Korean ADHD Rating Scale Research Articles

The Relationship between Hair Zinc and Lead Levels and Clinical Features of Attention-Deficit Hyperactivity Disorder

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 <TEX>$R^2$</TEX>=.243, p<.01, adjusted <TEX>$R^2$</TEX>=.362, p<.01, and adjusted <TEX>$R^2$</TEX>=.275, p<.01), the score for omission errors of auditory ADS in ADHD group (adjusted <TEX>$R^2$</TEX>=.407, p<.01) and the entire group (adjusted <TEX>$R^2$</TEX>=.292, p<.01). Zinc was significantly explanatory for the K-ARS scores for the entire group (adjusted <TEX>$R^2$</TEX>=.248, p<.001) and the ADHD group (adjusted <TEX>$R^2$</TEX>=.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.

주의력결핍 과잉행동장애 아동과 아스퍼거장애 아동에서 사회기술훈련의 효과 비교

Objectives : Attention-deficit hyperactivity disorder (ADHD) and Asperger's disorder (AD) in children are associated with attentional problems, impulsivity, hyperactivity, and difficulties with social interactions. Pharmacological treatment may alleviate symptoms of ADHD, but seldom solves difficulties with social interactions. Social skills training (SST) may assist in improving their social interactions. We examined the effects of SST on children's social competences, general behavior, and ADHD symptoms. Methods : Thirty four children, aged 7 to 12 years, participated in the cognitive behavioral SST program once a week at the outpatient division of child-adolescent psychiatry. SST was composed of 24 sessions (ninety minutes) for 6 months. Twenty-five children were diagnosed with ADHD, and 9 children were diagnosed with AD. Parents of the children rated Korea-Child Behavior Checklist (K-CBCL), Conner's rating scales, Korean-ADHD Rating Scale (K-ARS), Social Skill Rating System (SSRS), and Matson's Social Skill Rating Scale as an evaluation of the treatment effect, before the first session and after the final session of the training. Results : The ADHD group showed significantly increased scores of social and social competence of CBCL and SSRS. Further, scores of externalizing problems of CBCL, CRS, and ARS were significantly decreased. The Asperger's group showed significantly increased scores of social competence of CBCL, SSRS, and MESS. There was a significant difference of the improvement in CBCL's school and total behavior problem score, CRS between drug change group and no drug change group. Conclusion : The result of this study suggests that SST is effective in improving social skills for children with ADHD and AD. In addition, SST has shown its effectiveness in treating attentional problems for children with ADHD. To prove objective usefulness of SST, further studies with a more structured design and long-term duration along with a sufficient number of AD participants will be necessary.

No Association between the Response to Methylphenidate and DRD4 Gene Polymorphism in Korean Attention Deficit Hyperactivity Disorder: A Case Control Study

ObjectiveRecently the relationship between alleles frequency distribution, drug response and the attention deficit hyperactivity disorder (ADHD), has been actively researched. We investigated the association between the genetic type, alleles and drug response for the dopamine receptor D4 (DRD4) gene in ADHD patients in Korea.MethodsOne hundred fourteen patients diagnosed with ADHD according to the the Diagnostic and Statistical Manual of Mental Disorders version IV (DSM-IV) diagnostic criteria were selected for the study. The clinical features of patients were confirmed by Korean version of Conners' parent rating scale, Attention deficit Diagnostic System, Korean version of Spielberger state-trait anxiety scale. Blood samples were taken from the 198 subjects. DNA was extracted from blood lymphocytes, PCR was performed for DRD4 Polymorphism. Alleles, genotype frequencies, the Clinical Global Impression (CGI) improvement score were compared using the chi-square test. Korean ADHD Rating Scale (K-ARS) and CGI severity scores were compared using the t-test.ResultsIn comparing the ADHD with 4/4 repeats group and without the ADHD with 4/4 repeats group, no significant difference was seen between the DRD4 genetic type, alleles distribution, and CGI drug response.ConclusionAs a result, it is viewed that there is no relationship between ADHD and DRD4, but final decision is indefinite. Follow up studies with larger patient or pure subgroups are expected.

주의력결핍 과잉행동장애 아동에서 어머니의 대상관계가 양육태도와 아동의 자아존중감에 미치는 영향

Objectives : This study examined maternal object relations, child's and mother's perception on rearing attitude, and children's self-esteem in children with attention-deficit hyperactivity disorder (ADHD) and their mothers. Methods : 64 children with ADHD and their mothers were included in the study group. In the control group, there were 85 children and their mothers. Mothers completed the following tests : Bell object relation inventory (BORI), maternal behavior research instrument (MBRI), Beck Depression Inventory (BDI), and Korean ADHD Rating Scale (K-ARS). Children completed Children's Report of Parental Behavior Inventory (CRPBI) and Rosenberg self-esteem scale. Results : Mothers of ADHD children displayed more rejecting and controlling parenting style than mothers in the control group. ADHD children showed lower self-esteem and perceived their parents as not affectionate, but rejecting and controlling. Mothers with ADHD children who belonged to object relations pathological group showed more rejecting rearing attitude and their children believed that they were more controlling, compared with children and mothers in other conditions. Among factors in mother's object relations, insecure attachment and ego-centricity impacted the rearing attitude. In turn, affective rearing attitude mainly influenced children's self-esteem. Conclusion : This study suggests that the approach focused on mother's object relations may help with the treatment of children with ADHD.

