HRQOL. Lower levels of maternal education and the number of antiepileptic drugs were also associated with a decline in the HRQOL; the HRQOL and social behavioral problems remained significantly correlated after adjusting for maternal education level, number of antiepileptic drugs, and non-social behavioral problems.

CONCLUSION

Parents and practitioners should provide intervention if behavioral problems, particularly social behavioral problems, are observed in children or adolescents with epilepsy.

Identificación por padres y maestros de síntomas del trastorno por déficit de atención con hiperactividad

Con el fin de contribuir a la investigación epidemiológica del Trastorno por Déficit de Atención con Hiperactividad–TDAH se analizaron las semejanzas y diferencias en los cuestionarios contestados por padres y maestros para la identificación de síntomas del TDAH en niños que acuden a consulta psicológica al Hospital Civil Fray Antonio Alcalde en Guadalajara, México. Padres y maestros de 168 niños (46 niñas, 122 niños, edad promedio de 8.2 años) contestaron respectivamente un cuestionario de 18 preguntas, estructurado a partir de los criterios diagnósticos para el TDAH propuestos en el DSM-IV. Como resultados, el análisis estadístico arrojó una concordancia moderada entre padres y maestros, observando diferencias significativas (p < 0.05) en 6 de los 18 reactivos. Los criterios concordantes se refieren, en su mayoría, a síntomas de desatención, mientras que las diferencias observadas tienen que ver con conductas asociadas a hiperactividad e impulsividad, con puntuaciones más altas otorgadas por parte de los padres. También se observó que al analizar en forma separada a niños y niñas no se encuentran diferencias significativas en la mayoría de las puntuaciones otorgadas a las niñas, mientras que las discrepancias son observadas principalmente en los puntajes otorgados a los niños, tanto de los primeros como de los últimos grados escolares, con mayores puntuaciones asignadas por los padres de familia. Se concluye que, efectivamente, tanto padres como maestros dan diferente significación a la conducta de los menores, dependiendo de su edad y su género, principalmente por su capacidad de control atencional y de su actividad motora, tanto en casa, como en la escuela.

The validities and efficiencies of korean ADHD rating scale and korean child behavior checklist for screening children with ADHD in the community

OBJECTIVE

The purpose of this study is to examine the validity of primary screening tools for attention deficit hyperactivity disorder (ADHD) in a community-based sample of children using the Korean version of the Child Behavior Checklist (K-CBCL) and the Korean version of the ADHD Rating Scale (K-ARS).

METHODS

A large-scale community-based study for ADHD screening was conducted in the Jeollabuk province in the Republic of Korea. In 2010-2011, we surveyed a total of 49,088 first- and fourth-grade elementary school students. All of the participants in this study were assessed by the K-ARS-Parent version (K-ARS-P) and the K-ARS-Teacher version (K-ARS-T) as the primary screening instruments. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used for confirming the diagnosis of ADHD. DISC-IV was administered to subjects who received top 10% scores in the K-ARS-P or K-ARS-T tests.

RESULTS

Of the 3,085 subjects who completed the DISC-IV, 1,215 were diagnosed as having ADHD. A reasonable level of sensitivity, specificity, and negative predictive value were obtained when the total K-ARS-P scores were ≥90th percentile. The positive predictive value and specificity increased significantly when the total K-ARS-P scores were ≥90th percentile, T scores were ≥60 in the attention problems of K-CBCL, and T scores were ≥63 in the total problems of K-CBCL.

CONCLUSION

These results suggested that the K-ARS-P could effectively serve as a primary screening tool to identify elementary school children with ADHD in the community. Also, there might be some increment in the effectiveness of K-ARS-P when combined with K-CBCL-A and K-CBCL-T as a secondary screening tool.

Comparison of aripiprazole and other atypical antipsychotics for pediatric bipolar disorder: a retrospective chart review of efficacy and tolerability

Objective

This study compared the efficacy and tolerability of aripiprazole with that of other atypical antipsychotics by examining patients with pediatric bipolar disorder (PBD) at a child and adolescent psychiatric clinic in a university hospital in Korea.