Factors Influencing Life Satisfaction for Mothers of Elementary School Children

Purpose: The purpose of this study was to identify factors influencing life satisfaction for mothers with children in elementary school. Methods: Participants were 243 mothers with a child in first and fifth degree of one elementary school in G city. Data were collected from March 20 to April 9, 2010. The instruments used were Satisfaction with Life Scale, Parent Satisfaction Scale, Korean ADHD Rating Scale, Parenting Alliance Inventory and Scale for Measuring Family Strengths. The data were analyzed using SPSS/WIN 14.0 computer program and included one-way ANOVA, Scheffe back-testing, Pearson's correlation coefficients and stepwise multiple regression. Results: The life satisfaction of the mothers showed significantly positive correlations with parent role satisfaction, spousal support, and family strengths and negative correlations with ADHD. Significant predictors of life satisfaction for mothers with children in elementary school were spousal support and sharing of value systems, and these variables explained 37.0% of the variance in life satisfaction. Conclusion: The results of this study indicate that improvement of spousal support and sharing of the family value system should be helpful in promoting life satisfaction for mothers with children in elementary school.

Effects of a Responsive Parenting Education Program on Child's Behavioral Problems and Pivotal Developmental Behaviors in Children at Risk for Attention Deficit Hyperactivity Disorder

Purpose: This study was done to determine whether a parenting education program using responsive teaching strategies is effective for parenting stress, maternal interactional behavior and behavioral problems in children at risk for Attention Deficit Hyperactivity Disorder (ADHD). Methods: Participants in this study were 17 elementary school children and their parents. The ADHD risk group was determined by scores on the Korean-ADHD Rating Scale. The parenting education program was developed based on Dr. Mahoney’s responsive teaching curriculum. Mothers participated in the program once a week for 8 sessions. Treatment outcome was evaluated using the Korean version of the Child Behavior CheckList (K-CBCL), parenting stress, maternal interactional behavior, and child pivotal developmental behavior. Data were analyzed using Wilcoxon signed rank test, Mann-Whitney test, and regression analysis. Results: After the parenting education program, no significant difference in parenting stress (Z=-1.00, p=.320) was found, but there was a significant decrease in the child’s internal behavior problems (Z=-2.05, p=.040), and also a significant improvement in maternal interactional behavior and a significant difference in child pivotal developmental behavior (Z=-2.67, p=.008). Conclusion: The results indicate that parenting education programs based on responsive teaching strategies are effective and that application of a program is recommended to prevent behavioral problems and improve maternal child interaction for children at risk for ADHD.

Analysis of Relationships between Parenting Stress, Maternal Depression, and Behavioral Problems in Children at Risk for Attention Deficit Hyperactive Disorder

In this study differences in behavioral problems between children at risk for Attention Deficit Hyperactive Disorder (ADHD) and normally developing children were identified. Further, relationships between parental stress, depression, and child behavioral problems according to ADHD symptoms were explored. Participants were 222 elementary school children and their parents. The ADHD risk group was determined by the Korean-ADHD Rating Scale. Data were collected using the Korean-ADHD Rating Scale, Korean version of Child Behavior CheckList (K-CBCL), Parenting Stress Index, and Beck Depression Inventory. Data were analyzed using t-test, Pearson correlation coefficients, and regression analysis. 1) The ADHD risk group showed higher levels of behavioral problems, parenting stress, and maternal depression than the normal group. 2) There were significant relationships between ADHD scores and parenting stress (r=.66), maternal depression (r=.35), internal behavioral problems (r=.47), and external problems (r=.55), but, ADHD risk scores were negatively correlated with social competence (r=-.40). 3) The regression analysis revealed that ADHD levels affected the child's internal behavioral problems, mediated by maternal depression (beta=.29, p<.001). The study results show that higher risk scores for ADHD indicate a significant effect for behavioral problems. Also, parenting stress and depression influence child's behavioral problems. These results suggest that identification of children at risk for ADHD and development of parental education programs would contribute to the prevention of behavioral problems and aggravation of the ADHD symptoms.

Effects of Methylphenidate and Bupropion on DHEA-S and Cortisol Plasma Levels in Attention-deficit Hyperactivity Disorder

We evaluated plasma levels of DHEA-S and cortisol before and after treating ADHD patients with one of two medications: methylphenidate (n = 12) or bupropion (n = 10). Boys with ADHD (combined type) were evaluated with the Korean ADHD rating scale (K-ARS) and the computerized ADHD diagnostic system (ADS). All assessments were measured at baseline and repeated after 12 weeks. There were significant clinical improvements in both treatment groups as measured by K-ARS and ADS. DHEA-S levels increased from baseline to endpoint, but cortisol levels did not change significantly. This study suggests that both methylphenidate and bupropion increase plasma levels of DHEA-S in boys with ADHD.