Methods

We reviewed the medical records of 127 pediatric patients with bipolar disorder aged 4-18 years treated at Department of Child and Adolescent Psychiatric, Yonsei University Severance Hospital between January 2010 and October 2011 to collect demographic and clinical data. Using the Clinical Global Impression (CGI) scales, we evaluated levels of severity of and improvements in symptoms at the first, second, third, fourth, and fifth hospital visits.

Results

The mean age of patients was 12.29±3.47 years. The sample included 91 (71.7%) male and 36 (28.3%) female patients. Aripiprazole was prescribed to 62 (48.8%) patients, risperidone to 52 (40.9%), quetiapine to 11 (8.7%), and paliperidone to two (1.6%). Patients treated with aripiprazole had lower CGI-Severity (CGI-S) scores than did patients treated with other atypical antipsychotics at the second and third visits. The CGI-Improvement (CGI-I) scores of patients treated with aripiprazole were lower at the second visit. Treatment with atypical antipsychotics was well tolerated, and no serious or fatal side effects were observed.

Conclusion

The present retrospective chart review suggests that atypical antipsychotics may be effective and safe for the treatment of patients with PBD. In particular, treatment with aripiprazole may be more effective than treatment with other atypical antipsychotics in the early phase. These results should be verified in future multi-center controlled studies.

Clinical symptoms and performance on the Continuous Performance Test in children with attention deficit hyperactivity disorder between subtypes: a natural follow-up study for 6 months

BACKGROUND

The aims of this study were to determine the time course of improvements in attention deficit hyperactivity disorder (ADHD) clinical symptoms and neurocognitive function in a realistic clinical setting, and the differences in ADHD symptom improvement using different classifications of ADHD subtypes.

METHODS

The Child Behavior Checklist (CBCL) was completed by parents of ADHD children at the initial visit. The computerized Continuous Performance Test (CPT), Swanson, Nolan, and Pelham, and Version IV Scale for ADHD (SNAP-IV), and ADHD Rating Scale (ADHD-RS) were performed at baseline, one month, three months, and six months later, respectively. Patient care including drug therapy was performed at the discretion of the psychiatrist. The ADHD patients were divided into DSM-IV subtypes (Inattentive, Hyperactive-impulsive and Combined type), and were additionally categorized into aggressive and non-aggressive subtypes by aggression scale in CBCL for comparisons.

RESULTS

There were 50 ADHD patients with a mean age of 7.84 ± 1.64 years; 15 of them were inattentive type, 11 were hyperactive-impulsive type, and 24 were combined type. In addition, 28 of the ADHD patients were grouped into aggressive and 22 into non-aggressive subtypes. There were significant improvements in clinical symptoms of hyperactivity and inattention, and impulsivity performance in CPT during the 6-month treatment. The clinical hyperactive symptoms were significantly different between ADHD patients sub-grouping both by DSM-IV and aggression. Non-aggressive patients had significantly greater changes in distraction and impulsivity performances in CPT from baseline to month 6 than aggressive patients.

CONCLUSIONS

We found that ADHD symptoms, which included impulsive performances in CPT and clinical inattention and hyperactivity dimensions, had improved significantly over 6 months under pragmatic treatments. The non-aggressive ADHD patients might have a higher potential for improving in CPT performance than aggressive ones. However, it warrant further investigation whether the different classifications of ADHD patients could be valid for predicting the improvements in ADHD patients' clinical symptoms and neurocognitive performance.

Development of a Decision Support Model for Screening Attention-deficit Hyperactivity Disorder with Actigraph-based Measurements of Classroom Activity

OBJECTIVE

Questionnaire-based ADHD screening tests may not always be objective or accurate, owing to both subjectivity and prejudice. Despite attempts to develop objective measures to characterize ADHD, no widely applicable index currently exists. The principal aim of this study was to develop a decision support model for ADHD screening by monitoring children's school activities using a 3-axial actigraph.

METHODS

Actigraphs were placed on the non-dominant wrists of 153 children for 3 hours, while they were at school. Children who scored high on the questionnaires were clinically examined by child psychiatrists, who then confirmed ADHD. Mean, variance, and ratios of low-level (0.5-1.0G) and high-level (1.6-3.2G) activity were extracted as activity features from 142 children (10 ADHD, 132 non-ADHD). Two decision-tree models were constructed using the C5.0 algorithm: [A] from whole hours (class + playtime) and [B] during classes. Accuracy, sensitivity, and specificity were evaluated. PPV, NPV, likelihood ratio, and AUC were also calculated for evaluation.

RESULTS

[Model A] One child without ADHD was misclassified, resulting in an accuracy score of 99.30%. Sensitivity and NPV were 1.0000. Specificity and PPV were 0.992 and 0.803-0.909, respectively. [Model B] Two children without ADHD were misclassified, resulting in an accuracy score of 98.59%. Specificity and PPV were scored at 0.985 and 0.671-0.832, respectively.

CONCLUSION

The selected features were consistent with the findings of previous studies. Objective screening of latent patients with ADHD can be accomplished with a simple watch-like sensor, which is worn for just a few hours while the child attends school. The model proposed herein can be applied to a great many children without heavy cost in time and manpower cost, and would generate valuable results from a public health perspective.

Screening Efficiency of the Child Behavior Checklist and Strengths and Difficulties Questionnaire: A Systematic Review

OBJECTIVE

  Assess the screening efficiency of the caretaker-report CBCL and SDQ in community and clinical samples using published data.

METHODS

  PyschInfo, Medline, and EMBASE were systematically searched to identify studies with appropriate efficiency data. Estimates of sensitivity and specificity were extracted from identified studies and used to generate summary likelihood ratio estimates on which the scales were compared. Summary estimates of sensitivity and specificity were calculated with respect to a 'true' diagnosis to compare scales.

RESULTS

  A total of 29 and 3 studies met inclusion criteria for CBCL and SDQ respectively. Summary estimates of the likelihood ratios for domains assessed by CBCL ranged from 3.86 (2.23, 6.69) to 4.87 (2.90, 8.18); and for SDQ from 5.02 (1.61, 15.63) to 8.32 (2.72, 25.48). Heterogeneity was low. For total problems, the SDQ caretaker-report was found to be most specific (0.93, 95% CI 0.92, 0.94) and the CBCL caretaker-report to be most sensitive (0.66, 95%CI 0.60, 0.73).

CONCLUSIONS

  This meta-analysis supports continued use of the CBCL and SDQ via caretaker-report in clinical and community samples. Additional research is required to determine if there is a true difference in efficiency between the two scales.

Comparison of the Child Behavior Checklist Profiles between community- and clinic-based children with attention deficit hyperactivity disorder in Korea

OBJECTIVE

The aim of this study was to examine whether there is a difference in the behavioural characteristics of community- and clinic-based children with attention-deficit hyperactivity disorder (ADHD) in Korea.

METHOD

The study included 75 community-based and 72 clinic-based subjects with ADHD. The parents of all the children completed the parent versions of the Child Behavior Checklist (CBCL).

RESULTS

The community-based ADHD subjects scored significantly higher (P < 0.01) than clinic-based subjects in the Somatic Complaints and Delinquent Behaviour profiles of the CBCL. The community-based subjects with ADHD, combined subtype, showed significantly higher mean scores in the Somatic Complaints (P < 0.01) and Thought Problems (P < 0.05) profiles than the clinic-based subjects with ADHD, combined subtype.

CONCLUSION

These findings suggest the possibility of an increased incidence of behavioural or emotional problems in community-based ADHD subjects when compared with clinic-based subjects in Korea.